/& -j^'Ct/sp ^7^ / ME.M **■■ ■m% THE INSTITUTES OF MEDICINE. y by MARTYN 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 Royal Verein fiir Heilkunde in Preussen; Corresponding Member of the Gesellschaft fiir Natur und Heilkunde zu Dresden; Member of the Medical Society of Leipsic; of the Medical Society of Sweden; of the Montreal Natural History Soci«ty; and of many other Learned Societies. All are but parts of one stupendous whole, Whose body Nature if, and God the soul. Pope. Theory is only common sense applied to calculation__La Place. FIFTH EDIT NEW YORK SURGEON GENERAL'S OFHCi HARPER & BROTHERS, PUBLISHERS^ FRANKLIN SQUARE. 18 5 9. LONDON: SAMPSON LOW, SON & CO., AMERICAN AND V. V R O P E A N BOOKSELLERS, 47 LtTDGATH II ILL ■* W6 PI 47. 1859 Entered, according to Act of Congress, in the year one thousand eight hnndred and fifty-nine, by HARPER & BROTHERS, in the Clerk's Office of the District Court of the Southern District of New York. THIS WORK Xs respectfully 31e*fcate& TO THE MEDICAL PROFESSION OF THE UNITED STATES, BT THEIR OBEDIENT, HUMBLE SERVANT, TIIE AUTHOR. » PKEFACE TO THE FIRST EDITION. The Author of this work has endeavoured to keep before him the difficult objects of adapting it to the student in medicine and to the more advanced. For the advantage of the former, therefore, he has aimed at such method as he might command, and such illustration as might not seem irksome to the latter. With a view to the former, also, he has endeavoured to indicate the intimate manner in which all the topics embraced in the work are related to each other, and their mutual dependences, by constant references from one part to others; and, what is unusual, the Author has made these connecting refer- ences in a prospective as well as retrospective manner. With a view, also, to the same objects, the Author had designed a more copious Index; but as the stereotype was completed as long ago as the mid- dle of Xovember, and as the state of his health, and other avocations, have not permitted him to complete the Index, in its regular order, beyond the 125th page, he has concluded to print it as it now stands, and to extend it in a future edition. Many subjects, however, throughout the work, are now incidentally carried out in the Index; but many of the most important receive only a general reference, ex- cepting as they are related to others which are more amply noticed. New York, Jan. 1, 1847. PREFACE TO THE FOURTH EDITION. Three Editions of these Institutes, the first of which was pub- lished in 1847, having been exhausted, the Author now submits a fourth to his medical brethren, in which he has endeavoured to incor- porate, in an Appendix, the most important of the recent discoveries in Physiology, Pathological Anatomy, Therapeutics, Organic Chem- istry, and Microscopy that are relative to the principles about which this work is interested, and he has connected the Appendix intimate- ly with the main body of the work by copious references to the sec- tions embraced in the former, while the same system is carried out reciprocally in the latter. It is also gratifying to the Author to pay his humble tribute of admiration particularly to the immense labors of the microscopist, who, through the great improvements of the in- strument, is now enabled to analyze with surprising accuracy the ul- timate and varying conditions of the solids and fluids. The Author has also fulfilled his design, as expressed in the Preface to the first edition, of extending the original Index, a second one being now added, in which he has endeavoured to present an epitome of the whole work. It is proper, however, to suggest that the Reader will find an advantage in consulting simultaneously the original Index, as it is more particularly analytical. New York, November, 1857. PREFACE TO THE FIFTH EDITION. The preceding Edition of 1858 having become exhausted, the Au- thor presents another, in which some remaining typographical errors are corrected, numerous references to sections introduced, and a Sup- plement added. Another Preface enables him, also, to express his sense of obligation for the generous opinions Avhich have recently ap- peared in the Medical Press of his various professional writings. It is especially gratifying that this tribute has been rendered with great unanimity in his own country, and he desires no greater reward for his toil and anxiety. But he by no means intends to imply that his doctrines have been always accepted, although they have been very generally allowed to be logically sustained. And the Author feels it his right to say that, in all the critical reviews which have fallen un- der his observation, Avhose object has been to affect his writings in- juriously, such reviews have consisted altogether of falsifications and perversions of his statements and opinions. Xor is this unqualified assertion made without a full knowledge that all the objections al- leged have been critically examined, and the results placed upon rec- ord, and from a belief, also, that it is due to the interests of medicine. Some of the false and ungenerous reviews the Author thought it worth while, many years ago, to expose in elaborate articles. But his particular motive for referring now to the subject is to express his thankful acknowledgments to his friend Professor Charles A. Lee, M.D., and to Professor James B. M'Caw, M.D., the distinguished Editor of the Virginia Medical Journal, for having, with great ability and disinterestedness, performed a similar labor in his behalf. But he would not, therefore, have it inferred that he supposes his writings are invulnerable, and he would much honor the critic who would employ himself fairly in refuting any doctrines or opinions that may be open to objection. The Supplement which is added to the present edition embraces observations that go to corroborate some of the Author's principal views in medical philosophy; but he is not aware of any discoveries in Physiology, or of any new facts in Pathology, or of any improve- ments in Therapeutics since the late edition to affect adversely any of his doctrines. Indeed, as a work of principles, and as a consistent whole, should any doctrine of importance be shown to be fallacious, the entire fabric must be abandoned. But if, on the contrary, its principles be founded in Nature, they can not be affected by any fu- ture accumulation of facts—no more than the law of gravitation was Vlll PREFACE TO THE FIFTH EDITION. rendered more absolute by the successful calculation of the periodic time of Halley's comet. That achievement was simply a corrobora- tion of a great discovery. It is of no importance, therefore, to the essential objects of this work to introduce new discoveries tHl some one or more may present themselves, that, like chlorine, iodine, etc., in their relation to Lavoisier's theories of oxygen, shall invalidate the system of medical philosophy herein embraced; by which the Author means such facts as can be undeniably shown to contradict that phi- losophy. This, it is true, will appear strange to those (and of such there are many) who look upon principles as "liable to exceptions" —as having no stability—exposed to daily fluctuations—as consisting even of isolated facts; such philosophers, particularly, as see no dis- crepancy between the conflicting laws of organic and inorganic be- ings, and who, therefore, are ever ready to engraft them indiscrim- inately upon organic philosophy, or as one or the other may have its chance in the irresistible pronunciations of organic life, or in the spu- rious analogies of simple matter. To multiply facts in this work which merely contribute to the validity of its principles, or to incor- porate others that may be speciously arrayed against those principles, would constitute a defect for the most ordinary criticism. Never- theless, some things, both of the former and latter nature, have been admitted into the Appendix, although precisely parallel facts -occur in the body of the work. But they were said to be new, and the Author yielded to this general belief, though he concedes that the facts are more fully displayed in the latter than in the former cases, and that he therefore contemplated an advantage from their corrob- orating effect. But their exclusion would not have otherwise affected the work, though it might have been regarded by some as a defect. The same may be also affirmed of the Supplement, where, for exam- ple, some late observations relative to absorption by the intestinal villi are stated, although they simply confirm what had been long ago ascertained; but they are more precise and complete, and place the doctrine in these Institutes beyond question. Again: Richard- son's late experiments tending to show that the blood's fluidity is owing to ammonia were not admitted into the Appendix, as the Au- thor believed that they were contradicted by the general philosophy of life; but reference is made to them in the Supplement because they have been contradicted by other and later observations. It would be superfluous to add that it would have been irrelevant to the objects of the work to have gone into the minutiae of histology, to have even introduced the discovery of white globules in the blood, or the late observations upon the supposed tributary influences of the spleen and thymus upon the blood, &c, since they have no bearing upon a work of general principles (§ 83 c). New York, August, 1850. TABLE OF CONTENTS, PRELIMINARY REMARKS 1-15 PHYSIOLOGY.....15-412 Composition......23-49 Structure......50-73 Vital Principle and its Properties .... 73-125 Vital Principle .... 73-89 Irritability......89-100 Sensibility......100-103 Mobility......103, 104 Vital Affinity..... 105 Vivification...... 105 Nervous Power .... 106-111 General Remarks upon the Philosophy of Life . . 111-122 The Mind and Instinct, and their Properties . . 122—125 Functions, Common . . . 125-280 Motion.......126-128 Absorption ...... 128-134 Assimilation . . . . . 134 Distribution . . . . . 207-217 Appropriation . . . . . 217-227 Excretion......227-234 Calorification.....234-279 Generation......279,280 Functions, Peculiar . . . 280-362 Sensation......280-283 Sympathy......283-362 Its general relations to the nervous system . 284-295 Experiments illustrative of.......295-321 Varieties or kinds of. . 321-335 Laws of, applied patho- logically and therapeu- tically . .... 335-353 In its relation to special tissues and organs . 353-362 Relative to the Mental Prin- ciple and Instinct . . 362 Vital Habit......363-372 Age ......... 373-383 Infancy.......373-375 Childhood......375,376 Youth.......376-380 Manhood......380,381 Old Age......382,383 Temperament, Constitu- tion, Idiosyncrasy . . 383-391 The Sanguine.....386,387 The Melancholic .... 387-389 The Choleric..... 389 The Phlegmatic .... 389,390 The Nervous..... 390 Physiology—continued. Races of Mankind . . . . 391-393 Sex.........393,394 Climate ....... 394-396 Habits and Usages . . . 396,397 Relations of Organic Be- ings to External Ob- jects ....... 398-400 Death........401-404 Summary Conclusion in Physiology, or its Uni- ty of Design .... 405-412 PATHOLOGY......413-540 Remote Causes .... 414-427 Pathological or Proximate Cause......427-434 Symptoms.......434-455 The Pulse......443-448 The Tongue.....448-450 Secretions and Excretions . 450-455 Morbid Anatomy .... 456-463 Inflammation.....464—489 Description of.....464-480 Remote Causes of . . . 480,481 Pathological Cause of . . 482-489 Active and Passive . . . 486-489 Fever........489-499 Description of.....489-497 Remote Causes of . . . 497-498 Pathological Cause of . . 498-499 Venous Congestion . . . 500-513 Humoralism......514-540 THERAPEUTICS .... 541-777 General Consideration of 541-563 Cathartics......563-570 Astringents......570-578 Tonics and Diffusible Stim- ulants ....... 583-590 Antispasmodics.....590-593 Cinchona, and its Alka- loids ....... 593-607 Arsenic.......607-612 Iodine ........ 612-620 Ergot........620-628 Emmenagogues.....628, 629 Diuretics.......630-633 Expectorants ..... 633-642 Counter-irritants . . . 642-660 Remedial Action, its Gen- eral Philosophy . . . 661-689 The Seton......679-681 Local Sedatives, Warm Poultices, 4-c.....681-683 Genito-urinary Agents . . 683-689 Uterine Agents .... 683-68 9 X TABLE OF CONTENTS. Page Therapeutics—continued. Bloodletting ..... 690-777 Leeching......692-698 General Bloodletting. . . 698-702 Cupping......702—703 The Nervous Power in its Relation to the Effects of Loss of Blood • • ■ • 703-711 General and Practical Obser- vations upon .... 711-777 General Extent of Bloodlet- ting ....... 711-724 In Congestive Fevers . . 724-732 In the recognized Forms of Inflammation .... 732-736 In Simple Continued and Therapeutics—continued. Bloodletting—continued. Simple Intermittent Fe- ver ....... In the Cold Stage of Fever In Apoplectic Affections . . Experience and Opinions of distinguished Physicians as to Bloodletting in In- flammatory, Congestive, and Febrile Diseases . . In the Diseases of Infancy and Old Age . . Spontaneous Hemorrhage . Misapplied and Excessive . General Conclusions as to . p*e» 736-739 739-741 741-747 747-766 768-770 770-772 772-776 776-777 CONTENTS OF APPENDIX. Progress of Physiological and Pathological Chemistry .... 779-802 Production of Animal Sugar..............'°° Progress of Physiology................801-816 Structure of Organs..................801-803 Of the Spinal Cord..................." "8" The Nervous Power and Organic Properties..........o^oVo Animal Heat in its connexion with the Nervous System......807-8U The Primordial Cell..................812"q!! The Boundary-line between Animals and Plants........ 815 Hybrid Animals................... 816 Absorption and Circulation in Plants...........817-824 Experiments to ascertain whether the quantity of Blood circulat- ing in the Brain may be reduced artificially.......824-828 Sedatives—a farther exposition of their uses and of the philosophy relative to their effects....................828-835 Alteratives—their uses and mode of action considered practically, &c. . 835-851 Jalap, p. 851-853—Saline Cathartics, p. 853-854—Rhubarb, Scammony, Aloes, Colocynth, Senna, Colchicum, p. 855-862. Of the action of Chloroform and analogous agents in producing Insensibility when inhaled..............862-864 Of the Influence of the Mind upon the Action of Remedial Agents 865-868 Have Diseases undergone Changes of Type within the last forty Years, or have new ones appeared 1...........868-872 Physiology of the Soul and Instinct, or Demonstration of their substantive existence and self-acting nature.......873-911 Rights of Authors..................912-920 SUPPLEMENT. Correlation of Forces.—The Glycogenic Function of the Liver.—The Cause of the Blood's Fluidity.—Modus Operandi of Remedies.—Absorption by ^the gkin.—Transfusion of Remedies.—Intestinal Absorption and Lacteal Circula- tion.—The Forces which circulate the Blood...........921 Indexes 935 INSTITUTES OF MEDICINE, PRELIMINARY REMARKS. " Until it is proved that the forces which, in a living body, interrupt the play of the natu- ral chemical affinities, maintain a proper temperature, and preside over the various actions of organic and animal life, are analogous to those admitted by natural philosophy, we shall act consistently with the principles of that science, by giving distinct names to these two kinds of forces, and employing ourselves in calculating the different laws they obey."—Andral's Pathological Anatomy. See, also, Medical and Physio- logical Commentaries, vol. i., p. 626-632. " Our notion of life involves something more than mere reproduction, namely, the idea of an active power, exercised by virtue of a definite form, and production and genera- tion in a definite form. The production of organs, the co-operation of a system of organs, and their power not only to produce their component parts from the food presented to them, but to generate themselves in their original form and with their properties, are characters belonging exclusively to organic life, and constitute a form of reproduction in- dependent of chemical powers. This vital principle is only known to us through the peculiar form of its instruments; that is, through the organs in which it resides. Its laws must be investigated just as we investigate those of the other powers which effect motion and changes in matter."—Liebig's Organic Chemistry applied to Physiology, p. 355. " Simple views, whether of health or disease, however ingenious, can seldom be just. They have their origin in the spirit of system, not in the careful study and faithful enu- meration of the complicated circumstances which concur in the production of all vital phe- nomena."—Thompson, on Inflammation. 1, a. Solidism: and vitalism will form the basis of these Institutes. If consistent in all their parts, without a violation of facts, it is, pri?na facie, a proof of their foundation in Nature. To show this consist- ency, and to develop the great principles and laws of organic beings, and erect a substantial fabric of Institutes which shall guide the hand of art, we must ascend, progressively, along the fundamental facts in physiology, pathology, and therapeutics; till, at last, we proceed to convert the great system to practical uses, in the preservation of health, and a just, intelligible, and philosophical application of the materia medica to morbid states of the body. To render this work, therefore, most practical, and to simplify as far as possible the highest department of knowledge, I shall adopt an analytical method. I have also endeavored to arrange the various topics in their most natural order, or as each successive one may ap- pear to emanate from, or to depend upon, the preceding. The stu- dent, therefore, to understand the last, must comprehend all the pre- ceding, and so of each in succession. We have thus a connected link throughout; a difficult achievement, and the more difficult as it is the first effort that has been made to present the natural relations of my whole subject in their just order, to point out the affinities, and to ex- hibit throughout the important laws and essential foundations of vital- ism and solidism, and to maintain throughout a consistency of facts and of laws that shall stamp the whole as the Philosophy nj Medicine. In making this claim for the Institutes, I am prepared, as in the case of the Commentaries, to invite the most rigid scrutiny. If there be any where a collision in principles or facts, or any contradictions of myself, let them be pointed out. My aim is truth, and I desire A 2 INSTITUTES OF MEDICINE. nothing for myself which I do not yield to others. That other im- perfections exist there can be no doubt. Many of the original doc- trines which appear in this work are presented in various connections in the Medical and Physiological Commentaries. The spirit of the Commentaries will pervade the Institutes, as being, in my judgment, the only stable foundation. 1, b. In the farther prosecution of this work, it will still be my object to speak of such errors as have usurped the rights or blighted the interests of rational medicine. It is not now the time for a simple expression of facts, of experience, and of philosophical doctrines. The errors which surround them must be also exposed and refuted, or the foe of truth, or the ambitious aspirant, or the lover of indolence, will gain something from an indulgence which they know how to seek and appropriate. Nor is any one W?\CJ'^aware of the tendencies of free discussion or unsparing of physiologists, than he who has been most successful in the propagation of error, or who would sooner stifle inquiry into factitious systems. Thus, it is said by Liebig, that " It is too frequently forgotten by physiologists that their duty really is, not to refute the experiments of others, nor to show that they arc erroneous, but to discover truth, and that alone."—Liebig's Organic Chemistry applied to Physiology, Sfc. Now this obvious sophistry betrays its motive, since it is utterly at variance with the habits of him who would enjoin the fiction upon others. Truth should be, indeed, the ultimate object of pursuit; but the first and most important step toward its attainment is the removal of obstacles that may lie in its way (§ 820). It is allowed, indeed, by one of Liebig's most zealous advocates, the editor of the London Lancet, that " the removal of error claims a place next to the establish- ment of truth" (Dec, 1844); and it has grown into a proverb, that "it is more difficult to subdue a prejudice than to build a pyramid." Although, therefore, the contemplated method must be sometimes argumentative and controversial, it has the advantage of leading more immediately to a knowledge of the truth upon disputed questions, than any other which is not demonstrative. There can be no doubt, indeed, that the "establishment of truth" in medical philosophy can be effected only by a simultaneous refutation of the errors which sur- round it. The mind will not surrender a favorite doctrine, however false, to the force of truth alone. Even its practical disasters, as we every where witness, are an inadequate demonstration. But, when error and truth are presented in forcible contrast, it is the pride of reason to embrace the latter. What is also important,, the reader will have been presented, as in the Commentaries, with the great rival doctrines in medicine, and in their proper relations to each other (§ 3501). 2, a. The Institutes of Medicine are natural inductions of principles and laws from the healthy and morbid phenomena of living beings. They relate to Physiology, Pathology, and Therapeutics, and to noth- ing else. All other systems, therefore, must be spurious. The sub- stitutes have no depth, no principle, no laws, and are recommended alone by their naked simplicity. "Gentlemen," says Bacon, "nature is a labyrinth, in which the very haste with which you move will make you lose your way." 2, b. The immediate objects of physiology are a critical analysis of PRELIMINARY remarks. 3 the vital conditions and results of organic beings, as manifested in different organs, and in their relations to each other. It contemplates organic nature, therefore, in its natural state; and the laws which it obeys are its highest end. Pathology is to the physician the great final object of physiology. It investigates the causes which disturb the physiological conditions, and inquires into the phenomena, and the nature of the vital and structural changes. These, in connection, form the ground-work of Therapeutics, which considers the indica- tions to be fulfilled, and the means and the manner by which they are to be accomplished, and nature thus aided in the process of cure. The Materia Medica comes last, and is the subordinate object of all the rest. It investigates the composition and physical character of the material objects by which the therapeutical intentions are fulfilled, and interrogates especially their relations, as vital and alterative agents, to pathological conditions. Disease, being a modification of the phys- iological or natural condition, produces new relations between the properties of life and the natural, morbific, and remedial agents; and these are ascertained by observation of their effects upon morbid states alone. It is thus that remedies become beneficial when they would be morbific in health; and what is salubrious in health is ren- dered morbific by diseased conditions. The principle is in beautiful harmony with the instability of the vital properties; and the final cause of this instability is the preservation of organic being (§ 133, c, 153-156, 638). 2, c. Nevertheless, each of the four great departments of medicine possesses so many peculiar characters, that they may be severally con- sidered as constituting, to a large extent, distinct parts of one great symmetrical whole ($ 83, c). Pathological conditions could never have been inferred, a priori, from any extent of physiological inquiries, nor could the effects of therapeutical agents, or the natural termina- tion of disease in health or in death, from any knowledge of anatomy, physiology, or pathology. The whole is originally the work of ob- servation ; and we come to learn the relations of the four great branches of medicine by comparing the phenomena which are pre- sented under the various conditions of health and disease, and as these phenomena may be affected by artificial influences. Anatomy, however, affords no such standard of comparison. And yet it is obvious, as will more distinctly appear hereafter (§ 83-163), that anatomy is the basis of medicine. It is, however, of the system of organic life that I mainly speak. All, at least, that is superficial in animal life, the voluntary muscles, &c, abstracted from their rela- tions to the organic condition, belongs to the domain of surgery, and is, therefore, of little importance to the physician. 2, d. Notwithstanding, therefore, the foregoing qualifications, it will be seen, in our inquiries into the great fundamental points, that the science of medicine is, throughout, a perfectly connected chain; beginning with the laws which govern the modes in which the ele- ments of matter are combined in organic beings,—advancing to the union of organic compounds into cells and tissues,—to the laws which respect the various processes which are conducted by these tissues, and by the organs into which they are combined,—to those laws as affected by the contingencies of disease,—and, lastly, to the laws which regulate the changes through which the morbid states return to 4 INSTITUTES OF MEDICINE. the natural conditions of life. All are connected together by intimate dependencies, and are determined by the natural or by the varying Btates of the vital properties in their operation through material parts. The ground-work of the whole is, therefore, perfectly simple; since the laws by which the whole is regulated are established upon the constitution of the organic properties (§ 169, f, 638). 2, e. To the eye of the philosopher, therefore, Nature, in her or- ganic department, as in every other, appears in an aspect of astonish- ing simplicity, when he contrasts her forces and laws with the diver- sity of their phenomena; nor does he confound the principles and laws which distinguish the different departments of nature. To every other eye the phenomena of life appear confused, and seem referable to no common powers or laws. But he who has obtained the key to the true philosophy of life, by a wide observation of nature, lays open at once the apparent secrets of all its results, whether in health or disease. Whatever he sees has its individuality, and stands in re- lief from all the rest. He knows at a glance, from whence this or that springs, how it is related to others, and he traces the whole directly up to a few simple principles. To all but such an eye, however, the phenomena of life, and more especially of life diseased, appear as does a field to all but the botanist. The common observer sees nothing but a confused assemblage of grasses, and probably will tell you there is but one species where the botanist will as instantly discover fifty. Each species has to the latter a distinct individuality, and he cannot regard them in that state of confusion which is seen by the ignorant. He has studied each plant, knows its specific characters, its relations to others, its habits, &c. By these modes of observation, he has also acquired the knowledge that nature has pursued a common plan of organization, and linked the whole, by close analogies, throughout the vegetable kingdom. Were the botanist, therefore, to range simulta- neously among the 100,000 species of plants, he would see nothing but individuality, and the greatest simplicity in the principles upon which the whole are constituted. And just so it is with a philosophi- cal observation of the healthy and morbid phenomena of the animal kingdom. 3. The organic and inorganic kingdoms have, respectively, their peculiar properties and laws. Such as appertain to life, in its nat- ural, as well as morbid aspects, are denoted by an incomparably greater variety of phenomena than those of the external world ; and as their only intelligible foundation is the phenomena evinced, we attain our knowledge of either according to the extent and variety of the phenomena. We know nothing more of matter itself. Without a comprehensive knowledge of the properties and func- tions of living beings, and especially of the laws by which they are governed in their healthy and morbid states, the practice of medicine is mere empyricism. The ignorant, alone, undervalue causes and principles, and depend upon unconnected facts. 4, a. In medicine, therefore, we must concern ourselves with some- thing besides effects. We must understand the laws under which they take place, and, as far as possible, trace up the effects to the pri- mary causes. This is always done in other sciences and in the arts. Why, then, should it be neglected in that science whose practical ap- plication relates to the highest welfare of man ] PRELIMINARY REMARKS. 5 The human mind will have its theories upon all subjects; and the whole history of medici. 3 is a perpetual exemplification, that in no inquiries do theory and hypothesis abound so universally as in the healing art (§ 819-960). This arises, in part, from the intricacies of the subject, but mostly so from the constitution of the mind itself. The Almighty designed it for theoretical conclusions, and set us the example in those stupendous theories upon which the universe, and all it contains, are founded. And what else are, or should be, our inquiries and our theories, than finding out and adopting those of which He is the author ] What other theory in the natural world can there be, than such as are instituted by the Almighty Being 1 And shall we hesitate to embrace, and to act upon such theories 1 And yet it is one of the pretended improvements of the day to insist upon nothing but facts, and to denounce all principles in medicine ; as if the Almighty had not ordained principles and laws as well as facts, which are mere emanations from the former. 4, b. The ignorant pretender will tell us that all this is unimport- ant ; though no one is so much directed by hypothesis, or theory, as this very pretender himself (§ 884). Does not every empyric in the land prescribe his drastic cathartics for the purpose of cleansing the blood of its supposed impurities 1 Are they not exactly on a par, in their doctrines, and in their practice, with the most speculative of our enlightened humoralists 1 Nay, have the ignorant portion of that sect, our Brandreths, our Morrisons, et id omne genus, any reference whatever to facts or experience % Is it not all hypothesis, and, there- fore, all a reckless waste of human life 1 Mount up the scale, and you shall find at every step of your ascent, from him who prowls about the outskirts of the profession, to him who directs the all-potent drug with the most consummate skill, that each and all mainly rely upon their conceptions of the philosophy of disease. But you shall also find, that in proportion as Nature has been taken for their guide, and as medical principles are founded upon the absolute phenomena of life, in their healthy and morbid aspects, there will always be the greatest reference to facts and experience. Hence, again, the importance of looking well to our theories, and of seeing that they are established on well-grounded facts, or on the analogy to which they conduct us. Could we, as we cannot, conduct the treatment of disease without principles, we never should; and it should therefore be the business of the practitioner to enlighten his mind upon the philosophy of medicine, or his unavoidable disposition to theorize may prove a scourge to mankind. Of this, indeed, the records of medicine abound with examples (§ 801, b, 819, &c, 960, 1005). It will therefore be my agreeable task to expose, in these Insti- tutes, the fallacies of the prevailing physical doctrines of life and dis- ease, as well as to inculcate principles which exalt our science above the mere world of matter, render it consistent in all its details, and present it to the profession as a department of knowledge fundament- ally distinct from all other pursuits. Differences of opinion on questions of great moment to mankind are apt to be strongly conveyed, and apparent error to be censured in no measured terms. This, perhaps, is often admissible, considering the obstinacy of error, and so long as it is the doctrine, and not its au- 6 INSTITUTES OF MEDICINE. thor, which is assailed. We may revere the names of Voltaire, of Hume, and of Gibbon, yield them a proud rank in the scale of intel- lect, and gratefully acknowledge the rich legacies they have left be- hind. But, who of us would hesitate to speak of their infidelity ac- cording to its nature and tendencies 1 This is even demanded by what we believe of the precepts of religion. And so of the principles of medicine, which hold as high a relation to the temporal interests of man as do the precepts of religion to his spiritual welfare. The high- est order of intellect is often devoted to the dissemination of error, and perhaps more frequently in religion and medicine than in any other of the great interests of mankind. This must be fully and firm- ly met, not only by evidences of the truth, but by an exposure of its pervei'sions and corruptions. 4^, a. The physiological world has been lately divided into three schools. One of these sects virtually regards organic nature as a part only of inorganic, endowed with the same properties and governed by the same laws. It maintains, in short, that there is no essential dif- ference between a man and a stone. At the head of this school stands Liebig, the distinguished and able chemist. It is a great and power- ful school, but is falling, daily, beneath the weight of its vast errors and corruptions. It is denominated the chemical school of medicine. 4^, b. Contrasted with this is the school of vitalism, which regards organic and inorganic nature as distinct in their most essential attri- butes. It supposes that each department is governed by properties and laws peculiar to itself. It regards the organic being as funda- mentally distinct from the inorganic in its elementary constitution, in the aggregation of its molecules, in the structure of its parts, in its condition as a whole, and in every phenomenon which it evinces. It sees design in every part of the living being—eloquent even in the dry bones of a skeleton; a design peculiar to every part, while all concur together to the common ends of the more universal designs of procuring the means of sustenance, of maintaining life, of perpetua- ting the species, &c. On the other hand, this school discerns nothing of the nature of design in the constitution, or in the condition of inor- ganic matter. It sees nothing here but mere vis incrtice, which, however, is supposed by the chemical school to be capable of evolv- ing from simple matter every variety of organization, with all its spe- cific designs, even instinct and reason, while, at the same time, we hear from the depth of materialism, that " organic nature is the mys- tery of mysteries." Again, the vitalists, in consideration of the facts now stated, main- tain, in the language of Liebig, the great head of the school of mere physics, " the existence of a principle distinct from all other powers of nature, namely, a vital principle;" which organizes and governs all living beings, and which is the fundamental cause of all their phe- nomena in health and disease. I say, in the language of Liebig, "a principle distinct from all other powers of nature;" for this mere chemist, in his conflicts with living nature, concedes the existence of such a principle as at the foundation of all vital phenomena, yet, in the same general manner, and on all specific questions where he had introduced its direct and exclusive agency, he as unequivocally de- clares that there is no such principle, and that every result of life and disease, even thought itself, are entirely owing to chemical agencies. PRELIMINARY REMARKS. 7 His whole system, as set forth in his " Organic Chemistry applied to Physiology," and in his " Animal Chemistry" as applied to Pathol- ogy and Therapeutics, is a tissue of similar contradictions, and of the boldest assumptions. Yet, with deep mortification I say it, he has been hailed with an enthusiasm, before unknown in the annals of med- icine, as the only true expounder of physiology and of medical phi- losophy. The world, however, is fast awaking from its spell-bound delusion, and the doctrines of this " reformer" will soon be mingled with the same and more original chimeras which did their part in "the dark ages of science" (§ 350, 1029, 1030, 1034). 4^, c. Finally, the third school, or that of chemico-vitalism, en- deavors to form, as it were, a bond of union between the schools of pure vitalism, and of pure chemistry; though such an alliance be as unnatural as human brains in a block of granite. The chemico-phys- iologist makes a compromise with philosophy, and takes for his rule " in medio tutissimus ibis." It is as regardless as the school of pure chemistry of the universal consent with which physiology has been hitherto restricted to the condition, functions, results, and laws of liv- ing beings, and chemistry to the condition and laws of dead matter. This school, therefore, mingles the doctrines of vitalism and chemis- try; allotting to the former one half of the phenomena of life, and the other half to the latter. This is the school to which the young student has the greatest chance of becoming the victim; for it is apparently recommended by the conciliatory principle which I have stated in the form of its motto, and by many of the most distinguished members of our profession. 4^, d. I have said that it is a remarkable characteristic of the medi- cal school of pure chemistry, that its doctrines are in perfect conflict with each other, as shown in a work (Liebig's "Animal Chemistry") which is assumed as the basis of the chemical philosophy of life—as the great foundation on which the school itself has been erected. And how could it be otherwise, seeing that this school, and this writer, are constantly employed about two subjects which have no affinities; that is to say, the philosophy of life and the philosophy of chemistry 1 I shall think it of sufficient importance to substantiate the foregoing fact by many proofs in the course of this work; and, as an example of the whole, I shall adduce the contradictory views which are put forth upon the most important principles which lie at the foundation of organic life, and at the basis of medical science. On the very subject of a vital principle itself the genius of the school is as flatly contra- dictory as on the most unimportant doctrine; for at one moment he avows the existence of such a principle " distinct from all other pow- ers of nature," and calls it "the vital principle," which, he says, gov- erns all the processes of living beings (§ 59, 60), and at the next moment he asserts that, " in the animal body Ave 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 exercise on each other. The only known ultimate cause of vital force, either in animals or in plants, is a chemical process" He renders, as will be seen by ensuing quotations (§ 350), what he assumes as an original fundamental cause of life the indispensable source of another cause, which he avows to be equally original and fundamental; and what is yet more indicative of the chaotic state of 8 INSTITUTES OF MEDICINE. the chemical speculations relative to living beings, this author (as 1 have shown in the Medical and Physiologidfel Commentaries of many others) assumes, at one time, the chemical force to be the sole cause of all vital processes and results, while, at another time, he regards the vital principle as the only power concerned in the same phenomena. It will be gratifying to curiosity, for example, to observe how Liebig entangles his reader, as it respects the physiology of digestion, by making that process to depend on a purely chemical action, and to evolve that vital principle which he as unequivocally declares to be the only power concerned in chymification (§ 350, nos. 2, 17, 48). 5. Chemical and mechanical philosophy, as we have already seen, are strangers to the philosophy of medicine. There is a natural con- flict between the subjects of each. They have no relationship, no sym- pathies, but carry on a perpetual hostility. The organic being is for- ever converting to its own uses the inorganic, and changing its very nature into its own. The inorganic is fruitless in resistance and in assault, till the former is passive. It then lays waste the fabric by which it had been wrought into a great system of designs, and de- grades the whole to its own level. Chemistry, therefore, begins where physiology ends; and physiology begins with organic influences upon the elements of matter, or where chemistry leaves off. No depart- ment of medicine has any thing to hope from chemistry beyond its power of analysis (§ 1029, 1030). And yet do the labors of chemists aspire at a substitution of the ever-fluctuating principles of chemical science for all that has been hitherto founded upon the phenomena of life and disease. Their oft repeated effort to carry a science which is mainly analytical and me- chanical into that which is eminently intellectual and overflowing with the most sublime institutions, and distinguished by the most pro- found principles and laws of nature, and therefore seductive to an am- bition which is restif under the practical manipulations of the labor- atory, would raise no inquiry as to motive, or end, did not the proper guardians of the science not only abandon their old and rich domain at the very approach of the enemy, but, with most unnatural distrust of self, invite the destroyer (§ 733, d). The late publication of Liebig's "Animal Chemistry" has abund- antly proved the truth of what I sufficiently established in the " Med- ical and Physiological Commentaries," that the recent application of chemistry to physiology and medicine is not a partial, but a complete substitution *of that science. In justification of all this, we are now told that the means of investigation, of analysis, and of creation, have received an extension of which our predecessors had no knowledo-e. Such, however, has always been the pretext of chemistry for its inva- sions upon the science of life. Take, for example, the words of Fourcroy, who wrote more than sixty years ago, and who, like Lie- big and his school, attempted to substitute chemistry for physiology, and to rear up a fabric of medicine upon that imaginary foundation; and this, too, in the case of either of the masters, without having ever read a medical book, or having ever prescribed for a disease. The language of Fourcroy is exactly such as we now hear from the lips of Liebig and his followers; who cheerfully allow that nothino- flow- ed from the labors of Fourcroy to illuminate the dark ways of'organ- ic life (§ 1029, 1030). PRELIMINARY REMARKS. 9 So identical are the language, and ambition, and hope or confi- dence, and the visionary speculations, of the older and recent chem- ists, that a space may be well assigned to this exposure of chemical pretensions. We read, then, in Fourcroy, what we read in the works of Liebig and his cotemporary chemists. Thus : " The errors of the chemical physicians of the last century, and the indifference many practitioners of the present time seem to have for chemistry, have produced a disadvantageous opinion in the minds of many persons, which time alone can remove. If the enthusiasm of those physicians, who cultivated chemistry, misled them, it does not follow that any conclusion can be drawn from thence that may be ap- plied to the present time. The exactness which the moderns have introduced into every part of experimental philosophy, ought to re- move the apprehensions of such as, for want of acquaintance with the subject, are apt to imagine that chemistry is still the dark, mysterious science it was a century ago." " It is chemistry alone that can throw any light on the composition of the fluids, and the changes they under- go by the processes that are carried on during life. We cannot avoid having recourse to this science, in our endeavors to discover the true mechanism of the animal functions ; the properties of the fluids separ- ated by the different viscera; or the alterations such fluids undergo." " It will be necessary to enlarge and multiply these researches on subjects of different age, size, and temperament, in various climates and seasons, and to pursue them among the different classes of ani- mals," &c. " We think it equally necessary to examine the solids, by chemical methods, as well in the sound as in the diseased state, and by a comparison of their properties, endeavor to discover to which of the fluids they owe their formation ; and this being known, we may proceed to conjecture, in morbific dispositions, the solid or fluid that has suffered a change. " If it be thus established that the theory of medicine is capable of receiving the most essential advantages from chemistry, it is equally certain that the practice is no less in need of the same assistance; since both must of necessity accompany each other, and are promoted by the same means-." " Nothing can be more evident than that the choice of aliments, and of air, cannot be made with any certainty, but in consequence ofchemical researches into the nature of foods, and the properties of the atmospheric fluid" (§ 18).—Fourcroy's Medical Chemistry, 1782 (§ 1034). I have said, in the Commentaries, that " a prosperous harvest" was promised from Fourcroy's reformation. But, again I reiterate, where is the evidence ] since which time, also, chemistry has made greater advances than any other science, has had its unmolested sway, and Fourcroy's example has been followed with a corresponding diligence. Can you point to a solitary instance in which organic chemistry, ex- cept in a negative sense, has advanced the science of life or disease] Do not the very chemists of this day incidentally allow the perfectly abortive nature of their science in relation to physiology and medi- cine ] Consult the quotations in section 350, b, 1, &c, and 350|— 350|. Or take the affirmations of the distinguished Mulder (§ 350f), which go, with the rest, to establish the truth of my former assertion, that "chemistry has been a perfect incubus upon medicine; and the time is not distant when it will have proved, by its o>cn showing, its want of 10 INSTITUTES OF MEDICINE. relation to our subject, if it have not done so already."—Comment., vol. i., p. 586, note.— See Appendix § 1028-1030. ' 5], a. I agree with the chemical physiologist that "facts are stub- born things," and, with the analogy which reposes upon them, are at the foundation of all philosophy ; but it does not equally follow that facts are always philosophically or even honestly applied, nor that he who devotes himself to the laboratory is the best qualified, to apply his own facts to organic nature. " We* can have no very high idea of experiments made by gentlemen," says Hunter, " who, for want of anatomical knowledge, have not been able to pursue their reasoning even beyond the simple experiment itself." Least of all can the chemist be permitted to charge upon the vitalist a neglect of chemical facts; since it is as well by these as by the phenomena of life that the vitalist overthrows the artificial system (§ 350-350|). Nor let it be forgotten that it is purely by an appeal to certain false analogies, and by a disregard of the phenomena of living beings, that the physical and chemical hypotheses of life and disease have obtained their ascendency (§ 733, d). All our theories and principles in medicine, it cannot be too often reiterated, should rest upon well-ascertained facts. The great diffi- culties with which truth has had to contend since the restoration of the proper method of observing nature, consists in the mistaken nature of facts, or of false conclusions from admitted facts. What is often assumed to be fact is just otherwise, and, where the premises are sound, they have frequently led to spurious theories (§ 350^-350f, 433, &c, 493, 823, &c). 5|, b. The phenomena of nature are the facts about which all phi- losophy is concerned, and therefore form the substantial ground of" all intellectual acquirements. As they relate to organic beings, to their laws, their properties, their functions, whether morbid or healthy, they are to be found in the organic being himself, not in the work shops of the chemist or of the mechanical philosopher. But, even where the mind admits this proposition, if prone to speculation, it too often regards each fact by itself, and rears up hypotheses wrong in themselves, and in conflict with each other. Facts should therefore be compared before they are reduced to theory ; or, where they may conflict with acknowledged principles, they should remain in an iso- lated state till their true nature may be better understood, or till the principles which they appear to contradict may be shown to be erro- neous. Should some fact, for example, appear to indicate the depend- ence of life upon chemical or any other physical forces, the evidence to the contrary is so various and conclusive, that that fact must be considered as deficient in some of its elements, which, if known, would readily bring it under a well-established principle in physiology. These absent elements are some other facts which escape our obser- vation ; and thus what is truly fact, in an abstract sense, is made the ground-work of important error. 5\, c. It is the peculiar misfortune of science to generalize too hastily; and it often happens that the explosion, or the introduction of one error, is the parent of many others. It is also astonishingly true that a few phenomena are abstracted from the whole, of which they may be only sequences of the others, and are made the ground of conflicting doctrines, and substitutes for the theories that are inst.i- PRELIMINARY REMARKS. 11 tuted upon the more fundamental facts; and thus a blind disregard of consistency is permitted to prevail, till a most incongruous series of assumptions, as in Liebig's Animal Chemistry, is presented to us as the science which Nature teaches. Again, there is a proneness of the human mind to admit of no real- ities but such as make a strong demonstration upon the senses; and hence it is that the physical and chemical philosophers of life prefer the facts of the laboratory to such as are supplied by organic beings. The former are therefore assumed as the foundation for principles and laws in physiology and medicine ; and when it is considered how large a proportion of mankind have not the ability to distinguish the true from the false, especially when the latter is set forth in a confi- dent and dogmatic manner, it ceases to be remarkable that what is comparatively simple, and comes plausibly recommended by the tangi- ble and visible attributes of matter, should command their confidence beyond those realities which can be appreciated only by an exercise of the ^understanding in connection with the revelations of sense, and which form the ground-work of principles of difficult penetration. There are few, indeed, who are capable of reasoning beyond their senses and the facts themselves, and this is equally true of the chem- ist, both as to the facts of the laboratory and the phenomena of living beings, whenever he attempts an exposition of the properties and laws of a department of nature which lies not within his sphere of investi- gation. " Truth, whether in or out of fashion, is the measure of knowledge and the business of the understanding. Whatever is be- side that, however authorized by consent or recommended by variety, is nothing but ignorance or something worse" (§ 1034). 51, d. It cannot but be conceded, that, as knowledge advances, and the subjects of inquiry become more or less exhausted, ambition is likely to depart from an observation of nature, to seek gratification and renown in artificial expedients. This is becoming a prevailing propensity in medicine; and many have left, and are leaving, the bul- wark of knowledge to rear up hypotheses upon distortions of nature, which, for their better success, they dignify by the name of " experi- mental philosophy." 5\, e. In medicine, at least, there is but one kind of experimental observation, which consists in the simple study of the phenomena of nature. Or, if art be applied to give them a fuller development, the means must be such as shall elicit results conformable to the institu- tions of nature. But aside from chemistry, it has been the fatality of the physiological department of medicine to have been encumbered with rude experiments, giving the wildest distortions to the features of nature. When we consider the wonderful susceptibility of the properties of life, how readily their actions and results are influenced by natural agents, how a drop of hydrocyanic acid, or of the alcoholic extract of nux vomica, applied to the tongue of an animal, will ex- tinguish life in an instant; or that the same may be done by thrust- ing a needle into the medulla oblongata; or how concentrated mias- ma may almost as instantly induce an attack of fever; or how a little excess in eating may bring on an attack of apoplexy as immediately fatal as a blow on the region of the stomach—fatal, perhaps, in either case, as the artillery of the clouds ; or how simple irritations of a nerve may be followed by death from tetanus; or how all the veg- 12 INSTITUTES OF MEDICINE. etable and animal poisons, as well as all things else which do not pos- sess natural relations to the properties of life, will variously change those properties and all their results,—when, I say, we consider all these things, we may well imagine the difficulty of imitating nature by the most cautious experiments, or of developing her laws by mutila- ting the structure of organic beings, or of illustrating those modifica- tions which spring up in disease, by resorting to processes which are foreign to natural influences. Even the greatest experimentalist in modern times, he who has performed more vivisections than any other man, has placed it upon record, that it is one of the most diffi- cult things in physiology to perform an experiment that shall not be liable to objection. Yet no man ever ventured more hastily upon conclusions from such experiments, and none has thrown greater ob- stacles, in consequence, in the way of physiology and pathology. 5\,f. The limits which restrain the interposition of art are very narrow; and when organic nature is brought under the influence of arti- ficial causes with a proper reference to these limits, the resulting phe- nomena may form a safe ground of reasoning as to the laws by which organic beings are governed. Much has been accomplished, in this way, as to the physiological connections of the nervous system with organic actions, the part which it takes in the morbid processes, the sympathetic communications which it establishes throughout the or- ganization, and the interpretation which it supplies of the operation of remedial agents. Nevertheless, the most important part of our knowledge upon these great and intricate questions is abundantly supplied by the natural phenomena of life, as manifested under the varying conditions of health and disease. And that this is so, is suffi- ciently evident from the fact, that but little practical information of the foregoing nature has been added, by recent experiments, to what had been known centuries ago. The late experiments, however, upon the nervous system have confirmed what had been deduced from the more natural process of observation, and have developed some useful facts which it might have been impossible to have known by any other method. Such, for example, is the difference of function be- tween the component parts of the spinal nerves; one part being de- signed for the transmission of sensation and sympathetic influences, the other for the operation of the will and the development of motion. And yet, if analogy were allowed its proper weight in physiological inquiries, as it must be in reality the great basis of medical science,— if there had been less pertinacity as to the necessity of abstract facts for every conclusion, we might have come, by a process of analogy founded upon ultimate facts, to a knowledge of the constitution of the compound nerves. This could have been inferred from their complex functions as evinced by their phenomena, and by associating them with the simple elements of the cerebral nerves, where it is plainly seen that many of the nerves have, individually, a specific function, and whose phenomena are destitute of complexity. 5\, a. But the reign of " experimental philosophy" which so lately appeared in the mutilations of animals to discover their natural func- tions ; in the injection of corrosive and putrid substances into the cir- culatory apparatus of animals to illustrate the pathology of human disease; in the transfusion of remedial agents into the same order of beings, and even into plants, to ascertain the virtues of remedies, their PRELIMINARY REMARKS. 13 modus operandi as curative agents, and the right treatment of human maladies, has given place to an " experimental philosophy" in which organic life has no participation. This is the " philosophy" against which the observer of nature is now called upon to contend; fraught with far greater evils than the spurious systems which it has so sud- denly surprised and superseded. It is impossible to calculate the mischief which must result to mankind from its unrestrained popular- ity. Something may be gathered from its former effects when chem- istry was young ; and something from the progress of error under the fresh spur of Liebig's Animal Chemistry (§ 350-350|, 821).' We all know how common the enthusiastic belief that this " Reformer" had overthrown all former systems in every department of medicine ; and we may take the following editorial passage from the London Lancet as expressing a very common opinion of the profession as to the ap- plication of chemistry at the bedside of disease : "As organic chemistry marches on, the basis of an improved system of medical practice," says the veteran editor, " it will prove impera- tive that a rigorous examination of the products of the animal frame, the several humors and excretions of the body, should be employed in the investigation of disease. The period approaches when it will be incumbent on us, not perhaps invariably, but still very often, in pre- scribing,—say, for typhus, or purpura, or any of the numerous vari- eties of cutaneous affections, that by a chemical analysis, we should first ascertain the constituents and proportions of the proximate elements of the urine, the saliva, the expired breath, the perspired matter, per- haps the blood, the faeces of the patient, before applying our remedies; and this process may have to be gone through not once only, but sev- eral times in the progress of the malady." " The time is, we repeat it, approaching when the foundation of practice on the laws of Organic Chemistry will form the distinction between the enlight- ened physician and the mere pretender" (§ 851, 863, e; 883, b).— London Lancet, April 29, 1843. (Also, § 1029, 1030.) 5^, b. In the foregoing quotation we have essentially what is now extensively denominated " the progress of medical science," and the nature of the doctrines to which these Institutes are opposed. These Institutes will be found mainly, so far as physics are alleged to be concerned, by the side of all the most illustrious physiologists from Hippocrates to us, whose general views are thus summarily express- ed by Bichat: " The organic chemistry of the laboratory," says Bichat, " is the dead anatomy of the fluids, not a physiological chemistry. The physiology of the fluids should be composed of the innumerable variations which they experience according to the different (vital) states of their respective organs." " The instability of the vital pow- ers is the quicksand on which have sunk the calculations of all the physicians of the last hundred years. The habitual variations of the living fluids, dependent on the instability of the powers of life, one would think, should be no less an obstacle to the chemical physicians of the present age." " Again, had physiology been cultivated by men before physics, I am persuaded that many applications of the former would have been made to the latter. Rivers would have been seen to flow from the tonic action of their banks, crystals to unite from the excitement 14 institutes of medicine. which they exercise upon their reciprocal sensibilities, and planets to move because they mutually irritate each other at vast distances. All this would appear unreasonable to us, who think of gravitation only in consideration of these phenomena. And why should we not, in fact, be as ridiculous when we come with this same gravitation, with our chemical affinities and chemical compositions, and with a language established upon their fundamental data, to treat of a sci- ence with which they have nothing whatever to do ]•'—Bichat's Gen- eral Anatomy and Physiology. 6. We may now readily perceive the reason why chemistry has undergone changes within a few years, while all that relates essen- tially to the properties and laws of organic beings may have been long since known. The chemist operates, and makes all his discov- eries, through the forces and laws of inorganic matter. These he may carry into his laboratory, turn into his test glasses, or involve in his crucible. He can therefore oblige nature to form the same inor- ganic compounds as she forms spontaneously. He can then separate the elements again, and again oblige nature to recombine them after their original manner. But, can he do the same thing with organic beings % He cannot form the most simple organic compound—can- not even recombine the elements when they are once separated;— although he has then the necessary elements, and in their exact pro- portions. The reason is obvious. The chemist has not at his com- mand in this case, as in the other, the necessary powers; or, as the chemist expresses it, " he cannot place them in the same circumstan- ces as Nature does." It is clear, therefore, that while the laboratory is the proper place for the study of the inorganic kingdom, we must go to the organic being itself to learn the nature of the powers and laws by which it is governed. These, then, are the reasons why the laws of organic be- ings have been long so much better understood than those of chemis- try. Every thing is artificial in the laboratory, so far as experiments are concerned; and, if these be not the right ones, or be imperfectly conducted, they will either fail to represent nature correctly, or will give her a wrong interpretation. Hence the great instability of this science; and yet we are told that every new theory in chemistry is applicable to physiology and medicine. But, it is quite otherwise with organic beings. Here all the ex- periments are carried on by Nature herself, and they cannot deceive. The various results and phenomena are seen in the being itself, and can be seen nowhere else. They must, therefore, be the true «-uide and the only guide, to the powers and laws by which organic beino-s are governed. These phenomena, too, are astonishingly multiplied in any given being, and new ones are presented as the being may come under new influences. But, this variety is extended almost to infinity when we consider that every distinct species of plants and animals has its peculiar manifestations of life. It is also true that each one of this endless variety is utterly different from any of the phenomena of the inorganic world. And when we take all the phe- nomena of organic beings in connection, and find a perfect harmony among the whole, the nature of the proof is so various and immense as to conduct us to a right knowledge of the principles and laws of life in all their aspects. PHYSIOLOGY. 15 Now all this variety has been perpetually before the observation of mankind, and always presented to our observation by nature her- self. It therefore ceases, I say, to be remarkable that the science of life had so greatly outstripped that of chemistry; and it will proba- bly forever remain better understood; since nature is the experi- menter in one case, and man in the other. PHYSIOLOGY. 7. The sensible world is composed of animate and inanimate be- ings, which, with their difference in composition and structure, has led to their division into the organic and inorganic or mineral kingdoms. 8. The relations between the two great kingdoms of nature, and their contradistinctions, render a general reference to the inorganic indispensable to our physiological and higher branches of inquiry. 9. Animals and plants, which make up the organic kingdom, are essentially dependent on the inorganic; but the latter kingdom is per- fectly independent of the organic. 10. The beginning of organization is in plants, which are the pri- mary source of nourishment to animals. 11. From the foregoing law arises the great fundamental distinc- tion between plants and animals—that the former subsist on the ele- ments of matter, while the latter are nourished by those elements in an organic state. It appears, therefore, that vegetables are more creative than animals (§ 303). 12. All organic substances are compounds of the simple elements of matter. They are combined by the vital powers, while inorganic compounds are produced by chemical forces. 13. As organization begins in vegetables, it is obvious that a de- compounded organic substance can be restored to an organic state only by that vegetable kingdom which was created for the specific purpose of organizing the mineral kingdom, for the ultimate final cause of supplying food to animals. The plant reduces, the animal consumes (§ 303). 14, a. If an animal compound be decompounded, the reunion of the elements into an animal substance requires the agency of both vegetable and animal organization; and, not only so, but nothing can reproduce any given animal compound but the precise part of the same species of animal which gave origin to the part so decompound- ed (§ 12). 14, b. Owing to this universal law, by which the animal is rendered so perfectly dependent on the vegetable kingdom, the Creator has given a striking perfection to the grand design, in the institution of an invisible world of animalcula for the consumption of that vast pro- portion of organic matter which is passing through the process of maceration to its elementary state. Thus arrested by these econo- mists of nature, it advances through an ascending series of animals, till, at last, it becomes the food of man (§ 151, 1052). The foregoing distinction is fundamental in nature; and here, at the very threshold, we are met by a barrier which the chemist and 16 institutes of medicine. physical philosopher cannot pass from one side, nor the physiologic from the other (§ 1052). , 14, c. I may also say, that it is no small proof of a Creator, that the elements of all combinations which are generated by animals and plants are derived from the inorganic kingdom, which will be allowed to be less productive than the organic. And since, especially, no or- ganic being can generate any elementary substance, nor the ele- ments unite, of themselves, into organic compounds, it follows that the whole was created by a Being of greater power. We can go no farther back than the elements of matter. Here the atheist himself pauses in dismay. They proclaim a God, and reason submits to this limit of its powers. I may also propose another, and perhaps greater proof of the error of spontaneous generation. The kingdoms of nature are governed by inherent powers, and the organic possess powers peculiar to them- selves ; but the existence of matter, whether organic or inorganic, is also indispensable to their respective forces. These forces, therefore, did not create matter; and since matter cannot create matter, and therefore did not create itself, it follows that its associate powers did not create themselves. Whence it is obvious that some greater Power exists by which the powers of nature were created in union with matter. These arguments, therefore, may be taken in connection with those which I formerly adduced for the purpose of exposing the fallacy of the doctrine implied by Carpenter, Pritchard, Fletcher, and others, by assuming that the vital properties exist in the elements of matter, and that, therefore, the elements are capable of arranging themselves into organic beings. (See my Examination of Reviews, p. 37, and my Notice of Reviews. Also, § 1051, 1052.) 15. Exact analyses are readily made of mineral compounds, and the elements may be recombined into the same or other mineral com- pounds. The precise analysis of the most simple organic compound, solid or fluid, as fibrin or albumen, is very difficult, and always liable to doubt. 16. In a primary sense, plants subsist upon the atmosphere and what it contains (§ 303); but they immediately derive much of their nourishment from decaying organic substances that are incorporated with the soil. But, before such compounds can be appropriated by plants, they must be resolved into their elementary state. They can be taken into the organization of plants only in the condition of min- eral substances; and even then the most simple binary compound must be decompounded before organization can begin. All the re- combinations, as constituting parts in the vegetable economy, are es- sentially unlike any substance in the mineral kingdom. 17. If animal organization resolve an organic compound into a min- eral condition, such compound is useless in the animal economy (§ 13, 14). There is never present, therefore, in the animal organization, as a part of, or as a source of supply to that organization, any mineral substance (§ 360). Whatever mutations the materials of supply may undergo, they must always exist in an organic state, or be permanent- ly restored to the mineral kingdom (§ 16). 18, a. We learn from the foregoing premises (§ 17), that food does not lose its organic state during the process of digestion ; and since it PHYSIOLOGY. 17 becomes more and more nearly assimilated to the living solids from the earliest action of the gastric juice, it is evident that chemical agencies have no connection with the transformations to which it is subjected in the alimentary canal (§ 350-376). 18, b. Hence, also, the fallacy of attempting, by chemical analysis, to indicate the proper sustenance of man and animals. " To deter- mine," says Liebig, " what substances are capable of affording nour- ishment, it is only necessary to ascertain the composition of the food, and to compare it with that of the ingredients of the blood." He then pro- ceeds to a practical application of this principle by setting forth the chief elements of the blood. The difficult subject, also, of identifying hay with the flesh of animals, and all the vegetable substances which enter the human stomach with the various tissues of the body, is so far disposed of as to require no other interposition between the nutri- ment and its conversion into living animal compounds than the chem- ical forces. This chemical doctrine is thus set forth by Liebig: " The most recent and exact researches have established as a univer- sal fact, to which nothing yet knoion is opposed, that the nitrogenized constituents of vegetable food have a composition identical with that of the constituents of the blood"—Liebig's Animal Chemistry. 18, c. And such, too, is a common example not only of the assump- tions of this writer, but of that positive manner which has inspired such universal confidence (§ 3501-350^). There are, of course, in nitrogenized vegetable food certain combinations more or less analo- gous to what are called the constituents of the blood, though never the same, and but comparatively few in many that are appropriate as means of nourishment; nor could it be doubtful that the elements of the flesh and blood of animals subsisting on vegetables must exist in their food. But the identity of elements in any given vegetable and animal compounds is very different from identity of compounds, and this, too, with every imaginary latitude of the isomeric and polymeric problems. Nor have any two chemists agreed, as yet, in their analy- sis of blood, or of any animal compound. But we have from the laboratory most ample admissions of the groundless nature of the preceding statement. Thus, again, Liebig : " As far as our researches have gone, it may be laid down as a law, founded on experience, that vegetables produce, in their organism, compounds of proteine ; and that out of these compounds of proteine the various tissues and parts of the animal body are developed by the vital force, with the aid of the oxygen of the atmosphere and of the elements of water. " Now, although it cannot be demonstrated that proteine exists ready formed in vegetable and animal products, and although the dif- ference in their properties seems to indicate that their elements are not arranged in the same manner, yet the hypothesis of the pre-exist- ence of proteine, as a point of departure in developing and comparing their properties, is exceedingly convenient. At all events, it is certain that the elements of these compounds assume the same arrangement when acted on by potash at a high temperature" ! !—Liebig's Animal Chemistry. Nor is this the end of the contradiction; for we also read in the same work, that " We cannot, indeed, maintain that the animal organism has no B 1*8 institutes of medicine. power to form other compounds, for we know that it is capable of producing an extensive scries of compounds, differing m composition from the chief constituents of the blood" (§ 409, b, and 53, b). But, if the foregoing quotations be conclusive of the specific inqui- ries before us, the following admitted facts not only establish the same conclusions, but prove that chemistry is entirely incompetent to any one of its pretensions as to a proximate analysis of the blood, or of other organic compounds, and that it is strictly limited to a mere ele- mentary decomposition, while they also concede the existence of a vital principle as an " immaterial" governing power, wholly different from any attribute of inorganic nature, and therefore render it certain in another aspect, that the chemist, from want of this agent, can, at most, only effect the elementary analysis of organic compounds. Thus, then, the organic chemist: " If the problem to be solved by organic chemistry be this, namely, to explain the changes which the food undergoes in the animal body; then it is the business of this science to ascertain what elements must be added, what elements must be separated, in order to effect, or, in general, to render possible, the conversion of a given compound into a second or third; but we cannot expect from it the synthetic proof of the accuracy of the views entertained, because every thing in the or- ganization goes on under the influence of the vital force, an immate- rial agent which the chemist cannot employ at will."—Liebig's An- imal Chemistry. 18, d. If we now turn to section 409, b, we shall there find that it is in the blood alone that the reputed proximate principles of vegeta- bles are assumed to exist, and that many proximate compounds are allowed by the chemist to be elaborated from the blood, to which there is nothing at all analogous in the vegetable kingdom, or even in •lie blood itself. This, then, is the sum of the whole subject: 1st. The chemist has his favorite doctrine of digestion, as an important foothold for material- ism, forever present, to be extended as far as the obscurities of the subject will admit, and to borrow an apparent confirmation from these predicated assumptions. The absolute amount of that doctrine is thus expressed by Liebig : " In the natural state of the digestive process, the food only under- goes a change in its state of cohesion, becoming fluid without any other change of properties."—Liebig's Animal Chemistry. 2d. Now, the food undergoing no other change " in the digestive process" than that of becoming" fluid," it is the easiest matter to find it all in the blood just as it was taken into the stomach,—vegetable as well as animal; while, in so finding it, a pretended confirmation is set up of the " universal fact, to which nothing yet known is opposed, that the nitrogenized constituents of vegetable food have a compo- sition identical with that of the blood," and vice versa. Or, as Liebig also has it, " vegetables produce in their organism the blood of all animals" (§ 350, no. 76). But, 3d. We are assured by chemists, that nothing is more diffi- cult of analysis than the blood, even as it respects its elementary com- position; while it is well known that the analyses of this fluid are always discrepant. Hence the impracticability of instituting unex- ceptionable comparisons between even the elementary composition of PHYSIOLOGY. 19 " In the natural state of the digestive process, the food only undergoes a change in its state of cohesion, becom- ing' fluid without any other change of properties."—Lie- big's Animal Chemistry. blood and the nitrogenized constituents of plants; while the very nature of the chemical influences exerted upon a vital compound of" 17 or 18 elements with a view to its analysis, is conclusive of the arti- ficial condition of all the chemical compounds which may be thus formed out of the homogeneous fluid. Again, 4th. It is finally said that many substances elaborated from the blood are utterly different from any thing discovered in plants, or in the blood itself (§ 409, b). Here, the composition of the organic sub- stances being simple, readily leads to an exposure of the assumptions which have taken refuge under the greater difficulties, and obscu- rities, and disagreements, attending the analysis of the most complex substance known in nature (§ 53). 18, e. But we shall see, farther on, that the chemical school main- tain, through their principal chief, those doctrines of digestion, to suit other hypotheses in organic chemistry, which are fundamentally opposed to each other, and which I shall now arrange in connection, that the reader may see, at a glance, not only the speculative nature of organic chemistry, but the feebleness of the assumption as to the identity of the blood and the nitrogenized constituents of plants Thus : B. " The VITAL FORCE CAUSES A decomposition of the con- stituents of food, and destroys the force of attraction which is continually exerted be- tween their molecules. It alters the direction of the chemical forces in such wise, that the elements of the constituents of the food arrange themselves in an- other form, and combine to produce new compounds. It forces the new compounds to assume forms altogeth- er different from those which are the result of the attraction of cohesion when acting freely, that is, without resistance."—Liebig's Ani- mal Chemistry. It will be therefore seen by the quotations B and C, that the state- ment is admitted to be a mere assumption; while it necessarily fol- lows, by adopting either of the contradictory statements, B or C, that the vegetable substances undergo a radical change during the process of digestion, and, therefore, that we cannot find those sub- stances in the blood, but their elements, only, in new and peculiar combinations. The differences, indeed, are probably often much greater than between calomel and corrosive sublimate (§ 350i). What, also, gives to the whole of this subject its proper interpre- tation, is the parallel which is drawn by Liebig between the assimila- tion of the most virulent poisons and the most appropriate food, as set forth in Section 350, Nos. 41 and 42. The looseness of the clos- ing sentence of No. 41, abstracted from all the surrounding evidence of hypothesis, is abundantly conclusive of the conjectural nature of the whole of this pretended mathematical demonstration. There is no difficulty, however, in comprehending the source of the mistake which honest chemists have made in attempting, by "The most decisive ex- periments of physiologists have shown that the process of chymification is inde- pendent of the vital force ; that it takes place in virtue of a purely chemical ac- tion, EXACTLY SIMITAR to those processes of decom- position or transformation which are known as putre- faction, fermentation, or becay."—Liebig's Animal Chemistry. 20 institutes of medicine. chemical analysis, to indicate the I^J^^^jT^Sie mals. It lies in a wrong conception of the ec?™™/ Gf princi- life, and thence reasoning from a ^/^X in pie , which exist in the two departments of ^ZZTr^uCTlO, a strikingly modified state, to their more analogous results W iu, ^iL^, however, plants subsist «^££^S£ thofe ^lPTnpnfnrv state the chemist may often successiuny 11^11"1 ^L^lpo^ wnich will yield to any g-e-pecies of plant (whos! general elementary composition may be k™™)^e elements\hat go especially to its nutritive economy ^°m{^ damental distinction between plants and animals (§ }\}^L'>>" ™ vious that no such thing can be done m relation to th1£*• ™ better practical proof of this can be wanted, than the perfectly indiges- tible nature of many compounds which contain the requisite elements. Such compounds, upon the chemical philosophy, as I have said, and as admitted by Liebig, include many virulent poisons in the vege- table kingdom, and many inorganic substances whose binary com- pounds embrace numerous elements. We need not, indeed, go any farther than the recent experiments by Dr. Beaumont upon the va- rieties of food, as will be subsequently noticed (366), and Magendie s analogous experiments with the food of animals* to show that the whole of this subject must be left to natural experience Nor does it appear to have occurred to the chemical physiologist, in the foregoing inquiries, that the elementary composition of animals is greatly alike, at least in all mammalia. It should follow, there- for!, upon the chemical philosophy, that the practical distinctions should not exist between the food of man and animals, but that a common diet should be as universally adapted as atmospheric air. To this conclusion it may be also added, that the same chemical phi- losophy refers chymification to a purely chemical process; or, in the language of Liebig, " it takes place in virtue of a purely chemical action, exactly similar to those processes of decomposition or trans- formation which are known as putrefaction,fermentation, or decay. — Animal Chemistry, p. 16. And since, therefore, chymification is " independent of the vital force" (ibid.), and as chemistry identifies the gastric juice of man and quadrupeds, and even the chyme, it is obvious that chemistry can predicate nothing, upon this subject, of any difference in the vital constitution of man and animalst (§ 409, 350, d). 19. In respect to their general structure, inorganic bodies are ho- mogeneous, organic beings heterogeneous. This applies as well to the elementary constituents in their modes of combination as to the compound structure of the whole being. Each particle of a mineral compound is as much a whole as the greater mass, and has the same combination of elements. Each element is as perfect as the com- pound conditions. Animals have muscles, glands, nerves, vessels, &c, with an endless variety in the elementary combinations in the same individual. All these parts are necessary to make a whole, and depend, mutually, upon each other for their existence. The same * See Medical and Physiological Commentaries, vol. i.. p. 697, &c t See my article on the foregoing subject in the Boston Medical and Surgical Journal, December 27,1843. PHYSIOLOGY. 2\ general principle is applicable to plants. Nevertheless, apparent ex ceptions occur in both animated kingdoms, as in parts of many plants and of polypi. But, in these instances, each part possesses essential- ly the whole apparatus of organic life. 20. Organic beings grow from within by interstitial deposition of molecules derived from the blood or sap, according to the exact na- ture of each part. Inorganic bodies do not grow, but increase only by a superficial juxtaposition of parts, which may, also, be wholly unlike the original crystal, or other nucleus, in their elements. In the process of growth and nutrition, the new material is con- veyed within from without, and subjected to many specific changes, till it is resolved into one homogeneous fluid. Atmospheric air is also indispensable to all organic beings. There is nothing analo- gous in the inorganic world; while these, and an endless series of other facts, establish the identity of the organic life of plants and animals. 21. A peculiar action of certain agents upon the whole organism of plants and animals, called vital stimuli, entirely unlike the action of chemical agents, is necessary to the growth and existence of or- ganic beings. They are both internal and external, and give rise to all the phenomena in organic life, and maintain the whole in one ex act condition; while the action of agents upon inorganic, or on dead organic, substances, does not elicit one of these multifarious phenom- ena (§ 74£, 188£). 22. Every part of an animal or vegetable is forever distinguished by the same vital phenomena and physical results; and the action of vital stimuli is forever the same on each part, respectively, but, like the vital phenomena and physical results, different in each; the whole being liable to invariable modifications at different stages of life, and according to temperament, and according, also, to every other modifying influence. 23. Unlike inorganic bodies, organic beings require the coexist- ence of solids and fluids in their composition. 24. All organic beings have the power of generating motion within all their parts. Mineral compounds have no such endowment. If motion take place in their internal constitution, it depends upon in- fluences which have no existence in living beings. Nor is this all; for motion is always generated in living beings by the operation of a power implanted in their constitution, and this power is brought into action by the mind, and by internal and external physical agents. 25. The solids and certain fluids of organic beings act upon each other. But the fluids act only upon the organic properties of the solids, while the solids transmute the most important fluid into their own substance. The stimulant action of the blood upon the organic properties, and the reaction of the solids upon the blood, are design- ed for a common end. The concurrence of the whole fabric is ne- cessary to these, as to all other, results. There is nothing analogous in the mineral kingdom. 26. When external or internal agents produce motion in organic beings, they do not affect the composition, in the natural state. It is quite otherwise with inorganic or dead organic compounds. 21. Organic beings are perpetually subject to a vital decomposition and removal of old parts, while the old are exactly replaced by new 22 institutes of medicine. ones. It is essential to mineral compounds that they remain without change. Any disturbance of their molecules deranges their structure or composition. While, therefore, inorganic compounds are forever the same, or- ganic beings are subject to an unceasing loss of identity as respects their present component parts. 28. The external forms of plants and animals are variously and greatly contradistinguished from those of inorganic bodies. The condition of one, also, is uniform; that of the other, even when crys- talized, is variable. 29. " The only character," says Muller, " that can be possibly compared in organic and inorganic bodies, is the mode in which sym metry is realized in each; that is to say, the character which miner- als possess in their state of crystalization." Yet there is not, in this respect, the slightest analogy; since no true organic compound ever approaches the condition of a crystal. Here we may trust the au- thority of Liebig, who says of the "vital principle of the animal ovum, as well as the seed of a plant," that, " Entering into a state of motion or activity, it exhibits itself in the production of a series of forms, which, although occasionally bounded by right lines, are yet widely distinct from geometrical forms, such as we observe in crystalized minerals. This force," he goes on, "is the vital force, vis vitas, or vitality." 30. The foregoing considerations, each and all (§ 8-29), demon- strate a radical difference between the forces and laws of organic and inorganic beings, and a remarkable modification of such as are com mon to plants and animals. But, as the institutions of organic life lie at the foundation of medical science, they should be still farther sought in the contradistinctions between the organic and inorganic kingdoms, and in those diversified phenomena which indicate a com- mon but modified government of animals and plants. All organic beings possess in common the most essential conditions of life, though existing in the two great departments of living nature under specific modifications or varieties ; not, however, very dissimilar, but inti- mately connected by a gradation of analogies, as we descend along the chain of either, till we arrive at their more absolute connecting link in the lowest being of one and the other. Other conditions are superadded to the nobler department, which, with the differences of structure and the modifications of their common properties of life, and their modes of subsistence, distinguish the two living kingdoms from each other. 31. Physiology may be divided into, 1st. The composition of or- ganic beings; 2d. Their structure; 3d. Their properties; 4th. Their functions ; 5th. Modifications of properties and functions which arise from sex, temperament, climate, habits, age, &c.; 6th. The relations of organic beings to external objects; 7th. Death. These several topics will be considered with a special view to the great principles which form the Institutes of Medicine. PHYSIOLOGY.--COMPOSITION. 23 FIRST DIVISION OF PHYSIOLOGY. COMPOSITION. 32. The principal object contemplated by this work in ascertaining the facts relative to the composition of organic beings is to settle the principles and laws upon which such beings are constituted, by tracing them out in the fundamental conditions of organic matter. 33. Composition is subdivided into ultimate or elementary, and the proximate parts; the latter being compounded of the former. 34. Of the fifty-five known elementary substances, the following seventeen have been found in the composition of plants : carbon, oxy- gen, hydrogen, nitrogen, potassium, calcium, iron, manganese, phos- phorus, sulphur, silicium, magnesium, aluminum, chlorine, sodium, iodine, bromine. 35. The same elements (34), with the addition of fluor, and the probable exception of aluminum, occur in animals. Arsenic is also often found in man.* Although animals are exposed to various sources from which other elements might be derived, they reject ev- ery other elementary principle; or, rather, are incapable of their assimilation. 36. The foregoing coincidence in the common nature of the ele- ments of plants and animals supplies no small proof of the peculiar properties and laws of organic beings. Others, however, more stri- king, lie at the foundation, and form, also, contradistinctions with the inorganic world. 37. Animal and vegetable substances are mostly composed of car- bon, oxygen, hydrogen, and nitrogen, four out of the fifty-five ele- ments that go to the formation of inorganic compounds. The main bulk of plants, indeed, such as the cellular and vascular tissues, is probably composed of carbon, hydrogen, and oxygen alone, as the essential elements; though nitrogen is indispensable to many of the products of vegetable organization, and Liebig says it is found in all parts of a plant (§ 62, f note). The three or four indispensable ele- ments compose 90 or more parts of 100 of all the soft textures of an- imals, and of all plants. These are selected, universally, by the veg- etable kingdom, as if by instinct. This circumstance increases great- ly the force of the conclusion in the foregoing section (§ 36). 38. The elements of mineral compounds are always united in a binary manner; those of organic in a ternary, quaternary, &c, being always intimately blended with each other. This distinction involves an absolute difference in the powers and laws of the two kingdoms. 39. No two elements, therefore, can form a true organic compound. The rare exceptions which have been made by the chemists are not organic substances, nor can they be rendered such by the animal or- ganization. They belong to the mineral kingdom, from which they cannot be elevated but by the properties of vegetable life (§ 14,16,17). All mineral compounds may be resolved into their elements, which are as perfect minerals as when united. Indeed, the most natural con- dition of a mineral is the state of a simple element. * Whence come the fluor and the arsenic, unless through plants? (§ 14-18.) 24 INSTITUTES of medicine. 40. What, therefore, is so fundamental in organic beings as ex- pressed in sections 38 and 39, and universally admitted, allows of no introduction of powers, principles, laws, &c, which shall conflict with the powers and laws upon which the simplest organic compound is constituted. In the progress of this work, it will be seen that this position is every where substantiated. Unity and harmony prevail throughout each department of nature, respectively; and while the powers and laws of the organic are as fully contradistinguished from those of the inorganic kingdom as are their physical and all other attri- butes, we shall find that the former are apparently embarrassed by a great diversity of phenomena as manifested in health and disease, but that, in reality, all the variety goes to the conclusion that the funda- mental principles are the same throughout (§ 638, 733, d). 41. Again, we may suppose at least some 20,000,000 of distinct oi- ganic compounds in the various species of plants, and some 30,000,000 more in the animal kingdom, formed mostly out of four elements (§ 37), while these same elements form scarcely a dozen combinations in the mineral kingdom. 42. The foregoing organic compounds are formed in each individ- ual, respectively, out of one common homogeneous fluid, composed of about seventeen elements* No chemical hypothesis can interpret this universal characteristic of the organic kingdom; while all the relative facts of inorganic chemistry are totally opposed to this almost endless and undeviating variety of new combinations out of a common fluid, according to the species of animal or plant, and according to the nature of every particular part. If chemical agencies operated, there would be no uniformity in any secreted product at any two successive moments (§ 741, b, 1052). It is one of the frequent concessions of the distinguished chemico- vitalist, Muller, that " The opinion that the component principles of the organs exist in the blood in their perfect state cannot be possibly adopted. The com- ponents of most tissues, in fact, present, besides many modifications of fibrin, albumen, fat, and ozmazome, other perfectly peculiar matters, nothing analogous to which is contained in the blood." " Even the fibrin of muscle cannot be considered identical with the fibrin of the liquor sanguinis."—Muller. John Hunter also laid down the following doctrine, as expressed by his editor, Mr. Palmer : " It is highly probable that the different proximate principles of vegetable and animal substances hold different ranks in the scale of organized substances, in the same manner that one animal ranks high- er in the scale of organized beings than another."—Hunter. And thus Liebig, as a vitalist, in opposition to himself, as a chemist : " In that endless series of compounds, which begins with carbonic acid, ammonia, and water, the sources of the nutrition of vegetables, and includes the most complex constituents of the animal brain, there is NO BLANK, NO INTERRUPTION. The FIRST SUBSTANCE CAPABLE OF AFFORDING NUTRIMENT TO ANIMALS IS THE LAST PRODUCT OF THE CRE- ATIVE energy of vegetables."—Liebig's Animal Chemistry. * It is now conceded by physiologists, generally, that the chyle, lymph, and blood are each, severally, as expressed by Wagner, "homogeneous fluids, with certain rjec'uliar corpuscles mixed with them."—See Wagner's Elements of Physiology n 250 Ton don, 1842. J " t>*> v- ■4du- LMn PHYSIOLOGY.--COMPOSITION. 25 43. Although it be generally true that it is the wonderful province of organization to elect only four elements from the homogeneous fluid (§ 42) in the formation of organic compounds, yet there are some com- pounds which embrace a greater number, though unlike the elements of inorganic compounds, in intimate union with each other (§ 38). The blood, indeed, has not less than seventeen or eighteen elements thus united; a circumstance in itself conclusive that other powers than the chemical must preside over the elaboration of the very limited number of elements that go uniformly to the formation of all other organic compounds. And, although the metallic and earthy sub- stances form no part of the essential organs of life, they are yet vitally united with the indispensable organic compounds in particu- lar parts, and are elaborated from the blood or sap by those parts only, and with an astonishingly relative proportion to the other elements, as sulphur by the brain, phosphate of lime by the bones, fluate of lime by the teeth, phosphate of magnesia by wheat, silex by the stem of wheat, and by the skeletons of many poriferi, &c. We shall not regard these substances as accidental, or as introduced by a physical process, but, as contributing a subordinate part with the essential organic elements toward the perfection of an unfathomable system of Designs, whose moving power is only short of the Creative Energy, in being substituted for that Great First Cause, with limita- tions that chain it to the fulfillment of secondary ends (§ 847). 44. Organic compounds are forever the same, in health, in any given part of any species of being at each stage of existence, but liable to be more or less modified in an exact manner at the several stages (§ 153-159). And so of disease. The same morbid state of any given part, cete- ris paribus, always produces the same modifications of the organic compounds of which it may be composed, the same alterations of the secreted fluids, and the same new formations. All this is distinctly seen in the phases of scrofula, in small-pox, cow-pox, lues, measles, hy- drophobia, &c. It is opposed, to all facts, that any chemical influences can decom- pound a fluid composed of seventeen or eighteen elements, not only in the exclusive manner represented in the last section, but according, also to the exact vital constitution or vital modification of each part. 45. Nevertheless (§ 44), the general composition of animals is the same, whether they subsist upon grass, or flesh, or whatever be the nature and variety of the food. So of the chyme, the chyle, and the blood. There is nothing in chemistry that will throw any light upon these coincidences (§ 17, 409). 46. Contrary to what has been seen of the variety of organic com- pounds out of four simple elements (§41), only a few hundred, at most, of distinct inorganic compounds can be formed out of the 55 elements which compose the mineral kingdom (§37). Those few compounds, however, make up the great mass of the globe, while the organic are only scattered over its surface. Nor is there a globe in the universe that would not be as worthless as space, did it not administer to the purposes of life. 47. Different combinations of carbon, oxygen, hydrogen, and nitro- gen, constitute, mainly, the whole vegetable and animal materia medi- 26 institutes of medicine. ca; while their inorganic compounds do not contribute one remedial agent. 48. It is evident that the four principal elements of organic com- pounds combine not only in different proportions, but so variously, m respect to the proportions, among themselves, as to bewilder the imagination (§ 41). Chemistry can give us no light upon these sub- jects, but what is purely analytical; while, in respect to their mineral compounds, the same elements unite only in a small number of pro- portions, upon which chemistry throws its light with a brilliancy that may be said to penetrate the unfathomable recesses of their organic compounds. This fundamental distinction is necessarily conceded; and it were well for science if chemistry did not overstep the limit. But, the chemist shall always speak for himself. Thus Liebig : " 6 eq. tartaric acid, by absorbing 6 eq. oxygen from the air, form grape sugar, with the separation of 12 eq. carbonic acid. We can explain, in a similar manner, the formation of all the component substances of plants, which contain no nitrogen, whether they are pro- duced from carbonic acid and water, with separation of oxygen, or by the conversion of one substance into the other, by the assimilation of oxygen and separation of carbonic acid. We. do not know in what form the production of these constituents takes place. In this respect the representation of their formation "which we have given must not be received in an absolute sense, it being intended only to render the na- ture of the process more capable of comprehension. But, it must not be forgotten, that, if the conversion of tartaric acid into sugar, in grapes, be considered a fact, it must take place under all circumstances in the same proportions" !—Liebig's Organic Chemistry applied to Physi- ology. The reader should never lose sight pf the foregoing hypotheses and admissions. They should be ever ready to chasten his credulity as to the chemical interpretation of every organic compound. They stamp the whole " science of organic chemistry," in its synthetical aspects, as one of pretension, and unworthy the confidence of an intel- ligent mind (§ 350-350f). And this is farther confirmed by the statements in the two next following sections. 49. " The particles of matter," says Liebig, " called equivalents in chemistry, are not infinitely small, for they possess a weight, and are capable of arranging themselves in the most various ways, and of thus forming innumerable compound atoms. The properties of these compound atoms differ in organic nature, not only according to the form, but, also, in many instances, according to the direction and place which the simple atoms take in the compound molecules. " When we compare the composition of organic compounds with inorganic, we are quite amazed at the existence of combinations in one single molecule, of which ninety or several hundred atoms or equivalents are united. Thus, the compound atom of an organic acid of very simple composition, acetic acid, for example, contains 12 equivalents of simple elements; 1 atom of kinovic acid contains 33 • 1 of sugar, 36 ; 1 of amygdalin, 90 ; 1 of stearic acid, 138 equivalents! The component parts of animal bodies are infinitely more complex even than these."—Liebig's Organic Chemistry, &c. 50. " Inorganic compounds differ from organic in as great a degree PHYSIOLOGY.--COMPOSITION. 27 in their other characters as in their simplicity ofconstitution. Thus, the decomposition of a compound atom of sulphate of potash is aided by numerous causes, such as the power of cohesion, or the capability of its constituents to form solid, insoluble, or, at certain temperatures, volatile compounds with the body brought into contact with it; and, nevertheless, a vast number of other substances produce in it not the slightest change. Now in the decomposition of a complex organic atom there is nothing similar to this."—Liebig's Organic Chemistry &c. 51. "An essential distinction between organic and inorganic com- pounds is, that in organic products the combining proportions of their elements do not observe, as in mineral compounds, a simple arith- metical ratio." 52. An interesting corollary flows from the foregoing facts (§ 22, 41-50), namely, that all animal and vegetable poisons, all remedial agents of an organic nature, and all the varieties of food, depend upon the modes and proportions in which three or four simple elements unite with each other. It is evident, also, from § 41, that no two re- medial agents generated by different species of plants or animals, however analogous, can be exactly alike in their morbific or remedial virtues. Hence the differences among cathartics, emetics, &c. As composition, especially of the sap, also varies more or less at the dif- ferent ages of plants and at different seasons, and also from unhealthy- conditions, so will corresponding differences arise in their remedial and morbific virtues. In all the cases, however, the characteristics of organic products as vital agents are uniformly the same under any given condition of the organic being ; and so of each simple element, and of the physiological effects of all vital agents (§ 188£, d). The precise natural or morbid states of the organic properties lie at the bottom of the whole philosophy, since these properties, through their instruments of action, combine the elements exactly according to their existing state (§ 650, 826,y*). 53, a. From the facts now stated (§ 38-51), it is evident that the organic chemist can do no more than effect an analysis of organic compounds. He can only present each simple element by itself, without the possibility of acquiring a knowledge of the modes and proportions in which they combine with each other. 53, b. So, also, if the aggregate compounds, such as blood, sap, muscle, gastric juice, &c, be, in reality, made up of mere simple compounds, or " proximate principles," by the union of compound atoms, chemistry can give us no information as to the conditions in which they naturally exist. Those combinations which are most alike are different from each other in every distinct part of the or- ganic being, and different in the same parts of distinct species. This is so from the first development of the germ; and what is then begun is perpetuated through the life of the individual, and transmitted to all succeeding generations (§ 63-81, 155). The differences, as we have seen, result from the different proportions in which some three or four simple elements are united together, and from the proportions of different compound atoms which may enter into the entire combi- nation, and from the manner in which they and their elements are combined among themselves. It must be obvious, therefore, that we can never reach the secret of these combinations. We should neces- 28 INSTITUTES OF MEDICINE. sarily expect, even from the shades of elementary distinctions, that chemistry would confound and even identify many compounds that are totally unlike in their nature. And this it actually does, in pre- senting to us sugar, vinegar, starch, gum-arabic, wood, &c, as the same substance ; and in identifying pus and cheese, and, again, the albumen of eggs, lymph, mucus, and the product of certain cancerous affections. Nor is there generally any agreement among the chem- ists in their analyses of organic compounds. It is as true now, as when Bostock (a chemical physiologist) affirmed, that " every subse- quent attempt to discover the elements of organized substances differs more or less from those that preceded it." The moment chemical agencies begin their operation, artificial transformations necessarily ensue, and the nature of the organic com- pound is changed in a corresponding manner. A large proportion of the resulting products are perfectly new formations, particularly all the binary compounds (§ 38, 39). Nor can there be any doubt that the reputed " proximate principles" are intimately incorporated in any given compound, and have no such separate existence as chemistry teaches. It lies at the very basis of chemistry, that all the elaborations are the artificial results of affinities which have been set in motion by the agents employed, and which are employed for that very purpose. This I have already endeavored to demonstrate in the Medical and Physiological Commentaries (vol. i., p. 674-682), even so far as to show that urea may not be formed by the kidneys, but is the result of spontaneous changes after the elaboration of urine, as it is of artificial influences (§ 54, a). But, attentive observation will gen- erally detect the chemist in the admission of facts which are subver- sive of his speculative doctrines (§ 18, 350); and so it is in the case before us. The admission covers the whole ground as to the preten- sions of organic chemistry beyond the most simple elementary anal- ysis. Thus, 53, c. " Were we able to produce taurine and ammonia directly out of uric acid or allantoine, this might perhaps be considered as an additional proof of the share which has been ascribed to these compounds in the production of bile. It cannot, however, be viewed as any objection to the views above developed on the subject, that with the means we possess, we have not yet succeeded in effecting these transformations out of the body. Such an objection loses all its force, when we consider that we cannot admit, as proved, the prc-ex- istence of taurine and ammonia in the bile ; nay, that it is not even probable that those compounds, which are only known to us as the products of the decomposition of the bile, exist ready formed, as ingredients of that fluid. By the action of muriatic acid on bile we in a manner, force its elements to unite in such forms as are no longer capable of change under the influence of the same re-a^ent." —Liebig's Animal Chemistry. By the admissions, also, in § 18, 42, and 350, it will be seen that the Utopian nature of organic chemistry is equally established in all its pretensions by its own founders and advocates (§ 1030). 54, a. Organic substances alone undergo fermentation and putre- faction ; and this shows us, also, in the language of Tiedemann that " even when the life of organic bodies is extinct, we should consider the qualities which they possess, from the time of death to the com- PHYSIOLOGY.--COMPOSITION. 29 plete resolution of organization, as the result of the vital powers which have been active in them." This obvious principle conducts us at once to the whole philoso- phy of those numerous transformations of which organic compounds are susceptible from chemical agencies, while they still retain their elementary combinations, and appear under uniform aspects when subjected to the same chemical influences, and often analogous to the natural condition of the compound. " It is the power of formation," says Tiedemann, " which, after the extinction of the individual life of organized bodies, renders the organic matters, separated from their organization, capable, provided they have not been reduced to their elements by external physical or chemical actions, of assuming new and more simple forms, according to the diversity of external in- fluences, such as heat, light, water, &c, which determine them in taking on this new form. This power appears, therefore, to be a prop- erty inherent in organic matters in general, rendering them able to take other more simple configurations when detached from the com- binations of living bodies " (§ 1029, 1030). Some organic compounds undergo transformations of the foregoing nature as soon as separated from the organic being. The homo- geneous blood is immediately reduced into three principal compounds, which have no natural existence as such. Nor is this all; for there is a fundamental change among the elements and the compound atoms of the entire mass. The changes arise from the loss of the vital properties, and the subsequent operation of chemical influences. Such, too, is the constitution of organic compounds, that there may be a remarkable uniformity in the resulting products when the same chemical agents operate upon any given compound; as exemplified in the various transformations to which sugar is liable, and as seen in the uniform production of morphia, narcotina, quinia, cinchonia, &c. 54, b. It is obvious, however, from the premises which I have set forth, that chemistry can, at most, present but a few compounds as appa- rently distinct from each other in their elementary composition; for, al- though there are many millions of these distinct combinations in organic beings (§ 41), they commonly possess such analogies that chemistry is obliged to confound all but a few which have strong characteris- tics. These few, which are denominated proximate principles, are supposed by the chemist to make up the entire composition of organic beings. But, a greater proportion even of these few are so inscruta- bly different from each other in their elementary combinations, that they are classed under common denominations, not only for the fore- going reason, but on account of certain resemblances in their physical properties; while it is by these last, and by their differences in re- sults as vital agents, we come to know that broad distinctions may exist among them. Such, for example, are the various acids, oils, resins, &c. 55. All organic substances, while endowed with life, resist the de- composing influences of all surrounding agents. All inorganic com- pounds yield to these influences. 56. As soon as organic beings are dead, the very agents that had contributed to their growth and nourishment, now become the causes of breaking up their elementary combinations, and with a rapidity un- known in the ordinary decomposition of mineral compounds. In the 30 INSTITUTES OF MEDICINE. former case, it is allowed by Liebig, that the " vital principle op- poses to the continual action of the atmosphere, moisture, and tem- perature, upon the organism, a resistance which is in a certain degree invincible." 57. In the seed and ovum the properties of life are in a state of ac- tion which maintains their elementary combinations against the chem- ical forces. They resist degrees of cold which operate destructively upon their composition when their life is extinct. Those agents, too, as heat and moisture, which speedily resolve the egg and seed, when deprived of life, into their ultimate elements, will in the same de- grees of intensity develop from the germ, when alive, a perfectly organized being. In the former case the operation of the principle of life is generally mistaken for " a force in a state of rest." Thus, Lie- big: " In the animal ovum, as well as in the seed of a plant, we recog- nize a certain remarkable force, the source of growth, &cc.,aforce in a state of rest."—Liebig's Animal Chemistry, first sentence. See, also, my Examination of Reviews, p. 7-28. 58. It follows, therefore, that the power which resists the decom- posing forces and agents in living beings combined the elements of such beings, and that death is an extinction of that power. The chem- ical forces can have no connection with the combinations, since they are held together by a power in direct opposition to chemical influ- ences. What, therefore, unites the elements and maintains them against the action of chemical agents, being the fundamental power, must ne- cessarily preside over all the processes and results to which organic beings are liable. 59. " The elements of dead organic matter," says Liebig, in his Or- ganic Chemistry, " seem merely to retain passively the position and condition in which they had been placed." " The atoms exist only by the vis inertia of their elements." So, also, Mulder, § 350|, m, and other chemical physiologists. This shows that the original union is effected by other powers than the chemical, which, otherwise, would still operate after death, and prevent decomposition. We also thus learn why dead organic compounds so readily undergo fermentation and putrefaction, and from the slightest influences. All of which, indeed, appears to be abundantly conceded by the chemical philoso- pher, when he yields to the force of facts. For what can be more ample than Liebig's affirmation, that " The vital force is manifested in the form of resistance, inas- much as by its presence in the living tissues, their elements acquire the power of withstanding the disturbance and change in their form and composition, which external agents tend to produce ; a power, which as chemical compounds, they do not possess."—Liebig's Animal Chem- istry. And yet again may I press into the service of truth the organic chemist, when he temporarily loses sight of the laboratory, and con- tradicts those speculations which impart to his writings the zest of novelty. In his Lectures for the winter of 1844, Liebig appears to have been alarmed for the safety of his empire, and we have here an unusual amount of " vitality." The work on Animal Chemistry applied to Pathology and Thera- PHYSIOLOGY.--COMPOSITION. 31 peutica was more of a distillation from the laboratory than its prede- cessor, Organic Chemistry applied to Physiology; and, as many of the rrost eminent physiologists in Europe, who were inclined to min- gle chemistry with vitalism, were nauseated by the dose which was last administered^ Liebig came out in his Lectures with the following placebo for the vitalists, and the chemico-vitalists. Were it not con- tradicted by the lecturer, it should place him in the very front rank of vitalism. The doctrines are of the most fundamental nature, and lie at the basis of these Institutes, and of my " Medical and Physiological Commentaries." It will be seen that they are strictly relative to my present subject, and inculcate all that the most transcendental vital- ist can desire as to the distinct nature of the vital principle, its full con- trol over the processes of life, its extinction at death, and an absolute distinction between vital and chemical processes and results, while those processes and results are, respectively, referred to forces of a totally dis- tinct nature. Thus: "After the extinction of the vital principle," says Liebig, " in or- ganic atoms, they maintain their form ahd properties, the state into which they have been brought in living organisms, only by reason of their inherent inertia. It is a great and comprehensive law of matter, that its particles possess no self-activity, no inherent power of origin- ating motion, when at rest; motion must be imparted by some exter- nal cause; and, in like manner, motion once imparted to a body can only be arrested by external resistance. " The constituents of vegetable 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 vital principle, therefore, must be a motive power, capable of imparting motion to atoms at rest, and of opposing resistance to other forces producing motion, such as the chemical force, heat, and elec- tricity. We are able to reliquefy and redissolve albumen, after it had been coagulated by heat, but the vital principle alone is capable of restoring the original order and manner of the molecular arrangement in the smallest particles of albumen. Coagulated albumen is again converted into its original form, it is transformed into flesh and blood in the animal organism. " In the formation of vegetable and animal substances, the vital principle opposes, as a force of resistance, the action of the other forces,—cohesive attraction, heat, and electricity,—forces which ren- der the aggregation of atoms into combinations of the highest order impossible, except in living organisms. " Hence it is, that when those complex combinations which consti- tute organic substances are withdrawn from the influence of the vital force,—when this no longer is opposed to the action of the other dis> turbing forces, great alterations immediately ensue in their properties, and in the arrangement of their constituents. The slightest chemical action, the mere contact of atmospheric air, suffices to cause a transpo- sition of their atoms, and to produce new arrangements ; in one word, to excite decomposition. Those remarkable phenomena take place which are designated by the terms fermentation, putrefaction, and decay ; these are the processes of decomposition, and their ulti- mate results are to reconvert the elements of organic bodies into that state in which they exist before they participate in the processes of life." 32 INSTITUTES of medicine. The reader, however, will be more astonished to learn that he has not discovered, amid the multitude of conflicting statements and doc- trines, a passage in the work on Animal Chemistry which, even more than the preceding, identifies " the Reformer" with the most exclu- sive vitalists, and completely annuls all his chemical and physical speculations as to organic life, and his radical distinctions between plants and animals (§ 350, nos. 7, 12, 15). It will be also seen with what pretense he has been denominated " the Reformer," and " the author of a new and the greatest era in physiology." The extract in- culcates the doctrines of an independent vital principle, its identity in plants and animals, the action of stimuli upon that principle, its susceptibility of influences from the nervous power in animals, the absence of that influence in plants, and the dependence of all organic processes and results, equally in plants and animals, upon that prin- ciple. Now these are exactly the doctrines which are also fundamental throughout the Medical and Physiological Commentaries and these Institutes. They are relative to the constitution and processes of organic beings as a whole, while the foregoing quotations from Lie- big's Lectures comprehend the principles by which I have interpret- ed the elementary condition of organic bodies. Thus our author: " The activity of vegetative life manifests itself,in vegetables, with the aid of external influences ; in animals, by means of influences jwo- duced within the organism. Digestion, circulation, secretion, are, no doubt, under the influence of the nervous system; but the force which gives to the germ, the leaf, and the radical fibres of the vegetable the same wonderful properties, is the same as that residing in the se- creting membranes and glands of animals, and which enables every animal organ to perform its own proper functions."—Liebig's Ani- mal Chemistry. 60. " The diversity of the transformations and of the resulting products," says an able advocate of Liebig's physical doctrines of life, " indicate most certainly the complexity of an organic product" (§ 41). " The metamorphoses which occur after organic substances are removed from the influence of the vital force, constitute a separa- tion, or splitting up into new and less complex compounds" (§ 54).— Mr. Ancell, in London Lancet, Nov. 26, 1842. Thus, again and again, does the chemical physiologist unavoidably concede that the elements of organic beings are held together by a vital principle, and, therefore, that they are originally united by that principle. Vitalism becomes established in all its aspects, even in what has been denominated "transcendental vitalism," when it may be shown that the elements of organic beings are, in the language of Liebig, '•united by a peculiar mode of attraction, resulting from the existence of a pofiver distinct from all other powers of nature, namely, a Vital Principle;" since, as I have said, the powers and laws which regu- late the composition must be at the foundation of all the subsequent :esults. Concessions of fundamental principles overthrow all spuri- ous " facts," and all secondary- doctrines of a conflicting nature. These, therefore, may be advantageously connected with demonstra- tions of the truth. There are few intelligent minds that do not right- ly appreciate those grand phenomena of Nature which conduct us to PHYSIOLOGY.--COMPOSITION. 33 a knowledge of her fundamental laws, or do not incidentally betray their conviction of the right, however the enticements of fame may beguile them into ingenious substitutions. I shall, therefore, as on all former occasions, continue to bring to the aid of my conclusions the powerful concessions of the most eminent men who belong to the adverse schools in organic philosophy. It is manifest that such au- thorities must weigh with the force of demonstration, since it is obvi- ous that their admissions can only flow from convictions that have been obtained in the school of Nature. Among the most illustrious of the adverse school is Liebig, and standing intermediate is the pro- found and erudite Muller. And having thus referred again to this great philosopher, I will not lose the opportunity of obtaining from him an important contribution to the doctrines of vitalism as they re- late to the very composition of organic beings, and in which he insti- tutes a broad contrast between the affinities which unite the elements of organic and inorganic compounds. Thus : " Chemical substances," says Muller, " are regulated by the intrin- sic properties and the elective affinity of the substances uniting to form them. In organic bodies, on the contrary, the power which in duces, and maintains, the combination of their elements, does not consist in the intrinsic properties of those elements, but in something else, which not only counteracts those affinities, but effects combina- tions in direct opposition to them, and conformably to the laws of its own operation."—Muller, Elements of Physiology, p. 4. Liebig, also, variously inculcates the same great principle. Take, in the first place, a demonstration the converse of Midler's. It is the last paragraph in the work on Organic Chemistry. Thus: " The same numerous causes which are opposed to the formation of complex organic molecules, under ordinary circumstances, occasion their decomposition and transformations when the only antagonist POWER, THE VITAL PRINCIPLE, NO LONGER COUNTERACTS THE INFLU- ENCE of these causes. New compounds are formed in which chem- ical affinity has the ascendency, and opposes any farther change, while the conditions under which these compounds were formed re main unaltered." Again, we are informed by this chemist, that " The equilibrium in the chemical attractions of the constituents of food is disturbed by the vital principle, as we know it may be by many other causes. But the union of the elements, so as to produce new combinations and forms, indicates the presence of a peculiar MODE OF ATTRACTION AND THE EXISTENCE OF A POWER DISTINCT FROM ALL OTHER POWERS OF NATURE, namely, the VITAL PRINCIPLE." " If the food possessed life, not merely the chemical forces, but this vi- tality would offer resistance to the vital force of the organism it nourished." " The individual organs, such as the stomach, cause all the organic substances conveyed to them, which are capable of transfor- mation, to assume new forms. The stomach compels the elements of these substances to unite* into a compound fluid for the formation of blood."—Liebig's Organic Chemistry, p. 356, 357, 346, 384. 61. It is a remarkable characteristic of organic beings that they aie composed chiefly of combustible substances, properly so called, and a supporter of combustion ; with the principal exception of that anom- aly in the inorganic kingdom, nitrogen gas (§ 37). 34 INSTITUTES OF MEDICINE. 62, a. The general introduction of nitrogen gas into the constitution of animal compounds, and into many of a vegetable nature, while it is excluded from mineral compounds, is one of the most striking distinc- tions between the two kingdoms of Nature. Upon that distinction I have founded an argument, in my Essay on the " Philosophy of Vital- ity," in proof of the difference in the powers and laws by which the two kingdoms are governed. It appears also appropriate to this work that the proof should be here introduced. 62, b. I have said in the foregoing Essay, that it is abundantly ev- ident that living beings are endowed with properties which protect their elementary composition against all those decomposing agencies which are perpetually separating the elements of all mineral com- pounds. This shows that the properties, by which the elements of living beings are united, are utterly different from such as combine the elements of inorganic compounds. Nevertheless, the living or- ganization is undergoing a systematic change, a perpetual decomposi- tion, surpassing any mutations that are in progress in the surrounding world. These decompositions are, also, of a peculiar nature, govern- ed by established laws, various in different parts of the same individ- ual, yet forever the same in any given part (§ 44). I shall not stop to show how the old are replaced by new materials, and how the pro- cesses go on pari passu, and in opposition to all the philosophy which chemistry teaches, but only say that the decompositions must be effect- ed by properties as peculiar to the living compound as are the results; and that these results conspire with the peculiar modes in which the elements are combined in proving the existence of specific properties, which are the common cause of all the harmonious phenomena of liv- ing beings (§ 38-42). 62, c. When, however, the organic being dies, a new order of de- composition begins, eminently of a chemical nature, and in forcible contrast with that which concerns the vital process of renewal. This is due to the special element, nitrogen gas, which may be called the principle of dissolution. Wherever present, it gives rise to transfor- mations and disunion of all the other elements after the properties of life have lost their sway. The moment these cease, chemical decom- position begins,—confusedly, violently; and such are the nature and combinations of the elements, that their disruption would go on with no other contribution from surrounding agents than water alone. Hence the more rapid transformations and dissolution of animal than of vegetable tissues, and of sap and other substances which are gen- erated by vegetable organization. 62, d. Liebig says of nitrogen gas, that "there is some peculiarity in its nature, which gives its compounds the power to decompose sponta- neously with so much facility. Now, nitrogen is known to be the most indifferent of all the elements. It evinces no particular attrac- tion to any one of the simple bodies, and this character it preserves in all its combinations ; a character which explains the cause of its easy separation from the matter with which it ,is united." And again, " When those substances are examined which are most prone to fer- mentation and putrefaction, it is found that they are all, without ex- ception, bodies which contain nitrogen."—Liebig's Organic Chemistry applied, &c., p. 241. 62, e. In the inorganic kingdom, nitrogen is mostly confined to the PHYSIOLOGY.--COMPOSITION. 35 atmosphere, where it probably exists in a state of simple intermixture with oxygen. " All bodies which have an affinity for oxygen abstract it from the atmosphere with as much facility as if the nitrogen were absent altogether ;" and we have striking examples of the disposition of nitrogen to separate from its compounds, " in the easy transposi- tion of atoms in the fulminating silvers, in fulminating mercury, and in all fulminating substances," whose ready explosion is owing to the presence of nitrogen. " All other substances," says Liebig, " con- taining nitrogen acquire the same power of decomposition when the elements of water are brought into play." 62, f. Now the foregoing characters belong to nitrogen only as it exists in inorganic or in dead organic compounds, while the former, also, are artificial, or due to accidental causes. In living beings, where it abounds,* it adheres to its associated elements with a tena- city which no agent can impair till it destroys the life of the part; or, in other words, till it destroys those vital properties by which the ele- ments were truly united. It is then, however, that the forces of chem- istry take possession, and the elements may explode, I had almost said, with the facility of the fulminating compounds. 62, g. " There is," says Liebig, " in the nature and constitution of the (inanimate) compounds of nitrogen, a kind of tension of their component parts, and a strong disposition to yield to transformations, which effect spontaneously the transposition of their atoms on the in- stant that water or its elements are brought in contact with them." On the contrary, " it is found that no body destitute of nitrogen pos- sesses, when pure, the property of decomposing spontaneously while in contact with water."—Liebig. But, although dead animal compounds readily pass into sponta- neous decomposition under slight degrees of moisture, yet, composed as they are, in part, of the elements of water, and very largely im- pregnated with aqueous substances in their living state, neither those elements, this water, nor any other agent, can disturb the exact com- binations. ^ But, when the organic being dies, chemical agencies have their play, and it is then that " The result of the known transformations of substances containing nitrogen proves," according to Liebig, " that the water does not mere- ly act as a medium in which motion is permitted to the elements in the act of transposition, but that its influence depends on chemical affinity. When the decomposition of such substances is effected with the assistance of water, the nitrogen is invariably liberated in the form of ammonia."—Liebig. In respect to the inorganic world, had nitrogen been incorporated in its compounds, there would have been no stability among them. They would have been perpetually undergoing decomposition, until finally the whole of the nitrogen would fly off by itself, and nothing of the original compound would remain; and it could never be re- combined. 62, h. Besides the disposition of nitrogen to tear asunder the ele- * Nitrogen is well known to abound in all the tissues of animals. Of vegetables, Lie- big says, that, " Estimated by its proportional weight, nitrogen forms only a very small part of plants, but it is never entirely absent from any part of them. Even when it does not enter into the composition of a particular part or organ, it is always to be found in the- Quids which pervade it."—Liebig's Organic Chemistry applied to Physiology, &c, p. 4. 36 INSTITUTES of medicine. ments with which it may be combined, the complexity of these ele ments in organic beings contributes to the disorganizing results after death, and is another principal cause of spontaneous fermentation and putrefaction (§ 38, 41, 46, 48, 52, 53). 62, i. From the foregoing facts, especially from the universality and fixedness of nitrogen in organic beings, I arrive at the conclusion that the elements of their compounds are united by forces as peculiar as the facts which relate to these compounds, and that the forces of chemistry have no agency in combining the elements, or in effecting changes of their combinations ^during life. It is also abundantly man- ifest from my premises, that Liebig's declaration that " by chemical agency we can produce the constituents of muscular fibre, skin, and hair," is without the slightest foundation (§ 12, 13, 14). 62, k. The whole labyrinth of combinations in organic beings, and their ultimate return to binary compounds, are full of the most stu- pendous design. The final cause of the reduction of the organic being, when its own specific purposes are ended, is that of again supplying the means of growth to vegetables yet alive, that the elements may be again elaborated into ternary and quaternary compounds, to carry out the final purpose of the vegetable kingdom in supplying nutriment to animals (§ 303). 63. In the Essay to which I have referred in the last section, I have endeavored to deduce the principles of vitalism from the phenomena that attend the development of the incubated egg, as had been briefly set forth in my " Examination of Reviews." The considerations there made are peculiarly appropriate to the present work, and to the place at which I have now arrived. It was my object to consider, 1st. The constitutional nature of the ovum. 2d. To show by the philosophy of generation, and by the nature of the powers which are universally admitted to be alone concerned in developing the germ or ovum, and in forming the organs of the new being, that the same powers are, also, alone concerned in carrying on forever afterward the processes of life, and, of course, that no new powers, or principles, are introduced. 3d. To consider the manner in which the germ is impregnated, or its vital properties so stimulated into action as to result in the devel- opment of the germ, and in unfolding the various attributes of the new being. 4th. To show that we may find in the physiology of generation, or the principles through which the ovum is impregnated, the whole phi- losophy of organic life, or the principles through which the actions of life are forever carried on. 5th. To state the manner in which the natural peculiarities of each parent, whether as it respects the properties of life, or the physical conformation, are infused into the germ and combined in the full- grown offspring. 6th. To show that hereditary diseases are transmitted in the same way as those more natural peculiarities which belong to parents. 7th. To show, also, that the principles which are concerned in the transmission of hereditary diseases are the same as concur in the pro- duction of ordinary diseases. 8th. To deduce from the philosophy of generation the vital nature of hereditary diseases ; or, in other words, to show that the morbid PHYSIOLOGY.--COMPOSITION. 37 impression is established upon the vital properties of the ovum, and, of course, upon those of the new being ; and that the hereditary vitia- tion does not consist in any transmitted impurity to the blood or other fluids of the offspring, as is now supposed by the humoralists. If the foregoing propositions be true in relation to man, they will, of course, be equally so of animals, and of the whole vegetable king- dom (§ 169/, 1051,1052). 64, a. If it be universally conceded, as a matter of course, that not only the elementary constitution of the ovum, but its whole develop- ment, depends entirely upon a vital principle or vital properties, it will follow that the same principle or properties are forever afterward concerned in organic processes, and alone concerned. Let us hear, in the first place, the most eminent in the school of vitalism, but who are inclined to lean upon chemistry after the full development of the ovum. 64, b. It is said, for example, by Tiedemann, " That it is the vital power, which in the fecundated germinative liquid, brings the molecules of the organic combinations to the solid form, and calls the first lineaments of the vegetable and animal em- bryo into existence. All the parts and tissues that are formed in it, according to a definite order of succession, are products of the power of formation, and on this they depend in all that relates to their first appearance, their development, aggregation, configuration, and ar- rangement. The phenomena exhibited in the act of formation of an embryo, are placedyar above all the mechanical and chemical acts we observe in bodies not endowed with life."—Tiedemann, Comparative Physiology. 64, c. By the illustrious Muller, it is said, " The creative force exists already in the germ, and creates in it the essential parts of the future animal. The germ is potentially the whole animal. During the development of the germ, the essential parts which constitute the actual whole are produced." " The en- tire vital principle of the egg resides in the germinal disk alone; and since the external influences which act on the germs of the most different organic beings are the same, we must regard the simple germinal disk as the potential whole of the future animal, endowed with the essential and specific force or principle of the fu- ture being, and capable of increasing the very small amount of this specific force and matter which it already possesses, by the assimila- tion of new matter." And again he says, " This force exists before the harmonizing parts, which are, in fact, formed by it during the development of the embryo." " The vital force inherent in organic beings itself generates the essential organs which constitute the whole being." " The formative or organizing principle is a creative pow- er, modifying matter blindly and unconsciously ;" yet with such won- derful precision that Muller also says, that " this rational creative force is exerted in every animal strictly in accordance with what the nature of each requires." " The vital principle," he says, " is in a quiescent state in the egg before incubation."—Muller, Elements of Physiology. 64, d. Passing from the chemico-physiological school to that of pure chemistry, we shall find the same admissions as to the exclusive agency of a vital principle i^i the formation and development of the 38 institutes of medicine. seed and ovum. The extraordinary contradictions, which will aston- ish the reader, necessarily abound in all authors who are employed in identifying two subjects that have no relation to each other. 64, e. Take Liebig, as a first example; and take, in the first place, his chemical doctrine of life. " In the animal body," he says, " we recognize, as the ultimate cause of all force, only one cause, the chemical action which the ele- ments of the food and the oxygen of the air mutually exercise on each other. The only known ultimate cause of vital force, either in ani- mals or in plants, is a chemical process. If this be prevented, the phenomena of life do not manifest themselves. If the chemical action be impeded, the vital phenomena must take new forms." And yet only a few sections before, and in the very first sentence of Liebig's work on " Animal Chemistry applied to Physiology and Pathology," we read, " In the animal ovum, as well as in the seed of a plant, we recog- nize a certain remarkable force, the source of 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 action of external influences, by impregnation, by the presence of air and moisture, the condition of static equilibrium of this force is disturbed. Entering into a state of motion or activity, it exhibits itself in the production of a scries of forms, &c. This force is called the vital force, vis vita, or vitality" —Liebig's Animal Chemistry. Turning back to the same author's work on " Organic Chemistry applied to Physiology," we not only meet with a similar contradiction of his grand doctrine of the entire dependence of life upon chemical processes (and as we had before seen in respect to digestion, section 60), but with that which is particularly apposite to my present inquiry. " Our notion of life," says Liebig, " involves something more than mere reproduction, namely, the idea of an active power exercised by virtue of a definite form, and production and generation in a definite form (§ 59). The production of organs, the co-operation of a system of organs, and their power not only to produce their component parts from the food presented to them, but to generate themselves in their original form and with their properties, are characters belonging ex- clusively to organic life, and constitute a form of reproduction inde- pendent of chemical powers. The chemical forces are subject to the invisible cause by which this form is produced. This vital principle is only known to us through the peculiar form of its instru- ments ; that is, through the organs in which it resides. Its laws must be investigated just as we investigate those of the other pow- ers WHICH EFFECT MOTION AND CHANGES IN MATTER."--LlEBlG's Or- ganic Chemistry, &c, p. 355. 64, f. Roget, of high authority, maintains that, " However the laws which regulate the vital phenomena may ap- pear, on a superficial view, to differ from those by which the physical changes taking place in inorganic matter are governed, still there is really no essential difference between them." " It may, in like man- ner, be contended, that the affinities which hold together the elements of living bodies, and which govern the elaboration of organic products, are the same with those which preside over inorganized compounds." * See my Examination of Reviews p. 7-28. PHYSIOLOGY.--COMPOSITION. 39 " Hence it becomes every day more and more probable that the forces immediately concerned in the production of chemical changes in the body, are the same as those which are in constant operation in the inorganic world; and that we are not warranted in the assertion that the operations of vital chemistry are directed by distinct laws, and are the results of new agencies." " However natural it may be to conceive the existence of a single and presiding principle of vitality, we should recollect that this, in the present state of our knowledge, is only a fiction of the mind, not WARRANTED BY THE PHENOMENA THEMSELVES."--RoGET's Outlines of Physiology. Let us now hear this able writer on the suject of foetal development. " A portion of the vital power of the parent," he says, " is for this purpose employed to give origin and birth to the offspring. The ut- most solicitude has been shown in every part of living nature to se- cure the perpetuity of the race, by the establishment of laws, of which the operation is certain in all contingent circumstances." Roget ultimately describes, in his usual felicitous manner, the de- velopment of the ovum; and here we have nothing from our author but the agency of the vital powers. " The foundations of the edifice," he says, " are laid in the homo- geneous jelly by the efforts of the vital powers." " At first, all the energies of vitality are directed to the raising of the fabric, and to the extension of those organs, which are of greatest immediate util- ity; but still having a prospective view to farther and more impor- tant ends,"—and so on throughout the chapter; the whole work of developing and fashioning the fcetal organs being assigned, exclu- sively, to " the efforts of the vital powers," and to the " energies of vi- tality."— Roget's Animal and Vegetable Physiology, Bridgewater Treatise. 64, g. Finally, let us hear, also, Dr. Carpenter, who advocates the chemical doctrines of life so far as to lay down the following princi- ple no less than twice within six pages, and in nearly the same words. Thus: " Reason," he says, " has been already given for the belief that the affinities which hold together the elementary particles of organized structures are not different from those concerned in the inorganic world; and it has been shown that the tendency to decomposition AFTER DEATH BEARS A VERY CLOSE relation with THE ACTIVITY OF THE CHANGES WHICH TAKE PLACE IN THE PART DURING LIFE."--CARPEN- ter's Principles of General and Comparative Physiology, p. 140; also, p. 146. Now the authority of such a writer, and a prominent leader in the purely chemical school of physiology, must be allowed to be impor- tant when any unavoidable concession is made to vitalism. Let us then hear him in the matter of the ovum: "Organization, and vital properties," he says, " are simultaneously communicated to the germ by the structures of its parent. Those vital properties confer upon it the means of itself assimilating, and thereby organizing and endowing with vitality the materials supplied by the inorganic world."—Carpenter's Principles, &c, p. 138. And again, this mere chemist, in his general views of the philosophy of life, observes, that 40 institutes of medicine. " The agency of vitality, as Dr. Prout justly remarks, does not change the properties of the elements, but simply combines them [the elements] in modes which we cannot imitate."—Carpenter s Principles, &c, p. 146. 64, h. Dr. Prichard is strictly of Dr. Carpenter's school (see my " Examination," &c, p. 37), between whom there is a point of agree- ment which is worth noticing in its connection with the subject now before us, and to which I have referred in a former work, in its rela- tion to Dr. Carpenter. Both of these writers see so much of peculiar design in organic nature, and find it so impossible to interpret the phenomena of organic beings upon the chemical and physical princi- ples which they have so strenuously set forth, and in their aversion to any other principles, and to the obvious rule of analogy as to second causes, that, in the end, they assign the functions and phenomena of life to the immediate action of the Deity. " The theory of a vital principle," says Dr. Prichard, " has been applied in a different manner, to account for the phenomena displayed at the beginning of life in animals and vegetables, and to get rid of the mystery which attends the gradual evolution of organic structure from ova and germs. Here the vital principle is no longer considered a chemical agent, but assumes the character of a plastic and formative power," &c. Now Dr. Prichard " cuts the knot" and " gets rid of the mystery' after the following manner : " We may," he says, " if we choose to do so, term the cause which governs the organization and vital existence a plastic principle; but it is a principle endowed with intelligence and design [! ] It is, in fact, nothing more than the Energy of the Deity." " The devel- opment of forms, according to their generic, specific, and individual diversities, not less in the vegetable than in the animal world, can only be accounted for by ascribing it to the universal energy and wisdom of the Creator."—Prichard's Review of the Doctrine of a Vital Principle. See, also, Paine's Commentaries, vol. i., p. 10, 25; and his Examination of Reviews, p. 37, 41, 43, 44. This is a far greater admission than the vitalist can desire; since, if the development and growth of the germ depend immediately upon Almighty Power, so must all the analogous processes of the living being at all stages of its existence, and science would be merged in the direct manifestations of that Power. But, while this doctrine is utterly exclusive of all the assumed chemical agencies at all periods of life, and overlooks the analogy between the development of the germ and the subsequent processes, there can be no hesitation as to the disposition which should be made of it, without any reference to its prevaricating nature (§ 179 d, 699 c, 740). 65. Having now before us a plain statement of our necessary prem- ises as they respect the exclusive agency of the " vital principle," or "organic force," or "creative power," or "vital properties," or "vital powers," or "vitality" (whichever term may be preferred), in carrying out the full development of the embryo, it may be interesting to know the details of that development and growth, which is thus allowed, on all hands, to be conducted by powers utterly distinct from the chemical and physical, and in which these have no agency. " The development of the separate parts," says Muller, " out ot physiology.--COMPOSITION. 41 the simple mass, is observable in the incubated egg. All the parts of the egg, except the germinal membrane, are destined for the nu- trition of the germ. The simple germinal disk is the potential whole of the future animal, endowed with the essential and specific force, or principle of the future being, and this germ expands to form the germinal membrane, which grows so as to surround the yolk; and by transformation of this germ, the organs of the future animal are pro- duced. The rudiments merely of the nervous and vascular systems, and of the intestinal canal, are first formed ; and from these rudi- ments the details of the organization are afterward more fully devel- oped ; so that the first trace of the central parts of the nervous sys- tem must be regarded neither as brain nor as spinal marrow, but as still the potential whole of the central parts of the nervous system. In the same manner, the different parts of the heart are seen to be developed from a uniform tube; and the first trace of the intestinal tube is more than the mere intestinal tube; it is the potential whole, —the representative of the entire digestive apparatus; for, as Baer first discovered, liver, salivary glands, and pancreas, are, in the far- ther progress of the vegetative process, really developed from that which appears to be merely the rudiment of the intestinal canal. It can be no longer doubted that the germ is not the miniature of the future being, with all its' organs, as Bonnet and Haller believed, but is merely potentially this being, with the specific vital force of which it is endowed, and which it becomes actually by develop- ment, and by the production of the organs essential to the active state of the actual being. A high magnifying power is not necessary to distinguish the first rudiments of the separate organs, which, from their first appearance, are distinct and very large, but simple. So that the later complicated state of a particular organ can be seen to arise by transformation from its simple rudiment. These remarks are now no longer mere opinions, but facts; and nothing is more dis- tinct than the development of glands from the intestinal tube, and of the intestinal tube itself from a portion of the germinal membrane." —Muller, ibid—(§ 1051, 1052). Such, then, is the history of the development of the germ in birds, and in all the higher animals; and the whole work is ascribed by physiologists of every denomination exclusively to principles un- known in the inorganic world, and wholly distinct from any of a chemical nature. They are called, indiscriminately, vital properties, vital powers, vital principle, organic force, creative force, &c, to distin- guish the principle, or properties, from every thing that has any known existence in inorganic substances, or as the source of any in- organic results. But, physiologists of the chemical school stop here, and ascribe all organic compounds after the being is fully formed to chemical agencies. It is remarkable, however, that it has not occur- red to these philosophers, that precisely the same elementary combi- nations, the same formation into tissues, and the same secretions, take place at all stages of the rudimentary development as at all future periods of life, and that the rudimentary development consists in these formations of simple compounds and their union into tissues; and if the early or rudimentary growth of the being, all its secreted products, all its elementary combinations, be determined by the vital properties, so are the same results determined by the same properties 42 institutes of medicine. or powers forever afterward. To call in the agency of chemical ot physical forces, to accomplish precisely the same results at any future stage of the organic being as are admitted to be performed in the de- velopment of the "essential parts" of that being by the "vital prin- ciple" or "vital properties" alone, is not only a violation of the plain- est rule in philosophy, but of the clearest facts (§ 41, 42, 55-58). 66. We have thus before us a peculiar order of powers by which the organic being is developed, fashioned, and forever exclusively governed. It is these powers about which physiology, pathology, and therapeutics, are essentially concerned. We may, therefore, seek in the composition of organic beings, and in the laws of their development,^/br the whole rudimentary principles of medicine. The vital principle has also the extraordinary task of laying out, in the ovum, the whole organization of the future being; so that its subse- quent labor must be-comparatively simple, and it is then, least of all, that it can require any help from the forces of the inorganic king- dom, or that it would permit a violation of the great principle in na- ture, of avoiding an unnecessary multiplication of causes. 67. It may be farther shown, by the incipient development of the ovum, that the vital powers, or properties, are more concerned in the growth, nutrition, and all the subsequent physical results, throughout the whole existence of the being, than is generally supposed by even the exclusive vitalists. The usual supposition is that the vessels or instruments of action, which are moved by the vital powers, perform the work of decomposing the blood and other parts, and recombining them again in other proportions and forms, according to the particu lar organization of parts, and the modification of their vital states, It has been the doctrine of all physiologists of the present day, that the ovum, in its germinating part, is a mere organic fluid, destitute of vessels, and all other parts of the future apparatus. Very lately, however, it has been asserted, on the authority of the microscope, that the rudiment of a cell has been discovered; and what is thought by some to render this probable was the simultaneous discovery of the hypothetical spermatozoa, the ancient homunculus, within the ovum after copulation. Whether, however, such a rudiment has been detected, or whether the doctrine of the " homunculus" is destined for a temporary revi- val, there can be no doubt that the first " assimilation of new matter" must take place without the agency of vessels, or of any parts which are subsequently formed ; and, therefore, the same powers which converted the fluid germ into vessels, nerves, &c, continue to make the same conversion out of blood; and as all this was originally done without the aid of vessels, so must the same powers be forever car- ried on with their subsidiary agency only. Nothing in mathematics can be more certain, and nothing, therefore, more incontrovertible. We see, therefore, that Muller, reasoning upon other grounds, may not have been altogether hypothetical in his inference that the " vital principle exerts its influence even beyond the surface of an organ, as shown by its effects on the chyle, in maintaining the fluidity of the blood," &c. By the same rule, it may be at once shown that the only ingenious chemical hypothesis ever invented to interpret organic results,__the catalytic,—is purely an assumption; since this hypothesis is pr'edica- PHYSIOLOGY.--COMPOSITION. 43 ted of the blood-vessels. But, if there be no vessels in the germ, the first vessels must, of course, be produced without the supposed chem- ical influence of vessels, and, by my showing, therefore, as to the subsequent formation of vessels and other parts, the supposed agency of the catalytic forces is a mere assumption (§ 41, 42; also, Medical and Physiological Commentaries, vol. i., p. 74-76). On this subject, too, chemistry must abide by admissions which are made in the very face of consistency; so imperative is fact, and so imbecile is hypothesis. Thus, it is said by the distinguished chemico- physiologist, Dr. Prout, that " The most determined sceptic cannot assert that there is any ne- cessary relation, or, indeed, any relation whatever, between the mechanical arrangements and the chemical properties to which they administer. There is no reason why the chemical changes of or- ganization should result from the mechanical arrangements by which they are accomplished [! ]; neither is there the slightest reason why the mechanical arrangements, in the formation of organized be- ings, should lead to the chemical changes of which they are the instru- ments" !—Dr. Prout's Bridgewater Treatise.—Such is the proof which chemistry offers. 68. The question then arises as to what is the particular office of those vessels where the elementary combinations and decompositions take place? Simply this: to convey, and eliminate through the agen- cies of the vital properties, those parts from the blood out of which the vital properties effect the new elementary combinations, whether solid or fluid,—to aid in arranging the new molecules, and to carry forward those fluid products which may be destined for other ends. 69. But, have not the nerves an indispensable agency in effecting the elementary combinations and decompositions 1 Certainly not, for the reasons stated in relation to the blood-vessels (§ 67, 68); and this induction concurs with all other facts, and overthrows the hy- pothesis that the nerves are conductors of galvanism, and, therefore, the supposed agency of this fluid in the processes of life. 70. But, all the vessels, and all the solid parts of the organism, have their various specific offices. Here, in every part, reside the vital properties, which had been fully developed in the ovum, and here are they modified according to the exact nature of the organization and the peculiar final causes of "the properties of the vital principle" in each part. Hence they manifest peculiarities in parts that are nearly analogous. The modifications vary, for instance, in the serous membranes, and more remarkably in the mucous, as known by the influence of foreign agents, their phenomena, their products, &c. The vital properties differ in different parts of one and the same con- tinuous tissue, as in the mucous tissue of the nose, lungs, stomach, &c. Hence one of the important objects of studying the structure of organs, and the nature of their tissues ; for, as the vital properties are naturally modified in different parts, so will their alterations in the same disease be different in different tissues of one organ, and, for the same reason, even of different parts of one continuous tissue. These natural modifications of the vital properties in different parts have, at least, three great final causes. The first is what I have al- ready stated, namely, to separate from the blood, through the agency of the capillary vessels, that exact part which is to be decompounded 44 institutes of medicine. at any given point; the second is, by these modifications, to enable " the properties of the vital principle" to decompound and recombine the elements according to the exact nature of the combinations which belong to the part; and the third, to qualify the properties, through the medium of the capillary vessels, to shape and unite the new mole- cules to the old. It is easy to apply this principle, under its different aspects, to all other vessels, as the veins, the secretory and excretory vessels of the glands, and the absorbents. 71. Now, at the first start of the development of the germ, " the properties of the vital principle" (as they are well designated by Mul- ler) are but very imperfectly, if at all, aided by any of the foregoing physical means, though they come into operation at the moment they are successively produced. " The properties of the vital principle," therefore, must exist in that organic fluid, in a modification, and with a formative energy which they do not possess in any of the new de- velopments ; and herein it will have been seen that the very chemist has come to this conclusion (§ 64 f, 190 b). 72. The process of generation presents a varied and most impres- sive illustration of the peculiarities of the vital properties, and of the manner in which they are liable to be impressed and permanently modified in their nature. It results in the production of organic be- ings similar to those which exercise the generative faculty. This fac- ulty is therefore manifested with as many specific modifications as there are different species of organic beings. If we allow to the globe one million of distinct species of animals, the specific modifications of the germinal product will be as numerous, and these are more or less influenced by the semen of the male. The seminal or productive principle of the male exerts its special influences upon the living prop- erties of the germ, and according to the special constitution of the ovum, directs their operation in such a manner that none but beings of the same kind with the parents, where both are of the same species, are produced. That the various modifications which distinguish each species are determined by both parents, is fully demonstrated in hybrid animals, and is sufficiently obvious in the transmission of the peculiar- ities of the male or female, where the individuals are of the same spe- cies. And, notwithstanding our supposed million of distinct species of animals, and the specific variations in all the parts of each species (§ 41), this almost endless variety is made up by successive deposi- tions of elementary compounds out of mainly four simple substances (§ 37, 42, 46), three of which are gaseous, united in modes unknown to chemistry (38-40, 48), and which chemistry cannot detect, and for- ever uniting in different modes and proportions according to the ex- act nature of every part (§ 43, 44). The act of generation establishes the essential modifications which are to be continued, without varia- tion, throughout the life of the new being; and this new individual, be- coming in its turn the agent of procreation, perpetuates all the specif- ic modifications which appertain to itself and to its ancestors. The intermingling of species, which results in hybrid animals, proceeds upon the same plan. It must therefore necessarily be, that the vital properties of the ovum are so impressed by the exciting influences of the semen, that those peculiar elementary combinations and aggrega- tions are started which ultimately make up the hybrid. " These vital properties," says Dr. Carpenter, " confer upon it the means of itself PHYSIOLOGY.--COMPOSITION. 45 assimilating, and thereby organizing, and endowing with vitality, the materials of the inorganic world ;" leaving it, also, clear to all minds that the action of the semen must be exerted directly upon the vita) properties of the ovum (§ 189). That this important question as to the direct action of the semen upon the vital properties of the ovum, and its capability of establish- ing certain modifications of these properties, and that the humoral in- terpretation of transmitted peculiarities is an unfounded assumption, may be definitively settled, I will also add, " The well-known fact, that when the Earl of Morton's Arabian mare was covered by the quogga, not only did the mule so begotten partake of the character of the sire, but when the mare was subsequently sub- mitted to an Arabian stallion, by whom she had three foals at differ- ent times, the first two continued to exhibit some of the distinctive peculiarities of the quogga conjoined with the characters of the Ara- bian breed."—Montgomery, on the Signs and Symptoms of Pregnan- cy, p. 17. The author of the foregoing statement supposes that the semen " may influence several ova, and so continue to manifest its effect in tire offspring of subsequent conceptions when impregnation has been effected" by males of another species. The reader will also not fail to remark that the history of this case is in direct conflict with the late attempts to revive the old doctrine of referring the germ to the male parent (§ 67, 1051, 1052, 1078). 73, a. The semen, then, is a vital stimulus, and so far on a par with the ordinary stimuli of life. These may be natural, like air, food, heat, &c.; or they may be morbific, like malaria, poisons, &c.; or cu- rative, like medicines. In all the cases, their action is upon the vital properties ; and it is in consequence of these influences, that the ovum is developed, that life is maintained, health preserved or impaired, or disease removed. The ova of oviparous animals show the analogy in respect to stimuli, and the principles involved, more impressively than those of viviparous ; since by an admirable design, in respect to the former, the impression of the semen has a limited operation, when the vital properties of the ovum return to their quiescent state, but may be again roused into action by the simple stimulus of heat. (See Med. and Phys. Comm., vol. i., p. 21, &c.) 73, b. The action of the semen upon the properties of the vital prin- ciple of the germ is a type of all the influences that are produced upon the same vital properties during the life of the animal, and from which all its organic actions, and all their results, arise. And so of the ger- mination and growth of plants; which, by-the-way, evinces the com- mon nature of the principle of life, and of organic actions, in the two departments of the animated kingdom (§ 188|, d). It is the whole es- sential philosophy of physiology. It is the alterations produced in the vital properties which constitutes the philosophy of disease, and in which, indeed, all disease virtually consists. It is the art of finding out the remote causes, and the nature of the alterations they produce, and of adapting to the altered condition of the properties of life such agents as shall establish new impressions upon them, and thus enablu them to return to their natural state, which forms the basis of thera peutics in its connection with pathology. 74. a. Here I shall digress for a moment, to consider certain anal 46 INSTITUTES of MEDICINE. ogies in the development of special organs, through the influence of specific stimuli, with that general evolution of the organic fabric which is started by the action of the seminal principle upon the germ. These analogies are to be found in the organs of animal life. The senses, for example, sometimes manifestly require for their full de- velopment the prolonged operation of the stimuli which are natural to each. This is habitually observed in the young of some animals, and is seen conspicuously in the subterranean fish of Kentucky. In this last instance organic life is perfectly developed ; but, owing to the exclusion of the natural stimulus of the eye from the very outset of life, that organ remains in its rudimentary state. A fortiori, therefore, the reputedly first inhabitants of this globe, such as the trilobite, attest the existence of the same light at their crea- tion as is enjoyed at the present day; geologists to the contrary not- withstanding (§ 1079, b). Superficial observers of nature, either through inattention to the moral consequences, or through infidelity, are apt to believe that phys- ical agents are the real creative forces of organic beings, from ob- serving that particular parts are clearly dependent for their develop- ment upon the action of certain specific stimuli. But, in all these cases, the rudiment is there, and has been perpetuated ever since the original species came from the Hand of Creative Power. That Power is en- titled to all the praise, as the Author of the rudiment, of its endow- ment with peculiarly modified properties of life, of the existence of the physical agents, and of the mutual adaptation of these modified properties of the rudiment and the virtues of the physical causes, so that the operation of the latter upon the former shall result, for exam- ple, in vision, and, under certain circumstances, as when the ovum is developed and matured out of the body, the physical agent, in the ex- ample supposed, shall be necessary to the development of the rudi- mentary organ of sight (§ 350|, 7^-350^, 1). The principle is much the same as that which applies to the necessity of external heat and light to the development and growth of plants. The specific stimu- lus of light by which the vital properties and actions of the leaf are enabled to decompound carbonic acid, and to assimilate the carbon, is manifestly a parallel example with the supposed influence of light in developing an animal organ in which the nervous system is extensive- ly incorporated for the final cause of the whole organ ; although it be certainly true that, in the case of the eye as of the leaf, the essential influences of light are exerted upon the organic properties of either part, and that the nervous system, in the former case, is only a medi- um of transmitted influences to the organic properties (§ 188, 188^, 189, 202, 203, 222, 223, 226, 227, 514 A, 1072 a, note). It would be an interesting inquiry to ascertain whether, by a total exclusion of light from the ovum of fish, after fecundation, the pecu- liarity of the Kentucky wonder may not be established in the first generation; and whether, also, an exclusion of light for a series of years would not be followed by a failure of the balance of absorption and nutrition in the eyes, and consequently a wasting of those organs. The general law of absorption operates universally, without the aid of any specific stimulus; while it is clearly otherwise in respect to nutrition, and especially in regard to certain organs. The voluntary muscles become emaciated from want of the stimulus of exercise, &c. PHYSIOLOGY.--COMPOSITION. 47 We see, therefore, how it happens that fishes with and without eyes may exist together in subterranean caverns as extensive as that of Kentucky; the latter inhabiting the dark regions, while the former exist in springs near the crevices of the cate (§ 136,137,548 a, 649 d, 733 b). 74, b. Such, then, is the philosophy of this subject, and such the full extent of the ground upon which infidelity would plant its standard. Nor will I dismiss this subject without referring, now and hereafter, to the calm indifference with which this infidelity is regarded even by the religious world, by adducing not a few of the present popular treatises on theoretical geology (fy 350f, g-k). 75. Let us now see if the beginning of individual existence does not supply a key to the whole philosophy of disease, as it does to that of physiology. We have seen that all the actions, and all the results of life, are merely effects which arise from the operation of the vital properties through their organic instruments (§ 65-67, 133, &c, 188, &c). These properties must be constantly excited into action by foreign agents, as by food, blood, &c, or the properties will become extinct, and, of course, the effects will cease (§ 188^, b). Now, the actions in disease are nothing more than the altered actions of health, and the same rule applies to all the morbid products. It follows, therefore, that the properties of life, upon which these altered condi- tions depend, are modified or altered in a corresponding manner. As a consequence of this, it also results that the vital properties have been varied from their natural state by agents or causes capable of producing the change. These agents make their impressions in the same way as the natural stimuli of life, only the morbific agents at the same time affect the nature of the vital properties, and bring them into a new condition. This new condition constitutes disease. 76. The type of all this may be found in the impregnated ovum. The properties which animate the germ before conception are deter- mined entirely by the vital constitution of the female parent. But we have seen that the new being may partake of the physical characters of the male as well as of the female, and it happens not unfrequently that the characteristics of the male are predominant. Hence it fol- lows that the semen so far establishes changes in the original consti- tution of the vital properties of the germ. Since, therefore, all the foetal developments, all their physical pe- culiarities, depend upon the precise modifications and actions of the vital properties (§ 70), and since these properties in the unimpregnated ovum are determined entirely by the female parent, their nature after impregnation must be more or less affected, and assimilated to the peculiar nature of the male parent in all the cases where the offspring manifest any of the male characteristics. This is entirely analogous, in principle, to the modifications which are produced in the properties of life by morbific causes ; but with this difference in contingencies : in the case of the impregnated ovum, the modifications are perma- nently established, and can never be altered, so far as the vital prop- erties, in either parent, upon which the modifications depend, are fun- damental in their nature. In the case of the morbific agent, or the cause of disease, the vital properties are diverted from the healthy state, and from such modified conditions they commonly possess the ability of escape, and of returning again to their natural standard (§ 48 INSTITUTES OF MEDICINE. 853, 858, 898). In the case of the impregnated ovum, a modifying agent operates, whose properties are intended to confer on the new being a stable condition, however they may modify the exact consti- tution of the impregnated germ. This vital stimulus, the semen, therefore, in virtue of its specific properties, bestows upon the corre- sponding vital properties of the ovum the peculiarities which belong to itself and these being natural, vital, and determinate, the trans- mitted peculiarities should be equally so. Or, where the male parent enjoys a perfectly natural constitution, the innate predispositions to disease depend upon special peculiarities in the vital state of the ovum, which may be as permanently established, through the modified con- stitution of the female parent, as any of the natural characteristics. In the case of disease, however, the morbific agents have none of the properties of h"fe which are natural to the fecundating semen, and the modificatiops, therefore, which they may determine may be different, even if we suppose them to act, as in the case of the germ, upon the whole constitution. Whatever modifications, therefore, may arise from their action, they must consist of deviations from the standard of health. But, it does not necessarily follow that certain artificial modifications may not be as permanent as the natural ones; and it is from observation alone, that we learn that they are so, or nearly so; as in the case of artificial "temperaments," the effects of domestica- tion upon animals, the changes which are wrought in the vegetable kingdom by cultivation and by change of climate (§ 535, &c). 77. In the case, however, of the formation of temperaments by change of climate, and the more remarkable alterations produced in animals by domestication, and in plants by cultivation, &c, the results are brought about by the new and habitual influences to which the properties of life are exposed; and, in all these cases, a radical, and often permanent modification is established, approximating closely the modifications which are bestowed upon the germ by the fecunda- ting semen. Now, it is also true, that what is denominated predispo- sition to disease is entirely analogous, in principle, to the permanent temperaments of which I have just spoken. Both are results of phys- ical agents, modifying the properties of life; and this chain of analo- gies conducts us to those predispositions to disease which are im- pressed upon the germ by the fecundating semen, and by which I show that the philosophy of the operation of morfibic causes is vari- ously, and even exactly exhibited in the impregnation of the germ (§ 63, 75, 535, 539, 559). 78. Take the scrofulous subject as supplying an example of hered- itary predisposition to disease. If it exist in the female, her ova will partake of this peculiar modification of the vital properties, and it is in this way that her progeny inherits the scrofulous diathesis (§ 144- 147). In this case, as in all transmitted predispositions to disease, the peculiarities induced in the parent have arisen, originally, from the operation of deleterious agents—imbuing the ovum with the mod- ifications belonging to the female, or imparting to the semen the whole concentrated force of what may have been the slow work of numerous causes upon the male parent. Here, then, we see illustrated in the very ovum, even before im- pregnation, the whole principle which concerns artificial tempera- ments, and those influences of morbific agents which establish predis- PHYSIOLOGY.--COMPOSITION. 49 positions to'disease in the full-grown subject. It frequently happens, also, that this natural diathesis is so great, that it results in actual dis- ease before the birth of the offspring, as manifested by tuberculous affections of the lungs in still-born infants. 79. But, to make the philosophy of this subject more obvious, let us consider the germ when it derives its scrofulous diathesis from the male parent. Before impregnation, its vital condition is perfectly natural. The semen of the male parent establishes upon it the modification which constitutes the predisposition to scrofula, just as malaria deter- mine those modifications which result in fever, &c. And here we may readily detect a perfect analogy between the alterative influences of the semen, and of remedial agents, and come to understand how it is that the latter produce their effects (§ 904, d). We have only to observe those instances where some of the offspring inherit the scrof- ulous diathesis of the female parent, while others are as entirely ex- empt as the male parent; the natural condition of the semen having altered the vital constitution of the ovum in the latter case, and im- pressed a disposition to a development of the new being in its perfect state. 80. The subject may be pursued under a variety of aspects, and with various illustrations, .whether physiologically or pathologically. Other exemplifications will occur under the subjects of vital habit and the temperaments. The same principle is concerned throughout, whether in respect to the physiological conditions impressed upon the ovum by the seminal fluid, or as those conditions are modified in he- reditary scrofula, gout, &c, or whether it concern the temperaments and other permanent changes that are induced by climate, domestica- tion, &c, or as malaria may establish their peculiar modifications of the properties of life. Nor can such conclusions be unexpected to those who duly consider the simplicity of nature in her elementary principles and laws (§ 561). 81. Could the doctrine entertained by Walker, Elliotson, and oth- ers, that the imagination of the parents influences the physical organ- ization of the offspring, be shown, the philosophy which I have set forth, though not rendered more clear, would be yet fortified. But, this is at best but speculation. I could, however, turn to the myste- rious production of the soul. This remarkable principle is doubtless developed at the very outset of foetal life, as evinced by its often com- bining the intellectual peculiarities of both parents, or, again, pf man- ifesting chiefly those of the male. But here we have no other fact to guide us, and all beyond has been involved in an impenetrable mys- tery by the great Creator. Here it is a pride and a help of philoso- phy to rest on faith alone (§ 433). 82. For an examination of vital phenomena, and relative facts, in proof of the existence of properties peculiar to organic beings, and of the abstraction of such beings from the laws of the inorganic world, see Essay on the "Vital Powers," in Medical and Physiological Com- mentaries, vol. i. D 50 INSTITUTES OF MEDICINE. SECOND DIVISION OF PHYSIOLOGY STRUCTURE. 83, a. There are certain details in respect to the structure of or- gans which must be stated, now and hereafter, to enable us to com- prehend the laws which govern the healthy and morbid states of man. Perhaps few things can impress us more forcibly with the impor- tance of a correct analysis not only of the physical organization of all parts of the body, but more especially of the vital characteristics of each part, than the continued propagation from high sources of doc- trines like the following; while they equally prove my position as to the appropriate sources of knowledge (§ 5\-5h, &c), and the tenden- cies of the microscope.* 83, b. The errors in doctrine to which I have referred are revealed sufficiently in the following extract from an article by the distinguish- ed Mr. Paget, contained in the 27th volume of the Transactions of the Royal Medical and Chirurgical Society, London, 1844. The article is entitled " An Account of the Examination of a Cyst containing Seminal Fluid;" in the course of which Mr. Paget observes, " If, with the aid of these observations, we endeavor to find an ex- planation of the occurrence of spermatozoa in the fluid of cysts con- nected with the testicle, we may suppose either that the fluid part of the semen has permeated from the seminal tubes into the cysts, and been farther organized in them ; or, that the cyst itself secretes a fluid in which the organic structures of the semen may be developed." " The most probable explanation of these cases, therefore, seems to be, that certain cysts, seated near the organ which naturally secretes the materials for semen, may possess a power of secreting a similar fluid."t I cannot doubt that before I shall have parted with the reader in what I shall have said of the peculiarities of structure, and the more remarkable modifications of vital properties and functions, there will be a disposition to concede the importance of the subject, and that this importance is rendered more manifest by the prevalence of opin- ions analogous to those in the foregoing extract. S3, c. As I have already intimated, however (§ 2, c), anatomical science can lead, originally, to no conceptions of the properties and functions of life, and therefore to none of their modifications in dis- ease. The most that we can infer, abstractedly, from a knowledge of structure, are certain general results that are denoted by the constitu- tion of organs, or assemblages of organs, upon the known principles * See Medical and Physiological Commentaries, vol. i., p. 699-712. Also, my Exam ination of Reviews, p. 6, 89, 90. t The Medico-Chirurgical Review for January, 1845, quotes this paragraph, and ob- serves of it, that " Mr. Paget's explanation of the vicarious appearance of the spermatozoa, which has of late so much puzzled the members of the society, has the merit of bein0, in- genious and original."—I cannot acquiesce in this decision. The doctrine is old, though recently, for the first time, enforced by the deceptive report of the microscope. It is thus noticed in the Medical and Physiological Commentaries: " True, we know that the an- cient belief is even maintained at this day, by Sir A. Cooper, and others, that the testis is of no special use, but that the semen is the product of those simple reservoirs the vesi- cute seminales. But, what does this show 1" &c. See, also, my comments on this sub- ject, in vol. i., p. 588, and on the supposed vicarious secretion of milk, urine, Sec, p. 601- 603 PHYSIOLOGY.--STRUCTURE. 51 of Design. The construction of the eye, for example, evinces some great final cause relative to light; that of the urinary apparatus, that a fluid is produced by the kidneys, and conveyed to a receptacle where it accumulates, and is finally evacuated through the urethra; and.so of many other parts. We thus infer, also, the uses of each part, individually, from their relations to each other as a system of Design. In other cases the function of a part may be inferred from the known uses of other parts to which it is related ; as the valves of the veins, for example, were supposed by Harvey to be designed for giving the blood a direction toward the right cavities of the heart; and this induction from anatomical Design conducted him to a full exposition of the circulation. But, in respect to the great processes of life, no conclusions can be originally drawn but through their phe- nomena. Having, however, acquired a knowledge of structure in a particular species of animal, as man, for example, and learned the uses of each particular part by a study of its phenomena, so perfect is the system of Design throughout organic nature, and so harmonious are the anal- ogies of function among organs that bear certain resemblances of structure, or of relations to each other, in all species of animals, al- though the differences in respect to structure, particularly, may be very great (§ 107, 409, e), yet illustrated by greater analogies of relation, we may generally infer, by this analogical process (§ 5\), the absolute uses of every part in any species of animal that may be, for the first time, subjected to the knife of the anatomist. And this process of in- duction may be carried to a great extent from an established standard of comparison in the animal to the vegetable kingdom. But the prin- ciple is equally comprehensive in respect to plants, when, as with an- imals, a complex being is marked out, as a standard, in all its struc- tures and functions. The same is also true, though in a far more limited extent, of the modifications of structure, and the corresponding modifications of func- tion, at the different eras of life (§ 153-162). And when we come to the variations of function in morbid states, though unattended by any appreciable alteration of structure, and consider how various must be the treatment according to the nature of the affected tissue, we are deeply impressed with the indispensable importance, to the physician, of an accurate knowledge of all that is relative to the sensible organ- ization of the material part of organic life (§ 2, c). Though the struc- ture, itself, reflect no light upon pathology, excepting through its mor- bid alterations, an observation of its morbid phenomena leads us to a knowledge of the parts diseased, and this knowledge is important to a just interpretation of the phenomena, and to a right method of treat- ment (§ 131). 83j. We have now seen that the composition of organic beings ia formed by properties peculiar to organic structure, and that what ia thus at the foundation presides over all, and is the cause of all that is superinduced upon that composition. The structure of organic be- ings, which is comprehended under our second division of physiology, is therefore dependent on the same creative cause. 84. The greatest physical characteristic of organized structure is supposed to be its arrangement into cells. Here all analogy with in- organic substances disappears entirely. The chemico-physiologists 52 INSTITUTES OF MEDICINE. imagine that the contradistinction between organic and inorganic be- ings commences at this step in the ascending series of organic results (§ 42). But we have seen sufficiently that all that relates to the com- position of plants and animals is equally significant of a radical dis- tinction between the simplest organic compound and those of an inor- ganic nature ; the same powers being equally concerned in the forma- tion of organic compounds as in their arrangement into tissues. 85. The general structure of organic beings is made up of tissues. A knowledge of the vital characteristics of the different compound tis- sues, of the same tissue in separate parts, of the different parts of one and the same continuous tissue as it may pass through different com- pound organs, of the whole as they may be combined into complex organs, of their vital relations to each other, and of all parts to each other, is indispensable to a knowledge of the laws in physiology, pa- thology, and therapeutics. 86. Bichat analyzed the tissues more ably than others, and arranged them as follows: 1. Cellular. 2. Nervous.....\ cerebrospinal. \ ganglionic. 3. Muscular.....{ in™luntary. ( voluntary. ( arterial. 4. Vascular.....^ venous. ( lymphatic. 5. Osseous. C fibrous. 6. Fibrous.....) fibro-cartilaginous. ( dermoid. 7. Erectile. 8. Mucous. 9. Serous. 10. Synovial. 11. Glandular. 12. Epidermous, or corneous. 87. Until the era of Bichat, the tissues were limited to three, as designated by Haller; namely, the cellular, muscular, and nervous The cellular was supposed to form a large proportion of other tissues 88. There was a great error, physiological and pathological, in the foregoing limitation (§ 87), since it took no note of the modifications of the vital properties, and of the particular functions of the tissues as arranged by Bichat. 89. The several tissues are distinguished by differences of internal structure, as well as by modifications of their properties and func- tions. They are called simple organs, when considered in their func- tional character; and when two or more go to the formation of more complex parts, they are called compound organs. Certain compound organs, which concur together in some general function, are called an apparatus; as the urinary, the digestive, the circulatory &c As the whole exist in the universal body, they are called an 'organism. Each tissue, collectively, is also a system; as the mucous, serous muscular, &c ' PHYSIOLOGY.--STRUCTURE. 53 91. The simple tissues rarely occur in a separate state, but are more or less connected together into complex organs. 92. The simple textures are, themselves, compound organs, so far as their organization is made up of various textures. The union of tissues, therefore, in the simple textures, is quite different and far more intricate than when the simple textures form what is called, specifically, a compound organ. 93. The structure of the general body, and of its different parts, is radiated. The rays, or branches, of certain parts, as the vessels and nerves, are called ramifications. The rays increase in number and diminish in size, as they go off from the centres of radiation. 94. The trunks of vessels and nerves, and their ramifications, unite, respectively, in various ways with each other. This is anastomosis, and subserves very important uses. It promotes circulation in the vessels, and through the nerves it contributes especially to bind all the organs together in one harmonious action and common depend- ence. Through the last, also, the play of remote sympathies is pro- moted when the nervous power is developed in the central parts of the cerebro-spinal and ganglionic systems by morbific or remedial agents. 95. The animal organism is symmetrical as a whole, and in its va- rious parts. This symmetry is conducive to uniform results, is im- portant to the great processes of life, is always the same in the natu- ral conformation, is indicative of great Design, and of peculiar proper- ties and laws. 96. Bichat, " following the path marked out by nature herself," di- vided the animal organism into two great systems or classes; the dis- tinction having been already indicated by Aristotle. 97. The first class relates to the individual being; the second to the species. 98. The first, class is divided by Bichat into the organs and func- tions, of animal life, and the organs and functions of organic life. 99. " The two classes have nothing in common, but the general connection that unites all the phenomena of living bodies; but a va- riety of distinctive attributes characterize them, which cannot be sep- arated from them."—Bichat. 100. The organs of animal life are those whose functions connect us sensibly with external objects, are peculiar to animals, and distin- guish them from vegetables. 101. The organs of organic life consist of such as perform functions that are common to animals and plants. " The only condition of en- joying this life is organization." It forms an indisputable boundary between organic and inorganic bodies. 102. Animals have two states of existence, sleeping and waking; but the former applies only to the division which embraces the func- tions of animal life. The animal powers are subject to fatigue, and require repose; the organic are not, and are in perpetual operation. 103. The foetus has only the organic functions in operation ; but all its animal faculties and the soul exist in a passive state.* The latter are brought only gradually into exercise. 104. The great, immediate, office of the organs of organic life is to maintain a constant vital composition and vital decomposition of or- ganic matter; or nutrition and waste. * See Medical and Physiological Commentaries, voL i., p. 13. 54 INSTITUTES of medicine. 105. The organs of digestion, absorption, circulation, respiration, and secretion, compose organic life. Secretion comprehends nutrition exhalation, calorification, and excretion; which four are often ranked as distinct functions. 106. "Animal life is composed of the organs of sense which receive impressions, of the brain which perceives them', reflects, and wills, of the voluntary muscles, and larynx, that execute this volition, and of the nerves which are the organs of transmission."—Bichat. 107. The organs of organic life are quite analogous in the lowest animals and plants; but each has peculiar characteristics. In ani- mals a little higher in the scale, the common functions are performed by organs of greater complexity, and this complexity increases in the ratio of the development of animal life. Nevertheless, in most ani- mals above the rudimentary there are the same subsidiary functions, whatever the difference in organization. There is in most, for exam- ple, the secretion of gastric juice, saliva, bile, &c, which subserve the common function of assimilation. 108. No organ of animal life, in a philosophical sense, is necessary to the individual. But, no part of the animal can exist without all parts of the organic system, or an equivalent; which is also true of the organic viscera. If the heart, for example, be wanting in the foetus, the blood-vessels, as an equivalent, carry on the circulation. 109, a. The indispensable organs, of which no one can be abstracted without destroying the whole, are generally single in animals (§ 128). The same is true of plants, if we regard those organs which perform a common function in the light of a single organ. If the leaves fall spontaneously and abruptly in cold climates, no injury results to the plant, because it is passing into a torpid state. 109, b. Nevertheless, neither the action of the heart by which the blood is circulated, nor that of the lungs by which the blood is oxy- genized, nor that of the brain by which the harmony of organs is main- tained, nor that of the kidneys and skin by which redundancies are excreted, nor that of the liver by which bile is generated, nor that of any other compound organ, constitutes the real functions of life. They are only secondary or subordinate to others in which the absolute pro- cesses of life consist; and these are carried on by those extreme vessels which perform the immediate work of nutrition and vital decomposi- tion. This is exemplified in the development of the ovum (§ 63-72), and throughout the vegetable kingdom. Indeed, life may be continu- ed after removal of the brain merely by inflating the lungs ; and could we substitute a machine for the heart, and the process of transfusion, both the heart and the lungs could be dispensed with for awhile. These facts are important in showing the nature of the organic properties; how it is, and through what influences, the compound or- gans contribute, and are, each one, indispensable, to the life of animals; and that it is to the fundamental organization that we must look for all the absolute processes of life, and for the essential conditions of disease. 110. The parts by which life is carried on in the organic viscera are blended in the organs of animal life, and in those of the species. 111. The cerebro-spinal system is assigned both to animal and or- ganic life. The sympathetic, like the cerebro-spinal, goes to the or- ganic life of animals, and therefore pervades the organization in ani- mal as in organic life (§ 110). PHYSIOLOGY.—structure. 5) The cerebro-spinal nerves and the sympathetic interchange con- tributions, in all parts, by which important influences of the former are established in the organs of organic life (§ 452, &c, 500, 512. &c). 112. Nevertheless, the cerebro-spinal system is especially designed for the uses of animal life; but an important final cause is answered in making it subservient to the common interests of the whole being (§ 455). 113. The sympathetic system is added especially to the organic life of animals, on account of the complexity of the organs, and to unite them in harmonious action, through circles of sympathy, and thus render them, each in its place, conducive to a common end. The cerebro-spinal system contributes to this result (§ 111, 112); and each system, unitedly, or independently, exerts special influences on the specific actions of organs, though these actions are carried on es- sentially through properties inherent in the several tissues (§ 226-233, 485|). 114. The most important common end (§ 113), as it respects the in- dividual, relates to the functions of animal life. The organic system, then, in animals, though physiologically the most important, must be held subordinate to the uses of animal life. In plants, organic life is the whole being. 115. The foregoing union of organic life with all other parts (§ 110- 114) establishes mutual relations between all parts of the organism, and brings the animal and sexual systems under the laws which ap- pertain to the organic system (§ 455). 116. The same intimacy of parts confounds, in a degree, the dis- tinction in the two lives (§ 115). 117. An important consequence of the foregoing vital union of or- ganic with animal life (§ 110-114) is a general coincidence in the pathological as well as physiological condition of the whole. The dis- eases of each react mutually on each system of organs, each requires common methods of treatment, and remedial, as well as morbific, agents operate upon the universal body through any given organ (§ 455, 524, no. 1, 647). Nevertheless, diseases of the animal organs more readily derange the organic viscera, than the latter the former; but, remedial agents operate far more powerfully in the opposite relation. The sympa- thies in the two lives, therefore, are not exactly reciprocal. The foregoing apparent want of harmony in the physiological, pathological, and therapeutical relations of the two systems of life is reconciled by the consideration that nature has ordained, for the pro- tection of the organs of animal life, that their wants shall be emphat- ically made known to those of the life on which they depend, and, on the other hand, their dependence on organic life has placed them un- der the special therapeutical control of that life; while the organic viscera being independent of the organs of animal life, therapeutical influences are but feebly propagated from the latter to the former. Such are the final causes in the great plan of Unity of Design. 118. The second class of organs and functions, which relate to the species, are divided into three orders : 1st, such as belong to the male; 2d, to the female; 3d, the functions relative to impregnation. 119. The several organs, and reproduction, belong both to plants 56 institutes of medicine. and animals. They are not necessary to the individual, though the whole organic system is necessary to their existence. 120- Although the organs of generation be not necessary to the in dividual, they exert many natural vital influences upon the animal functions. Their full development has also certain influences in or- ganic life, which illustrate some important laws as to the vital prop- erties. Their diseases may also give rise to great derangements of the organic functions. They fail earlier than the animal functions (§117,578). 121. In the great sense of ultimate Design, all organic processes have for their final cause the development of the generative organs, and the production of germs; that similar beings may be maintained in one unvarying round of development and growth. Many beings die as soon as this end is attained, and return to the mineral kingdom to be again reorganized by plants, and again, and again, refitted for the nutriment of animals, and carry out, in both organic kingdoms, the final cause of their regeneration from the mineral. 122. It is necessary that the ovum of mammiferous animals should remain connected with the parent till the organs of organic life,are developed. The law of dismemberment (§ 108, 109) does not apply to the ovum of oviparous animals, nor to the seed. They are en- dowed with the whole essential organization, and maturity of the vital principle, for independent life. The former gets its nutriment from the parent, till the organs are brought forth. The latter are supplied with nutriment from within themselves. In this case, also, the spe- cies are destined for great multiplication and distribution; in the other, their numbers and sphere are more circumscribed. Nevertheless, the germ of all animals contains within itself the prin- ciple "of carrying out the full development of a being similar to the parent, in all its complicated parts, which, however, have no rudi- mentlry existence in the ovum. The progress, too, of fcetal devel- opment is always the same in each species, and every part is brought forward in the order of its importance in the organic life of the foetus, and of its future uses. It is the same in the vegetable kingdom. 123. The history of the seed and egg probably supplies one of the most remarkable illustrations of Design that can be found in nature ; especially that of the seed. They are the only instances where the entire properties of life cease their ordinary operation without be- coming extinct; and were it not for this interval of repose, the spe- cies would probably disappear; since, even if the properties of life carried out the development of the seed into the plant, the chances of preservation, and especially of multiplication, would be vastly dimin- ished (§ 633, 1051,1052). 124. Besides the foregoing general division of the organs and func- tions of living beings, another arrangement of the organs is founded upon the relation of special functions. Each component part, each group of organs, and the whole collectively, are replete with various and wonderful Design; each, and all, having peculiar ends, all con- spiring to common ends, and in one harmonious Unity of Design maintaining the life of each other. 125. The following is PHYSIOLOGY.--STRUCTURE. 57 2. Vascular System. Direct circulatory or- gans. [ Destined for waste. ) Conveying the means J of repair. Respiratory Sys- tem. 6. Cutaneous Sys- tem. 7. Urinary System. Special Sensitive System. 9. Osseous System. The Arrangement of Organs according to their relative Functions. ( Brain and cerebral nerves. 1. Nervous System. < Spinal cord and its nerves. ( Sympathetic ganglia and sympathetic nerve. ^ Heart and its Pericardium. Arteries. Veins. Lymphatics. Lymphatic glands. Lacteals. i Lacteal glands. Mouth, stomach, intestine. Salivary glands and pancreas. Spleen. C Larynx and vocal system. Trachea. Lungs. Diaphragm. i Muscles of thorax and abdomen. System of voluntary muscles. C Derma, or main portion. J Papillary tissue. j Rete mucosum. (^ Epidermis. C Kidneys. J Ureters. S Bladder. | Urethra. Organ of hearing. " sight. / " smell. f Bones. J Cartilage. | Ligaments. I Synovial capsules. ^ Testes. "j Ductus deferens. Seminal vesicles. Prostate gland. J^K' c ■ \ Copulative. Muscles of permaeum. ) r Ovaries. } Fallopian tubes. ✓> Formative. Uterus. ) Vagina. Hymen. Clitoris. Nymphae. Labia. Constrictor vaginae .Mammae,—accessory parts. j 10. Genital System. •Formative. V Male. > Copulative. 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, arid 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, that is, reflex action of the nervous system. 129, e. The sympathetic relations are most strongly pronounced among organs which concur together in the performance of special functions, as the circulatory, the digestive, the urinary, the sexual systems, &c. (§ 124). Other special relations subsist between the 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, f. Plants are devoid of all that intimate association of parts which is owing to reflex nervous influence in animals, as well as to peculiarities of structure and special modifications of the common properties of life. But, a general relation of functions obtains to a certain extent in plants through the law of continuous sympathy, which as I have endeavored to show, depends upon the organic properties (§ 498). r 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 reflex nervous actions 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 MEDICINE. lacioas 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., p 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 recovery 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 venous systems. This has its deep foundation in the whole physiological condition of man and animals, and I may also add, in the whole vegetable tribe (§ 847, c). While every sur- face has some secreted product adapted to its own special modifi- cation of irritability, many of these products may be offensive to other parts. Again, the special irritability of one part may be exactly suited to some product of another part, and this may or may not be a natural vital stimulus, and perfectly inoffensive, to the second part, while it may excoriate all other parts. Bile, for instance, is the nat- ural stimulus of the intestine, but will injure other parts. Venous blood is harmless in the veins, and excites them, more or less to a contractile action ; but is rapidly fatal within the arteries (§ 849). Urine is the natural stimulus of the bladder, but will excoriate most other parts (§ 74, 188£ d, 650, 847 e). PHYSIOLOGY.--STRUCTURE. 63 137, a. In this relative sense the animal is filled with poisons; each one of which, however, in its proper place, is not only inoffen- sive, but indispensable. Here is the principle. 137, b. It is, also, upon the foregoing organic constitution of differ- ent parts, and which gives rise to a mutual relation of the different vital agents and products of organs and of the 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, e. It is, therefore, one harmonious system of laws throughout. Were it, indeed, otherwise, remedial agents could have no existence, and disease, of course, could receive no help from art. These, also, are the beginning of a long series of facts, which show us that the effects of all agents, whether morbific or remedial, may be traced to the peculiar impression which they exert upon parts with which they come in contact; and by which, also, we overthrow the whole system 64 INSTITUTES OF MEDICINE. of chemical physiology, the humoral pathology, and the doctrines ol 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 th® 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 the system at large is increased by morbid changes, or predisposed by morbific influences, so, in a general sense, will the alterative action of reme- dial agents be felt in a corresponding manner (§ 137 d, 152 b, 715). By the law of adaptation as set forth in the Medical and Physiological Commentaries (vol. i., p. 649, 653-655, Sec), 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?*, 133-137, 143,155,156,169/ 387, 399, 422, 514 h, 524 d, 525, 528, 638, 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 changeswhich 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 dven 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 rital 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), all depending upon reflex nervous action. 148. Certain causes appear to be capable of affecting, directly and indirectly, all the tissues of the body, as in idiopathic fever; though, in these cases, the primary morbific effect is on particular parts, from which it is disseminated by 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- 233f, &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- nood. Hence a greater development of the organic properties in those parts, and a greater consequent liability of the brain to inflammatory and congestive affections, and to hydrocephalus. The large propor- tional size of the nervous and arterial systems affects the physiolog- ical and pathological condition of all other parts; giving activity to nutrition, and susceptibility and intensity to disease. The glandular tissue of the liver has the largest proportional size in infancy; but not so the venous system of the liver. Hence, again, 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: 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. V 14. Arterial. 1. Mucous texture TABLE II. 1 of the nose. " lungs, fauces. " eyes. ( Ilium, " small intestine, < Jejunum, ( Duodenum. " stomach. " large intestine. " uterus and vagina. i_ " bladder. PHYSIOLOGY.--STRUCTURE. 71 0 Venous texture (form- ing, mostly, venous congestion)..... 3. Cellular texture . . 4 Serous texture . 5. Glandular texture. 6. Lymphatic texture 7. Fibrous texture . . 8. Nervous texture . 9. Synovial texture . 10. Osseous texture . . C 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. fiver. testis. lacteal glands. kidney. thyroid gland (goitre). thymus gland. pancreas. of the lower extremities. " upper extremities. " uterus (see Comm., vol. ii., p. 470). others rarely. ligaments. dermoid. periosteum. . ^ cartilage. tendons. pericardium. dura mater. brain. nerves. ganglia of sympathetic. spinal cord. of the knee-joints. " ankle. " joints of upper extremities. spongy bone. solid bone. 72 INSTITUTES OF MEDICINE. C of the brain. . , . 1 arch of aorta. 11. Arterial tebcture. .. .< « extremities. [ 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 othei 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. Uterus. 13. Textures of kidney. PHYSIOLOGY.--VITAL PROPERTIES. 73 14. Mucous texture pf stomach. 15. Mucous texture of large intestine. 16. Serous texture of lungs and chest. 17. Serous texture of abdominal parietes. 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 yulgar acceptation, synonymous with the term life ; and life, therefore, is a cause, and not an effect, as has been assumed by many distinguished physiologists. (Common inflammation.) 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 preside over the various actions of organic and animal lite, 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 m 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 (§ H): " 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, c\c. 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 1 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.| 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 under the 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 Archceus, an immaterial principle, which he lo- cated in the upper orifice of the stomach. It presided over the body in a general sense, and had under its command several subordinate spirits (one for each organ), to execute the orders of the great spirit. But, like Paracelsus, he expounded much of his physiological results upon chemical principles, and had no definite conceptions of the office of his 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 Reviews," p. 43. X 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 gTeat 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., p. 124-140. Also, "Examination of Reviews," p. 43 ; "Notice of Reviews," p. 4; "Essays'on Vital- ity," &c, p. 17. PHYSIOLOGY.--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, e. 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 Midler'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,/ 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 ipvxr), 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."t—(Hall * See " Examination of Reviews," p. 26-28 ; also, this work, § 189 b, 350J 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!" (6 844.) ,.,,■• e ■»» , I may also add the followiug extract from the New York Journal of Medicine for March, " New York, Feb. 14, 1845. " Mr. Editor, " Dear Sir—In a letter of the 11th inst., addressed to myself, you desire me to state what I witnessed of the firmness of a young gentleman, upon whom the operation of ex- section of the inferior maxillary bone was performed by Prof. Mott, ' and the reflections to which it gave rise, as bearing on the subject of alleged surgical operations without pain in the mesmeric state.' "The case to which you refer is briefly reported in the January number of the New York Journal of Medicine, by some person, who, like myself, was present at the opera- tion. The subject is there stated to have been ' a fine intelligent young man, whose he- roic deportment greatly facilitated the operation.' " Perhaps it is enough that I should have quoted the expressive language of one, who appears to have looked on with the same admiration as myself; though these examples of 'heroic deportment' are common enough in the walks of surgery, especially among females; and that, too, without mesmeric imposture. The same eminent surgeon, who operated in the case which is the subject of these remarks, 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- ganic movements, under similar conditions, which has been set forth in behalf of animal magnetism. "To appreciate properly the 'heroic deportment' of young Baker, you must imagine yourself to have been a spectator; follow the able surgeon in all the capital steps, and in all the minor details of the operation, and watch attentively the ' deportment' of the sub- ject. He was laid at a convenient elevation upon a table, his feet crossed upon each other, and his hands lapped. I mention this position, because he did not move his feet, nor displace his hands during the operation. "Now observe the operator; first, making a long and deep incision among the muscles of the neck, and then tearing his way down to the carotid artery, and throwing and tying the ligature. It was, in itself, one of the most capital operations in surgery ;"but, owing to the dexterity with which it was performed, and with an operation still before us far more difficult, and tedious, and dangerous, this grand step toward the exsection of the jaw lost much of its usual interest to the spectator. But it was not the less painful to the sufferer; who, however, sustained it without betraying the slightest evidence of pain. " Next came the circular incision, reaching all the way from the joint of the maxillary bone, down along its lower edge, up to the middle of the chin. This was done by one rapid, immense sweep of the knife; but there remained the same imperturbable compo- sure of the patient. Not a sigh, not a groan escaped, no muscle moved—the very eye did not wink. And then followed, as you may well suppose, a prolonged, tedious, painful dis- section, in which it became necessary to exasperate the suffering by securir- many bleed- ing vessels; till, finally, the operator was ready for his saw. But nothing'had yet hap- pened to elicit a single manifestation that the patient was not in a profound slumber, ex- cepting that his eyes were open, and that he occasionally swallowed. " But, before sawing the bone at the middle of the chin, it was necessary to remove one of the incisor teeth, and this was so firmly rooted that a straight forceps slipped in the hand of a capable assistant. Another pull, however, brought with it the tooth • but in neither attempt was there any more indication of suffering than in drawing a nail from a board. " Then came the process of sawing, and this was calculated to greatly annoy the patient trom a slight accident which happened to the saw, and which prolonged this part of the operation. Still, however, the same ' heroic deportment' distinguished the patient for- bearance of the sufferer, the same unexampled complacency continued to mark every lin- eament ot his face, his very eye displaying nothing but gentleness, softness, and calm rc siej nfltion. 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, see 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 witn 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 mesmerite might be dis- posed to evade the overwhelming rebuke which the recital of this case cannot fail to in- flict on his love of the marvelous, or his love of mischief, or his yet more culpable designs on human credulity. " I have said that there was something physiologically interesting in the foregoing case Deyond its simple merit of an 'heroic deportment,' and that it goes to the very depths of mesmeric assurance and duplicity. It was this : " On feeling the pulse of the patient twice during the operation (the last time after the lapse of an hour), I found it calm, undisturbed, and with about the same frequency it had before the operation was begun. This proves to us what I have before expressed, that it is not pain, but the consequent mental emotions which 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 tho reach of greater re- proof or mortification. " I remain, very truly, your friend and obedient servant, " Marttn Paive." so INSTITUTES OF MEDICINE. In the language of Liebig, " In regard to the nature and essence oj 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. 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 inor- ganic world, that has embarrassed the progress of medicine, and en- cumbered it with a spurious philosophy. 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,/ 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 h, 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. F 82 INSTITUTES OF MEDICINE. this is not only atheistical, but is opposed to all the suggestions of reason* (& 74, 350| k). Nor is this all. The varieties m 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, c. 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, \ 43; and "Notice of Reviews," p. 2, &c., in "Med. and Physiolog. Comm.," vol. iii. PHVSIOLOGV.--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 the elements of matter in peculiar modes, and arranges the compound molecules into tissues and organs, and in modes identical with those which came originally from the Creative Energy of God, Who thus far imparted to the principle of life a formative endowment. The principle is capable of protecting the matter which it endows against the decomposing influences of all the physical agents by which it is nat- urally surrounded, while the extinction of the principle exposes the or- ganic substance to an intestine chemical dissolution, and to the decom- posing action of surrounding agents, which proceeds with a rapidity without parallel in the natural state of the inorganic world. The principle is also susceptible of certain limited changes from the in- fluence of causes, 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 natuml 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, we have irritability, mobility, sensibility, &c, and the modifications of 84 INSTITUTES OF MEDICINE. each of these in the same or different tissues form the specific or par- tial variations. These properties are also constantly varied in dis- ease, and these variations I call changes in kind. The parted modifi- cations-in their natural state I designate as variations in kind" (§ 133- 163, 171). . 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, 1881 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 1 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 1" " 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. ? 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 1 What rouses the organ to its wonted secretion of mind 1 Are there any analogies supplied by the liver, the kidneys, &c. (§ 241)1 What is it, I say, that brings the great nervous centre into operation in all the acts of volition, in all the acts of intellection 1 This ques- tion must be answered consistently, or in some conformity with the argument drawn from analogy. If that can be done, then it must be conceded that the analogy is 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 [o 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 vita) 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 (§ 350? h-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, 350f g-350% o, 376i, 733 d). In my " Notice of Reviews" (in Comm., vol. iii.) I have shown that the doctrine of " the properties of life in the elements of matter" is thoroughly material as it respects the soul (§ 14 c, 189 b, 350f I, in). 176. Besides an organized substratum and a principle of life, there is something still beyond not less important to all the great purposes of life. This consists of the actions and various results of life. If all animated beings existed in the state of the seed and ovum, the whole universe would be nearly without any other apparent anima- tion than what is elicited by the forces of physics and chemistry. The movements of the heavenly bodies would be the principal de- monstrative source of power. Although, therefore, the actions and phenomena of organic beings, like the motions of the heavenly orbs, are merely the effects of a pe- culiar power which we call life, they are, nevertheless, the only at- tendants of life that interest our senses beyond the physical struc- ture. Hence, it is not remarkable, considering how liable the senses are to take the lead of the understanding, that even the soundest minds have supposed that life consists of its results alone, and have overlooked the great efficient cause or power upon which the results PHYSIOLOGY.--VITAL PROPERTIES. 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 nature?), 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 terhperaments, and hereditary diseases, which many refer to the ever-changing blood (§ 238, 666). 182, a. According as the vital properties may be modified, either in the foregoing manner (§ 181), or as in disease (§ 177), so will be the condition of the elementary combinations, and other physical products. 182, b. 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). • i • 183. In their highest development, the properties of the vital prin- ciple are six; namely, irritability, mobility, vital affinity, vivificalion, 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, Sec, 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,/). 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 belter 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. 187|. The conditions now mentioned as to the principle of life, as well as all those to be hereafter stated, and the phenomena of which they are predicated, form other groups of facts, which, individually and collectively, contradistinguish the principle of life from all the forces of inorganic nature (§ 1041). IRRITABILITY. 188, a. Irritability belongs to all tissues, and is the property upon which all vital agents, external and internal, physical and 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/). 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 doctrine is entirely unfound- ed which supposes that vital agents produce their effects in organic life by direct impressions upon the nervous system, excepting so far as 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. . . . 188i, 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. I885, 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^, 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. 188J, 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 close of the last century it was shown that the rays which produced this effect were invisible, and therefore could not be regarded as rays of light. At a later period I showed that they could not disturb a thermometer, or communicate to our organs the impression of warmth, and therefore must be distinct from heat. From the circumstance that they are always accompanied by light, I gave them the provisional name of Tithonic rays, from the fable of Tithonus and Aurora. " The same species of modification which light exhibits (as colors) has been traced by Melloni for the rays of heat, and by me for the Tithonic rays. But, as both these classes of rays are invisible, their coloration must be necessarily so too, and is known to us only by in- direct facts. We speak of it, therefore, as ideal or imaginary. There are seven colors for heat and the chemical rays, as there are seven for 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, Sec). It is this which settles the individuality of the numerous rays. The results of sensation, the test of tint 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 (§ 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 34 INSTITUTES OF MEDICINE. least, reaches far beyond the peculiarly modified sensibility of the retina (§ 199); since, by its long privation, the entire organ of vision ceases to be developed (§ 74). Again, by what chemical philosophy shall we interpret not only the painful effect of light upon an inflamed eye, but its aggravation of the disease 1 And here, by-the-way, its simultaneous action upon the sensibility of animal life and the irri- tability of organic life concur together in the demonstration. And now to continue the analogies with electricity and galvanism. Either will promote the growth of plants which no degree or modifi- 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 ? 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 in animal life and irritability in organic life, if their action in the former case be not chemical, but vital, so is it equally in the 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 together, either mechanically or chemically, a new agent is created, which 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 e, 1072). 189, a. Where physical views of life obtain, their advocates sup- pose that vital agents operate directly upon the structure. This is one of the first steps in materialism. Many of the chemical school imagine, as Liebig expresses it, that " every motion, every manifesta- tion of force, is the result of a transformation of the structure, or of the substance of parts ;" that " every thought, every mental affection, is the result of a change in the composition of the substance of the brain." And so of every pulsation of the heart (§ 350). Others, again, who belong to the school of vitalism, to accommodate their lan- guage to the physical conceptions of the day, speak of the action of vital agents " upon the structure through the medium of the vital properties." This difference among vitalists is only verbal; since, by admission, the structure can only be affected " through the medi um of its vital properties," upon which, therefore, the impression must be made. Hence, distinguished vitalists, Professor Caldwell, for example, who defend the semi-physical mode of expression, often fall into the simple realities of their philosophy. Thus the professor, in his u 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, 350| 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, 350? 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 (§ 222-233|, 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 they op- erate upon the functions, since those are merely effects (§ 176). And is it not a greater paradox that hydrocyanic acid, or aconite, &c, should destroy life in a second of time by its action upon the mere structure than upon that living principle which imparts to the organic kingdom all its peculiar characteristics] Or, as the blood, or joy, or 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 being, 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 egg, 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 ot nature. We do not find that dead matter is endowed with proper- ties as specifically distinct from the matter itself as the living being and the properties by which it is governed. And, so far as this analogy extends to dead matter, its properties do not appear to be liable to any mutations in kind, but only in degree ; and here it would seem that the analogy should end, since we do not find that instability in the mineral world which, in the organic, grows out of the mutability of the properties of life. What I have thus said of the analogies between the properties of living and dead matter is sustained by the late researches of chemists. Thus, on the allotropism of simple bodies, it is said by Prof. Draper, that, " to a certain extent, the views of M. Berzelius coincide with those which have offered themselves to me from the study of the prop erties of chlorine. They are not, however, altogether the same. M. Berzelius infers that elementary bodies can assume, under varying cir- cumstances, different qualities. The idea which it is attempted to communicate in this memoir is simply this,—that a given substance, such as chlorine, can pass from a state of high activity, in which it possesses all its well-known properties, to a state of complete inac- tivity, in which even its most energetic affinities disappear. And that, between these extremes there are 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- iOO 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, or reflex nervous action. All the modifications of sensibility are designed for the transmission of impressions from the circumference to the nervous centres (§ 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 per- ception (§ 451, 523, nos. 1, 2); and it is these upon which true sen- sation depends. Whenever brought into operation, the mind takes cognizance of the transmitted 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 meant by PHYSIOLOGY.--VITAL PROPERTIES. 101 natural modifications of the vital properties; and illustrate those mod- ifications which constitute the essence of disease (§ 133, &c, 191). The three principal kinds of sensibility, and the several modifica- tions of the specific kind, as shown by the special causes which, re- spectively, give rise to seeing, tasting, smelling, &c, also illustrate the principle which governs the special relations of different agents, natural, morbific, and remedial, to irritability as modified in 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 are 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 transmitted 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, Sec—(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 we may reason analogically, and infer insensible motions of the sap-vessels, the secretory apparatus, &c, as is also done in an- imals ($ 1054). Mobility, therefore, gives rise to sensible and insensible motions. They are generally sensible in animal life, and of either kind in or- ganic (§ 476-492, 516, no. 2 ; also, Medical and Physiological Com- mentaries, vol. ii., p. 150, 379-391). 208. Mobility is brought into operation through impressions made on irritability, whether by vital stimuli in organic life, or by the ner- vous power in either organic or animal life (§ 188). The philosophy of this will be considered along with the attributes of the nervous power, .the function of sympathy, and the laws of sympathy. 209. If sensation apparently give rise to motion, it may be occa- sioned by the action of external or internal causes upon sensibility; 104 INSTITUTES OF MEDICINE. Dut 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- I ter property and the function of motion (§ 222-233J, 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 Spallanzani's Experiments in Opusculi di Fisca Animate, Opere, t. vi., p. 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 oidy operate upon com- pounds of this complexity. Vegetable organization is, therefore, more of a creative nature than animal (§ 13). 5. VIVIFICATION. 218. By vilification, 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 (§ 5| 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--ITS DIRECT AND REFLEX ACTION. 222, a. The analysis which I shall make of sympathy establishes so clearly its functional character, that I shall remove it from among the properties peculiar to animals, where it has been hitherto placed. In 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). This is reflex nervous action. 222, b. The philosophy of the operation of the nervous power in producing motion, under all its various aspects, as manifested in its natural regulation of organic functions ($ 202), or by its ether reflex actions as induced by morbific and remedial agents, or by the influ- ences of disease, in the motions which are generated in the organs of organic life by the passions and analogous affections of the mind, in the movements of the voluntary muscles, iu 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, Sec, 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 £ 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 according to the nature of the operating cause, and the intensity and suddenness with which it may operate (§ 480, 743, 951). In blushing, the pow- er is rendered stimulant; by fear, depressant; by grief, anger, hope, &c, alterative (§ 844). These effects are also commonly very sud- den, especially the physiological. Even such as are morbific are oft- en almost instantaneous ; and this rapidity of change ceases to be re- 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 through sensitive nerves. 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 tho 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, which I call sympathetic from the office of the sensi- tive conductors in this function of reflex nervous action. The impres- sions are then communicated to the cerebro-spinal axis, or to other central parts of the nervous system, and there bring into operation, and variously modify, the nervous power (§ 224). The power, thus developed, thus influenced, or so modified in kind that it partakes of the nature of the transmitted impressions, which are more or less co- incident with the virtues of the remote causes, is then exerted, through the motor system of nerves, upon the organic properties of distant parts, or of the nervous system itself (§ 208, 209, 462-469), by which those properties, and their resulting functions and products, are vari- ously affected according to the foregoing circumstances. From this fact it also results, that the modified conditions which are brought about by the nervous power, when the preternatural operation of this power depends upon 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. 898^ 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 suite'd 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 doses, the respiratory movements are not affected, but only the condition of the skin, &c, and in lesser degrees. But, these examples embrace PHYSIOLOGY.--VITAL PROPERTIES. 109 jnly 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 the sensitive conductors. Thus alcohol, applied to the brain or spinal cord, increases the action of the heart and capillary blood-vessels, and so do anger, joy, hope, love, imagination. But, a watery infusion of opium or of tobacco, applied in like manner, depressesthoseactions,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 of all parts, upon which nutrition, vital decomposition, &c, depend ($ 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 great 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) than its reflex and direct actions. 233. The nervous power does not generate motion either in animal or organic life (§ 476-492, 516, nos. 2, 7). It only influences the or- ganic property mobility, upon which all motion depends, through the medium of irritability (§ 188, 205, 208, 209, 226). Even voluntary motion is entirely independent of the nervous system, excepting as the nervous power is a stimulus to irritability. In the production of this complex function several elements are concerned : 1st. The will, Dperating 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 (5 464, &c, 476, &c, 1041). ^ V 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 (^ 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 (§ 188^ d, 234 e) 1 Do you cast aside all the phenomena of irritability and sensibility, and maintain that the action of internal and external causes, the mind and its passions, is exerted upon the struc- ture alone, because you cannot see the properties (§ 169, 189) ? Can * See Medical and Physiological Commentaries, vol. i., p. 397, 511, 512 514 515 as to Magendie. ' ' PHYSIOLOGY.--VITAL PROPERTIES. 113 you see the Maker of the eye, or did the eye make itself (§ 74) ? Do the muscles move without a moving power'? 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 Is 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 1 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, gazing at the north for some sign that shall help the un- derstanding as to the nature of the mysterious agent. But you see and 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 ] Do not the infinite phenomena of sympathy mutually con- spire together without a contradictory fact, in proving the occurrence H 114 INSTITUTES OF MEDICINE. of 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? 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, e. 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 1 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 1 Were you not equally in the dark as to the modus operandi of the so lar beam in its various agencies upon inorganic compounds, till a few obscure phenomena led to the hypothesis of undulations ? But, what have you gained by the undulations ] Can you tell us how these in- conceivably small motions operate, without a resort to absolute as- sumptions 1 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,/ 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 1 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 1 Have you any better data for your conceptions of the relation of the magnetic pole to the needle ; and to explain that relation, do you not admit a pecu- liar imponderable, invisible agent, which acts upon the properties of the needle ] Do you understand any better, or have you any bettei 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, sensibility? 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 1 The forces of life are concerned about sensation in a peculiar manner, and there would be a violent interruption of the law of analogy were there not something interme- diate between mind and matter, a bond of union, as it were, through which impressions upon the senses should reach the spiritual existence. We may fancy it to be electricity, or the chemical forces; but, this no more aids our comprehension, through the known phenomena sup- plied by these causes, as to the communications from matter to the immaterial, thinking existence, than if we regard the nerves, 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 ot 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 ;t is hard or soft; if an- alyzed, it is found to be composed of several urstinct 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 Logic!' 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 1 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, mix 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 ? It is the merest assumption to sustain an unintelligible and absurd hypothesis, to affirm that struc- tural derangement is necessary to death. If galvanism, the chemical forces, &c, be the immediate cause of the deposition which constitutes the interstitial growth, what bestows vitality (or life, if it be preferred) on the new-formed matter ? Or, if this vitality be imparted by spe- cific powers of the formative instruments, why should not those pow- ers be adequate to the entire work (§ 64) 1 Why so great a violation of the most common rule in philosophy, as to introduce other forces, whose great office is to pull down, and whose results are confusion ? 234, i. The whole art of medicine consists in producing certain im- pressions upon properties or powers that are wholly unlike those which rule in the inorganic world. It will not answer to talk of mod- ifying the operation of galvanism, magnetism, gravitation, light, chem- ical affinity, &c, by an emetic or cathartic. It must, however, come to this, if you will have it that those forces preside over organized beings, or even if they be allowed to have a subordinate agency (§ 175, d). 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. Whoever prescribes for disease upon any other ground is a mere charlatan. Who, again, will define the nature of cohesion, gravitation, chem- ical affinities, &c. 1 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 mure 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, cceteris 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 tu 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, Sec, at the several eras. From these natural and uniform modifications of the vital states, we may turn to those of a fluctuating and accidental nature, which grow out of the influence of climate, habits, employments, &c, and which may be not only as lasting as the individual, but may be transmitted to his posterity. As at the different eras of life, we here find, also, variable influences from the natural, the morbific, and the remedial agents, variable sympathies, &c, among organs, according to the arti- ficially-modified condition of the properties of life. These conditions, however, are rarely exactly the same in any two individuals; but, they are strictly analogous in principle to the natural ones which dis- tinguish the several stages of life, and, so far as they may be known in any given case, we may calculate, with great approximation to the truth, what will be the special characteristic phenomena that will mark the organic, the animal, and the intellectual existence of that in- dividual-^ 153-156, 535, &c, 574, &c). Thus we have a series of analogies, in respect to the mutability of the properties of life, and corresponding results, which bring us upon the confines of disease ; which consists, also, in certain modifications of the vital properties, but more profound, more various, and more tran- sient (§ 176-182). Here lie the difficulties of medicine ; difficulties attending our knowledge of the modifying causes, the influences they produce, the complications of sympathy, and other contingent circum- stances. All these conditions must be known in any given case, to foresee, with certainty, any immediate or more remote result either of disease or of the action of any medicine, or of any natural vital agent. But, the properties of life being never very greatly varied from their natural character, we may come, by a careful observation of their varying phenomena, to a knowledge of their conditions, and to foresee the results, or such as may spring from the operation of medicine, from the different kinds of food, &c, with sufficient accura- cy for all useful purposes. With this knowledge, we get at the most important laws of disease, general and specific, and build up princi- ples which are more valuable in practice than ages of disconnected experience (§ 149, 150). 238. I have said, that although instability is a prominent character- istic of the properties of life, and lies at the 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 naturce, 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 itrun- 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). 241, 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 age ; 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- * Here I may say that analogy proves that there is but one species of mankind, since th< manifestations of reason and instinct are the same in all. 124 INSTITUTES OF MEDICINE. bles him, with the foreign aid of reason, to imbibe the sustenance re- quired by organic 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 ranging through all the labyrinths of nature, investigating their phenomena, developing their powers, their subsidiary causes, and their laws, turning in upon itself and multiplying its knowledge, and en- larging its powers by its own independent efforts, laying up the gains of the past as a fruitful source of present good and of farther acquisi- tions, distinguishing good from evil, from which results the sense of moral responsibility, investigating its own attributes, and attempting even its own nature, and tracing up its existence to a Higher Power, as the Author of the Universe which was made for the contemplation and the enjoyment of mind (§ 175). 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, 350£ 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 will, another property of the mind, upon which volition depends, 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). 246. Thus it appears that the unity in the great plan of the ner- vous power, in its relations to both organic and animal life, to mind as well as to matter, and the perfect concurrence of all the facts, and the obvious nature of the whole, which declare a harmony of principles and laws throughout all the immense variety relative to the nervous power, continue to unfold a grandeur of the subject which invites an unprejudiced attention to the expositions I have made of this brilliant institution of Nature (§ 1069-1082). FOURTH DIVISION OF PHYSIOLOGY. FUNCTIONS. 247. Our fourth grand division of Physiology comprehends the functions of organic beings. They are carried on by the properties of life in their connection with organized structure (§ 170, 175, 177), and of which the functions are the great final causes, or effects (§ 176). They 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, 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. TIL Other mental and instinctive functions. 126 INSTITUTES OF MEDICINE. T. 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 cceca; in a third by bunches of cells ; in a fourth by a spongy mass; in a fifth by branched ducts ending in feather-like terminal twigs';" and so on, up to the complication of the most perfect animals. Nevertheless, they all secrete a very analogous fluid. And so of oth- er organs and functions. A due regard for the preceding facts must unavoidably reconcile every mind to what I have said as to microscopical explorations of the minuteness of structure (§ 131, 304, 306, 409, 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 musclen 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 sc (§ 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, are 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 entire!v 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- nize a unity of design, and a simplicity in the great institutions of nature. Every system of vessels, so far as known, has but one func- * 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, and 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 equilibrio. 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 (§ 1089). 276. Different substances are absorbed with various degrees of ra- pidity, both in animals and plants. This depends on their peculiar virtues, and on the manner, therefore, in which they affect irritability; thus showing the vital nature of the process (§ 149,188, &c, 207). The same conclusion is also inferable from experiments, as well upon plants as animals. 277, a. Again, the lacteals, in virtue of their special modifications of irritability, exclude every thing but chyle. Bile is not taken up either by the lacteals or lymphatics ; cathartics pass off; emetics are rejected. The principle is every where; is shown in the larynx, pylorus, &c, in the 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 * See Med. and Physiolog. Comm., vol. ii., p. 168, 169, 171-173. t Ibid., vol. i., p. 683-690, 699-712. I 130 INSTITUTES OF MEDICINE. whole. Had not the lacteals and lymphatics been endowed in this wonderful manner, or were absorption a mere physical process, or ca- pillary attraction, 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 m 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 h, 524 d, 525, 526 d, 528 c, 638, 649 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). 2S0. 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 progress 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 I have omitted the investigation of one essential fact or experiment that has been alleged or instituted in behalf of humoralism. If such omission has occurred, let it be shown. 282. Many distinguished men have been led into the error of sup- posing that noxious substances are taken readily into the circulation because the skin is deeply tinged with yellow, in jaundice ; or because the bones become red when madder is eaten; or the urine is colored by rhubarb, or manifests the odor of 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 moro 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 as allow the existence of a vital principle. Thus, for example, Liebig has it, that, " A cotton wick inclosed in a lamp, which contains a liquid satura- ted with carbonic acid, acts exactly in the same manner as a living plant in the night. Water and carbonic acid are sucked up by capil- lary attraction, and both evaporate from the exterior part of the wick." Again, "All substances in solution in a soil are absorbed by the roots of plants exactly as a sponge imbibes a liquid, and all it con- tains, without selection."—Liebig's Organic Chemistry 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." In the first place, however, it is not true that the roots of plants imbibe their nourish- ment " without selection." When plants are cultivated in glass ves- sels containing distilled water, their roots will even decompose the glass, and select its silica, or alkali, or take them both, and assimilate them to themselves, and in the absence of any known chemical affini- ties or influences. Absorption is nearly as exact in plants as in ani- mals ; and so is appropriation. Like animals, their absorbent system PHYSIOLOGY.--FUNCTIONS. 133 is naturally repulsive of every thing that is offensive and not suitable to their economy. If poisons, when artificially applied, get admission, it is by inflicting a violence on the radicles of plants (§ 27S). 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 effects of vital action ; [ ! ] as in the wick of a lamp, which draws up oil to supply the combustion above, but will cease to do so when the de- mand no longer exists" ! (§ 64 g, 175 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 is 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 Barbieri 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 ex4osmose. They are gen- erally predicated of experiments upon dead matter, and are then car- ried, by way of analogy, to the living organism, and in defiance of all the contradictory phenomena of life. Having entered extensively into a refutation of the hypothesis of endosmose and ex«iosmose, 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. PHYSIOLOGY.--FUNCTIONS. 135 298. The nutriment of vegetables consists always of inorganic sub- Btances, 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 (fy 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 whir-b 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 elements must have been embraced originally in the atmosphere, and in the simple conditions which I have stated. Nor is it a difficult process to follow out that circuit of causes and effects in which revolves the economy of nature in making the waste of organic beings during their own existence a subsidiary supply of nourishment to themselves, or to others of their own day, or to generations in the womb of time; or, when consigned " to the dust," how their elements, from one genera- tion to another, form an endless round of materials for reproduction and growth, either in the form of gases and vapor diffused in the air, or as 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 making 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 (§ 188£ 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 (§ 188^, 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, Sec, p. 70, 71. 303i, c. 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 (§ 303}). ... As to the relations of the living plant to organic life, it is computed by Saussure, and allowed by others, that the atmosphere contains about __i__th part of'its 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 1800 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. 3031. 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 cai'bonic 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-|. 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 foregoing quotation (§ 1052, 1053). But, it may, perhaps, be well enough, before dismissing this sub- ject, to say, that, although " the laws of life cannot be investigated in an organized being which is dying," the laws which govern diseased actions and their results are only slightly modified " laws of life," and often reflect great light upon their strictly healthy condition. We are, or should be, constantly reasoning in this manner in all cases of disease; and it is only by comparisons of the modifications, which constitute disease, with the natural conditions of life, that we can have 140 INSTITUTES OF MEDICINE. any just knowledge of diseases. In proportion, however, as the indi- vidual approximates a state of death, all this reasoning fails; and, when actually dead, no such comparisons can be instituted. Here, then, it is that the foregoing admission of the chemist applies with all the force of truth. . '. 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 m 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 xepeatedly 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, Sec, 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- tatinor 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 saliva; while the disappearance of some of the components of the bile, and other relative facts, show a direct connection of this fluid with the 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, being its great final causes, we may safely reject the hypothesis of the mechan- ical theorists, that the liver, like the lungs, is designed to depurate the blood. The injury consequent On the failure of the liver, by ex- periment or otherwise, to perform its function, no more proves its supposed depurating office than a like contingency befalling the stom- ach would place that organ in the same category. 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 ro 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 seives 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 secreting or- gans, yet only generated, respectively, by one special part, their pro- duction in unusual quantities, especially of the gastric juice, to meet the exigencies of digestion; the apparently exact similarity in the composition of the chyme of all animals, whatever the nature and the variety of the food ; it appears to be one of the highest absurdities to suppose that all this complexity of 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 manner of Cuvier, the constitution of animals in respect to the subserviency of the various parts of the fabric to the single function of digestion, and according to the nature of each species of animal; and when we shall have reflected upon the principles which determine the coincidences, and see that no one of them can be explained by any of the forces and laws of the inor- ganic world, let us cast from us, as unworthy a thoughtful mind, the supposition that the final act, or that of digestion, is a chemical pro- cess ; and let us also apply the same induction to every other process of living beings. "Every organized being," says Cuvier, "forms a whole, a unique, and 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 vertebras 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 the clavicle and acromion, and the straightness of the scapula. Not naving 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 thatvorgan 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.--FUNCTIONS. 147 more instantaneous changes which are effected in the entire circula- ting mass of blood by abstracting only an ounce of it from the arm (§ 845, &c). 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, toi, 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 vita, 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- ogy and Organic Chemistry, in their relation to healthy and morbid processes. 333. The doctrines of life, as hitherto expounded, should be appli- cable to all the problems in organic beings which may seem to a su- perficial observer to fall under the laws of chemistry, or of physics. Such problems are especially presented by digestion, respiration, and the production of organic heat; and these are the main intrenchments 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 chemistrv 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 ? 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 chantzes. 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 ot 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 bis 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 combinatioxs and forms, indicates the presence of A peculiar mode of attraction, and the existence of a POWER DISTINCT FROM ALL OTHER POWERS OF NATURE, namely, THE vital principle." " If the food possessed life, not merely the 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 poavers 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 doe's not the blood putrefy ] Why not any other animal or vegetable fluid 1 Why not any living animal or vegetable solid? 340. Let us now hear the student of organic nature upon the phys- iology of digestion. What says John Hunter, of whom it is said by one, that "he stands alone in our profession ;" that, " in his immense career, every thing bore reference to one great idea,—the discovery and elucidation of nature's laws ;" " 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 proeess 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 intestines of the living animal, can in the smallest degree influence the doctrine of digestion." " Food placed in all the chemical circum- stances that can be conceived similar to those in which it is placed in the living animal, will never be converted into chyme, but will under- go other changes totally different." He finally adds, as the result of his own experiments out of the stomach, that, " 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). 342. It is the opinion of Tiedemann, another distinguished inquirer into the nature of digestion (§ 340, 341), that, " All the phenomena of digestion and assimilation, and which are only observed in living bodies, appear to rest, as to their foundation, on the vital property which organized liquids possess of producing, under certain circumstances, in other organic matters, similar changes that cause these bodies to acquire the properties themselves are en- dowed withal." Again: " It cannot be mistaken that digestion is an operation exclusively the property of living bodies, and is in no 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. clergo 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 (§ 5\, b). 344. In considering farther the physiology of digestion, I shall in- troduce, in the first place, a series of general conclusions which have been derived from chemistry, both as to digestion and other organic processes, and when in this respect and otherwise prepared, I shall state the remaining grounds upon which I rely more specifically for establishing the vital doctrine. 345. Let us hear, then, the distinguished chemist, Dr. Prout, as the representative of those who mingle chemistry with vitalism. "First," says Dr. Prout, "the stomach has the power of dissolving alimentary substances, or, at least, of bringing them to a semi-fluid state. This operation seems to be altogether chemical. " 2d. The stomach has, within certain limits, the power of changing into one another the simple alimentary principles," and " this part 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 chemistiy 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. 347. 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 chemjcal 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."—Dr. 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,^). " 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/??- human science to detect, or for human art to imitate." And thus the eminent Wagner, not less arrayed on the side of chemistry: "The existence of one or more powers, commonly called vital powers, is not, however, denied. The final cause of the secretion of the gastric juice lies in the nature of the animal organism, and is unknown to us."—Wagner's Physiology, London, 1842, p. 346. And yet this distinguished observer is one of the manufacturers of gas- tric juice. 349, a. Thus might I go on with one after another, till I should have exhausted the whole that have attempted to confound the scie'nce 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- 151 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 Philosophy of Vitality and the Modus Operandi of Remedial Agents" I had occasion to say of the article on " Poisons, Contagions, and Miasma," in Liebig's " Organic Chemistry applied to Agriculture and Physiology," that " it is certainly'the most stupendous exhibition of perverted facts, of combinations of conflict- ing doctrines, and of the rudest system of pathology and therapeutics, that can be found in the records of dreamy speculation." It was objected by the editor of the London Lancet, that I did not prove my allegations (§ 5£, a). Nor was it in any respect the object of that work to do so. I was satisfied with calling attention to the facts, and with what I had already published in the Medical and Phys- iological Commentaries. Since that day, the work on " 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- stowed the honor of achieving the enterprise upon a foreign Chemist. The note of proscription has been sounded in high quarters, in due conformity (§ 5\ a, 350| 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) 1 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 Potuers, 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, Sec, " 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- iology, &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 applied to the investigation her quantative method of research" ! (§ 18, 409.) c. "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 foetus in a fowl's egg ? Not more, surely, than with the development of the seeds of a plant. Let us first endeavor to refer to their ultimate causes those phenomena of life which are not psychological; and let us beware of drawing con- clusions before ice 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 must 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 mater'al, the human intellect has only conceptions. We can ascertain how- ever, the laws wnich 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" (§ 108, /*)•—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 tiling. 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."—B,eid, ore 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 of chem- 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- 48. " 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 quainted with it."—Liebig's their methods of research the Animal Chemistry. (See mottoes greater part of the success which b, e.) has attended their labors."—Lie- big's Animal Chemistry (a). 3. " In the animal bo dy we 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 prevented, 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. 41,181). ' \ 5i. Nevertheless, " we ascribe the higher phenomena of mental exist- ence to AN IMMATERIAL AGENCY, and that, in so far 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 m 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, Sec, p. 13-18.) 51\. " 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 AT REST, and of OPPOSING RESISTANCE to other forces producing mo- tion, Such as THE CHEMICAL FORCE, heat and electricity."—Liebig's Lectures for 1844. " Every thing in the organism goes on under the influence of the VITAL FORCE, AN IMMATERIAL agent, which the chemist cannot employ at will."—Liebig's Ani- mal Chemistry. 54. " There is nothing to pre- vent us from considering the vital force as a peculiar property, which is possessed by certain ma- terial bodies, and becomes sensi- ble when their elementary parti- cles are combined in a certain ar- rangement or form. This suppo- sition takes from the vital 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. 56. " 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 § 3501, 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 heart.] 11. " The power to effect trans- 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, Sec 12. " The combinations of the chemist relate to the change of matter, forward and backward, 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."--LlEBIG'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- discoveries (chemical), appears the duces. Its laws must be inves- process of nutrition in animals, tiga.ted.just as we investigate those the FORMATION OF THEIR ORGANS," of the OTHER POWERS which effect &c. motion and changes in matter."— 14. "Inthehandsofthephysiolo- Liebig's Organic Chemistry ap- gist, organic chemistry must be- plied to Physiology, Sec 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^-350|). 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 arities of chemical forces, and with the galvanic battery. We of the not less wonderful cause know not how a certain invisible which we regard as the ultimate something, heat, gives to certain Origin of electrical phenomena." bodies the power of exerting an —Liebig's Animal Chemistry. enormous pressure on surround- 17. " The mysterious vital ing objects. We know not even L 162 institutes of medicine. chemical doctrines. principle can be replaced by the chemical forces."—Liebig's Or- ganic Chemistry applied to Phys- iology, Sec. 17^. " The high temperature of the animal body is uniformly and under all circumstances the result of the combination of a combusti- ble substance with oxygen." " The carbon of the food, which is converted into carbonic acid within the body, must give out ex- actly as much heat as if it had been directly burned in the air, or in oxygen gas. The only difference is, that the amount of heat pro- duced is diffused over unequal times." " By the combination of oxygen with the constituents of the 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). 18. " The nerves which accom- plish the voluntary and involunta- ry motions in the body (no. 7-9) are, according to the preceding exposition, not the producers, but ONLY THE CONDUCTORS OF THE vital force (§ 59). They permit VITAL DOCTRINES. how this something itself is pro- duced when we burn wood or coals. " So it is with THE VITAL FORCE, and with the phenomena exhibit- ed by living bodies. The cause of these phenomena is not chem- ical force; it is not electricity, nor magnetism. It is a peculiar force, because it exhibits mani- festations which are formed by no OTHER KNOWN FORCE." 61. "In regard to the nature and essence of the vital force, we can hardly deceive ourselves, when we reflect, that it behaves, in all its manifestations, exactly like other natural forces; that it is devoid of consciousness or of vo- lition, and is subject to the action of a blister." — Liebig's Animal Chemistry. 61£. " Certain other constitu- ents of the blood may give rise to the formation of carbonic acid in the lungs. But, all this has no CONNECTION with that VITAL PRO- CESS by which the heat necessa- ry for the support of life is gen- erated in every part of the body." —Liebig's Animal Chemistry. 62. " In the present state of our knowledge, no one, probably, will IMAGINE that ELECTRICITY is tO be considered as the cause of the phenomena of motion in the body." " Every thing in the ani- mal 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.] 18j. " 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 imitself 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 power, capable of re- newing itself at every moment of their existence."—Liebig's Ani- mal Chemistry. 21. "While the assimilation chemistry—functions. 163 t 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 the nerves 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 require light, and, indeed, sun light, it is not necessary that the direct rays of the sun reach them. Their functions certainly proceed with greater intensity and rapidity in sunshine, than in the diffused light of day; but it merely accelerates in a greater degree the action ALREADY EXISTING." -- LlEBIG's Organic Chemistry applied to Physiology, Sec 65. " The vital principle is only known to us through the pe- culiar form of its instruments ; 104 institutes of medicine. I ♦ chemical doctrines. vital doctrines. of food in vegetables, and the that is, through the organs in WHOLE PROCESS OF THEIR FORMA- WHICH IT RESIDES. Hence, what- tion are dependent on certain ever kind of energy a substance external influences which pro- may possess, if it is amorphous duce motion, the development ofthe and destitute of organs from animal organism is, to a certain which the impulse, motion, or extent, independent of those exter- change, proceeds, it does not nal influences, just because the live. Its energy depends, in animal body can produce within this case, on a chemical action. itself that source of motion Light, heat, electricity, or other which is indispensable to the influences [justly considered here vital process."—Liebig's Ani- by Liebig as vital stimuli and not mal Chemistry. forces] may increase, diminish, or 22. " Neither the emission of arrest this action ; but they are carbonic acid nor the absorption not its efficient cause." " The of oxygen (by plants) has any con- vital principle opposes to the nection with the process of assim- continual action of the atmosphere, ilation ; nor have they the slight- moisture, and temperature, upon est relation to each other. The the organism, A resistance which one is purely a mechanical, the is, in a certain degree, invincible. other a purely chemical process. It is by the constant neutralization A cotton wick, inclosed in a and renewal of these external in- lamp, which contains a liquid sat- fluences that life and motion are urated with carbonic acid, acts ex- maintained" — Liebig's Organic actly in the same manner as a liv- Chemistry applied to Physiology, ing plant in the night."—Liebig's &c. (§ 188^, d). " Organic Chemistry applied to 66. "An abnormal production Physiology, Sec of certain component parts of plants 23. " At night, a true chemical presupposes a power and capabil- process commences, in conse- ity of assimilation, to which the quence of the action of the oxygen most powerful chemical action of the air upon the substances cannot be compared. The best composing the leaves, blossoms, idea of it may be formed, by con- and fruit. This process is not at sidering that.it surpasses in power all connected with the life of the the strongest galvanic battery, with vegetable organism, because it which we are not able to separate o-oes on in the dead plant exact- the oxygen from carbonic acid, as ly as in a living one" ! is done by the leaves of plants," Nevertheless, " and without the direct solar rays." 23£. " What value can be at- 67. " All that we can do is to tached to experiments, in which supply those substances which are all those matters which a plant adapted for assimilation by the requires in the process of assim- power already present in the or- ilation, besides its mere nutri- gans of the plant."—Liebig's Ce- ment, have been excluded with ganic Chemistry applied to Phys- the greatest care ] Can the iology, Sec laws of life be investigated in 68. " The living part of a plant an organized being which is dis- acquires the whole force and di- eased or dying 1"—Liebig's Or- rection of its vital energy from ganic Chemistry applied, Sec—Or, the absence of all conductors of r,an those laws be investigated in force. By this means the leaf is PHYSIOLOGY.--ORGANIC CHEMICAL DOCTRINES. ' a cotton wick, inclosed in a lamp V 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 (§ 3501, 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, Sec 26. "All substances in solu- tion in a soil are absorbed by the roots of plants, exactly as a sponge imbibes a liquid, and all that it contains, without SELECTION," and "THEIR ASSIMI- LATION is a PURELY CHEMICAL PRO- CESS."—Ibid. (no. 22, § 289-291). Nevertheless, 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 orgam 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, Sec 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 Chamopodium 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 ; they 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, Sec. (§ 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, or decay." —Liebig's Animal Chemistry. " Those remarkable phenom- ena, FERMENTATION, PUTREFAC- TION, and decay, are the pro- cesses of Decomposition, and their ultimate results are to re- convert the elements of organic bodies into that state in which they exist before they participate in the processes of life."—Liebig's Lec- tures for 1844. 30. " The second part of the work will treat of the chemical processes which effect the com- plete destruction of plants and animals after death, such as the peculiar modes of decomposition usually described as fermentation, putrefaction, and decay."—Lie- CHEMISTRY--FUNCTIONS. 167 VITAL doctrines. To of oo o of its 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 of force 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, Sec—(§ 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, Sec 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 of parts 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 6tomach, to which a few drops of muriatic acid have been added, precisely as in the stomach it- self."—Liebig's Organic Chemis- try, Sec (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, Sec, (§ 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 f.t.e- PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 169 CHEMICAL DOCTRINES. 35. Although "the process of CHYMIFICATION IS INDEPENDENT of the vital force, and takes place in virtue of a purely chemical action, exactly similar to those processes of decomposition which are known as PUTREFACTION, FERMENTATION, or decay ;" nevertheless, " Inor- ganic compounds differ from or- ganic in as great a degree as in their simplicity of constitution."— Liebig's Animal Chemistry, and Organic Chemistry. 36. " The power of elements to unite together, and to form pecu- liar compounds which are genera- ted in animals and vegetables, is chemical affinity." — Liebig's Organic Chemistry applied to Physiology, Sec 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 VITAL DOCTRINES. ments of these substances to unite into a compound fitted for the for- mation of the blood."—Liebig's Organic Chemistry, Sec 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, Sec 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. 865. " 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, Sec 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."~ IjIebig'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. 17] CHEMICAL DOCTRINES. VITAL DOCTRINES. and that we are enabled to exer- 91. " The vital force in a liv- cise an influence on every part of ing animal tissue appears as a an organ by means of substances cause of growth in the mass, and possessing a well-defined chem- of resistance to those external ical action."—Liebig's Animal agencies which tend to alter the Chemistry (mottoes a-e). form, structure, and composition 41. " It is singular that we find of the substance of the tissue in medicinal agencies all depend- which the vital energy resides."— ent on certain matters, which Liebig's Animal Chemistry. differ in composition [moral emo- 92. " The slightest action of a tions, heat, cold, change of air, ex- chemical agent upon the blood ex- ercise ?]; and if, by the introduc- ercises an injurious influence. tion of a substance, certain abnor- Even the momentary contact with mal conditions are rendered nor- the air in the lungs, although ef- mal, it will be impossible to reject fected through the medium of cells the opinion, that this phenomenon and membranes, alters the color depends on a change in the com- and other qualities of the blood." position of the constituents of the —Liebig's Organic Chemistry ap- diseased organism [no. 5], a change plied to Physiology, Sec in which the elements of the 93. " Every substance may be remedy take a share similar to considered as nutriment, which that which the vegetable ele- loses its former properties when ments of food have taken in the acted on by the vital principle, formation of fat, of membranes, of and does not exercise a chemical the saliva,, of the seminal fluid, Sec action upon the living organ. An- [!] Their carbon, hydrogen, or ni- other class of bodies change the trogen, or whatever else belongs direction, the strength, and inten- to their composition, are derived sity of the resisting vital principle, -from the vegetable organism; and, and thus exert a modifying influ- after all, the action and effects of ence upon the functions of its or- quimne, morphia, and the vegeta- gans. These are medicaments. ble poisons m general, are no A third class of compounds are hypotheses" ! — Liebig's Animal called poisons, when they possess Chemistry (§ 18, and motto d). the property of uniting with or- 42.« With respect to the action gans or with their component of quinine, or the alkaloids of opi- parts, and when their power of ef- um, &c, physiologists and pathol- fecting this is stronger than the re- ogists entertain no doubt that it is sistance offered hy the vital princi- exerted chiefly on the brain and ^."—Liebig's Organic Chemis- nerves. If we reflect that this ac- try, Sec. 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, 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 (§ 350|, 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 sugar and gluten, that the two processes have been long since compared to one another, althouo-h 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 byfe 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 VITAL DOCTRINES. 96. "It is only by a just appli- cation of its principle that any theory can produce really bene- ficial results."—Liebig's Animal Chemistry. 97. " We can have no very high idea of experiments made by gen- tlemen (chemists, with reference to digestion) who, for want of ana- tomical knowledge, have not been able to pursue their reasoning even beyond the simple experi- ment itself." — John Hunter's Observations on Digestion. CHEMICAL DOCTRINES. generated" ! " The susceptibility of infection by the virus of human Bmall-pox must cease after vacci- nation, for the substance to the presence of which this suscepti- bility is owing has been removed from the body by a peculiar pro- cess of decomposition artificially excited" ! " Cold meat is always in a state of decomposition. It is possible that this state may be communicated to the system of a feeble individual, and may be one of the sources of consump- tion" !!—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." " The true cause of death is THE RESPIRATORY PROCESS, [! ] that is, the chemical action of the at- mosphere." — Liebig's Animal Chemistry (§ 674-676). rC£ 7he ?f 0tm °aJ -f5°m ','^iebi?'s 9rSanic Chemistry applied to Physiology" are de- rived from Mr Playfair's edition, London, 1840; those from •« Liebig's Animal Chemis- try are taken from Professor Gregory's edition, reprinted New York, 1842. The italics and capitals are mine. 3501. To carry out the full object of the foregoing section, I shall devote another to a farther exhibition of the pathological and thera- peutical doctrines which have been deduced by the author of the " new era in medicine" from his chemical and physiological elements, as their resulting compounds. This more extended display of theoret- ical and practical doctrines, as they came to us from the laboratory, will reflect a broad light upon the chemical hypotheses of digestion, nutrition, &<•., as set forth in the preceding section, and show us, also^ the extent of the probabilities which relate to the analysis of food and of the conclusions which are predicated of that analysis (§ 18, 409, 676 b), and, in brief, enable us to comprehend the nature and amount of the service which organic chemistry has rendered to the science of medicine. This otherwise isolated subject will be farther interesting, as I shall embrace in the quotations the whole science of medicine as founded 174 INSTITUTES OF MEDICINE. on chemistry and physics, and thus place in contrast the systems of the two rival schools, and enable the reader to adjust their relative mer- its. To do this work of consigning chemistry to its legitimate pur- suits the more effectually, I shall also expose, in an appropriate place, the chemical doctrine of animal heat in the language of him who is supposed to have settled the philosophy of that subject (§ 433-450, 676). And before proceeding to a farther exposition of the vital and chemical doctrines of digestion, I shall, in consideration of the gen- eral surrender of this subject to the laboratory of the chemist, exhibit the corroborating testimony of the distinguished Mulder, that physiol- ogy and medicine have nothing to hope from observations conducted out of the living body (§ 350, nos. 48,49, also Lehmann, §1029,1030). By the method now contemplated, obstacles may be removed, and the reader better disposed to consider maturely the grounds upon which I have placed the vital doctrine of digestion, and come the more willingly to the conclusion that none are so imperfectly qualified to interpret the properties and laws of organic beings as they who can reason alone from the slender and deceptive analogies supplied by in- organic nature, and artificial expedients. It is certainly remarkable that this systematic exposure should be necessary at the middle of the nineteenth century, when arts and all other sciences, though more so the arts, are making a steady, some- times an astonishing progress. I may be mistaken in the importance which I have attributed to the innovations which have been made by organic chemistry upon medi- cal philosophy. I know that I am but feebly sustained by others in my conclusions; though now and then a blaze of mind assures me that deep volcanic action is in smothered progress (§ 376|). 350|, a. We have, then, from the authorized works of Liebig (§ 349, d), in the first place, the following inductions, in the order of their occurrence, of Pathological Principles, or " Theory of Disease" (350, no. 59). " Every substance or matter, every chemical or mechanical agency, which changes or disturbs the restoration of the equilibrium between the manifestations of the causes of waste and supply, in such a way as to add its action to the causes of waste, is called a cause of dis- ease. Disease occurs when the sum of the vital force, which tends to neutralize all causes of disturbance, in other words, when the re- sistance offered by the vital force, is weaker than the acting cause of disturbance ;"—with the reservation, nevertheless, that " the cause of disturbance, or chemical force and the vital force, are one and identical." 350%, b. " Death is the condition in which all resistance on the part of the vital force entirely ceases. So long as this condition is not es- tablished, the living tissues continue to offer resistance." 350|, c. " To the observer, the action of a cause of disease exhibits itself in the disturbance of the proportion between waste and supply which is proper to each period of life. In medicine, every abnormal condition of supply or of waste, in all parts, or in a single part of the body, is called disease." 350.}, d. " It is evident that one and the same cause of disease will produce in the organism very different effects, according to the period PHYSIOLOGY.--OPvGANIC CHEMISTRY--FUNCTIONS. 175 of life. A cause of disease which strengthens the causes of supply, either directly or indirectly, by weakening the action of the causes of waste, destroys, in the child and in the adult, the relative normal state of health ; while in old age it merely brings the waste and supply into equilibrium. 350-|, e. " A child, lightly clothed, can bear cooling by a low exter- nal temperature without injury to health. [! ] The force available for mechanical purposes and the temperature of its body increase with the change of matter which follows the cooling; while a high tempera- ture, which impedes the change of matter, is followed by disease." 35Q±,f. " A deficiency of resistance, in a living part, to the causes of waste, is, obviously, a deficiency of resistance to the action of the oxygen of the atmosphere. 3501, g. " When, from any cause whatever, this resistance dimin- ishes in a living part, the change of matter increases in an equal de- gree. 3504;, h. " Now, since the phenomena of motion in the animal body are dependent on the change of matter, the increase of the change of matter in any part is followed by an increase of all motions. According to the conducting power of the nerves, the available force is carried away by the nerves of involuntary motion alone, or by all the nerves together. [! ] 3501, i. "Consequently, if, in consequence of a diseased transforma- tion of living tissues, a greater amount of force be generated than is required for the production of the normal motions, it is seen in an ac- celeration of all or some of the involuntary motions, as well as in a higher temperature of the diseased part. This condition is called fever. 3501, j. " When a great excess of force is produced by change of matter, the force, since it can only be. consumed by motion, extends itself to the apparatus of voluntary motion. This state is called a febrile paroxysm. 3501, Ji, « In consequence of the acceleration of the circulation in the state of fever, a greater amount of arterial blood, and, consequent- ly, of oxygen, is conveyed to the diseased part, as well as to all other parts; and, if the active force in the healthy parts continue uniform, the whole action of the excess of oxygen must be exerted on the dis- eased part alone (§ 350, no. 10). 3501, I. " According as a single organ, or a system of organs, is af- fected, the change of matter extends to one part alone, or to the whole affected system. 3501, m. " Should there be formed, in the diseased parts, in conse- quence of the change of matter, from the elements of the blood or of the tissue, new products, which the neighboring parts cannot employ for their own vital functions ; should the surrounding parts, moreover, be unable to convey these products to other parts, where they may un- dergo transformation, then these new products will suffer, at the place where they have been formed, a process of decomposition analogous to fermentation or putrefaction" ! 350j, n. "If we consider the fatal accidents which so frequently occur in wine countries from the drinking of what is called feather- white wine, we can no longer doubt that gases of every kind, wheth- er soluble or insoluble in water, possess the property of permeating ani- 176 institutes of medicine. mal tissues, as water penetrates unsized paper [! ] (§ 350, no. 24). This poisonous wine is wine still in a state of fermentation, which is in- creased by the heat of the stomach. The carbonic acid which is dis- engaged penetrates through 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 at- mospherical air. [!!!!!!] The patient dies with all the symptoms of asphyxia caused by an irrespirable gas, [! ] and the surest proof of the presence of carbonic acid in the lungs is the fact, that the inhalation of ammonia, which combines with it, is recognized as the best antidote against this kind of poisoning" !—(§ 1055). " No doubt a part of these gases may enter the venous circula- tion through the absorbent and lymphatic vessels, and thus reach the lungs, where they are exhaled; [! ] but the presence of membranes offers not the slightest obstacle to their passing directly into the cavity of the chest" ! (§ 349 d, 449 b, 827 h). 3501, o. " It is known that in cases of wounds of the lungs a pecu- liar condition is produced, in which, by the act of inspiration, not only oxygen but atmospherical air, with its whole amount of nitrogen, pen- etrates into the cells of the lungs. This air is carried by the circula- tion [! ] to every part of the body, [!! ] so that every part is inflated or puffed up with the air, as with water in dropsy. [! ] This state ceases, without pain, as soon as the entrance of the air through the wound is stopped." 3501, p. " The frightful effects of prussic acid, which, when in- spired, puts a stop to all the phenomena of motion in a few seconds, are explained in a natural manner by the well-known action of this compound on those of iron, when alkalies are present" !! (§ 494 d, 3, 827 d, 904 b).—Liebig's Animal Chemistry. 350%, q. The foregoing doctrines, with the humoral philosophy as quoted in § 350, nos. 40-45, make up the whole science of pathology as delivered to us from the laboratory; and such, too, are the doc- trines which are hailed as the foundation of " a new and the greatest era of medicine." There can be no doubt, however, that deliberate investigation will satisfy every mind that they are unintelligible, im- practicable, absurd; and, consequently, that the whole pretended sys- tem of physiology from which they are deduced, is equally unworthy the dignity of reason. 350|, a. I shall now employ the same authorized chemist (§ 349, d) to give the last blow to his baseless fabric, and to scatter its fragments beyond the reach of idolatry itself. This will be done by setting forth, in the language of the author, his deductions from the physio- logical and pathological doctrines of the laboratory, as to The Chemical Treatment of Disease (§ 350, no. 59). " The accelerated change of matter, and the elevated temperature in diseased parts, show that the resistance offered by the vital force to the action of oxygen is feebler than in the healthy state. But this re- sistance only ceases entirely when death takes place (nos. 1 and 2). By the artificial diminution of resistance in another part (as by blis- ters, sinapisms, or setons), the resistance in the diseased organ is not, indeed, directly strengthened; but the chemical action, the cause of the change of matter, is diminished in the diseased part, bein"- direct' PHYSIOLOGY.—organic chemistry—functions. 177 ed to another part, where the physician has succeeded in producing a still more feeble resistance to the change of matter, to the action of OXYGEN. 350|, b. " A complete cure of the original disease occurs, when ex- ternal action and resistance, in the diseased part, are brought into equi- librium. Health, and the restoration of the diseased tissue to its orig- inal condition, follow, when we are able so far to weaken the disturb- ing action of oxygen, by any means, that it becomes inferior to the re- sistance offered by the vital force, which, although enfeebled, has never ceased to act; for this proportion between these causes of change is the uniform and necessary condition of increase of mass in the living organism." 350|, c. "In cases of a different kind, where artificial external dis- turbance produces no effect, the physician adopts other indirect methods to exalt the resistance offered by the vital force. He dimin- ishes, by blood-letting, the number of the carriers of oxygen (the glob- ules), and, by this means, the conditions of change of matter; he ex- cludes from the food all such matters as are capable of conversion into blood, &c. 350|, d. "If he succeed, by these means, in diminishing the action of oxygen in the blood on the diseased part, so far that the vital force of the latter, its resistance, in the smallest degree, overcomes the chem- ical action; and if he accomplish this without arresting the functions of other organs, then restoration to health is certain. [! J 350f, e. " Practical medicine, in many diseases, makes use of cold in a highly rational manner, as a means of exalting and accelerating, in an unwonted degree, the changes of matter. This occurs espe- cially in certain morbid conditions, in the substance of the centre of the apparatus of motion; when a glowing heat and a rapid current of blood toward the head point out an abnormal metamorphosis of the brain [! ] (350, motto i, nos. 3, 5). When this condition continues beyond a certain time, experience teaches that all motions in the body cease. [! ] If the change of matter be chiefly confined to the brain, then the change of matter, the generation of force, diminishes in all other parts. [! J The metamorphosis Avhich decides the issue of the disease is limited to a short period. We must not forget that the ice melts and absorbs heat from the diseased part; that if the ice be removed before the completion of the metamorphosis, the temperature again rises; that far more heat is removed from the head than if we were to surround the head with a bad conductor of heat. There has obviously been liberated, in an equal time, a far larger amount of heat than in the state of health. [That is to say, such is the pathol- ogy of cerebral inflammation, such the remedy, and such its modus operandi.] 350|,y: " The self-regulating steam-engines, in which, to produce a uniform motion, the human intellect has shown the most admirable acuteness and sagacity, furnish no unapt image of what occurs in the animal body. " Every one knows, that in the tube which conveys the steam to the cylinder where the piston-rod is to be raised, a stop-cock of peculiar construction is placed, through which all the steam must pass. By an arrangement connected with the regulating wheel, this stop-cock opens when the wheel moves slower, and closes more or less completely M 178 institutes of medicine. when the wheel moves faster than is required for a uniform motion. When it opens, more steam is admitted (more force), and the motion of the machine is accelerated. When it shuts, the steam is more or less cut off, the force acting on the piston-rod diminishes, the tension of the steam increases, and this tension is accumulated for subsequent use. The tension of the vapor, or the force, so to speak, is pro- duced by change of matter, by the combustion of coals in the fire- place. The force increases (the amount of steam generated and its tension increase) with the temperature in the fire-place, which de- pends on the supply of coals and of air (§ 433, &c). There are in these engines other arrangements, all intended for regulation. When the tension of steam in the boiler rises beyond a certain point, the passages for admission of air close themselves; the combustion is re- tarded, the supply of force (steam) is diminished. When the engine goes slower, more steam is admitted to the cylinder, its tension di- minishes, the air-passages are opened, and the cause of disengage- ment of heat, or production of force, increases. Another arrange- ment supplies the fire-place incessantly with coals in proportion as they are wanted. " If we now lower the temperature at any part of the boiler, the tension within is diminished. This is immediately seen in the regu- lators of force, which act precisely as if we had removed from the boiler a certain quantity of steam, or force. The regulator and the air-passages open, and the machine supplies itself with more coals. " The body, in regard to the production of heat and force, acts just like one of these machines. With the lowering of the external tem- perature, the respirations become deeper and more frequent; oxygen is supplied in greater quantity and of greater density, the change of matter is increased, and more food must be supplied, if the tempera- ture of the body is to remain unchanged."—Liebig's Animal Chemistry. Here ends the science of therapeutics, as founded upon the prece- ding doctrines in physiology and pathology; and as the whole system is comprehended within the limits of the last three pages, the reader will readily contrast its brevity with the labors of the past, and will not fail to discover in this time-saving, thought-saving attainment of medicine, as well as in the impenetrability of the system itself, and the unequaled confidence with which it is set forth, the main causes of its success. I shall now proceed, as proposed in § 3501, to demonstrate by the farther showing of chemistry itself, that physiology and medicine have little to hope from the laboratory of the chemist. 350a, a. Of the school of pure chemistry, and of an authority ap- proaching to Liebig, is the distinguished Professor Mulder; less in- consistent than Liebig, but compelled to admit the existence of pecu- liar forces in living beings, yet positively denying them. He advo- cates, after the manner of Prichard, Carpenter, Fletcher &c. the existence of all the properties of living beings in the elements of mat- ter, which conducts him, like others, to the belief in Equivocal Gen- eration ; adopts the Catalytic theory of Berzelius, in which he differs fundamentally from Liebig (§ 409, j); reasons, after the usual manner of the physical philosophers of life, from the results of inorganic pro- cesses, and overlooks entirely, except by admission of their existence, all the unique phenomena of living beings, and, perhaps, more than physiology.—organic chemistry—functions. 179 any author of merit, is guided in his conclusions as to the processes and results of organic beings by the fallacious analogies which are studiously sought in the inorganic world. The whole system of vital philosophy, as taught by this distinguished Professor of Chemistry, may be so briefly set forth in extracts from his work on " The Chem- istry of Vegetable and Animal Physiology," and they convey so forci- bly the conjectural nature and worthlessness of chemical physiology, that the selection will contribute its important part toward the final expulsion of chemistry from the rich and fascinating domain of or- ganic nature. The quotations will be made in the order of their oc- currence in the work; and we learn from the first the author's opinion of force, which corresponds with my own as employed in the Com- mentaries, and as defended in my Examination of Retiews. Thus : 350^, b. " It is a matter of indifference whether w e conceive that the forces slumber in two substances, and are brought into operation by contact; or that these forces were present in the two bodies in an active state, previous to the contact, but produced the phenomena of combination only during the contact. The mode of considering this point is almost a matter of indifference ; but we must always bear in mind that it is a power, a force which is exerted by the one, and which acts upon the other."—Mulder. 3501, c. The next quotation is preliminary to the total denial of the Principle of Life, and of all the properties in living beings excepting such as are active or "slumbering" in the elements of matter. Here, too, appears the fallacy of analogies derived from the laboratory of the chemist. Thus: " Adhering to what we observe and know with certainty, we calcu- late that every elementary body is endowed with a great many specific properties, which, to a large extent, are dependent on the same prin- ciple that causes their combination, and thus on the proportion and character of the chemical tendency. If we adopt this idea, we have the advantage of seeing somewhat of vitality in dead matter. [!] It is an idea derived from the endless series of phenomena which are observed in the laboratory, in daily occurrences, and in nature at large" (§ 175, d).—Mulder.—(§ 1034, Lehmann). 350f, d. After the usual disquisition upon the " catalytic action" of platinum and other inorganic substances, we come next to the same application of catalysis, in connection with the ordinary laws of chem- ical affinity, to the interpretation of organic processes and results, as I have examined in the " Commentaries" (vol. i., p. 55-78). It com- prehends Mulder's whole theory of life, and is a good specimen of the author's analogical reasoning. Thus : " Platinum possesses chemical tendency in a high degree; but it is of such a kind, that it does not react upon the platinum. Hence it may be inferred, that we have good reason for distinguishing by a pe- culiar name such actions as proceed from certain substances without reacting upon themselves; and we have to acknowledge that to the introduction, by Berzelius, of the peculiar term catalysis, we are in- debted for a more correct idea of the nature of ordinary chemical action. " What is called the nascent state of substances is that condition of the elements in which they exhibit both analytic and catalytic phenom- ena ; in which, being free and unconstrained, not rendered powerless 180 institutes of medicine. % either by being agglomerated into masses, or by combination into com- pounds, they show themselves in their proper chemical condition; that is, an active one, in which they can operate upon others, excite a slumbering energy, and cause combinations and decompositions, in which they themselves may either participate or not. This nascent state is the real chemical state of bodies. In that state both the ele- ments and compounds exhibit themselves in their true character. In the organic kingdom the greater number of substances are actually in that condition; and to this nascent state we ought to ascribe the nu- merous peculiar phenomena apparent in organic substances" (§ 409).— Mulder.—($ 1034, Lehmann). 350f, e. The next quotation sets forth the whole practical applica- tion of the foregoing doctrines, and is a fine example of the chemical reduction of organic nature to the condition of dead matter, and one of the best summary exhibitions of chemistry in all its pretended re- lations to living beings. It begins with the caption " Disturbance of Chemical Equilibrium." "It is a property of the chemical forces, when active in any substance, to excite analogous forces in others. We notice this especially in organic nature, and it is nowhere more strikingly illustrated than in the nutrition of animals. Blood, a homogeneous fluid, circulates through very different parts of the body (§ 42). In the muscles it sustains muscles, in the liver it supplies the component parts of the liver, and from it the gall is there secreted; in the kidneys it maintains their various parts, and secretes the urine, &c. None of these secre- tions appear in the blood with their peculiar qualities ; of some of them not even a trace is found. But the four organic elements of the whole are to be found in protein and its combinations, in the coloring mat- ter of the blood, &c. The elements of protein might, no doubt, be transposed in the liver, &c, by means of catalysis, and so the compo- nent parts of the liver and gall be produced from it. It would only be necessary, then, that the constituent parts of the liver should be put into contact with the component parts of the blood, and the forces of affinity resident in the substance of the liver would not require to influence those in the protein, or to produce any chemical alteration in its component parts. "Other causes, however, ought undoubtedly to *be considered. For instance, a change of its component parts takes place in the liver itself, and, from the first, chemical forces actively operate therein For the continual change of its component parts is a chief character istic of every living organic substance. These forces may disturb the chemical equilibrium of other substances, and cause the formation of new products. If the constituents of the blood—the combinations of protein, the coloring matter, &c.—enter the liver when it is in a state of action, and are there put in contact with the gall during its secre- tion, and with the substance of the liver itself, which is in a state of continual alteration, then the result will be, that this change of their component parts having taken place, the action will be transferred to the elements of the blood, and will maintain the secretion. If, on the other hand, the constituents of the blood are in a state of continual change, then the circle of action in which they are involved will ex- tend to the mass of the liver; and so with every organ (§ 18). physiology.—organic chemistry--FUNCTIONS. 181 " We have, however, no more knowledge of the manner in which this secretion originally commences—whether it proceeds from the blood or from the secreting organ, [! ] or whether each of these con- tributes its part—than with the manner in which the first germ of the whole organ, the liver, is produced, or in which the germ of the ani- mal is converted into an animal. But the continuance of the action— the duration of secretion—entirely corresponds with some other phe- nomena, which we may observe separately, and which therefore throw light upon these animal actions. This is the case especially with fer- mentation, from which Liebig has drawn many illustrations, for the purpose of clearly exhibiting his ideas; and with the same view we shall also avail ourselves of this process. " Yeast changes sugar into carbonic acid and alcohol, and is at the same time changed itself. The latter change causes the former, and is only transferred to the sugar. If we substitute blood for yeast, and the liver for sugar, we may form an idea, more or less distinct, of the secretion of the gall. [! ] The component parts of the blood are con- tinually undergoing change. This constant change of the component parts in organic bodies is a chief cause of the continuation of their ex- istence. The liver without intermission assumes new parts and loses others. This process we call nutrition. At the same time that the parts of the blood in the substance of the liver are thus undergoing change, chemical forces are excited; these forces are transferred to the elements of the blood, and so are enabled to produce from them the gall. This takes place the more easily, as the blood itself is also in a state of continual alteration, and thus readily yields to the impulse which, in some way or other, is communicated to it. As the impulse varies, so does the effect. Hence that great diversity in the secre tion of very dissimilar substances, which are in a state of alteration, from the same fluid—that is, the blood, which is itself at the same time in a state of decomposition."—Mulder. 350\,f. In our next quotation we have an assumption founded on a begging of the very question at issue; that is to say, whether there be or not a radical difference in the original constitution of organic and inorganic nature. The author having assumed that there is no difference, proceeds, by the force of surmised analogies drawn from the probable constitution of inorganic matter, to repeat the assump- tion already stated that there are no other properties in living beings than such as exist in the elements of matter. Thus : " The idea ofcommunication of forces is unsound; it is only what is substantial that we can communicate. Forces may be excited, they cannot be communicated. Hence it results that every transformation in plants is effected by the molecular forces of carbon, hydrogen, ox- ygen, and nitrogen,—the elements of carbonic acid, water, and am- monia,—the forces being excited in these elements by the plants them- selves." " Any one who imagines that there is any thing else in ac- tion than a molecular force, than a chemical force, sees more than ex- ists. The forces excited in the elements vary with the influence which certain agents—temperature, moisture, light, &c.—exert. By the aid of crucibles and retorts, therefore, compounds can be formed which differ from those produced by the organs of plants ;■ while, from car- oonic acid and water, plants can produce cellulose and oxygen, a result which cannot yet be imitated by art." " To expres-g our idea in a 182 INSTITUTES OF MEDICINE. few words:—The elements of the organic kingdom, carbon, hydro- gen, oxygen, and nitrogen, are susceptible of endless modifications. For that reason they can form, with minute changes, a great diversity of products (§ 41); and by the operation of the same primary forces, they stand toward each other in entirely different relations from those assumed by all the other elements ; so that they can produce a pecu- liar scries of bodies, which are called organic substances" /* " Organic substances, whether called germs or food, possess properties of a pe- culiar kind, existing in the four elements of which they are all constituted" !—Mulder. 3501, g. The difficulty, therefore, with the chemists appears to li* in their habits of reasoning exclusively from what they observe of in- organic compounds and their elements, and an indisposition to admit that the Almighty superadded to organic beings a principle of life, while they allow the special creation of mind in animals. Nor does their philosophy permit them to imagine that the former may be as capable of governing all the processes of organic, as the latter is of animal life, and that the principle of life may be supposed, with as much reason as the principle of intelligence, to be imparted by the exact organization perpetuated from the Almighty Hand to new ac- cessions to that organization ; while the phenomena of life are far more multifarious and conclusive of the existence of a special princi- ple than such as oblige the chemist to yield bis assent to a mental principle distinct from the matter with which it is associated. Why, then, does not the chemist equally maintain the existence of mind, as of the properties of life, in the elements of matter, and that its devel- opment is alike owing to a difference of circumstances ] Does he fear that this stretch of materialism, this act of philosophical consist- ency, or his neglect to abjure the obvious inference, may impair our confidence in the apparency though not really less objectionable scheme of reducing organic life to the virtual condition of the simple elements of matter, and thereby divest the Creator of His great Pre- rogative by attributing creative power to those elements (§ 14, c) 1 3501, gg. But, let us hear the chemist upon this interesting point, And Liebig, first; who, also, shall show that no injustice is done by the preceding remarks. Thus : "The higher phenomena of " Physiology has sufficiently de- mental existence cannot, in the cisive grounds for the opinion that present state of science, be refer- every thought, every sensation, is red to their proximate, and still less accompanied by a change in the to their ultimate causes. We only composition of the substance of the know of them that they exist, brain; that every motion, every We ascribe them to an immaterial manifestation of force, is the re- agency, and that, in so far as its sult of a transformation of the manifestations are connected with structure or of its substance."— matter, an agency entirely distinct Liebig's Animal Chemistry. from the vital force, with which it has nothing in common."—Lie- big's Animal Chemistry. And now the other able and distinguished chief: * See my "Notice of Reviews," utcit, and my "Examination of Reviews," p. 43, 44, in " Commentaries," vol. iii. PHYSIOLOGY--ORGANIC CHEMISTRY--FUNCTIONS. 183 •• I will not venture to raise the veil, by which the action of the nerves, or the higher functions of the mind, have hitherto been shrouded from observation. As man has an immaterial and immor- tal part, which is identical with his real being, and of which alone he will consist, when the material frame by which he is bound to the earth, shall be dissolved; and, as the inferior animals possess, in com- mon with man, certain powers of perception, associated with certain appropriate organs, whose functions have no connection with con- sciousness ; so do animals and plants perform in common a great many operations which are distinct from both of those now mentioned, o\' which, at least, have their origin in distinct causes. " It is only the latter class of which I speak, and to which I apply the general term of organic life. To that subject I shall restrict my remarks."—Mulder, ut cit. Now, I say, 1st. Why not "raise the veil from the action of the nerves" in a professed work on physiology, and a work, too, which would revolutionize the science ? Have you no phenomena to guide you in " raising the veil ?" Do you fear their contact with the phe- nomena of the laboratory ? Is it right to make this declaration, and then to refer a vast series of phenomena exclusively to " organic life," which could have had no existence without the " action of the nerves" (see § 350, no. 18£) 1 I deny, too, 2d, that " the higher functions of the mind have hitherto been shrouded from observation;" and I am supported by all who truly believe in the independent existence of mind, in the affirmation that its " functions" are characterized by an infinitely greater variety of unique phenomena than are the processes of inorganic nature. There is no " veil to be raised" in this or the other case. It is, indeed, by the recognition of these phenomena that our author feels obliged to admit the existence of " an immaterial part," however inconsistent the simultaneous declaration that " the functions of the mind have hitherto been shrouded from observation." And, I am alike sustained, also, and by every dictate of philosophy, in the conclusion that, if the phenomena of mind are deoisive of the existence of " an immaterial part," so are the far more varied, and numerous, and equally unique phenomena of organic processes, con- clusive of the existence of some not less peculiar force, power, or " immaterial" or material " part," upon which they depend. In any event, however, the physiologist has a right to insist that the chemist shall not reject all considerations relative to the " action of the nerves," when he invades organic nature with retorts, crucibles, acids, &c. " Analogy is," undoubtedly, as Bacon says, " the basis of all the sciences." Nature, throughout, is bound together by analogies. The principle reaches from the Creator to the mind of man, to his " im- material and immortal part." And so it does from the force and the properties of life to those of dead matter. Here is the delusion of the chemist. But, there is even a wider difference between the formative principle of life and destructive chemical affinity, than there is between the Creative Spirit of God and the created, dependent spirit of man ($ 1076). 350f, h. The grand characteristic of organic life is the principle of life, capable of imparting that principle to matter which is destitute of it, and which it retains only while in its proper connection with the being by which it was so endowed. The doctrine which refers the 184 INSTITUTES OF MEDICINE. properties of life to the elements of matter is atheistical in its applica- tion (§ 14 c, 74, 175); and the recognition, simultaneously, of a " Cre- ative Power," is but another conventional word for nature, or design- ed to protect the doctrine against the fatal imputation of irreligion (§ 64, h). That imputation, however, is indelibly stamped by nature herself. The mode of defense is well shown in the late highly laud- ed and popular work on the " Vestiges of the Natural History of Creation," in which the author considers La Place's infidelity as to the modus operandi of matter in forming the Universe, and the doc- trine of spontaneous generation in its most ample extent. The au- thor's defense of Mr. Crosse's creation of animals out of silex is a good example of the specious reasoning by which so many are cheated into projects which contemplate the worst results to philosophy and relig- ion.* Thus: 350|, i. " The supposition of impiety arises from an entire miscon- ception of what is implied by an aboriginal creation of insects. The experimentalist could never be considered as the author of the exist- ence of these creatures except by the most unreasoning ignorance. The utmost that can be claimed for, or imputed to him, is, that he ar- ranged the natural conditions under which the true creative energy, that of the Divine Author of all things, was pleased to work in this instance. On the hypothesis here brought forward, the Acarus Cros- sii [! ] was a type of being ordained from the beginning, and destin- ed to be realized under certain physical conditions. When a human hand brought these conditions into the proper arrangement, it did an act akin to hundreds of familiar ones which we execute every day, and which are followed by natural results, but it did nothing more." The defense of La Place's system proceeds upon the same specious assumption (p. 910-911, § 1083). Now the foregoing doctrine transcends not only the usual geologi cal hypothesis of a successive creation of animals, but that, also, of spontaneous generation; both of which are, of course, anti-Mosaic, and regardless of the established order of creation (§ 303 a, 303i). But here we have an exemplification of a strictly atheistical expedi- ent, in the attempt to assign the existence even of organic beings to the merest chance, under the pretext of ascribing to that chance the intrinsic attributes of a Creative Power, and the imposing title of " the Divine Author of all things" ! It is the same with each and all who allow a God, a Creator, &c, yet reject entirely His Revelation as to creation, supported as it is by the most consummate and endless systems of Design. It is the old expedient of the wolf in the disguise of the sheep (§ 14 c, 64 h, 74, 733 d). 3501, k. Nevertheless, the foregoing work is powerfully sustained by able articles in the British and Foreign Medical Review for January, 1845, consisting of twenty-six pages of eulogistic remarks; and in the Medico-Chirurgical Review for the same month, often pages not less congratulatory. The work was published late in 1844, and, although not at all relevant to medicine, it was taken up with avidity by the two leading medical journals of Europe, and an effort See Medical and Physiological Commentaries, vol. i., p. 707 ; vol ii p 96 In vol i Grass ia a typographical error for Crosse. It is also possible that the "created animal's," instead oi being " crystalized spiculav' were real animals evolved by the action of tralvan- sim from ova contained in the water (see $ 74. 188^ d). B PHYSIOLOGY.—organic chemistry—functions. 185 made to prepossess the medical profession before the work itself should fall under their observation; observing in this respect the sys- tem which was almost universally pursued by the periodical press even in anticipation of Liebig's work on Animal Chemistry. In my Essay on Spontaneous Generation, embraced in the Medical and Physiological Commentaries, I have had occasion to refer to the charge of infidelity which is often laid against the Medical Profession. I have there, too, defended that Profession against so great an injus- tice, and have held responsible the proper Sources that have given rise to this imputation. I have also shown that that imputation is greatly due to the cultivation of the chemical and physical hypotheses of life, to which the foregoing Reviews have been laboriously devoted. In conclusion of the whole matter I have said that, " The steps are gradual from the incipient errors in natural philos- ophy to a disbelief in the Mosaic Record of Creation. When we have ultimately reached the brink of the precipice, there is but one dreadful plunge, and we are then in the vortex of atheism. We may begin, as I have said, by a simple denial of the living powers of or- ganized beings, when it will become, at last, an easy argument upon this, and analogous premises, that the Almighty had but very little, if any agency, in the most sublime part of existences." " Let philosophy interrogate nature to its fullest satiety, under the direction of its Heaven-born principles; but let it be consistent, and maintain its dignity. And should it sometimes, as it must in its wide range of nature, come in contact with miracle, that is its limit, con- tented that it begins at the confines of Creation; yet still may it stretch into the regions of Eternity, past and to come; but now it is employed in its nobler work of sacrificing its relations to second causes, and in establishing relations with the First Cause of All." —Medical and Physiological Commentaries, vol. ii., p. 140. 350|, kk. It is now my purpose to quote the foregoing Reviews in connection with the " Vestiges of Creation," partly for the object just assigned, and in part to supply other examples in justification of what I have said in behalf of the Profession, and of the tendency of the chemical and physical hypotheses of life and disease to lay the foun- dation of a grosser materialism, and of infidelity in Religion (§ 175). It seems peculiarly appropriate that Reviewers, who wield an exten- sive and powerful sway, and whose occupation it is to defame what- ever molests that dominion, should be used for the. contemplated pur- pose, and this, more especially, as both Reviewers offer defiance to the " Saints," and the "timid religionists." The Reviews are conducted with great diligence and research. Their influence is coextensive with medicine. That influence must be sapped by a display of its tendencies. There can be no difficulty with a defense of the right. The inculpated are able, their means ample, their coadjutors numer- ous and powerful, the public generous, and, as I said on a like occa- sion in the Commentaries, " I am single-handed, and have nothing but facts for my weapons" (vol. i., p. 391). Infidelity is certainly a term which should be well sustained in its application; better, at least, than when applied to myself by the first of the following journals (see Examination of Reviews, p. 84-88). As it respects the Reviewers, the imputation appears to be invited and expected, as an obvious consequence of the doctrines advanced; 186 INSTITUTES OF MEDICINE. and, although I do not belong to the denomination of " Saints," or of the " timid religionists," it is not less my duty as a man, and as an ex- pounder of the Institutes of Nature, to bring those institutions to op- erate upon infidelity. There can be no place more appropriate foi looking " through Nature up to Nature's God," than in the general survey of organic beings. If ordained in their organization and their laws by a higher Power, that organization and those laws may well be urged in proof of their Origin. Then, too, shall the minister of health realize the importance of the Institutes of Medicine, and the spirit of the Hippocratic maxim, that " a philosophical physician is like a god." I shall quote a passage of general import from each of the forego- ing Reviewers, that no doubt may linger upon the mind of any reader as to the justice of the criticism which I have now exercised in behalf of religion, of morality, of the dignity of medicine. The emphasis is mine. And first the elder brother; beginning thus : " This is a remarkable volume, small in compass, but embracing a wide range of inquiry from worlds beyond the visible starry firma- ment, to the minutest structures of man and animals. No name is pre- fixed,—perhaps in order to avoid the snarls of the narrow-minded and bigoted saints of the present day," &c. The middle thus: " For how many millions and millions of years this production and reproductions of animals went on before man made his appearance on the scene, no human being will ever know. [! ] In all probability, countless ages must have elapsed, before this master-piece of creation appeared. Our author's speculations on the how, the why, the when, and the wherefore this great event occurred, will not give satisfaction to the present race of mankind. [! ] His hypothesis is three or four centuries in advance of the times, and will be stigmatized by the modern saints as downright atheism," &c. And the end, thus : " We have dedicated a space to this remarkable work that may in- duce many of our readers to peruse the original. The author is de- cidedly a man of great information and reflection. He will have a host of saints in array against him, and many will join in the cry, from hypocrisy and self-interest. As we said before, bis doctrines have come out a century before their time."—Medico-Chirurgical Review, p. 147, 153, 157. London, Jan., 1846. Next, Dr. Forbes, in the British and Foreign Medical Review. " This is a very beautiful and a very interesting book. Its theme is one of the grandest that can occupy human thought,—no less than the Creation of the Universe." "We are also influenced by the abstract desire to place before our readers matter for their contem- plation, which cannot fail at once to elevate, to gratify, and to enrich the mind. It has always been one of the boasts of our noble profes- sion that it touches and blends with every science; and we should be sorry that our humble efforts should at any time be wanting to stimu- late its professors to exertions that might still justify the boast"! Of La Place's nebular hypothesis, he says : " So far from admitting the atheistical tendency which timid relig- ionists have attributed to the nebular hypothesis, we consider it the grandest contribution which Science has yet made to Religion," Sec. PHVSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 187 The reader, therefore, will have no difficulty in understanding the "conventional" nature of certain phrases in the following remarks by Dr. Forbes. (See h.) " That the Creator formed man out of the dust of the earth, we have scriptural authority for believing, and we must confess our own predi- lection for the idea, [! ] that, at a period however remotely antece- dent, the Creator endowed certain forms of inorganic matter with the PROPERTIES REQUISITE TO ENABLE THEM TO COMBINE, AT THE FITTING season, into the human organism, [! !] over that which would lead us to regard the great-grand-father of our common progenitor as a chimpanzee or an orang-outang."—British and Foreign Medical Review, p. 155, 158, 180. London, January, 1846. (See I.) The author of the Vestiges of the Natural History of Creation is thus quoted by Dr. Forbes: " We have seen powerful evidence that the construction of this globe and its associates, and, inferentially, that of all the other globes of space, was the result, not of any immediate or personal exertion of the Deity, but of natural laws which are expressions of His will. What is to hinder our supposing that the organic creation is also a result of natural laws which are, in like manner, an expression of His will ?"—Natural History of Creation. Upon the foregoing extract, which is a part of a more extended one of the same nature, Dr. Forbes remarks, that, " The complete accordance of these views with those some time ago propounded by ourselves (vol. v., p. 342), must be evident, we think, to our readers. To the objection which some timid religion- ists may urge against them, that they are inconsistent with the Mo- saic record, we simply reply with our author, that we do not think it right to adduce that record either in support of, or in objection to, any scientific hypothesis, based upon the phenomena of nature," &c! —British and Foreign Medical Review, p. 167. Dr. Forbes assumes, of course, that all the misapprehensions and perversions of " the phenomena of nature" are paramount to any thing declared in the Mosaic Record (§ 5i, 74, 733 d, 1079 b). The most superficial reader cannot fail of discerning \n the fore- going principles, as in many other analogous instances, the motives which have induced those foremost medical Reviews to lend their powerful aid in propagating the materialism of Carpenter, the absurd- ities of Liebig, the humoralism of Andral, and the putrid anatomy of Louis, and of their respective schools; and why, on the other hand, they have been equally regardless of truth in their vocation as critics on the labors, the researches, and the statements of others. 350f, I. I have already shown in this and other works how conve- nient a matter it is for " the properties of life in the elements of mat- ter" to bring these elements into an organic state. And since I am now on the subject of the first and greatest step in the process of vivi- fication, it may be useful, as it is appropriate, to show how the advo- cates of " the properties of life in the elements of matter," and the propagators of spontaneous generation, and eminent geologists who promulgate a successive creation of animals according to their scale in organic nature and in conformity with the development of new physical agencies, ay, and certain eminent vitalists whose otherwise sound philosophy should have enlightened them as to the Great First 188 INSTITUTES of medicine. Cause—in view of all these things, I say, it may be conducive to sound physiology to show how the foregoing schemers of " creation" arrive, in part, at least, at the conversion of organic matter into the complex fabric, after that matter shall have been duly compounded by "the properties of life which reside in the elements." For this purpose I will take the statement of the distinguished vitalist Tiede- mann. Thus, " The most probable hypothesis is, that the substance of organic bod- ies existed primitively in water, as matter of a particular kind, and1 that it was there endowed with the plastic faculty; that is to say, with the power of acquiring, by degrees, different simple forms of living bodies, with the concurrence of the general influences of light, heat, and perhaps also of electricity, &c, and of then passing from the sim- ple forms to other more complicated ; varying in proportion to the modification occurring in the external influences, until the point when each species acquired duration by the production and manifestation of activity of the genital organs" !—Tiedemann's Physiology of Man. That is the doctrine, candidly avowed by those to whom genius and the conviction of a right discernment of the ways of nature impart a fearless independence, however it may be disguised by others under the " conventional term" of creation. But, Tiedemann is a philosoph- ical vitalist, and did not confound the principle of life with the forces of inorganic matter, nor, like Carpenter, Fletcher, Prichard, Roberton, Forbes, &c, place the properties of that principle in the elements of matter. He started with matter in more or less of an organic state, and leaves it problematical how its elements became united into that peculiar vital compound. He did not even imply that the elements being so endowed could organize themselves, for he adds to the fore- going statement, that, " Although we cannot here answer the question, whence came the water and the organic matter which it contained, yet this hypothesis is the one which accords best with the facts with which geology has lately been enriched." And again, " If it be asked, whence organic matters proceed, how they are produced, together with the power of formation inherent in them, we are necessitated candidly to confess our ignorance on the subject, inasmuch as the first origin of organic matters and living bodies is altogether beyond the range of experi- ment."—Tiedemann's Physiology of Man, p. 14, 193. It will be thus seen that even Tiedemann's doctrine enjoys " a loop- hole" which cannot be allowed to those who place " the properties of life in the elements of matter," or who endeavor, or propose, to cre- ate organic compounds in the laboratory of the chemist; since, in re- spect to the latter, were the production of organic compounds within " the range of experiment," the accidental nature of the origin of such compounds, and, therefore, the incipient being of man, would be established by the laboratory. And now I ask, does not the or- ganic chemist attempt or profess to create organic compounds 1 So says Liebig, § 350, no. 39, and so say most other distinguished chem- ists. Liebig and his disciples create the compounds ; Crosse and his followers create the animal. Others do but make the attempt; and this is a very numerous class who thus enter into competition with the Original Author of organic compounds. What, therefore, is the difference in principle between him who pretends to have succeeded physiology.—organic chemistry—functions. 189 in this work of creation, and the other who has attempted the work, but without success 1 From the physiologist who advocates the existence of " the proper- ties of life in the elements of matter," we hear that, " There is no reasonable ground for doubt that if the elements could be brought together in their requisite states and properties by the hand of man, the result (artificial organic compound) would be the same as the natural compound." Again, " that the germs (of parasitic plants and animals in the interior of others) have been conseyedfrom without into the situations where they are developed, must be held as a very forced supposition" !—Carpenter's Principles of General and Comparative Physiology, p. 146, 395 ; also, this work, § 14 c, 175 c, d, 189 b. 350£, m. Mulder has the manliness to carry out the obvious ten- dency of his doctrines, which may be expressed in a brief quotation. Thus, " Upon the principles which have been stated, no room is left for the dispute as to equivocal generation and epigenesis." Nevertheless, it is allowed by Mulder that cellular structure " cannot yet be imitated by art." But, waving this conceded difficulty, if the physiological ar- guments which I have advanced in section 14 c, as to a real Creator, can be invalidated, I shall concede that a ground has been obtained for the doctrine of spontaneous generation (§ 1051). 350~, n. As I shall soon dismiss this author, it may be useful, in consideration of his exalted worth as a chemist, and his authority among physiologists, to show that even one who endeavors to hold a consistent philosophy on the subject of chemical physiology, yet sees in organic beings so much to contradict his chemical doctrines, that he evinces the usual inconsistency of those who have endeavored to con- found the science of life with that of chemistry (§ 4^, d). For this purpose I shall select two passages only, and place them in parallel columns, after the manner adopted in relation to Liebig in section 350. I shall elect, also, for the negative side, a passage which will show, what cannot be too often repeated,that the chemists are absolute- ly regardless of their own fundamental doctrine, of " ascending from phenomena to their causes," by rejecting all the unique phenomena of life as indicative of any peculiar force or laws. The affirmative side, however, is all that the vitalist dawws (§ 189). c£iAVr4~& , Denial of the Vital Principle and Recognition of the Vital Principle Vital Properties. and Vital Properties. " Wherever forces are found in " The question is, whether, du- organic nature, there are substan- ring decomposition, the organic ces which are all supplied with forces grow weaker of them- molecular chemical forces. Even selves, permitting the elements to those singular structures, the obey their primary tendency,—or nerves, consist of the same ele- whether causes must exist* by ments as the ordinary substances which these organic forces are of the organic kingdom. It is made weaker 1 Neither is im- thus undeniable, that the molecu- probable. Every thing which lar forces act a chief part in the ceases to be subject to the vital organism, so far as a change of principle, becomes incapable of substances takes place therein being stimulated by the vital 190 institutes of medicine. and that no general, no vital force, should be assumed as the source of those molecular forces. Such a vital force is irreconcilable with the true principles of science, which require that nothing should be assumed as existing, but that every thing should be sought for in nature; which teach us to as- cend only from an unprejudiced consideration of the phenomena to their causes, and to assign those causes only as we deduce them from the observed phenomena." —Mulder's Chemistry of Vege- table and Animal Physiology, p. 68. 1845. forces ;—it is placed in other circumstances ; and as the prod- ucts of the vital functions are different from the prod- UCTS OF INORGANIC NATURE, in consequence of the very differ- ence of the circumstances in which the elements are placed, so the products of substances, de- prived of VITAL INFLUENCE, must also greatly vary with circum- stances. Hence it may happen, that the forces present in organ- ic substances, when deprived of the vital influence, may disap- pear of themselves. The impres- sion they had at first received is changed, modified, obliterated, and therefore the effects can no longer be the same. A substance persists in the state into which it was first put, according to the law of inertia; but the maxim, sub- lata causa tollitur effectus, is of equal value."—Mulder's Chem- istry of Vegetable and Animal Phys- iology, p. 54 (§ 59). I shall conclude with an extract from Mulder, in which it will be seen that he has adopted the method set forth by myself in my Essay on the Philosophy of Vitality" (1842), of investigating the subject in the development of the germ. It may be useful to place in contrast the purely chemical and the purely vital interpretations of that devel- opment (§ 65). I may also premise that it should be observed that the chemist keeps out of view all the remarkable circumstances at- tending the development of the egg which I have set forth as irrecon- cilable with chemical phenomena, and limits himself to statements founded on a supposed analogy with the simple results of chemical affinity as observed in inorganic nature. Thus : " If we review the phenomena of life, caused by change of materi- als, we must go back to the original formation of organs—to the growth of an individual from a germ." After illustrating the devel- ment of the germ by " an example from the inorganic kingdom" (the formation of prisms from a solution of the sulphate of soda!), this distinguished chemist proceeds to say, that "Undoubtedly the differences which exist between the particles of the same organic substances are not chemical, in the ordinary gross signification, but are of the nature of those which are connected with polymorphism. The chemist gives us but a rude result—the compo- sition in a hundred parts, frequently not affording us any insight into either the real characters of substances, or into their real differences. Whenever such dissimilar particles come together, a compound must be produced, possessing peculiar forces, which, though dependent upon physiology.—organic chemistry--FUNCTIONS. 191 the molecular forces of the elements, are yet not determined by these alone. The new arrangement causes a modification of those primary forces. Whenever it takes place, they appear modified, and therefore indicate their presence by producing new effects. In sulphate of soda, the whole collected forces of its constituent molecules—those of sul- phur, sodium, and oxygen—are still existent; and upon these alone depend its qualities, composition, and crystaline form. Sulphate of soda cannot possess other qualities—cannot become other in property —than what results from its elements, and exclusively originates in these. " Thus, then, we suppose that the molecules of the substances in the embryo are arranged, in the first place, simply, and afterward more complexly. Not a trace of any organ is as yet perceptible^however; nor of any force, therefore, by which these organs will be governed. By the new arrangement of the particles, the molecular forces are modified anew, and this process is continuous. Although the primary forces, once united with the materials, remain the source of every ac- tion, of every manifestation of phenomena, of every chemical and or- ganic, that is, physical, combination ; they must, nevertheless, produce different effects, as the combinations become more complex. Each existing particle is the germ of a subsequent one, which is more com- plex; and, while the temperature necessary for hatching keeps the primary forces always excited, there is originated in the new arrange- ment of the particles, and also in the forces proceeding from the groups recently formed, a modification of these primary forces, which is constantly on the increase. " The whole material of the embryo in the egg is gradually brought in this manner within the circle of action. Then the circle is still more extended, and in its action are comprehended the elements of the yolk, and also of the albumen. These are erroneously called the food of the newly-formed chicken, or its rudiments. In these ele- ments there are forces also conjoined with the materials—chemical forces, analogous to those which exist in the embryo, and contributing to the production of the whole. These forces differ from those found in the embryo, not in nature, but only in direction, or in the mode of manifestation."—Mulder, ut cit, p. 71-73. • 351. Having in the preceding sections, as well as at other times, summoned, in behalf of truth, and of the noblest institutions of na- ture, an adverse party, and having shown, not only by the nature of the pursuits which engage the whole practical attention of the leaders of that party, but by an open cross-examination of the acknowledged chiefs, that the entire field of physiology and medicine remains, as ever, in sole possession of those who are employed in its cultivation, and that, by no possible accident, fraud, or conspiracy, can it be trans- formed or transferred into the laboratory of the chemist, I shall pro- ceed to a more critical examination of the philosophy of digestion, both in its vital, and its supposed chemical attributes. 352. All other processes of living beings, whether animal or vege- table, and especially the whole work of assimilation after the entrance of the food within the lacteals, being exclusively vital, it follows, as a great analogy of nature, that the first step in the process of assimila- tion is equally due to vital influences (§ 323-326). 353. Since every species of animal possesses some peculiarity of 194 INSTITUTES OF MEDICINE. organization, not only of the alimentary canal, but of the liver, sali- vary glands, pancreas, te 3th, jaw, skeleton, muscles, and also of in- stinct, corresponding with a certain modification of the vital endow- ments of the gastric juice in each species of animal, which shall be exactly, and forever, and undeviatingly suited to the digestion of those kinds of food which were ordained by the Creator for the sustenance of each when He thus wonderfully instituted this almost endless sys- tem of exact Designs; each individual part having its specific final cause, each final cause modified in every species and with correspond- ing peculiarities of organization, and all concurring to one great final cause of subserving those exigencies of life which are fulfilled by the gastric juice, and whose modifications in different species of animals harmonize with the special attributes of all the concurring causes, and so suited rJy Infinite Wisdom to the nature of the food of every ani- mal, that its incipient change shall be one of assimilation to the nature of the being, yet nearly coincident in all animals from the general co- incidence in all organic compounds; I say, in all this labyrinth of De- signs, so exactly modified in every species, yet correspondent in all, and each and all, in their individuality, their variety, their modifica- tions, and their unity of purpose, having a specific reference to the alimentary material of each species of animal, we see in perpetual progress what is equivalent to a never-ending voice from Heaven, proclaiming that the organic stomach has no parallel in its capabilities and results in the inorganic world, or in the laboratory of the chemist, But this is not all; nor will I fail to convert the stupendous whole, as I advance with the details of assimilation, to the fundamental philoso- phy of organic life. 354. The constituent elements of the food having been subjected to special transformations, and imbued with the first gradations of life, by the vital action of the salivary and gastric juice, and perhaps, also, by contact with the stomach, is thus converted, in all animals, into appa- rently one and the same homogeneous product. It is then submitted to the farther organizing effects of the bile and pancreatic juice, pass- ed through the wonderfully vivifying lacteals, carried forward and subjected to the whole animating influence of the pulmonary system, perfected in its exalted endowments by the whole labyrinth of the circulatory organs, and, lastly, though not least, the various com- pounds are determined, each and all, from that one homogeneous fluid, and in one everlastingly exact manner, and according to the nature of each part, by other complex living systems, and thus per- petuated forever in all their exact varieties,—but how, no imagina- tion can form the most remote conception, but through the instrumen- tality of those specific properties of life which were the only power concerned from the beginning to the ending of the astonishing series of unvarying changes (§ 42); and, however it be that each ultimate product is destined for the immediate uses of the individual, it is un- deniable that the great final cause of every step in the assimilating pro- cess, till it results in the formation of blood, is the reproduction of gastric juice for the maintenance of an unceasing supply to the exigencies of organic life, and the perpetuation of the species (§ 41, 323-326). 355. The gastric juice being designed to prepare the material for the formation of blood, has its powers so constituted as to be merely an agent. The blood, being the pabulum vita fully prepared for the • PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 193 regeneration of the gastric juice, as well as of other organic compounds (§ 354), is mostly a substance acted upon by the living solids, or by the fluid ovum, just as the food had been by the gastric juice, while it serves, also, as a stimulus to the vascular parts, and is highly endow ed with the properties of life to facilitate its conversion into living solids or fluids, and to make its presence in the blood-vessels compat ible with their life. 356, a. And thus pursuing, and while describing, the various de- tails of assimilation, attention is unavoidably arrested by the magnifi- cence of its unique philosophy, and by the ultimate aim of every de- tail, of all the immense variety (§ 353-355), even excretion itself (§ 412, &c), at the production of gastric juice ! And as we penetrate the more latent, but yet more impressive physiological laws to which that juice is obedient, we rise in admiration of the preliminary means of their fulfillment; and now again addressing myself to the chemist, I ask him as a philosopher, as one who would protect the consistency of hjs own science, what can be more emphatically significant of the abstrac- tion of digestion from chemical agencies, than the fact that the nervous power so modifies the vital constitution of the gastric juice that it fails of its usual function when a division is made of the pneumogastric nerve 1 Imagination can surmise no connection between the nervous power and the processes of chemistry. And yet do the writings of Liebig, and of other organic chemists, abound with assumptions that the supposed affinities of chemistry, as operative in animals, are sub- ject to the nervous power! though it is conceded that the nearly co- incident processes and results in plants sustain no such nervous influ- ences (§ 500, n). " TJie animal organism," says Liebig, truly, " is a higher kind of vegetable." To suppose that such powers operate in harmony together, and that the mind or its passions are capable of in- fluencing, extensively, the operation of chemical forces, in constantly modifying the various secreted products, both as to quality and quan- tity, is a positive violation of the most obvious and universal rules in natural philosophy (§ 500, n). 356, b. It is evident that a great difficulty exists with many, who admit a principle of life in relation to the solids, in imagining a fluid to be equally endowed, and alike capable through that principle of acting upon organic matter. But we must take the facts as we find them, nor allow inorganic nature the slightest interference. If analo- gies must be had, let us seek them in the organic being, and we shall be certain of success. In the instance before us, we have the admit- ted vitality of the blood ; but, unlike the gastric juice, it produces no changes in matter. We have, however, the fluid ovum, " whose vital properties," in the language of Dr. Carpenter, "confer upon it the means of itself assimilating, and, thereby organizing and endowing with vitality the materials supplied by the inorganic world" (§ 64, g). Here, then, the analogy is remarkably forcible, and the more so, as the fact is conceded by the strictly chemical school of digestion. So, of the semen, in another aspect of the active condition of the principle of life in an organic fluid; this substance, through that principle, being ca- pable of modifying the organic constitution of the ovum in such wise, that the offspring shall inherit the intellectual, vital, and physical pe- culiarities of the male parent, with six fingers instead of five (§ 72, 73). 357. One of the most important arguments in favor of vital diges- 19* INSTITUTES OF MEDICINE. tion consists in the remarkable endowments of the stomach, as mani- fested by its vital signs, and by the sympathies which prevail between this organ and all other parts. The final cause of this peculiar con- stitution of the stomach,.this lavish supply of the properties of life, this subservience of other organs to its dominion, must be sought in its adaptation to the generation of a fluid that may bestow the first and most difficult act of vitalization upon dead matter (§ 356, a). There would also have been something harsh and abrupt in nature, to have admitted into the recesses of her living organization mere dead mat- ter. It is opposed to all analogy, and is, therefore, opposed to all reason. But, that a fluid should perform this astonishing office, this first and great step in the ascending series, it must possess in a high decree the principle of life. Mysterious as it may be represented, we must all of us come at last to the admission of the existence of a vital principle; yet far less mysterious, and far less difficult of comprehen- sion than the human soul. It is fair, then, to conclude that an organ destined for such a high function should possess that principle, in common with all other parts, as the means on which its function de- pends ; and the best evidences iniavor of this analogical inference are to be seen in its diversified manifestations of life. 358. We have seen, also, that it is conceded by philosophers who defend, in exlenso, the chemical hypothesis of life, that there may be something appertaining to the stomach totally distinct from the chem- ical powers, and which is capable of imbuing the chyme with vitality and an organic condition; and it is, therefore, quite a philosophical conclusion, that this vital something has an important agency in pre- paring the material for the admitted exercise upon it of the vivifying or organizing power. Nor can there be any valid objection to the supposition that this vitalizing power, which so far transcends the chemical forces in the organizing effect it is allowed to exert, may be fully adequate to any transmutations the food may undergo; and this inference is the more corroborated by the consideration that matter already in an organic state must be better fitted for the process of vivification, than it can possibly be after its elements are broken up and recombined by forces with which those of life are in absolute op- position. Besides, the vitality of the gastric juice, or the vital influ- ence of the stomach itself, being fully admitted, and even capable of organizing the food anew, this, in itself, should protect the alimentary matter against any chemical agencies which have been supposed to operate. That this counteracting power, indeed, prevails to the full extent which I have alleged, appears to be rendered certain by the ordinary absence of any of those chemical changes which take place where numerous substances are mixed together out of the stomach- substances which often possess strong chemical affinities for each other, and whose operation within the stomach would be promoted by its high temperature. On the contrary, whatever the variety, it is uniformly resolved into one and the same homogeneous substance, ut- terly unlike the results of chemical reactions of one kind of food upon other kinds; and what is also as conclusive as it is astonishing, the chyle is apparently the same substance in all animals. Chemistry must here be consistent with itself, and not renounce, for the sake of hypothesis, those precise laws by which, in its legitimate pursuit, it lays open, with astonishing exactners, what had appeared the arcana PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 195 of nature. Here, too, upon the chemico-physiological hypothesis, is presented an instance in which it is necessarily assumed that the properties of life and the forces of chemistry act together in concert in converting dead into living matter—one destroying, and at the same moment the other vitalizing! while the assumption is contra- dicted by all that is known of the relation of these forces to each other (§ 338). Nor may we lose sight of the demand of philosophy not to multiply causes, where one is perfectly adequate; and especially where it is admitted that all the others are of themselves wholly inadequate. 359. The last remark may be also equally applied to a common as- sumption which is set forth in the following apparently plausible man- ner : " The vitalists," says one of their opponents, " are loath to admit the operation of chemical agents at all, and would seem to consider it derogatory to suppose that any changes, save the subtle ones effected by the powers of life, are worked upon the aliment." " The vital principle," he says, " whatever it may be, incessantly makes use of chemical and mechanical agents for its purposes; and it is no more degrading to it to employ an acid liquid, and a triturating process, in order to digest the aliment, than it was to have recourse to bony lev- ers, cartilaginous pulleys, and tendonous ropes." Here, in the first place, will be observed an entire begging of the question as to digestion by an acid, since that has never been shown, and is the main point at issue. It is a perfectly unfounded and ex- torted inference from the factitious analogy supposed to be seen in the admitted mechanical movement of the food in the stomach, bony levers, cartilaginous pulleys, &c. But the pretended analogy, I say, is utterly inapplicable, were it admissible to reason from better prem- ises of this nature to the existence of important facts which have no other foundation. The bony levers, muscles, tendons, heart, and large blood-vessels, are mere instruments acted upon by the vital principle, and have no part in the vital results, except as they are the passive instruments of the properties of life. The same distinction exists be- tween the process of digestion, and the mechanical movement of the food in the stomach, or the " trituration" of the food, as it is errone- ously called by the writer just quoted; since food is not triturated by the stomach excepting where that organ is designed to supply the place of teeth. There exists, I say, a total want of analogy between that mechanical movement of the food, and the assumed action of an acid ; since, in the latter case, a radical change is supposed to be wrought in the alimentary mass, while no such change is wrought by the mere movement, or even by the trituration or grinding of food in the stomach. The contractions of the stomach, which are purely of a vital nature, facilitate the process of digestion; but they do no more than to expose the food freely to the action of the gastric juice, by which, alone, the conversion into chyme is performed. The contrac- tions, or " trituration," are exactly on a par, as auxiliaries to diges- tion, with the teeth, or with the knife, which divide the food. The acid alone applies to the supposed chemical process of chymification. This is the only agent, involving the only force distinct from the vital principle that is supposed to operate, and to take part with the prop- erties of life in the functions which belong to these properties. Nor is this all. Those chemical forces, or an equivalent agent, are sup 196 INSTITUTES OF MEDICINE. posed to appertain to the gastric juice (a product of the most highly- endowed organ in the animal system); and through that product, and by that product, to operate independently of the vital properties, or, under their control. But, here it may be again affirmed that through- out nature there is not an analogical fact to warrant the conclusion; and with equal truth it may be said that there is nothing to aid our conception of the co-operation of the chemical and vital forces, while all that is known of their relations to each other proclaims their ab- solute independence. 360. But, again, it is the admitted final cause of the gastric juice to bestow life upon dead matter, while it is incontrovertible that inorgan- ic matter is insusceptible of any such influence from gastric action. Every fact proclaims that nature has provided the vegetable kingdom for the purpose, especially, of determining organic combinations out of inorganic substances for the sustenance of animal life. In the lan- guage of Liebig, " The first substance capable of affording nutriment to animals is the last product of the creative energy"—ay, " the creative energy," he says, " of vegetables."—(Animal Chemistry.) It is manifest, therefore, that it would be an absurdity on the part of nature to have ordained that chemical agencies should operate even at the very threshold of life, at the very fountain for which she had provided elaborate means to subvert the combinations of chemistry, and to bring them into those entirely new arrangements that approx- imate the changes they are destined to undergo in the animal stom- ach. And far less probable is it, that this fundamental principle should be lost as we ascend from vegetable to animal organization; since every chemical result within the stomach would tend to reduce the aliment to the state of that inorganic matter whose complete re- duction into organic compounds was effected by the vegetable king- dom for the uses of the animal. Such chemical results, therefore, would counteract the great final cause of nature, in either organic kingdom; and, in the animal, would render the means of sustenance more and more indigestible, and progressively liable to the condition of inorganic matter (§ 338). This is fully allowed by the chief of the school of pure chemistry, as shown in the foregoing parallel quota- tions. Take another summary statement, than which nothing can he more contradictory of the chemical rationale. " While no part of an organized being," says Liebig, "can serve as food to vegetables, un- til, by the process of putrefaction and decay, it has assumed the form of inorganic matter, the animal organism requires, for its support and development, highly-organized atoms. The food of all animals, in all circumstances, consists of parts of organisms."—(Animal Chemistry.) The chemical philosophy of digestion becomes, also, most obviously unfounded when it is considered that nutriment of an animal nature requires but little more than the solvent process, and the bestowment of vital properties; while, in accordance with the chemical hypothe- ses, animal compounds must be, more than vegetable, subject to dis- organizing agencies, and thus more completely removed from their original and near approximation to the compounds of the living ani- mal (§ 301, 303 a, 338,1052). 361. But again I say, if the vital principle be " capable of making use of chemical agents," no reason can be assigned why it may not be enual to the whole work of digestion, and of every other process PHYSIOLOGY.--ORGANIC chemistry--FUNCTIONS. 197 of living beings. The simple construction may be comprehended, while the other is utterly unintelligible. The former alone is agree- able to the rules of philosophy, and abolishes the inextricable confu- sion which attends the chemical hypothesis. What, indeed, can be meant, by the vital properties making use of chemical forces % Can there be a more glaring absurdity ] more absolute nonsense X How are those chemical forces brought into use, how held in subjection, how forever maintained in one exact operation in each particular or- ganic process, of which there are multitudes, distinct from each other, going on in the same individual 1 How do they elaborate from one common, homogeneous fluid, either the blood, or the sap, all the va- rious, unique, unchanging, secreted products of the whole organic be- ing 1 Products, forever the same in every part, yet differing from each other according to the nature of the part ? Did you ever hear or dream of any thing analogous to this in that inorganic world where chemistry holds its empire 1 When do those chemical forces begin to operate, in the living body, what part do they perform, and what is the allotment of the properties of life ] Is there any known concert of action between the two species of forces ? On the contrary, is it not every where demonstrated that the properties of life are in direct opposition to the forces of chemistry 1 Whatever be the construction, by uniting the two forces (as is done by the only chemical school that is entitled to a respectful notice), we convert what is a simple problem, like all other processes of nature, into the greatest paradox that has been yet devised by the ingenuity of man. It is in vain to say that some one or two of the products of organization, such as carbonic acid, and urea, are such as result from chemical affinities, since these are excrementitious; while chemistry assures us that all organic compounds are utterly different in their el- ementary combinations from any compound of a chemical nature. Thus might I go on to argue this subject upon general principles alone ; while at every step of the argument, we should see the whole chemical hypothesis of life taking its proper rank as a dream of the imagination, or as a project of ambitious minds. 362. Digestion having been assumed to be more or less, or alto- gether, a chemical affair, it rationally followed that it might be imita- ted by art. Accordingly, when this ambitious science had succeeded in turning the whole inorganic world into the laboratory, it set itself at the manufacture of organic compounds, and even at the entire ani- mal. It did not, like Alexander, sit down and weep because it had no more worlds to conquer; but, like Shakspeare, having "exhaust- ed worlds, it then imagined new." Even eminent physiologists, who should look with jealousy upon any invasions upon the laws of nature, especially upon such as it is their peculiar province to illustrate, be- gan the manufacture of gastric juice by fire and acids, and metallic salts. We are thus presented by these philosophers with artificial compounds, of a most incongruous nature, and we are told that each one is the gastric juice; that each is capable of the same precise results as that universal product of animals, apparently the same in all, and elaborated from the blood by an organ of the highest vital endowments, and to which there is nothing analogous in all the other products of living beings, each product being, also, equally unique and all derived from one common source (§ 135 a, 316, 419, 827 b). ' 198 INSTITUTES OF MEDICINE. 363. A diversity of opinions exists as to the real nature of the chemical agent supposed to be employed by nature in the process of digestion. Free muriatic acid having been found, or supposed to ex- ist, in the stomach, it has been concluded by many that this must be the great agent; while Dr. Prout, and others, affirm that " free mu- riatic acid more or less retards the process of reduction." Dr. R, Thompson, however, states that, by digesting muscular fibre in dilute muriatic acid, he produced a substance "exactly resembling chyme." This experiment was pretty widely repeated, and many were equally successful with " dilute muriatic acid" as was Dr. Thompson.- Oth- ers, on the contrary, declared their failure, and others, like Dr. Prout, maintained that this acid retarded digestion. Eberle had already ad- vanced the hypothesis that mucous membranes, no matter whether of the stomach or the bladder, dissolved either in muriatic or acetic acid, would form the true gastric juice, and perform its wonderful opera- tions. There is now a general bias in favor of one of these com- pounds, though other preparations are supposed by many to form very good gastric juice. Again, it is said that the "digestive mixture," as it has been well denominated by the manufacturers, " retains its sol- vent properties for months," while the gastric juice loses its solvent power soon after its abstraction from the stomach (§ 341). And what equally establishes a total difference between the " mixture" and the gastric juice is the no small circumstance that the chemist may torture and extinguish the artificial "digestive principle" in a variety of ways, and then transmute it back in all its vigor. Thus, according to Schwann and Muller, the artificial "digestive principle" may be neutralized by an alkali, and afterward " precipitated from its neutral solution by acetate of lead, and obtained again in an active state from that precip- itate by means of hydro-sulphuric acid." This precipitate, we are told, when thus treated, and thus compounded of principles radically different from the original mixture, is essentially the same as the gastric juice, and that the results of such artificial preparations must be taken as the test of the physiology of natural digestion ; that, aban- doning nature, we must look to the resources of the laboratory for any satisfactory account of her vital processes. Nor do I at all exag- gerate ; for it is distinctly avowed that we knew nothing of digestion till the invention of the artificial mixtures. Thus, it is said of Schwann by one so able and distinguished as Muller, that he (Schwann) "hav- ing discovered that the infusion of dry mucous membrane with dilute acid, even after it is filtered, still retains its digestive power, the di- gestive principle, therefore, is clearly in solution, and the theory of di- gestion by contact falls to the ground." Here, a most important phys- iological induction is wholly founded upon a process which has not the most remote connection with organized matter. 364. I have said that the experimenters took the hint of manufac- turing gastric juice from the occasional discovery of an acid in the stomach. But, this is undoubtedly a rare phenomenon in a healthy stomach, and where the food has been at all appropriate in quality and quantity. The chemical hypothesis, as I have said, was long ago in vogue, and was put at rest by demonstrative proof. Distinguished observers, Hunter, Haller, Willis, Spallanzani, Fordyce, and more recently Dumas, Schultz, and others, insist that the reputed acid is the result of a true chemical decomposition of vegetable matter. PHYSIOLOGY*--ORGANIC CHEMISTRY--FUNCTIONS. 199 ispaflanzani, whose experiments were almost endless, Scopoli. Chev- reuil, and others, rarely succeeded in finding it at all, and in some an- imals never. Spallanzani, indeed, affirms that the gastric juice is neither acid nor alkaline in its natural state. ^ As far back as Haller's day, when this subject was agitated, it is said by this illustrious and accurate observer, that, " although there may be some rare signs of an acid in the stomach, it does not, there- fore, become us to suppose that food is animalized by a chemical process; much less to compare this process with the action of an acid." And, anticipating the modern experiments with the " diges- tive mixture," he declares of analogous proceedings at his own era, " frustra etiam quisquam, imitatus liquores acres chemicos, liquorem corrodeutem invenerit, qui carnem in pultem resolvat." And there can be no doubt that Hunter's prophecy holds good to this day, that, " If ever any matter is formed in any of the juices secreted in any part of a vegetable or animal body similar to what arises from fer- mentation, we may depend on it, it arose from that process; but we may also depend on it, that there is a defect of the living principle in these cases." \ These are not the mere speculations of genius, but the facts and the conclusions of genius after a long, and wide, and experimental survey of nature. And are these observations, nay, our own experi- ence, our own senses, to be set aside to accommodate an hypothesis of life which identifies dead, even inorganic, with living beings 1 364$. But perhaps even a greater violence, than the foregoing manufacture of gastric juice, has been recently done to physiology, in the alleged conversion, by chemical manipulations, of the secreted products of organs, totally unlike, into each other. It should be con- ceded, however, that this has been generally sanctioned by the jour- nals of the day. Thus, in the London Lancet for July, 1845, is a quotation from the report of MM. Villefranche and Barreswill to the French Academy on the " Chemical Phenomena of Digestion," from which the conclusion is deduced that " Thus, it appears easy to transform the gastric juice, the pancreatic fluid, and the saliva, into each other, and to make an artificial gastric juice from the pancreatic fluid, and vice versa"! It appears, also, from these late experiments, that the digestive principle depends on an organic matter, that " the said matter may be destroyed by an elevated temperature," and that " its digestive pow- ers vary, according as it is associated with a fluid having an acid or an alkaline reaction." It would seem, therefore, not improbable that a new hypothesis will soon be in vogue, and that the acid principle will be abandoned to satisfy the claims of new aspirants. 365. The assumed identity of the artificial products with the chyme of the humaii and other stomachs has never been shown in the slight- est degree; and that it is the merest assumption, is not only proved by what I have already set forth, but is fully admitted by those who advocate the chemical doctrine. The conclusion rests upon the mere appearance which the artificial substance offers to the eye. Thus, it is lately said by Dr. Davy, that " It is impossible to witness the change which takes place in mus- cular fibre, in consequence of putrcfariiov giving rise to a fluid very 200 institutes of medicine. like chyme in appearance, without asking, may not putrefaction be concerned in digestion itself, according to the earliest theoretical no- tions on the subject," and as now maintained by Liebig, and his fol- lowers (§ 350) ] Farther on, however, in the same work, he says, " twenty different semi-fluids might be mentioned, to which, as far as ihe eye can judge, this putrid matter bears as close a resemblance as to chyme" (§ 341). 366. " Dr. Beaumont [of St. Martin celebrity] has instituted several experiments with a view to determine the power of acids in dissolv- ing articles of food; and the results which he obtained, although they varied somewhat according to the substances employed in the exper- iments, have nevertheless led him to the conclusion that no other fluid produces the same effect on food which the gastric juice does, and that it is the only solvent of aliment" (§ 341, 373).—Muller's Physiology, p. 589. London, 1839. So far Dr. Beaumont's accuracy may be readily admitted. But, as his observations upon the natural process of digestion, as carried on in St. Martin's stomach, have become incorporated in most of the subsequent works on physiology, and even in systematic works on diet, where they generally serve as a foundation for some of die most important conclusions in the science of life, and have been seized upon with avidity by the supporters of the physical and chemical doctrines, and without any reference to their credibility, or to the un- natural condition of that celebrated stomach, it may be well to show, by their conflict with universal experience, that those observations are not only worthless, but pregnant with the greatest practical er- rors. For this purpose, it is only necessary to present a brief abstract from the tabular view supplied by the author of the average time oc- cupied by different alimentary substances in undergoing digestion. Thus: v articles of diet. Mean Time of Chymifia.ttion. Preparation. | h. ro. Cabbage, with vinegar .... Hash, meat and vegetables Pork, fat and lean, recently salted . Green corn and beans .... Beef, fresh, lean, rare .... Fowls, domestic..... boiled. do. do. raw. raw. warmed. roasted. baked. roasted. raw or stewed. broiled. do. boiled. do. baked. do. boiled. stewed roaste-1 do. do. and boiled. boiled. 1 00 1 00 1 30 1 30 2 00 2 30 2 30 2 30 2 30 3 00 3 15 3 20 3 00 3 45 3 30 3 15 3 30 3 30 3 00 3 15 4 00 3 30 _ Here, then, we have pigs' feet nearly four times as easy of diges- tion as baked bread, or roasted mutton, or beef, or domestic fowls, or eggs, or oysters; raw cabbage nearly twice as easy of digestion; roasted pig and goose a third or more easier, &c. And these are PHYSIOLOGY.--ORGANIC chemistry--FUNCTIONS. 201 common examples of what is known, in medicine, as " the experi- mental philosophy of the nineteenth century," and " the march of med- ical science" over all former and more rational experience (§ 18). 367. The experiments with pepsin, or the artificial mixtures, have been limited to substances already animalized, in their simple condi- tions, and in minute proportions. Hay, nuts, onions, and even arrow- root, would be appalling to pepsin; and the quantities of the gor- mand, or the variety of the epicure, would soon show the nature of this branch of " experimental philosophy." 368. A chemical dilemma presents itself. The supposed chemical agent in digestion should be the same in all animals, to explain, in the least, the identity of the resulting products,—and so it is admitted by the advocates of one " mixture," or of another, respectively. But this, on the other hand, is clearly contradicted by the variety of the " mixtures," and by the vast variety of alimentary substances, con- sumed by different species of animals; while, indeed, if the least re- gard were paid to the laws of chemical affinity, it should be obvious that there would be no small variety of chemical influences in the stomach of omnivorous man. 369. Nevertheless, if the " digestive mixture" be made from the mu- cous tissue of the stomach of a strictly graminivorous animal, or even from its bladder, it will " digest" meat and other substances which form the peculiar food of carnivorous animals, but will refuse to di- gest most of the substances common to the animal from whose stomach the " digestive mixture" is prepared. This, therefore, is contrary to nature. 370. Digestion is well performed and often promoted when alkalies are taken into the stomach in sufficient quantities to hold the reputed amount of acid in a neutral state. 371. On the contrary, digestion is always impaired by the introduc- tion of acids into the stomach while the process is going on. 372. Did the supposed acid exist in the gastric juice, it would ren- der the medicinal doses of the nitrate of silver, or the acetate of lead, perfectly inert. This principle is also of obvious application to many other substances. Indeed, it would be a perpetual " incompatible" with many remedial agents. 373. If digestion depend on the supposed chemical agencies, the stomach should always undergo more or less of that change after death; especially violent death. It is the rarest phenomenon, however, in man or animals, to witness the slightest change in that organ that can be referable to the gastric juice (§ 366). 374. It is fundamental in nature that an organ which is desio-ned for the production of an organic fluid does not also generate an inor- ganic substance, especially a simple element like chlorine, for the pur- pose of bestowing organization and life. 375. Again, since it is the mucous tissue of the stomach alone which, m all animals, secretes a juice capable of producing chyme • and as no other part of any organized being can generate a substance ot similar power, how arrogant, therefore, the supposition that art can manutacture a fluid of the same virtues (§ 323-325)! 376. As new aspirants enter the field, novelties, of course will spring up. 1 hey serve, however, to show us the importance of re- garding with suspicion whatever may conflict with the long-establish 202 INSTITUTES of medic ive. ed conclusions which have been drawn from an observation of the most common phenomena of living beings. This leads me to advert to the experimental researches of Dr. Schultz, the eminent Berlin professor, which, whatever be their foundation, effectually destroy our confidence in all those " digestive mixtures" which have figured, of late years, so conspicuously in nearly all the systematic works ou physiology. In the first place, Professor Schultz infers that neither the stomach nor the gastric juice have much agency in digestion, but that this great office is mostly performed by the saliva. This distinguished observer also finds that, 1st. " The secretions of the stomach are always alkaline excepting during the process of digestion." 2d. " No food undergoes digestion without saliva." 3d. " The chyme is not produced by chemical action, but is an or- ganic compound formed by a vital transformation of the food." 4th. " There is no such product as the supposed acid gastric juice; only a sour chyme" (§ 364, Hunter). 5th. " The acid found in the stomach is the result of a chemical de- composition of the food" (§ 364).—Schultz, de Aliment. Concoctione. Also, the Rejuvenescence of Man, Sec. 1842. Again, still more recently, M. Blondlot, under the guidance of "ex- perimental philosophy,"* affirms that the saliva is of the nature of mu- cus, little else than the waste of organs (as Liebig regards the gastric juice, § 350), contributing nothing to digestion, and only useful as a shield to the mucous surface (Blondlot, Traite de Analitique de la Digestion, p. 124, 126). 376£. It appears, therefore, that all the prevailing physical views of digestion, the chemical doctrines of secreted products, the healthy and morbid processes of living beings, the modus operandi of morbific and remedial agents, which completely shuts out the magnificent laws of sympathy, and the whole bathos of the humoral pathology, have been, in recent times, the work of the laboratory. Physiologists and therapeutists, the British especially, appear to have forgotten that it is their business to explore the facts and the laws of organic nature, and to have turned the whole matter over to the chemist (§ 349, d). They have surrendered this high calling to the laboratory, and have bowed in submission to whatever its acids and crucibles have pretended to reveal as to the processes and laws of living beings. A vast number have thus discarded their lofty pursuits, and have substituted for them a most unnatural dependence upon the laboratory of the chemist. The chemist has seized the opportunity with avidity; since his em- ployment with inorganic nature is mostly analytical, mostly exhausted, while that which relates to living beings supplies an unbounded field for the institution of great principles and laws, whether true or false, and for the highest renown in philosophy. It is not remarkable, therefore, considering the prizes are few, the competitors many, that the " race is to the swift, and the battle to the strong," that the ambi- tious chemist should abandon the mere work of analysis, and push his inquiries into that magnificent department of nature where the richest laurels may be gathered. Inorganic chemistry supplies no such op- portunities. Its work is analytical, and its principles few and simple j An artificial fistulous opening in a dog's stomach (§ 366). PHYSIOLOGY.--ORGANIC CHEMISTRY-—FUNCTIONS. 203 and this, alone, is the legitimate object of organic chemistry. That ob- ject has been lately well expressed by Mr. Hoblyn, in his Manual of Chemistry. Thus: "The peculiar principles which exist in all organized beings are distinct from those which operate on inorganic matters, and may be denominated organic agents. Their mode of operation is mysterious. The object of organic chemistry is to investigate the chemical history of the products which occur in the vegetable and animal kingdoms, and which are hence called organic substances." I therefore say, let us look well to the doings of the chemist. Let us properly regard his tampering with so profound a subject as phys- iology, whether in its natural or morbid aspects. Let us scrutinize his facts when he assails the experience of all the renowned in medi- cal science through all past time, and declares that experience worth- less (§ 350, mottoes). Let us not, however, indignantly retaliate upon him his attempts to overthrow the great fabric of medicine, or his ef- forts to undervalue the labors and the doctrines of men who have toiled in the field of organic nature, and have immolated themselves in the chambers of the sick. Let us rather kindly advise the chemist to cultivate modesty, and tell him, frankly, that, to comprehend the laws and the processes of living beings, they must be perpetually the objects of profound study, both in the natural state of the being, and in all the variations to which he is liable from the influences of mor- bific and remedial agents. Let us tell him that he has acted wisely in refraining from all such observations, and in making the laboratory the exclusive theatre of his experimental inquiries. Either science, analytical, and limited in principles and laws, as chemistry may be, is enough for the compass of an individual; and medicine transcends the powers of the most gigantic mind. The physician, therefore, if he aim at the highest practical usefulness, or at the science of medi- cine, will find only the leisure to acquire the outlines of chemistry, and it is equally certain that the chemist who aspires at a profound knowledge of that department, must spend his days and his nights within the precincts of his work-shop. And now let us remember, that there is not one name in all the annals of medicine which rests for its distinction on the physical and chemical doctrines of life. On the contrary, in every instance where attempts have been made to carry the science of chemistry into physiology, in all, and every such instance, the individuals who have been so employed have sunk rapidly into oblivion; unless here and there a name, like Fourcroy's and Liebig's, which is rescued by lofty genius, and by purely chemical labors in the inorganic kingdom. 376|, a. Finally, I will not forego this opportunity of bringing to the support of opinions which I have hitherto advanced, the following extract from Judge Story's late address before the Alumni of Har- vard University. It will be seen that the views of this distinguished man are entirely coincident with those which I had expressed in a former work. (See Medical and Physiological Commentaries, vol. i., p. 331-333, 310, 307, 308, 327, 385-400 ; vol. ii., p. 666-677, 801- 815, 12, 13, 203, 644, &c.) " I have said," says this eminent jurist, " that the tendency in out day is to ultraism of all sorts. I am aware that this suggestion may appear to some minds of an easy good-nature, or indolent confidence 204 INSTITUTES OF MEDICINE. to be over-wrought, or too highly colored. But unless we choose voluntarily to blind ourselves to what is passing before our eyes in the daily intercourse of life, it seems to me impossible not to feel that there is much which demands severe scrutiny, if not serious alarm. I meddle not here with the bold, and yet familiar speculations upon government and polity, upon the fundamental changes, and even abo- lition of constitutions, or upon the fluctuating innovations of ordinary legislation. These might, of themselves, furnish out exciting themes for public discussion, if this were a fit occasion to introduce them. I speak rather of the interests of letters—of the common cause of learn- ing—of the deep and abiding principles of philosophy. Is it not pain- fully true that the spirit of the age has broken loose from the strong ties which have hitherto bound society together by the mutual cohe- sions and attractions of habits, manners, institutions, morals, and liter- ature % It seems to me, that what is old is no longer a matter of reverence or affection. What is established, is not on that account esteemed positively correct, or even salutary or useful. What have hitherto been deemed fundamental truths in the wide range of human experience and moral reasoning, are no longer admitted as axioms, or even as starting-points, but at most are propounded only as prob lems, worthy of solution. They are questioned and scrutinized, and required to be submitted to jealous proofs. They have not even con- ceded to them the ordinary prerogative of being presumed to be true until the contrary is clearly shown. In short, there seems to me, at least, to be abroad a general skepticism—a restless spirit of innova- tion and change—a fretful desire to provoke discussions of all sorts, under the pretext of free inquiry, or of comprehensive liberalism. And this movement is to be found not merely among illiterate and vain pretenders, but among minds of the highest order, which are ca- pable of giving fearful impulses to public opinion. We seem to be borne on the tide of experiment with a rash and impetuous speed, confident that there is no risk in our course, and heedless that it may make shipwreck of our best hopes, and spread desolation and ruin on every side, as well on its ebb as its flow. The main ground, there- fore, for apprehension, is not from undue reverence for antiquity, so much as it is from dreamy expectations of unbounded future intellect- ual progress; and, above all, from our gross over-valuation and in- ordinate exaggeration of the peculiar advantages and excellences of our own age over all others. This last is, so to say, our besetting sin; and we worship the idol, carved by the cunning of our own hands, with a fond and parental devotion. There are many even among the educated classes, and far more among the uneducated, who imagine that we see now, as men never saw before, in extent, as well as in clearness of vision; that we reason, as men never reasoned before; that we have reached depths and made discoveries, not merely in ab- stract and physical science, but in the ascertainment of the moral and intellectual powers of man, and the true structure and interests of gov- ernment and society, which throw into comparative insignificance the attainments of past ages. We seem to ourselves to be emerging, as it were, from the darkness of by-gone centuries, whose glow-worm lights ' show the matin to be near, and 'gin to pale their ineffectual fires,' before our advancing radiance. We are almost ready to per- suade ourselves that their experience is of little value to us; that the PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 205 change of circumstances is so great, that what was wisdom once is no longer such; that it served well enough for the day, but that it ought not now to be an object of desire, or even of commendation. " Nay, the comparison is sometimes eagerly pressed of our achieve- ments in literature with those of former ages. Our histories are said to be more philosophical, more searching, more exact, more elaborate than theirs. Our poetry is said to surpass theirs in brilliancy, imag- inativeness, tenderness, elegance, and variety, and not to be behind theirs even in sublimity, or terrific grandeur. It is more thoughtful, more natural, more suggestive, more concentrative, and more thrill- ing than theirs. Our philosophy is not, like theirs, harsh or crabbed, or irregular; but wrought out in harmonious and well-defined pro- portions. Our metaphysical systems and mental speculations are (as we flatter ourselves) to endure forever, not merely as monuments of our faith, but of truth ; while the old systems must fall into ruins, or merely furnish materials to reconstruct the new—as the temples of the gods of ancient Rome serve but to trick out or ornament the mod- ern churches of the Eternal City. Ay, and it may be so. But who will pause and gaze on the latter, when his eyes can fasten on the gi- gantic forms of the Coliseum, or the Pantheon, or the Column of Tra- jan, or the Arch of Constantine ] " May I not stop for a moment, and ask if there is not much delu- sion and error in this notion of our superiority over former ages ; and if there be, whether it may not be fatal to our just progress in litera- ture, as well as to the permanent interests of society ] I would not ask those who entertain such opinions to accompany me back to the days of Aristotle and Cicero, whose works on the subject of govern- ment and politics alone have scarcely received any essential addition in principles or practical wisdom, down to this very hour. Who, of all the great names of the past, have possessed so profound an influ- ence and so wide an authority for so long a period ] If time be the arbiter of poetical excellence, whose fame is so secure as that of Ho- mer and Virgil ] Whose histories may hope to outlive those of Thu- cydides and Tacitus 1 But I would limit myself to a far narrower space, to the period of the two centuries which have elapsed since our ancestors emigrated to America. Survey the generations which have passed away, and let us ask ourselves what have been their lit- erary labors and scientific attainments 1 What the productions of their genius and learning % What the amount which they have con- tributed to meliorate the condition of mankind—to lay deep and broad the foundations of Theology, and Jurisprudence, and Medicine—to establish and illustrate the principles of free governments and inter- national law—and to instruct as well as amuse the leisure, and to re- fine the taste of social life 1 Unless I greatly mistake, a calm survey of this whole matter would convince every well-balanced mind, that if we may claim something for ourselves, we must yield much to the scholars of those days. We shall find that much of our own fruits have been grafted on the ancient stocks. That much of what we now admire is not destined for immortality. That much which we deem new is but an ill-disguised plunder from the old repositories. And that much which we vaunt to be true consists of old fallacies, often refuted and forgotten, or of unripe theories, which must perish by the way- ■de, or be choked by other weeds of a kindred growth. 206 INSTITUTES OF MEDICINE. " The truth is, that no single generation of men can accomplish much of itself or for itself which does not essentially rest upon what has been done before. Whatever may be the extent or variety of labors and attainments, much of them will fail to reach posterity, and much which reaches them will be felt, not as a distinct formation, but only as com- ponent ingredients of the general mass of knowledge. Many of the immortals of one age cease to be such in the next which succeeds it; and, at best, after a fitful season of renown, they quietly pass away, and sleep well in the common cemetery of the departed. What is present is apt to be dazzling and imposing, and to assume a vast im- portance overthe distant and the obscure. The mind in its perspect- ive becomes affected by the like laws as those of the natural vision. The shrub in the foreground overtops the oak, that has numbered its centuries. The hill under our eye looms higher than the snowy Alps, which skirt the edge of the horizon. " But let us subject this matter to a little closer scrutiny, and see if the annals of the last two centuries alone do not sufficiently admonish us of the mutability of human fame, as well as that of human pursuits. What a vast amount of intellectual power has been expended during that period, which is now dimly seen, or entirely forgotten! The very names of many authors have perished, and the titles of their works are to be gathered only from the dusty pages of some obscure catalogue. What reason can we have to suppose that much of our own labors will not share a kindred fate 1 But, turning to another and brighter part of the picture, where the mellowing hand of time has touched with its finest tints the varying figures. Who are there to be seen but Shakspeare, and Milton, and Bacon, and Locke, and Newton, and Cudworth, and Taylor, and Barrow, not to speak of a host of others, whose works ought to be profoundly studied, and should illustrate every library. I put it to ourselves to say, who are the men of this generation to be brought into comparison with these, in the extent and variety of their labors, the powers of their genius, or the depth of their researches ? Who of ourselves can hope to exercise an influence over the human mind as wide-spread as theirs 1 Who can hope to do more for science, for philosophy, for literature, for theolo- gy, than they 1 I put the argument to our modesty, whether we can dispense with the products of their genius, and wisdom, and learning; or may cast aside their works, as mere play-things for idlers, or curi- osities for collectors of the antique ] " I have but glanced at this subject. It would occupy a large dis- course to unfold it in its various bearings and consequences. But the • strong tendency of our times to disregard the lessons and the author- ity of the past must have any thing but a salutary effect upon all the complicated interests of literary as well as social life. It not only loosens and disjoints those institutions, which seem indispensable to our common happiness and security, but it puts afloat all those prin- ciples, which constitute, as it were, the very axioms of all sound phi- losophy and literature. In no country on earth is the danger of such a tendency so pregnant with fearful results, as in our own; for it nurses a spirit of innovation, and experiment, and oscillation, which leaves no resting-place for sober meditation or permanent progress. It was the striking remark of an acute observer of the human mind, that' he who sets out with doubting, will find life finished, before ho PHYSIOLOGY.--FUNCTIONS. 207 becomes master of the rudiments;' and that he who begins by pre- suming on his own sense, has ended his studies, as soon as he has commenced them."—Judge Story's Address, Sec. 376f, b. In parting, for the present, with organic chemistry, 1 would again pay my humble tribute to a science of exalted worth, in its vocation of laying open the constitution and laws of inorganic na- ture, and in applying its results to many of the most useful purposes of life. The physiologist venerates the science, does homage to its cultivators, would do battle for its cause. In protecting the great In- stitution which it is his province to illustrate, in preserving unsullied the stupendous philosophy of Medicine, he makes no encroachment on a sister science ; but, ever obedient to the voice of Nature, he wor- ships in all her temples (§ 1034). 4. DISTRIBUTION. 377. The fourth function common to animals and plants is distribu- tion or circulation. In the former, after the food has become so far assimilated as to receive the final act of appropriation, or, in other words, after it is formed into blood, it must be distributed to all parts of the body, for their growth, nutrition, &c. This office is performed by the heart and blood-vessels in all perfect and superior animals, and by the blood-vessels alone in the inferior tribes, and whenever the heart is wanting. In the last instance, the means are very similar to those which carry on the circulation in plants. 378. The mechanism of circulation is shown by the function. In the perfect animals, the blood is expelled by the left ventricle of the heart into the aorta, and thence distributed to all parts of the body; where it is applied to nutrition and secretion, and undergoes depura- tion by the excretory organs. Such as is not thus appropriated is sent forward to the communicating veins, by which it is conveyed to the right auricle, and from thence to the right ventricle, to be distrib- uted to the lungs through the pulmonary artery, and returned, again, to the left ventricle through the pulmonary veins and left auricle. In the lungs, the venous blood is converted to arterial, and perfected for the various exigencies of organic life, by the joint agency of the pul- monary mucous tissue and atmospheric air (§ 419, 827 b). 379. A remarkable exception occurs to the foregoing general plan of the circulation, in the transmission of venous blood from the ab- dominal viscera to the liver, through the vena portae. It is also anomalous, that this blood is appropriated, in part, to the formation of an organic fluid, the bile, while the residue is transmitted to the vena cava through the hepatic veins; these veins being also the asso- ciate medium for the return of blood from the hepatic artery (§1031). 380. There are three principal distinctions between the blood sent out by the left ventricle and that which is returned to the right: 1st. The color of venous blood is a modena red ; that of arterial a bright scarlet. 2d. Venous blood is more highly charged with carbonaceous matter than the arterial. 3d. Venous blood will not support the life of organs. 381. The blood supplies all parts with their means of nutrition, se- cretion, &c, and is, itself, the stimulus by which its own circulatory organs are excited to motion, and by which the formative and secre- tory vessels are maintained in their action. The pabulum vita: is, 208 INSTITUTES OF MEDICINE. therefore, remarkably distinguished from all other substances in na- ture, in being equally the stimulus of the whole circulatory system, and the substance acted upon and appropriated according to the na- ture of every part in which it may circulate (§ 136). It is the same with the sap of plants as with the blood; both being alike the pabulum vita. Each is every where converted into the solid organs to which it is distributed, and into fluids and other prod- ucts which have their special allotment in organic life; and nothing is formed which is not derived immediately from the blood or sap (§ 41-44, 847 c, 1053). OF THE POWERS WHICH CIRCULATE THE BLOOD.* 382. Much of the philosophy of medicine is involved in a right es- timate of the powers which carry on the circulation of the blood. But, having set forth this subject extensively in the Medical and Physiological Commentaries, I shall now limit my remarks to a state- ment of the most prominent facts (§ 407, a). 383, a. A great error has prevailed of ascribing the circulation of the blood to the propelling power of the heart alone. Another, less common, imputes venous circulation to the action of the capillary ar- teries ; while a still greater regards it as a hydrostatic phenomenon dependent on the arterial column of blood. Another, subversive of all principles in medicine, refers the circulation in the capillary ves- sels—those instruments of all the essential organic processes—to cap- illary attraction. Another supposes that the blood is moved in virtue of its own inherent power. Another, that the globular portion is composed of animalcula, which traverse the circulatory system by their locomotive endowment. But, the most obnoxious to objection is the latest speculation which flows from the universal doctrine of Liebig, that " All vital activity arises from the mutual action of the oxygen of. the atmosphere and the elements of the food ;" that " the life of ani- mals exhibits itself in the continual absorption of the oxygen of the air, and its combination with certain component parts of the animal body;" and that " the cause of the state of motion is to be found in a series of changes which the food undergoes in the organism; those changes being the results of processes of decomposition, to which the food itself, or the structures formed from it, or parts of organs, are subjected." (See § 350, nos. 9, 10, § 1054). This last hypothesis imputes the circulation entirely to the chemical action of oxygen gas upon the tissues and upon the blood itself; re- jects, altogether, the propelling and suction power of the heart, over- looks the respiratory movements, the peristaltic action of the intesti- nal canal, the permanent contraction of the sphincters, the motions of the iris, denies all vascular action, even in the face of such phenome- na as blushing, and all other sympathetic movements, nor recognizes a local morbid physiological determination of blood, or a morbid pro- cess, or a physiological influence of therapeutical agents, but con- strues all these unique results upon the same chemical phenomenon. 3S3, b. A modification, however, of this doctrine concedes an in- strumentality of the heart in circulating the blood. The heart still acts in virtue of the combustive process; and so far the doctrine is *■ The term powers, as here employed, comprehends the instruments of circulation. PHYSIOLOGY.--FUNCTIONS. 209 consistent. But it is fundamentally contradicted by the incongruity of the two great sources of power at the apex and at the circumfer- ence of the circulation, when contrasted with the exact balance which prevails between the moving power of the heart and the circulation of the blood in the capillary system. Nor is there to be found in na- ture two such distinct sources of power for the accomplishment of a specific effect as that which imputes the circulation of the blood to an associate mechanical impulse by the heart and a chemical process in the capillary blood-vessels (§129). 384. There are numerous elements concerned in the circulation of the blood, each one of which I have endeavored to substantiate in a former work* 1st,. The heart possesses, through its vital properties, an active power of dilating and contracting (§ 498, e). 2d. The arteries possess a similar power, though in a far inferior degree. This has been determined by the application of irritants.— (Medical and Physiological Comm., vol. ii., p. 147-152, 375-403.) 3d. The capillary arteries, or the reservoirs of blood to the ex- treme vessels, have the same power, which is much more actively ex- ercised than in the larger arteries. The capillaries are consequently brought into greater action when stimulated by physical agents, as in inflammatory diseases, or by the nervous power, as in blushing (§ 480, 1039). 4th. The extreme vessels, or terminating series of the arterial sys- tem, have, also, a like power of contracting and dilating actively, and in a still greater degree than the capillary arteries (§ 136, 750). 5th. The extreme capillary veins have, also, a special action of the foregoing nature, which aids in transmitting the blood from the arte- rial system to the next larger series of veins. 6th. The larger veins possess the power of dilating and contracting actively, according to the varying quantities of blood transmitted from the arterial system. Their constant conatus to contract on their con- tents assists in the transmission of the blood. 7th. All the cavities of the heart operate upon the principle of an exhausting pump, during their dilatation. 385. All the foregoing powers (§ 384) concur together, according to a consummate Design, in circulating the blood. All are important elements; no one adequate in itself, while each should be studied by itself, as well as in connection with the whole (§ 74, 80, 117, 137, 143, 155, 156, 169/, 266, 3031 a, 306, 310, 311, 387, 399, 409/ 422, 514 h, 524 d, 525, 526 d, 528 c, 638, 649 d, 733 b, 764 b, 811, 847 c, 848, 902/, 905, 1054). 386. The contraction and dilatation of the heart and arteries are, respectively, nearly synchronous. Although there be a perfect consent of action between the capillaries, the extreme vessels, and the heart, those vessels are not associated with the movements of the heart, nor with each other, in the same way as the actions of the heart and arteries; and they are modified, also, according to the special func- tions they perform in different parts (133 b, 135 a, 136). The case of blushing shows us the law in regard to the capillaries (§ 476, Sec). 387. Tbe final cause of motion in the veins is chiefly that of sub- * Medical and Physiological Commentaries, vol. ii., p. 375-426, 147-152, and the Essay on the Theories of Iiiflammation, ibid. O 210 INSTITUTES OF MEDICINE. serving the arterial system; and here the consent of action between the veins and arteries is still more illustrative of the profound nature of the principles and laws which govern the functions of organic life. It has been, indeed, the universal doctrine that the capacity of the veins is determined in a mechanical manner by the volume of blood transmitted from the arteries ; but I have endeavored to show that the supposed physical distension and elastic contraction of the veins are without foundation, and would form a most serious obstacle to the cir- culation of the blood. On the contrary, it appears that those actions are not only of a vital nature, but that they are a perpetual illustra- tion of sympathy, depending upon sympathetic relations of the veins to the communicating series of arterial capillaries. This peculiar constitution of the veins explains the reason why they collapse when divided ; since their sympathetic relation to the arteries is thus extinguished. The veins, indeed, appear to be not less sus- ceptible of action from the stimulus of sympathy with the capillary arteries than the iris with the retina (§ 514, k), whose phenomena so clearly demonstrate the operation of that principle in developing sen- sible motions. The dilatations and contractions of the veins are, therefore, very greatly effected by sympathetic influences exerted upon them by the varying states of the capillary arteries, as well as by the quantities of blood they are employed in transmitting to the veins. These influ- ences appear to be originally felt by the capillary series of veins, where the organic properties are most strongly pronounced, and thence propagated by continuous sympathy to the larger series (§ 498, and Comm., vol. ii., p. 520, 521, &c), when reflex actions ensue. Did not a consent of action with the arteries (depending on the principle of sympathy, § 452, 495, &c, 498) exist in the veins, the vi- tal contractility, and the elastic property of the coats, must be me- chanically overcome by the increased quantity of blood transmitted to them. The blood must be forcibly injected into the capillary veins by the vis a tergo, and in numerous parts which cannot be penetrated by the finest injections of art. This is utterly repugnant to that Uni- ty of Design which prevails in all parts of the organized being, and would be leaving an important function to a fortuitous and inadequate provision. Nor can it be consistently supposed that the phenomena which appertain to one class of vessels are of a vital nature, and those of the other, resulting in an anatomically associated series, mechanical. The veins possess, also, longitudinal fibres, by which they are fit- ted for rapid and uniform motion over an extensive tract; and this action implies a predominance of continuous sympathy (§ 498). It is also proved that the veins, like the heart and arteries, dilate actively on the application of certain stimuli to their external surface.— (Med. and, Physiolog. Comm., vol. ii., p. 147-152, 375-401.) 388. Venous circulation is determined principally by the suction or derivative power of the right cavities of the heart, but is aided by the contractile power of the large veins, by the more specific action of the capillary veins, and by the propelling power of the communi- cating series of arterial capillaries. The contraction of the left ven- tricle of the heart, and that of the large arteries, have little or no agency in venous circulation. Their force is probably exhausted, or PHYSIOLOGY.--FUNCTIONS. 211 nearly so, when the blood has reached the terminal series of the arte- rial system. The blood is returned from the lungs to the left cavities of the heart by the powers just stated. It' is not alone the dilatation of the auricles which constitutes the derivative power, as had been supposed till 1 investigated this subject; but equally, also, that of the ventricles. 389. In the Medical and Physiological Commentaries, I have ex- amined every objection which has been alleged against the imputed dependence of venous circulation upon the dilatation of the cavities of the heart, and atmospheric pressure. One objection had been stated with greater force and apparent plausibility than the rest, by Drs. Philip, Arnott, and other eminent men; namely, that the parietes of the veins should collapse upon the supposed doctrine of suction. To this objection I have replied, that the injecting power of the commu- nicating arterial capillaries maintains the veins in a state of fullness. The perfectly harmonious relation among the powers which circulate the blood establishes a correspondence between the movements in the venous and arterial systems, by which nature has duly provided against so great an evil as apprehended. 390, a. The suction power of the heart, as I have endeavored to show in the "Commentaries," is indispensable to thevportal circula- tion, and to that, also, of the lymphatics, lacteals, thoracic duct, and umbilical vein; though, doubtless, the independent action of these vessels contributes to the motion of their contents. 390, b. In the foregoing work I have considered the objection rela- tive to the occasional jet of blood from a vein wounded in venesec- tion in certain conditions of disease; and I purpose now, from its ambiguous relation to my subject, adverting to the causes of the in- termitting pulse that so often attends congested states of the liver. This phenomenon has been long observed; but no substantial cause has been assigned. It is due, I apprehend, to two influences, one of which is sympathetic, the other more or less mechanical. The sympathetic is readily appreciated; the mechanical, and most important, requires explanation. In my Essay on Inflammation, and in the present work, I have endeavored to show that the current of blood is accelerated in the vessels immediately concerned in that morbid process, notwithstanding the enlarged diameters of the vessels (§ 711, '&c). But not so in venous congestion, unless the propelling, and therefore, also, the suction power of the heart, be considerably increased. It often happens, however, that the force of the heart, in venous congestions of the liver, is even reduced below its ordinary standard, however there may be an attendant hardness of the pulse (§ 688). Now, therefore, since the veins undergo an enlargement in their congested states, and since, also, the volume of blood which is transmitted to the heart through the portal system is very large, if it < enter that organ in an unusual manner, it is highly probable that it would embarrass its action. Such would be the effect of a sluggish or irregular ingress, especially, as will be seen, if not correspondent with the egress of blood. But, it not unfrequently happens that the pulse becomes intermit- tent, for the first time, after the hepatic affection has sensibly yielded. This occurs, however, mostly, if not altogether, in rather intense 212 INSTITUTES OF MEDICINE. forms of venous congestion, and where the force of the heart, and therefore its suction power, are manifestly increased, so much so, indeed, that practitioners, cautious of blood-letting, will venture upon the remedy. An incomplete subsidence of the disease, and the means of treatment, reduce the action of the heart; and the suction power being thus lessened, while the veins remain yet enlarged, the blood moves with a tardy pace in the portal veins, and disturbs the rhythmic action of the heart. There is also another, and important element of this mechanical cause, which consists in an interrupted balance between the blood which enters the heart and that which is projected from it; its en- trance being rendered slow by the state of the portal veins, while its projection is unembarrassed. If the pulse be merely intermittent, and only so after several beats, excitement from exercise, but not from the mind, will often restore, for a short time, the harmony of both ventricles. Moral excitement, on the contrary, through nervous influence, is apt to increase the intermission, and often adds an irreg- ularity (§ 227, 509, &c). But, unlike the simply intermitting, an ir- regular pulse is commonly increased in its irregularity by violent exercise, as well as by excitements of mind. The intermitting pulse, on the contrary, is often most strongly pronounced in the horizontal posture. The nature of the sympathetic cause will be readily appreciated by the accurate observer, when he considers how often intermis- sions or irregularities of the pulse are increased by a full, and some- times a scanty meal (§ 512). Cerebral inflammation often gives rise to an irregular action of the heart; but here the cause is determined by the nervous power alone (§ 226, &c). In the case of the brain, also, the pulse is apt to be more irregular than intermittent; while in that of the liver it may be both (§ 687, &c). 391. The valves of the veins have been universally supposed to con- tribute essentially to venous circulation, by supporting the column of blood. This, however, I have endeavored to show, is a mistaken opinion ;* for they are always open when the current of blood is pass ing. Like the valves of the heart, their great final cause is to prevent the reflux of blood when pressure operates, and to contribute to the like design of the frequent inosculation of the veins. The supposed co-operation of the voluntary muscles in venous circulation is also merely accidental. 392, a. It appears, therefore, that the whole theory of the circula- tion is strictly relative to the properties of life. The pressure of the atmosphere, by which the blood is forced along the returning vessels, is entirely incidental; and, although the transit of blood from one part to another is merely mechanical, its motion originates entirely in vital agencies. The facts, of which the foregoing conclusions are predicated, are very numerous, and contribute to some of the most important pathological and therapeutical principles. It may be use- ful to consider yet farther some of the most indisputable, and to re- gard them, at the same time, in their connection with the laws of which they are the foundation. 392, b. Although the vascular system contributes an important part * Medical and Physiological Commentaries, vol. ii., p. 412, 426. PHYSIOLOGY.--FUNCTIONS. 213 toward the common circulation, the heart possesses within itself a general control over this great function of life. Had it been other- wise, " a thousand causes might intervene, over which the organ, so limited in influence, could have no control, to retard or divert the course of the blood; and which, by occasioning one short delay, might prevent its return forever." It is, therefore, not only the great mo- tive source, through its contractile power, in the universal act of dis- tribution, but, to effect a return of the venous blood, " it is made the centre of atmospheric pressure and gravity, and designates the stage in the circulation in which a deficiency of supply would be the last in being felt. Hence it appears that the functions of the heart are per- formed, and life preserved, notwithstanding long and copious dis- charges of blood, which, upon any other hypothesis, must have been fatal. For, according to these hypotheses, the heart, or at least the auricles, are placed at the end of projection. They mark the highest advance of the tide, and would first be abandoned by the retiring fluid. They would be drained by every profuse hemorrhage, and the heart would expend its energy in fruitless efforts to circulate a fluid that came not within its reach." Upon any other theory, how could what Armstrong calls "the beautiful balance between the right and left sides of the heart" be preserved? How, otherwise, would the circulation be restored in syncope 1 In respect, also, to the absorbent power, it is farther well said by Carson, that, " though we are not ac- quainted with any data from which the power of the heart can be cal- culated, there must exist, nevertheless, certain limits, within which it must reasonably be supposed to be confined. If we consider that the quantity of blood in circulation is nearly one fifth of the weight of the whole body; that this great mass is spread over an immense surface; that it is therefore subjected to great resistance from friction, espe- cially in the small vessels where each globule is to be rolled over a fixed surface; that the currents, in consequence of anastomosing branches, are perpetually flowing in opposite directions, and that at- traction must powerfully prevail between the blood and small vessels; when we consider the mass moved, the motion with which it is moved, and the resistance opposed, it is impossible to imagine that this labor could have been performed by the propelling power of the ventricle ;" besides the obvious objections of the liability of the curvature of the aorta and the capillary arteries to be ruptured, and the exigencies of the portal, placental, and lymphatic circulation (§ 390). Again, "the two trunks of the ascending and descending cava meet at the heart in such a manner as to form a straight line. The streams of blood which are conveyed by these vessels to the heart are placed at that point in direct opposition. Upon the supposition that the blood is returned to the heart by a vis a tergo, this position of the vessels is the most unfavorable that can be conceived for the office that is as- signed to them. The momentum of blood in one vessel would be de- stroyed by that of the other; or, if the current in the descending was stronger than that in the ascending cava, the blood in the weaker stream would be prevented from ever reaching the heart." 392, c. In the Medical and Physiological Commentaries, especially in the Essays on Inflammation, and the Powers which Circulate the Blood, I have exhibited a great amount of proof establishing the vital actions of the capillary blood-vessels, and showing that the mo- 214 INSTITUTES OF MEDICINE. mentum of the blood, as derived from the left cardiac ventricle, is nearly lost in the capillaries. The opinion of Hunter, Bichat, Philip, and other distinguished observers, to the same effect, being founded upon the most ample investigations, would seem to leave no doubt upon a question of such fundamental importance in the philosophy of organic life. " Have they," savs Wilson Philip, " who maintain that the circulation is supported by the muscular power of the heart alone, made even the rudest calculation of the degree of resistance to be overcome in driving the blood through two capillary systems at such a rate, that, in a given time, the same quantity shall be delivered by the veins, which is thrown into the arteries 1 Have they made any estimate of the strength necessary in the different sets of vessels, and particularly in the larger arteries, to sustain a power capable of overcoming this resistance T Let them give what imaginable power they will, they cannot make this power greater than the coats of the vessels will bear without rupture" (§ 1054,1056). So completely arrested, indeed, is the momentum of blood when it reaches the arterial capillaries, so manifest are the vital actions of these vessels, and so unaccountably did Philip and Bichat overlook the suction power of the heart, that they ascribed the circulation in the veins entirely to the propelling action of the capillary arteries. Owing to this limited view, Bichat was led to observe, that, " not- withstanding all that has been written as to the cause of venous cir- culation, there is an obscurity in it, in which there are but few rays of light." The circulation of the liver embarrassed him especially; since any general hypothesis which should fail here must be wholly abandoned (§ 390). He considered it, however, " incontestibly proved, that when the blood has arrived in the general capillary sys- tem, it is absolutely beyond the influence of the heart, and that the left ventricle has no influence in the venous system." 392, d. The demonstrations of a direct nature, to show the inde- pendent action of the blood-vessels (the veins as well as arteries), are too numerous and various for concentrated observation. They are scattered throughout this work, and many of importance occur only in the Medical and Physiological Commentaries (vol. ii., p. 147- 152, 375-401). The original suggestions of many belong to myself, as, also, their general application to the subjects before me. It has been one of my special objects to demonstrate an active dilatation of all the blood-vessels, as well as their active contraction. The latter, indeed, proves that the dilatation is active and vital. The greater principle lies in the necessity of a counteracting power; since active contraction alternating with dilatation necessarily implies correspond- ing principles of motion, or there would be a permanent state of contraction or tonic spasm. The sanguiferous system, therefore, would be devoid of function, and nothing but " stagnation" would be the great law of organic nature (§ 748, 1039). 393. The doctrine of venous circulation, as I have expounded it here, and proved it extensively in the " Commentaries," is replete with the most important physiological, pathological, and therapeutical conclusions. It strikes a fatal blow at the whole mechanical hypoth- esis and the stimulant treatment of venous congestion (§ 788-793), as shown in my Essay on that affection. It determines all the great fundamental points which have been in dispute respectino- the circu- PHYSIOLOGY.--FUNCTIONS. 215 lation of the blood. It proves that the propelling force of the left ventricle of the heart is lost, or nearly so, in the extreme capillary arteries. It proves, what is of greater importance than all things else in the Institutes of medicine, that the extreme vessels possess an independent vital action ; since otherwise the blood could never be carried forward in the veins by the power of suction (§ 389). But that would not be the greatest oversight in the plan of organic na- ture ($ 1039,1040). 394. The highest practical, as well as philosophical, conclusions are involved in a correct estimate of the powers which determine the circulation of the blood (§ 393). But there are no errors so prolific of evil, and so derogatory to medical philosophy, as that which as- sumes a passive state of the terminal series of the arteries, or that circulation is carried on in that series by capillary attraction, or by their oxydation (§ 383). Were either of these hypotheses true, there could be none of the organic products, as derived from the blood, no secretion, no nutri- tion—not a principle in physiology, pathology, or therapeutics; for all the essential organic functions, and all the processes of disease, are carried on by the terminal series of the arteries (§ 481 g, 483, &c). Consider the phenomena of sympathy; contemplate the experi- ments of Philip to determine the laws of the vital functions; study the laws of the nervous power in their relation to organic functions; observe how instantly mental emotions will variously affect the action of the heart, or bring a suffusion of blood to the pallid face, or how stimuli applied to the brain will as instantly produce corresponding results (§ 4 81-485); and you will concede that these results of the operation of the nervous power demonstrate the independent vital ac- tion of the capillary vessels, and overturn the physical and chemical hypotheses of life. 395. The foregoing influence of the cerebro-spinal and ganglionic systems upon the capillaries and extreme vessels is of the highest im- portance in pathology, and in the philosophy and treatment of dis- ease. These vessels are not only the instruments of disease, but they sustain all the morbific influences which result in sympathetic dis- eases, and upon these vessels all remedial agents exert their curative effects, whether by their direct action, or through the instrumentality of the nervous power (§ 222-233|, 456 a, 1039). 396. Nor is it alone an active condition by which the terminal se- ries of arteries is remarkably distinguished. Our various facts estab- lish the no less important principles, that the several orders of term- inal vessels have their vital properties and actions strongly pronoun- ced, and that these properties and actions are peculiarly modified in . their natural state, both in a general sense, and in different parts, and that they are liable to various other peculiar modifications from the operation of morbific and therapeutical agents. Hence, all our cura- tive means must have a steady and direct reference to the existing condition of these extreme capillary vessels (§ 149, 150, &c). 397. Of the extreme vessels physiologists have supposed, with great reason, that there are at least three series ; one being destined for nu- trition, another for the secretion and excretion of the fluids, and an- other series coinciding with the veins. Without being disposed to submit this question, in the least, to the 216 INSTITUTES OF MEDICINE. microscope (§ 131), there might be allowed, according to WTagner, what has probably been hypothetically suggested by the well-known simplicity of nature, that there is " but one kind of termination in ref- erence to an artery—a passage into a vein through a capillary vessel, and an intermediate net-work." In this case, however, there must either exist lateral projections from the terminal capillary, or there must radiate from the " intermediate net-work" vessels whose office is to carry the white blood, from which are eliminated the materials for nutrition, &c. 398. The extreme vessels which are destined for nutrition, secre- tion, and excretion, elect from the blood, contained in their reservoirs the capillary arteries, the precise elements that are necessary to the formation of each peculiar compound throughout the body, and in such uniform proportions and modes of combination as shall forever, and without deviation, render them exactly conformable to the nature of every part, as ordained at the Creation (§ 41-44). This is done in virtue of the peculiarly modified states of irritability and other properties of life, according to the exact office of every part. Yet are these the vessels which are said to be under the sole government of physical and chemical laws (§ 383), and whose morbid state in in- flammation is constituted by a mechanical relaxation of their parietes, and a stagnation and coagulation of their contents (§ 711, &c.)! 399. In their natural state, the foregoing vessels refuse admission to the red globules of blood, in virtue of their peculiarly modified ir- ritability; and this, therefore, where the calibre surpasses the diam- eters of the red globules. There is no mechanical "straining off of the finer from the coarser parts of the blood" by an inadequate capa- city of those vessels which convey only white blood (§ 493, d). The separation is effected in a homogeneous substance, and by causes which are very foreign to " strainers" and " sieves" (§ 129, 135-138, 266, 649 d). The same principle interprets the admission of the red globules into those serous vessels, in inflammation. Irritability is there morbidly affected, and the usual process of vital decomposition of the blood is, of course, arrested (§ 327-329). The entire blood then finds its way into the lymph vessels, as they are called ; and the organic law by which that result is determined (§ 192, 278) is beautifully illus- trated by two experiments; one by Buniva, the other by Procter. The experiments also confirm the doctrines which I have taught as to the character of the nervous power, and its agency in organic actions, while each observer pursuing different routes, and attaining a com- mon end through opposite effects, but by common principles relative to the nervous power, illustrate and confirm the experiments of each (§ 222-233f, 476, Sec, 500). Buniva had great difficulty in effecting an injection of an artery of a living dog, till he divided the spinal cord, when, by thus withdraw- ing the stimulus of the nervous power, the capillaries lost their pecu- liar susceptibility, and the contents of the syringe passed freelY on.— Buniva (§ 1039,1056). r J In Procter's experiment, " a horse was killed by dividing the me- dulla, the bowels turned aside, and the branch of the sympathetic nerve, which joins the ischiadic, laid bare; also, one of the arteries of the leg. A wire applied to the positive pole of a galvanic bat- tery, defended with sponge, was applied to the nerve, and the nega- PHYSIOLOGY.--FUNCTIONS. 217 tive wire to the artery. The positive wire was then drawn slowly along the plates of a fifty-plate battery and the effect was certainly not only to reproduce the pulsation in the artery, but also clearly to excite circulation in the more minute vessels." A by-stander ex- claimed, " See how that pipe beats when they put on those wires!" —Procter, on the Sympathetic Nerve. 1844. To the foregoing may be added the experiment by Dr. Hall (§ 263), which, it will have been observed, is insuperably opposed to his con- clusions as to the agency of the nervous system in producing organic actions, and as examined in my Essays on " Vitality," &c (p. 42, note). See, also, Experiments by Kriemer, § 485, and Philips, 5 483, and Dr. Parry's case, § 487, gg. 5. APPROPRIATION, OR NUTRITION AND SECRETION. 400. Appropriation, like assimilation, is a comprehensive, though less complex, function. It embraces what are commonly designated as two functions, namely, nutrition and secretion. 401, a. A common fluid being formed, and distributed to the sever- al parts of the animal and vegetable, is then appropriated to their several uses. 401, b. Animals are distinguished by an unceasing change of the materials of which they are composed. The actions of life disturb the composition of parts, which, being thus unsuited for the purposes of organization, and reduced to a fluid state, are returned to the general circulating mass of blood, where they either again undergo assimilation, or are eliminated and cast off by the excretory organs. To supply this waste is, in part, the office of appropriation, which furnishes new molecules from the blood, in exact conformity with the process of disintegration after growth is completed, but occurring in excess while nutrition is engaged in rearing up the fabric to a state of maturity. Appropriation is also the function through which those secreted fluids, which act as auxiliaries in the processes of life, are renewed in their original character. 402. Appropriation, therefore, whether it refer to the increase and renewal of the solid parts, or to the production of useful fluids, being equally a process of secretion, every organic product, vegetable or animal, is the result of secretion. But appropriation, as applied to the useful fluids that are formed from the blood or sap, is more com- monly known as an act of secretion; and though the next function which will be considered, namely, excretion, is very analogous, yet the final causes of secretion and excretion being entirely different, it is proper that they should be arranged as distinct processes. Since, however, nutrition, secretion, and excretion are very analo- gous processes, secretion is a good generic term for the whole. Each process consists of certain acts by which new formations are gener- ated from the blood. All parts are first eliminated in a fluid state. Such as are destined for nutrition assume the condition of the solids which they supply as soon as eliminated: such as subserve the uses of fluids remain permanently fluid. It is evident, therefore, that ap- propriation, in a philosophical sense, is the highest act of assimila- tion, but may be very properly regarded as a function by itself 403. Every part of the body possesses a secreting apparatus, since every part appropriates the blood to itself (§ 398). 218 INSTITUTES of medicine. 404. The organs which generate the permanent fluid products are very various, and more complex than such as carry on nutrition. The former are either glands or simple membranes, acting in their com- pound condition (§ 92). The immediate instruments consist of a sim- ple series of extreme vessels which pervade every part, and which are every where so constituted, anatomically and vitally, that they elaborate from the common nutritive fluid such compounds as are ex- actly conformable to the nature of each part respectively (§ 41-44, 133, &c, 135 b, 188, Sec, 205, &c, 233, 397, 398). 405. The variety of secreted products, solid and fluid, is greatei, and the quantity more abundant in animals than in plants, and in pro- portion, also, to the complexity of organization. 406. The following products of secretion which remain more or less fluid occur in the animal kingdom. The first six are common to most animals: 1. Gastric juice. 2. Saliva. 3. Pancreatic juice. 4. Bile. 5. Serous fluids. 6. Mucous fluids. 7. Tears. Jo—a-a.- f Of the serous tissues. " cellular tissue. " articular tissues. " chambers of the eye. " capsule of the lens. " labyrinth of the ear. f Of the mucous tissue of the mouth. " " " nose. " " " pharynx. " " " larynx and trachea. " " " lungs. " " " stomach. " " " intestines. " urinary and genital organs. " skin of aquatic animals. \' Suet, and fat of cellular tissue. Marrow of bones. Liquids in the cryptae of the skin. Cerumen of the ear. Fatty fluid of prepuce. Many other oily products. ^ Ink of the sepia. {Liquids of insects. Virus of serpents, &c. Galvanism of torpedo, &c. Humors of the spider, and of other insects, from which their webs, cocoons, &c, are formed. f Germinal fluid. Semen. Product of vesiculce seminales. Liquor of Cowper's glands. Liquids in the foetal membranes. The milk of mammifera. 8. Fatty or oily liquids. 9. Fluids of defense. 10. 11. Fluids necessary to the preservation of the< species. PHYSIOLOGY.--FUNCTIONS. 219 The foregoing fluids are variable according to the nature of the an- imal, but always the same in each species, and analogous, respective- ly, in all (§ 63, &c, 83). 407, a. In considering the mechanism and the function of appro- priation, it devolves upon the Institutes of Medicine, as in all other anatomical and physiological inquiries, to apply the whole to the elu- cidation of the laws upon which the mechanism is founded, and un- der which the phenomena take place. It will still be my purpose, therefore, to interrogate the whole in their various relations, and to illustrate the philosophy of the whole by contrasting the defects of spurious systems. 407, b. The exact anatomical condition of the instruments of nu- trition and secretion, as well as the functions themselves, can never be brought within the cognizance of sense ; nor would it be of any practical use to know them beyond what is revealed by the vital and physical results (§ 83, 131). By these facts we are enabled to insti- tute many of the most important conclusions in physiology. By them, especially, we demonstrate the errors of the physical and chemical doctrines of capillary circulation, and of the chemical and mechanical hypotheses relative to secretion. By them, we show that all the products from the blood, as well as effusions of blood in the ordinary forms of capillary hemorrhage, find their way out of the vessels through some vital act, and that the physical doctrines of per- colation, and endosmose and exnosmose, have no foundation in or- ganic nature (§ 131, 275). 407, c. It has been also seen by demonstrations in respect to the development of the ovum, that appropriation is conducted by the same powers throughout the life of the being that were brought into action by the stimulus of semen ; and it may be now added that the coincidence is beautifully enforced by a progressive and uninterrupt- ed march of that primary development, which was* instituted in the ovum, after the beginning of independent life (§ 63-81, 153-159). 408. The mechanical doctrine of filtration, which supposes the in- calculable variety of secreted products to exist already formed in the blood (§ 41), still disfigures the physiology of the schools, and forms a prominent characteristic in the prevailing pathology of in- flammation. To the whole of this subject, as well as to the chemical hypotheses, I have given an extensive investigation in my Essays on the Humoral Pathology, on the Vital Powers, on the Theories of In- flammation, on Endosmose and Ex**osmose, and on Diabetes, as em- braced in the Medical and Physiological Commentaries. Many re- markable assumptions, intended to sustain the physical rationale of vital processes, are there examined and refuted. But, the explosion of one error, it has been said, often prepares the way for another; as exemplified in the following quotation relative to the hypothesis of endosmose and ex**osmose: " This permeability to gases," says Liebig, " is a mechanical prop- erty, common to all animal tissues; and it is found in the same degree in the living as in the dead tissue."—Liebig's Animal Chemistry.— See, also, § 350, 1031 b. 409, a. When considering the subject of proteine in a former sec- tion (§ IS), I reserved for this place all that was not immediately rel- ative to elementary composition. What was there set forth should b« 220 INSTITUTES OF MEDICINE. applied in connection with what I shall now. advance in continuation of the subject. 409, b. We have seen that, in opposition to the received doctrines as quoted from Liebig in section 18, there is nothing in the secreted products of animals, solid or fluid, that subsist on vegetable substan- ces similar to the food, except in elementary composition, nor in the blood itself; while it is also affirmed by Liebig, that " analogy, that fertile source of error, has unfortunately led to the very unapt com- parison of the vital functions of plants with those of animals." But the reader, who may have attended to the parallel columns, and the sections on the chemical hypotheses of disease and therapeutics, will be neither surprised at the inconsistencies now and formerly indicated as to the prerogative of the vegetable kingdom in doing the whole work of assimilation, and even trespassing upon that of appropriation, in behalf of the animal tribes, nor unprepared for a farther explosion of the doctrine by its principal author. Let us, therefore, hear the chemist yet farther in his contradiction of the great fundamental doc- trine (§ 18). Thus: "We must not forget," says Liebig, "that, in whatever light we may view the vital operations, the production of nervous matter froiri the blood presupposes a change in the composition and qualities of the constituents of blood. That such change occurs is as certain as that the existence of the nervous matter cannot be denied. In this sense, we must assume that from a compound of proteine may be form- ed a first, second, third, Sec, product, before a certain number of its elements can become constituents of the nervous matter." Again, having in view another special point, we are told that " This much, at least, is undeniable, that the herbs and roots con- sumed by the cow contain no butter; that in hay, or the other fodder of oxen, no beef suet exists; that no hog's lard can be found in the potato refuse given to swine; and that the food of geese or fowls contains no goose fat or capon fat;"—" that as yet no trace of starch or sugar has been detected in arterial blood, not even in animals which had been fed exclusively with those substances."—(See Comm., vol. i., p. 674-682.) And what gives special plausibility to these speculations is the con- troversy which has taken place between " the Reformer" on one side, and Dumas and other French chemists, on the other, respecting the origin of fat; the former maintaining that it results from trans- formations of sugar, starch, and other " vegetable proximates," while the latter contend that not only this, but agree with Liebig that all the other unique products of herbivorous animals are formed without the aid of their complex assimilating organs,—that they are merely applied as generated by the plant. In this latter doctrine is also seen a striking display of the human mind to run into simple views of na- ture ; overlooking all the complicated facts and the whole labyrinth of animal organization, and making the ultimate sustenance of animal life but one remove from the constituents of the atmosphere (§ 3034-, 304, 305, 322). And again, when chemical demonstrations cannot be resisted, " We must admit," says Liebig, '' as the most important result of the study of the composition of gelatinous tissue, and as a point unde- niably established, that, although formed from compounds of proteine, PHYSIOLOGY.--FUNCTIONS. 221 it no longer belongs to the series of the compounds of proteine. No substance analogous to the tissues yielding gelatin is found in vege- tables." Nay, not even in the blood itself; though, " It is conceivable that membranes and tissues which yield gelatin are formed from albumen by the addition of oxygen, of the elements of water, and those of ammonia, accompanied by a separation of sul- phur and phosphorus. At all events, their composition is entirely different from that of the chief constituents of the blood." " But there is no doubt that these tissues are formed from the constituents of the blood" ! Q,. E. D.—Liebig's Animal Chemistry. It will be thus seen that the chemist is finally coerced to the admis- sion that many of the most important organic compounds depend altogether upon the specific action of organs by which they are elab- orated from the blood, and that he is even embarrassed with a " doubt" whether " these tissues are formed from the constituents of the blood." This is all the vitalist desires. It betrays the factitious nature of the whole physical rationale. It proclaims that every secreted product is different from the common source of supply, and different in every part of the animal. Chyme differs from chyle, and blood from either. Each differs in every species of animal, from man down to the white- blooded tribes; yet each, wherever existing, is forever the same in the same species. And so with plants, even with such as seek for ammonia and nitrates upon the dung-hill, or others that gather iodine from the deep (§ 289, 350, nos. 26^, 77). Each product, therefore, is generated in its unique characteristics by agents and processes which are designed specifically for the formation of each. Nor would this be doubtful to any observer who may pass along the various grada- tions of the assimilating organs from their simple condition in plants to that complexity which demanded the superaddition of the nervous systems (§ 336). If we take, now, the premises on which the chemist proceeds to the exact conclusions which he sets forth in his formulae of organic compounds, those who have been inattentive to his method will be surprised at its destitution of all but vague conjecture, where organic compounds are concerned ; and, for the unique nature of these com- pounds, the reader must turn to what I have said on the subject of Composition. The following is the great starting point: " The organs are formed from the blood, and contain the elements of the blood. They become transformed into new compounds with the addition only of oxygen and water. Hence the relative propor- tion of carbon and nitrogen must be the same as in the blood. " If, then, we subtract from the composition of blood the elements of the urine, then the remainder, deducting the oxygen and water which have been added, must give the composition of the bile. " Or, if from the elements of the blood we subtract the elements of the bile, the remainder must give the composition of urate of ammo- nia, or of urea and carbonic acid" ! Q,. E. D.—Liebig's Animal Chem- istry. Such, once more, is the basis of organic chemistry, with all the ap- parent precision of mathematics, in its extraction of a cube root; yet never the same in its analysis of the elementary composition of the blood, avowing the homogeneous nature of that compound of 17 or \ 222 institutes of medicine. 18 elements, and, finally, in the very midst of its mathematical accu- racy, allowing that there is no one organic compound elaborated from the blood by the living similar to the results of artificial processes. This I have,already abundantly shown, even in the present section, and in another relative to it (§ 18). The same evidence abounds in the parallel quotations (§ 350), and a glance at the " Animal Chem- istry," or the " Organic," would supply other facts for my present purpose. Thus, in -the following sentences, enough is conceded to substantiate my position; and it is worth the specific remark that " we know with certainty" that albumen and fibrin have not the same composition. " We must t>e careful not to deceive ourselves in our expectations of what chemical analysis can do. We know, with certainty, that the numbers representing the relative proportions of the organic elements are the same in albumen and fibrin, and hence we conclude that they have the same composition." " If we reflect, that from the albumen and fibrin of the body all the other tissues are derived, it is perfectly clear that this can only occur in two ways. Either certain elements have been added to, or removed from, their constituent parts," and so on.—Liebig's Animal Chemistry. 409, c. If the viper be fed exclusively with any one substance, its peculiar poison will be generated ; and so of the characteristic prod- ucts of the civet, the cuttlefish, the skunk, the beaver, &c.; each, also, being always generated by one particular part. Here, then, are tests for an important and comprehensive philosophy. From these we may descend along a scale, where we shall find in some of the se- creted products of every animal and plant certain prominent charac- teristics which declare that not only these, but the less striking, also, are as much dependent on special organization, and special powers and actions, as the poison of the viper, or the foetor of the skunk, or the civet, or the beaver, or the ink of the cuttlefish, &c. Will any thing in nature, excepting the mucous tissue of the stomach, produce a substance at all analogous to the gastric juice ] Is there any thing analogous to semen in the blood 1 Can it be generated by any thing but the testis (§ 83, b) % Can it be surmised that it is at all the prod- uct of forces which govern the inanimate world 1 Consider the na- ture of granulations, so obvious to the eye, and yet so analogous to the products of nutrition. From whatever parts of the body they spring up, they have all, originally, the same appearance. The same in bone as in muscle. But, so various are the modifications of their vital constitution, that they ultimately elaborate substances exactly conformable to the nature of the tissues, respectively, by which the granulations were generated. We know that there must be specific powers to effect these results, and that in each tissue, and in the gran- ulations thereof, the powers are modified; and we know, also, that the results defy all explanation by any chemical or mechanical laws. 409, d. Carry the same principle to morbid conditions. Is not the virus of hydrophobia generated exclusively by the salivary glands, and by those glands in a particular state of disease, and probably, also, by the canine and feline tribes alone ] Does not every morbid prod- uct require a specific mode of disease ] Is not this distinctly exem- plified in scarlatina, measles, small-pox; and, therefore, equally true PHYSIOLOGY.--FUNCTIONS. 223 in less striking cases ] Equally as true of common pus as of the pus of variola ] And here I would refer to what I have said, in my Es- say on Inflammation, of the nature and formation of pus ;* how its formation is indiscriminately imputed by the same philosophers to a spontaneous alteration of blood in the large vessels, to chemical ac- tions in the small, and to the decomposition of dead animal matter; how its analysis has led different chemists to opposite conclusions both as to its nature and formation; and how it is affirmed by the chemist to be unchangeably the same, whether the product of an ab- scess, of a chancre, or of the variolous pustule. The confusion in these respects is very remarkable, showing the perfect inadequacy of the principles by which the explanation is attempted; while they, who believe that animated nature operates by other forces, see noth- ing but admirable simplicity, and a fountain of the highest practical advantages to mankind. 409, e. Again, do we not find remarkable relations between the structure of secreting organs and the matter secreted (§ 346) % Where organization is most complex, the secretions are most compounded, and, as the structure becomes more and more simple, so also do the corresponding secretions. And yet, in the most simple membranes, apparently of the same organization, the products, according to Cu- vier and others, are almost as various as the different species of ani- mals, consisting of fluids in some, and of air in others; yet always the same in each species. On the other hand, what complexity of organ- ization in the liver of the higher animals; yet all is precise, harmoni- ous, and adapted to specific ends. Those ends, and that complexity, are fatal to all the chemical and physical views of the functions of assimilation and appropriation. And yet is the secretion of bile, which, according to the chemists, is composed of forty different com- pounds, and these made up of four or five elements, compared to what is supposed to be a chemical evolution of carbon from the blood; and the liver is also said, by distinguished physiologists, to be oierely an " abdominal lung." We are told that " physiologists have been induced to suppose that the structure of the kidney is such that it allows the urea to percolate through the fine vessels emptying into its pelvis, like the mechanical operation ofsifting or filtering, but de- nies a passage to the other constituents of the arterial blood." But liow " deny" them ; why do they never escape ; why do not the con- stituents of the bile come this way, and vice versa ? Is it more diffi- cult for one substance to " sift and filter" its " passage" through one set of vessels than the other 1 The iatro-mechanical, it is true, are comparatively few with the iatro-chemical philosophers. The latter have also greater zeal. They are more recently in a field full of se- ductive novelties, and other allurements, while pure chemistry can offer nothing but the details of analysis (§ 1032). 409,/ All the secreted fluids have not only an apparatus peculiar to each, whose complexity corresponds remarkably with the com- pound nature of their products, but they are all destined for import- ant specific ends in the economy of living bodies ; a final purpose of which chemistry and physics are wholly incapable. One would be perfectly unsuited to the office of another, and would be even destruc- tive of life, in most of the cases, should one product interchange with * In Medical and Physiological Commentaries, vol. ii., p. 181-204. 221 INSTITUTES OF MEDICINE. another (§ 129, 135-137). The saliva, gastric and pancreatic juices, are designed for digestion; the blood being thus an almost direct cause of its own reproduction (§ 323-325, 356 a). The bile sub- serves three specific purposes, which, when regarded in their connec- tion, supply one of the most remarkable instances of Design. This fluid participates directly in the assimilation of food, is the important cause of peristaltic motion, and performs, lastly, that inferior office, which is often regarded as its only one, of contributing with the lungs, kidneys, and skin, as an emulgent of the blood, though in a different aspect from the organs of excretion (§ 415, 423). The products of the serous membranes are designed, for the most part, to facilitate organic and voluntary movements; mucus serves, like the cuticle, to protect its organ against offending causes, &c.; the " humors" of the eye, and of the internal ear, are media of communication between external ob- jects and the nerves of sensation; and they are wonderfully adapted to the laws which they are intended to subserve. The semen, milk, fat, animal heat, &c, are other remarkable examples of final causes which secretion is intended to fulfill. To these might be added many others, less important, but not less to our purpose; as the poison of snakes and of insects, the galvanism of aquatic animals, the ink of the sepia, the flu- id from which the spider builds his house, and with which we cure in- termittent fever, &c. And, when we regard, in connection, the bile, the gastric juice, semen, milk, &c.—all derived from the homogeneous blood,—and consider the uniformity of their respective composition in health, their changes according to the alterations of the vital prop- erties in disease, and these changes corresponding with certain modi- fications of the vital phenomena, are we not moved with astonish- ment at the total difference in their nature % Is there any relief for our astonishment but in a firm reliance upon powers that are equally unique in their operation % Would not amazement otherwise increase, till it should prove that the human mind does not rightly interpret the laws of nature, and is unjust to its own endowments ] 409, g. If we now survey the vegetable kingdom, we shall find all things constituted upon the same plan. The poppy, digitalis, croton, spurge,—every thing growing side by side in the same earth, the same air, and watered with the same fluid, have," each one, its unique and unvarying sap and secreted products ; an infinite variety of precise combinations derived from about four simple elements (§ 41, 42). Again, also, not only different species of plants when flourishing in the same soil yield different products throughout, but the same species have produced, from the day of their creation, the same identical products, in all their parts, in every variety of soil and climate. And so of all animals, whatever the variety of food. In the vegetable kingdom, we are also amazed at the systematic Design manifested in the coincidences between the various elementary combinations and their virtues as vital stimuli, or as morbific or remedial agents, which obtain among numerous species of many genera of plants, and which are maintained in all the varieties of soil to which the plants may be subjected.' But, while these analogies prevail among the medicinal properties of certain extensive groups of plants, the products of each species, and of the several parts of the same species, have certain pe- culiarities, and these, too, will depend, in many plants, upon the stage of their advancement toward the flowering season, while they are not influenced by soil, climate, Sec. (§ 52, 155). PHYSIOLOGY.--FUNCTIONS. 225 409, h. Apply what has now been said of the products from the sap of plants to the formation of blood alone, which is composed of about the same elements, and we see how vain the attempts to explain by chemical laws even the formation of chyle; its conversion even from a white to a deep red color, and yet that color changing to white again under the influence of slight disease; and, finally, the vitality with which the blood is endowed. And, notwithstanding the complexity of the human body, its endless variety of food, and its artificial com- binations and changes, has not the chemist given us a standard of the composition of the chyle, the blood, the gastric juice, bile, saliva, milk, &c, by which their morbid changes are to be tested in all countries, at all seasons, at all ages of man and of the worli ] Has he not told us that all this is so uniform in the natural state of the animal, so unlike the results of chemical agencies, that when changes arise they are in- dicative of changes in health? And does he not offer to show, that this alteration of the blood and secretions » so uniform under the same circumstances of disordered health, that you may tell by it the nature of disease and the appropriate remed/ (§ 5, 5\ a) 1 Is not this the basis of practical humoralism? I g*ant the fact as to the relation of specific changes in the secretions, *he blood, also, and specific modifi- cations of action. But is not al-1 this in absolute opposition to what- ever is known of the capricious operation of chemical forces ? And what shadow of proof is there, that these vital powers, which the chem- ist now and then invoke^ to his aid, are not entirely adequate to the physiological results th* are ascribed to the forces of chemistry ? And having also just reminded the reader that the elementary composition of the blood and s-P is about the same in all animals and plants, he can hardly be prepared to believe that they are the same thing, either in a general se*se> or as it respects the individual species in either department o^he organic kingdom (§ 1032 a, 1052). 409 i. A*d now, turning again to the mere physical theorist, if there be r»iy who cannot appreciate the objections which I have set forth to -'heir peculiar views of secretion, let them appeal to their or- dinarvnabits of observation, and look at the condition of the blood as j-^putedly laden with the various compounds which are supposed to Je strained off from the great vital fluid. What an unphilosophical fixture ! All the forty ingredients of the bile into which that homo- geneous substance is separated by the various manipulations of the chemist,—all the variety into which the urine is resolved by the same ingenious devices,—mucus, saliva, gastric juice, albumen, gelatin, ce- rebral substance, fat, tears, sweat, milk, semen, the germinal fluid, &C,—nay, more, all the peculiar compounds which go to the forma- tion of the different parts of the body; and each one, and no other, strained off by that part alone which has been forever engaged in the individual office of eliminating one exact compound, or one special variety of compounds. Nor is this the end of the absurdities ; for the same physical doctrine supposes that this principle is coextensive with the vegetable kingdom, and that every species of plant and ani- mal embraces in its circulating fluid special varieties, which, in the aggregate, make up the many millions of specific and unvarying com- pounds of which the organic kingdoms are composed (§ 41). Nor is it. a small part of the difficulties which surround tho mechanical and chemical hypotheses of secretion, that all these millions of compounds P 226 INSTITUTES OF MEDICINE. are liable to exact variations, according to morbid changes in the parts by which they are elaborated. 409, j. Is the chemical hypothesis of catalysis better calculated than the mechanical to resolve the great problem which concerns the formation of the millions of unique products from one common fluid, and in conformity with the facts which have been hitherto stated? This doctrine is, doubtless, the most ingenious of any which has been advanced by chemistry; but it has little to sustain it even of the spe- cious analogies supplied by inorganic processes. Indeed, so little is catalysis supported by the phenomena of inorganic nature, that its existence is denied by many able chemists. Thus: " Liebig," says Mulder, "has been led to reject catalysis entirely, and to give a totally different explanation of facts. He has assumed, that chemical forces aie in action in those substances which, accord- ing to the supposition of Berzelius, are capable of exciting action, though without taking pari in that action ; and he thinks that by such chemical action, another mty be excited in other substances. He adopts the principle, indicated, by La Place and Berthollet, that a molecule, being put in motion, om communicate its motion to others, if in contact with them. He apples this principle to yeast especial- ly," &c.—Mulder's Chemistry of Vegetable and Animal Physiology. In section 350|, d, is a brief statement of the catalytic theory as advocated by Mulder; and in the Mescal and Physiological Com- mentaries (vol. i., p. 55-78) I have considered specifically the obsta- cles to its application to organic processes, vhile it must encounter, also, all that I have here alleged against the mechanical and other physical doctrines. Nor is it the least objection to the whole chem- ical system of organic life, that the two principal!eaders in organic chemistry "give a totally different explanation of fact-1" that make up the essential attributes of living beings. Mulder affirns that Liebig's theory is an " assumption," while Liebig " rejects entirQy" the cata- lytic theory of Mulder. The medical reader will easilj appreciate the worth of Liebig's " assumption," by referring to its attempted "explanation of facts" as revealed by disease. (See § 350,^05. 40, 41, 42, 44, 45, 3501.) It has been hardly worth while to advert particularly to the hy- potheses which assign to electricity and galvanism an agency, mo?e or less extensive, in the formation of the secreted products, or whict regard the nervous system as the source and conductors of that fluid, or which identify galvanism with the nervous power. Enough is here said, as also of the phenomena of the nervous power (§ 222-239,500, &c), to evince the absence of all connection of organic processes and results with electrical or galvanic influences. In the Medical and Physiological Commentaries, however, I have critically explored the whole subject (Essay on the Vital Powers, and its Appendix). 410. We may therefore well conclude that there is nothing so im- portant in the whole compass of physiology, and in the philosophy and practice of medicine, as a proper understanding of the vital con- stitution, in their properties and functions, of those extreme vessels by which nutrition and secretion are performed. Those are also the instruments of all morbid processes, and those by which all morbid products aie elaborated from the blood. And since all healthy prod- ucts are clearly the result of processes to which there is nothing anal- PHYSIOLOGY.-—FUNCTIONS. 22? ogous in the world of dead mater, how obviously must all the prod- ucts of disease, all those of irdammatory conditions, which vary but little from the natural standa'd, be owing to the same vital processes of those formative and secretory vessels somewhat diverted from their natural states, and in whicl deviations disease must be allowed to con- sist (§ 750, 1039, 1040, W56). 411. Finally, the function of appropriation is that which evinces, more than any other, hie existence of a vital principle. This princi- ple, beino- admitted as the basis of that function, must be carried to ev- ery other process of living beings. It is by appropriation that the new elementary combinations, in their endless variety, are formed from the blood or s'P- By nutrition, which begins at the earliest develop- ment of the enbryo in the aspect of growth, under the government of a peculiar rower, as admitted by all, the organic being is carried for- ward to ful maturity, and maintained while life continues. At every stao-e of bs existence, it is the same process as that which was start- ed by th* impression of the semen upon the germ; and, since no new results ire brought forth, no new powers can be called into opera- tion, f he living semen is the first stimulus of the organic properties of theembryo, and in this respect it is analogous to those vital stimuli whici forever after maintain the same powers in action, and by which the same nutrition, or the same elementary combinations, are effected at every subsequent stage of existence. By nutrition, through the operation of these vital properties, and according to specific plans in- stituted by the Creator, and to be forever perpetuated by the substi- tuted energy of the vital principle, all those forms of organic beings, which pass by almost insensible gradations from the mushroom up to the gigantic tree, and from the microscopic animalcule to the majesty of man, are maintained in all their exact peculiarities, in all their anal- ogies to each other, in all their vital and moral attributes. It is by nutrition, that is to say, by the specific modes in which some three or four principal elements are united together, and joined to pre-existing parts of the same nature (§ 41, 42), that each animal or plant, accord- ing to its species, acquires and maintains a specific configuration and organization, exhibiting vital results that are peculiar to each, pro- ducing specific germs that are developed in exact conformity with the nature of the parent, and each pursuing forever a certain path which was marked out for itself alone by the Hand which gave it existence. Such, and far more, is the wonderful power, a power substituted for the Creator Himself, which directs capillary circulation, and governs the process of nutrition in the development of the embryo, in the ma- turity of the being, and in the perpetuation of the species. Briefly, then, the whole essential philosophy of organic life, all that is important, or useful, or dignified in medicine, is directly relative to the vital constitution, and the vital actions of the formative and secre- tory vessels. Here is the labyrinth of life, here of disease, here the ul- timate aim of medical philosophy (§ 1040). 6. EXCRETION. 412. Excretion is the sixth grand function common to animals and vegetables. It is analogous to secretion, and is performed by analo- gous organization ; though the differences in these respects are prob- ably greater than between nutrition and secretion, in their ordinary acceptation (§ 402, 404). 228 INSTITUTES OF MEDICINE. 413. By excretion useless matter's elaborated from the blood and ejected from the body. The results of this function, therefore, are entirely different from those of secretioi, which are destined for use- ful purposes in the animal economy. 414. The terminal series of the arteria1 system, as with appropri- ation, are the immediate instruments of he function of excretion, But, like secretion, a compounded organization is necessary to excre- tion. In this respect there appears to be about the same anatomical variety allotted to secretion and excretion (§ 404}. The same tissue, indeed, and even the same part, may perform botk functions; as in the lungs, and in the uterus (§ 135), Notwithstanding, however, these coincidences, the puppos^d to PHYSIOLOGY.--FUNCTIONS. 243 act as a substitute for free respiration in the production of heat" (no. 10), we shall not be surprised to learn that " its absorption answers as a substitute for food in the production of animal heat." So it is ex- tensively affirmed in the work on Animal Chemistry. Why, then, is the temperature of a very fat ox and a very lean one, or of a very fat man and a very lean one, exactly the same in each species, respectively 1 Why does the fat man sustain a much less exaltation of heat than the lean one, when emaciation is in rapid progress in febrile diseases 1 Why those daily periodical evolutions of heat (100° to 110° Fh.), in the emaciated subject of phthisis, sub- sisting on barley-water; and respiring with lungs unfitted for half their usual functions 1 And this leads me to state the chemical phi- losophy of mania and delirium, which flows immediately from the subject before us; and by which we learn, also, what is more im- portant, the extent of our author's theory of combustion. Thus : " In the progress of starvation it is not only the fat which disap- pears, but also, by degrees, all such of the solids as are capable of be- ing dissolved. In the wasted body of those who have suffered starva- tion, the muscles are shrunk and unnaturally soft, and have lost their contractility. All those parts of the body which were capable of en- tering into a state of motion, have served to protect the remainder of the frame from the destructive influence of the atmosphere. [! ] To- ward the end, the particles of the brain begin to undergo the process of oxydation, and delirium, mania, and death, close the scene." This construction of the cause of delirium and mania is conformable to the author's hypothesis of thought, mental emotions, &c. (§ 349, e); but that the phenomena are due to totally different influences " in the progress of starvation," is shown by the uniform preservation of the intellectual powers in the most emaciated subjects of phthisis pulmo- nalis (§ 441, c). 440, cc. But, we are only beginning with the contingencies which contribute to the fundamental principle of animal heat, and which are designed to interpret its remarkable uniformity, yet variety, in differ- ent species of the warm-blooded tribes, and its variableness in the cold- blooded, and to bring the general doctrine into correspondence with a great law of caloric which prevails in the inorganic world 1% 440 e no. 14). 12. "In cold and temperate climates, the air which incessantly strives to consume the body [ ! ] urges man to laborious efforts in or- der to furnish the means of resistance to its action, while, in hot climates, the necessity of labor to provide food is far less urgent" (§ 445, b).—Animal Chemistry. In the first place, all animals are overlooked in the foregoing state- ment, and our philosopher is actually regarding man as the only liv- ing creature who has a temperature above the surrounding atmo- sphere ; for it surely will not be said of animals that they must work harder for a supply of food in temperate than in warmer climates. Nor will the reader fail to observe that much of the statements and reasoning, throughout, is predicated specifically of man, and of man, too, in a state of health. As to the necessity of more "laborious efforts to provide food" in cold than in hot climates, a very different philosophy lies at its bottom than assigned by Liebig, which consists in the greater necessity of 244 INSTITUTES OF MEDICINE. labor to cultivate the earth and raise the means of supply in the for- mer than the latter sections of the globe. It is evident, also, that " the Reformer" had not only man exclusively in view, but in that part of the contrast which relates to "hot climates," he was thinking alone of the indolent and luxurious master, without reference to the slave, who toils the day long under a torrid sun for his own scanty subsistence and his master's too. But again, although man be compelled to work in cold climates " to provide food" to keep up his temperature, while this " necessity for labor is far less urgent in hot climates," the cold-blooded finny tribe, and the warm-blooded whale, and beasts of prey are quite on an equality, in that respect, in all regions of the earth. 440, d. But, we are yet far from the end of the " contingent influ- ences" which modify the exact law of animal heat (nos. 5, 6), and which go to the preservation of its exact uniformity. One of our au- thor's hypotheses, which will be soon stated (no. 14), betrays him into a mistake, which has been often made and as often exposed. Thus: 13. " The contraction of muscles produces heat; but the force ne- cessary for the contraction has manifested itself through the organs of motion, in which it has been excited by chemical changes. The ultimate cause of the heat produced is, therefore, to be found in these chemical changes."—Animal Chemistry. Now, setting aside the sophistry of this reasoning in a circle, we have the simple proposition that " the contraction of muscles produces heat;" and evidently because "a piece of caoutchouc, when rapidly drawn out, forcibly contracts again, with disengagement of heat." And to this conclusion the " Reformer" was impelled by his funda- mental doctrine that the living and the dead are un distinguish ably governed by the same properties and laws, as implied by no. 14, and as extensively set forth in § 350. This assumption as to the effects of muscular motion I have sufficiently noticed in my former Essay on Animal Heat; but it may be now said that it is disproved by the uni- formity of animal heat in all warm-blooded vertebrata, under all cir- cumstances of rest and exercise. When the latter is sufficient to give an impulse to the general circulatory and other organs, an increased evolution of animal heat is liable to happen, like an increased flow of saliva, sweat, or any other secreted product; but it does not happen with any certainty, and is never due to the physical causes assigned; neither the mechanical one of "muscular contraction," nor the "chem ical changes." 440, e. I come now to one of our philosopher's parallelisms of or ganic and inorganic beings in respect to their great laws and functions, and which necessarily flows from the grand physical hypothesis that the living body is a mere chemical apparatus. Thus : 14. i "The animal body is a heated mass, which bears the same RELATION TO SURROUNDING OBJECTS AS ANY OTHER HEATED MASS. It receives heat when the surrounding objects are hotter, it loses heat when they are colder than itself.""—Animal Chemistry. (See § 3501, e, 1044 a, b). Thus we have throughout a consecutive series of mistakes and blun- ders, emanating from a false position in respect to the fundamental constitution of living beings; while this perversion of nature is the monomania of materialism. But there remains much of the like na- ture yet in prospect. PHYSIOLOGY.--FUNCTIONS. 245 From the last proposition, and from the common level in which liv- ing and dead objects are regarded, and in his unacquaintance with physiological facts, the chemist has been betrayed into the supposition that all the contingent circumstances which I have now stated (nos. 1-14) contribute, along with the fundamental law, 5 and 6, to the pro- duction and maintenance of that uniform temperature by which every warm-blooded vertebrata is distinguished, while every other product of the tissues is forever variable in quantity, and which are to explain equally, also, the vicissitudes of the cold-blooded race, and all the diversities of temperature which spring from disease. The plainest facts in " experimental philosophy" contradict the as- sumption, and place the generation of animal heat upon its own inde- pendent ground. If we enter an apartment Iieated to 260° F., the temperature of the body remains unaffected ; and equally so in a bath of water, where all evaporation is prevented. If we pass the day in an ice-nouse, or dwell in an atmosphere at 50° below the zero of Fahrenheit, it is all the same (§ 442, c, d). If water, at zero, be dashed on the body, a glowing heat is instantly lighted up on the sur- face ; and so it is upon the cold and shriveled skin of the starving man as soon as food shall have entered his stomach. A flash of indig- nation, or an impulse of shame, will, on the instant, set the whole face in a state of " combustion;" the face being then said, by common consent, to "burn" (§ 441, c). With the last proposition (14) goes another which has the concur- rence of all; namely, 15. " The heat given off to the surrounding medium is restored within the body with great rapidity."—"All living creatures, whose existence depends on the absorption of oxygen, possess within them- selves a source of heat independent of surrounding objects." 16. And (for the third time, 5 and 6), " This disengagement of heat is, uniformly and under all circumstances, the result of the com- bination of a combustible substance with oxygen."—Animal Chem- istry. Such a chemical machine, with an internal source of heat, and con- stantly liable to elevations and depressions of temperature from " sur- rounding objects like any other heated mass," could possess no sta- bility of temperature,—none comparable with the inanimate objects by which its own internal source of heat is said to be influenced ; and when we superadd the various other contingencies, the varying quan- tities and qualities of food, variableness of respiration, the oxygen respired, clothing, climate, season, weather, rest or exercise, age, fat, candles, train oil, and rum, which are said to have important influen- ces on animal heat (nos. 1-14), and then carry out the assumed rela- tion of the living body to " surrounding objects," and thus identify it with a "heated mass" of iron, a thousand other modifying contin- gencies present themselves, which, in connection with the " internal independent source of heat," should render the temperature of the living warm-blooded vertebrata variable at every moment, while that of the cold-blooded animal should be distinguished by the greater uni- formity. It need scarcely be added, that the warm-blooded vertebrata are remarkably exempt from the law which chemistry, to be consistent, imputes to them as conductors of caloric (no. 14). And herein, as 246 INSTITUTES OF MEDICINE. every where else, chemistry betrays the fallacy of its fundamental as- sumption (nos. 5, 6, 16). The warm-blooded vertebrata are espe- cially contradistinguished from "other heated masses, in their relation to surrounding objects," by their resistance of heat from external ob- jects (§ 441 c, 442 e); and this contradistinction is not only shown by universal experience, but forcibly so by the comparative relation which cold-blooded animals and " other heated masses bear to sur- rounding objects." These animals depend mostly for their tempera- ture upon that of the surrounding medium, and consequently sustain much of the relation of " other heated masses." Still, they possess not only a feeble power of generating heat, but, what is more to my purpose, they have a corresponding power of resisting its ingress from surrounding objects, since it was ascertained by Crawford that "« living frog acquires heat more slowly than a dead one."—London Philosoph. Trans., 1781, p. 485. It is also worthy of remark, that the chemist has mistaken the rise of animal heat, when occasioned by the heat of a fire, for that inter- change of caloric which takes place between inanimate substances of different temperatures. The phenomenon is peculiarly a fact for the vitalist, since, in the former case, the rise of heat is due to the action of caloric as a stimulant to the organic functions (§ I882). On the other hand, when the temperature falls from the direct ac- tion of cold upon the living body, it is from the abduction of heat from the superficial capillaries alone, by which the calorific function is ar- rested not only in the skin, but may be also, sympathetically, through- out the body. And what also forcibly shows the vital nature of this phenomenon, is the frequent and speedy exaltation of the cutaneous heat after its sudden reduction by the application of cold water. 440,yi In the midst of so much error and confusion, it is no diffi- cult matter, as already seen (§ 350), to paralyze an author by an ex- posure of palpable contradictions in fundamental doctrines. As an example of this nature in relation to the present subject, I shall place in opposition the following statements : Affirmative. Negative. 17. " In whatever way carbon 18. " Carbon never combines may combine with oxygen, the act at common temperatures with ox- of combination cannot take place ygen, so as to form carbonic acid." withoutthe disengagement of heat. " There is no example of car- It is a matter of indifference wheth- bon combining directly with oxygen er the combination take place at a at common temperatures; but nu- high or at a low temperature ; merous facts show that hydrogen, the amount of heat liberated is a in certain states of condensation, constant quantity." possesses that property. Lamp- " In the foregoing pages, it has black which has been heated to red- been assumed that it is especially ness may be kept in contact with carbon and hydrogen which, by oxygen gas, without forming car- combining with oxygen, serve to bonic acid. The spontaneous in- produce animal heat." flammability of the charcoal used " The.carbon of the food, which in the fabrication of gunpowder is converted into carbonic acid has been correctly ascribed to the within the body, must give out ex- hydrogen which it contains in con- actly as much heat as if it had siderable quantity; for during its PHYSIOLOGY.--FUNCTIONS. 247 been directly burned in the air or reduction to powder, no trace of in oxygen gas." carbonic acid can be detected in " The 13-9 oz. of carbon which the air surrounding it. It is not are daily converted into carbonic formed until the temperature of the acid in the body of an adult, mass has reached the red heat. evolve 197477'degrees of heat, The heat which produces the in- which is sufficient to raise the tern- flammation is therefore not caused perature of 370 lbs. of water to by the oxydation of the carbon."— 98-3°, the temperature of the hu- Liebig's Organic Chemistry ap- man body." — Liebig's Animal plied to Physiology, Sec, p. 263, Chemistry, 1842. [See, also, nos. 311. 5, 6, 16.]' 440, g. These contradictory doctrines were put forth in different works, but almost simultaneously, and each was designed to sustain * important hypotheses that regarded, respectively, the negative and the affirmative statement. But, even in the work on Animal Chem- istry, a subject collateral to the general hypothesis of animal heat leads the author to a partial contradiction of his all-pervading idea of the ready combustion of carbon at temperatures as low, at least, as those of cold-blooded animals; since, upon that collateral subject, he says, "at the temperature of the (warm-blooded) body, the affinity of hydrogen for oxygen far surpasses that of carbon for the same ele- ment." (See § 441, e.) 440, h. I shall not undertake to decide whether oxygen unites sin- gly with carbon or hydrogen, in the living body, or along with other elements from which the carbon is ultimately excreted, nor is it the province of these Institutes to inquire into a truth which belongs to the laboratory. In my former Essay on Animal Heat, I have exam- ined this subject in its physiological aspect adversely to the chemical doctrine, and in conformity with the great law which excludes the formation of all inorganic compounds within the living organism, as set forth by chemistry (§ 38, 39, 419). 440, i. Of the remaining subsidiary causes, that relative to the bile should not be neglected. It is thus summarily expressed by Liebig's interpreter, Mr. Ancell: 19. " These facts, and the reasoning founded upon them, have led Liebig to the conclusion that the function of the bile is to support respiration and produce animal heat, by presenting carbon and hy- drogen in a very soluble form to the oxygen of arterial blood."—Mr. Ancell, in London Lancet, 1843. The reader will, therefore, the more readily comprehend the doc- trine of " the Reformer" as stated in the following language. Thus : " In the carnivora the bile contains the carbon of the metamorphos- ed tissues. This carbon disappears in the animal body, and the bile likewise disappears in the vital process. Its carbon and hydrogen are given out through the skin and lungs as carbonic acid and water; and hence it is obvious that the elements of the bile serve for respiration and for the production of animal heat."—Animal Chemistry. That may answer for the " carnivora ;" while the graminivora de- pend more upon their "fat," and other tribes upon their special al- lotments. Having already adverted to the true uses of the bile (§ 314-316, 248 INSTITUTES of medicine. 409y), I shall proceed to say, without stopping to inquire how the foregoing " facts" were ascertained, that this part of the doctrine will hardly abide the test of morbid conditions. It often happens, for in- stance, when the production of bile is nearly or wholly arrested, that the temperature of the body is exalted above its natural standard, while at other times, when the bile is redundant, fhe temperature sinks below its equilibrium. This, too, is familiar to physicians as occurring in the progress of the same disease; and I have thus intro- duced this subject more for its bearing upon physiology and disease, than on account of its perversion by the chemist. 441, a. Having now set forth the principal doctrine, and the most important contingencies which are brought to its support, I shall pro- ceed to make some farther comments both upon the doctrine and its auxiliaries, and present a variety of facts in confirmation of the phys- iological theory of animal heat. 441, b. In the first place, it is worthy of farther remark in regard to a principal element of the main hypothesis, that scarcely any two individuals, of whatever species, consume the same quantities of food in a given time, while society abounds with habitual examples, where, under the same circumstances of age, health, sex, climate, tempera- ture, employment, &c, there is every gradation in quantity from a daily consumption of many pounds to a few ounces, or with slight va- riations as to quantity in many individuals. Without, however, now reverting to the preceding relative statements of our author, let us adduce another for the sake of its logic and precision. Thus : " The consumption of oxygen in equal times may be expressed by the number of respirations. It is clear that in the same individual the quantity of nourishment required must vary with the force and num- ber of the respirations."—Animal Chemistry. Immediately after this quotation, which has for its object an adjust- ment of "the quantity of nourishment required" for the assumed amount of carbonic acid generated in the body, we are told that, " A child, in whom the organs of respiration are naturally very ac- tive, requires food oftener than an adult." Thus, therefore, according to this statement (which has the merit of being true, not only as it respects a " child," but all young animals), the author has presented a fact subversive of his hypothesis relative to the source of animal heat; since, if a " child" and all young ani- mals consume more food and oxygen in the ratio of their size than men and adult animals, the power of evolving heat should be greater in the young than in the adult. But the experiments of Edwards, and others, have demonstrated that young warm-blooded animals may be cooled down rapidly to near the temperature of the surrounding air, which is impracticable with adults. But Edwards adds the fact, which farther confirms the vital doctrine of the generation of animal heat, that "the rapid progress which they make in acquiring the power of producing heat is wonderful." The same facts are applicable to a " child," though probably less so than to unfledged birds, puppies, &c. (§ 153-155, 442 a, 445 /). I may finally add, that the whole of this subject is extensively considered in my former Essay on Animal Heat. 441, c. Nor can I neglect referring the reader to the facts which I have arrayed in the Commentaries upon the subject of food, with a view as well to the humoral pathology as to the chemical doctrine of PHYSIOLOGY.--FUNCTIONS. 249 animal" heat,—how the northern savages, as known by observation, and from the necessity of the case, consume much less food than the civilized man of the temperate and even equatorial climates ; the for- mer, also, often breaking his fast only at distant intervals. There,* too, may be found a multitude of corresponding facts in relation to the endurance of Fasting without any sensible influence on the human system,—a general survey, also, of the habits of animals in relation to temperature, and which, like many of my arguments and other facts, have been advantageously employed by subsequent writers to accom- plish what I had already done. I have urged the fact, in respect to animals, that they enjoy, ex necessitate rei, but a scanty supply of food in the arctic regions, and that, when gorged with the same sustenance on their removal to warmer climates, they still maintain nearly their original constitutional temperature; and there may be found a series of facts as to the relative temperature of the warm-blooded and the cold-blooded tenants of the deep, which, side by side in the arctic seas, subsist on food of the same quality; the whale, with a temperature of 102° F., and the far more voracious shark, whose heat is down to a lower standard. There it is urged, that when the emaciated hiberna- ting animal is roused by pricking, &c, ay, even by exposure to a still lower temperature, 25° F., his heat suddenly rises from 39° to 97° F.; besides a multitude of similar proofs which should be examined in connection with what I have said extensively on the influence of the nervous system upon the generation of organic heat in the warm-blood- ed vertebrata (\ 1047, 1050). How poorly accords our author's assumption as to the greater vo- racity of polar animals with the well-known facts relative to the hy- enas, tigers, lions, crocodiles, vultures, cormorants, Sec, that range in temperate and equatorial quarters ! And what answer will chemistry make to the poor ability of all tropical animals to bear even the au- tumnal cold of the temperate zones, whatever the quantity of food ? But the facts are " the things," and let us, therefore, have them (§ H, «)• They will show how far " the animal body bears the same relation to surrounding objects as any other heated mass" (§ 440 e, no. 14), and how far a large supply of food is necessary to the same animal temperature in frozen regions as appertains to the inhabitants of warmer climates. In the Commentaries, then, I have called to witness, against the assumptions which I am again employed in refuting, the half-starved bears, and foxes, and reindeers, and hares, and even small birds, sub- sisting on a 6canty amount of half-frozen food, and respiring and sur- rounded by an atmosphere at 30° to 50° below the zero of Fahrenheit; yet maintaining about the same temperature as when transported to a southern climate. I have said that " in 15 out of 16 foxes, the tem- perature was 100° to 106£° in the other 98° ; the thermometer rang. mg below zero from 30 to 32° Fh. Capt. Lyon found that the tetro albus maintained its temperature at 50° below zero. It was, also equally so with the smallest birds" (§ 442 b, 842 d). After what has been stated, however, of " tallow candles," " labori- ous efforts," " heated masses," " clothing," &c. (§ 440, nos. 9,11,12), the reader will not be surprised at our author's statement that, " every * Medical and Physiological Commentaries, vol. i., p. 691-695. Also, the Essay on An. fanal Heat, w vol. u. *»»»/ wi ao- 250 INSTITUTES OF MEDICINE. one knows that the animals of prey in the arctic regions far exceed in voracity those of the torrid zone." And yet " every one knows" that the consumption of food is universally greatest where it is most abun- dant, and therefore least where it is assumed to be most abundant. And what will the disciples of chemistry say to the fact that the low-born of the North of Europe, the exiles of Siberia, &c, often get little more than bread made from the wood of trees, and a wardrobe equally expressive of their destitution of the " comforts of life" (§ 442 e, and Commentaries, vol. i., p. 691-698) 1 What is the contrast in temperature between the well-fed loungers of Europe and the half- starved laborers of the same countries 1 What, again, between the slave and his master 1 One, too, feasting on animal food and other highly " combustible matter," in the shape of brandy, porter, wine, &c, while the other gets nothing but potatoes, yams, or bread, at best, and limpid water (nos. 7, 8) ] Their temperature is alike. The only contrast in the case is between truth and error. Is the balance, then, to be found in the difference of clothing (no. 11)? Exactly otherwise; for the man of ease is incased with flannels and broad- cloths, and lives in heated apartments (no. 10), while he of the shovel or the hod is no less contented and comfortable in rags, and whether he repose upon a bed of straw or a bank of snow. And here I may add, what is equally fatal to the chemical hypothesis, that this house- less sans culottes will maintain his warmth better with water than with rum, and that, the more he consumes of the " combustible substance," the greater will be his danger from frost (nos. 7, 9). It is also manifest that the ever-varying quantities and qualities of food employed by man, in temperate and torrid zones, while his heat is always nearly the same, shows, with my other facts, that it is less dependent on food than are other products of organization. More especially is this demonstrated in many acute diseases, where the temperature of the body, or of particular parts only, is often greatly exalted, and where, too, the patient is wholly deprived of food, and emaciation so far advanced that not only the " fat," but the very " tis- sues" are nearly " consumed." Without inquiring into the hypothesis that meat is more combustible, and yields a greater quantity of heat than vegetable matter, it is im- portant to place their relations to the calorific function in the proper physiological aspect. There is no doubt that the generation of heat is more promoted by animal than by vegetable food, until the system is accommodated to the latter by its habitual use; and even then the preponderance will be in favor of the former in high northern latitudes. The princi- ple to which I now advert depends upon the law of vital habit and that which relates to the virtues of different natural stimuli, and is as foreign from chemistry as any two subjects can be from each other (§ 136, 150-152, 1881, 442, 512 b, 535-568). The whole philosophy, then, which concerns the greater tendency of animal than of vegetable food to promote the generation of heat, consists in the fact that animal is a greater stimulus than vegetable matter to the organic functions (§ 188£, 512 b). The fact is demon- strable, as I have said, while the food lies yet undigested upon the stomach of the famished wayfarer; and every one knows that his warmth will be thus instantly increased to a greater degree by cold PHYSIOLOGY.--FUNCTIONS. 251 meat than by cold potatoes (§ 512, b). And so is it, to a greater ex- tent, with the alcoholic liquors which the chemist assumes are burned in the recesses of the organization (nos. 7, 9). The principle which concerns the whole is exactly the same as when warm water lights up a glow upon the surface, or determines perspiration, or an act of vomiting. Here, too, in all this development of heat, as in the other results, is involved a magnificent agency of the nervous power, but which to the chemist is impenetrable darkness (§ 350, no. 97, 500 n, 512 b). Those that have but imperfect views in physiology may compre- hend the merits of this subject by considering the relative effects of animal and vegetable food in fevers and inflammations. An ounce of the mildest broth may raise the temperature many degrees, while a liberal supply of appropriate vegetable food would have no such in- fluence ; though a great exaltation of temperature would ensue upon solid vegetable food that should not undergo digestion. The reason of all this gives the right interpretation to the relative effects of ani- mal and vegetable food in the generation of heat in ordinary states of the system, or till habit may interpose its influence. Irritability be- ing in an exalted state in febrile affections, is more than usually sus- ceptible of the stimulus of animal food, and hence the increase of vas- cular action and the greater evolution of heat (§ 137 d, 150, 188, &c, 4411 b, 535, Sec). Where vegetable food remains undigested, in the foregoing case, it becomes a morbid irritant to the stomach, and the cause of sympa- thetic influences that augment the fever or the inflammation, and thus engenders a rise of temperature (§ 137 d, 150-152, 222, &c, 512, &c). The same philosophy is applicable to differences in climate. Little vegetable food is consumed in the arctic regions, and, as little animal food should be eaten by man in the equatorial. Nature has ordained this allotment to men and animals, by a scanty vegetation at the north, while she appears to have limited her provision of animal food in tropical climates to the wants of the carnivorous race. To the north she has given beasts and birds, but with a stinted hand, and has been scarcely more liberal of the tenants of the deep. To the tropics a profusion of esculent roots, fruits, &c.; and has displayed a munifi- cence in animal and vegetable creation throughout the vast temperate regions. This ordination of nature is particularly suited to the exi- gencies of the human constitution. Animal food is especially stimu- lating to all the functions of man, and therefore to that which gen- erates heat. Irritability is greater, more susceptible to the action of stimuli, in equatorial than in other climates. The tropical beat is its measure of endurance; and when the stimulus of animal food is su- peradded, the tropical man is extremely prone to fever, and dies early. If wine, brandy, &c, be added also, so much the worse; but not because it is "burned" in the body (§ 188, &c, 615, &c, 618). Our author's philosophy, however, is too much of a curiosity to be neglected, and should have gone along with the pathological induc- tions (§ 350^). Thus: " The Englishman in Jamaica sees with regret the disappearance of his appetite, previously a source of frequently-recurring enjoy- ment; and he succeeds, by the use of Cayenne pepper and the most powerful stimulants, in enabling himself to take as much food as he 252 INSTITUTES OF MEDICINE. was accustomed to eat at home. But the whole of the carbon thug introduced into the system is not consumed. The temperature of the air is too high, and the oppressive heat does not allow him to increase the number of respirations by active exercise, and thus to proportion the waste to the amount of food taken. Disease of some kind, therefore, ensues."—Animal Chemistry. Again, also, for a like physiological reason that animal food is too stimulating for man in tropical climates, vegetable is not sufficiently so for the obtuse irritability of the northern man (§ 191, 585, &c.); and it is therefore true in this acceptation that the arctic man would be more likely to freeze upon vegetable than animal food, despite of the superabundance of carbon in the former (§ 447, h). But, as I have said, and shown, he may, by the mere force of habit, come to endure the cold nearly as well upon vegetable as on animal diet (§ 442 b, 535, 1048). I will also say, that it is a vulgar prejudice that " train oil and tal- low candles" are appropriate food for man in any climate (§ 440 b, no. 9). The arctic, like every other man, would soon perish upon these indigestible substances. They would yield him neither flesh nor "fuel." And, having thus come again upon the philosophy of " fat" as a source of heat when taken into the stomach (§ 440, bb), the chemist is evidently embarrassed by the contrast which is presented by certain graminivorous and carnivorous animals (§ 440, i) ; and so he clears the way by the following assumptions, which have only ref- erence, also, to a limited number of two genera of animals (§ 440, cc). The conclusion of the extract is a good specimen of our author's mode of disposing of former observation, and a profitable commentary upon what is requisite in " experimental philosophy" (§ 350, mottoes a-e, and no. 28). Thus : " We know, in fact, that the graminivora expire a volume of car bonic acid equal to that of the oxygen inspired, while the carnivora, the only class of animals whose food contains fat, inspire more oxy- gen than is equal in volume to the carbonic acid expired. Exact ex- periments have shown, that in many cases only half the volume of ox- ygen is expired in the form of carbonic acid [3501 n, 440^ nos. 17 and 18, 447iy*]. These observations cannot be gainsayed, and are far more convincing than those arbitrary and artificially produced phenomena, sometimes called experiments [by the " digestive mix- ture," retorts, acids, lamp-wick, &c 1]; 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 surpass the latter in the formation of fat ? Wherever, therefore, we look at the " facts" of the organic chem- ist, we find ourselves not only in the midst of contradictions, but em- ployed in refuting assumptions that are opposed by universal experi- ence (§ 5i). That experience I had employed in the Commentaries for the very purposes to which its adverse assumptions are now con- secrated by the disciples of the " improved philosophy" (§ 349 d, 3501). 441, d. In the case of the hibernating animals (§ 441, c), the ex- cessive cold, and mechanical 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, e. That is a test. If the beat 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 contradictionsNof 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 power is dependent on heat; that is, on a certain temper- ature peculiar to each specific organism." " The abstraction of heat must be viewed as quite equivalent to a diminution of vital energy." —Liebig's Animal Chemistry. Now, according to this reasoner, " in the animal body we recognize as the ultimate cause of all force only one cause, the chemical action which the elements of the food and the oxygen of the air mutually ex- ercise on each other." We are also told that " the mutual action between the elements of the food and the oxygen conveyed by the circulation of the blood to every part of the body is the source of animal 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. 17g, &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. 17A. ; § 440, no. 17). Taking, also, in connection the two parts of the foregoing quotation, we have one of those palpable contradictions of a fundamental assumption which are the never-failing characteristic of false doctrines. There is the double affirmation that carbonic acid resulting from any other source than a vital process is not a cause of animal heat, and that animal heat is alone generated by a vital process. (See, particularly, § 440, nos. 6 and 16.) Or, allowing what the language does not admit, the dependence of animal heat upon carbonic acid " generated in every part of the body," we should then have the curious phenomenon in chemistry of the production in the animal body of carbonic acid by a chemical process and by a vital process, while that of the former, the very gist of the doctrine, does not, as avowed, contribute to animal heat (§ 1044). 441, f. Again, it is reiterated, that " the mutual action between the 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 oxygen," 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 oxygei 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. 441£, 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 be thence inferred, that what is so remarkably conspicuous 256 INSTITUTES OF MEDICINE. in the torpid hibernating animals is only the result of a law that pre- vails throughout the animal kingdom. This law extends equally to the vegetable kingdom, which possesses a far greater power of gen- erating heat than frogs and other cold-blooded animals. The trees and shrubs which belong to northern climates have, also, exactly the peculiarity of the hibernating animals, while those of tropical regions maintain a greater uniformity of temperature, and are destroyed by a degree of cold in which some northern herbaceous plants spring into active life, and pierce their way through snow and ice. 44l£, 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 the 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, d. 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, f), 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 1 PHYSIOLOGY.--FUNCTIONS. 257 4A2, a. In respect to the affirmation that " clothing is merely an w^uivalent 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 greatiy 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 the rapid increase of the resistance of cold in the young of the warm- blooded vertebrata proves the vital character of the calorific function (§ 153-159, 441 b, 1047, 1048). 442, 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 is 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, 1817; notwith- standing, also, he was full, to intoxication, of the most combustible substance (§ 440, no. 9). But, again, we are informed by Captain Wilkes, that, when the thermometer was at 40° F., " the Petcherai Indians were entirely naked, with the exception of a small piece of seal-skin, only sufficient to cover one shoulder, and which is generally worn on the side from which the wind blows, affording them little shelter against its pierc- ing influence." Again, says Captain Wilkes, "On the 11th of March, three bark canoes arrived, containing four men, four women, and a girl about sixteen years of age, four little boys, 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 glow of warmth from athletic exercise, while the other shall perish with the same counteracting means. It is a common event to witness the blasters, in the vicinity of New York, at work in winter with heavy drills in their naked hands, while others, unaccustomed,, would be frost-bitten at the same temperature. The difference is manifestly owing in part to a difference in constitution, but especially to the influence of habit, which engenders the power of enduring intense degrees of cold, and which no chemical principles can possibly expound (§ 535—568). 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 (§ 74,450^, h-^i). 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, 44l£). 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 band," 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, e. 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 latelv consecrated as the true " experimen- tal philosophy" of animal heat"(§ 349 d, 1047)! 443, a. As my former Essay embraces an extensive range of inquiry into the facts and philosophy attending the calorific function in the cold-blooded race, I shall now add only a few remarks to what I have already stated upon this subject, and as suggested by the present stage of my inquiry (§ 44iy, 441^ a). 443, b. Frogs and other cold-blooded animals are supplied with capacious lungs ; and, however it may be argued that their consump- tion of oxygen is lesi 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. 17£, and § 440, no. 10). And what will chemistry answer to the exalted temperature which attends the inflammations of the cold-blooded vertebrata 1 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 we 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, &c, upon vital principles, do the phenomena of vegetable heat evince the same great law of organic nature. This subject has been ably explored by John Hunter, and, as I have intimated in the foregoing section, has re- ceived a careful attention from myself. Senebier, also, saw the ther- mometer rise from 79° to 143° F., when placed in the midst of a dozen spathes of the arum cordifolium, at the time of opening their sheaths. And so Huber, and others. 445, b. That fact, and the ability of plants to generate a tempera- ture often far above the earth or the surrounding atmosphere, are so apparent that they are universally admitted ; but obtain from the chemist no farther notice. Indeed, the following is all that we have from Liebig on the subject of vegetable heat. Thus : " All living creatures, whose existence depends on the absorption of oxygen, possess within themselves a source of heat independent of surrounding objects. This truth applies to all animals, and extends, besides, to the germination of seeds, to the flowering of plants, and to the maturation vffruits."—Animal Chemistry. And yet is the " combustive process" always in progress, more or less, in all parts of vegetable organization. The question, therefore, arises as to the motive for not only concealing an important fact, but in thus implying, by circumstantial statements, that no other parts of vegetables " possess within themselves a source of independent heat." The very fact that such a source belongs to seeds in their germinating state, &c, is sufficiently conclusive that it extends to every part of the plant, and " the Reformer" could not have been ignorant that the very 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, 303f). 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 source 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. [ 1 ] 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, e. Thus is the problem solved. There is either no heat gen- erated by plants, or, otherwise, the chemical doctrine of animal heat is radically false. To show how this may be, I shall now introduce an abstract of some observations made by myself on the temperature of trees. It is unnecessary to state the mode in which the observa- tions were conducted, or the precautions adopted, as they are record- ed in the Commentaries. On the 9th of April, 1839, in a neighboring forest, the following re- sults were obtained: "Range of the thermometer in the shade, during the observations, which lasted six hours, from 38° to 52° F. Near freezing at sunrise. " A dead upright tree was selected as a standard of comparison. Its diameter was 12 inches. The temperature of this tree, at the close of my observations, was 45° at the centre and in all other parts (S 440, nos. 14, 15, and 16). Juglans squamosa, diameter 10 inches, 48° Buds slightly enlarging. Fagus sylvatica, duercus tinctoria, Castanea Americana, Betula nigra, Salix Babylonica, Do. do. Pinus Canadensis, Platanus occidentalis, Do. do. Do. do. Juniperus Virginiana, Robina pseudacacia, Populus laevigata, Do. do. Do. do. Do. do. Do. do. Do. do. 6 " 49° do. 10 " 49° Buds swelling. 7 " 49° No budding. 12 " 50 do. 4 " 51° Flowering. 18 " 53 Buds unfolded. 18 " 53° do. 18 " 54° 18 " 50° No budding. 6 " 54° do. 4 " 55° do. 4 " 55° 3. " 62° do. 4 " 62° In bloom. 4 " 64° do. 3 " 63° do. 3 " 65° do. 2 " 67° 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 (§ 441i 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. duercus virens, 8 62° do. Do. do. 2J " 73° Buds much more advanced Do. tinctoria, 18 65° Buds swelling. Do. do. 6 66° do. Juniperus Virginiana, « 5 64° Do. do. 2 " ' 79° Acer rubrum, 12 65° In bloom. Castanea Americana, 4 66° Buds swelling. Cornus Florida, 2 68° 5 Flower-buds advancing; no ( leaves. Fagus sylvatica, " - 12 68° Buds opening. Juglans alba 4 75° Buds swelling. Do. do. " 1 " 83° Buds larger. Do. do. % '• 82° 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- PHYSIOLOGY.--FUNCTIONS. 263 oration of heat, in the natural condition of the body, while this induc- tion is strengthened by what is known of other secreted products in both of the animated kingdoms. Still, in respect to the animal king- dom, the mere existence of the cerebral and ganglionic systems, their remarkable properties and susceptibilities, and their intimate connec- tion with all parts of the organization, 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 in relation to many; and that unusual, or sudden impressions that are not unnatural, as the.operation of the pas- sions, for instance, may be extensively and profoundly propagated from the brain to other organs. It has been fully demonstrated that the natural condition of the secretions depends upon the integrity of the nervous connection between the secerning organs and the cerebro- spinal axis; while it has been equally shown that the organic func- tions, and all vascular action, may be immediately and powerfully influenced by impressions made upon the brain and spinal cord, whether in a direct manner, as in Philip's Experiments, or indirectly through 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 the 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, 17|, 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/, 500 n, 638^). 446, d. The modifying influence of the nervous system upon the generation of animal heat being established not only by experiments, but especially, also, by facts relating to morbid states of the system, to which I shall soon advert, and by all that is philosophical in physi- ological science ; and when we consider, also, how easily and rapidly the nervous influence may be determined upon the vascular system (as in blushing), and upon the organic viscera, we have an intelligible explanation of the operation of a very low degree of cold in recall- ing into action those vessels upon which depends the exaltation of temperature in the torpid hibernating animal (§ 441 d, 441A, 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 ither 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 jusfthe 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. 447, b. Indeed, it cannot be too often said, as shown by the ques- tion before us, that the phenomena supplied by diseased conditions are often the most important in illustrating the properties and laws of organic beings; and upon no question have they a 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, whethei high or low, the diet is often the same, very spare, or when the tem- perature is most exalted, as in active forms of fever and inflammation, there is a total abstinence from food. Consider, also, the brute ani- mal under the same circumstances, abstaining totally, yet suffering a very exalted temperature (§ 440, nos. 1, 4, 5). I shall proceed, therefore, to a statement of some of the important facts which are supplied by disease, as set forth in my former Essay on Animal Heat. For the authorities quoted, see the Essay. 447, d. Diseases of the brain supply a variety of facts which illus- trate our inquiry. Thus, in phrenitis, one arm, or one side of the body, is colder than the other. " That the temperature of a paralyzed part is generally below the normal standard is now universally admit- 266 INSTITUTES OF MEDICINE. ted." That this is owing to impaired vitality, is also shown by the frequent failure of nutrition in the paralyzed part, as well as other co- incident phenomena. In a case related by Mr. Earle, he found the temperature at 70° F., in the hand of a paralyzed arm, while that of the opposite hand was 92°. He could also effect a temporary res- toration of temperature by electricity and by blisters. " The circula- tion of the blood did not appear to have suffered, the pulse at the wrist being synchronous, and equally strong with that of the other limb." In an injury of the sympathetic nerve, Chaussat saw the temperature fall from 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- lento paroxysmo") are recorded in the Ephemerides Germanii, in which the blood, as it flowed from the veins, was actually cold. Mor- gagni mentions an instance of another affection in which the blood flowed " in an icy cold stream" from the arm. Thackrah saw a sim- ilar phenomenon. So, also, De Haeii. 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 vshows, 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 intended for our special purpose : " February, 1781, a boy, about three years old, appeared not quite so well aa 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 heat But, standing alone, they must either subvert the hynothesis 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 ReJurmer" 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. Lt 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 ] 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, again, in congestions of other organs, when the respiration is natural, the cir- culation in the lungs unobstructed, but the animal heat greatly re- duced, why does it happen that the abstraction of blood will at once exalt the temperature, without affecting the respiration, or even in- creasing the force or frequency of the general circulation (§ 961, d) ] In the latter cases, the rationale appears to be, as I have endeavor- ed to explain in my Essay on Blood-letting, that a direct change is exerted by the abstraction of blood upon the instruments of all vital actions, by which the calorific, as well as other functions, are improv- ed or 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 the Influence of Physical Agents on Life, p. 275. 270 INSTITUTES OF MEDICINE. of all the manifestations of the organic forces, whether they consist of vital phenomena, or of material products. The function of respira- tion is just as much concerned with one as with the other, and prob- ably no more. It aids, like the chylopoietic viscera, in perfecting the 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 'I In this way : the affected organ acts sympathetically on the tonic forces of the part; these being raised, more caloric than usual is disengaged. It is precisely the same as in sympathetic 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.--FUNCTIONS. 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 stream from the vein was so bright, that the gentleman who opened it had at first some suspicion that he had opened the artery."* Here, also, we have, from a distinguished chemist, a philosophical resort to the modified condition of the system in disease, for an inter- pretation of the wonderful peculiarity of living organized matter in manifesting the power of generating heat. 447, f. We have thus again seen that the chemical hypotheses which immediately concern the functions of 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 natural character, the former is liable to corresponding variations, which can only be explained on the principle that the power of generating beat 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. We hear much about the " power of the system to generate beat," 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 urjform 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. cii. In this conclusion I do not at all agree. It is an unwarrantable abandonment of nature for the contrivances of art. Morbid conditions, above all others, give us a clew to the true philosophy. The vital properties are altered by disease, and with them there is a change in all the phenomena and results, of which the modifications of animal heat are one. Hence, it appears to me, that a very obvious "conclu- sion" may be deduced. 447, h. In respect to the natural differences in constitution that are denoted by apparently contradictory facts in relation to animal heat, they are as clearly constituted by natural modifications of the same forces, which are as much, or more influenced by other causes than by respiration ; whose power of evolving heat in young animals is great- ly and rapidly depressed by the operation of cold, notwithstanding the respiration is accelerated, during the first stages of the decline of temperature; but which, again, as the same animals adyance 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 he- 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. v* * Portal says that the heat has been known to remain very high in these cases, as in apoplexy, for many hours after death.—Sur I'Apop. 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 m the elaboration of bile, gastric juice, heat, &c, from the blood. lhat particular determination by which thev eliminate heat, in all parts of the body, may be called a law, though it is but the joint re- "£• m? Vltal 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 ot heat are variations, more or less coincident, of other products The causes are obvious from the effects. The forme* 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- imes attends fts 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 mg of animal heat," to make the subject intelligible F It is from the blood, like all other animal products, that heat is de nved. And since decarbomzation, and, perhaps, an absorption of ox- ygen, is indispensable to the healthy performance of all other func- 10ns i is doubtless important to the generation of heat; though man- ifestly less so in the latter instance, since we see the evolution of heat whTlelnrL^Lf Jn7!ien .reSPiration is ne^ or quite extinct; while in the cold-blooded animals it exerts but little, if Iny influence upon temperature. Decarbonization of the blood, and probably the absorption of oxygen, are among the numerous processes by which on of thP n-S Perfe-Ctei' ^ by Which k is PreP««d for ™ elabora on of the various animal products, and in animals of a certain consti- tution for the evolution of heat. When respiration ceases, all the Z voTtionof hUnf°nS immediat6!y faiI' but k is remarkable tha me evolution of heat appears to be the very last 1 conclude, therefore, that the elaboration of animal heat, and all other secretions, are on a par in regard to principle. It is tme a cer tain proportion of latent heat may be extricated by the conveSion of blood mto the solid parts. But this would be counterbalanced by a corresponding change of the solids, particle for particle, into fluids This appears to me to be fatal to a late doctrine which imp'utes animal" heat to this cause; as well, also, to the condensation ofgases Be sides what becomes of the principle of condensation where the tem- perature rises after apparent death (§ 447, d) 1 Where is oxygen gas / 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, 1054). It is not, therefore, remarkable that " the Reformer" should have considered animal beat 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 .vith carbonic acid, combine with that substance (§ 440y, 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- plied by the latter."—Animal Chemistry (§ 438, b, c). 447s, 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 extiosmose (§ 419). There is here the same in- congruity as we have seen of the chemical theory of digestion, in es- tablishing antagonizing processes for the conversion of food into chyme (§ 358, 360, 374). 447|,y! It remains now to notice, of the foregoing quotations (§ 447| a, nos. 3 and 4), another of those 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, in 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," &c, that are designed for the maintenance of the same temperature in " the rest of the body" which is accomplished by the two chemical processes in the lungs (§ 440, nos. 10, 11, 12 13, 14). While now adverting to the subject of carbonic acid in its supposed relation to animal heat, I will place in contrast two doctrines by our author, which make up a part of his system of pathology, as the best evidence I can offer, in parting forever with Organic Chemistry, of the sincerity of the motives which have governed the demonstrations I have endeavored to make in behalf of sound philosophy, the honor of my profession, and the best interests of man (§ 1 b, 3501, 376a 5 820). Chemistry as founded on the basis Physiology as founded on the ba- of" Experimental Philosophy." sis of" Experimental Philosophy." " We find, in point of fact, that " If we consider the fatal acci- the living blood is never, in any dents which so frequently occur in state,saturated with carbonic acid; wine countries from the drinking that it is capable of taking up an of what is called feather-wine, we additional quantity, without any can no longer doubt that gases of apparent disturbance of the func- every kind, whether soluble or in- tion of the globules. Thus, for soluble in water, possess the prop- example, after drinking efferves- erty 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, be 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). 448, e. As showing farther, also (c), that there is some obscurity attending the phenomena of ordinary combustion, I may quote the high authority, Dr. Kane, to that effect, who says, that, " Laying aside altogether the attempt at deducing the phenomena of combustion from any change in the amount of latent or specific heat in the bodies which enter into combination, it remains only to be admitted as a general and independent principle, that chemical com- bination is a source of heat and light. It is, however, impossible to 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 fcetus, in the sympathetic influences of the uterus upon the mammas which result in the formation of milk, and in all their individual and connected designs, and in their great final cause of perpetuating the species, and in the various incidental provisions which are supplied for the fulfillment of that end, that chemistry and physics may be as effectually banished from physiol- ogy, as by the demonstrations which I have made in relation to the germ, or by those which respect digestion, or organic heat, or the nervous power. 449, b. 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 alono- 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 like 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- oortant to remark, that the parts most essential to sensation are the extremities of the nerves at their origin and termination, and that the trunks are, mainly, the conductors. This is also true of voluntary mo- tion, and of those involuntary movements that are excited by the ner- vous power. The nerves of the organic viscera, therefore, follow this rule, as it respects all natural, morbific, and remedial agents. A neg- lect of this consideration has led to fallacious conclusions in medicine from experiments on the trunks of nerves (§ 110-117, 826 d). 450, c. Common and specific sensation require a continuity of the nerves with the brain, and a co-operation of the mental power, per- ception. Sympathetic sensation may be excited in the brain, or spi- nal cord, or certain parts of the ganglionic system, either in their connected state, or when disconnected. In their most natural con- dition, it is probable that all the parts concur more or less together in giving rise to sympathetic sensation; though some parts more than others, according to the nature of the impressions transmitted and the part from which they are transmitted (§ 201). • 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 wifi 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, e. Specific sensation corresponds with specific sensibility. It is the function through which we acquire a knowledge of external things, and is, therefore, the great inlet of knowledge. It has, of course, the several modifications which appertain to specific sensibil- ity (§ 199, 200); consisting, indeed, of five apparently different func- tions. The expanded nerves of sense, which are the organs of this function, it is superfluous to say, are supplied with auxiliary means, such as the various appendages to the retina, to the auditory nerve, &c. A close analogy exists among the whole, and they may be brought more or less to the aid of each other. Although a common function, its remarkable modifications are shown by their uses, respect- ively, and by the necessity of certain specific stimuli to each. As with common sensation, the specific kind requires the aid of percep- tion. The rationale of the entire function is far more wonderful and incomprehensible than that of sympathetic sensation and its various results which terminate in the influence of the nervous power on or- ganic actions, and for which the grossest doctrines in chemistry and physics have been substituted, because the vital interpretation is " in- conceivable," or cannot be subjected to the 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 with 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, and in each of the cases through the aid of some special mechanism ; 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 theii real material existence (§ 188£, d, 500, n) 1 450, f. 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 >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 (fy 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, whicb has been sufficiently described in the preceding sec- tion, and in what has been said of sympathetic sensibility (§ 201-204). 451, f. 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 the former case bear with the strongest force of analogy in demonstrating the entire absence of all chemical agencies in the phenomena of the nervous power. The alliance of the whole, through- out the 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, OR REFLEX ACTION OF THE NERVOUS SYSTEM. 452, a. I now enter upon the consideration of a function.which be- longs not only to animal life, but has far greater and more important relations to the organic life of animals. Although it have no existence in the vegetable kingdom, where its anatomical medium is also want- ing, it does 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 be appreciated only by an extensive investigation of its endless vari- ety of phenomena. And yet is this function extensively ridiculed by enlightened men ; and even 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 ex*rosmose in ex- tenso, interprets all the secreted products upon chemical principles, expounds diseases by the humoral pathology, and recognizes no ther- apeutical influences of medicine but through its absorption into the circulation. For all this he was well commended by the British and Foreign Medical Review, while the same critical survey of that re- markable work on Physiology stamped its displeasure upon those doctrines of life which render the work a proud monument of the age. Again, no one has employed his knowledge of the laws of sympa- thy more usefully than Bichat. " The word," he says, " is of but little consequence, provided what it expresses is understood." And yet, while he also affirms that " we know the principle exists," he also says, that the " word is only a veil for our ignorance in respect to the relations of the organs to each other" (§ 234). 452, c. Sympathy is the most important function which is peculiar to animals ; since upon it depend, very greatly, the right performance of the organic functions, and a vast range of pathological conditions, and the greatest amount of therapeutical influences. It also over- throws the venerable doctrines in humoralism, in all their contempla- tions of vitiated blood, morbid lentor, "living putrefaction," and of those conformable therapeutical means which were invented under the significant names of incisives, deobstruents, inviscants, incrassants, diluents, attenuants, astringents, relaxants, refrigerants, &c. 453. Sympathy has been commonly reputed as one of the proper- ties peculiar to animals; but it is not only a function, but one of great • 284 INSTITUTES OF MEDICINE. complexity, since it involves the united operation of sensibility and the nervous power. The result of that concerted action is sympathy, or reflex nervous action. 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, &c). 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 of 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. t 455, c. Thus we learn that the various parts of the organic mechan- ism of animals are not only indispensable to each other, but that a cer- tain established influence of one upon the other is necessary to each, and that the functions of the whole may be fatally deranged, 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 derangements, 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- 2333, &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 dpon 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 wondeiful 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 reflex actions, as the result of disease, or of morbific or remedial agents. 459, a. All parts of the nervous centres are not only more or less mutually connected in function, but all parts of the nervous system are subordinate to the brain. There are no distinct, separate, and independent influences, of an involuntary nature, exerted by any parts of the nervous 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 ©f that influence when the spinal cord is divided or de- stroyed. Both principles, in the latter case, may act in co-operation; the cerebral influence being determined through the superior nerves ind 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). While, 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 derangesthefunctions. 461. It is an assumption to say that the nerves have any generating effect upon the secreted products, however certain 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 pneumoga6tric 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 fcetus, not even to the action of the sphincter muscles ; since both have been wanting in the full-grown human fcetus (§ 459, f). Is it possible, as supposed in Dr. Clark's case, that even the sympa- thetic nerve may be absent ;* organic life being carried on in the fce- tus mainly by the simple vessels of nutrition, and without any action, concerted or otherwise, of the great organic viscera (§ 109 b, 264) 1 Is concerted action unnecessary ? 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, except contingently. 461£, 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. 46 lh, 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 nsrve, as in contiguous sympathy (§ 497), this nerve transmits the impiessions it leceives to the brain and spinal cord in the same * Rendered very improbable by the exigencies of the sphvneter am. 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 ihua distributed to various well-known parts; and what is of the high- PHYSIOLOGY.--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). 469. The two orders of nerVes occur in the great sympathetic, and appertain, also, to those nerves which proceed directly from the brain, where they are either compounded, as in the spinal nerves, or make up, respectively, distinct 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 are either themselves entirely motor, and receive sensitive fibres from other nerves, or which, if their roots contain sensitive fibres, still cannot be classed with the double-rooted nerves. These are the occulo-motorius, the trochlearis, the abducens, and the facial nerve."—Muller. 470. The nerves of the sympathetic system are exquisitely endow- ed with that modification of sensibility which I have denominated sympathetic sensibility (§ 201-203, 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 influence 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. 471. 1. " The motor influence is propagated only in the direction of the nervous fibres going to the muscles, or in the direction of the ramification of the nerve; and never in a retrograde course." 2. " The application of mechanical or galvanic irritation to a part of the fibres of a nerve does not affect the motor 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 impat 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 Cerebrospinal 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 ia 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. 298 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 the brain and of volition, and, when irritated, give rise to sensation." 473, c. " 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- ately, those of the spinal nerves through the medium of the spinal cord." 5. " The spinal cord has the property of reflecting irritations of its sensitive nerves upon the motor nerves, but without itself perceiving the sensation" (§ 201-204, 451 d-\5lf, 1037 b). " The spinal cord, even when separated from the brain, and without any external stimulus, can excite automatic movements." 6. " The spinal cord, although capable of exciting the motor nerves to automatic actions, nevertheless, in the healthy state, leaves a great part of the motor nerves, those supplying the muscles of locomotion more especially, in a quiescent state; while on others it exerts a con- stant motor influence (§ 500, k). It thus maintains constant involun- tary contractions, which are arrested only by the spinal cord becom- ing paralyzed. The motions of this kind are, 1st, those of muscles which are also subject to the influence of the will, as the sphincter ani; 2d, those of muscles not subject to the influence of the will, as the sphincter vesicae urinariae, the muscular coat of the intestines, &c."—Muller. 474. 1. " The activity of all the special functions of the nerves is 294 INSTITUTES OF MEDICINE. determined by the central organs, partly under tfte influence of tho mind, and partly independently of this influence." 2. " The central organs connect all the nerves into one system. To this even the sympathetic nerves do not form an exception." 3. " The central organs are the exciters of the motor nerves which conduct the motor influence of the nervous principle to the muscles. This motor influence may be constant, as we see in the case of the sphincters; secondly, it may be evidenced in intermittent rhythmic movements, such as those of respiration ; and, thirdly, the motor influ- ence may issue voluntarily from the 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 ot materialism requires a constant appeal to the senses, as the only recog- nized mode of reaching the understanding (§ 234, 350| 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 (§ 1S8| 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. Le Gallois' experiments upon the spinal cord, and his in- ductions from them, and as sanctioned by others, are remarkable ex- emplifications of the fallacies to which results, artificially obtained, may conduct us, and supply a forcible illustration of the propensity of the mind to grasp at a single fact, and to draw important conclusions from it, to the exclusion of all others, however contradictory. It is mainly, however, as to the supposed dependence of the functions of the heart, intestines, and other organic viscera, upon the spinal cord, that these errors relate. A general summary of the observations will aid the inquirer after the philosophy of this subject. I am the more induced to present this outline from the misapprehensions which con- tinue to surround the subject, even in the ranks of the most erudite physiologists. Thus, Dr. Marshall Hall, in his late Memoir on the Nervous System (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. Hi.).—§1041. 476^, c. Such were the results of the experiments, and such their novelty, that, having led their author to the conclusion that the func- tions of the heart, and other organic viscera, depend upon the nervous power of the spinal cord, the doctrine was received with eclat by the French Institute, and, indeed, by all Europe, in defiance of the well- known fact that foetuses have been born alive without brain and spi- nal cord, that the heart will palpitate for hours after its removal from the body, that the intestines will roll about upon the table, 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\). 476g, d. The 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). 476i, e. Now, although rabbits twenty-two days old have no diffi- culty in living for some time after the head is cut off, yet the fact was ascertained that the destruction only of the spinal cord destroyed life, at that age, in less than four minutes ; respiration ceasing first. This experiment, especially, led to the belief that the principle of life upon which the heart depends resides in the spinal cord. Le Gallois next ascertained that the destruction of either the dor- sal or cervical portion of the spinal cord was fatal to rabbits of the foregoing age, even in a shorter time than that of the lumbar portion; that is, in about two minutes. The results, however, as to time, va- ried at different ages; and death took place soonest in parts that were opposite to the portion of the cord destroyed. Now this sudden abolition of life, from a partial destruction of the spinal cord, was imputed by Le Gallois to the loss or extinction of the circulation; and this, regarded as a remote result, was in part true. But, as will have been seen, the immediate and essential effect con- sisted in the destruction of the organic properties of the heart and blood-vessels, by determining upon them, and all other parts em- braced within the compass of experiment, a pernicious nervous influ- ence by the sudden destruction of the spinal cord (§ 226, 227, 510). It also appeared to follow (and such was the conclusion), that the power, on 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|-,y! Such, however, was the effect of the foregoing influence upon the powers of the heart; and, as the blood-vessels are, also, pros- trated in their action by the same cause, it is obvious, if the extent over which the blood circulates be lessened in proportion as the heart is enfeebled, the circulation will be prolonged in parts 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. &76%,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 actions, and thus deranging the organic relations (§ 129, 455, 510). 476^, h. Le Gallois found, to his surprise, and beyond his explana- tion, that if the spinal cord be slowly destroyed, the effects were great-' ly different from such as resulted from its sudden destruction ; that is to say, the circulation was at once arrested when the cord was sud- denly destroyed, but not so when gradually destroyed. This fact, in itself, is subversive of his principal conclusions; and the difference in results depends upon the greater violence of the nervous power when suddenly, than when more slowly excited (§ 479). This is also shown in paroxysms of joy and anger. These passions may kill on the in- stant, if suddenly excited, but never when gradually produced, what- ever their ultimate intensity (§ 230). So a blow upon the region of the stomach, which shall not exceed in force ten pounds, may destroy life instantly, when a weight of one hundred pounds, gradually ap- plied, may be wholly innoxious (§ 509). This is a very important law of the nervous influence, as it is in constant operation in the produc- tion and cure of diseases, whether the effects depend upon physical or 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 no suddenly curative in croup, Sec.; 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. Exp. 4. " In another rabbit, insensibility was produced in the forego- ing manner, the whole spinal marrow removed, and artificial respira- tion not performed. The carotid artery being divided, dark-colored blood flowed per saltum. The lungs were then inflated, and florid blood began to spout out of the artery. Exp. 5. " In this experiment the rabbit was rendered insensible, but not motionless, by a blow on the occiput, and natural breathing con- tinued. The spinal cord was then destroyed by a hot wire. A femo- ral artery was now opened, and the blood spouted out. Then the other femoral artery was opened, from which the blood flowed copi- ously, and continued to flow for seven minutes ; when one of the 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 vertebrae, 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, ifc was 60 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 the 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 Dhan 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 ihe 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 modify the ner- vous power in the same direct manner. Such as are exciting, are analogous in their effects to those of alcohol; such as are depressing, to those of tobacco, opium, &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 (§ 1074). 481, c. It is now important to observe in the relative experiments upon the brain and spinal cord, that when they exist in connection, the influence of agents applied to the cord, in developing the nervous power, may be mostly exerted upon the brain (§ 459). Exp, 12. " Preparation the same as in Exp. 10 and 11, excepting only the anterior part of the brain was laid bare. The spirit of wine applied to this part of the brain produced as decided an effect on the motion of the heart as in Exp. 10 and 11. The spirit of wine was washed off, and a watery solution, first of opium, then of tobacco, was applie.d, with the effect of an increase, but of a much less increase of the heart's action, than arose from the spirit of wine. The increased action was greater from the opium than from the tobacco. The first effect of both was soon succeeded by a more languid action of the heart than that which preceded their application to the brain. This effect was greatest and came on soonest when the tobacco was used ; and there was always observed, for the experiment was frequently repeat- ed, an evident increase in the action of the heart when the tobacco was 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. 481, e. The foregoing Exp. 12, 13, and 14, independently of the multitude of other facts, also completely refute the doctrine of the op- eration of 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, &c. (§ 945). Exp. 15. " The spine of a rabbit was divided near the head, and the spinal marrow destroyed by means of a wire. Spir t of wine was then applied to the brain, which influenced the action vf 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. 3Q5 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. 483, a. The next important step in our inquiry is to ascertain, in a more specific manner than the preceding experiments, how far the ves- sels of circulation are capable of being influenced through the brain and spinal cord (§ 1040). To determine the foregoing problem, it is first necessary to settle another; namely, how far the vessels of circulation can support the mo- tion of the blood independently of the heart. That the small arteries possess this power in an eminent degree has been already rendered sufficiently certain (§ 392, 393. Also, Med. and Phys. Comm., vol. ii., p. 145-151, 398, 422, &c). But we now arrive at the same knowl- edge by another process. 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 beforethe microscope, and while Mr. Hastings observed tbe 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, ihe 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, und 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 Lhe 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 bu raised against his experiment; for he remarks that, " I believe that there PHYSIOLOGY.--FUNCTIONS. 207 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 been removed, and the spinal marrow destroyed, the stomach was violently crushed with a hammer. The heart, which had previously beat vigorously sixty times in a min- ute, stopped suddenly and remained motionless for many seconds. It then contracted; after a long interval it contracted again, and slowly and gradually recovered an action of considerable frequency and vigor." Dr. Hall, therefore, argues that the nervous system had no agency in transmitting influences -of the injured stomach to the heart, and that, "the organic structures (meaning others than the nervous) must have been the medium through which the effect of the violence was conveyed to the heart." I need not go far to indicate the capital error of Dr. Hall's conclu- sion, so opposed to the phenomena of the passions, and the well-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, through 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 fished 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 he 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 ihe 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 tefresh itself; then gave it another dose of opium. The blood then m wed 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. I 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, Sec). Here, then, we see, more and more clearly, the propriety of the ap- lication which I have made of Philip's experiments, and which will ecome more strikingly obvious by connecting them with the sequel, * Hall, on the Influence of the Brain and Spinal Marrow upon the Circulation, p. 111. 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, Sec, 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 ihe Action of ihe Muscles of Voluntary Motion depends, and ihe 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; but that they are alike capable of being stimulated through the nervous system. " We do not, surely," he says, " in the experi- ments which have been laid before the reader, see any difference in the nature of the muscular power of the heart, and that of the muscles of 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. 487, 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." 487, 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, Sec (§ 133-162, 188^-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." 487, e. Again, it was found " that stimulating every part of the brain and spinal cord equally affects the action of the heart (also, the stomach and lungs), while the muscles of voluntary motion are onlv excited by stimuli applied to the parts of those organs from which their nerves originate; that stimuli applied to the brain and spinal cord never excite irregular action of the heart, while nothing can be more irregular than the action they excite in the muscles of voluntary motion; that their effect on those muscles is felt chiefly on their first application, but continues on the heart (and blood-vessels) as long as the stimulus is applied" (§ 233£, 506, 516, no. 6). 487,/ In connection with this comparative inquiiy, 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 •"•tkn is confined to a small por- 312 INSTITUTES OF MEDICINE. don 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 § 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 be 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 in these cases (as in the vast range of congestive fevers), and reasoning from the prostration of muscular power to a supposed analogous state of the great powers of life, and thus mistaking mere prostration of ani- mal life for absolute "debility" of the organic viscera, that has led so extensively to the administration of stimulants and tonics, where bloodletting and analogous agents are most imperatively required. The mind, too, is inoperative in all these conditions, and the volun- tary muscles languid, in consequence; and the very failure of the will to rouse them into action, where drowsiness has contributed its effect, has been often regarded as an evidence of that " debility'''' which calls for the " stimulant plan of treatment" (§ 473, 961, &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 are widely different,—that it simply fails to stimulate the voluntary muscles, and hence the greater amount of apparent "debility;" while in relation to the organic processes, it has been so modified as not only to exalt, or perhaps depress, the forces of life, but to alter profoundly their very nature (§ 476 c, 500 h). There is nothing in the whole range of medical philosophy so prac- tically important as these considerations (§ 569, 961, 967). It is a subject, however, which requires thought for its proper understand- ing, as well as a comprehensive view of profound laws in physiology. It is therefore repulsive to the many, who will rather rest upon the simple chemical and physical hypotheses, than contemplate Nature in her dignified and rational aspects. The charm of simplicity which hung around the celebrated theory of John Brown encircles, also, the humoral and other chemical hypotheses, and adds its fatal delusion to those prevailing doctrines. 488. An important remark is made by Philip, at the close of his experiments relative to the functions of the heart, blood-vessels, and voluntary muscles, and their essential independence of the nervous 314 INSTITUTES OF MEDICINE. system, which goes to corroborate the conclusions I have 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, 188f-190, 222-233, 205, 206, 208, 209, 256, 476 c, 484, 500 h). 488J. I shall now advert, once 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, 454-46l£, 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 the parts became cold, so that when the intestines exposed to the air have lost their power, that of those beneath still remains." " It appears from these experiments, that the power of the stomach and in- testines, like that of the heart and blood-vessels, resides in themselves, and is wholly independent of any influence derived from the nervous system." 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 § 476A, 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 spinal cord, 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 spinal marrow increased the motion of the canal;" that, " the stomach, like the heart, is capable of being influenced by every part of the brain and spinal marrow" (§ 487, g). For these important investigations the reader is referred to the work itself. Review of the Inferences from the preceding Experiments. 492. The following inferences are made by Dr. Philip in relation to his various experiments, and it will be seen that they are 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 says, " only convey the fluids to be operated upon by the nervous in- fluence'' Here the " influence" is regarded strictly as a chemical agent. But, at the same time, he unavoidably concludes that " the vessels of secretion, like the vessels of circulation, are independent of, but influenced by, the nervous system ;" galvanism, however, being the supposed agent in all the cases.* And yet Dr. Philip, through the light of galvanism, is led to the contradictory statement, " that, although the powers of circulation are independent of the nervous system, those of secretion are very far from being so." And, as to the products themselves, had he, or had others subsequently, consid- ered the simplicity of the laws of Nature, and the remarkable Unity of Design which prevails in the fundamental constitution of all organic 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 (§ 350J, 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 subject 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 fcetus; 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 iiaving a vital function 1 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 i, 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^ 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, &c, are removed from frogs, so that nothing remains but bones, muscle, and nerves (as was done in Girtanner's experiment), the ani- mal will hop about for half an hour, and appear in all respects as nat- ural as in its perfect state. (See, also, Spallanzani, § 441, 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 Midler's interpretation of the action of prussic acid in producing instantaneous death when a drop is ap- plied to the tongue, and which has been extensively employed by the humoralists to preserve the purity of their doctrines. The more we consider the profound familiarity of the Berlin Philosopher with the laws of the 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 ihe blood more rapidly than that fluid circu- lates, to permeate the animal tissues very quickly, and in a manner independent of its distribution by means of the blood," &c. And yet, in the same paragraph he states that nux vomica, which is not vola- tile, will produce the same speedy death (§ 500 c, 826 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" Mulder'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, 514£ 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 6tomach, 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, Sec). 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). 496. Remote sympathy is the principal condition of the function. Its office is the transmission of impressions, whether natural, morbif- ic, or remedial, to and from parts separate from each other, or differ- ent parts of a compound organ, or through which the nervous influ- ence is determined on parts which receive the primary impressions, or when that influence proceeds from direct impressions, physical or 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). In the former, it is reflex action of the nervous system. 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. 49S, a. C}ntinuous 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 anotler continuous with it, upon which the primary impression ia 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 may be much more in- tense in some parts of the tissue than in others (§ 516, no. 2). 498, c. In the natural condition of the being, the operation of this principle is strikingly manifested in the various sensible motions of plants. For example, " To excite the motion of the leaflets and petiole of the mimosa,'it is not necessary that either the intumescence itself, or even the leaves, should be touched. The stimulus may be applied to a more or less distant part. Even the roots transmit the excitation to the leaves. M. Dutrochet moistened a small portion of the roots of the mimosa with sulphuric acid, and, before there was time for the absorption of the acid to have taken place, the leaves became folded" (§ 289).—Mul- 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."—Mulleb'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 the liver, skin, &c, with a salutary effect, through the motor fibres of the same nerve ; and thus remote sympathy is simultaneously brought into operation (§ 523, no. 6. Also, Medical and Physiological Com- mentaries, vol. i.,-p. 135, &c). 498, g. The continuous impression, in the foregoing case, upon the intestinal mucous-membrane, is equivalent, in principle, to that which is produced by cathartics ; so that reflex nervous influences may be propagated from all parts of the canal, as well as from the verge of the anus. Exactly the same order of influences springs from ene- mas and suppositories, whether of a sedative or purgative nature (§ 526). In all the cases, the functions of the liver are reached through the instrumentality of the intestinal mucous tissue, just as mechanical irritations of the conjunctiva, or of the membrane of the mouth, affect the lachrymal, or the salivary glands (§ 923, 524 a). 499, a. The brain and spinal cord, therefore, are the great sources of true sympathy; but the ganglionic system has an important parti- cipation, and probably supplies, in its ganglia, centres of sympathy. Remote sympathy appears sometimes to spring from these ganglionic centres, and contiguous sympathy more commonly (§ 455, 458, 459, 490, 493, 507, 520, 1038). 499, b. It is also evident, that the most essential element in sympa- thy is the nervous power. It is this power which brings about all the ultimate and important results. It is excited by all kinds of physical and moral causes, and variously modified in its nature and effects, according to the nature of the exciting causes (§ 222-233). 500, a. Remote sympathy depends, primarily, upon impressions made upon the sensibility of parts distant from the nervous centres, or directly upon the centres themselves. In one case the function it- associated with sympathetic sensation, in the other it is not (§ 451). 500, b. When made upon distant parts, the impression is transmit- ted to the nervous centres through nerves of sensation or the sensitive fibres of compound nerves, and brings the nervous power in those centres into unusual operation, from which this power is reflected through nerves of motion, or the motor fibres of compound nerves. upon the irritability of other parts, or of the part which sustained the primary impression, and thus gives rise to those various results which are the prominent phenomena in this complex function (§ 455 d, 464- 471), and which for brevity, I call remote sympathy, or sympathy. 500, c. The ordinary results of remote sympathy will follow im- pressions made directly upon the nervous centres, and, indeed, upon the trunks of nerves (§ 474 b, 507). These impressions may be made 324 INSTITUTES OF MEDICINE. upon the brain and 6pinal cord, and by all kinds of physical agents, and by the mind and its passions. The physical and the moral are alike operative. They rouse the nervous power, and modify it according to the nature of the cause, as in the former case (b); when it is transmitted to other parts, as in the more complex process (§ 222-233, 476-492). If the brain or spinal cord be ir- ritated by the direct application of alcohol, it will increase the ac- tion of the heart and blood-vessels; or, on the contrary, their action will be diminished by the application of tobacco, opium, &c. (§ 476, &c). And just so with the different passions, and emotions. Joy produces a lively action of the heart and all the cutaneous vessels; anger a more violent state of general arterial excitement; shame suf- fuses the face in one way, and love in another; fear subdues the ac- tion of the heart and capillaries, induces palpitation, covers the body with a cold sweat, and leads to unwonted micturition; jealousy is at- tended by other remarkable results in organic life; grief undermines digestion, &c. Disgusting sights, like emetics, produce vomiting, as will even their recollection. These cases are all coincident with those in which organic actions are influenced by irritating the brain or spinal cord mechanically, and involve exactly the same essential principle which is concerned in the most complex processes of remote sympathy (§ 476, &c., 508). 500, d. The operation of the will, in producing voluntary motion, follows the same rule as that of the passions. Each is equally a cause of development of the nervous power. The will merely acts as a stim- ulus to the brain, by which the nervous power is developed and trans- mitted to the voluntary muscles, where, by iis operation upon mobil- ity, through irritability, voluntary motion is produced (§ 215,226, 233, 243-246, 258, 467, 476 c, 818|). " Irritability," says the able Macbride, " is to be held as a requi- site foundation for the power of voluntary motion ; for, if we maybe allowed to make a comparison, the soul would be no more capable of moving any particular muscle, or set of muscles, if their fibres, in general, had not the property of irritability, than a musician would be capable of bringing music out of a violin, if its strings were not en- dowed with the property of elasticity" (§ 189, 206). And this shows, us, also, the final cause of the exquisite endowment of all muscles in organic and animal life with irritability, while they possess only a low degree of sensibility (§ 193, 206). We thus see, too, another remarkable exemplification of the man- ner in which the nervous power is so excited by the nature of the ex- citing cause that it shall give rise to voluntary motion. That the will acts as a stimulus, only, to the brain, and that voluntary motion is im- mediately determined by the nervous power, is manifest from the co- incidence between voluntary motion and the spasmodic affections of the same muscles that arise from irritations of the gums or of the in- testinal canal. The same is shown by the spasmodic actions induced by nux vomica, in paralytic affections; which also illustrates the dis- tinction between irritability and sensibility, and shows that motion does not depend upon the nervous system (§ 188, 3 93,195, 206, 208) In this case, sensibility may be very obtuse in the affected limb, while the agent will exert a greater spasmodic effect on the paralyzed thau on the sound muscles. This greater effect is owing to the morbid PHYSIOLOGY.--FUNCTIONS. 325 development of irritability. And what farther illustrates the philoso- phy as to the action of the nervous power upon irritability in rousing paralyzed muscles, is the opposite effect of conia; for, in this case, conia paralyzes the muscles without impairing sensibility (§ 487, gg). In all these cases of spasmodic action, the irritations are propaga- ted upon the cerebro-spinal axis, and prove an exciting cause of the nervous power; in the case of the will the irritation is direct, in its analogous function of voluntary motion. And what shows, in the case of the will, that it is the nervous power, transmitted to the irritability of the voluntary muscles, which is the immediate exciting cause of vol- untary motion, is the manifest fact that this power is the immediate exciting cause of the analogous spasmodic movements. " We know the peculiar office of the brain," says Philip, " by ob- serving what functions are lost by its removal; the sensorial functions. The nervous, then, obeys the sensorial system, in the same way in which the muscular obeys the nervous system; but, as the muscular power has an existence independent of the nervous, so has the nervous an existence independent of the sensorial power." 500, e. Motion is produced in muscles that are partly voluntary and partly involuntary (as those of respiration), through the principles now stated; and the modus operandi of their involuntary movements also il- lustrates fully the philosophy of voluntary motion. Thus, in the involun- tary act of respiration, some peculiar impression upon the lungs, arising, perhaps, from want of air, is the cause of that development and transmis- sion of the nervous power to the respiratory muscles which induces an action precisely similar to that which is excited in the same muscles by an act of the will. The only apparent difference is, that, in the latter case, the nervous power is excited by the will, and not, as in the other case, by an impression transmitted to the brain from the pulmonary mucous membrane. It appears to be a common phenomenon, also, for the will to determine the nervous power upon the muscular coat of the intestine, just as it is, indirectly, by the irritation of a cathartic. This is evinced by the quickened peristaltic action when on the way to the temple of Cloicina. It is an example, too, in which the will is seen to exert a retarding as well as accelerating effect upon the intes- tine. The will has a still greater control over the muscular coat of the bladder, by which that organ is excited into action in the voluntary discharge of urine (§ 518). In the foregoing cases, however, the will commonly operates upon the organic muscles through its associate ac- tion upon the muscles of the abdomen andperinaeum (§ 243, 519). Here, also, is presented another fact in proof of the exactness of Design, another display of the special modifications of the properties of life, since it is here, if any where in organic life, that the will may be instrumental in carrying out the final causes of nature, while there is no reason to suppose that the will can exert an influence on any other part of the truly organic system (§ 72-74, 136, 18l£ d, 199). 500, ee. The principle concerned in the foregoing voluntary and in- voluntary movements is the same as when an emetic operates ; only, in this instance, the peculiar impression transmitted from the mucous tissue of the stomach, through the sensitive fibres of the pneumogastric nerve, modifies and directs the nervous power in a way peculiar to itself; 60 that besides taking its reflected course through the respira- tory nerves of motion, and exciting convulsive instead of respiratory 326 INSTITUTES OF MEDICINE. movements, it falls upon various other parts, and may thus simultane- ously induce copious perspiration, establish profuse secretions from the liver, intestines, Sec, and break up croup, or pneumonia. Exactly the same law, also, is concerned when other remedial or morbific agents exert their effects upon parts remote from the direct seat of their operation. 500,f. The foregoing analogy between voluntary and spasmodic motions, and the mixed motions of respiration, extends to those move- ments which are generated or influenced by the passions, and between the whole there is a close analogy with the effects of all physical agents, and all morbid states, which influence organic actions through the medium of the nervous power, or sympathetically. The passions, also, like physical causes, produce involuntary movements in animal as well as organic life (§ 245, 844). 500, g. Different orders of nerves are, however, concerned in the transmission of impressions, more or less, according to the nature of the exciting causes. Thus, the nerves of volition are not those by which organic processes are influenced. Even in the voluntary mus- cles the irritability which is relative to their organic functions, as, also, sensibility, may be morbidly exalted, and yet the muscles be incapable of obeying the will, as often happens in paralysis (§ 487, gg). Again, other muscles, as those of respiration, are influenced both through the will and through remote sympathy. And while, in these respects, we can recognize no anatomical distinction, either in structure or re- lation of the parts, this inscrutable phenomenon is not less paradoxical than the agency I have ascribed to the nervous power in the produc- tion and cure of disease ; while yet more astonishing is the institution of different orders of nerves, even of fibres in common nerves, for the transmission of impressions to the nervous centres, and from those cen- tres to the circumference; and more surprising still is the reception and transmission of impressions from these centres (§ 189, 234, 236). And still more remarkable is the manner in which the will, the pas- sions, and other exciting causes of motion, through the agency of the nervous power, pass over intermediate nerves, and elect, as their mo- tor channel, those which are variously disconnected in their anatomi- cal relations (§ 233f). And here we may observe, farther, the analo- gy which subsists between the modus operandi of the will, and of phys- ical agents, in developing motion (d). In all the cases, whether vol- untary or involuntary, or mixed, as in respiration, the nervous power is roused and transmitted through motor nerves upon the irritability of all the parts that may be influenced (§ 188, 205). In the case of the will, and the passions, and of the immediate action of physical agents upon the nervous centres, the development of the nervous power is direct; but, when causes operate upon the nervous extremi- ties, the nervous power is, of course, developed by impressions trans- mitted to the central parts (fy 1072, &c). 500, h. Again, we learn from the foregoing considerations, that, since the will determines voluntary motion, but has no influence upon organic actions, with the exceptions stated (e); and since, on the con- trary, the passions operate powerfully in organic, but imperfectly and only in an involuntary manner in animal life, and as judgment, per- ception, and reflection, exert no appreciable influences in either life, unless as morbific causes, or sometimes lessening the action of the PHYSIOLOGY.--FUNCTIONS. 327 heart, while each are special exciting causes to the nervous system, it appears that all these causes or properties are distinct elements of the mental and instinctive principle; just as irritability, sensibility, mobility, &c, are distinct properties or elements of the vital principle (§ 175 b, 183, 188£ d, 234 c, 476 c, 1067, 1072 b). 500, i. Consider, again, how different agents applied to different parts will affect particular organs, remotely situated, in a very uni- form manner, and, by common consent, through the nervous system; as the respiratory muscles, for example (§ 137). " The whole system of respiratory nerves can be excited to action by irritation of any part of the mucous membrane, from the mouth to the anus, from the nos- trils to the lungs." This irritation may be established, and result in increased respiratory movements, by mechanical agents, as by tickling the fauces, and by many others through their intrinsic virtues, as to- bacco applied to the nose. But, what is more remarkable, respiration may be also accelerated by impressions made upon particular parts of the surface of the body, as by tickling the feet; and again, by a strong light impinging on the retina; and yet, again, by hope and fear, by love and hatred. These examples embrace all the varieties that occur be- tween the simple act of respiration and coughing, sneezing, and con- vulsive spasm. Again, another modified order of movements may be induced in the same muscles by agents of yet other virtues; as from the irritation of emetics. Mechanical irritations of the throat may also determine either coughing or vomiting; and here, as with the in- creased respii atoiy movements, certain irritations of the surface, as tobacco to the soles of the feet, will excite the abdominal muscles to the act of vomiting. In this last case, however, the irritation is first transmitted, sympathetically, to the mucous tissue of the stomach (§ 504), from whence it is returned to the nervous centres, and from thence reflected upon the respiratory muscles, the skin, &c. (§ 504, 514 d, k, I). It will be thus seen, that these various agents, acting upon different parts, give rise to analogous or similar phenomena through the me- dium of the nervous power, but they involve a great variety of sensi- tive nerves, while the motor nerves are about the same in all the cases. This reflex nervous action is our medical calculus. 500, j. But, the foregoing complexity, which must find its solution in the attributes of the nervous power operating through its anatomi- cal medium, is vastly increased by the coincident phenomena which may be determined by the will and by mental emotions. Thus, in- creased respiration, coughing, vomiting, Sec, may be produced by an act of the will; grief occasions weeping and sighing; joy, laughter; yawning gives rise to yawning in another; disagreeable recollections produce vomiting, &c. 500, k. It is readily seen that a common philosophy must interpret all the foregoing effects. The fundamental cause is the same through- out. It is every where the influence of the nervous power; but what strange variety in the remote exciting causes ! Nor is this all; for the same great and simple law obtains in all voluntary movements. Let us also especially remark the parallel which exists between the deter- mination of the will upon particular muscles, according to its own choice, and thus constantly passing over, or isolating, various motor nerves, or, yet more remarkably, sending its influences through cer- tain branches of a compound nerve and holding in passive subjection 328 INSTITUTES OF MEDICINE. all the rest, and of those agents which we have just seen to extend their influence specifically to the nerves of respiration, and those of a remedial or morbific nature which, like the will, elect and avoid the nerves without reference to order (§ 233^, 492, no. 6). This aston- ishing phenomenon is perpetually in progress in health among all the organic viscera; and when we consider, also, how the well-trained juggler brings into simultaneous action almost every voluntary mus- cle, and each one in obedience to the foregoing law of elective influ- ence, we shall readily comprehend how disease, and morbific and remedial agents, give to the nervous power the same complex direc- tion, in organic life. But even more remarkable are the various in- tonations of voice, and especially such as form the melody of song. Each one, every variation, whatever the succession of change, is de- termined by an act of volition, rousing, and determining the nervous power, with all the rapidity and mutations of thought, with varying in- tensity, and incalculable changes of direction, and compounded in an endless manner, upon those muscles which are the immediate instru- ments of the vocal apparatus (§ 234 e, 473 c, no. 6, 526 d). Following, in the foregoing manner, the path of nature, it is no dif- ficult problem to understand how embarrassments in speech, as stam- mering, Sec, should often depend upon morbid irritations of the ce- rebro-spinal axis, either of a direct nature, or from influences propa- gated from the digestive viscera, or from other parts. This philoso- phy, therefore, so opposed to the conclusions in surgery, enlightens us as to the temporary benefit, but the ultimate failure, in numerous cases, of dividing the sublingual muscle, and places the fallacious relief upon the true ground of a transient moral influence. These cases, therefore, should go into the hands of a profound physiologist. 500, I. In what has been said, therefore, of the various exciting causes of motion in the respiratory muscles, alone, we have a great element by which we readily attain the philosophy of those analogous examples in which morbific and remedial agents establish changes in organs where the nervous communications with the direct seat of the morbific or remedial action may be obscure, or far less manifest than with other parts on which no sympathetic influence is simultaneously exerted. And, coming also to those complex influences which hold the iris in complete obedience to the great final cause for which it was ordained, and many other equally demonstrable but intricate problems relative to the nerves, and those others which concern an unintermitting action of the nervous power in maintaining some of the most exact and obvious conditions of animal life, as seen in the permanent contraction of the sphincter muscles, we have a flood of light upon the subject which will not fail to dissipate every remaining obscurity, and estab- lish forever an impregnable barrier against the chemical and physical doctrines and all the corruptions of the humoral pathology (§ 1072, a). 500, m. How shall we expound the seemingly paradoxical phe- nomenon of morbific or remedial agents transmitting their impressions through special nerves, in the foregoing irregular manner 1 We must look to the special relations of the operating causes to the vital prop- erties of the parts remotely influenced, both in regard to the natural state of the properties and their acquired susceptibilities, and also as the operating causes may modify the nervous power. The fundamen- tal principle is the same as where the will develops motion' by deter- PHYSIOLOGY.--FUNCTIONS. 329 mmin^ the nervous power upon the animal muscles without reference to the order in which the nerves are distributed (k). 500, n. Contrasted with all this should now be stated the doctrine of the chemical school, as it comes applauded from the laboratory (§3501). The source of motion, then, with this scTiooi, vorantaiy and involun- tary, is the same with that which Liebig assigns for thought, namely, a chemical change in the substance of the organ (§ 349, e). The mo- tions of the heart, blood-vessels, intestines, &c, are said to be main- tained by this incessant chemical process. If the will operate, chem- ical changes are at the foundation of the motion. The will is the de- composing cause, and chemical changes in the brain are the cause of the will, though " the Reformer" does not say what is the cause of those changes in the cerebral substance that give rise to the will and to other acts of intellection (§ 175 c, 349 e, 500 h, 1054, 1076 a). It is presumable, however, that these acts are themselves the causes of the physical changes upon which they depend ; just as it is said that the chemical forces are the cause of the vital force which is the cause of all the organic processes and results that depend upon and are pro- duced by the chemical forces. That is the latest approved version (§ 4£ d, 349 d, 441 e, 4±7if). In this way, too, the chemist expounds the balance between waste and nutrition; and that the latter may sometimes gain upon the former, sleep has been ordained. In times of sleep, voluntary motion being suspended, there is less of the chem- ical waste; and therefore a chemical increase. That, also, is the ap- proved philosophy of sleep. Here is a summary of the whole. " Now, since in different individuals, according to the amount of force consumed in producing voluntary mechanical effects, unequal quantities of living tissue are wasted, there must occur, in every indi- vidual, unless the phenomena of motion are to cease entirely, a con- dition in which all voluntary motions are completely checked; in which, therefore, these occasion no waste. This condition is called sleep. 0 " Now, since the consumption of force for the involuntary motions continues in sleep, it is plain that a waste of matter also continues in that state; and if the original equilibrium is to be restored, we must suppose that, during sleep, an amount of force is accumulated in the form of living tissue, exactly equal to that which was consumed in vol- untary and involuntary motion during the preceding waking period." —Liebig's Animal Chemistry (^ 1076, c) Here it is evident that the chemist was " nodding," from the over- sight he has made of the coincidences presented by the nutrition of plants (§ 350, nos. 64-76). Nor is it the least remarkable part of the foregoing rationale of animal and organic functions, that the nerves are made the conductors of a force which is every where generated by chemical changes, and upon which force it is said the more sensible motions immediately depend, notwithstanding, also, these motions and those of an insensible nature are said to depend immediately and ex- clusively upon the chemical forces, as well as altogether upon the vital force ($ 350, 441 e). But again, I ask the chemist for the primary cause of those chem- ical changes in which originate the acts of the mind, its passions, &c, and which call us from the sleeping to the waking state (175 c, 349 e, 330 INSTITUTES OF MEDICINE. 3502 ggy I ask the chemist, and the physical philosopher of life, tu explain the mechanism and the laws of sympathy by the application of any principle in physics or chemistry. Let the chemist consider, that in every process of remote sympathy there are involved very di- verse, yet very precise effects, and that he must have one species of chemical change for the transmission of impressions through the sen- sitive nerves to the nervous centres, another for the impressions ex- erted upon those centres, another for the reflection of the influences through the motor nerves, and yet another for the effects exerted at the ultimate destination of this amazing round of never-ending influ- ences, as indispensable to the process of respiration ; and coming to morbid states, there must be another series of chemical changes con- forming, respectively, to the nature of every morbid influence and product (§ 188£ d, 464, 451/, 649 b, 675). Take any single attribute of the nervous system, and we shall find it as remarkably distinguished from all things else as is the mental principle. The power which appertains to that system, and presides over the whole life of animals, is just as unique in all its operations. The distinction alone, in various aspects, between the condition of the sensitive nerves, or the sensitive fibres of compound nerves, and those which are appropriate to the motor influence,—those which convey impi-essions to the central parts and those which transmit them to all parts of the organization, to the organic structure of the fountain itself—those, I say, which serve to awaken the mind, or to stamp on the nervous centres, with all the precision of thought, an inconceivable variety of influences which are unceasingly in progress in every other part, but with no other appreciable result than the movements which follow in all the organic constitution, contrasted with the totally dis- tinct prerogative of those nerves, and those fibres of compound nerves, which give rise to the distant movements and changes,—place, at an unutterable distance, all analogy with the recognized imponderable substances and with every other agent or power in the mineral king- dom (§ 451 c, 453). B»t, I would not so far speculate upon the na ture of the nervous power as even to assume for it a place among the imponderables, which the physical philosopher, upon no better evi- dence, unhesitatingly avows as the condition of light, heat, and that more inscrutable substance, imponderable magnetism, which awakens no sensation, and produces no effect upon organic life. Least of all would I place the principle of life, or its element the nervous power, upon a par with the imponderables in their designated condition as material " fluids," nor claim for the latter a distinct individuality (§ 175, bb). The true physiologist attempts not problems which have no relation to principles and laws, and which divert philosophy from its practical uses. It is true, he argues the existence of the principle of life, its remarkable attributes, its contradistinction from all other agents, upon the ground of the philosopher in physics, that he may meet the obtruder with his own ratiocination. He tells him that his premises are the same, only more various, distinct in their nature, and more demonstrative. He points him to bis " undulations" of light, the velocity of their movements, the prismatic analysis, its confirmation by life, his imponderable mystery which spans the globe, its co-operation with the electric fluid, their instant transmission of a disturbing cause to the ends of the earth, making the record at one PHYSIOLOGY.--FUNCTIONS. 331 of its poles ere the impulse has ceased which began at the other (§ 175 bb, 1884; d, 234 c, d, e, 281). 500, o. Let us now observe, summarily, the wonderful system of analogies which Nature has ordained among the vital stimuli, and learn from this, and from the same system of relationship which distinguish- es other parts in the great chain of existences, that her laws are sim- ple where the phenomena are various and complex, and that all her designs and operations are susceptible of reduction to a few general principles, which, when once known, illuminate the darkest labyrinth, and serve us instead of the voluminous facts which have been gradu- ally accumulating for ages. One principle is a key to a thousand phe- nomena; and as new ones spring up, having analogies with such as are known, the principle comes to their ready interpretation. In respect to the analogies among the vital stimuli, the mind, being connected with the body, and acting upon it both directly or through the nervous power, should naturally be one of them ; and here we find it operating in peculiar ways upon the irritability both of organic and animal life,—first directly upon the brain, and then producing volun- tary motion through the nervous power, or so affecting the organic states as to be a morbific or a curative agent. Just so with foreign agents. Irritate the brain and spasms will follow, while the same ir- ritation goes to the recesses of organic life. The natural stimuli of life maintain the vital actions by exciting the vital properties. But, there are many foreign agents which are morbific, and these operate in the same way, only, at the same time, they alter the nature of the vital properties; and it is exactly in this way, also, that the mind and its passions produce disease. The impressions, however, in the former case, may be reflected from the nervous centres, while in the latter, they originate in those centres. Again, there are other foreign agents which aid in restoring the diseased properties and actions to a healthy state, and their principle of operation is exactly similar to that of the mind when this agent aids in the removal of disease ($ 1067). Take next the blood, the natural vital stimulus of organic actions, which makes its impressions upon the same properties and in the same way as we have just seen of the mind and foreign agents. But, unlike the latter, it is a living agent, and calls into action the properties of life for the purpose of being itself acted upon, that it may be incorpo- rated with*the organized structure and receive the plenitude of those powers through which it becomes a part of the organized tissues, that this new formation may again generate the same fluid, and be acted upon, in its turn, by other blood. Its analogy, therefore, to the men- tal principle relates especially to its property as a vital agent. But, we find in the nervous power an agent of more extensive analogies with the blood, since this agent, like the blood, not only affects the organic properties and actions, but is also exquisitely susceptible of modifying influences, of changes in its nature, from the action of the mind and from external morbific and remedial agents,—acquiring even the very character, as an operating cause, which appertains to the agents, respectively, that may call it into action (§ 223-232). The range of analogies is, therefore, coextensive between the nervous pow- er and all other vital agents (§ 74 a, 188£ d). And so of the semen in its action upon the organic properties of the ovum ; infusing, also, pot only a physical, but a moral constitution into the ovum. ' The 332 INSTITUTES OF MEDICINE. corporeal and mental attributes of both parents are, in consequence, blended together (§ 63, &c). Consider, finally, the hibernating animal, whose general modifica- tion of irritability (§ 191) is so constituted with a reference to preser- vation against low degrees of external temperature, that mechanical irritation, heat, and a variety of agents applied to the surface, shall so awaken the nervous influence that his temperature will suddenly rise from below the 40th degree of Fahrenheit up to its natural standard oi 98°. But the curious fact attending this remarkable law of preserva- tion is the same result from an intensity of cold that would otherwise destroy the animal (§ 441, d). 500, p. In respect to the subserviency of the brain to the operations of the mind, I will add in farther explanation of what I have said in section 241, that we have the best reasons for believing that the brain is especially designed for the subserviency of the will and perception, and has comparatively little connection with judgment, reflection, &c, and less with perception than with the will. Its great final cause, in respect to mind and instinct, is to serve as a medium of communica- tion with the voluntary muscles, through the nervous power (§ 455, a). The will is, therefore, a stimulus to the brain, while this organ sup- plies, in consequence, the nervous power by which the voluntary mus- cles are brought into action. In respect to perception, we discover the relation of the mind to the brain in another aspect, and, also, another analogy between the will and physical agents as vital stimuli. Through sensibility the brain is acted upon, and this impression rouses the mind, or its prop- erty, perception, and sensation is the resulting effect (§ 175, c). 501, a. Sympathy is active when it produces sensible effects. It is passive when its effects are insensible, as in the natural rhythm of the organic system, meaning, reflex action of the nervous system. 501, b. In the perfectly natural condition of sympathy in organic life, the nervous influence is a mere regulator of the organic proper- ties. Its natural operation is disturbed by morbific and remedial agents, and by mental emotions. 501, c. It is mostly in conditions of disease that we notice the re- sults of sympathy. In health we see only the universal harmony; unless disturbed by a blush, or by the abundance of urine when cold chills the surface, or fear exerts its more mysterious sway* Disease affords the striking examples of display in the nervous power, and these examples are what most engage the attention of the physician. To trace out their complexity, as one part after another gives rise to disease consecutively in each, and as each may exasperate the morbid states of the whole, or as remedial agents may institute corresponding circles of reflex action, are the most important and difficult objects of medicine. 502, a. Diseases generally begin without the agency of the nerves. Morbific causes make their impression upon the organic properties of some particular part, when it commonly happens, sooner or later, that the altered state of the part is felt by the nervous centres, from whence a disturbing nervous influence is transmitted to other parts (§ 133-154, 18S-193, 516, no. 7, 657, 666). 502, b. It is not improbable, however, that where disease invades the system extensively from its first explosion, as in idiopathic fever, PHYSIOLOGY.--FUNCTIONS. 333 sympathetic sensibility is affected by the primary morbific cause as an important element in establishing the general predisposition (§ 149, 201, 451 b, 559, 660, 666). 502, c. Remedial agents may operate directly upon a part, and re- store its morbid properties and functions without any agency of the nerves. This is generally true where the remedy is applied directly to the tissue affected; but, in all other cases, the nervous power is the medium of transmission. Upon these fundamental principles, the main art of therapeutics is or should be founded. 503. When disease, or morbific, or remedial agents transmit their influence from any part to the brain and spinal cord, and there develop and modify the nervous power, the modification corresponds with the nature of the impression which is transmitted to the nervous centres. These transient modifications of the nervous power are similar, in principle, to the changes which occur in the organic properties, and which essentially constitute the disease. The passions also modify the nervous power in ways peculiar to each; and, in all the cases, corresponding effects are produced upon the condition of diseased parts upon which the nervous power thus modified may be reflected. That is to say, the nature of the nervous power is variously modified in all the cases; and, therefore, like external morbific or remedial agents of different virtues, modifies the vital states according to its own acquired modifications. The nervous power, therefore, thus acquires, more or less, the virtues of the exciting causes, and becomes, more or less, a substitute for them (§ 226). 504. Various circles of sympathy are generated by the action of remedial agents upon the stomach, intestines, &c. The first impres- sion of the agent may set in motion a great range of reflex nervous actions; as the operation of emetics (§ 500, g) ; and, as new impres- sions are sympathetically instituted, they become the points of depar- ture for other circles of sympathy, and react upon and increase those in which they originate. 505. When the nervous power is excited by remedial agents of positive virtues, it is essentially morbific, like the remedial agents themselves. Each is, therefore, only curative by inducing new mor- bid conditions by which the natural recuperative tendency of the vital properties is brought into operation. The great difference is, that morbific agents alter the vital conditions more profoundly and more permanently than the remedial. 506. Impressions once made upon any part may continue for an in- definite time after the cause is withdrawn, and may continue to de- velop and modify the nervous influence, and direct its operation upon other parts, as when the agent was in operation (§ 487, c). Thus, the operation of many active remedial or morbific agents will continue to be exerted upon the system at large, for a longer or shorter time, af- ter they shall have been thoroughly removed from the stomach, &c. Inflammations excited by cantharides, issues, wounds, &c, hold an unceasing operation, curative or morbific, upon remote parts. The specific impression made by the virus of the mad dog becomes establish- ed in the bitten part, and continues to be propagated by reflex action till, through the law of cumulation, an explosion of disease ultimately follows (§ 558, a). The same principle, exactly, is applicable to mer- cury, when a small dose, or its external application, produces saliva- 334 INSTITUTES OF MEDICINE. tion, or when miasmata give rise to fevers in a month, or six months, after their direct operation has been withdrawn. The principle is constantly illustrated in natural states of the body ; as where the sphincters remain permanently contracted after the expulsion of the urine or of fecal matter (§ 514 g, 516, no. 6). Here, then, we have another important law to interpret the true modus operandi of remedial and morbific agents (§ 503). 507. The nervous power pervades the whole system of motor nerves; and, although its active operation in the ordinary function of sympathy be developed mainly, if not altogether, in the central parts, it may be brought into operation by irritating any of the motor nerves (§ 474 b, 499). A division, or other injury of nerves going to the organic viscera, as the par vagum, may destroy their functions, or otherwise affect the vital constitution and products of the part, or in- duce inflammation, by the shock of nervous power thus inflicted on the organic properties of the part (§ 485). 508. The nervous systems are as liable as other parts to be affect- ed in their organic condition by the nervous power, which, in the same way, may be actively determined upon them. But, there is this difference. When any part of the nervous system is the seat of dis- ease, it is liable to produce greater disturbances in remote parts, than other organs when diseased. These disturbances are occasioned by the direct propagation of the nervous power, but they are apt to be less of a morbid nature than when produced by the more complex process of reflex action (§ 500, a-c). 509. The nervous power may extinguish life with great instanta- neousness. When rapidly fatal, the causes by which it is brought into operation must be violent and sudden in their action (§ 455, d). Ex- amples occur in the fatal effects of joy, anger, blows on the epigastric region, drinking cold water, prussic acid, sudden death from small losses of blood, apoplexy, &c. (§ 479, 1040). In the case of joy, anger, and apoplexy, the nervous power is de- veloped in a direct manner (§ 500, c), and destroys mainly by its sud- den determination upon the organic properties of the brain and heart. Blows on the stomach give the same determination through remote sympathy, as do also cold water and prussic acid (§ 476£, h). The mode of death from small losses of blood will be explained under the philosophy of the operation of its loss (§ 943, 946, &c). In the foregoing cases, the nervous power is also determined with violence upon the stomach and intestines, and upon the whole capil- lary system of blood-vessels (§ 481, &c, 490). The general effect is also increased by the injury sustained by the brain itself. 510. The foregoing modus operandi of the several agents is similar to the causation of sudden death from injuries of the brain or spinal cord. Thus: If the spinal marrow be suddenly destroyed, or only one half of it, by a large stilette, life is immediately extinguished. The modus op- erandi appears to be the following:—1st. An injury of the vital prop- erties of all the organic viscera. 2d. A violent interruption of the concert of organic actions. 3d. An interruption of respiratory move- ments. 4th. A pernicious nervous power is propagated from the cord to the organic powers of the brain. 5th. Pernicious influences are propagated by the organic viscera to the cerebral and ganglionic sys- PHYSIOLOGY.--FUNCTIONS. 33j tems,—thus greatly increasing the destructive nervous influence upon themselves (§ 455, c). They are complex circles of nervous influ- ence, but are determined by exact laws, and each circle has its distinct individuality, although involved in each other. A like explanation is also applicable when a sudden destruction of life is effected by crushing the brain. 511. It is upon the principle that the effects of the nervous influ- ence depend upon the exact nature of the impressions made upon the nervous centres, whether direct or indirect (§ 426, 500), that we must explain the differences in the results of slightly-varied experiments relative to these parts; those, for instance, by which the brain or spi- nal cord is slowly destroyed interrupting the harmony of actions and the organic functions more gradually, and therefore less fatally, than such as produce their destructive effects with greater rapidity. V. THE LAWS OF SYMPATHY, OR REFLEX ACTION OF THE NERVOUS SYSTEM, AND THEIR APPLICATION TO PATHOLOGY AND THERAPETJTCIS. General Facts and Laws relative to the Cerebro-spinal and Ganglionic Systems. 512, a. The various nervous communications of the intestinal canal with the brain and all other organs are demonstrative of the ascend- ant influence which the stomach, particularly, possesses when acted upon by remedial agents. We see all this exemplified, analogically at least, in the endless remote derangements which follow the com- mon irritations and morbid states of the organ, as, also, of the intes- tines. We see, indeed, the whole in natural progress. When, for example, hunger operates, an actual sensation is then felt by the brain, and the mind, of course, participates (§ 323). Numerous and complex influences may be thus brought fnto operation, of which the stomach is the primary source. The will, being excited, brings into action all those muscles which are necessary to obtain a supply of food, and other muscles to effect its mastication, and convey it to tho stomach. Various sympathetic organic influences are, in the mean time, taking place, which it is unnecessary, as it might be difficult, to explain. Many of these organic influences spring from the mind it- self. Thus, the brain feeling the sensation of hunger, the salivary glands begin to pour out their fluid at the sight or smell of food, or even at its expectation. The food establishes an influence upon the nervous centres, by which an exciting nervous power is constantly propagated to other parts. The bile, saliva, &c, are thus increased, though other more direct sympathetic influences contribute to these results. The stomach being supplied with its wants, all these influ- ences cease, and a new order arises. Cut off the par vagum and none of them will obtain, unless feebly through the ganglionic and spinal nerves. When the food has undergone digestion, and all ex- citing impression is removed from the stomach, all the reflected influ- ences of the brain and spinal cord cease in consequence. 512, b. The vascular action and the glow of warmth, which are lighted up in the skin of the fasting, half-frozen traveler, and his in- vigorated strength before digestion has made any advances, and the flow of bile which is determined by the action of food on the stom- ach, especially where the food is of an animal nature, and therefore. S36 INSTITUTES OF MEDICINE. likewise, operative in part through ks stimulant virtue ; or, again, the copious perspiration, and other results, which often follow immediate- ly a draught of hot water, illustrate the whole philosophy of this ap- parently entangled subject of sympathy, whether in relation to natu- ral, morbific, or remedial agents; and we learn from these obvious examples that the essential principle is simple, and readily explains all the diversified phenomena, which are purely effects of a complex play of sympathies, whose original starting point is the gastrointesti- nal mucous membrane. But when, in the case of the food, it shall have been digested, and have entered the circulation, some of its ear- liest and strongest demonstrations may have disappeared. It is wor- thy of remark, too, that such is often the immediate effect of food upon the great nervous centre, that sleep is almost irresistible, or apoplexy follows, "paulo post prandium," as no unusual result; the nervous power being determined, in the former case, upon the organic prop- erties mildly and agreeably, in the latter with sudden and destructive violence (§ 226-233, 480, 500, 508-511, 1040). 513. Physiological conditions, like the foregoing, are so intelligible as to be peculiarly important in illustrating coincident problems in pathology and therapeutics. Whenever well-pronounced sympathetic influences are propagated from one organ to others through the me- dium of the cerebro-spinal system, in their natural states, and by nat- ural stimuli, as by food, these influences are generally greatly increas- ed, as well as modified in kind, by morbific and by remedial agents (§ 524, no. 1). 514, a. The foregoing considerations lead me to the statement of one of the most important laws in physiology, which is alike applica- ble to the cerebro-spinal and ganglionic systems, namely: " When impressions, made by the action of external stimuli on sen- sitive nerves, give rise to motions in other parts, these are never the result of the direct reaction of the sensitive and motor fibres of the nerves on each other. The irritation is conveyed by the sensitive fibres to the brain and spinal cord, and is by those communicated to the motor fibres."—Muller (§ 445, 462-472). The foregoing law is in operation in all cases of remote sympathy, whether of a physiological, pathological, or therapeutical nature (§ 455, c-h). It is clearly exemplified in the natural process of respiration, by the analogous results of emetics, &c. In respiration, the want of air is felt through the medium of the sensitive fibres of the pneumo- gastric and sympathetic nerves, and appears to be concentrated about the medulla oblongata. The nervous power is thus developed, and is then reflected upon the various motor nerves which supply the mus- cles of respiration ; when the action of these muscles follows as a con sequence (§ 233, 462-472, 500). 514, b. The only remarkable difference in the physiology of vomit- ing from that of respiration consists in the primary impression being made upon the same nerves in the mucous tissue of the stomach, and the convulsive movement of the abdominal muscles. A radical dif- ference, however, obtains in the influences which may be exerted by an emetic upon the organic states; especially in their diseased condi- tions. This, too, will depend greatly upon the cause of vomiting; and so of every other agent, according as it may be natural, morbific, or remedial. When the effects depend upon sympathetic influences, PHYSIOLOGY.--FUNCTIONS. 337 the morbific and remedial agents so modify the nervous power that it alters the existing condition of the organic properties and functions of all parts upon which its positive action may fall (§ 129, 226, 227). If the stomach itself be the seat of disease, even its mucous tissue, the remedial effect of any agent may not be wholly, or principally, due to its direct action upon the organ, but may be also exerted through a chain of causation exactly similar to that by which the re- spiratory muscles are thrown into action in respiration or vomiting. This must be obvious enough in the case of peritoneal disease of the stomach ; and it is equally true of diseases of its mucous coat, that the impression of the remedy is transmitted, more or less, through the sensitive fibres of the pneumogastric and ganglionic nerves to the brain and spinal cord, when the nervous power is reflected, with an alterative effect, through the motor fibres of the same nerves upon the mucous, as upon the serous, tissue of the stomach. The same philos- ophy applies to the muscular coat of the stomach in the action of an emetic, and to the same tissue of the intestines when peristaltic move- ments are excited by cathartics (§ 657 a, 658). In the case of vomiting, the impression upon the stomach may be direct or indirect; and the various mental as well as physical modes by which it may be produced, unfold an extensive range of sympa- thies, open a wide door to a knowledge of the modus operandi of morbific and remedial agents, and confute the physical and chemical doctrines of life and disease. But this is only at the threshold of an endless number of analogous examples supplied by the mucous tissue alone ; since " the whole system of respiratory nerves can be excited to action by the irritation of any part of the mucous membranes from the mouth to the anus, or from the nostrils to the lungs, or of the urinary organs." 514, c. We thus comprehend how an emetic of the most simple na- ture may suddenly arrest a paroxysm of hooping-cough, or of spas- modic asthma, or of hysteria. The emetic, through the foregoing process, induces new movements in the affected muscles, and thus ends the paroxysm. Dr. Greenhow, for example, has lately related, in the London Medical Gazette, the case of a man, who was affected with a choking, as if a ball was rising in his throat, and shortly after a violent hiccough began, which continued for several days. About the eighth day, his wife, sister, and maid-servant, " got into the same state;" the affection being sympathetic in the last three cases, and in- duced by the operation of the mind (§ 227, no. 1, 230). " It was a painful spectacle, though a somewhat ludicrous one, to see four indi- viduals all hiccoughing at the same time." Opium, valerian, asafoet- ida, camphor, magnesia, Sec, failed entirely of affording relief. "How- ever, something taken by the maid-servant made her vomit, and from that moment the complaint ceased. A mustard emetic was immedi- ately ordered for the others, when the sister and wife were also re- lieved ; but not so the husband, whose attack, however, was always suspended by vomiting, but soon returned." In the case of the hus- band, there was present a state of disease, which continued to repro- duce the paroxysms ; but in the other three there was little else than the spasmodic action of the muscles. Dr. G. says he " always after- ward found that vomiting put an end to attacks of hysteria, and be- lieves that the dread of an emetic has often had the effect of checking 338 INSTITUTES OF MEDICINE. an hysterical attack;" in which case the mind develops a controlling nervous influence. 514, d. Consider, next, an example of the manifestation of sympa thy between the skin and other parts, as indicative of the modus ope- randi of remedial and morbific agents when they establish their influ- ences upon distant parts through the medium of the skin. Volkmann, in pointing out the great difference between the trunks and the minute terminations of the nerves in the power of exciting reflex motions, prefers the skin for illustration; which, he says, sur- passes all other organs in the property of exciting these motions. When an animal, for example, is under the influence of opium, the slightest touch of the skin is frequently sufficient to give rise to strong spasms, while reflex actions excited by irritating the distinct nerves of the skin are generally less. The philosophy is the same when cold air, or cold water, restores a patient from a state of syncope. A drop of cold water, when snapped upon the face, rouses the subject by trans- mitting an impression through the cutaneous nerves to the nervous centres, which instantly develops an exciting nervous influence that is then reflected upon the muscles of respiration, and upon the heart and extreme blood-vessels. The same law governs, also, the constant mu- tual interchange of action between the skin and alimentary canal, the skin and kidneys, &c, whether in health or disease. From these ex- amples of a great fundamental law, we readily obtain the modus operandi of mercury, iodine, blisters, issues, &c, when applied to the skin (.§ 226, 232, 527 b, 559, 666). 514, e. With the qualifications stated in sections 458, 459, it is "a general law, that, whenever general spasms are excited by local im- pressions, the phenomenon depends on no other communication be- tween the sensitive and motor fibres than exists in the spinal cord. In many cases, however, local irritation of the nerves gives rise, not to general, but to local muscular spasms." " In the contraction of all the perineal muscles in expelling the semen, which are excited by irritation of the sensitive fibres of the penis, the spinal cord is the medium of communication between the sensorial impressions and the movements."—Muller. 514,f. Many "muscles invested by sensitive membranes, and are not themselves exposed to the direct stimulus, can only be excited to action by irritation of the sensitive property of their investing mem- brane, the transmission of this irritation to the nervous centres, and the propagation of the motor influence from the nervous centres to themselves. Thus, the contractions of the glottis and air-passages, excited by the contact of irritating gases, are not the immediate result of the irritation of the parts themselves, but of the excitement of the sensitive fibres distributed to the mucous membrane and the reflected influence of the brain and spinal cord upon the motor nerves of the muscles. The movements of deglutition belong to this class. The stimulus of the morsel in the fauces excites the act of deglutition. In this case, the sensitive nerves which transmit the impression to the nervous centres are, according to Dr. Reid, the glosso-pharyngeal, the superior laryngeal, and the branches of the fifth, sent to the soft palate and isthmus of the fauces. The motor nerves for the movements oi deglutition are the pharyngeal branches of the par vagum. A like explanation applies, also, to the irritations of the sphincter ani and the PHYSIOLOGY.--FUNCTIONS. 339 sphincters of the bladder. The muscles cannot be themselves stimu- lated by the excrement and the urine ; but these matters act upon the sensitive nerves of the mucous membrane and excite the spinal cord, which, as if constantly charged with motor influence, reacts upon the muscles. In this case the phenomenon appears to depend on no other communication between the sensitive and motor fibres than exists in the spinal cord. Hence, after injury of the spinal marrow, these sphincters become relaxed."—Muller. The operation of cathartics involves more complex laws. These are agents of specific virtues, and are capable of modifying the vital states of the intestinal canal and of parts remotely situated. Their di- rect impression is exerted upon the intestinal mucous tissue; but the muscular is brought into increased action both by contiguous and re- mote sympathy (§ 497). It is not improbable, indeed, that remote sympathy is concerned in the ordinary peristaltic movements that are induced by the natural contents of the alimentary canal (§ 475, 490); though observation assures us that, as in the case of the heart, the nat- ural stimuli maintain the movements without any well-pronounced re- flection of the nervous power upon the muscular coat (§ 475, 490). But in the case of cathartics, something more happens. The influence being extended to the nervous centres, the nervous power is propa- gated through motor fibres of the pneumogastric and sympathetic nerves upon the intestinal mucous tissue, by which the various influ- ences of these agents are increased, as in the experiments by Wilson Philip (§ 491). 514, g-. The sphincters remain contracted after the expulsion of the fasces and urine. This is owing to the permanence of the impression upon the mucous tissue, which maintains an excitement of the nervous influence till the excretions are again deposited. And so of the con- tinued influences of remedial and morbific agents long after the agents themselves have ceased to operate; the impressions remaining upon the parts where their direct action had been exerted. In this way miasmata, the virus of the mad dog, mercurial and other remedies which may be slow in the full development of their effects, establish their influences where their direct action may fall, and these are subse- quently and slowly propagated to other parts (§ 516, nos. 2 and 6, 518 b, 666, 657 a). 514, h. More complex examples of the law with which this section was begun will be presented hereafter. Such as have been stated are intended as introductory to the series of laws which are soon to fol- low. But we see from examples already produced, that when sym- pathies are set up in one part they may become the cause of sympa- thies in other parts, and that in this manner remedial and morbific agents, which begin their action on some given part, may establish very complex circles of sympathy, each modifying the others through new influences upon the nervous power (§ 228). When the food, for instance, as in § 512, induces vascular action and warmth in the skin before digestion commences, that organ, in consequence, reflects salu- tary influences on the digestive organs, and thus promotes digestion. When tartarized antimony, in small doses, establishes its sudorific im- pression, the skin becomes the source of many reflex nervous actiom upon other organs; thus showing, also, that it is not the perspiration but the vital change in the organ itself which leads to results that can- 340 INSTITUTES OF MEDICINE. not be imitated by any other mode of exciting this excretory function.* And so, more or less, of other parts upon which the antimony may exert its primary sympathetic effect (§ 863, e). Thus it happens, that whether certain remedial agents are applied to the stomach or skin, reflex nervous actions are propagated to each, as well as from each to other organs, while each, in its turn, reflects the impressions back to the brain and spinal cord, from whence they are again returned with increased intensity; or organs not before in- volved are ultimately brought under their influence (§ 129 h, 674 d). And so of disease of any given organ ; which is only equivalent to the influences of morbific causes (§ 647, 660). If two or more remedial agents be united, it is readily seen thai their combined effect may be extended from the stomach to various parts of the body, and from thence sympathetic influences propagated among themselves, and variously determined upon other parts. 514, i. We may now regard an example which presents a union of the physiological, pathological, and therapeutical principles, as set forth by myself, in their relation to the nervous influence; all refera- ble to one common law in its connection with modifications of the ner- vous power (§ 226). Thus : " Certain cases," according to Marshall Hall, " as hydrophobia, epilepsy, hysteria, and certain remedies, as strychnia, cantharides, &c, not only induce augmented excitability, but manifest their effects upon the organs which are physiologically under the dominion of the excito-motory power." 514, k. Finally, a glance at the physiology of the contraction of the iris may aid our understanding of the complex sympathetic influences of morbific and remedial agents, and of the applicability of the follow- ing physiological laws to the modus operandi of such agents. It is first worthy of observation, that the iris may be pricked with a knife without exciting contraction, while it is exquisitely sensitive to the action of light (§ 74 a, 188£ d, 136, 137). The co-operation of a sensitive and motor nerve, through the medium of the brain, is neces- sary to this phenomenon. The impression upon the retina being transmitted to the brain through the optic nerve, is reflected upon the iris through the motor ciliary nerve. This may, perhaps, open the eyes of the chemist as to the true doctrine of vision (§ 188£ d, 500 »). But it is a more interesting fact, that when one eye is closed, and the other open, the pupil of the closed eye will follow, in a measure, the movements of the open eye ; and this will happen to an amaurotic eye when the sound one is exposed to the stimulus of light. This sympa- thy between the two eyes, as well as in other respects, and the har- mony between the two ears, involve very delicate considerations as to the influences of the nervous centres, and may be employed in tracing out the philosophy of many obscure interchanges of action among dif- ferent organs, either in their natural states, or when they are disturb- ed by morbific or remedial agents (§ 1072, a, note). 514, I. A multitude of illustrations may be brought to the same purpose, which show us, also, how complex may be the influences of morbific and remedial agents, and how the mind may participate, when these agents operate upon the organic properties which con- duct the insensible movements. Thus, sneezing is commonly produ- ced by the action of stimuli upon a nerve of common sensibility dis- tributed from the fifth pair to the mucous tissue of the nose, and the * Here is the origin of Ihe term " excito-secretory function". Ses p. 913. PHYSIOLOGY.--FUNCTIONS. 341 reflection of this irritation upon the respiratory nerves. But the stimulus of the sun's light may produce sneezing by acting first upon the optic nerve, and through that medium upon the nervous centres. The nervous power thus developed is reflected upon the Schneiderian membrane through the branches of the fifth pair which impart com- mon sensibility to the nose (§ 198). Here a new sensation arises, which is sent back to the brain and spinal cord, the nervous power again developed, and, according to relations between that mem- brane and the respiratory organs, and the nature of the remote cause, the nervous power is now reflected upon the respiratory muscles, when sneezing follows as the result of the convulsive movement. (See, in connection, § 188£ d, 500 n.) The mind itself will do the same thing by dwelling intensely on a former paroxysm of sneezing. Here the nervous power is excited in a direct manner by the mind, and is then, as in the foregoing case, directed upon the nasal branch of the fifth pair. And so of sympa- thetic yawning, sympathetic micturition, &c. 514, m. The olfactory nerve is mostly endowed with specific sensi- oility, and is only excited by odors, while they have no such effect upon the nasal branches of the fifth pair, unless the odors be at the same time of a pungent nature; and then it is the pungency, not the odor, that operates. Odors affect the mind agreeably or disagreea- bly. The smell of a rose may have no other effect than that of so impressing the brain as to give rise to a pleasurable sensation. But, in some constitutions, its impression will excite a very complex train of sympathies. Its effect may be at first pleasurable, but followed immediately by the transmission of a disturbing influence to the heart, or stomach, or even to the intestines. The heart may be thus depressed in its action, the stomach nauseated, and the bowels have been purged by the same cause. Hence the poet's expression, to " die of a rose in aromatic pain." Even the recollection of disagree- able results from offensive odors brings on nausea and vomiting (§ 500, i. See, in connection, § 188^, d). haws of Action of the Sympathetic Nerve, and the Propagation of Im- pressions in it. 514^, a. Having now, and in former sections (§ 471-475, 477-496, 500), stated the most important facts and laws which relate to the cerebro-spinal system, whether acting independently, or in connec- tion with the sympathetic nerve, I shall proceed to speak of those which concern especially the latter system. But the cerebro-spinal is so interwoven with the sympathetic nerve, it is obvious that the influences which appertain to the brain and spinal cord must be more or less common to the ganglionic nerve (§ 115). 514£, b. The following laws are generally inferable from what has been already said of the nervous power, and of sympathy. But, I have deemed it most useful to the young student of medicine, and possibly to the more advanced, to present them in a brief and sys- tematic form, with comments of a practical nature. The quotations are from Muller, unless otherwise stated. In this branch of physiol- ogy, Muller is eminently philosophical; and in thus adhering to the path of nature, he is arrayed in opposition to those chemical and physical views with which he has thought proper to oblige the mate- 342 INSTITUTES OF MEDICINE. rialists of the age, and which prevail in other parts of his work on Physiology. After variously expounding the laws of the vital prin- ciple, and reasoning as a philosopher upon the abstract subject of re- flex nervous influence, like Marshall Hall, and others, he cuts loose from all analogies, and from the whole philosophy of the vital prop- erties. As in the equally remarkable case of Wilson Philip, he as- cribes all the organic functions and products to physical and chemi- cal agencies,—maintaining that, " The formation of any one of the peculiar secretions, the essential proximate constituents of which do not exist in the blood, presupposes the operation of a special chemical apparatus, whether this be a mem- brane or a gland." Of all morbid states, be affirms, that " AH these phenomena are owing to a noxious matter absorbed into the blood, or generated in it." The same humoral interpretation is applied to the modus operandi of remedies, which, like morbific agents, are supposed to be taken into the circulation by endosmosis or by capillary attraction, and it is quite "uncertain," he says, "whether the matters are first received into the blood-vessels or lymphatics."—Muller's Elements of Physiology. Also, Medical and Physiological Commentaries, vol. i., p. 37, note, 56, note, 565, 570, 684, 685 ; and this work, § 494, dd. I have thus adverted again to the discrepances in the views of this philosopher, that the reader may appreciate the value of his luminous exposition of the laws of sympathy, since they contemplated no theo- retical conclusions in pathology or therapeutics. 515. It is still a controverted question how far the sympathetic nerve is independent of the brain and spinal cord, though in their nat- ural state the intimate physiological relations of the latter to the for- mer admit of no doubt (§ 459). Microscopical investigations have been carried on extensively with reference to this inquiry by Valentin, Volkmann, Bidder, Muller, Remack, Henle, Purkinje, Rosensthat, Pap- penbeim, and some others less known in the walks of physiology. As may be readily supposed from the nature of the investigation, and the means relied upon, there has been great discrepancy, and even entire opposition, in the principal statements and conclusions ; all tending to strengthen my objections to the use of the microscope in anatomical and physiological inquiries (§ 131. Also, Med. and Phys. Comm., vol. i., p. 699-712; and Examination of Reviews, in vol. iih, p. 6, 89). We know enough, however, of the relations of the sympathetic nerve and cerebro-spinal systems, and of thetir connections with other parts, and enough of the phenomena which grow out of those rela- tions, to lay down the important laws of sympathy; and these are what we require for practical purposes. Of the Actions of the Sympathetic Nerve in Involuntary Motions. 516, a. 1. " All the parts subject to the influence of the sympathet- ic nerve are incapable of voluntary motion." 2. " The parts which are supplied with motor power by the sym- pathetic nerve still continue to move, though more feebly than before, when they are separated from their natural connections with the rest of the sympathetic system, and wholly removed from the body." This is an important fact, as contributing to prove that the viscera of organic life are not dependent on the nervoua power for the ac- PHYSIOLOGY.--FUNCTIONS. 343 tions, but that all the essential processes are carried on by pr ipertiea peculiar to themselves (§ 184, 188, 205-216, 222-232, 475, 476-492, 494, 500). 516, b. Clear demonstrations of the foregoing law abound in the history of organic life. That in relation to the extirpated heart, which has been stated in a former section, is alone abundantly con- clusive (§ 498, e). 516, c. Again, if the intestines be removed from the body, and some part of them irritated, their motion is increased, " and this effect con- tinues long after the stimulus is withdrawn, and does not immediately attain its greatest degree." And so with the heart (§ 516, b). Its contractions may not begin till some seconds after it is irritated, and they may then be long continued (§ 516, nos. 6 and 7). The phenom- enon, and its causes, are the same as when the leaflets of the mimosa sensitiva contract when irritated by a pin. 516, d. We have, therefore, in these examples, a type of all the movements which arise from continuous sympathy (§ 498, 524, no. 2), and a proof of the existence of the organic properties, of their inde- pendence of the nervous system, and of the active, vital nature of the dilatation of the heart (§ 498, e). The principle is of great moment in a pathological and therapeutical aspect. We see, for example, that the direct facts, and the analogy supplied by the active dilatation and contraction of the heart, substantiate a rhythmic, consentaneous movement of the arteries (§ 384). We carry this with the other facts to pathological conditions. Thus, when the extreme capillaries of the skin, as of the finger, for instance, or any other part, are irritated mechanically, or by any chemical or other agent, an inflammation may be excited at the point irritated; just as the heart, or intestine, is roused into action by the prick of a pin. The inflammation then extends, progressively, from the point irritated, the finger throbs, its principal artery begins to pulsate, and finally the radial. And so of the irritation of the ducts of glands, by which the glandular secretion is increased. At other times, remote sympathy, or the operation of the nervous power, is simultaneously brought into action (§ 498,^/*, g). 3. " Hence, all the parts endowed with motion and supplied with nerves from the sympathetic, are, in a certain degree, independent of the brain and spinal cord," as well as of the sympathetic nerve. The same affirmation is true of the muscles of animal life (§ 487, 494 d). 4. " The central organs of the nervous system can, however, exert an active influence on the sympathetic nerves and their motor*power" (§ 222-232, 475). This is a very important physiological fact to the physician, and is fully established by the experiments of Philip, Valentin, Muller, and others, and is conspicuously shown by the effects of the passions. It is through the liability of the whole body to be influenced by the nervous power of the brain and spinal cord, through the sympathetic nerve, as well as through their ow*i nervous contributions, that I in- terpret the whole philosophy of sympathetic diseases, and the opera- tion of all morbific and remedial agents when they affect parts that are distant from the direct seat of the action (§ 495-507). 5. " The experiments of D,r. Philip tend to show, that distinct parts of the sympathetic, and the movements dependent upon them, 344 INSTITUTES OF MEDICINE. as of the heart, for example, do not derive their nervous influence from distinct regions of the brain and spinal cord; but, on the contra- ry, that the whole brain and spinal cord, or every part of them, can exert an influence on the motions of the heart," of the capillary blood- vessels, of the intestinal canal, &c. (§ 476-492, 494 d). 6. Next follows a most important physiological law, when applied pathologically and therapeutically, and by which I explain the con- tinued operation of morbific and remedial agents long after the ces- sation of their direct action. " The movements excited in organs which are under the influence of the sympathetic nerve, by irritation applied to them or to their nerves, are not transitory and momentary contractions. They are either enduring contractions, or they consist of a long-continued modi- fication of the ordinary rhythmic action of the organ. Hence, in these organs, the reaction consequent on the irritation is entirely of longer duration than the action of the stimulus" (§ 514 g, 516, no. 2, c, 487 e). Now, what is true of the nervous influence as it respects its effect on the great organs is, according to the experiments of Dr. Philip, and others, equally so of the small blood-vessels, and the vessels of se- cretion. The foregoing law is founded upon experiments in which the irri- tation produced by agents is not directly morbific, such as galvanism and mechanical irritants. If such causes, therefore, will continue to derange the actions of the organic viscera after the operation of the causes is withdrawn, those which are truly morbific will continue in action longer, and establish disease more permanently through the same channel. And so of remedial agents. The law is shown, nat- urally, by the unabated contraction of the sphincter muscles after the evacuation of urine and of fecal matter. This physiological law, therefore, is of vast moment in interpreting the effects of remedial agents, corresponds with that natural condition which is set forth in § 514, g", shows us how the influence of an emetic or cathartic may continue to be felt by the lungs, the brain, &c, long after their most characteristic effects are over; or how an uninter- rupted and cumulative action of the foregoing nature may be main- tained by small and repeated doses of mercury, antimony, &c, or by the peculiar change which leeches establish in the vessels to which they are applied, and, finally, how a morbific cause of yet other spe- cific virtues may, by its momentary action on the mucous tissue of the stomach, or lungs, &c, be kept up in those tissues long after the re- mote cause is withdrawn, and progressively shed a morbific influence Over all the organs of the body (§ 150, 498/ 545, 549, 550, 558 a, 559, 666). The impression is maintained, in all the cases, upon the organic constitution of the organs immediately impressed, for an in- definite time after the agents themselves have ceased their operation. While that impression remains the influence which has been thus ex- erted continues to modify, more or less, the vital nature of the parts, and to be propagated with varioirs effect upon distant organs. We have seen the simple physiological elements operating through the combined media of the cerebro-spinal and sympathetic systems, in section 514, f, as it respects the permanent contraction of the sphinc- ter muscles, and in the explanation which I have given of the persist- ence of their contraction after the expulsion of the urine and faeces. PHYSIOLOGY.--FUNCTIONS. 345 Now, that principle which physiologists have limited to an expla- nation of the natural phenomena in relation to the sphincters, is most extensively applicable in resolving the problems of disease and of re- medial influences, and I shall carry it, in connection with the forego- ing law, far into the labyrinth of organic life, as it may fall under the cognizance of the pathologist and therapeutist. In the aspect, alone, of its bearing upon the amount and frequency of doses, &c, in the treatment of disease, the law is of incalculable magnitude (§ 857), The same impressions which are left upon the bladder and rectum after the evacuation of their contents, and which continue to propa- gate the nervous power upon the sphincter muscles, and to maintain them in a state of contraction till the urine or the faeces again accu- mulate, equally appertain to morbific and remedial agents. Hence I deduce an important practical rule for the regulation of doses, the frequency of their repetition, the order of their application, &c, ac- cording to the nature of disease, the nature of the agents employed, the duration of their effect, &c.; all of which is amply sustained by the results of practice, especially those which so constantly accrue from excessive doses, and their repetition before the influences of the pre- ceding shall have duly abated, or where other means should have been substituted. There is nothing, I say, of greater practical impor- tance in the whole circuit of medicine than what is involved in this section, and in those which I shall have brought to its illustration. We must attend to the physiological facts. The effects of mistaken practice are entirely insufficient to enlighten the understanding. Phys- iology must be brought back as the basis of pathology, the ground- work of therapeutics; keeping ever before us those natural laws through which the evil and the good of practical medicine are essen- tially determined. However various the causes and the phenomena, a concurrence of principle and of laws obtains among the whole; which is the surest proof that the doctrines here taught have their deep foundation in nature (§ 237). There is nothing that can assure us more emphatically of the importance of sweeping away the chem- ical and physical doctrines of life, of disease, of therapeutics, than the facts about which I am now interested, and the mischief which has arisen either from removing pathology and therapeutics from their proper foundation, or in deriving their foundation from the laboratory of the chemist (§ 5\ a, 350£, 350|, 819, &c). 7. The next following law shows that the organs of organic life are essentially a system by themselves, that their actions are carried on by their own inherent powers, and are essentially independent of the nerves, and that the great office of the sympathetic nerve is to main- tain a harmony or concert of action among them. It will be seen, however, that the capital error occurs, that " the immediate cause of the involuntary motions lies in the sympathetic nerve" (§ 516, no. 2). " The immediate cause of the involuntary motions, and the cause of their type, lies neither in the brain nor in the spinal cord, but in the sympathetic nerve itself. Even the influence of the ganglia is no1 necessary. The branches of the sympathetic going to an organ may be entirely removed, the twigs distributed to the substance of the or- gan only being left, and the motions will be maintained as before, the reciprocal action between the muscular fibres and these ultimate ner- vous twigs being apparently adequate to their production." 34(i INSTITUTES OF MEDICINE. The phenomena are the same in plants. They depend, not on the nervous power, but on the organic properties of every part. This ap- pears from Muller himself, who says that, "to excite the motion of the leaflets and petioles of the mimosa, it is not necessary that either the intumescence, or even the leaves, should be touched. The stimu- lus may be applied to a more or less distant part (§ 184, 207, 208, 233, ;-!57, 490, 502, 524, no. 2. Also, Med. and Phys. Comm., vol. i., p. 17, 474-480, 572 ; and Essays on the Philosophy of Vitality and of the Modus Operandi of Remedial Agents, p. 42, 43, note). 8. Now follows the ;rreat law, that, notwithstanding the foregoing separate nature of the rganic properties and their essential independ- ence of the nervous J >wer, the organic properties may be greatly influenced through the ( jrebro-spinal and sympathetic systems. What is said, however, of the " extreme branches of the sympathetic" must be regarded as erroneous (no. 7), though it be probable that influ- ences may be determined sympathetically through the ganglia and plexuses of the sympathetic nerve (§ 459). The law is thus express- ed by Muller: " Although, from the foregoing observations (no. 7), it is certain that the extreme minute branches of the sympathetic have still the power of regulating the movements of the parts not subject to the will (when such parts are abstracted from the body), yet it is not less true that both the brain and spinal cord, and the ganglia themselves, when in a state of .irritation, exert an influence on these movements as long as the contractile organs are connected with them through the medium of the nerves. The brain and spinal cord are, however, also to be regarded as the source of the power of the sympathetic itself, which would, without them, become exhausted" (§ 524, no. 6). The last clause of the foregoing law is inapplicable to the fcetus without brain and spinal cord (§ 493, b). It is nevertheless true, how- ever, in a general sense, that " the phenomena of radiation and coinci- dence of sensations, of the associated and reflected motions, are in- dependent of the action of the sympathetic, and comprehend by far the greater part of the sympathetic phenomena formerly attributed to its influence." The second clause involves all the phenomena of remote sympathy, of the operation of the passions, and of other direct cerebro-spinal in- fluences on the organic viscera (§ 227, 230). 9. I would vary the phraseology of the following law, to render it more conformable with the facts. I do not believe that the sympa- thetic nerve is any longer charged with the influence derived from the brain and spinal cord than during its connection with those parts. So far as this nerve manifests an influence after that connection is sever- ed, it is itself the source of that influence ; and this conclusion is sus- tained by the fcetus without brain or spinal cord (§ 1038). " It results," says Muller, " from the fact already stated (nos. 7 and 8), that the sympathetic nerve is charged, as it were, with nervous power by the brain and spinal cord, which may be regarded as the sources of nervous influence ; but that, when once charged, it con- tinues to emit this influence in the manner peculiar to itself, even when the farther supply is, for a time, diminished" (§ 516, nos. 7 and 8; § 520, 524, no. 5). The foregoing fact clearly evinces a certain independence of the PHYSIOLOGY.--FUNCTIONS. 347 sympathetic of the cerebro-spinal system, which becomes strongly pronounced when the latter is wanting in the fcetal state, or when de- stroyed by disease. 10. The next law shows that the action of agents is incomparably greater upon the minute terminations of the nerves than upon their trunks. It is equally applicable to the cerebro-spinal as to the sym- pathetic. Thus: " The influence of narcotics locally applied to the sympathetic nerve, does not extend to the distant organs which the nerve sup- plies ; but these organs may be paralyzed by the direct narcotization of the minute nervous fibrils which are distributed to them." The principle is general, extending to all other agents, and has been misapplied by Muller, and many others, to sustain the humoral pathology (§ 826, d. Med. and. Phys. Comm., vol. i., p. 563, 564). 11. The next following: law will be seen to be important in inter- preting some of the various phenomena of sympathy, when they orig- inate in the sympathetic nerve. Thus: " The laws of reflection (in the cerebro-spinal system) stated in the third chapter of this section prevail, likewise, in the actions of the sympathetic nerve. Strong impressions on parts supplied by the sympathetic nerve may be propagated to the spinal cord [and brain], and give rise to motions of parts which derive their nerves from the cerebro-spinal system." As an illustration of this law, "Volkmann has observed convulsions of the body produced by irritating the intestines of a decapitated froff." With the head on, and in animals more susceptible than frogs, the foregoing law becomes extensively applicable to agents applied to the intestinal canal, or other viscera that are especially supplied by the sympathetic nerve. Thus, nux vomica produces spasmodic action of the voluntary muscles, while opium, Sec, relieves them in the same way. Indeed, it is well ascertained that all the spasmodic movements of the voluntary and respiratory muscles that arise from affections of the abdominal organs depend upon irritations transmitted to the brain and spinal cord, and their subsequent reflection upon cerebro-spinal nerves. Hence, also, the action of the abdominal muscles in the vomiting excited by irritation of the intestines, by irritation of the kid- neys, of the uterus, &c. And so of the natural movements of the re- spiratory muscles (§ 500). 12. " Impressions on parts of which the nerves are derived from the sympathetic are communicated to the spinal cord and brain, and excite the motor influence of the sympathetic nerve by reflection." The foregoing law is an extension of no. 4, and is the most impor- tant of well-ascertained laws in medicine, as explaining all the sym- pathetic influences of disease, all the influences of remedial and mor- bific agents exerted upon parts distant from the seat of their direct action ; except such phenomena as may also fall more or less under the laws 11 and 13, in connection with which this law should be con- sidered.—(Med. and Phys. Comm., vol. i., p. 569-572.) 13. " Reflected action of the sympathetic, from an impression com- municated to the spinal cord by cerebro-spinal nerves, is a frequent occurrence." The "frequency of the occurrence" is such, that it is through the 348 INSTITUTES OF MEDICINE. foregoing law, and the 12th, that remedial agents operate upon the organic system when applied to the skin, that diseases of the skin af- fect the abdominal viscera, that the contact of cold air suddenly in- creases the excretion, or the discharge, of urine, &c. The 12th law is involved, since both the cerebro-spinal and sympathetic nerves of the skin are the media of transmitted impressions. The chain of in- volved influences is of the highest importance, pathologically and ther- apeutically. As one of a thousand illustrations, if tobacco applied to the skin produce vomiting, the effect is first propagated to the ner- vous centres, from which it is reflected upon the stomach through the motor fibres of the par vagum and sympathetic nerve. This irritation of the stomach is equivalent to a direct impression from tobacco upon the stomach (§ 500, 503). It is then returned to the nervous centres through the sensitive fibres of the par vagum and sympathetic nerve, and reflected upon the respiratory muscles through the motor nerves of those organs. But there are other profound influences, and other circles of sym- pathy simultaneously established. The organic properties of the stomach are affected, sympathetic influences are reverberated upon the skin, excited in the heart and blood-vessels, in the liver, and oth- er important organic viscera, while these influences also mutually re- act upon the several organs, respectively, and involve other parts, such as the uterus, the kidneys, the bladder, the voluntary muscles, the sphincters, the senses, the mind, &c, in the deep complexity of results. And all this astonishing consecutive series of effects, moving forward under the most precise and fundamental laws of nature, and all the work of a moment, is set in motion by the simple application of a leaf of tobacco to the sole of the foot (§ 502)..* 517. Finally, the nervous power may be determined upon the or- ganic properties of the brain, or of any part of the nervous system, by physical and moral causes, with much of the variety of effect which it produces on other parts (§ 230, 512). 518, a. "In certain organs, which are subject to the influence of the sympathetic and of the cerebro-spinal nerves at the same time, a voluntary influence seems to be exerted only after the long continu- ance of a centripetal or sensitive impression." So far as this principle is operative, it goes to demonstrate the re- markable peculiarities, the versatile and complex nature, of the func- tions of the nervous system (§ 500,^' and k). The urinary bladder, for example, which is under the influence of the will, presents the fol- lowing phenomenon : " The will does not come into operation until a considerable accumulation of urine has taken place ; in other words, not until the fluid has made a long-continued impression on the sensi- tive nerves of the bladder, and through the medium of these upon the cerebro-spinal axis" (§ 500, e). 518, b. Analogies evidently occur in the viscera over which the will has no control, while the facts are illustrated by the principle as ascer- tained in the foregoing manner ; such, for example, as the long incuba- tion of miasmata, of the hydrophobic virus, mercurial influences, &c, and the sudden accession of the phenomena to which they respectively give rise (§ 500 c, 514 g, 516, no. 6). In sections 500,^' and k, are some remarkable facts which will deter us from rejecting difficult problems in sympathy (§ 473, no. 6, 523, nos. 6 and 7). PHYSIOLOGY.--FUNCTIONS. 349 519. The following law is a farther exemplification of the forego ing comments (§ 518, b), and should be considered in connection with the 11th and 12th laws. Thus : " Many parts which are supplied by the sympathetic nerve, and ca- pable of involuntary motion only, become associated with the motions of parts subject to volition ; a part of the voluntary motor influence being communicated involuntarily to them; just as in the associate motions of the voluntary muscles." Of this, examples are afforded by the iris, the vesicula seminalis, and intestine (§ 500, e). 520. The problem is propounded by Muller, " Can reflex phenom- ena be produced in the sympathetic nerve through the influence of the ganglia, and independently of the brain and spinal cord V He is disposed to answer the question negatively, and observes that, " We are at present entirely ignorant as to whether irritations in one organ ever, through the medium of the sympathetic, give rise to sym- pathetic movements in another." And yet when he comes to reason from the phenomena of nature, he remarks that, " in many cases, it is probable that the reflections are produced through the medium of the sympathetic alone;" and again, that in such cases, "it is probable that the sympathetic nerve alone is engaged in the production of the phenomena." This is enforced by the considerations, that, " the pe- culiarity of the organic or sympathetic nerves, namely, the difficulty of distinguishing either origin or termination of them, their want of (definite) arrangement into trunks and branches, and the increase in their course which they frequently undergo, is certainly in favor of their actions being propagated in all directions from the central points of the ganglia." This was the old doctrine, and that such is the fact to a certain ex tent, and under certain circumstances, appears to be evinced by some of the phenomena of contiguous sympathy (§ 497), and by the fcetus without brain and spinal cord. It seems, also, to have been shown by the experiments of Henle, Grangier, and Valentin, upon the in- testines. But careful attention is necessary, in these cases, to distin- guish what is due alone to the independent organic properties of any part, from that which is owing to an influence exerted upon those properties by the nervous power (§ 222, &c, 507, 516, nos. 7 and 8, 1038). 521. " It is not proved, and several facts have been observed which are opposed to the belief, that the ganglia can exert an insula- ting action so as to impede the transmission of motor influence from the brain and spinal cord" (§ 523, no. 4). All the phenomena of sympathy in organic life appear to be oppo- sed to this belief. 522. " It is not certain that the ganglia are the cause of the parts supplied by the sympathetic nerve being withdrawn from the influ- ence of the will." It is probable that the cause is inscrutable, since it is owing to pe- culiarities in the vital as well as mechanical constitution of the two systems of nerves. We see, however, that influences are as readily transmitted from the brain to the organic viscera as the will operates on the voluntary muscles; and while the passions scarcely operate in animal life, they have a powerful and rapid effect on organic. 350 INSTITUTES OF MEDICINE. Laws of the Sensitive Functions of the Sympathetic Nerve. 523. 1. " The sensations in parts, the nerves of which belong to the sympathetic system, are faint, indistinct, and undefined; distinct and defined sensations being excited in them only by violent causes of irritation" (§ 201, b). 2. " The sensitive impressions received by the sympathetic nerve, although conveyed to the cerebro-spinal axis, may not be perceived by the sensorium" (§ 199^, 451). 3. " The impressions which give rise to reflex motions, when con- veyed to the spinal cord by the sympathetic nerve, are, in most in- stances, not productive of sensations; while those impressions which are received by cerebro-spinal nerves always give rise to sensations" (§ 199^, 451). 4. " The ganglia of the sympathetic nerve do not prevent the transmission of centripetal actions in that nerve to the spinal cord. They have not an insulating power over its centripetal currents" (§ 521, 1038). 5. " The ganglia are likewise not the cause of the impressions on the sympathetic nerve being unattended with true sensation." 6. " In many cases, irritation of a violent nature in organs supplied by the sympathetic nerve gives rise to sensations in those parts. In other cases, the irritation being less violent, the sensations in the parts affected are indistinct, while distinct sensations are present in other parts supplied with cerebro-spinal nerves" (§ 518, b). We have examples of the first kind in inflammations of the intes tines and liver; of those of the second kind, in the troublesome itch- ing of the nose and anus in affections of the intestinal canal, and pain of the shoulder in hepatic and cardiac diseases, of itching of the glans penis in chronic affections of the bladder and kidneys. 7. " The secondary sensations in cerebro-spinal nerves, consequent on irritation of the branches of the sympathetic, occur especially at the extreme parts of the organs affected." Morbid states of the stomach produce a sense of irritation in the throat; and nothing is more common than obstinate inflammation of the mucous tissue of the fauces from gastric derangements, which are not inflammatory. In all these cases, remote and continuous sympa- thy are more or less in combined operation. An ignorance of the laws which govern in such instances leads many physicians to apply their remedies to the parts where the sensation is felt, or the inflam- mation appears. There is also a special sympathy between the ex- tremities of the intestinal mucous membrane. Smoking, for instance, often brings on an attack of the piles; though an intermediate chain of morbific influences is also propagated to the anus through the stomach and liver (§ 498^*, 514 h). Laws of the Organic Functions of the Sympathetic Nerve. •524, a. 1. "When, in consequence of impressions on sensitive nerves, secretions take place in distant parts, the brain and spinal cord are probably the medium of communication." Thus, " impres- sions on internal mucous membranes, as by hot drinks, frequently give rise immediately to a general sweat." PHYSIOLOGY.--FUNCTIONS. 351 This is precisely similar to what I have said of the effect of food in lighting up a warmth in a cold skin (§ 512). The foregoing law is true, in a general sense (§ 455, 458, 459, 490 493 b, 516, nos. 7 and 8). It lies at the foundation of the whole doc- trine which I have projected as to remote sympathy, and through which I interpret all diseases that spring up as consequences of each other, and the operation of morbific and remedial agents upon parts remote from the seat of their direct influence. It is variously express- ed in the preceding laws. If hot water operate upon the stomach and transmit its influence through the cerebro-spinal and sympathetic system to the whole sur- face 6f the body, it is clearly in the same way that tartarized antimo- ny produces a sweat over the whole cutaneous organ when it deter- mines nausea, or the act of vomiting, and therefore, also, when it acts upon the stomach in a more insensible manner. And so of the re- mote influences of other remedies, or of morbific agents, or of gastric, or any other primary disease. If it be the principle as laid down physiologically, it must be equally the same for analogous effects in disease, or in its treatment. 2. " There prevails a consent of action between the different parts of a secreting membrane. Thus, the state of one spot influences the condition of the whole extent of a mucous membrane" (§ 498^/) 516, nos. 2, 3, and 7). This is the continuous sympathy as expounded in this work. It is more or less manifested in most of the diseases of all tissues, and al- though not a function of the sympathetic nerve, I have retained the law under that denomination (§ 141, 498, 520, 923). 3. "A particular state of one organ, such as inflammation, or a se- creting action in it, often causes the production of a similar state in other parts." This proposition is intended in a specific, not in the general sense in which disease of one part gives rise, sympathetically, to diverse af- fections of other parts. It refers to peculiar states of disease in which remote sympathy is often remarkably characterized. Thus, "inflam- mation of the testicle may be replaced by inflammation of the parotid ; erysipelatous inflammation of the skin may be transferred to the mem- branes of the brain; suppression of the secretion of one organ may give rise to increased secretion in another." So of the extension of rheumatism and gout from one part to another of very different or- ganization (§ 142). 524, b. Where sympathies of the foregoing nature arise, there is often a special relation of natural functions between the respective parts, as between the uterus and mammae. Or such relation appears to be pronounced only by morbid states, as between the parotid and testis, and the parotid and mammae, in the mumps (§ 142). 524, c. As resulting from the foregoing (no. 3), though apparently the reverse of it, we have the important effect of sympathy, that when disease springs up in distant parts as a consequence of some affection of other parts, the secondary affection often proves curative of the primary one. It is the same, in principle, as when blisters, setons, Sec, relieve some internal malady. Many sympathetic diseases have, as it were, a great final cause, as a part of the natural constitution of animals. The ordinary forms of inflammation which supervene on 352 INSTITUTES OF MEDICINE. venous cono-estion often relieve a more formidable affection of the veins (§ 803^804, 905. Also, Med. and Phys. Comm., vol. ii., p. 519- 524). Inflammation of the bronchial mucous membrane, or of the pleura, supervening on pneumonia, may assuage the latter affection. Phthisis, supervening on gastric disease, sometimes removes the lat- ter condition. Eruptions of the skin relieve disease of the internal viscera. The hepatic action which leads to morbid redundances of bile overcome cerebral or other congestions and inflammations, and the effusion relieves the liver; while it is the tendency of inflamma tion of all parts to relieve itself by some morbid product, whether the disease be primary or secondary. Nature, in these cases, has suppli- ed indications for the hand of art; and, instead of waiting for the in- direct and spontaneous course, we should abstract blood, or hasten to establish those changes which result in increased secretions, &c. While, also, we are accomplishing these results, which, abstractedly considered, are depletive, we are acting, at the same time, upon the diseased properties, either by a direct impression upon them by the remedies, or indirectly by the nervous power (§ 503). But this is mainly true of the natural processes as it respects spontaneous hem- orrhage. All the other natural effusions are greatly wanting in those direct remedial effects which are exerted by therapeutical agents that lead to similar products. " The principle of the balance of sympathy teaches us how we must avoid aggravating the morbid condition of one organ by the means which we apply to another; but it also teaches us how we may pro- duce a change in the state of one organ directly inaccessible to us by effecting an appropriate change in another."—Muller. Here Muller is any thing but a humoralist, as, also, throughout his disquisition on the laws of sympathy ; though in other places he lays down the broad doctrine that morbific and remedial agents produce their effects by absorption into the circulation (§ 494 dd, 514£ a. Also, Med. and Phys. Comm., vol. i., p. 563-571). 524, d. It might seem, at first glance, that the fact of the vital prop- erties and actions being liable to disease is inconsistent with the great laws of recuperation and self-preservation. But it is not so; since morbific agents being permitted, their occasional deleterious action grows out of the natural constitution of the properties of life, which is physiologically designed for the healthy processes. That these processes may be carried on, the properties of life must be susceptible of being acted upon by foreign agents, as food, &c, and universally by the blood. They must also be liable to modifications in their na- ture, that certain specific functions may be instituted from time to time, as the processes of gestation, lactation, &c, and the powers of all other parts must be so constituted as to adapt themselves to these transient modifications. And so of other changes, as from infancy to childhood, from childhood to puberty, &c. (§ 153-159). Now the changes which arise in disease are analogous to those of gestation, lactation, and more remotely to those which occur at puberty; and they are, therefore, necessary consequences of the natural and essential constitution of the vital properties when noxious agents act upon them. We therefore return again to our proposition that it is even a neces- sary consequence of the final cause of the adaptation of the properties of life to the influence of salutary agents. And hence, also, the natu PHYSIOLOGY.--FUNCTIONS. 353 ral law of adaptation (§ 136) extends to morbid states of the system; being, for example, the principle already adverted to, which pro- tects the general system against those morbid changes in the blood that ensue upon local diseases, and diseased parts against the irrita- tion of their morbid products (§ 74, 129, 137 c, 143 c, 150-152, 155, 156, 387, 524 d, 944 c, 980, 1019). 4. " The ganglia appear to be the central parts from which the vegetative influence is distributed to the different organs." 5. " This radiating influence appears to be, in a certain degree, in- dependent of the brain and spinal cord" (§ 520, 516, no. 9). 6. " It appears, however, that the brain and spinal cord are the main source whence the power of the organic nerves is gradually ren- ovated" (§ 1038). 7. Finally, it is the great office of the sympathetic nerve, through the medium of the cerebro-spinal axis, to maintain all parts in con- certed action. Every organ, through this channel, is rendered sensitive to the condition of each other, and they so interchange their influences upon each, that the whole are maintained in those relative states of action which are most conducive to the good of the whole. From the exquisite susceptibility of the nervous power, and of sympathetic sensibility, which is so conspicuous in this function, arise those dis- turbances that are inflicted by organs upon each other, and the sym- pathetic effects of remedial and morbific agents (§ 201,227, 455, 459, 449). OF THE SYMPATHIES OF THE INDIVIDUAL TISSUES. Sympathies of Similar Tissues. 525, a. Enough, perhaps, has been said upon this subject (§ 85-98, 133-143). We have seen that tissues of a similar vital constitution have the greatest tendency to sympathize with each other; but it is not necessary that the secondary disease should be of the same na- ture aq the primary, though such is apt to be the case (§ 140, 141, 149-152). The most frequent instances of morbid sympathies in tissues of the 6ame nature, but remote from each other, occur in the following or- der (§ 162) : 1. The venous tissue, in the form of venous congestion (§ 786, &c). 2. The fibrous tissue, as in rheumatic inflammation. 3. The serous tissue, as seen, especially, in dropsical affections. 4. The mucous tissue. 5. The cellular tissue. 6. The lymphatic tissue. 7. The nervous tissue. 8. The arterial tissue. 9. The muscular tissue. 10. The osseous and cartilaginous tissues. 525, b. When similar tissues sympathize with each other, the sym- pathetic disease and its phenomena are apt to be similar to the pri- mary affection; while, in the case of sympathies arising among dif- ferent tissues, the .phenomena are different in each, even though the primary and secondary affections be of the same general nature, as, Z 35, INSTITUTES OF MEDICINE. however, they are not wont to be. When like tissues sympathize with each other, the diseases and the phenomena are most analogous, because the same tissue in different compound organs has, respect- ively, modifications of the organic properties that are more alike than those of different tissues. And hence, mainly, the greater difference between the primary and secondary diseases of different tissues (§ 133-140). . . *525, c. When disease springs up in tissues of the same organiza- tion, but remote from each other, as in rheumatic inflammation of the fibrous tissues, for example, the primary affection often exists in some other part or parts, as the digestive organs, and is generally of a dif- ferent character from the secondary affection. In these cases, which are common, the successive secondary affections may be more owing to direct sympathy with the parts primarily diseased than to the sym- pathetic influence of the tissue secondarily affected upon other parts of its own denomination. This is an important'practical considera- tion, for upon its just estimate will depend much of the treatment in any'given case of disease (§ 902 m, 905). It is also equally true that the sympathetic affections which supervene among compound organs are apt to be more or less different from the primary affection. 526, a. Tissues morbidly affected sympathize, continuously, in their several parts, most readily in the following order (§ 133-136, 498): 1. The venous tissue, in congestion or sub-inflammation. 2. The lymphatic tissue. 3. The cellular tissue. 4. The mucous tissue. 5. The fibrous tissue. 6. The serous tissue. 7. The glandular tissue. 8. The dermoid tissue. 9. The nervous tissue. 10. The muscular tissue. 11. The cartilaginous and osseous tissues. 12. The arterial tissue. Owing to the peculiar vital constitution of each tissue, disease 19 apt to be confined to that which it first invades, but to disturb the condition of other parts with which it may be associated (§ 133-136). There are, indeed, some striking exceptions to the general rule; as, rheumatic inflammation of the ligaments is often propagated to the heart, and sometimes to a mucous tissue. Inflammation of the pul- monary air-cells is very apt to be extended to the serous tissue of the lungs, or inflammation of the liver to its investing membrane. In- deed, the serous membranes generally participate in the morbid states of the other tissues with which they are associated; nor can much intensity of disease affect any tissue without disturbing, more or less, the condition of its associate tissues. But there is much va- riety in these respects, even in continuous organs, as between the stomach and the small and large intestines. If the mucous coat of the small intestine be actively inflamed, it is frequently the cause of a like condition in the peritoneal coat, when the mucous inflammation may subside as a sympathetic consequence; thus representing the double operation of the law in § 524, no. 3. But, however severe- S'ilYSIOLOGY.--FUNCTIONS. 355 ly the mucous coat of the stomach may be affected with inflammation, the disease is rarely propagated to the serous tissue of the organ, but far more readily to the serous or other tissues of the lungs, &c. In respect to the arterial tissue, when we regard the extreme and capillary series as the instruments of all diseases, and, therefore, al- ways involved in morbid action in the diseased states of all other tis- sues, it must rank as the first in its liability to continuous and remote sympathetic influences (§ 1040). The arterial tissue itself is but little subject to other conditions of morbid action; and when the large arteries become inflamed in any part, the disease remains very circumscribed. They have, also, no great action in their natural state; it being their office, mainly, to serve as conduits for the blood. Nevertheless, they are constantly liable to sympathetic irritations, either by continuous or remote sym- pathy (§ 516, no. 2, d). The next series, or the capillary arteries, are reservoirs of blood to the extreme vessels; and to meet the exi- gencies of this function, they have their vital properties and actions more strongly pronounced, and are readily and manifestly influenced by the nervous power, as abundantly shown in blushing, &c. (§ 512, b). Hence, from this natural, physiological constitution, this series of the arterial system is more liable than the larger to irritations and aug- mented actions, as manifested in most inflammations. We come next to the extreme series, in which the capillary arte- ries terminate; and here we find the vital properties developed in an eminent degree. This is known from their being the essential in- struments of all healthy and morbid processes; and the changes in their phenomena and products during disease evince the rapidity and great extent in which these properties and actions may be modified by the nervous power, and which are brought about in an instant of time when that power is developed by the mind (§ 227, 500, 516 d). Sympathy, therefore, plays an incessant and extensive round among this extreme series of vessels, both in health and disease. A breath of cold air may arrest the secretion of sweat, and simultaneously de- termine an increased flow of urine, or fear will as suddenly aug- ment both excretions. Coming to disease, and the influence of reme- dial agents, this natural relationship of the extreme vessels, and the same physiological principle, are at the foundation of the principal philosophy. Indeed, the organic properties being now more suscep- tible than in health, and the nervous power more intensely developed by morbific and remedial agents, its operation must be more rapid. extensive, and profound, in the latter than the former case. Hence, in part, inflammations, &c, are liable to spring up in rapid succession in various remote organs, after their invasion of any onepart(§ 1056). 526, b. Next, as to the venous tissue. Here the sympathies are great, both of the remote and continuous kind, particularly the latter (§ 498). It is especially through the natural physiological sympathies of the veins, that I have endeavored to show how they co-operate in circulating the blood, as also the error of the physical doctrine of ve- nous congestion, which supposed that this most prevalent and fatal disease depends on obstacles to the circulation and consequent stag- nation of the blood. I have, therefore, endeavored to expound the pathology of this affection upon purely vital grounds, and in conform- ity with physiological laws (§ 786, &c). The main physiological prin- 356 s INSTITUTES OF MEDICINE. ciple of a sympathetic nature, however, should be stated in connec- tion with the subject before us. The venous radicles possess a vigor- ous action which is constantly influenced, through continuous sympa- thy, by the corresponding state of the capillary arteries, and by the quantities of blood transmitted to them; and that the trunks of the veins have a most visible action is shown by their rapid contraction and dilatation when cold or heat may operate upon the skin. This action is simultaneous, or nearly so, over a large extent of the veins, and is the result of continuous sympathy with the arterial system, as well as dependent on the quantities of blood transmitted from the ar- teries to the veins. But, when an increased quantity is transmitted, the enlargement of the veins is in no respect mechanical, but produced, in part, by the greater impression which is thus made upon the ex quisite susceptibility of the organic properties of the veins. From these few remarks as to the vital endowments of the veins, and of the active functions they perform, it is evident that they must be quite liable to morbific influences, and that remote and continuous sympathy of a morbid nature must have a ready operation among them (§ 74, 117, 137, 155, 156, 387, 422, 514 h, 524 d). 526, c. In respect to the lymphatic system, the principle of continu- ous sympathy, as in the veins, is strongly exhibited under the influence of irritating agents. If a lymphatic become inflamed at some point in the skin, the inflammation may extend rapidly along the course of the vessel, while the glands, also, will take on the same condition. Here is the great bulwark of humoralism. Here it is, and in the lacteals, that the humoral pathologists suppose that morbific agents enter the circulation and corrupt the blood, or remedial ones step in to purify it, and transmute it from a morbid to a healthy state! But, since the needle, whose prick may propagate an extensive inflammation along the course of a lymphatic vessel, is not absorbed, nor the leeches which remove the inflammation, we may rest satisfied that the poison of the viper, of the mad dog, &c, do not produce their effects upon the prin- ciple of absorption (§ 268, &c. Also, Med. and Phys. Comm., vol. i., p. 480-514). Diseases of the lymphatic glands are especially owing to constitu- tional predispositions, as in scrofula. When disease is developed in any one or more of these glands, others readily take on the same state of inflammation. While, therefore, under special circumstances, re- mote sympathy predominates in the lymphatic glands, the continuous form is mostly witnessed in the lymphatic vessels. In the great plan of organic Design, those inlets of the absorbent system, the lacteals, are greatly exempt from morbific influences. 526, d. Sympathies between the brain, spinal cord, and nerves, and between the nerves themselves, are more or less in progress, in the natural state of the body. Their phenomena, however, are not very manifest, unless the nerves of some particular part sustain an irrita- tion ('§ 501). Thus, the irritation from stone in the bladder occasions morbid sensations in the penis. Other examples occur in § 513, no. 6. When disease is produced, sympathetically, in the brain, or spinal cord, or nerves, by morbid states of other organs, it is not due, as sup- posed by Muller, to sympathy with the nerves of the parts so affected, but to the morbid change in the general vital constitution of such parts.. In this respect, the sympathies of the nervous system with other or- PHYSIOLOGY.--FUNCTIONS. 357 •rans observe the same laws as apply to other sympathizing parte (§ 230)- It is difficult to analyze the sympathies which occur, specifically, in the nervous tissue, since it is the medium through which remote sym- pathies take place. Continuous sympathy we know to be of very limited extent, and have every reason to believe that the great final cause of the nervous system is protected by an unusual exemption of this system, especially such parts as supply the organic viscera, from severe morbid conditions, which never fail to inflict great injuries upon other parts. It is also true that diseased conditions of the nervous tissue are not easily reached by remedial agents; and the injury they inflict on other parts constantly reacts in maintaining morbid states of the nervous tissue. The sympathies of which I am speaking refer to the changes which may be produced in the organic state of the nervous system, not to the transmission of impressions, nor to the development and influences of the nervous power, excepting so far as this power may be produc- tive of direct changes in the organic properties and actions of the ner- vous tissue (§ 230). The general convulsions that arise from irritation of the nervous expanse in the intestinal canal, or from teething, &c, imply no absolute disease of any part of the nervous system ; but only a strong development of the nervous power, and its forcible determina- tion upon the muscles that may be spasmodically affected (§ 223-226, 233, 500). I therefore think that authors, as Marshall Hall, for example, in his work on the Nervous System, are wrong in considering " all convul- sive affections to be diseases of the true spinal or excito-motory sys- tem." On the contrary, I apprehend that in most of these cases there is no actual disease of any part of the nervous system ; and it is of no little practical importance that this question should be rightly settled. The " principal causes," says Dr. Hall, " are dental irritation acting through the fifth nerve; gastric irritation acting through the pneu mo- gastric; and intestinal irritation acting through the spinal nerves." Now, we have variously seen how the nervous power may be pre- ternaturally excited, and determined with various effect upon the or- gans of organic and animal life; being so constituted as to be exquis- itely susceptible to a vast variety of natural causes (§ 226, 227, 500). The muscles of animal fife are naturally under the powerful influence of the nerves; this being a special ordination in relation to the ner- vous power and the* mobility of muscles of animal life, to enable the will to determine the nervous power so as to produce voluntary mo- tion, and other causes to render it subservient to respiration (§ 205, 208, 226, 233, 500 c). Hence convulsions readily spring up; while, from the nervous system being only a regulator of functions in organic life, preternatural influences of the nervous power give rise to othei phenomena in that division of life. Owing, also, to these constitu- tional peculiarities, as well as to the natural modifications of the vital properties of the animal muscles, the nervous power, when determin- ed with violence upon them, rarely occasions disease ; while in respect to the same properties in the organic system, where they have a dif- ferent modification, and the nervous power a different physiological function, it readily proves morbific (§ 133-150, 452-456). We have', therefore, all the elements that are necessary to show that 358 INSTITUTES OF MEDICINE. Dr. Hall's pathology is wrong. The convulsions to which he refer? as actual diseases of the spinal system, affect the muscles of animal life, upon which the will may operate with violence in an instant, or which are perpetually held in action by the nervous power for the per- formance of the respiratory movements, and to carry out the office of the sphincters. A slight irritation, therefore, propagated to the ner- vous centres may rouse these natural motions into irregular and more violent ones, without producing any more disease in the nerves or the muscles, than is produced by the operation of the will, or by those causes which maintain the movements of respiration. Again, if a cere- bro-spinal nerve be irritated, convulsions are produced, and the same is done by a shock of the electric fluid. Now, these results are ex- actly analogous to the natural convulsions which are supposed to de- pend on disease of " the true spinal system of nerves." If we analyze the supposed cases, the same conclusions will follow. When, in one case, the gum is lanced down upon the tooth, the convulsions may cease immediately. In another, or when the convulsions depend on gastric or intestinal irritation, a dose of morphia, or an emetic, or an enema, or warm bath, will generally remove the convulsions very speedily, and they are not apt to return. Diseases of the membranes of the brain or spinal cord, or of the substance of the brain or of the spinal cord itself, do not often occa- sion convulsions ; which, indeed, are commonly independent of any disease of the nervous system. When, however, they do give rise to convulsive movements, or when such result follows an affection of a nerve, as in traumatic tetanus, there is no morbid state sympatheti- cally exerted in any other part of the nervous system, but the convul- sions are owing to a propagation of the nervous power upon the mus- cles as in the foregoing cases. Here, the disease of the nervous tis- sue is exactly equivalent, in developing the nervous power, to the irritation propagated to the nervous centres by dentition, intestinal irritation, &c. It sometimes happens, therefore, that a division of the affected nerve, in tetanus, will at once remove the spasms. When, therefore, convulsions arise from dentition, or intestinal irri- tation, we apply our remedies to the gums, &c, and not to the spi- nal cord, or to its nerves. Such as may depend upon disease of the nervous centres, or of a nerve, are obstinate, and the treatment is then directed with a special reference to the part which may be thus affected. Here, also, we learn the importance of an intimate acquaintance with the laws of the nervous power, and of correct theory. Convul- sive movements, under most circumstances, have a very similar char- acter ; and to ascertain their causes, we must apply ourselves to other symptoms and other considerations. Nevertheless, they are apt to have certain differences in some affections. Those of tetanus have the strongest peculiarities ; and here there is a very limited state of disease at the wounded part, but idiopathic tetanus may depend upon intestinal disease. But, there is often a complete resemblance be- tween the ordinary convulsions from dentition, and gastric, and intes- tinal irritation, and those of hysteria and epilepsy ; whatever may be the exciting causes in either case. Since, therefore, it may be of the highest importance to ascertain the particular causes, we institute a diagnosis through other attending facts. PHYSIOI OGY.--FUNCTIONS. 359 Sympathies of Dissimilar Tissues. 527, a. Morbid sympathies of much intensity occur less frequently among organs of different organization than among many of those which are constituted alike, with the exception of the mucous tissue of the alimentary canal and other parts, and between the skin and oth- er parts. Between these two organs and all others there is, on the part of the latter, the most intimate connection by sympathetic influ- ences, especially the mucous tissue of the stomach (§ 512); and it is through this natural relation, and the increased susceptibility of diseas- ed parts, that remedial agents so readily exert their effects upon the dis- eases of all organs, when such agents are applied to the intestinal ca- nal or to the skin. 527, b. Sympathies between the mucous tissue of the alimentary canal and other tissues are variously considered in the progress of this work. Those between the skin and other tissues deserve farther con- sideration in this place. Their predominance and intensity between that organ and the alimentary mucous tissue are shown in the depend- ence of a vast proportion of cutaneous eruptions upon primary dis- ease of the latter tissue. There is great reason to believe that such is the fact even in relation to measles, scarlet fever, and small-pox, when it occurs spontaneously, and probably also in the inoculated form; though, in the last case, there must be first a reflected influ- ence from the artificial pustule of the skin upon the intestinal mucous membrane, from whence the influence is propagated back to the whole surface of the body (§ 902, m). This construction, so opposed to the humoral pathology, is sustained by the analogy which is supplied by most other cutaneous affections, and by the direct fact that the eruption of scarlatina and of measles appears in the mucous membrane of the throat before it does upon the skin. The eruption, especially of measles, is apt to be preceded, also, by inflammation of the mu- cous tissue of the eye, the nose, and lungs, as well as by cough. But, as will have been seen, it is not necessary that the secondary, or sym- pathetic, disease should be like the primary; especially in parts that are dissimilar (§ 527, d). If this pathology as to the consecutive or- der of developments be true, it is of great practical importance ; since it assures us that great care must be bestowed upon the intestinal mu- cous membrane, as a principal seat of the radiating morbific influen- ces. Hence, it is found that irritating cathartics exasperate the fore- going diseases, &c. Other examples abound. Thus, the action of cold upon the skin is variously morbific, as set forth in a subsequent paragraph (§ 527, d). Sympathies between the skin and kidneys are naturally instituted for special exigencies of the animal economy; but these organs are sc constituted in their relative susceptibilities, that the great final cause of their physiological relations shall not be defeated by the propaga- tion of morbific influences from one to the other (§ 422, and references there). Sympathies between the mucous and serous tissues are compara- tively rare in health, and, therefore, in disease. Since, also, the same principles, in a general sense, are concerned in the remote influences of remedial agents, we thus understand why medicine taken inwardly has so moderate an effect upon peritonitis, or pleuritis, &c.; and this 360 INSTITUTES OF MEDICINE. philosophy is clearly confirmed by the ready action of cold upon the skin in developing inflammation of the pleura, and by the manner in which that inflammation may be often overcome by blisters or other irritants applied to the skin. Indeed, so extensive are the natural sympathetic relations of the skin to most internal parts, that there is scarcely an inflammation of an internal tissue or organ, that may not be more or less mitigated by irritants applied over the neighboring surface, if the application be not prematurely made (§ 514, d). There is a very intimate sympathy between the fibrous membranes and the cartilaginous and osseous tissues, which leads to the determi- nation of morbific influences among them (§ 141, b). 527, c. Sympathies of different tissues with each other, of much in tensity, are more common in parts that are distant, than among the tissues of one and the same compound organ. 527, d. When sympathies arise among different tissues, they are, as I have said, apt to be more or less different from the primary affec- tion, or if alike, their phenomena more variable than among tissues of the same organization (§ 525). The primary affections may be mild while the sympathetic are severe. This relative mildness and intensity is constantly seen in the supervention of inflammations and congestions in remote parts as consequences of some minor derange- ment of the stomach, or other digestive organs, and in the manner in which severe diseases of all parts are subdued by the action of reme- dial agents upon the stomach. So, again, the action of cold upon •the skin induces, sympathetically, inflammation of any of the tissues of the lungs, or of the intestines, uterus, liver, ligaments, &c.; but here no actual disease is produced in the skin, and the morbific agent is also of a negative nature. Hence a difficulty, notwithstanding its importance, of detecting the original source when a complex series of sympathetic affections have ensued (§ 527, b). Sympathies of Individual Tissues in their Relation to each other in Compound Organs, and with entire Organs. 528. When any tissue of a compound organ becomes the seat of disease, the influence of such disease is felt, more or less, by all the tissues of such an organ, where the primary disease is at all severe; especially in the organs of organic life. The tissues, as we have seen, which are secondarily affected may or may not sustain the same character of disease as the original affection; and this will depend much upon the nature of the organ. The sympathies, for instance, between the different tissues of the lungs are far greater than be- tween the different tissues of the stomach, and I may say, indeed, of any other organ. If the mucous coat of the stomach be even severe ly inflamed, the influence generally remains limited to that tissue, and will far sooner give rise to inflammation of the pulmonary mucous membrane, than it will be extended to the cellular, muscular, or se- rous tissue of the stomach, however much it may otherwise disturb their functions. On the contrary, however, it is quite otherwise with the lungs; especially when the cellular or parenchymatous tissue of these organs is actively inflamed, or when chronic disorganizing inflammation invades the same tissue. In either of the cases, the in- flammation is apt to be propagated, sooner or later, both to the serous and mucous tissues of the organ (§ 115-117, 129, 132-155). And PHYSIOLOGY.--FUNCTIONS. 361 here may be observed a wise ordination of Nature for the ultimate relief of so grave a disease as acute or chronic inflammation of the main substance of the lungs; an augmented secretion of mucus or serum contributing to that result, in connection with a curative sym- pathetic influence of the action which is necessary to those increased products (§ 74, 117, 129, 137, 155, 156, 387, 422, 524 d, 525). When these redundant secretions take place, the general law is, that the primary and secondary inflammations begin to abate. The salutary in- fluence of the secondary disease, independently of the depletive effect, is seen in the frequent abatement of chronic muco-inflammation of the lungs or of the stomach, when it may supervene in one organ or the other as a sympathetic consequence of a primary inflammation of either (§ 905). SYMPATHIES OF COMPOUND ORGANS WITH EACH OTHER. 529, a. CompouVid organs generally sympathize most readily with each other in proportion to the relation of certain functions which they may perform, and the importance of those functions, the stomach al- ways excepted (§ 528). These groups or systems of organs have been already specified, and the sympathies to which they respectively give rise among their component parts sufficiently designated (§ 124-130 149, 150). 529, b. Morbid sympathies are influenced by a great variety of ac- cidental causes, although they depend essentially upon the constitu- tional relations of the various parts of the organism to each other. One, of the most remarkable is the determination which is given to 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 and rapid in their operation, are very circumscribed in their analogous sympathetic effects (§ 149, 150, 163). In the case of the morbific agents, where many organs are brought into sympathetic derangement, the various results may be mostly due to the action alone of a single cause, as with the mias- mata of fever, the 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 362 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 again and again to all those who would study medicine as founded in Na- ture, and escape the temptations which have been devised for the gratification of indolence, or for the accommodation of imbecility. We have seen it said, in high 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 «Z-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, 500 o,p). 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). 539, a. The philosophy of vital habit consists either in a tendency of any given condition of the vital states to remain without change, as a consequence of its duration, or in certain impressions or changes that are produced in irritability, sensibility, and mobility, in their re- lation to each operating cause, by which their susceptibility to the action of the particular cause or causes is diminished or increased (§ 176-215). The philosophy is alike applicable to the properties of the mind as to those of the vital principle, and, of course, to the func- tions of each (§ 173-176). 539, b. In animal life, therefore, habit concerns the senses, volun- tary muscles, and the intellectual and instinctive faculties. In organ- ic life, it 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, Sec). 539, c. Since, also, the influence of habit in either life generally relates to the particular agents only by which it is induced, we learn the advantages of interchanging cathartics, anodynes, &c. ('§ 149, 163, 550). And so of the different modes of exercise, as it concerns both organic and animal life; and so, too, of the employments of the in- tellectual faculties, that a due improvement may be imparted to each (§ 565, 566, 855, 872 a). 540. The principle of habit is every where the same; always rela- tive to impressions, more or less durable, upon the vital or mental constitution. The analogy is perfect throughout, in all its details, and is utterly subversive of every chemical or physical view of life or disease (§ 1047). 541. It illustrates the instability of the vital properties (§ 177-223). 364 INSTITUTES OF MEDICINE. 542. The modifications arising from vital habit exercise an impor- tant sway in the treatment of disease; since remedial agents must be varied in kind, force, quantity, time of repetition, &c, according to the artificial modifications of irritability and sensibility, especially the former (§ 150, 188-204, 857). 543. Habit is liable to obtain under the repeated or continued op- eration of almost all agents which are capable of affecting the vital or mental properties. Exceptions occur in sensibility as it respects pain from injuries, and in the ordinary pleasures of sense, which are always about the same, however frequently repeated. But the pain on tasting acrids, the nausea from tobacco, &c, may cease to be pro- duced by repetition of the causes. So, also, of the bougie, music, landscapes, the verdure of spring, &c, which are more or less varia- ble in effect. An interval of suspension, however, in these cases, re- stores the original effect of the causes. 544. It is by vital habit that morbific agents, such as miasmata, cease to be injurious. This is most likely to happen, if the individual reside from infancy in the miasmatic region, or, in the unacclimated, after recovery from an attack of the miasmatic disease. Such is the philosophy of acclimation (§ 539, 551); and the same is alike appli- cable to tobacco, &c, and to its ultimate conversion into a luxury. 545. Sometimes the single application of a particular agent will so confirm the intensity and permanence of habit, that it becomes for- ever afterward inoperative. Such is not unfrequently the case with miasmata, and it is conspicuously shown in small-pox, measles, scar- latina, &c. And so of vaccination in its relation to small-pox; though repetitions of the vaccine disease may be necessary to even a tempo- rary exemption from small-pox, while at other times the effect goes off, leaving individuals exposed to small-pox (§ 350, no. 45, 543). All this shows, too, a near identity between the vaccine and variolous dis- eases (§ 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, Sec 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. 548J, 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, at»d at every hour, under equal circumstan- ces f§ 136, 137). PHYSIOLOGY.--FUNCTIONS. 365 548£, 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, asafcetida, &c, luxuries (§ 543). 549. The law of habit, in respect to morbific and remedial agents, follows the law which governs the relative duration of disease when produced by remedial agents and such as are truly morbific. Disease excited by the former, if not in great intensity, soon subsides sponta- neously ; but when by the latter, it is far more lasting. This princi- ple, also, as it relates to remedial agents, is at the foundation of their curative effects (§ 893, &c, 926). 550. Since habit subsides in various degrees, and at various times, after the removal of its causes, and the properties of life acquire, therefore, more or less, their original susceptibility to the particular agents or causes (§ 539, 543), and since the effects of remedial agents are commonly transient in respect to habit (§ 549), we may, in most cases, soon resume the suspended remedy, and obtain its original ef- fect (§ 539 c, 857). And 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, 857). 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). 552, a. Other parallels hold, also, in the foregoing cases (§ 551). If, for example, the antimony be suspended for twelve hours, gastric ir- ritability will recover its natural relation to that substance, &c. And so of the miasmatic agent, if the acclimated subject retire to a salubri- ous region, and subsequently revisit the insalubrious (§ 557, b). 552, b. Again, the antimony impresses the system in the ratio of its action upon the stomach, or of the duration of its action. Fever, or pneumonia, &c, will fail to be assuaged unless the gastric effect be 366 INSTITUTES OF MEDICINE. kept up, if the agent be employed in its small alterative doses. 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 neglected (§ 514: g, 516 c, 518 b, 551 b). 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, oi vomiting will ensue. In this particular case, irritability is also increas- ed in its relation to ipecacuanha, and to most other irritants (§ 841). 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, c. The foregoing principle is farther shown by the effect of sa- line and other cathartics, in promoting salivation, when given a few hours after the exhibition of a full dose of calomel. The fact was as- certained by George Fordyce, and has been often verified in my own person after the use of blue pill. The mercurial agent will not ex- ert, in the cases supposed, this profound constitutional effect with- out the subsequent aid of the other agents, which so increase intesti- nal irritability, and that of the whole system, that the mercury operates with greater local and general intensity; a fact, by-the-way, which is also opposed to the doctrine of operation by absorption. 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 some 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 may be 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. 558, a. The principle involved in § 556"embraces what is called the 368 INSTITUTES OF MEDICINE. cumulative effect of remedies, and of which digitalis, hydrocyanic 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). 564. In my last proposition I was on the borders of education, which is mostly confined to animal life, or extended to both where animal and organic are associated in functions. Education is allied to habit in its philosophy, as manifested both in the cultivation of muscular power and the properties of the mind (§ 175 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 sight, is extinct, others, as hearing and touch, become very exquisite. In the case of the muscles, mobility is augmented, and their nutrition in- creased; in that of the senses, sensibility. 565, 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. 566, a. This chain of exact analogies brings us to the properties of the mind, which are improved upon the same principle (§ 175 b, 241, 565). 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 ? It is said by Samuel Johnson that he is more apt to cultivate all the powers of his understanding, and all departments of nature, too-ether, 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 former are cultivated through the medium of the senses and brain, and as well by external influences as by the operation of the sensorium commune, upon the same principle that the vital properties are influenced, more or less permanently, by the operation of foreign agents (§ 175 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. Much 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, b. Strength and debility are, also, often confounded, leading to still greater confusion and error. Thus, manifestations of full muscular power are said to denote strength, while the high vascular action of inflammation is supposed to depend on debility. The for- 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 may be inflam- matory or febrile affections upon which that contingency in animal life may depend. Tonics and stimulants, therefore, have their sway according to these supposed imaginary conditions,—imaginary, since disease consists neither in one nor the other, so far as they have any intelligible import. The designations, for the most part, are borrow- ed from the inorganic world; and even at this day some physiologists are making experiments upon the dead muscular tissue by immersing it in solutions of tonics and astringents, to learn the value, and the modus operandi, of those agents when applied to morbid states of the living being. Dr. Adair Crawford, for example, in his Experimental Inquiry into the Effects of Tonics and Astringents (1816), attributes their influence entirely to the tanning process, by which physical co- hesion is established. His 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 greatest strength of the body consists in a natural performance, by all the or- gans respectively, of the functions appropriate to each, without ei- ther borrowing from the others any assistance which it does not con- stitutionally enjoy, and without taking upon itself any undue amount of labor. In a state of undisturbed health, and temperate habits, the functions of all organs move on in harmony, each administering to the others a certain allotted contribution. But, in impaired constitutions, rhe whole of this natural harmony is more or less disturbed. Digestion is imperfectly performed, and every meal tasks the stomach beyond its natural ability. The other organs suffer, sympathetically, in conse- quence, and often seem to bend their actions toward a co-operative effort in aid of the diseased actions of the stomach. In this sense, therefore, all the powers of the system 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. The food escapes from this organ in a half-digested state, in which chemical changes have also occurred. These changes beget acids and flatulence, and, as the crude mass traverses the intestines, it 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, ihe 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 properly 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 FUNCTIONS ARISING FROM AGE, TEMPERAMENT, CONSTITUTION, SEX, VOLUNTARY HABITS, &c. 570. The differences among individuals, and classes of mankind, which arise from age, sex, temperament, &c, may be regarded in the light of qualifications of the four preceding grand attributes 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 afar 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 imtability, 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 fcetal 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, e. 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- ease, and to its rapid advances, render them also peculiarly sensible to remedial agents, when timely and happily applied ; and that they now operate speedily and with power on account of the great development of imtability, mobility, and sympathy ($ 150). Hence it is, that mild- er means which fail at adult age may succeed under apparently the same circumstances in infancy. An emetic, therefore, or cathartic, or alterative doses of tartarized antimony, &c, may become a substitute for a certain quantity of blood, whose abstraction in the same condi- tion of disease would be indispensable at adult age ; or leeching may be sufficient in the former case, when general bloodletting would be necessary in the latter. But, since the dangers of disease are great- er, and there is less time for delay, in the diseases of infants than of adults, we should be sure of the right before we decide on neglecting or procrastinating the more vigorous treatment. This observation, however, is intended to apply especially to the abstraction of blood. Active internal remedies should be delayed in cases of doubt. On the other hand, an early loss of blood is far less likely to be detrimental; and where it may be required, but delayed, the chance of its useful application may be lost, not only through the advances of disease, but by the prostrating effects of other remedies (§ 155, 156, 925 a, b, c, 974 c). 576, f. It may be 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 in all other parts than in infancy, they are less disposed to sympathize with diseases of the brain, and of each other, or the brain with them. The digestive system has undergone manifest changes; and here, too, irritability is particularly diminished. Solid food has become indispensable, while it was inadmissible in early infancy; is less frequently desired, and can be digested only when taken at longer intervals. The secretions and excretions haTre 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. \\\, 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 great laws by which the phenomena are regulated, and finally carries them up to the very powers from which they emanate. But it does not so clearly follow, that the provision which nature has made for the right government of the mind or the body will be duly employed. No sooner, indeed, are we born, than abuses begin,—if not on the part of infancy, on that, at least, of its natural guides and protectors. The stomach is crowded with solid food, instead of its natural fluid, or when solids become appropriate, the least appropriate are often se- lected. The properties of life being thus abused, they suffer, and not unfrequently perish in consequence. The passions, yea, even anger, are designed for our happiness or for our protection. But judgment is permitted to fail of its legitimate sway, and the passions are let loose to fill us with disease, to imbitter our corporeal and intellectual exist- ences, to incarcerate our bodies, or to hang us upon the gallows. Coming to the abstract operations of mind, do we not find a like abuse of the understanding1? 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? And do we not then, by this abuse of reason, proceed to refer these incongruous results to common laws and com- mon causes ? We need not go beyond the subjects before us for an affirmative answer. Are not all the unique phenomena of life, all those which mark the distinctions between infancy, childhood, and youth, all those which attend the consummation of the body for the de- velopment of the generative organs, for the production of the ovum, of the seminal fluid, even sexual desire itself, and its ultimate termina- tion in new beings, ay, the very thoughts which go up to Heaven, most extensively referred, at this thinking, speculative age, to the for- ces which rule over dead, inorganic matter 1 But there is a stage of human existence, which that modified materialism that acknowledges a soul has not yet dared to invade. That stage begins when both pa- rents infuse themselves into their future offspring, when a new soul, like a new body, is generated; and it extends throughout the fcetal development. The same processes, as we have seen, are now in prog- 378 INSTITUTES OF MEDICINE. ress as at every subsequent 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 ? We consequently find that the concerted action of organs is liable to be disturbed at the beginning of youth, independently of disease. The heart beats irregularly, respiration is hurried, or slow, or labori- ous, and fluctuates as the passions rise or fall, or as the mind may happen to poise; and the heart, and the cutaneous vessels of the face, obey the same influences. These susceptibilities may be more or less extended to all other parts, without the intervention of disease. Among these physiological results are frequent bleedings of the nose, head- ache, constipation, and partial disturbances of digestion. So, also, is that pain and distress which attend menstruation, and all the 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 this illustrates the laws of reflex nervous action in their application to disease, and expose the absurdities of the hujnoral 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 dead matter. And yet does the intellectual world abound with phys- ical hypotheses of life and disease for the interpretation of phenome- na, of which those now under consideration are only simple elements. Now, too, the mammae, for the first time, have their organic powers brought forth, to be in readiness for the secretion of milk. And mark, as we go along, the harmony of Design, and the coincidence between the preparation of the mammae and that of the uterus. The development of the latter takes the lead, while that of the mammas is the work of sympathy, and this ascendency is maintained in the pregnant state. And yet we are told that final causes should have no place in philosophy. But the mammae, like the uterus, now, and for the first time, become the seat of morbid conditions ; and, from what we have seen of their natural relations to the uterus, we readily com- prehend the reason why they inflame when the uterus undergoes its sudden and violent change in parturition, and why the secretion of milk is now started, and why they are liable to diseases, such as car- cinoma, which, at least, seldom occur before this organ is brought un- der the uterine influences (§ 138, 524 b, d). How forcibly do all such problems admonish the chemist and physical philosopher to re- gard all others relative to life, in its natural and morbid conditions, as a part of that great whole, of which the former are only more striking examples! Again, the testes now, also, for the first time, have their vital state so modified as to perform their function of secreting semen (§ 155). Of course, therefore, for the first time, these organs should be liable to morbid affections, should now, for the first time, sympathize with the diseases of other parts, and inflict reflex actions upon dis- 380 INSTITUTES OF MEDICINE. tant organs. But, besides the general functions, susceptibilities, and influences in which the testes, the uterus, and the mammae now par- ticipate in common with other organs, there are some special charac teristics relative to each part that reflect no little light upon our doc- trines of life and disease. The development of the testes, for exam pie, exerts a powerful reflex nervous influence on the changes which are simultaneously going on in other parts, as denoted by its well- known effect upon the voice. If the parotids be invaded by mumps, the testes and mammae are liable to inflame by sympathy, &c. The 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 state, the body, like the mind, increases in vigor, and is capable of all the labor of maturer years. Now is the period for athletic exer- cise, and feats of strength, and now the awkwardness of youth sub- sides into the gracefulness and dignity of manhood. 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. 580. The last period of life has been subdivided into incipient or green old age, which extends from 60 to 70; confirmed old age, or caducity, from 70 to 85 ; and decrepitude, from 85 years, upward. 581, a. More remarkable changes now take place in certain parts of the'organization, than from the beginning of youth, upward; but, 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 rio-id; 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 powers is accompanied by a subsidence of the passions ; and as sensibility also fails, former mor- bific causes and avenues to disease are thus greatly diminished. 581, 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- riculties, are the predominating accidents of old age. 583, a. Although, therefore, morbific causes are less energetic in old age than at other stages of life, remedial agents are, also, less op- PHYSIOLOGY.--TEMPERAMENT. 383 erative, nature less recuperative, diseases less easily arrested, are 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 temperament, 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 indif- PHYSIOLOGY.--TEMPERAMENT. 385 ferent individuals, or their natural constitution and temperament, or any more remarkable idiosyncrasy. They reach, also, to the mind, which is apt to bear certain relative peculiarities to those of the or- ganic states. 588. In the farther consideration of this subject, I shall regard those peculiarities of constitution which are mostly of a determinate nature, and include them under the general denomination of'temperament. 589. The physiological differences between temperament, idiosyn- crasy, and constitution, are neither great, nor of much practical im- portance. Indeed, so allied are they in principle, that a common philosophy determines the remedial treatment, which is always more or less modified by temperament. Each should be considered along with the modify' t influences of habits, climate, &c. 590. Tempen 3ent and constitution do not depend, as supposed by some writers, upon the special development of particular organs; though this is true of some of the vicissitudes of age (§ 153-159, 596). The former have their foundation in the system at large, and are apt to be transmitted by one or both parents; or the transmitted pecu- liarities may come from a remote ancestor, and not from the imme- diate progenitor. This last peculiarity is analogous to one of the characteristics of the scrofulous diathesis, where it passes over one generation and reappears in the third. 591. It appears, therefore, that temperament, whether innate or ac- quired, is due to the slow operation of causes upon the vital constitu- tion ; just as we have seen of the law of vital habit (§ 535-568). In the latter case, the modifications are more or less transitory; but may be so ingrafted as to be transmitted, for a time, like the permanent temperaments, from parent to child, as seen of some diseases, such as lues, or of predispositions to disease of a transient nature, as in small- pox, or even ordinary fever. Coming to hereditary disease of a per- manent nature, as scrofula, we run from the transitory phenomena of vital habit, by an intimate analogy, into the permanent temperaments; and from these we are conducted by the same philosophy, which re- spects the operation of physical agents in modifying the properties of life, to those more remarkable peculiarities which spring 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 perhf^1 \ therefore, may be considered the most natural. The skin remains- ^Vft and delicate; the limbs rounded and full; the superficial veins, .5jfFike those of in- fancy, large, conspicuous, and blue, especially ab» at the head and temple; the complexion fair, florid, and animated ; f^ie eyes large and blue ; the hair light, or red, or of intermediate hue '. 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 urce 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 aiways 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 heabh; 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), and morbific and therapeutical aspects of reflex nervous actions. 2. THE MELANCHOLIC TEMPERAMENT. 598, 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 inclining to yellow, thick, coarse, and hard to the lancet. The blood flows more freely from the sanguine when the skin is pricked; and this ex- emplifies the state of the capillary circulation at large. The same principle obtains, therefore, in the pulmonary circulation, and hence in part, the blood is darker in the melancholic than in the sanguine The eyes of the former are darker and less prominent than in the lat- ter ; and the hair is dark, coarse or stiff; eyebrows large, black, and 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. 11£, 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, 19*) 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 prod lets 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. 11J, 441 c). 390 INSTITUTES OF MEDICINE. But, with all the intellectual dullness and bodily indolence, which distinguish this temperament, it is obstinate, fearful, suspicious, and 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 4s 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, Disturbing reflex nervous actions are the leading char- acteristic. Irritability is also strongly pronounced. Hence, slight disturbances, even of unimportant parts, give rise to greatly dispro- portionate sympathies in the more important organs; and these sec- 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 General Remarks on Temperament. 602, a. Different epochs of life appear often to partake of a par- ticular temperament; one subsiding into another. The sanguine is most characteristic of infancy and childhood; the melancholic and choleric of middle age ; and the phlegmatic of old age. 602, b. The several temperaments are also often blended, more or less, with each other in the same individual, though the characteristics of one generally predominate. When combined in the same individ- ual, they are called the sanguineo-melancholic, the sanguineo-phleg- matic, &c. They are also liable not only to the foregoing modifica- tions from age, but from sex, climate, habits, education, &c. So great, indeed, is the influence of climate, that a change of residence (as from a northern to a tropical country) will sometimes gradually transmute one temperament into another; and this is particularly true of the sanguine, the melancholic, and the choleric. 602, c. The foregoing accidental influences are sometimes 6uch 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, Sec, in relation to man, integral parts of a common principle 1 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 soecula- 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 mora] 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 aflattish 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. 11|, 441 c), 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. 10 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 7ean 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, andHbere 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 j from which the conclusion was drawn that the disease was especially incident to those climates. This important fallacy I have pointed out in the Medical and Physiological Commentaries (vol. ii., p. 619-622). In that work, also, especially in the Essays on Blood- letting, and on the writings of M. Louis, I have set forth the facts, which, with the pre- ceding, and others of a coincident nature, enforce the importance of rejecting all 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 pout 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 OF 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 ] "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 those modifications presupposes, in no small degree, a knowledge of their special causes. They demand a great versatility of treatment where common principles may apply; and this may be determined more by a knowledge of the remote causes than by any resulting phe- nomena (§ 644, &c). V. HABITS, OR USAGES. 622. It now remains to speak briefly of the last subdivision of our fifth grand division of Physiology. Under the denomination of Habits are included the various pursuits of mankind, their social and political relations and institutions, their modes of living in respect to food, ex- ercise, clothing, Sec; 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, Sec, 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. 623. Habits, in their most extended sense, open upon us a field for endless observation. Here it is, in the neglect of the natural means of preserving health, in the pinches of poverty, in the filth of indo- lence, in Bacchanalian indulgences, and in the various resources of li- centiousness, we meet with nature so turned from her physiological condition, that when disease sets in, it presents the most embarrassing anomalies. The hospitals of all countries, especially of Europe, show a disgusting amount of these artificial deformities. And yet are they sent forth as legitimate grounds for important conclusions in patholo- gy and therapeutics (§ 620, note). All the foregoing varieties of disease, which grow out of deleteri- ous habits, or pursuits, may yield to the substitution of natural means, or to change of employment. 624. As to the active treatment of the cases last recited, I can only say, that, while the great principles obtain as in less artificial states, they demand greater modifications of practice than all other special condi- tions that are incident to man. But, let us renrember, 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 henatic and intestinal disease. 398 INSTITUTES OF MEDICINE. SIXTH DIVISION OF PHYSIOLOGY. THE RELATION OF ORGANIC BEINGS TO EXTER- NAL OBJECTS 626, a. That division of physiology which concerns the relations between living beings and external nature is very comprehensive, and brings into immediate connection the three great departments of medicine ; and it is 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^hose 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 these 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, Sec. 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 the properties and functions of life, the topics embraced with- in the present division of Physiology came, unavoidably, under anal- ysis; and have been variously reproduced when investigating the laws of vital habit, the influences of age, temperament, climate, &c. But little, therefore, remains to be added. 628. In regarding our relations to external objects, we should carefully discriminate between irritability and sensibility, the two properties through which the relations are established; the former connecting organic life, the latter animal life, with the external world (§ 188, &c, 194, &c). Vegetables, therefore, hold their connection through irritability alone; so that their organization is intimately as- sociated with outward objects. The connecting anatomical structure in the organic life of animals consists of the alimentary canal, the lungs, and the skin; in plants, of the radicles and leaves (§ 268, Sec). 630, a. In organic life, as has been already seen, agents of all kinds operate through the medium of irritability (§ 188). Their ef- fect depends upon the degree, and the kind of irritability, and upon the kind, energy, and quantity of the agents (§ 133, &c). Owing to changes in the degree of irritability, the same stimulus or sedative, and in the same quantity, does not always produce the same amount of effect. It will be more, or less, on one day than on another, even at one hour than another. This is constantly exemplified in the natu- ral states of the body, but distinctly in disease, when irritability is also modified in kind as well as in degree. The law is of great im- portance in medicine, and is subject to many contingent influences, both in health and disease, especially that of vital habit. These in- fluences involve some of the most difficult and delicate considerations in the practice of medicine. 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- Bpect 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 ? 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. Man was created imperishable. By sin came man's death, by perseverance in sin, a farther abbreviation of life. We must admit this doctrine of Holy Writ, and apply it philosophi- cally. We may not reason as to the Order of Providence, had the material man been immortal. Doubtless, ample "room" would have been provided for his indefinite multiplication, at least in the ultimate abode of the translated Prophet. Man alone was exempted from death. 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 are therefore compelled to take the Revelation of Heaven as it stands; or, in denying one part, to deny, also, the longevity of pri- meval man; which 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 ot 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 < he 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 great when interrupting the respiratory process by dividing the medulla oblongata. But in this case the influences are different from such as obtain in diseases of the brain, or in injuries done to that organ. If sufficient to embarrass or to suspend respiration, the nervous power is determined with a pernicious effect upon all the organic viscera; but very variously, according to the nature of the injury or of the disease (§ 478-482, 510, 634, 948). A simple removal of the brain and spi- nal cord occasions death, not only by suspending respiration, but by interrupting their influence upon the great organs of life ; which must be also true within greater limits of the division below the medulla oblongata. In the former case, as we have seen, no pernicious influ- ence of the nervous power is determined upon the organic viscera; in the latter, a direct violence being inflicted upon the spinal cord, a destructive effect is propagated upon the organic properties, which reaches *o 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, &c). In my work on the Cholera As- phyxia of New York, 1832, I have spoken of contractions of the vol- untary muscles which continued in progress, drawing up the legs, Sec, 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 500, 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, is1 continued till the being becomes again a subject for the mineral kingdom; bow the semen, also, is a type of all the various subsequent agents of life; how we may bene detect the nascent causes of transmitted disease, operating in conformity with those which play their part in the external world; how mind itself is impressed upon the embryo, and how the intellect- ual peculiarities of either parent maybe 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 eve^y 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. 401 j ower 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 tbe different eras of life, and to gestation, lactation, Sec, 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, &c, and see, also, that all these varia- tions are produced by causes that operate through the same fundamen- tal constitution; or, whether our hygienic and therapeutical treatment may be greatly regulated by each of the foregoing conditions, wheth- er natural or acquired; or, whether it be the peculiarities of idiosyn- crasy that render certain ordinary articles of food morbific to certain individuals, or the analogous constitution of marine and terrestrial plants which demands for the former tbe 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 morirfic 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 susceptibdity 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 tbe 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 tbe brain; or, whether it be the virus of the small-pox, of measles, &c, that effects certain modifications of the vital states rel- ative to each particular agent, and to no other, that forever protect the system, in a general sense, against a second attack; or, whether it be the cow alone, as with other animals in respect to the virus of hydrophobia, that can so modify the variolous poison as to generate in man the equally protective vaccine disease ; or, whether the sus ceptibility sometimes remain so as to give rise to another modifica- tion, while the varioloid, in its mildest state, but not the vaccine, will generate, by contagion, in the unprotected, the most virulent form of the original disease; or, whether it be the analogous miasmata that only slowly extinguish the susceptibility to their morbific effects after repeated attacks of the particular forms of fever which they are, re- spectively, capable of producing, or, if the subject thus acclimated re- move to another region, his original susceptibility may return,—being analogous, also, to those physical agencies which establish the temper- aments, and which change from one to another as the old influences may cease, and new ones operate, while analogies, in these respects, are also supplied by the variolous and vaccine diseases; or, whether it be bloodletting, or an emetic, or a cathartic, that produce their al- terative effects with a rapidity proportioned to the rapidity in which their sensible operation goes on; or, whether it be the alterative in small doses, and in its abstract sense, that slowly establishes analogous changes in the morbid states ; or, whether an alterative, as antimony, for example, must be generally increased in its successive doses to keep up the effect of the first dose, or, if there be, in respect to an- timony, a suspension of the remedy for at least twelve hours, 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 tbe changes which are thus effected consist in some alteration of the natural or morbid states, and according to the nature of the remote cause, whether it be positive, like mercury, or negative, like cold, or immaterial, like the mind and its passions, and according, also, to the special exercise of one mental power or another, or the operation of one passion or another, and thus proving the susceptibility of the nervous power to various modifications that coincide with the virtues of the remote cause, and a coincidence, in this respect, with the changes which are perpetually exhibited in the organic vital conditions, and which are even brought about by the ner- vous power itself; or, whether we realize the foundation of these last phenomena in the naturally exquisite susceptibility of the nervous power to various influences, that it may constantly operate as a regu- lator of the rhythmic movements of all parts, and through a law of the nervous system by which all parts are exquisitely sensitive to the con- dition of each other, and through which all remote morbific and re- medial influences are exerted ; or whether, in like way, inflammations are varied in their character by contused, and punctured, and incised wounds, or more greatly so by all animal and vegetable poisons, whether morbid or natural, and mostly so according to the special na- ture of the remote causes, respectively, or, if subordinate influences diversify the effects of many principal causes, there be others which control all other influences, as in small-pox, measles, scarlatina, &c. ; or whether in fever, as in inflammation, there be analogous varieties, corresponding, in like manner, with the special virtues of each cause, while the fundamental pathology is of one common nature in all the varieties of inflammation, and of another common nature in all fevers ; or whether an ephemera be the type of the intermittent, the remittent, and continued fevers, and of their several modifications, and consider how the paroxysms of the intermittent commonly observe established intervals of twenty-four, forty-eight, and seventy-two hours, or, if the usual time be anticipated or delayed, the paroxysms are then apt to go on with the particular irregularity with which they began, or when, by regular anticipations of the period of each last preceding paroxysm they approach the night, one paroxysm is often lost; or whether we look at the effects of all our best and most universally remedial agents, as bloodletting, mercury, antimonials, cathartics, &c, and see that they are strictly morbific to the healthy system, in their remedial doses, and that, therefore, they are aj; least equally so in their action upon diseased organs, yet contributing to tl eir 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 beino-, 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, tbe 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, yet complexity, of the principles, the stupendous whole, as it swells from the comparatively simple phenomena of the development of the ovum, when the properties of life are exposed to no influences that shall affect their instable nature, till we have traversed the animal king- dom in all its exposures to those influences, and have witnessed the in- calculable variety of change which the organic properties and-functions sustain in consequence of those exposures, and observe that the whole immense system, all the variety, springs from the simple influences of external and internal causes upon the properties of life, and that slight changes in these properties, like the differences which prevail among the results of their natural modifications in different animals, and in dif- ferent parts of a common or a continuous tissue, give rise to all the dif- ferences between health, disease, and convalescence;—in the contem- plation of all these things, I say, we are employed in witnessing the most comprehensive and sublime system of Unity of Design, and enjoy the conviction that we are cultivating a science whose foundations are laid in the most Consummate Wisdom (§ 892). REVIEW OF THE LAWS OF REFLEX ACTION OF THE NERVOUS SYSTEM, AND AS APPLIED PATHOLOGICALLY AND THERAPEUTICALLY. 638^. A large space has been given to the consideration of the nerv- ous system, especially to experimental observations upon it, for the purpose of developing the Laics of Reflex Nervous Action, or, as I have called them, also, for obvious advantages, Remote and Contiguous Sym- pathy, or, more generally, Sympathy. All this inquiry has been made with a sole reference to the application of those laws to many important problems in Physiology, particularly nutrition, secretion, modifications of structural development, calorification, and circulation, and to erect- ing upon them a substantial and philosophical fabric of Pathology and Therapeutics, which still lies extensively before us, and for the purpose, also, of simultaneously accomplishing the overthrow of the chemical and physical doctrines now prevailing in all the departments of medicine. Although I am about to enter upon the specific application of the Laws of lie flex Action of the Nervous System to Pathology and Therapeutics, I have, nevertheless, been constantly employed in exemplifying the mor- bific and therapeutical aspects of those laws as founded upon their nat- ural conditions. An indispensable requisite for this application is a rea- sonable proof of the modification of the nervous power according to the nature of the cause, whether physical or moral, by which it is brought into preternatural operation, nor is there any other consistent or intelli- gible mode of interpreting the great range of pathological and therapeu- tical problems, and the multifarious displays of the passions in organic life, according to their individual nature. The whole of the Author's phi- losophy upon this vast subject is predicated of the well-established laws of reflex action of the nervous system, nor is he aware of any fact by which that philosophy is contradicted, while, besides the admitted prem- ises, it is sustained by the whole history of morbific and remedial agents, and by the diseases which grow out of, and are maintained by, each other. It may be finally added, that, although the Author has shown that the passions, the will, cerebral diseases, and other causes acting directly upon the nervous centres, develop and project the nervous power without the intervention of sensitive nerves, he has also shown that the essential phi- losophy is the same as that which respects reflex nervous action. 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 their relations to the ultimate branches of medicine, and to approach these branches already prepared with a connected view of their depend- ence upon natural institutions. The complexities in physiology give rise to corresponding intricacies in pathology and therapeutics, and it has been therefore necessary to explore the ground-work in such vari- ous methods, and with such variety of illustration, as shall impart to pathology and therapeutics a consistency in principles, a ready inter- pretation of their endless problems, and give to the hand of art en- lightened confidence and firmness in the right. I have designed that this right shall follow naturally and easily from the premises hitherto laid down, and if I have come short of that, then have I failed in fun- damental requisites. No system in physiology can stand which is not true to Nature in her altered aspects; none that does not come to her interpretation under all the varied conditions and phenomena of dis- ease; none whose elements conflict with each other.(§ 516 d, no. 6, 524 a, 524 d). There must be clearness, individuality, harmony, dem- onstration. I claim not that I have accomplished all this. I do but say that I have attempted it, and with an earnest hope that the effort may not prove abortive. As much has been said, and much remains, which is original with myself, and generally relative to the most pro- found and important topics, and, as there has existed the necessity of exhibiting in a satisfactory manner those conflicting errors which have obtained such general ascendency, I have been impelled to all the amplitude of inquiry which may obtain either the acquiescence of the profession in the doctrines which I have taught, or their ready re- jection (^ 1, 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, &c). Pathology consists essentially, therefore, of those modified states of the physiological conditions which constitute disease. 640. Such, also, are the relations between the natural physiological conditions and those diversions which make up disease, that the latter often reflect the most important light upon the natural ones. The properties of life, in all their aspects, as well as their corresponding 414 institutes of medicine. functions, are not unfrequently best comprehended through the phe- nomena which distinguish their various departures from the normal standard (§ 198, 303|). 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 medjcal 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 licrht 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 tbe 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; whetheT 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- Dosing 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 fasces, hereditary predispositions, &c. (§ 75-80, 144, 561). 646, 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). 648, d. The predisposing causes of sporadic diseases are apt to bo more numerous than those of epidemics. 649, a. Remote external causes do not produce their effects indis criminately on all parts to which they are applied. Some are per fectly inert upon the skin, while others exert their principal effects upon this organ. And so of other parts. The surfaces upon which they operate are, 1st. The mucous tissue; 2d. The skin; 3d. The surface of wounds and abraded parts; 4th. By being forced into the vessels when wounds are made by instruments charged with poisons. It is in tho 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 suscen- » 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 tbe 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 h, 638J). 649, c. There are probably but few ordinary morbific agents which affect the skin in its sound state, though some may which are not sus- pected. Cold is one of the most remarkable. There are but a few of the active poisons of the materia medica that 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.--REMOTF CAUSES. 41? 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), )ust 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. 649, d. The reason why the skin is so little susceptible of the influ- ence of morbific and remedial agents consists partly in the protection which is afforded by the cuticle ; not, however, because of 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, cceteris pari- bus, a general corresponding modification of the vital properties and functions (§ 52). If two or more be united, chemically or mechani- cally, the compound is an agent of new virtues, and produces corre- sponding effects (§ 188£, d). This is the reason for combining reme- dial agents. Hence arise many varieties of inflammation, and of idio- pathic fever ; the differences being greater where the morbific causes differ most from each other, or, as two or more may operate (§ 766). This is rendered distinctly obvious by the specific character of those diseases which follow the application of morbid or healthy animal poisons in each of the cases, respectively. Thus, the poisons of small- pox, of measles, of scarlet fever, &c, always affect the vital condition in nearly one uniform way. From these distinct and strongly-mark- ed affections we might safely reason to all other morbific agents; but, independently of this analogy, which rarely fails in relation to any or- ganic laws, we have the same proof, though less remarkable, in respect to other affections. In the great family of idiopathic fevers, among which there are close resemblances, there is no rational doubt that each variety depends upon specifically different predisposing causes It appears, also, to be well ascertained that these causes are of vege- D D 418 INSTITUTES OF MEDICINE. table origin, and that the differences in their nature depend upon differ- ent combinations of their elementary principles, that take place 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, tbe 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, &<•, 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 tbe ordinary stimuli of life, and may variously modify tbe 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, &c. The importance of enforcing this fact, in a practical sense at least, is shown by a common disregard of the subject, as occurs in the fol- lowing example. Thus,—Pereira, in his erudite work on the Mate- ria Medica, very justly says, that, " 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 tbe 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, &c, may be unusually epidemic and malignant. 653, c. Healthy animal poisons, therefore, are never generated by the diseased processes which they excite; but the morbid ones are reproduced by such processes, and by no other, and mostly by indi- viduals of the same species, while the same law of individuality is universal as to healthy animal poisons. 653, d. For the foregoing reasons, no contagious disease can ever be propagated by any other cause than such as is generated by that precise modification of the vital states which constitutes the essence of the disease. By the same inductive process, all those affections which have for their causes the products of laws which govern inorganic matter can neither be 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 (fy 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! 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 tbe 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 Iustrative 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 am 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 (essen the severity of the disease. The principle is the same as when a stimulant diet, &c, contribute to their production (§ 551 J. 656. The ordinary exciting causes, which, in their usual force, com- monly fail of producing disease where a morbid tendency has not been induced by predisposing causes, may readily become predisposing, or both together, by a greater intensity of action. 657, a. It commonly happens, especially in acute diseases, that, when predisposing causes are not followed immediately by a devel- opment of disease, the principal morbid states take place in organs distant from that on which the morbific causes exert their direct ac- tion. The main predisposition, therefore, is produced by reflected nervous action ; and of course it is there that the principal explo- sion of disease takes place. It is subsequent to this, thnt the surfaces 422 INSTITUTES OF MEDICINE. on which the agents exert their direct action become sensibly ivivolved 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 presences 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 by reflex action propagated over the system; and here, as in miasmatic fever, the predisposition is sufficiently formed in various other parts as not to require, for the general explosion, a full devel- opment of disease in the bitten part. There are commonly present, however, in hydrophobia, symptoms which denote either inflammation or morbid irritation of the injured part, just antecedently to the gen- eral explosion, which is precipitated by it. Hence, also, the reason why the removal of the bitten 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 tbe 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 reflex nervous actions is equivalent, in principle, to a specific universal action of the original predisposing cause (§.228, 653, 516 d, no. 6, 638J). 658. If disease be limited to the part on which the morbific cause makes its direct impression, the changes maybe then instituted by the direct action of the cause upon the organic properties, and without any necessaryintervention of the nervous power. Andso of remedial agents, as when caustic is applied to ulcers, vesicants to the skin, &c. But, PATHOLOGY.--REMOTE CAUSES. J 93 it more commonly happens that the reflected nervous power is the immediate agent in the production or czttf&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, 222-233f, 475, 476-492, 500, 514 b, 657). 659, a. Predisposing causes are often involved in much obscuritv, 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 tbe 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 hepatrc 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 smokers, opium eaters, &c.; the poison being slowly morbific in all tbe cases, but aided in its operation by many concurring causes (§ 543, 544, 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, &c, down to those which, like a scald, or the bite of a venomous snake, develop inflammation at once, or, like prussic acid, extinguish on the instant, and without any other antece- dent change, the entire powers of the organic being. 659, b. The foregoing gradual operation of morbific agents lays the foundation of the scrofulous diathesis (§ 836), and is analogous, in principle, to the philosophy of acclimation, and to the formation of artificial temperaments (§ 558, 560-563, 591). The causes, indeed, being perhaps not remarkably different, and only morbific under spe- cial circumstances, may transform the melancholic into the sanguineo- melancholic, or into the nervous temperament, instead of producing chronic indigestion, or some habit of feeble health (§ 535-540, 602). 660. In the last section we have examples of what is in constant progress in disease, namely, the predisposing influence which a dis- eased organ exerts on others which were not diseased. These 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 uature, 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 tbe nature of the predisposing cause (§ #16, 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 the 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 (§ 859, 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 tbe 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 tbe 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, 5U 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 tbe 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 tbe 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 (§ 143-150). These cases approximate those ac- quired predispositions where incubation is of short duration, and where there can be no doubt that the organic properties sustain a profound lesion during the early operation of the predisposing cause, or take on, at an early time, a progressive tendency toward an explo- sion of disease (§ 76, 181, 578 c, 638£). II. PROXIMATE, OR PATHOLOGICAL CAUSE. 667. 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. 668. The remote causes, by their action upon the properties of life, lead to that change in their condition which forms the essential path- ological cause, or the essence of disease (§ 644, 658, 666). As a necessary result, there also follows a corresponding change in the functions over which the properties preside, and therefore a more or less modified action of the vessels which are the instruments of disease (§ 247). All the symptoms, altered secretions, lesions of structure, &c, are only consequences, more or less remote, of 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 the 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 their combined nature when two or more operate efficiently, and upon the natural or other antecedent modifications of the vital properties of the affected parts, and the general nature and vital relations of any compound organ of which an affected tissue may form a component part; subject, however, to modifications from temperament, age, hab- its, &c. 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, Sec, 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 tbe modified conditions of the properties of life, or their pathological states, therefore, all the modified actions of the vessels which are the instruments of disease, all the vital phenomena, and all the physical products depend; just as the healthy actions, phenomena, and products depend upon the same properties in their state of health (§ 177, 410). It is for this reason, the modification of the vital properties in disease, or the essence of disease itself, is called the proximate or pathological cause ; all the rest being merely results or effects. But, there are only certain facts that may be understood in relation to the changes which the organic conditions sustain from the opera- tion of morbific causes. We can see distinctly that they are exalted in inflammation, and exalted or depressed in fevers. But these are comparatively unimportant elements of the changes. There is also the greater change which consists in some absolute modification of the nature of the properties, some positive change in 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 (§ 234). The physiologist, I again say, concerns himself about the facts, the anatomical medium, the existence of the forces and the laws which they obey. He interrogates not the intrinsic Dature 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, Sect Here we have less light as to the nature of the changes, even of function ; and hence there is less guide from general principles, and more abstract de- pendence upon symptoms and experience. Still, as will be seen, the pathology and treatment of fever are not without their important gen- eral precepts. We reach a knowledge of the modifications which the physiological laws undergo, and this is the most that we require for the institution of medical principles. 674, d. The vital states of a part or of the whole system may be 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, and often call for the intervention of art (§ 714, 848). Or, such influences may give rise to severe forms of dis- ease in other parts. Thus, gastric derangements, not inflammatory may induce severe inflammation of the mucous tissue of the throat, or hepatic or cerebral congestion, &c. (§ 500, 741 c). Again, certain morbific causes, acting upon the stomach, make their principal demon- strations in remote parts ; as the narcotics, cantharides, &c. A sim- ple element of this is constantly seen in the manner in which cold on striking the skin will develop catarrh, pneumonia, &c.; though, in the former cases, there may be specific relations of the morbific agents to particular parts, while in the latter, other predisposing causes may have operated (§ 147-151, 649 c, 657, 722 b). This principle lies at the foundation of all the consecutive developments which may spring up in different parts as the consequences of some primary derange- ment of a particular part, or of some local morbific impression which may come short of apparent disease in tbe 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, 6381, 657 b). 675. As illustrative of some of tbe 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 tbe 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, tbe properties of life are profoundly altered; and, as this is the beginning of the paroxysm, the alteration has not ac- PATH0L0G V.--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 stage. Of the three remedies proposed, there are two which will often accomplish this result, and cut short the disease at this stage of the paroxysm, or at least conduct nature to an immediate consummation of her cure in tbe sweating stage. But, the nearer the beginning of the cold stage either of the two remedies are applied, whether loss of blood or an emetic, the more salutary, for the reason already stated, will be their effect. Numerous and striking examples of this important principle might be stated ; as, for instance, an emetic will often subdue, at once, pneumonia or croup, if exhibited at their very invasion, when it may be perfectly powerless in a few hours afterward. And so, in a more limited sense, of the abstrac- tion of blood, which reaches more profoundly and more universally all the organic properties, and determines upon them, when syncope approaches, a greater and more universal impression of the nervous power (§ 947, 948). This remedy, therefore, may often answer well at any period of the cold stage, should we determine upon its use. But, suppose that the hot stage supervene. A new condition of the vital states has now sprung up, and it must be treated accordingly. Whatever will lessen and otherwise favorably modify irritability (§ 188, &c), and contribute to the production of the sweating pro- cess, will be salutary at all periods of the hot stage, and whatever in- creases irritability and mobility will, as at the cold stage, exasperate the hot stage and embarrass the sweating stage. It is evident, there- fore, that quinine will still prove morbific. But we have in certain nauseating remedies, as tartarized antimony, and in bloodletting, ap- propriate means for reducing and otherwise modifying the morbid state of irritability, in the hot stage. Alterative doses of antimony, even short of nauseating, may now exert a powerful tendency to bring about that favorable change which ensues naturally; while in its full emetic dose, so often favorable near the invasion, or at the on- set, of the cold stage, this agent is rarely useful and frequently inju- rious. Abstraction of blood has the same useful tendency. But, this remedy, unlike its effect, and that of emetics, in the cold stage, will not operate with the greatest force at the beginning of the hot stage, but near the termination of this stage in the sweating process. The properties of life have now assumed a radically different condi- tion. They are rapidly throwing off the influence of predisposition and ^f morbid habit, and their tendency is toward a restoration of their natural state. Nature is therefore more successfully aided in this new condition as she approaches the sweating or more curative process, which is the final cause of the hot stage. Hence it follows, where the advantage of one impression only can be had from a reme- t32 INSTITUTES OF MEDICINE. dial agent, although it be useful, like bloodletting, at other periods of this stage, it should generally be delayed, at least, till the stage of ex- citement has reached its acme. If cathartics be employed at this stao-e, they should be delayed, at least, till tbe sweating process has becmn; and now an emetic may be sometimes salutary. But, the former, partly on account of their irritation, should rather be deferred till the sweating stage is over, while emetics are most salutary just before the invasion of a paroxysm, which, as in the hot stage, is al- ways an inauspicious time for cathartics. In proportion as nature is going on with a progressive march toward a comparatively healthy result, as in the sweating process, there should be no great interference from art. No help is wanted, for the restor- ative process will be soon spontaneously completed, and, at an ad- vanced stage of this process, and before it is finished, there will be always danger of making some unfavorable impression, unless it be from remedies of a mild character, whose uniform result is that of acting as' sudorifics, and coinciding in other respects with the changes which are in progress during the sweating stage. Such a remedy, for instance, is tartarized antimony, in doses short of nausea. Finally comes the interval of repose, which is remarkable for its specific, but various, duration; giving to intermittent fever its quotid- ian, tertian, or quartern type. There is, however, notwithstanding the apparent state of tranquillity, very often some morbid condition re- maining ; as sufficiently denoted by any subsequent return of the par- oxysm. In all such cases, there is a progressive change going on in the vital properties from the time of their comparatively natural state at the close of the sweating process toward that profoundly morbid alteration which constitutes the cold stage. The disease is again in a state of incubation, and therefore the tendency to change in the or- ganic properties is exactly the reverse of what had just antecedently existed during the hot stage and its termination in the sweating pro- cess (§ 666). It is now the object of art to prevent a repetition of the paroxysm. This may be often accomplished by mere rest in a hori- zontal posture, and abstinence from all solid food ; for the tendency of nature may be the right way, if she be not embarrassed by exciting causes ; tbe slightest of which, as a shock of the mind, may throw her into a state of incubation. This shows not only the great susceptibil- ity of tbe vital properties, during the intermission, to morbid changes, but, also, their frequent disposition to return, unaided, to their natural state. Should they require any other intervention from art than the mere act of withholding exciting causes, it is manifest, from what 1 have now said, that slight influences from remedial agents will be am- ply sufficient; so only we discard pernicious causes, and there be no severe local disease. The remedies for this purpose consist of a group that are called specifics, and have been suggested by experience inde- pendently of any general principles; so very peculiar is the state of the vital properties during the period of intermission. Of these specific agents the Peruvian bark and its alkaloids is one, arsenic another, and cobweb another; coming severally from each of the three great king- doms, and each exerting nearly an equal control over the progress of incubation, but without any other known analogies to each other; cer- tainly none of a chemical nature. The quinine, or arsenic, which would have been surely morbific at any other stage of the paroxysm, may PATHOLOGY.--PATHOLOGICAL CAUSE. 433 now be employed with a remarkably curative effect. But, a great er- ror is often committed in exhibiting quinine, in this very tangible state of the organic properties, in excessive quantities; by which the dis- ease is either prolonged, or the predisposition only temporarily sub- dued, or local affections induced or aggravated. As an invariable and important rule, also, just in proportion as the organic properties are approaching a state of health, so should our treatment be cautiously mild, or it will fight up disease (§ 764. Also, Med. and Phys. Comm., vol. i., p. 443, &c). 676, a. In the foregoing section I have stated a problem for the spe- cific object of showing the variety of changes which diseases are liable to sustain in their pathological character during a short period of their progress, and the importance of adapting tbe treatment to the changes which may ensue, with no other reference to symptoms than as they are indicative of the seat of disease and its true pathology (§ 762). But I have also, incidentally, at the same time, demonstrated the ab- surdity of attempting any part of the problems of disease, or the mo- dus operandi of remedial agents, by any philosophy borrowed from the inorganic world, or by any hypothesis in the humoral pathology. The vital solidists, however, being numerically small, they must be little ceremonious with error; and once more, therefore, I shall bring into contrast the adverse doctrines (§ 3504-376^, 433-450). With this intention I shall submit the philosophy as now taught in Great Britain and France, and leave it to the reader to interpret by that philosophy, if he can, the problems contained in the last preceding section. 676, b. It is scarcely necessary to remind the reader that Liebig's speculations in medicine are in general vogue in Great Britain (§ 349, d), and have become incorporated in medical works of every de- scription (§ 433). Take the following example, relative to my pres- ent topic, from the long-celebrated and able, but now completely met- amorphosed, Pharmacologia of Dr. Paris (§ 339, b). " In a recent work by Professor Liebig, to which I have frequently referred," says Dr. Paris, " we are presented with views not only ap- plicable to the question under discussion, but well calculated to ex- tend our knowledge with regard to the modus operandi of contagious matter, and its reproduction in the living body. I have already ex- plained his important application of the dynamic law of La Place to chemical action; viz., that a body, the atoms of which are in a state of transformation, may impart its peculiar condition to compounds with which it may happen to communicate." Dr. Paris then proceeds to say, that it " was reserved for the genius of Liebig" to apply this doctrine of "fermentation," "putrefaction," &c, to the living body, in explanation of " the modus operandi of con- tagious matter," &c. I had occasion to set forth this philosophy of the Continental Chemist in my Examination of Reviews, together with the principal examples by which it was sustained (p. 55). Some of them occur, also, in the present work (§ 350, nos. 29 to 46, and 78 to 97). Of tbe " sausages," by-the-way (to illustrate the extent of acqui- escence), it is said by Dr. Paris that, " by entering the blood, they im- part their peculiar action to the constituents of that fluid, and all the substances in the body are induced to undergo a modified putrefaction" (§ 339 b, 319 d, 350, no. 44). E E 434 INSTITUTES OF MEDICINE. I shall not pursue this subject farther, having, in the Medical and Physiological Commentaries (vol. i., p. 385-716), devoted an Essay tc the merits of the Humoral Pathology, where all the foregoing points, the "sausages," Sec, are duly investigated (§ 282). And now to complete this example of sudden and general illumina- tion, and to exemplify, again and again, " the recent progress of med- ical science" under the auspices of " experimental philosophy," let ua hear Dr. Paris as he was, at a former edition of his Pharmacologia, and when he and others were just as much enlightened as to the con- nection of chemistry with the healthy and morbid processes of man, as when he put forth the ninth and last edition of that distinguished work. Thus: " Every rational physician must feel, in its full force, the absurdity of expecting to account for the phenomena of life upon principles de- duced from the analogies of inert matter; and we therefore find that the most intelligent physiologists of modern times have been anxious to discourage the attempt, and to deprecate its folly."" 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- FIDENCE" (§ 709, 1006 a, 1034). III. SYMPTOMS. 677. Symptomatology is the third and last division of pathology; be- ing the doctrine of symptoms. It embraces all the phenomena which result either directly or indirectly from morbid states, and includes, therefore, the physical as well as vital signs (§ 883). 678. During the healthy state of the vital properties, all the results of life progress in one uniform way, according to the nature of the several parts of the organic being (§ 249). But, as soon as the prop- erties of any part undergo changes, there arise corresponding changes in the motions of the vessels, and in all the phenomena and products > (§ 177). 679. Now it is owing to the 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 tbe superiorityxof 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 foi mer 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 tbe 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, 447 b). 681, a. The symptoms, or effects to be employed as guides to the nature and seats of disease, are, 1st. Those which are denominated vital signs, and which are independent of physical products. 2d. The changes of motion and other conditions relating to the vessels which are the instruments of disease, but which are independent of structural changes. 3d. The physical products which are compre- hended under the denominations of secretions and excretions. 4th. Symptoms of the foregoing nature which are determined or modified by changes of organization, and about which morbid anatomy is in- terested. 5th. Signs of a physical nature which depend upon either some change of structure, or on the accumulation of fluids, or the presence of some unusual,fluid, or other substance, within the body. These last signs come to us principally through the medium of sound and touch. The first three of the foregoing classes of symptoms may be denominated 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- bid anatomy, and what we learn from remote causes, and the effects of remedial agents, supply all the knowledge we can obtain of the pathology of disease. 681, c. We must, therefore, constantly concern ourselves about ef- fects, whether investigating the natural world, the powers by which it is governed, or spiritual existences. Symptoms, then, are the language of disease, as effects are of all other real existences. 682, a. Certain symptoms are called diagnostic. By these, in part, we distinguish diseases from each other. A symptom, therefore, to be diagnostic, must be peculiar to one affection. Thus, hydrophobia is the diagnostic symptom of the disease which is called, like some other affections, after the name of its diagnostic. But it is only pecu- liar to the disease as it affects the human species. The diagnostic of intermittent fever is the intermission between the paroxysms; and so of their attendant intermittent apoplexies ; and paroxysmal increase of those inflammations that are relieved by bark, and the intermission of periodical headaches, and of tic douloureux, are their diagnostics. 682, b. 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 tbe 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 sense, should be employed only as starting points to a critical investi- gation of those numerous details which may alone conduct us to a knowledge of the extent and force of disease, its complications, &c. 683. There are other symptoms which are called prognostic. It is by these, in part, that we judge of the degree of danger, and of the probable issue of disease. Hence arise the 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, Sec, 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, &c. 8th. Examine the relation of different symptoms to each other; as, their relative duration, order of occurrence, &c. 438 INSTITUTES OF MEDICINE 9th. Calculate the degree or force of the symptoms ; a point of dif- ficult attainment, requiring a correct appreciation of the properties 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 tbe 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, &c.; 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 the 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, &c. These inquiries may leave little doubt that there is both inflammation and venous congestion within the head, which will be cleared up by an investigation of symptoms relative to other organs (§ 803, &c). Our attention may be next attracted to the chest by cough, or some embarrassment of respiration. We inquire when the cough began, what its frequency and severity,, how far it may be independent, in its origin, of other local burdens of disease, or how far consequent on abdominal affections, and whether attended by expectoration, and what the nature of the matter expectorated. We count the respira- tions, and observe their equality or inequality. We see, perhaps, that the brain influences the respiration unfavorably, especially if slow, and this adds to our conviction that mischief exists in the head; or, if the breathing be hurried, it may be due to febrile excite- ment, or to abdominal derangement. The cough and expectoration show us that some 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 intermissidn 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 be- 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 examirle 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,"* &c. The patient may require the loss of blood, and we observe its col- or, Whether dark or florid, the manner in which it flows from the arm, whether in a full stream or whether it trickle, whether it throw up a buffy coat, be indented or cupped in its centre, or fimbriated at its k edges; and, that these observations maybe 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 ^ess 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 fcetor we may observe come from the mouth, or stomach, or lungs, or from the surface of the body. The patient may also supply a variety of facts as to his sensations,—whether restless, weary, prostrated in his voluntary muscles, what as to pain, or sensations of heat, chilliness, &c. We vary his posture, to learn how it may affect respiration, or the state of his pulse. I have also left out of my examination of the * See Essay on the Writings of Louis, in Medical and Physiological Commentaries, vol. ii„ p. 724, &c. 442 INSTITUTES OF MEDICINE. foregoing case an inquiry as to the mode in which the symploms 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 reflex nervous action. And there yet remains to be considered the progress of the symptoms, their mode of progress, their spontaneous changes, or such as may arise from in- cidental exciting causes, or from the action of remedies, &c, and, also, their comparison with those of other modifications of fever, or other forms of disease. I said nothing, specifically, as to an inquiry into the degree or force of the symptoms, which is always a subject for accurate consideration, as it goes far in denoting the severity of disease in different parts, and is one important guide to the nature and extent of the remedies. But this is an attainment, as already im- plied, which cannot be imparted by a description of symptoms, since their force cannot be expressed in language. Their estimate must come, as it were, by intuition (§ 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 whicl distinguish the philosophical physician from the mere empyric (5£, a). The Pulse. 687^. There is one system of organs, particularly, whose actions Are so constantly modified by reflex nervous actions, and whose phe- nomena are universally employed in estimating the nature, force, &c, of all diseases, and at all stages of their progress, and which are also elementary in denoting the effects of remedies, especially of loss of blood, that I shall make a general analysis of the prominent charac- teristics. We generally learn the influences exerted upon this system of organs by the varying states of the pulse, and the radial artery af- fords the best opportunity for this purpose, though the pulse may be often advantageously examined in other places. Thus; in inflamma- tions and congestions of the brain, it is useful to learn how far the pulsation of the carotids may be specifically affected. So, in similar affections of tbe 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.) 688, 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. 688, 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. 688, c. 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 become 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, e. Compressibility and Incompressibility.—Incompressibility of pulse is probably peculiar to inflammatory conditions, and one of the most uniform characteristics of the pulse when such conditions invade the general circulatory system by reflex nervous actions. But when inflammation is fully overcome, especially if general bloodletting have been freely practiced, the pulse is often more easily compressed than in health. So long, however, as the disease continues to affect the general circulatory system, that peculiar characteristic remains, in va- rious 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 „o 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, ee. Coincident with hardness and incompressibility of pulse, and almost peculiar to inflammation, is the buffy coal, 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 reflex nervous action upon the general circulatory system. In such cases, also, it will often continue to occur after the cupping ceases to be formed. Like hardness and incompressibility of tbe 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 tbe veins. A shallow vessel is the worst, the form of a wine-glass the best. 688, f. Fullness and Smallness of pulse.—These terms are also in opposition, and both may imply a preternatural state of the pulse, being now employed in their morbid acceptations. Fullness is also synonymous with largeness. These morbid states of the pulse are owing to reflex nervous ac- >--■*■ tions determined both upon the heart and arteries. The extent of v-*' 76, 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 ia 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 eiTor. 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 unce true is true forever; and nothing has stood the test of truth like the great elements )f 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?;c

,oo~oq>ia<;"—the last vial of wrath is emptied, and that nation is irretrievably gone. This is humiliating to pride, and may have 'jeen designed as one of its correctives. But since it is so in tlie 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 erocts 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. Tliey 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" (§ 376£, 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. [t 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 actuated by the deepest sense of gratitude to some foreign countries that can be inspired in a man of literary habits. To those countries I am the more indebted as they are always just to my native land, do honor to her scholars, and are the great abodes of 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, ] trust it will be found in the facts themselves, and in the unavoidable nature of the con elusions at which I have arrived. <64 INSTITUTES OF MEDICINE. INFLAMMATION AND FEVER. 710, a. I proceed to illustrate the most important principles in med- lfiine, 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 knowledge of the principles which apply to the pathology of inflammation and fever will greatly aid our interpretation of the essential changes which con- stitute the pathological conditions of other affections. 710, b. Inflammation and fever have been generally regarded as one disease, and they who have considered them distinct affections have offered no analysis by which their individuality may be estab- lished, and by which each complaint may be readily distinguished in practice. Important evils to the sick are therefore in constant prog- ress from this source alone ; and when there is added to it the entire darkness in which venous congestion has been shrouded, both in its absolute pathology and as it modifies fever and the recognized forms of inflammation, it may be safely said that a vast opening is here pre- sented for the improvement of medical philosophy, and for the com- mon welfare of man (§ 787). INFLAMMATION. 711.1 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, tbe 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- tusion 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 caWed febrile action, or fever (§ 134, 139, 140, 150). But this kind of " fever" is purely sympathetic, never pre- cedes the local affection, and is mostly remarkable for a simple ex- citement of the heart and arteries; while in idiopathic fever, the most violent excitement often takes place without any appreciable antecedent local complaint, but simultaneously with the general ex- citement all the 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- Gg 466 INSTITUTES OF MEDICINE. fleeted upon the heart and capillary blood-vessels of the whole system. That power, thus reflected, proves a stimulant to these organs, by which their action is increased, and otherwise modified (§ 188, 205 22G, 480-485). Again, the same primary inflammation which 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-operating with it (§ 143-150, 226, 484 b, no. 6, 645, 652). This second part, 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, and 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 may be 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,x929-934, 944 b, 948). What I have now said of the modus operandi of sympathy in rela- tion to inflammation is applicable to tbe predisposing influences of the remote causes of fever (§ 148), of hydrophobia, of the constitutional effects of mercury, antimony, &c, and of all agents, indeed, which transmit their influences to parts remote from the direct seat of their operation (§ 500, 535, &c, 657). It is all by reflex nervous action. 716. The general sympathetic excitement is supposed to often con- stitute a state 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, it 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, &c, independently of the fore- going affection of the heart and arteries. It often happens, also, that some sympathetic derangement will disturb tbe system far more ex- PATHOLOGY.--INFLAMMATION—DESCRIPTION. 467 tensively than the primary affection. The heart may be the only or- gan that may be disposed to sympathize with an inflammation of the skin; but, when the action of the former important organ becomes disturbed, though only its irritability be increased along with that of the general arterial system, it may develop sympathetically, and by a mechanical impulse of blood, extensive derangements, perhaps inflam- mations, in other parts. And so, in the same vital sense, of the stom- ach, brain, &c, when one of those organs may sympathize with some distant inflammation (§ 139, 140, 525 c), by reflex nervous action. 718. The more active and extensive the inflammation, the more important the part affected, and the more irritable and disposed to sympathy the individual, the more readily, in a general sense, will con- stitutional effects ensue, and vice versa (§ 139, 140, 597 d, 600 b). Ex- ceptions are seen in the pleura and the mucous tissue of the fauces. But only, in the latter case, under special circumstances; probably of primary abdominal disease, when the secondary affection, which is commonly erysipelatous, reacts, in its turn, sympathetically (§ 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 affection is, therefore, often more or less dependent on the habitual association of the action of different organs while in health, as well as upon the nature of their vital constitution and their special relations to other parts of the body (§ 129). Owing, also, to the special modifications of the vital states of associated or- gans, some of them sympathize more readily than others with each other, and extend their influences more readily and powerfully abroad (§ 133, &c). Thus, the small intestine occasions sympathies more readily and forcibly than the large, and the stomach more readily than the liver, with each other. But these morbid sympathies are not mu- tual among the parts where they occur most readily, and the same i? 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. Such are plain cases of reflex nervous action. It may be also well to remark, that were it not that one part nat- urally sympathizes with others, it would never sympathize with them under circumstances of disease ; no more than in plants (§ 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 comparatively unimportant part, as convulsions from 468 INSTITUTES OF MEDICINE. ieething, &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 tbe 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, G61). 722, c. Inflammation is also modified by the natural peculiarities of the vital properties in the different tissues, and the sympathetic influences it may exert will often depend, both as to kind and inten- sity, upon the nature of the tissue inflamed, and the general nature of the compound organ of which the tissue may form a component part. As to the modifications of the disease and the reflex nervous actions as affected by the nature of the tissue, good examples of dif- ference occur in the comparative phenomena and sympathetic effects of pleurisy and phlebitis (§ 150, 160-162, 807, 809, &c). PATHOLOGY.--INFLAMMATION--DESCRIPTION. 469 As to the modifications of common or specific inflammation which grow out of the combined peculiarities of the vital properties of par- ticular tissues and of the compound organ of which the inflamed tis- sue is a component part, we have numerous and striking examples; as in inflammations of the brain, stomach, liver, intestines, &c. Again, the phenomena will be varied as inflammation may affect different parts of one and the same continuous tissue, according to the nature of the compound organs into which the different parts may enter. Examples of this occur in the pulmonary and intestinal mucous tissue, wherever it contributes to variations of the general structure (§ 135-140). 722, d. From all that has been now said, it is evident that those lesions which have been rejected from the general denomination of in- flammation by Louis, Andral, Marshall Hall, &c, and arranged un- der the designations of hyperasmia, 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. 723, 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, Sec, 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 u lacerated than an incised wound. But the reverse of this last is true of the skin (S 652, c). It is also worth observing, as contributing to a knowledo-e 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 witli the brain and spinal cord are separated (§ 188,193,205,489,500d,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 (fy 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 (§ 732 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 tbe 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 process consists of two stages; that by which lymph is effused, and the strictly adhesive. And, although the effusion of lymph be equivalent to the suppurative process, there is superadded to the former a distinct final cause, since Nature contemplates in this modification not only the curative effect, but, also, the reparation of injured parts (§ 732, a). 733, a. When suppuration occurs upon surfaces, as on the mucous tissue, the process happens in its most simple form. But, in other in- stances, as when pus is generated by the cellular or serous tissue, the matter cannot escape as when it is produced by the mucous tissue. In these cases, therefore, an obstacle intervenes between Nature and the cure, as when the formation of lymph or of serum takes the place of purulent matter (§ 732, d). But here, as there, Nature has provi- ded for the removal of the secondary evil, through a principle com- mon to all the cases, and which appertains to the absorbent vessels. This happens after the following manner, 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 ao 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 1 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, 143,155, 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, e. As we have now and before seen, Nature often contem- plates a variety of useful purposes in the individual processes she adopts for the benefit of organic beings. The healthy state of the body is full of examples. Every action of every part has commonly more than one definite object; often many. So is it, also, with those morbid processes which are instituted for the restoration of health. As soon as the tendency in diseased actions is set up toward the nat- ural condition, the subsequent changes have a specific reference to the ultimate cure; the completion of which, however, may be very remote from the initiatory step. The vital properties and actions may pass through a variety of changes before they attain the natural phys- iological condition (§ 672, 676). But each change, each step in the 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 vith these other useful objects. In the case but just before us, while ulceration is making its way to the surface for the discharge of matter, the puru- lent torrention 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 r>orbid process on which its pro- duction depends (§ 764, e). The properties of life are thus constituted in such a manner as not only enable* 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 of life are differently modified in each, and consequently the processes differ, though as intimately connected by analogies as the modifica- tions of the simple physiological states (§ 185, 672, 688 ee, 733 e). Nor is the granulating process an inflammatory one, but only conse- quent on that pathological condition ; while the simple production of lymph may be a direct emanation from inflammation, or only conse- quent on its decline, or on a near approximation to that mode of ac- tion. All the modifications, however, give rise to 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 of ap pearance that is presented by the pus of an abscess, or of a chancre, or of small-pox, or appear as identical as the granulations of every part. The last, indeed, are the things in question; and although their ultimate results supply an 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, 739, 740). By thus pursuing the inquiry, the various results will be found con nected by close analogies, though the extremes may be stumbling- blocks to the careless. The periodical regeneration of the stag's horn, where some of the most characteristic marks of inflammation PATHOLOGY.--INFLAMMATION--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 tbe removal of any important organ, is never followed by a regeneration of the part. Such parts do not em- brace, like tbe 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 tbe middle of a bone be re- moved, it is regenerated. But there must be opposite surfaces, and the ri16 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 tbe natural proper- ties and functions of the extreme series of the arterial system. 746, 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 infl%*rfn*»Mc45* consists, or how it co-operates either with mechani- cal or chemical agencies (§638J). 747. Hunter laid the foundation of the true theory of inflammation He supposes that the vessels are in a state of increased action, both as to contraction and dilatation, and that, in a general sense, they carry an increased quantity of blood. Irritability and mobility, the two great properties upon which 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, and 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 mechanicnl doctrine of inflammation, which, in conformity with the pian of this work, I have here intro- PATHOL0GY.;—INFLAMMATION--PATHOLOGICAL CAUSE. 485 duced as appearing to me the most adverse to facts and philosophy, but sustained, by a powerful school. I shall not enter upon its farther refutation, nor upon the proof of the vital theory, beyond the state- ment of a few prominent facts. Both of these objects I have endeav- ored to accomplish in the Medical and Physiological Commentaries, nor have I seen any fact whose import is not there considered (vol. ii., p. 141-214, 224-397. Also, my " Introductory Discourse," p. 22, &c, 1842, in vol. iii.). The mechanical doctrine of inflammation has grown out of experi- ments by which Nature is misrepresented. I mean that such is my opinion; but not without its attendant reasons. One experimental fallacy, however, lies mainly at the foundation of all the foregoing conclusions, which consists in the means by which inflammations are artificially produced for the purpose of 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, Sec, are interpreted upon purely mechanical principles (§ 396, 410). But, if this were true of inflammation, it should be equally so of the analogous results in the healthy state of the body ; and growth itself, and all the secreted products, should be equally determined by mechanical laws. Were the doctrine, therefore, founded in nature, it would completely overthrow the whole science of physiology, and re- duce the living being to a mere automaton (§ 639 a, 746 a). 750, a. We have already variously seen what analogy prompts. We have seen, too, that it has been demonstrated that the blood is ac- celerated in the capillary and larger vessels, when stimulants are ap- plied to them, or to the brain or spinal cord, and that they give rise to alternate actions of contraction and dilatation, even in the veins (§ 384, 387, 392, 399, 408-411, 480-485, 498 e). We have seen how the extreme vessels become enlarged and admit the red globules (§ 192). We have seen, physiologically, that all the vessels must have an independent vital action (§ 382, &c, 407, 410, Sec). And now I ask the physical philosopher, upon his own ground, how the extreme vessels in dense structures, such as ligament, cartilage, and bone, acquire their great enlargements in their inflammations 1 It is evident that the physical philosopher has limited his views, as he has his experiments, to soft, delicate membranes. He has reasoned from an isolated fact, and that fact evidently of a spurious nature (§ 5±, 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; by1 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 admittino- 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. (§ 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) 1 How explain the rapidity with which croup will yield to the prostrating effect of antimonials; or how deep-seated inflammations take their departure as soon as the same condition is produced in the skin by cantharides, or yield more gradually to the silent influences of antimony, ipecacuanha, mercu- rials, iodine, colcbicum, 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) ] 751. I have just intimated that, if vital action do not exist, there should be no varieties of inflammation. It should be all small-pox, or lues, or rheumatism, or, at least, all of the common variety. The vital phenomena and physical products should be always the same; the same in all tissues and in all constitutions (§ 409, c-i). Nor should we have any remarkable and diversified sympathetic influences of inflamed parts upon the system at large (§ 500, 512-530). The vitalist supplies the only intelligible solution of the facts which are presented in real life. He points to the various modifications of the organic properties, according to the peculiarities of every tissue, the diversities of the remote causes, constitution, age, sex, &c, which he believes, also, to be the foundation of all rational pathology; and upon the same principles he interprets the curative effects of remedies. Active and Passive Inflammation. 752. I endeavored, originally, in tbe 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 fown of inflammation there appears to be a vague recognition, so far as the verbal distinction gees, 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 hypcraimia 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. 755. Again, in the supposed opposite conditions, the vital signs, and the morbid products, are nearly identical; which evinces, sufficiently, a close affinity in the pathological states, while the analogy between those products and such as depend on the natural processes places both modifications of the disease on a common physiological founda- tion (§ 137 e, 150-153, 639, 746 a). 756, a. The occasional success of tonics and stimulants in the treat- ment of inflammation, whether applied internally or externally, or with or without antiphlogistic remedies, is no evidence, as supposed, of a pathological state manifestly different from that which is most readily surmounted by loss of blood, cathartics, &c, alone. This will be obvious when the true modus operandi of remedial agents is duly considered (§ 150-152, 638, 893, &c). It is also well known that a sudden and powerful impression even from alcoholic stimulants will sometimes subvert an inflammation or a fever of great activity, which, under apparently the same circumstances, would be aggravated by such treatment in the hundred next following cases, but where loss of blood, &c, would be speedily curative in nearly all ('§ 900, 904 d). The disciples of Brown have been thus enabled to sustain themselves in the midst of general failure. 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. ySo, too, do all the varieties attendant on specific forms of inflammation, as measles, scarlatina, lues, rheumatism, &c. Lues yields especially to mercury; rheumatism to colchicum and guaiacum; scrofula to io- dine, &c.; and yet the simultaneous loss of blood may be more or less useful or indispensable. The example of tuberculous phthisis is illustrative of our whole subject. A mixed, or even a stimulant, treat- ment is slow in its destructive effects; and its evils have been, there- fore, overlooked in the speculative views which morbid anatomy has suggested as to the nature of the pathological change in which tuber- cle originates (§ 695, &c), and in the brown chicken-meat which chemistry has contradistinguished from the white. This morbid con- dition has been recently and extensively considered non-inflammatory, and as supposed by Louis, when the most extensive inflammatory le- sions and products have supervened: and it supplies us with another exemplification of the irresistible tendency of theory, true or false, to determine the treatment of disease (§ 4). The antiphlogistic prac- tice has been abandoned. But what are its results 1 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 tbe 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, &c, 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, al! 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, o-out intermittent, scrofulous, &c, as well known as the general remedies for inflammation. And so with the varieties of fever. I say ar, 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 those 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 tbe 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 alb 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 tbe 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, &c). 770. It would be difficult to say why the paroxysms of fever are separated by definite intervals, and these intervals, too, remarkable for their variety as well as precision in the same form of fever. They show us at least, however, the absurdity of expounding disease by any of the laws or agencies that are known in the inorganic world. These definite intervals have given rise to several designations of the same form of fever; and according to the interval so is the 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 i epeated at the end of forty-eight 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, as it respects the pathology, an emetic, or a dose of quinine (of no analogous virtues), may so alter the morbid properties as to place them at once in a con- dition to recover their natural state (§ 557 a, 904 d). Much, however, of the prolongation of fever is often due to the lo- cal forms of disease which supervene on its progress, to errors in diet, fatigue, &c. 775. Opposed, also, to the humoral pathology, and all the physical hypotheses, is the occasional sudden termination of continued and in- PATHOLOGY.--FEVER--REMOTE CAUSES. 497 termittent fevers, in a state of health. This is generally preceded by a severe paroxysm, and the disease is ended at once (§ 557, a). The very violence of morbid action is attended by an alteration of the or- ganic properties 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 vital to restore health. " I believe," says Fothergill, " it hap- pens in most cases where there has been a temporary, or even mo- mentary cessation of the animal powers." Remote Causes of Fever. 776. I come next to the remote causes of fever, and to consider, also, yet farther, how the general pathological condition, as in inflam- mation, is liable to modifications by differences in the nature of the re- mote causes, and how, also, fever is influenced by coexisting inflam- mations and venous congestions; \vith a view to farther illustration of principles of various import. 777. The predisposing causes of idiopathic fever probably consist, in all cases, of the results of vegetable decay (§ 652, 653). The spe- cial type and modification of the fever are determined very greatly by the nature of the new combinations; though other influences may contribute (§ 650, 651, 758, 762, 773). The essential causes make their impression so profoundly, that the incubation goes on although the causes may have long ceased to operate; which is commonly dif- ferent with inflammations (§ 711, &c). The causes of fever are also distinguished by the peculiarity of so modifying the organic properties of certain parts by their direct action, that the entire system is sympa- thetically brought into a corresponding morbid state (§ 148, 657 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 [NST1TUTES 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, 767 a, 786, &c). What I have said, also, in former sections (§ 662, 670, 675) as to the fluctu- ating state of the vital properties and functions during the progress of a febrile paroxysm may reflect light upon this subject of analogies. Pathological Cause of Fever. 781. Coming to the pathology of fever, morbid anatomy yields 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 tbe 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 toe 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 (fy 1056). And how is it with the signs which denote the essential pathology 1 We have seen that tbe 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 tho 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 tbe 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 tfiroufhout 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 exclusive, 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 tbe blood would accumulate principally about the right cavities of the heart alone, and not in the veins of distant organs. Or, should a reflux happen, it should be coextensive and equal in the veins of all parts at equal distances from the heart. On the contrary, how- ever, venous congestion is limited to particular parts, often to one or- gan, which may be, also, distant from the heart or supposed centre of obstruction. It is often, for example, the brain only that is congested; where, too, accumulations of blood, unless from disease of the ve- nous parietes, would be prevented by gravitation alone. Again, also. were there any foundation for these hypotheses, the liver, stomach, kidneys, lungs, &c, should always be congested whenever the brain is the seat of the supposed reflux of blood. It is also obvious that, the moment an equilibrium is restored to the general circulation, as in bloodletting, the volume of blood should be equally reduced in the veins of all parts. Contrary to this, however, the veins of some par- ticular organ or organs often continue in a state of great enlargement, as in the brain, &c.; while the central accumulation of blood, the supposed cause, is now completely removed. 700, 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 they 502 INSTITUTES OF MEDICINE. swell when the band 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 tbe 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 1 If you put one hand into warm water, and the other into cold, you know that the veins of the former become dilated, and that those of the latter will contract." This is a clear illustration of the physiological constitution of the veins, both as to active dilatation and contraction. But it. goes no far- ther. The dilatation is the result of the operation of a healthy vital stimulus, and depends, in part, upon a constantly-increased volume of blood which is transmitted from the arteries, as set forth in section 387. In varix there is no such increased volume transmitted, nor in phlebitis, nor in venous congestion. The dilatation is also permanent in the latter cases, while in that of the cook it subsides as soon as the stimulus of heat is withdrawn. The illustration is, indeed, a con- tradiction of the intended philosophy, since cooks are not subject to varicose affections in their arms, which are alone, though constantly, exposed to hot water. And so of the glass-blower. It is nothing more than the phenomenon which proceeds from exercise, or febrile action,' or even from the common forms of inflammation; though slightly modified in these morbid states of action. The example serves to confirm, also, what I have taught as to the physiological re- lations between the arteries and veins, and the instrumentality of a great principle in the circulation of the blood. 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 ] 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, &c, 385). 795, a. Now, it is in the foregoing peculiar organization of the veins, and the special modifications of their vital properties, that all the remarkable phenomena of acute phlebitis and venous congestion have their foundation. The veins dilate actively when inflamed, be- cause such is their natural function when impressed by stimuli, espe- cially their natural stimulus, the blood. Their dilatation is permanent in inflammation, as that affection operates as a permanent stimulus; and irritability is permanently increased, by which the blood has, also, a preternatural effect (§ 143, Sec). t 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, &c). The arterial tissue is very little liable to inflam- mation, the disease is always very circumscribed, and produces but little, or no constitutional effect (§ 140, 526 a). 796. It was an important object in my Essay on Venous Conges- tion to establish satisfactory analogies between acute phlebitis and ve- nous congestion, and I extended the analogies to varix and venous 504 INSTITUTES OF MEDICINE. hypertrophy ; and in so doing, as well as by the specific facts, demon- strated the inflammatory nature of these last affections. The several conditions were thus brought to illustrate and confirm the common nature of their pathological cause. Nor was the necessity overlooked of showing the fallacy of the universal doctrine of the dependence of varix upon local obstructions to the venous circulation and stagnation of blood, nor of applying to practical uses the true pathology of varix (§ 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 jf 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 cono-es- 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 ir^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 cceliac 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. Thw harmonious process involves, also, another beautiful exemplification of reflex nervous action. As soon as the supposed influence is estab- lished upon the capillary arteries of the surrounding tissues, a reaction of sympathy takes place in the veins, by which the morbid state is overcome (§ 143 c, 152, 524 c, 528, 657, 660, 905). Their contraction then follows, as a consequence, and " the balance of the circulation," as it is called by the mechanical theorists, is more or less restored. This salutary reacting sympathy which arises from the supervening diseases is a common phenomenon. Pulmonary affections, for exam- ple, will 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 tbe 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 (§ 733 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 (§ 638j). 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. 805. With the farther object of illustrating the pathology of venous congestion, as, also, to ascertain the pathology of spontaneous hemor- rhage, I have gone into a critical inquiry relative to the latter subject in two Essays embraced in the Commentaries, one of which is devoted to that investigation (vol. i., p. 371-384; vol. ii., p. 546-566). The subject involves some physiological and therapeutical principles of great moment; and so far as I have shown the general dependence of hemorrhage upon venous congestion, it goes with my other facts in establishing the inflammatory nature of the disease. As a prelimina- ry step, I demonstrated by the observations of mechanical theorists, that the prevailing physical rationale is contradicted by their 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 wofild 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 venom? 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 the 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 tho veins of the external parts of the body are not, like those of the internal organs, subject to congestion, but rather to varix; and why, again, an acute inflammation of a large internal vein is often lim- ited to a point of divergence (§ 133-152, 526, 576 d, 578 d, 579 b, 721, 722, 794, 795). 809. It is owing especially to the foregoing peculiarities of venous inflammation, that when complicated, either in its form of acute phle- bitis or venous congestion, with idiopathic fever, it greatly modifies the phenomena of that disease ; rendering it insidious, obstinate, and fatal (§ 651. 652, 722 c). It is always an attendant of the plague, PATHOLOGY.--VENOUS CONGESTION. 509 yellow fever, typhus, cholera asphyxia, " black death," &c, and im- parts to them much of their peculiarities, severity, and danger. 810. Venous congestion and acute phlebitis not only steal their march in ambush (§ 807), but often throw a mask over constitutional fever, or present their own characteristics as the prominent phenome- na. Hence it is that when venous inflammation is artificially excited by mechanical injuries of the veins, or by irritating injections, the re- sults are said to resemble those of typhus, or yellow fever. It was this illusion, as well as a radical defect in his physiological views, and practical 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 tbe 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 sources of salutary impressions upon the more absolute seat of disease (§ 143, 149-152, 514 h, 638, 804. Also, Med. and Phys. Comm., vol. i., p. 649, 653-655, &c). The 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 reflex nervous influences exerted on remote parts correspond with the peculiar conditions now stated (§ 133-151, 191, 577, 578). It is also worthy of remark, that where ve- nous congestion is complicated with inflammation of other tissues, it is apt to lessen the hardness and force of the pulse, and to modify the other symptoms which are usually attendant on tbe 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 (§ 638|, 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 an. 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 tbe 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 bad 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, caeteris paribus, like that of fever, upon the exact nature of the miasma (§ 653). Hence, also, the constitu- tional modifications of fever by venous congestions will be more or less determined by the exact pathology of the venous disease, as well as by the general effect upon the system of the miasmatic agent (§ 644, &c, 722 c). 814. The considerations which have been now made enable us to understand the sources of those numerous modifications which distin- guish the different species of fever, and aid, especially, our compre- hension of their connections with venous congestion, and the various modifying influences of this disease upon the constitutional affection. Depending greatly on the specific nature of their predisposing causes, the local, as well as the constitutional changes, being imbued in the several cases with the specific influence of these causes, and the general characteristics being determined, for the most part, by the constitutional affection, the incidental venous congestions impart yet another general resemblance among the congestive fevers; varying the whole from their simple type, and often more or less confounding the specific phenomena under a common aspect (§ 638£, 811). It is upon principles which I have now, and at other times stated, that we may understand why jhe 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- flammation, there is no condition of disease which demands more im- peratively enlarged views in pathology, a deeper scrutiny of symptoms, or greater moral firmness for its appropriate treatment. If danger be seen, it appals the,timid, and prostrated muscular strength urges him to the fatal use of stimulants (§ 487, 488-J-, 569). Under these fearful, but common conditions, the presence of well-marked inflammation of other tissues contributes to the safety of tbe patient. Such inflamma- tions, however undesirable in other aspects, tend to counteract, for awhile, the depressing influence of venous inflammation, to lull the imagination, which sees nothing but " debility," or " putrefaction," in the prostrated state of the circulation and of voluntary motion, and in itself sustains the powers of life under the influence of depletive rem- edies, which alone can cure ; and gives the last remaining hope which may be inspired by the unaided vis mcdicatrix, 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 scarlatina (§ 589, I). Gastric irritations in childhood are com- mon causes of hepatic and cerebral congestions ; and in many adults ihere 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 tbe 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 natttre 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 tbe 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 ] 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 stimulants. 818. I now dismiss the great subject of venous congestion ; than which none greater can undergo the attention of the philanthropist or the med- ical philosopher. But he may not bring to its investigation any fancied analogies, nor any of the laAvs, or other conditions of the inorganic world. He must start with all the philosophy of organic life, carry it all into the depths of the subject, and finally try the grand result by the test of thera- peutical principles. He will then have found that he has accomplished a study of the most elaborate character, and where medical philosophy is presented in its most difficult but elevated aspects. He will have cleared up the way to all other obscurities in medicine, and have obtained a key by which he will acquire a ready access to most of the arcana of organic beings. REVIEW OF THE PHILOSOPHY INVOLVED IN THE FOREGOING DISCUSSION OF THE REMOTE AND PATHOLOGICAL CAUSES OF DISEASE, AND OF THE SPECIAL CONDITIONS KNOWN AS INFLAMMATION, FEVER, AND VENOUS CONGESTION, AS IT RESPECTS THE NERVOUS SYSTEM. 818 g. Throughout the foregoing field I have endeavored to expound the operation of the remote causes of disease, whether of an external or internal nature, and of all remedial agents, which, in either case, exert their effects upon parts remote from the seat of their direct action, through the natural laws of reflex actions of the nervous system, and have endeav- ored to demonstrate variously modifying influences of those causes, and according to their special characteristics, upon the nervous power which is thus brought into a preternatural and alterative condition (§ 222-233f, 498-514, 894-905, etc.). Every distinct external cause we have seen to possess certain peculiarities, or as two or more may operate, and ac- cording to their individual or combined properties the nervous power will be modified and thus governed in its production or removal of dis- ease, so far as this agent is concerned ; and the same philosophy applies to those internal remote causes which consist of the various forms of local disease, or any other internal cause, such as the passions, when they exert morbific effects. In the former cases the effects depend upon reflex actions of the nervous system, by which the modified nervous power is brought into alterative action; in the other series of cases, or that of the passions, and diseases of the nervous centres, the development of the modified nervous power is not reflex but direct. The philoso- phy is, however, as I have shown, precisely the same in both cases, the only difference being that in the one, or that of reflex action, the sensi- tive nerves participate, while they do not in the other. The latter, therefore, I designate as direct action, or direct sympathy, the former as remote and contiguous sympathy, or, simply, sympathy. These terms, and sympathetic influences also, are wanted to express the functional influences of the foregoing processes, especially their morbific and therapeutical, and as being brief and comprehensive. The terms remote and contiguous sympathy were introduced by John Hunter, and predicated of the phe- nomena, and their import is perfectly understood, even by the communi- ty, and sympathy as far back as Hippocrates, and are exactly adapted to all that has been recently ascertained as to the nervous mechanism through which the function is performed, whether reflex or direct (§ 222-233|, 495-500 /, 500 o-5U m, 638^, 894-905, etc.). 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 theory 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 ccmmon 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 ttrictum 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, &c). The same identical remedies have been employed under different names, according to the manner in which they were sup- posed to act. Deobstruent in one case, relaxant in another, refrigerant in another, the /--448y,). I have done this, I say, because of the gen- eral alliance of the whole philosophy, and its almost universal sway in Great Britain and France, urged on by the powerful influence of" the Parisian School, of the British Association for the Advancement of Science, of the British and Foreign Medical Review, the Med- ico-Chirurgical Review, the London Lancet, and other periodicals of less importance (§ 5£ a, 349 d, 350£ k, kk, 709, note). In consider- ing the causes which have led to the subversion of medical philos- ophy, we should steadily distinguish the projectors from those who give the impulse and who govern public sentiment. It will be read- ily seen by every discerning mind, from my analysis of doctrines, and from what I have shown of the absence of all method, of all consistency, and the manifest want of any definite conceptions, in the chemical and physical doctrines, from the intermixture of vitalism, solidism, chemistry, humoralism, mechanical philosophy, &c, as the basis, individually and collectively, of exactly the same laws, that if the systems which are thus projected had been permitted to address themselves to the reason of mankind, truth would have enjoyed, at least, an equal chance with error. But, the opposing school decided that it should be otherwise; and nothing remains, therefore, to the few who have been thus overlooked in the haste, but to disarm, if possible, the adversary, and turn his own weapons against him. These weapons, in the phraseology of science, are facts, and upon his own " facts" the great questions at issue might be safely rested. The whole matter, indeed, must ultimately turn upon this species of ev- idence. The theories naturally follow. As the mind becomes en- lightened about the nature of the premises, there will be no 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 1 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 ine, 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 o-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 all the principles of medicine (§ 639, a). The empyrical practice, on the contrary, discards every thing hut 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 of the common form of in- flammation (§ 721, 722). 886. Next in importance to the immediate symptoms, and as often indispensable to a correct apprehension of the pathological cause, is THERAPEUTICS. 561 a knowledge of the predisposing causes. This, also, has been amply shown in its appropriate places (§ 644, 742, 776, 813, &c). To these causes, besides the more immediate, belong the innate tendencies to particular forms of disease, and, more or less, all the natural and ac- quired temperaments, and all the habitual deviations from the natural standard of a sound constitution (§ 143-147, 561, 661, &c). It is evi- dent, therefore, 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 of the tonic and stimulant school (§ 476 c, 487 a, 488$, 569, 621 a). 888, a. It is commonly a simple problem for the enlightened and observing practitioner to resolve the general character of any patho- logical condition. With this knowledge we are ready to act in a cer- tain general manner, or, as it is called, upon general principles. But, there is something far more 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- 872). 888, c. 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 effects upon remote parts through reflex nervous action. 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. 8S8, «■. I now leave the subject of therapeutics in its general as- pects, to illustrate the doctrines which I have propounded, and to ad- vance the rational treatment of disease, by investigating still farther the modus operandi of remedial agents, and as that philosophy is mod- ified in its connection with the operation of loss of blood. At a future time it will be my purpose to carry the same philosophy through all the details of the Materia Medica. Before proceeding, however, to the summary consideration of the modus 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 moans 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 tbe treatment of inflammation, fever, and venous congestion, along with my investigation of their pathology, &c. CATHARTICS. 889, a. What I may now say of cathartics is a continuation of what has been set forth in section 863, d. Their definition as founded upon their most sensible and uniform effect is—agents which increase intes- • tinal evacuations. But this acceptation scarcely refers to any of their important physiological and therapeutical influences ; which are just as intelligible, through the various resulting phenomena, and the laws of reflected nervous actions, as the evacuations they produce. The increase of peristaltic motion, and the augmented product of the intestinal mucous tissue, spring from the irritation which is exerted upon that tissue by the action of cathartics; and the whole group of these agents are more or less capable of producing those results. It is through this irritation, which is variable in its kind according to the nature of the cathartic, that all the remote influences which they exert arise; and as these remote effects depend upon modifications of the nervous power corresponding with the nature of the primary impres- sion, it is obvious that one cathartic may be speedily curative, while others may be profoundly morbific, in certain given conditions of dis- ease (§ 52, 150, 227, 228, 500, 638$). But cathartics exert, also, important effects upon remote organs by continuous sympathy; as upon the stomach, and especially upon the 'iver (§ 498). It is extremely common, for instance, when a cathartic .s about operating, for nausea or vomiting to take place ; which, how- ever, may result from remote as well as from continuous sympathy. And here I bring the analogous influences of leeching into connection with tbe 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 of 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 reflex nervous actiou upon distant organs, in virtue of their intestinal action, and in the same manner as the stomach is affected by the remote process, but how, also, this organ is simultaneously ren- dered the point of departure of other profound influences upon distant organs ;—their main effects depending on reflex nervous actions. If we now look at what is going forward in the liver, at the same time, we shall see that here, also, are phenomena which denote the Bame principles, and the same chain of causation. Take, in the first 564 INSTITUTES OF MEDICINE. place, what is most obvious to tbe 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 occasions, as in the case of the stomach, reflex nervous influences upon distant parts, while, moi :;over, it may yield important relief to the brain, or tbe stomach, or intestine, &c, through an increased secretion of bile (§ 863). The irritation of the intestinal mucous tissue which determines the nervous action upon the muscular coat (§ 514/) is the occasion of extensive alterative reflex actions upon other structures, and the former phenomenon is a key to the latter, and of the modifications which result in increased secretions, the abatement or increase of disease, etc. Organic actions alone manifest change under such influences, never the muscular, and hence the difficulty of reasoning from the latter to the former (§ 893$). 889, b. But, cathartics often produce their full curative effects upon remote organs without determining any alvine evacuation; and this proves to us that the great curative operation of cathartics is of a phys- iological nature. Nothing, indeed, is more common than to exhibit cathartics when the intestine is empty; and all the good we then ob- tain from them (and it is often great) arises from those vital influences of which I have been speaking. If much bile, mucus, &c, happen to be discharged in these cases, they are mainly generated during the action of the cathartic (§ 694$). 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 tbe chloride of mercury and blue pill as the firs^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, differing only in the irritations and reflex nervous actions. We thus see how liable definitions are to lead us astray; and this is true of most of the designations which I have retained in my Phys- iological Arrangement, and more particularly so of those general de- nominations, such as demulcents, revulsives, deobstruents, &c, 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 of the others where gastric ir- ritability is rendered obtuse* by narcotic poisons. 889, f. Does the reader now inquire, why it so frequently happens that the best effects of cathartics, in diseases remote from the intes- tines, are obtained only when they operate decisively, and perhaps powerfully 1 The answer is important; for it goes far to illustrate the modus operandi not only of cathartics, but of all remedial agents. It is, then, because this strong impression upon the vital condition of the intestinal mucous tissue is necessary to establish those reflex nerv- ous actions on remote parts that may be the seat of disease, which re- sult in such a change as brings about their own natural curative ten- dency. The repeated evacuations are a necessary consequence of that requisite impression upon the intestinal mucous tissue, and serve as an evidence that such necessary impression has been produced. 889, g. It appears, therefore, that the results which follow the ac- tion of cathartics may affect powerfully all organs, however remote they may be from the intestine, without resorting to the common as- sumption of absorption, or to any doctrine in the humoral pathology. In 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, by reflex actions, cerebral inflammation or congestion; now of the liver; again, inflammation of the skin; at an- other time, of the bladder; in this subject rheumatism; in that, scrof- ula ; in another, croup; in others, inflammation of the fauces; here, of the eyes; there, of the nose; here, an attack of the gout; there, abortion ; and so on, through every part of the organization. Considering, therefore, I say, the foregoing anatomical and phys- iological relations between the mucous tissue of the alimentary canal, and how diseases of this membrane may give rise to disease in every other part, we may readily comprehend how it is that cathartics exert 566 INSTITUTES OF MEDICINE. powerful sympathetic effects upon distant organs when render™ an- usually susceptible by disease. And so of all other remedial aa» flts, internally applied, according to the nature of their virtues, t)eir doses, &c. The philosophy lies mostly in reflex nervous actions. 889, 7i..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; espeitally from the intestinal mucous tissue, and from the liver. 3d. The evacuation of the fecal matter, which, in a general sense, is the least of all. 889, i. Certain cathartics affect certain portions of the intestinal mu- cous tissue more than other portions; and this is owing to the pecu- liar modifications of the organic properties in different parts of that tissue, and the peculiar vital relations of particular cathartics to one or another of those different parts (§ 134-137, 150.) These special relationships should become the subjects of critical investigation, since it often happens that cathartics may be advantageously selected with a view to these exact physiological conditions. Tbe 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 of the anus in the ab- sence of hepatic derangements ; and then, also, there is comparatively little bile evacuated (§1063 b). 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 of the 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 of the philosophy ot lite, 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 ne 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 sensation 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 reflected nervous influences of all the agents which are thus employed (§ 227, 228, 500, Sec). 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 forc« upon those properties of life in the ratio of their proportions, and according, also, to the existing state of the properties (§ 137 d, 150, 189, 191,872 a), and so will be the modified reflex nervous actions. 889, I. Cathartics are often cumulative in their effects ; but this will depend much, as with numerous other remedies to which this princi- ple applies, upon the frequency with which they are administered (§ 556-558). If the interval be short, as about four or six hours, and the same dose be continued, the last may operate, with violence, al- 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 of the cathartic, or time for repetition, by considering the existing condition of the intestinal canal, or other con- tingent influences, such as jaundice, &c. But here, embarrassments frequently grow out of constitutional peculiarities of patients. These natural peculiarities, in relation to cathartics especially, are often re- markably great; one patient bearing far larger doses, and more ac- tive cathartics, than another under apparently the same circumstances of disease; just as in the case of bloodletting (§ 912). I am therefore always in the habit of interrogating patients with whose susceptibili- ties in this respect I am unacquainted, as to the quantity of salts, or of castor oil, they may be in the habit of using, with a view to their action upon the bowels. This enlightens us greatly as to their 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 otb> er agent. Every other must be subjected to the same analysis. 568 INSTITUTES OF MEDICINE. There is another and important modification of the cumulative effect of cathartics, according to the frequency of their repetition, and which may be said to apply, more or less, to most other remedies whose ef- fects are cumulative (§ 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 chorter, 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 g 516 d, no. 6, 549-558, 857). The principle now concerned explains the reason why tartarized antimony or ipecacuanha when united with the sulphate of zinc will take effect as soon as the latter. It is the same, too, which brings the permanent tonics into speedy operation when associated with the analogous diffusible stimulants (§ 890$, g). Now, therefore, if the interval be quite short between the doses of a cathartic, their cumulative effect will be more and more strongly pronounced. Thus: if an infusion of senna, or a solution of salts, forming, respectively, one full dose, be taken in divided quantities ev- ery half hour, the entire 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 reflex nervous action. We bring the virtues of the different agents more and more into relation with the organic properties; and, when that relation is fully established, the last dose appears to exert, and may exert, a greater power than all that had preceded it. 889, m. We may now, perhaps, more readily comprehend a part of the philosophy which should govern us where it is mainly an ob- ject to remove habitual constipation, and to which a brief reference was made in a former section (§ 556, b). In cases of this nature, there are two primary objects to be kept in view : 1st. To avail ourselves of the cumulative effect of cathartic remedies ; 2d. To establish a free secretion of bile, 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 of the best alterative nature, that it may reach the liver, and establish the most favorable change in the intestinal ca- nal ; the last of which has been already stated (§ 556, 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 tbe intestine and bring it fully into relation with the virtues of the agent; and, as the bile possesses, also, cathartic endowments, we shall have thus adapted intestinal irritability to the action of that natural and now augmented stimulus. The case is parallel, in its philosophy, with that of the emetics and tonics, as stated in the preceding section (889, 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 of the 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 of tbe 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 of the liver; but a not less important one occurs in the vital state of the intestine (§ 1057 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,Z>), 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 (§ 863, d). There is a certain attendant of the human constitution as already seerr (§ 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 paihological sense, and it is of great importance in that double ac- ceptation as it regards the operation of cathartics. It is obvious, I say, that the system is in its most irritable and sus- ceptible state toward the decline of the day, and that this period must be the worst for the operation of so powerful an irritant as cathartics, and more especially so if fever or inflammation be present (§ 137, d); though there is a great difference, in this respect, among different ca- thartics. The most appropriate time for their administration, in a gen- eral sense, is toward the decline of the 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 reflex nervous influence to parts that are diseased, and both the impression upon the skin and its salutary reflex nerv- ous actions will be much promoted by the warmth of the bed, by the horizontal posture, and by sleep. For the same reason, if cold should arrest the action in the skin which the cathartic institutes, that organ, suffering this violence, may reflect morbific sympathies upon other parts, and may thus, more or less, defeat the useful effects of the ca- thartic (§ 514, h). It is the work^throughout, of reflex nervous action. But, all cathartics whose operation is speedy should be exhibited at an early hour in the morning, when the irritability of the system is 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 of the secerning vessels, that redundant secretions of blood, 01 of other fluids, are arrested in virtue of that change of vital action. 890, b. Let us now look for an illustration of the foregoing to some agent which embraces other virtues in connection with that which is reputedly astringent. There are many of these ; such as the sul- phate of zinc, the sulphate of copper, rhubarb, &c. We will take the last mentioned, for the sake of indicating, also, its uses in prac- tice. This substance is positively cathartic in certain therapeutical doses, but so stimulating to the system in such doses, as to render great caution necessary in its administration in acute inflammatory diseases; while, on the other hand, in much smaller doses it is adapt- ed to many chronic inflammations. Again, in certain other small do- ses it is a valuable tonic, but still contra-indicated by active inflamma- tion. Lastly, it 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 of the 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 of the organic properties to changes according to the virtues of the agents which may act upon them, and their existing state when the agents are brought into operation ; and, secondly, as well, also, upon the doses in which they are administered. When the vital conditions are affected in a peculiar way, and under a given combination of cir- cumstances, if a vital agent possessing particular virtues be applied, it will so modify or alter tbe existing morbid state, that new and definite results will follow. Thus, when the intestinal mucous tissue is affect- ed with that condition of disease which results in a preternatural wa- tery secretion, and consequent evacuations, which is called diarrhoea, and rhubarb is administered in a certain dose, this substance first im- presses the membrane in such a way as to determine an increase of tbe 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 tissue removes the morbid reflex nervous action 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 tbe action of the rhubarb as a cathartic changed tbe 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 (fy 1062). Whether, theiefore, 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 tbe 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 of the various other products of the abdominal organs; the cause of the diminution of the bile, and of the urine, being the same as that of the diminution of the diarrbceal 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 reflex ac- tion of the nervous system. And here we may look at the coinci- dence in results between the application of an astringent to a suppu- rating surface and as tbe 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, Sec, 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 of the 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 of the former untoward treatment is tuberculous phthisis. This prac- tice nas 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 of the 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, &c, and which none can fail to recognize as salutary means em- ployed by Nature. These hemorrhages, too, are analogous to men- struation, and here, as there, a great final cause lies at the foundation There is, therefore, no more propriety in arresting hemorrhage, unless excessive, than in attempting to interfere with the natural function. 890, e. In the advanced stages of fever, and of other severe forms of disease, hemorrhages have been often followed by death. And here it is that hemorrhages have raised the greatest apprehension of their fatal tendency. But, it is very rare that it is the hemorrhage which destroys (§ 1019). It is only a symptom, at this advanced stage of the malady, significant of a fearful condition of disease. which, in itself, in a vast proportion of cases, is the true cause of death (§ oo» 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 tbe safety with which she makes her wonderful demonstrations of cure, and rebukes the timid practitioner. But she has now her own way of operating. She has taken the business of rational treatment upon herself, and out of the hand of art; for now it is that quarts of blood may flow away from the intestine, and triumph over disease, when bloodletting would be perfectly useless, and the abstraction of a dozen ounces of blood would probably be fatal. These are lessons from Nature of every- day occurrence, and should not be lost even to such as are incapable of appreciating disease, or who may be imbued with prejudice, or haunted by fear, in respect to the great remedy whose timely appli- cation would save them from the consternation of witnessing a natural 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 tbe 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 tbe 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. Cases 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 of the worst agents that can be devised ; since it possesses not only the virtue of a true astringent, but is stimulant to the whole circulation, irritant to the whole mucous tract of the intestine, now morbidly susceptible through- out its length from the severe and specific inflammation of its inferior portion (§ 137 d, 398), and if the agent arrest the discharge, it is com monly by increasing and otherwise unfavorably modifying the inflam- matory condition. 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 the 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. 890, i. Rhubarb, opium, and other agents which arrest redundant secretions, are often highly useful in some forms of diarrhoea, and some- times in chronic discharges of mucus ; but these products depend upon various pathological states, and whether astringent remedies will be useful or injurious will depend upon the precise nature of the disease (§ 150, 670-674, 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 purgative salts within the alimenta- ry canal. Saline cathartics are, therefore, also improper, and, more- over, scarcely extend their salutary permanent effects beyond the in- testinal canal. 890, k. But, even in the simple forms of diarrhoea, there is variety as to the exact nature of the morbid condition, which demands, in dif- ferent cases, a choice of astringent remedies (§ 150, 672-674, 733 ff 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, &c, when all other means which I have indicated would be either useless or injurious. 890, 1. 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- rhoea, 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 leucorrhoea. How badly is this affection often treated by astringents, internally and externally, and also by tonics! And all this, mainly, because the disease happens to have, for one of its symptoms, a discharge from the vagina, and is supposed • to depend upon debility of the general system, and relaxation of the mucous tissue; a sort of mechanical exudation from a flabby mem- brane that tonics and astringents may condense and 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 leucorrhoea, another luminous guide will be obtained to a right apprehension of THERAPEUTICS.--ASTRINGENTS. 577 the mode in which astringents may check, for awhile, those dischaiges which they may ultimately increase, or others, in other cases, success- fully and permanently. S90, 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 that astringents operate through reflex nerv- ous actions*; 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 of the best remedies, exter- nally applied, for inflammation of the skin, of the eyes, &c. Sulphate of zinc, also, for conjunctivitis, the mineral acids or vegetable astrin- gents for inflammation of the tonsils. These are active astringents, and the variety in their effects, according to the nature of the patho- logical conditions, whether employed internally or externally, declare their physiological action, and call upon the practitioner to study well the capabilities of each one. Nay, more ; their variety of action when applied externally is not less than what we have seen from their inter- nal administration. The acetate of lead, for example, may speedily relieve certain conjunctival inflammations, when such modifications of inflammation woulcnbjg greatly aggravated by the sulphate of zinc; • 578 INSTITUTES OF 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) 1 890, 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 (§ 1884- 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, fee. 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, Sec, 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$, a. Tonics may be regarded as a counterpart of the antiphlo- gistics. From the circumstance, therefore, of the latter occupying the high places in the materia medica, we may come, at once, to the con- clusion that the former are comparatively of very limited importance. Indeed, it is only in the advanced, or in the declining stages, of acute diseases, or in certain states of chronic affections, that tonics can ren- der much service. No remedial agents,however, have been more extensively employed, and therefore none which have been so extensively injurious (§ 569, e). This misapplication of the Materia Medica has arisen, as in other ca- ses, from erroneous theoretical views of disease, and mistaken notions of the modus operandi of remedies (§ 854 bb, 863 d, 892 b, 904 d). 890$, 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 regarding the true mode in which these intentions are ac- complished, and the absolute influences which are exerted by tonics, we shall come to a just apprehension of their relations to morbid states, :ind be better qualified to avoid them where they may be injurious. 890^, c. Tonics are commonly supposed to act upon mechanical prin- ciples, by bringing into close apposition the molecules of which the living tissues are composed, and attempts have been lately made, as at former times, to demonstrate the truth of this conjecture by exper- iments upon dead tissues (§ 569, b). This has led many to con- found the virtues of tonics with those of astringents. But, we shall find that here, as in all other cases, Nature is consistent, and that ton- ics bring about their results like other remedial agents; that here, as in all analogous instances, there is no departure from Unity of De- sign (§ 137, e). A few plain illustrations will place the operation of tonics in its proper aspect. 890$, 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 of the stomach, and their transmission by reflex nervous action to other parts. They are va- riously pronounced according to the exact combination of circumstan- ces. The food will display itself most distinctly in such as have suf- fered its privation, and where the surface is chilled; the wine where it is least employed (§ 535, &c). By varying these incidental influ- ences, a corresponding variety will obtain in tbe 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 cases the voluntary muscles are suddenly or grad- ually invigorated by reflex nervous actions propagated from the stom- ach. It is the same with the tonic as with the food or the winei 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 tbe 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 states 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 may be seen in the effects of some agreeable intel- ligence, which, no one can mistake, has imparted, on the instant, a keenness of appetite, a vigor of digestion, and an exaltation of mus- cular strength, which had not been enjoyed for a month or a year (\ 137 e, 227, 512, 514 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 of the parts affected turn- ed a little from the incipient pathological state, and under the influ- THERAPEUTICS.--TONICS--STIMULANTS. 581 ence of vital habit, tonics will prove less frequently detrimental, or may be so far curative that 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 of the cathartic, but are positively remedial, by going to the vital condition of organs (§ 137 d, 150, 569 c). And here, as in the case of rhubarb (§ 872, a), we may reverse the order of indications, and suppose that a tonic may be useful if it can be prevented from stimulating injuriously. This object may be often attained by uniting a mild saline cathartic, or, 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 virtue of cinchona, or quin- ia, interferes with the febrifuge virtue; while, at the same time, the antimony does its important work as an antiphlogistic alterative. Both of the agents, in these cases, are principal remedies. But it is the febrifuge, not the tonic virtue, which makes 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, 8S9 k, 890 b). 890$,/ But I say, again, that these agents are never wanted, in their relation to diseased states as tonics, in the early stages of any disease whatever; and, however they may now and then succeed (§ 756), they are generally prejudicial. If employed in certain forms of fever or inflammation in which tonics possessing febrifuge virtues, like cinchona, are not indicated, they endanger life (§ 150, 569 e, 621 a, 652 c, 662, 847 g, 848, 863 d). I think I shall have justified this as- sertion throughout the extent of these Institutes^ But, in failure of this, I have only to point out the results of the Brunonian doctrine of disease, which prompted the tonic and stimulant treatment to sr great an extent that it has been computed to have destroyed a great- er number of the inhabitants of Europe, in the first forty years of itt prevalence, than all the wars of that sanguinary period (§ 621, a, 1068). 890$, g. There are great resemblances between the virtues of ton- ics and diffusible stimulants, in their common acceptation; but there are also important distinctions. In instituting comparisons, therefore, between them, or of all other remedies, they should be regarded in their just relations to morbid states; for in this adaptation can they be alone remedial. We shall thus find that both classes of remedies are more of 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, 890$ d). When, also }32 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 mav 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 k, 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 tonics and stimulants, when employed in active febrile or inflammatory states, are on a par with the most irritating cathartics and emetics. Their effect then goes deep; which admonishes us, more and more, to study well the relations of remedies to diseased conditions, and to discard all the conclusions which have been drawn from an observation of their effects upon man in health (§ 137 d, 150, 662 a, 675, 854 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 c, 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 ccrebro-spino- excitants, moto-paralyzants, senso-paralyzants, and cerebro-spino-de- pressants. 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, ail 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, Sec). 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, &c, is roused into greater immediate violence by tonics and stimulants, or indirectly by other morbific influences which apper- tain to the narcotics (§ 150, 151). Take, for example, the opinion of the able and distinguished London physician, Dr. Sigmond, who says that, " Of all the different classes of 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 of the uses to which they are constantly applied. But, even these inten- tions can be rarely well fulfilled by narcotics where much disease is present. We must then resort to the class of antiphlogistics for our great curative means ; and, if the narcotics be summoned to their aid, it should be done with the greatest caution, or they may prove fatally morbific. We may exhibit opium, &c, for the relief of mere spasm of the stomach, to procure rest, &c, where no important acute dis- ease is present. But he who should employ them to assuage the pain of pleuritis, enteritis, or any other active form of inflammation, and, in a general sense, of chronic forms, would either most seriously ag- gravate the disease, or destroy the patient (§ 150, 151). Whenever, also, there is any affection of the head, or any tendency to cerebral disease, so great is the liability of narcotics to induce congestion 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 of the glandular organs, that the secretions of the whole, especially of that most important organ the liver, are more or less diminished ; whereby Nature is obstructed in one of her greatest processes, natural and curative, and morbific nervous actions reflected upon all diseased parts, and upon the whole organism (§ 862, 863). Should 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 strated the evils that arise from regarding the product and not the na- ture of the action upon which it depends (§ 512 b, 863 d, 902 g). Hence has arisen the pernicious custom of depending upon the com- pound powder of ipecacuanha as a principal curative means in the treatment of fever. The opium determines morbific nervous actions upon the glandular organs and nervous system; being scarcely modified for the better through its union with ipecacuanha, even in its greater determination of diaphoresis. S91, e. In respect to the modus operandi of narcotics, I shall now only lay down the proposition that these agents produce their saluta- ry or their morbific effects, like all other remedies, or all other causes of disease, and set forth the proof in other appropriate places (§ 891$ k, 904, &c). The principle involved is so perfectly in harmony with all physiological facts relative to the healthy state of the body, and supported by all the well-ascertained facts in medicine, that it ena- bles us to comprehend how it is that five drops of the tincture of opi- um administered by the stomach will afford more relief to one man than fifty drops will to another, or how the 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 and other attendant peculiarities, and, as for the rest, by the production of a sedative reflex nervous action corre- sponding with the existing susceptibilities (§ 227, 447, 904). The failure of narcotics to produce the same effects when applied to the trunk of a nerve as upon its expanded extremities is a promi- nent fact in 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 reflex actions of the nervous system. We have hitherto seen that an admirable variety of virtues apper- tains to many of the different members of each group of remedies, by which they are extensively adapted to various pathological conditions that approximate each other, but which are marked by such differen- ces that, were each group composed of only one or two agents, we should be constantly baffled in the treatment of disease (§ 889, k). And, how vastly, in this respect, has the Materia Medica been im- proved in recent times by simplifying certain substances of compound virtues, attended, also, with much excrementitious matter; as in the examples of many alkaloids, iodine, &c.! Opium, for instance, is gen- erally inadmissible in inflammations, unless to moderate irritability of the intestine, in muco-enteritis, or of the lungs, in pneumonia, 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 lactucairium, or lupulin, or churrus, &c, substitutes which maybe 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, qnd 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 of the eye upon the sunken or ghastly features of the patient may awaken ap- prehensions for which there is no just foundation. Now let the win- dow-shutters be closed, exclude all unnecessary attendants, let the nurse be seated quietly in a chair, lay aside medicine and even food, take down the bed-curtains, ventilate the room, but not from a win- dow that may throw a blast upon the patient, graduate the bed-clothes to his sensations, moderate or put out the fire, and if the patient have not rested when night comes on again, give him a suitable narcotic, keep all things quiet, and, at our morning call, we shall be likely to understand the reason why narcotics are so improperly administered when wakefulness arises from profound disease, perhaps of the brain, or when sleep is ample, but pain and suffering call for a relief that narcotics may not yield. It is the delightful effect of these agents, in the case which I have just supposed, and where 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 sense, relates to their power of diminishing the irritability of disease ; whether local or general (§ 188, Sec). 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 (§ 8S9, 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, by imparting a sedative influence to that reflex nervous action which occasions the spasm. 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. 891, 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 of the pain, its seat, and other circumstances. If owing to active inflammation, they will be likely to aggravate the disease in most parts, but not in all. And here we learn the vast importance of a critical knowledge of the special vital endowments of the different tissues, and of a studious reference 588 INSTITUTES OF MEDICINE. to the seat of disease, as well as a critical examination of the attend- ant symptoms, since the pain of mucous and serous inflammation of the intestine may be exactly the same, and opiates curative in the former, but certainly fatal in the latter (§ 133, &c, 150, 685, 686). Here, too, in the mucous tissue, they accomplish the double purpose of reducing irritability as well as sensibility (§ 150, 188, 194). In the other case, or that of serous inflammation of all parts, if they render sensibility obtuse, they 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, /. But, tbe great agent for tbe 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 acute inflammatory diseases. So, also, they afford im- mense temporary relief in pain of the stone. They operate like a charm in cramp of the stomach, and in the suffering attendant on the passage of a gall-stone along the ductus choledocus. In these last cases the narcotic is directly curative by relieving spasm. When pain attends chronic affections, narcotics may be adminis- tered with less hesitation ; but still with a careful reference to the seat and nature of the disease. They are of the greatest value, as pallia- tives, in the pain of cancerous affections, and 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, that is, by alterative reflex nervous action. The power of endurance, and, therefore, the degrees of injury which THERAPEUTICS.--NARCOTICS. 580 pain may inflict, depend greatly upon temperament, and the general condition of the constitution as arising from disease, habits, culture of mind, Sec, and these contingencies affect, also, the susceptibility of the vital states. Much, too, will depend upon the kind of pain ; and the kind, also, has its important influence in 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, 891$ b). Diseases of the liver, for example, give rise to pain in the right shoulder, which opium may relieve, while it would aggravate the hepatic affection. Or, if he apply a blister, or other agents, to the shoul- der, they will be useless. But, if placed over the seat of the liver, they will be 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 of the primary affection (§ 689 I, 905). 891, o. We see, therefore, that blisters are among the great means of assuaging pain ; but, like bloodletting, they operate in a very differ- ent manner from narcotics, though by reflex nervous actions. There are, also, other agents not of the class of narcotics, which are remarkable for their control over the pain of particular modifications of inflammation, such as colchicum, guaiacum, &c. Hence we see, more and more, the uncertainty of pain as a guide to treatment, and that our remedies should be mainly determined by other considerations. Nor will I neglect the opportunity of saying how deeply all this subject relative to pain, wakefulness, &c, and the counteracting influences of the narcotics, should impress us with the futility of the chemical and physical philosophy of natural and morbid processes. From what we have seen, too, of the great variety of means by which pain may be assuaged, we come to an unhesitating conclusion as to the modus operandi of narcotics. 891, p. There is one agent not yet mentioned, which is often very remarkable for the relief which it affords in tranquilizing restlessness, allaying pain, and in procuring sleep ; while it has also the great ad- vantage of being generally free from objection. This is the warm bath ; or analogous means in the form of warm fomentations and poul- tices. By these means intestinal pains, strangury, the intense suffering from sprains, painful menstruation, Sec, are frequently dissipated at once. Again, refreshing sleep may be often induced by the warm bath, when narcotics fail, or would be injurious (§ 150, 863 d). These agents are also curative in a direct manner; but variously so, accord- ing to the nature of the affection and the degree of heat employed. The bath at 105° or 110° F. frequently, perhaps daily applied, es- tablishes such impressions upon the skin that highly salutary influen- ces are often reflected upon some chronic forms of hepatic and intes- tinal disease, through the communicating sensitive and motor nerves. As farther illustrative of the remedial nature of narcotics in reliev- ing pain, and as contributing to many general objects in the philos- ophy of life, I may advert to the manner in which certain affections of the mind 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, Sec.; and here the di- rect nervous influence illustrates the reflex of narcotics. 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 ot sleep (§ 137 e, 150, 151, 175 c, 500 n). Certain special affections of the nervous system also counteract the usual effects of narcotics in an astonishing manner; as seen in deliri- um of drunkenness, which excites an irritating nervous action. 891, s. Finally, habit, in respect to the use of narcotics, is very re- markable. Instances are authenticated in which the habitual use ot 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 (§ 841). ANTISPASMODICS. 891$, a. Two principal objects are contemplated in rendering the antispasmodics a subject of consideration. First, to aid in illustrating the philosophy which concerns the nervous power; and, secondly, to indicate their misapplication in many conditions of disease. 891$, b. The group of antispasmodics embraces all the narcotics, and regards them in the special acceptation which it is my present purpose to consider. As the term implies, they are employed for the relief of spasm, and, mostly, of the voluntary muscles. Now these agents are very commonly applied for the relief of the symptom, and with too little reference to the fundamental cause. Thus, Dr. Pans 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- ino- 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, 891 n, 859 b, 863 d). 891$, c. Antispasmodics have been largely employed in hysteria. But here they have been almost as fruitless as in the spasms of chil- dren ; though, perhaps, not so detrimental. Hysteria, in numerous in- stances, is so dependent on some' uterine derangement, and this con- dition so often consequent on visceral disease of the abdomen, that the treatment should be, in such cases, of quite a compound nature, but in which antispasmodics can take no useful part. An emetic, however, in a general sense, will afford temporary relief, which it accomplishes in part by modifying tbe several conditions of disease, and in part ihrough influences which are called into operation in suspending a paroxysm of spasmodic asthma, and hiccough, as explained in section 514, c, where the philosophy rests upon reflex nervous action. S91$, 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, S63 d). S9H, 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 of the brain with an overloaded stomach ; when a mild emetic is the sure antispasmodic. In other cases the sympathetic disturb- ance of the brain depends upon profound disease of the liver and oth- er abdominal organs ; and here, cathartics of calomel, &c, and doubt- less bloodletting also, are the appropriate means. Again, it depends upon organic disease of the brain, or on a spicula of bone projecting from the dura mater, or on depression of some part of tbe 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$,/ Congestive asthma, the usual form of the disease, has had its full share of the antispasmodics, and, of course, with as little bene- fit as they have yielded to the preceding affections. They are more or less appropriate, however, to the rare form of spasmodic asthma; but here an emetic is often better, or a pipe of stramonium leaves may answer (§ 514, c). But congestive asthma depends upon some- thing more than simple irritation of the nervous centres. There is a highly-injected state of the venous system of the lungs, consequent on disease of the abdominal viscera, involves many important organs, and 592 INSTITUTES OF MEDICINE. calls imperatively for bloodletting, and cathartics (§ 150, 786, &c, 847 g, 848, 859 b, 863 d, 870 aa). 891$, 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$, h. We may now call up our recollection of the various prop erties appertaining to the narcotics, as set forth in former sections and we shall readily see that they must be commonly injurious in most of the diseases which give rise to spasms. 891$, i. But there are some agents which are mostly antispasmodic in their relation to the nervous system, such as asafoetida, musk, valeri- an, &c. These agents are 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 of the present inquiry (§ 891$, a). 891$, k. No one can mistake the immediate bearing of the whole of this subject upon the general philosophy which concerns the modus operandi of remedial and morbific agents, while the function of res- piration, and other natural processes, display the physiological laws under which the former are directed (§ 462-475, 495-534, 639 a). Although, therefore, the phenomena of spasm form so luminous a guide through the whole labyrinth of sympathy, and impart a peculiar in- terest to the discovery of Sir C. Bell in relation to the different orders of nerves (§ 462-470, 476 b), we need not be long detained in making the contemplated exposition. In the first place, then, we observe that the irritation of the nervous centres may be either direct, as in severe forms of epilepsy (§ 891$, e), or indirect, as in the more compound and ordinary reflex nervous in- fluences (§ 227, 230, 500). In the former case the nervous power is developed in a direct manner, either in .virtue of some disease af- fecting the nervous centres, or by some direct mechanical irritation, as in depressions of the skull-bone, projecting spiculae of bone, and extravasated blood (§ 476-494). In the latter case, the primary irri- tation is in a remote part, as in the gums, or intestinal canal, &c. (§ 891$, 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, 893$.) Such, again, are all the elements; and since they are now in oper- ation in their morbid aspect, we have the plainest demonstration that the whole process depends upon natural physiological laws. And now, briefly, for the opposing or curative influences. We have seen that when the simple antispasmodics arrest the movements, they institute 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), and their mor- bific impression may be transmitted from the stomach to the nervous centres, especially on account of their specific relation to the nervous system (§ 137, e), without first engendering or increasing disease in the stomach or other parts (§ 502, 6-), or, there may happen along with this a direct morbid change in the condition of the stomach (§ 502, c), or indirectly, through the increased morbid change in the nervous power, in other parts. These new conditions of disease may aggra- vate the spasmodic affection ; since the nervous power is not render- ed sedative to the affected muscles (§ 150, 228 £-232, 233|); or, on the other hand, the morbid change may be of such a nature as to break up the special condition of the nervous power which gives rise to the spasm, and thus put an end to that part of the malady, although there ensue a very aggravated state of disease (§ 890, 900, 901, &c). Thus we see presented the compound aspect of a remedial agent bringing about relief to one part of disease, or removing one symptom, and simultaneously aggravating or inducing disease in other parts, and in- creasing all other symptoms. The principle is distinctly the same, throughout, as when the narcotics, or simple antispasmodics, establish that change which results only in the removal of spasm. 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 tbe alleged connections of the savages, lions, and vultures, which continue to appear in works on the Materia Medica, are wholly fabulous. It was not, however, till a century afterward, or in 1738, that the plant became known to naturalists, through Condamine, the French savant. His account of the tree appeared in the Memoirs of tbe 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 of the 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- bacum. Before the time of the alkaloids, Von Bergen published the names of more than six hundred authors whose writings he had con- sulted on the subject of the Peruvian bark, and refers to eight hun- dred distinct treatises upon this remedy. Subsequently to that peri- od, the discovery of the cinchona alkaloids, and their application as therapeutical agents, have given rise to so vast an accumulation of ifooks, pamphlets, and memoirs, that the writings upon this single ar- ticle of the Materia Medica would, alone, form a library of very impos- ing dimensions. And yet do I find myself at the threshold of another paragraph upon what should seem so completely exhausted. I shall therefore endeavor to turn myself upon that track which has been least pursued, and which, as in many other cases, is too often aban- doned,—the path of Nature. The bark, having been early carried from Spain into Italy, it may be well supposed that a country so liable to intermittents, and those, too, of the most formidable character, would soon illustrate the virtues of this extraordinary febrifu»ge, and enlist in its favor the most power- ful patronage. About this time, however, it was called to encounter one of those checks which it repeatedly afterward underwent with less disaster, and which will remind us of what has befallen the phi- losophy of medicine in the laboratory of a German chemist. I shall therefore state it, in the hope, at least, that it may go with the rest in promoting independent habits of observation (§ 349 d, 350, 350-j). 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 of the powder. This Schedula soon became a target for those who had been hos- tile to the bark ; and the warfare was begun by one who had profess- ed to have entertained prepossessions in its favor! This individual, whose name was Chifletus, was prompted in his opposition to the bark by its partial failure in a case where it was important for the physician to have obtained more complete success. A relapse, how- ever, ensuing at the end of a month, tbe 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 tbe 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 of the decision. Nor was this condemned article ultimately rescued from the tram- mels of ignorance and prejudice by its proper guardians; but by a learned Jesuit, who once more bore it aloft by unequivocal proof of its extraordinary control over the great bane of Italy. From that time, opposition became more and more feeble, and the merits of the remedy gradually established. But, this is only a passage in the early history of the Peruvian bark. It was not, like the tobacco, required to encounter the edicts of des- pots, though it equally underwent the ordeal of a fierce disputation; and it is scarcely possible for us, who now contemplate these two re- markable members of the vegetable kingdom with the calm indiffer- ence of long and universal experience, to appreciate the uncertainty in which their virtues were held, or the angry and vindictive reproach to which that uncertainty gave-rise. We see, also, in the nature of the hostility 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 disposition to trample upon the best interests of society, where it may seem ex- pedient to bow to tbe 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 rcmcdium 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 of the former, and compelled his obstinate cotemporaries to acknowl- edge the healing virtues of the Peruvian febrifuge. But, to the Pon- tine marshes of Italy we may refer the stability which was first be- stowed upon the bark. Here were perpetually emitted the seeds of intermittents, which were now, for the first time, eradicated exten- sively by the all-potent drug. 892, aa. In my Arrangement of the Materia Medica, I have group- ed together, in the order of their therapeutical value, many agents which are peculiarly appropriate to intermitting forms of disease, and, into this group no other remedies are admitted. They possess, there- fore, what are commonly denominated specific virtues in relation to the diseases to which the group refers. This, indeed, may be more 596 INSTITUTES OF MEDICINE. or less affirmed of all the other groups, excepting those of a common antiphlogistic nature. It is not, therefore, to be inferred, when the remedies for any given character of disease are specifically 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 amenorrbcea, 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 that 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 of the1 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, m such, the methodus 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$ b, 530). But, cui bono 1 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 section (§ 904, d) for that part of my inquiry which would otherwise be presented in this place. We discern, at once, from what is there 6aid, 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 bow 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, 892| d). But, this peculiarity of virtues is more strongly pronounced in some things than in others, and is seen remarkably in cinchona; as in its profoundly morbific effect during the hot stage of tbe febrile paroxysm, and its equally curative demonstration during tbe period of intermission. Here, too, I may again say that its mode of operating at these successive stages of one and the same disease is distinctly seen to be of a common nature (§ 675, 891$ k). Here we have not only a consistent philosophy throughout, but, also, in that philosophy and the attendant facts, a fountain for many practical conclusions; such, for instance, as the importance of bringing about, in a general sense, distinct intermissions, before resorting to what are emphatically denominated remedies for intermittents ; and that it would be improp- er, in a general sense, to employ the agents now under consideration, in remittent fever, or, at most, not till the febrile action has been mod- ified by direct antiphlogistic means (§ 150, 847 g, 848, 857, 859 b 870 aa). 598 INSTITUTES OF MEDICINE. Nor may we begin, precipitately, the treatment of intermittents hv 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 J, 891 k, I). There may be present some local congestion or inflamma- tion, that may demand the abstraction of blood ; and the general con- dition of things will rarely fail of requiring a cathartic, at least. But it often happens before any preliminary treatment may have been adopted, that an intermission is pretty strongly pronounced, and yet that the intensity of the febrile condition is such as to raise apprehen- sions that the patient may be destroyed by the violence of the next paroxysm. These are frequently cases for grave deliberation, 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 of the two methods should be adopted; for there are two modes of treatment having essential differences. , One of these methods consists in making a very strong impression, at once, by a single blow, as it were, upon the diseased conditions, during the intermission, by the administration of a large dose of bark, or of quinia (as five or ten grains of the latter), and thus endeavoring to arrest the fever at once. The other method is one of greater moderation; the remedy being exhibited in small quantities (as that of a 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 he 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, 961-964, 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 Ave 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 tbe predisposition to fever, that the patient will con- tinue to suffer returns of it from time to time, during the residue of the brief period of life which an indiscreet practice not unfrequently allots to him. He is but " imperfectly cured," as Celsus has it; and diese imperfect cures become the slow cause of those chronic enlarge- ments of the liver and spleen for which iodine is especially beneficial. In respect to relapses, it is not infrequent that, when intermittents are suddenly stopped by a large dose of quinine, the paroxysms return as soon as the patient begins to exercise much, or to take his ordinary food,—certainly with far greater frequency than when the case has been treated upon the moderate system (§ 847 g, 848, 857, 859 b, 870 aa, 878). 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, Sec, 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, 447 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 tbe 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 of the 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 of the fever. In the treatment of tertians, the intermission being longer, more time is allowed for producing the requisite impression by the quinia, and I therefore take no unnecessary risk of aggravating, or of produ- cing any local forms of disease, but administer the sulphate of quinia in doses of one grain once in three or four hours; and 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, of the most formidable nature, after repeated abstractions of blood, and the exhibition of ca- thartics, especially of calomel, and alterative doses of tartarized anti- mony, 1 have in the end resorted to the sulphate of quinia in the minute doses set forth in section 870 aa, and patients have been thus rescued from otherwise inevitable death. Here, too, as in numerous other gradations of febrile action, espe- cially where the constitutional affection is not subdued into a distinctly intermitting form, or where it remains complicated with declining in- flammations, quinine may be brought to bear advantageously in small doses, by associating with it the minimum doses of tartarized antimo- ny, when the former agent would be otherwise morbific. The anti- mony lessens irritability, subdues arterial action, and thus counteracts the stimulant virtue of the tonic febrifuge, while it also reaches more profoundly by its alterative virtue. 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 of the Uni- ted States, ten grains of the 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- ciated, we should also hear of them much more unfavorable reports. 002 INSTITUTES OF MEDICINE. 892, i. The celebrated French writer, and admirable practitioner Tissot, more than a century and a half ago, complained that the bark nad 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 ao-e was one drachm-of the powdered bark. If the fever were of the ter- tian type, he administered eight of these doses during the intermission or a dose every three hours. For a quartan, he prescribed the same dose, and at the same interval, so that, instead of an ounce, as in the tertian form, an ounce and a half would be taken during the period of intermission. " These doses," he says, " frequently prevent a rep- etition of the paroxysm." And this it would have done with greater success, had it not been the usage of those days to enjoin exercise upon these patients, and even to allow them solid food during the in- termission. As to the quantity of bark, Tissot gave tbe 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 of the compound. But, in a great proportion of the barks in common use, there is not the quantity of one grain of the alkaloids in a drachm of the bark. The crown bark of Loxa (C. Condaminea), an excellent species, and mostly in use in Tissot's day, has less than half a grain of the alkaloids to each drachm. These facts are of 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 efforts with quinia, and other powerful internal agents, as is very natural with a class so entirely uninformed of the true merits of the case, run to an opposite extreme, and imbibe a belief that medicines are hazardous unless in such small doses as shall exert no effect whatever. The THERAPEUTICS.--CINCHONA. 603 confidence of the public being thus more or less impaired in the whole profession, there will not, of course, be wanting those who, as in Tis- sot's day, will take advantage of this false conclusion, and will, as in former times, employ cinchona, and other remedies, in such minute doses as will render no aid to Nature (§ 854 bb, 878, 894, mottoes). 892, 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, " All 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 be 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 are again reviving doctrines which time and experience 604 INSTITUTES OF MEDICINE. have already demonstrated to be erroneous. The disregard qfphysu 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 of the liver, &c, which supervene upon intermittent and remittent fevers. But, in all such cases, there are other means not less important; such as a well-regulated diet of mild vegetable food, leeching and vesica- ting the affected region, the local or internal use of iodine, &c. In all such cases, however, the doses of quinia should not exceed one grain ; and the practitioner and his patient must yield to the necessi- ties of the case, and be content with advances toward a state of cure that shall correspond, in some degree, with the gradual progress of the disease from its incipient to its aggravated form (§ 150, 548 a, 557 a, 855, 856, 926). 892, I. Pereira has presented a good summary of the effects of quinia in the exclusive practice, as inferred from general experience. Thus: " In doses of ten grains, sulphate of quinia has produced on man three classes of effects : " 1. Gastro-enteritic irritation, marked by pain and heat of the gas- tric region, nausea, griping, and purging. " 2. Excitement of the vascular system, manifested by increased fullness of pulse and augmented respiration. 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 tbe varied and exact pathology of the individual cases of intermittent fever; and clear up, at least, any local congestions THERAPEUTICS.— -cinchona. 605 that are so apt to stand in the way of the 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 tbe 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 us that it has reached deeply the peculiar modifi- cation which had been impressed upon the congested or inflammato- ry states by tbe miasmatic cause ; while, on the other hand, had tho 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 of the cinchona alkaloids (§ 150, 870 aa). 892, o. It should be added that it has occasionally happened within the experience of the best observers, that acute and violent inflamma- tions have 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 of the remote causes of intermittents (§ 150, 151, 813 a, 816). 892, p. Besides tha 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 bead, covered by the eyelid, which was also extremely inflated or puffed up. All these maladies begin precisely at a certain hour, last about the usual time of a fit, and terminate without any sensible evacuation, return exactly at the same hour the next day, or the next but one." This reminds us of Hippocrates ; and the practitioner in the mala- rious districts of the United States will not fail to recognize in the graphic portrait the same things in his almost daily walks, as he does in the "epidemics" of the venerated father of medicine. The treatment of the foregoing cases is very 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 tbe 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 snbsultus tendinum, black tongue, sordes, &c. This form of the con- tinued fever is the typhus, and belongs to climates where the inter- mitting diseases are scarcely known to occur. In these cases, the 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 sections, they operate in virtue of their tonic property. But, like all other tonics, their range of usefulness, in this acceptation, is very lim- ited ; being suited only to advanced stages of acute disease, or to some chronic maladies in which digestion is peculiarly impaired, or to others attended by profuse mucous discharges, as in old and ex- cessive bronchial secretion, old diarrhoeas, Sec 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 of the whole group of tonics. ARSENIOUS ACID. 892£, 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 of the cinchona alkaloids. But, it remains as ever a sure friend of man whenever his necessities may oblige him to call it from obscurity. It is partly from these considerations, and in part, to look at its peculiar attributes as a curative agent, and thus to elicit new rays of light upon organic life and the philosophy of medicine, that I shall venture to disturb the repose of this once busy member of the mineral kingdom. But, these objects need not detain us long, as I contemplate a ref- erence mostly to its relations to intermittent diseases ; and much of what was said of cinchona is applicable to arsenic. This agent, how- ever, is not complicated by any tonic virtue, as otherwise supposed by many, which divests it of objections that are relative to that char- acteristic of cinchona. 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 maybe 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. 892|, c. Fowler's Report upon the effects of arsenic appeared in 1786, and subsequent experience has amply established its febrihVe 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 of the practitioners, who neglected the true pathology of the disease, overlooked the local developments, and permitted their prejudices against bloodletting and cathartics to deprive them of the benefits which might have accrued from the Peruvian febrifuge. Be- ing thus baffled in their attempts with an agent of tonic virtues, a few practitioners availed themselves of the reputation which arsenic had obtained in Poland as a febrifuge ; and this substance being destitute of the tonic and stimulant virtues of cinchona, it was more compatible with the local condition of disease, and therefore succeeded in the THERAPEUTICS.--ARSENIC. 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 of the local burdens of disease. Parallel with the foregoing is an opinion which is thus stated by Dr. Sigmond. " The effects of arsenic are much more striking in the intermittent fever occurring during the autumnal months, than during that which is prevalent in the spring; and the more intensely the miasm has act- ed upon the system, the more decided are its good effects, while cin- chona, and the barks of certain trees, produce their characteristic ef- fects during the spring."—Sigmond's Lectures, 1837. I have quoted this remark for the purpose of carrying out the views which I have expressed as to the failure of the bark in the English epidemics, and as it is its tendency, also, to encourage the use of arsenic in the autumnal intermittents, without any just ground for the conclusion as to its superiority over the bark in the fevers of that sea- son. The greater success of arsenic as here stated has been observed only in the hands of those who administer the bark indiscreetly, and without properly subduing the local congestions and inflammations which are every where more common and severe in the autumnal than in the vernal intermittents. And, as one of the evidences that the greater success of arsenic, under the circumstances now stated, is due to the absence of the tonic and stimulant virtues of cinchona, I may quote the remark from Pereira that, " It is not necessary to in- termit the use of arsenic during the febrile paroxysm. In agues, ac- companied with inflammatory conditions, where cinchona and quinia disagree, arsenic may, according to Dr. Brown, be sometimes admin- istered with the best effects." It has, he says, no tonic virtue. Immediately after the events of the British epidemic of which I had been speaking, Dr. Fowler appeared with his " arsenical solution," or the liquor potassae arsenitis; which has been supposed by many to surpass the arsenious acid in its remedial virtues. This preparation became the means of establishing, rapidly, the character of the new agent all over Europe. 892^, d. The question arises, next, as to what conditions of inter- mittent fever arsenic is applicable in preference to cinchona. 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 single grain, or of inducing, violent symptoms, or of laying the founda- tion of other serious and even fatal affections, in its usual therapeu- tical doses, if administered in inauspicious conditions of the system, or when continued, under favorable circumstances, 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 tbe 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- ;md 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, S63 d). It appears, therefore, that arsenic will be wanted mostly in neg- lected or badly-treated cases of intermittent fever; and the former will be more likely to yield to other means than the latter. In the neglected cases, disease can, at most, have been aggravated only by errors on the part of the patient, while art, with its powerful morbific 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 (§ 892{ c), to which arsenic is better adapted than quinine, or where the latter may fail on account of its tonic virtue. Again, other cases sometimes present themselves at all seasons where the vegetable remedy fails under the most judicious treatment. This may be owing to very peculiar modi- fications of the pathological states, or to unusual affections of certain parts, or to some idiosyncrasy. In short, arsenic is the next remedy, appertaining to the group before us, which should be tried after the failure of cinchona. But, it by no means follows that agents from othei 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 oigans of circulation. Otherwise, that intensity should be first moderated by leeching, blistering, low diet, &c. With this quaMca- i 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 ia advantageously associated with quinia, or administered in the associ- ated form of a salt. 8924;, 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. 892J-,/ 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. 8921, Ji, 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 single compound remedy comes to be distributed into what is equivalent to several agents; each remedial adaptation to possess an individuality which distinguishes it from other remedial virtues that qualify the agent as a remedy for other morbid conditions. In this way, I say, we avoid a confusion which has prevailed so extensively from considering a remedy of compound virtues in its general aspect alone. We are led to an attentive examination of its several virtues of their critical relations to different 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, chorea, 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, 892i b). When its use is long continued, emaciation is said to have sometimes followed, and now and then a low state of gastro-enteritis has been supposed to have supervened when iodine has been employ- ed in large doses. This, however, is considered a rare effect, and to depend upon the incautious use of the medicine. It has doubtless happened in morbidly irritable states of. the .alimentary canal (§ 137 d, 150). Lugol, who had great experience with iodine, says, that so far from even occasioning a wasting of the body, it promotes growth, and increases the size of organs, in their healthy state. The nervous system is said, also, to have been occasionally disturbed, in natural states of the body, by therapeutical doses of iodine; attended by headache, giddiness, &c. But here, too, there had probably been an antecedent derangement of the alimentary canal, &c. It has been also laid to iodine, that it has occasioned a state of the system which merits a name significant of one of its morbific 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. Those effects depend on reflex nervous actions. 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 of the 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, S70 aa). 892i, c. Perhaps the most remarkable demonstration of which io- dine is capable is in those latent forms of disease where nothing is present to denote the morbid state but some gradual change of organ- ization. This is seen especially in bronchocele, for which affection it surpasses, greatly, any other remedy. And here it may be said, as indicative, in every aspect of the subject, of the vital philosophy of the operation of iodine, that it is often as efficient in most of the local forms of disease for which it is employed, whether it be administered internally, or applied externally. It is also an important fact, of the same import, that the external application must be made over the re- gion of the affected part, when disease is seated internally; in which respect its mode of action through a reflex nervous process borrows light from the modus operandi of counter-irritants. Its control over the ordinary form of bronchocele is thoroughly established, and where it has failed I have no doubt it has been generally owing to some defect in the treatment. I say, the common form of bronchocele; for there are some condi- tions of the thyroid gland which nothing will reach ; which is one of the endless exemplifications of the importance of addressing our rem- edies to the exact pathological condition. Now the true bronchocele is constituted by a low indolent action of an inflammatory nature, that which results in hypertrophy ; better known at present as a " lesion of nutrition." To these lesions iodine is adapted; and, although it seek out the obstinate forms of disorganization, there are some morbid changes of the thyroid gland which have been mistaken for bronchocele, 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 of the general circulation, or functional derangement of the chylopoetic vis- cera. These, indeed, are 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 tbe 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 of the labyrinth of medical philosophy through which the enlightened physician directs, with so much relief to the whole race of man, the most potent, as well as the milder agents, of the Ma- teria Medica,—ay, the rcmedium 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 of the remedy. 892$, e. It should be considered, however, in reviewing the favora- ble reports which have been made of a new remedy, that here, as in most other cases, other observers have been less successful with iodine; THERAPEUTICS.--IODINE. 615 though a general admission obtains that it is more useful in scrofulous affections, with the exception of phthisis, than any other agent. This, therefore, is sufficient to place it upon very high ground as it respects the most Protaean disease. There is much reason to think, however, that those who have been least successful have often failed 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 the remedy, in consequence, frequently fails when it would have succeeded under a proper regard for the subordinate means. Failure in this respect may turn the " specific" into a form- idable foe, especially in active forms of disease (§ 137 d, 150, &c). Again, since the early day, recent to be sure, of the wonder-work- ing power of iodine, the reputed pathology of scrofula has undergone a revolution ; and where abstraction of blood, general or local, a non- stimulating diet, &c, were often considered necessary, especially in the primary stages of phthisis pulmonalis, a tonic and stimulant treat- ment has been erected upon the new doctrine (§ 4, 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; while it will rarely fail to aggravate the disease if employed before inflammation is brought under the discipline of the lancet, low diet, &c, or where the alimentary canal, or the system at large, is in an ir- ritable state. 892$, / Thirdly. The power of iodine, and of its combinations, reaches yet farther, and more remarkably, perhaps, than as respects its control over bronchocele. It has often accomplished the removal of certain chronic affections which appeared to have been 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 in some instances, but is comparatively inoperative, and they are beyond the reach of quinine. Coming to those chronic enlargements and indurations of the liv- er and spleen, which form the sequelae of intermittent and remittent fevers, tbe Peruvian alterative finds a competitor in iodine, though they will now harmonize together (§ 892, kk). Mercury, too, in some of its forms, is also more or less applicable to these conditions. But, to iodine we look with greater confidence in the intractable shapes; and here we may not calculate much upon the cinchona alkaloids. Nevertheless, even here mercury may be often advantageously asso- 616 INSTITUTES OF MEDICINE. ciated with iodine; and this is particularly true of bad forms of he- patic induration. Iodine, however, is more apt to take, in its thera- peutical scope, those enlargements of the spleen which are known as ague cakes. They have often yielded to its influence in this and 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 of the uterus have given way ; yielding entirely, in the most successful cases, within periods varying from six weeks to four months. These uterine cases, like the ophthalmic, illustrate the safety and advantage of applying iodine directly to the affected part, wherever accessible ; it being rubbed, in the 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 of the ovaries, and probably little, if at all, in ovarian dropsy. Leaving the uterine system for its associate mammary gland, we have many accounts of its partial success, at least, in those 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 of the remedy of which cupping is incapable. THERAPEUTICS.--IODINE. 617 892$, g. Iodine has been employed internally and externally, with various degrees of advantage, in chronic affections of the 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$, h. Nor has secondary syphilis refused to yield to the power of iodine ; and this, too, in cases where mercury has either failed, or has aggravated the affection.- But, these cases are not common, and we should not be led away from the better remedy by rare exam- ples of greater success from an agent which will commonly fail. Where iodine has succeeded in cases of this nature, without the co- operation of mercury, the syphilitic affection was probably under the influence of the scrofulous diathesis (§ 659, 662 a). Besides the in- ternal proof concerned in these cases, the foregoing conclusion is strengthened by the emaciation, ulcerations of the skin and throat, and the inflammation of the bones and periosteum, which attend the cases where iodine has exerted an independent sway. But iodine has succeeded most happily in syphilitic cases when combined with mercury; especially w-here syphilis has affected scrof- ulous subjects. But simple iodine, true to its great prerogative of overthrowing deep-seated mischief of chronic glandular inflammations, has been successfully applied to old venereal affections of the testicles, and to indolent buboes. 892$, i. Gonorrhoea and leucorrhoea, in their indolent states, have been successfully treated by iodine ; especially so in scrofulous habits, when the relief it yields is more uniform than in other cases. 892$, k. I stated just now, that iodine has been more successful in real ovarian tumors than in simple ovarian dropsy ; but other drop- sical affections have not escaped the far-reaching virtues of this new agent; though I have not much to say in commendation of its efficacy on this score. As in many other affections, it is evident that iodine delights in the worst forms of dropsy, and is little disposed to grapple with those simple conditions which depend upon mere inflammation of the serous or cellular tissues. It makes its attack, rather, upon those dropsies which nothing else will reach; such as are symptom- atic of organic affections of the liver, or kidneys, or spleen, or heart, &c, and where a low inflammation is instituted, sympathetically, in the serous tissue of the abdomen or thorax, as the immediate proxi- mate cause, and kept up by the organic disease. And now we under- stand how it is that iodine will sometimes reach these most formidable dropsies, since it is the peculiar province of this agent to break up old organic lesions ; and, in exerting this astonishing office in regard to the liver, &c, the cause which maintains the serous inflammation is removed, and the dropsical affection disappears as a consequence. Hence, again and again, the importance of looking well not only to the nature of the pathological cause, but to all the complications with which it may be attended, and their sympathetic relations to each oth- er (§ 905). 892$, I. Iodine has been successfully employed as an emmenagogue by most of the 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 more or less applicable to other affections attended by morbid irrita- bility of the gastro-intestinal mucous tissue. The same agent is also entitled to much consideration as an indirect emmenagogue in all cases where suspended menstruation is complica- ted with chronic enlargements or indurations of any of the great in- ternal viscera. In these instances, the uterine affection is only symp- tomatic of graver disease, as, indeed, it may be said, in a majority of other cases, to depend upon a primary though only simple derange- ment of some other part, especially of the alimentary canal (§ 689 /, 905). 892$, m. Chronic rheumatism has proved itself amenable, in some cases, to iodine. We shall find, however, much better remedies for rheumatism, in all its aspects. But, it is not remarkable, that a power so sovereign in many other intractable maladies should sometimes succeed in whatever less difficult and somewhat analogous instances it may be brought to bear. It must be considered, also, that the scrofulous diathesis is common, and that here iodine is at home. 892!;, n. In the form of iodine vapor, the novelty is even held up as a remedy for pulmonary consumption by Sir C. Scudamore, Sir James Murray, and others. But, it is scarcely probable that this condition can be effected in any other way than through the constitutional method, and it may be expected that the vapor will share the fate of boiling tar, and the steam of the horse-stable. 892$, 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. 892$, p. Iodine is employed by the surgeon for various local pur- poses, among which many forms of ill-conditioned ulcers are the most common. Here it often manifests its sanative influence, but more so when the cases justify its internal use. It were well, too, if these cases were oftener treated according to the precepts of medical phi- losophy and the experience of sound physicians. 892$, 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 tbe 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 Bimple 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 8921, r. I have spoken of the iodide of starch as suitable in many cases where the intestinal canal, or the system at large, is too irritable for the more active forms of iodine. But, I am apt to think that, in such'cases, we may also fall back advantageously upon the vegetable ;i thiops, or upon the burnt sponge. They have done us service in former times, and may do it again. It is certainly a curious fact, in the history of the Materia Medica, that the fucus vesiculosus and the sponge, one an unseemly weed of the ocean, and the other an anomalous organic being from the bottom of the Mediterranean, should have been applied to the relief of broncho- cele and scrofula, and have led to the important supplement which the Materia Medica has enjoyed in the iodides and bromides. Nor is it less curious, that a remedy for the same affections had been de- tected in the liver of the cod. Although the day of these mysterious agents has passed away,— passed in their uses and their mystery,—it may be that exigencies may now and then commend to our notice their quiet influences ; when we may depend upon it, we shall find organic nature as unde- viating in these low conditions of life as in all other objects within its comprehensive range. We shall always find iodine and bromine among these humble tenants of the deep ; and, in doses of one drachm to four of the calcined preparations, we may depend upon 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$, 28). S92$, 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 salutarv 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 in a healthier aspect of the fecal discharges. Simultaneously, also, tbe bowels act more freely; and, when purging takes place during the use of iodine, it is probably often more from the redundant flow of bile which it has promoted, than from the direct action of the rem- edy upon the intestinal canal. 892$, 2. Here, then, through these effects upon the organs of diges- tion, we arrive at an interpretation of those salutary changes which are exerted upon parts remotely situated. It is either a direct sympa- thetic result, or the sympathetic consequence of the removal of disease from the abdominal viscera, by which the remote affections had been maintained (§ 803, 804, 905). 892$, u. In 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 of the 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 (S 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. 892|, a. The origin and special character of ergot have been only recently well determined. Many have supposed it to be a morbid conversion of tbe seed, produced by some insect. Others regard it as a parasitical fungus; and it is incorporated by them as a true plant in the genus selerotium. It has been shown, however, by Tes- sier, and others, that a part only of the grain sometimes becomes er- gotized; which proves sufficiently that it is not a fungus.. The stig- ma, too, often remains at the top, and the ergot, like the rye, is inti- mately connected with the receptacle. Other observations, more re- cently made, prove conclusively that the microscope has been at fault, even in this very visible and hard substance, in its report of parasiti- cal fungi as constituting the ergotized rye (§ 83 b, 131). The ergot is now sufficiently shown to be a morbid degeneration of the rye. 892^, 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. THERAPEUTICS.--ERGOT. 621 The brief statement, which has now grown into volumes, of the wonderful properties of ergot, and of the only known substance which is capable of exciting uterine contractions, contrasts in its brevity and modesty not less remarkably with the never-ending and inflated ac- counts which are often coming to us of worthless specifics, and more worthless speculations, than does the 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 any preternatural obstruction prevent the delivery; as the violent and almost incessant action which it indultes 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 spurious growth of rye. On examining a granary where rye is stored, you will be able to procure a sufficient quantity among the grain. Rye which grows in low, wet, ground yields it in greatest abundance. I have no objection to your giving this any publicity you may think proper."—John Stearns, in New York Medical Repository, vol. xi., p. 308, 1808. That is the whole ; correct in every aspect, and without a practical improvement from that day to the present; unless it be an extension of some of the minor points which are embraced in the comprehen- sive statement of the discoverer. It may, therefore, stand as an admi- rable concentration of all the leading details relative to this great ac- cession to the universal cause of humanity and medical science. It is the best general guide for the practitioner that can be devised, and had it been duly posted in medical journals and obstetrical works in- 622 INSTITUTES OF MEDICINE. stead of some of its violations which have appeared from time to time, it 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 thing3 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 tbe 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 (§ 892£, 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, ahso, 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. In very large quantities it is said to be destructive to dogs, cats, pigs, sheep, rabbits, fowls, &c. But this effect has been evident- ly overrated, since it appears that some ounces were necessary to affect rabbits and pigeons. Sheep are put down by Pereira, in his THERAPEUTICS.--ERGOT. 623 Materia Medica, among the animals that are liable to be poisoned by ergot. But a little farther on he says that, "In 1811, twenty sheep ate together nine pounds of it daily for four we,ek9, without any ill ef- fects. In another instance, twenty sheep consumed thirteen pounds and a half daily, for two months, without injury." And then as to other animals : " Thirty cows took together twenty-seven pounds dai- ly, for three months, with impunity; and two fat cows took in addition nine pounds of ergot daily," with no ill effect whatever. The same conflicting statements are made as to the effects of ergot on man in health ; some affirming that in doses of half a drachm to two drachms, it excites nausea, occasions pain in the head, dilated pupils, &c; while other experimenters declare that it produces no effects what- ever. This is probably the fact; since we have heard of only some very rare cases in which it has had any other effect upon the susceptible preg- nant, or parturient female, than that of exciting uterine contractions. We may, therefore, conclude that the fractional number of some 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, 859 b, 892 c, 892$ b, Sec). 892 j, 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 tbe 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,dndeed, 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 bv 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 monor- 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 case,' 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. 892f, e. It may now be said to the young practitioner, that he should bear in mind that the expulsive efforts are made by the uterus, that all the devices of the lying-in chamber, such as straining, pulling, &c, are worse than useless; that the uterine contractions are in- creased in violence and frequency soon after the administration of er- got, and that they generally go on increasing till the birth is effected. Indeed, the parturient process sometimes continues, under the influ- ence of the agent, for several minutes after the expulsion of the pla- centa ; but it commonly ceases, so far as the ergot is concerned, after delivery is consummated (§ 150, 151, 652 c). 892|, / The rapid and energetic action of the uterus led Dr. Stearns to say, that, among other things, it is " of the utmost conse- quence to ascertain whether any preternatural obstruction prevent the delivery;" and, from what is also said of the circumstances which justify the use of ergot, it is evident that the discoverer considered a full dilatation of the os uteri of indispensable importance to any thing like a safe 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 ergot may be administered when the mouth of the uterus has attained the diameter of half an inch! This has been recommended princi- pally with a view to saving the time of the practitioner; and it opens to us the ground of the prejudices, which have sprung up in enlight- ened and more honest quarters, against the use of ergot when it can be possibly avoided. Where the safety of the mother does not re- quire earlier interference, it is, doubtless, a good rule not to adminis- ter ergot till the head of the child has passed the brim of the pelvis, and the labor has become lingering. If the remedy be delayed till the os uteri is well dilated, then, by an admirable concert of sympathy, the external parts will have either undergone a corresponding dilatation, or a tendency to an easy dila- tation (§ 150, 151, 385, and references). 892f, g. " 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 R r 626 INSTITUTES OF MEDICINE. appeai-s to be conceded that ergot may be employed when the head is rurned from its usual position. But, this is not auspicious. Breach presentations admit of its use where labor has become prolonged, and the pains suspended; though here manual aid may be safely applied without the forceps. These instruments are always difficult but in the hand of experience, and are otherwise more or less liable to ob- jection. 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 tbe 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 of the child; what- ever may be the activity of the uterine contractions. In such instan- ces it is not unusual for the pains to be quite energetic throughout the labor, but to cease abruptly as soon as the child is born. The advan- tage of ergot, therefore, administered some fifteen or twenty minutes before 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. 892f, 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 tbe 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 tbe hu- man constitution, she pause at her remaining office, it may often be that she is prematurely started upon her recuperative process, in which she now makes all haste to her wonted station. But, whether so or not, experience assures us that uterine imtability undergoes changes very rapidly after the expulsion of the fcetus, and that, in the same ratio, the virtues of ergot lose their special relation to the organ (§ 150, 151). 892§, n. Where retention of the placenta depends upon spasmodic action of the uterus, or is owing to morbid adhesions, ergot yields no benefit, and may be injurious. The former condition certainly consti- tutes a serious objection to its use. The reason is, that one part of the organ is now in a more irritable state than the rest, and ergot, therefore, will act with unequal effect and increase the spasm; just as a cathartic will increase spasm of the intestine which depends upon some inflamed portion of the mucous tissue of that organ (§ 150, 151). 892|, o. Our parturient agent has shown itself capable of arresting uterine hemorrhage 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. of the 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 change in the action of the part peculiar to itself, but differing more or less from that of astringents, by which the secretion of blood is ar- rested (§ 904 d, 890, a). Again, it is said that ergot has been successfully employed in hem- orrhages from the stomach, intestine, lungs, nose, and gums; all of which concurs in farther illustrating the modus operandi of the pure astringents, and of ergot in restraining monorrhagia. It should be added, however, that the anti-hemorrhagic effect of ergot, except as it respects the uterus, has been overrated. 892§ p. All the foregoing effects of ergot, from its excitement of uterine contractions to its restraint over hemorrhage, are demonstrative of its operation through reflex action of the nervous system, and, with a multitude of other things which I have brought to the attention of the reader, supply a ground of analogical induction as to the modus oper- andi of all other remedies (§ 893$). EMMENAGOGUES. S92|, q. In the foregoing sections I have been so near upon em- menagogues, and as the right treatment of amenorrhoea concerns so nearly a vast number of important cases, I shall briefly state the re- sults of my own observation in connection with this subject, and with a view, also, of multiplying illustrations of the principles which form the ground-work of these Institutes. Emmenagogues are arranged in my Materia Medica, under the gen- eral denomination of Uterine Agents, of which ergot is the first, can- tharides the second, and guaiacum the third in importance. I drop- ped the usual denomination which appears in this section, partly with a view of moderating a common belief that suspended menstruation is to be always 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 amenorrhoea. But, when the failure of the uterine function stands by itself, all the emmenagogues may be inapplicable on account of some special mor- bid state of the uterus upon which the cessation of the discharge de- pends. They are always contra-indicated, cantharides and guaiacum especially, in all inflammatory and irritable states of the uterus; at least, till these conditions are overcome by antiphlogistic means, They are also inadmissible where menstruation is only suspended by some direct influences, as from exposure to cold, &c.; and they are positively injurious where the suspension depends upon sympathetic influences propagated by some active form of disease in other organs. S92|, r. In a large proportion of cases, amenorrhoea 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 of the humoral pathology, and is one of the every-day practical illustrations of the amount of its philosophy. But, menstruation has a totally different final cause than humoral- ism imagines (§ 428-432). The evils which 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. 892f, s\ The foregoing view of our subject inculcates a variety of treatment in the multifarious aspects of amenorrhoea, and regards all things as emmenagogue, in principle, which will restore the ute rine function; though that be commonly one of the least important effects. A cathartic may be best when menstruation is suddenly ar- rested by exposure to the cold, or a hot bowl of motherwort may do aa well. Bloodletting is the main remedy when amenorrhoea is ow- ing to inflammation or congestion of the uterus, whether it be prima- ry or secondary. Exercise in the open air, especially on horseback, chalybeate tonics, mercurial and aloetic laxatives, a well-regulated diet, &c, are the means when it is dependent on indigestion. 892|-, t. Having accomplished the leading intentions in the chronic forms of amenorrhoea, 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. This variety of things leading to a specific result can be expounded only through alterative reflex actions of the nervous system 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. 892£, 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- bific reflex nervous actions which those or other diseases reflect upon the kidneys, and, thirdly, by exciting the kidneys to a freer jroduction of urine. These remarks relative to cathartics lead me to advert to their con- trol over dropsical affections as one of the demonstrations that dropsy depends upon inflammatory conditions. That pathological cause be- ing removed by the antiphlogistic virtues of cathartics, the redundant effusions cease. 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$, k). _ . 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 ; whetner they threaten his life, his limb, or his reputation. And so with any event in the success of which he has an immediate interest. All this, too, is equally true of animals; and it all conspires in showing that humoralism, and " dynamic" and " quantitive" chemistry, are upon the wrong track, and that as mental emotions can produce diuresis and per- spiration only through direct nervous influence, so do physical causes by reflex nervous action upon the secerning vessels (§ 422 b). 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 niy 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, 233|, 234 e, 500 c, g, k, n, 512, 652 c, 827 c, 828 a, 844 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 514, I. And as to offensive sounds, which fall under the same category, it is related by Dr. Fairfax that, " Mistress Raymond, whenever she hears it thunder, even afar off, begins to have a bodily distemper seize her. She grows faint, sick in her stomach, and ready to vomit. At the very coming over of the thunder, she falls into a downright cholera, and continues under a violent vomiting and purg- ing as long as the tempest lasts. And thus hath it been with this gen- tlewoman from a girl." Beddoes speaks of analogous results. " At any moment," he says, "inflammation may be kindled in any part by some causes which we cannot distinguish; by others too subtle for 632 INSTITUTES OF MEDICINE our senses, as, perhaps, by a thunder cloud passing over head" (§ 230 828 c). Until the nature of lightning was understood, it was sup- posed that it corrupted the blood in such cases. But, later " experi- mental philosophy" has enabled the chemist to expound it in anothei way, and to the easy comprehension of most people (§ 349, d, e) while the few take a more circuitous method (§ 222-233|, 500 893- 905), although at no little peril (§ 5$, a). Again, cold, 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 place it mainly upon the ground of direct and reflex actions of the nervous system. 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 ;r indirectly upon the secreting vessels of the kidneys, and mostly by means of direct or reflex nervous action. Loss of blood may be directly exerted upon the organs, or it may be, as is generally true, through the instrumentality of the nervous system, by removing dis- ease from some other part, as the liver (which is a common example), and which had sympathetically diminished the excretion of urine. The principles, as it respects the nervous power, and the change of organic actions, are the same with cold, fear, &c. Coming, lastly, to the diuretics proper, such as are truly remedial produce their effects, also, upon exactly the same principles (§ 277). Nevertheless, it is undoubted that certain substances of mild remedial virtues, especially such as are not offensive to the lacteals, or to the general organism, gain admittance more or less readily into the circulation; and, com- ing in contact with the kidneys, may stimulate, and increase the action of, these organs. Such, for example, are certain neutral salts. Prob- ably the acetates of potass and soda may produce their effects upon the kidneys more or less in this way; though certainly, also, through the nervous influence when they prove cathartic. In respect to these two agents, however, the chemical and humoral theorists are not all satisfied with their general hypothesis (§ 278). Nor is it at all surprising that the functions of the skin and kidneys should be so readily affected by the nervous influence, as developed by the foregoing causes, 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 of the organs (§ 423, 513, 902 / 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 tiphlogistics; having but little effect upon inflammations or fevers. Yet are they often prescribed in high grades of those affections (where the urine is greatly deficient), in the vain expectation of reaching those profound lesions bythe removal of one of their least important sympathetic consequences. Their use, however, with the more en- lightened, is now mainly limited to dropsical effusions in the great cavities and the extremities; however defective may be the patholo- gy, or however inefficient these agents are compared with bloodlet- ting, cathartics, blisters, mercury, iodine, &c. They are always most useful in cases that are benefited by loss of blood and by ca- thartics. 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 simple mercurials should be selected, as calomel, or blue pill; prece- ded, however, by loss of blood, &c. If, on the other hand, the drop- sical effusion have existed a good while, or be attended by chronic enlargement of the liver, or of some other viscus, the mercurial should be chosen with reference to such organic affections; though calomel or blue pill may answer well. But, in these cases, the iodides and bromides of mercury are the most appropriate; and now we may, sooner or later, employ squill with or without other diuretics, though it is commonly most useful to combine two or more together. If the subject be of a scrofulous habit, iodine should be used freely. 892^,/ Much has been said of the connection of renal disease with dropsy, and many physicians have, in consequence, gone into a chem- ical analysis of the urine, instead of the signs to be observed in the body, for an exposition of the nature of disease. But, so many coin- cidences have sprung up from other causes, that it may be expected that this " experimental philosophy" will not endure. 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. 892|, 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 of the least important in a large proportion of the dis- eases where they are employed, while the most important can be ob- tained only by remedies that do not fall within the group. The tendency of the name, and the definition which is given of ex- pectorants, have turned a great amount of attention upon the quantity 634 INSTITUTES OF MEDICINE. af 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 tbe 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 of the skin; while none but agents of considerable power will institute reflex nervous actions in the lungs, or give rise to that expectoration which grows out of such actions. All the expectorants, therefore, of any im- portance 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. • Reflex nervous actions, as excited by the operation of agents upon the stomach, depend not only upon the nature of the agents, the nat- ural function of the sympathizing part, and the particular mode in which it may be affected by disease, but upon the analogies that may subsist in the structure and vital constitution of the mucous tissue of the stomach and the part remotely influenced (§ 133-152, 525-529). The group of remedies now before us refer to a tissue of the same species as that of the stomach upon which the remedial agents exert their direct effect; and reflex nervous actions upon the pulmonary mucous tissue, when induced by remedial agents applied to the stomach, are, for this reason in part, different from such as are ex- erted by the stomach upon the skin, and are generally much more profound, and of a more alterative nature. 892|, c The effect of remedies, therefore, in their acceptation of 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. Non-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 asafoetida. Ferula persica. 12. Galbanum officinale. It will be seen, therefore, from the foregoing general distribution of expectorants, that four of them only are adapted to any thing like acute inflammation of any tissue of the lungs; and that the first two only are wanted. Moreover, none of the expectorants are employed as such excepting in some inflammatory state of those organs; or, at least, according to my views of all the pathological conditions for the relief of which the expectorants are intended. And when it is con- sidered, also, how very irritable and susceptible the lungs are when affected in their parenchymatous structure, and even those parts of the mucous tissue which line the bronchi, laryn^c, 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 sequelae of inferior moment; it becomes apparent that this group of remedies, with the exception of the two leading members, has numbered its victims next after those agents which form the groups of tonics and stimulants. Why, then, it is asked, perhaps, does the squill rank, in the arrange- ment, as the third in therapeutical value, and before the non-stimulant American ipecacuanha, bloodroot as the fifth, seneka the seventh, gum ammoniac the eighth, and these last three before asafetida, &c. ? The answer is important, although the order of arrangement assumed that the reader was sufficiently conversant with the principles upon which it is foundqd. It assumed, in the first place, that he was famil- 636 INSTITUTES 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 of the inflammatory nature of the dis- ease for which he was prescribing, as well as its exact seat; that he distinguished between acute and chronic forms of inflammation ; that he understood, that, as one portion or another of the pulmonary mu- cous tissue might be the seat of disease, and according to the special modification of disease, it might be relieved or 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 principles, and as chronic in- flammation of the mucous tissue of the trachea and bronchi is a very common form of disease, and is often benefited, in constitutions that are otherwise sound, by a stimulating expectorant, it was important that some one, at least, should occupy a high place in the Arrangement. But, it should be also one whose virtues are most of an alterative nature, but most exempt from morbific tendencies; whence it be- comes plain that the scilla maritima should stand immediately after the cephaelis ipecacuanha. It should also precede the gillenia, since the virtues of this last, as, also, of the asclepias, are analogous to those of the great 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 pf the conditions of disease to which remedial agents of such various and even opposite virtues as the expectorants THERAPEUTICS.--EXPECTORANTS. 63'/ 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. But, a nice discrimination of the variously-modified forms of inflam- mation, whether as to its nature, intensity, duration, complications, &c, and a precise acquaintance with the peculiarities of each reme- dial agent, will be often necessary to guide us to the just regulation of influences which any given combination of symptoms may demand ; or, proceeding blindly to execute the results of an expectorant, in its ordinary acceptation, and under the belief that each substance so de- nominated will alike fulfill the intention, we may as readily destroy the patient, in the end, by this indiscriminate practice, as we might, with certainty, 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 by reflex action through the nervous power, in the other (§ 150, 151, 226, 228, 229). It is, there- fore, far from being true that the remedy is appropriate when the dis- charge from the lungs is promoted and increased, even though an ex- pectorant be especially indicated, and the proper one may even tend to lessen the quantity of mucus; provided it facilitate its ejection and lessen the morbid action upon which it depends. 892|, c. We see, therefore, more and more, how indispensable it is to look upon results as indicative only of certain complex vital conditions which should be ascertained, and, as far as possible, to regard the proximate causes in all our prescriptions (§ 673, 674, 699, 741). Here we have a patient with a cough. A favorable or a fatal issue of his case may depend entirely upon the exhibition of the right expectorant. He may be cured by tartarized antimony, or may be killed by squill, seneka, or bloodroot. It is evident, therefore, that " coughs" depend upon 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- 538 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. 892|,/ 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,Nwith 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. 892f, 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. 639 732 d, 862-864, 890 e). If the disease be of such intensity that res- olution may not be effected by tartarized antimony or ipecacuanha, no time should be lost in calling upon general or local bloodletting, cathartics, blisters, &c. And when we consider how these accomplish the intention to which the expectorants are inadequate only from the force of disease, it will go with the many other analogous considera- tions 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 [mother 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 of the disease. The expectoration, therefore, is a mere result, a mere symptom, of a certain change in the action of the organs by which the mucus is secreted; and it may be the result of a favorable or an unfavorable «fhange. 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 of the 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 tbe existing state of the system, in a general sense, and more particularly upon the precise pathological condition of the lungs. It is apparent, therefore, that remedies from almost any group may- be expectorant; bloodletting, cathartics, emetics, narcotics, tonics, counter-irritants, and even alcohol. The last, indeed, in the form of hot toddy, is a popular remedy for colds. It may or may not increase expectoration. It may relieve, but more generally aggravates the disease (§ 756). 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 tbe 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 sign* of disease, and in defiance of the plainest demonstrations which therapeutical agents can supply (§ 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 end- less reflex nervous actions may be set in operation, together with the situation of the lungs in a bony cavity, frequently render it difficult to ascertain their exact pathological conditions, and to distinguish what may appertain to pulmonary disease from what may be due to the play of sympathies. The stethescope, like the long-established method of percussion, has contributed much to clearing away the obscurities, and has done its good part in substituting pathological considerations for mere effects, and has shown us that cough, difficulty of breathing, &c, are not diseases, but merely symptoms of disease. The scientific physi- cian, therefore, no longer administers expectorants, &c, for the relief of cough, or dyspnoea, but he applies the various agents to overcome pneumonia, pleuritis, bronchitis, laryngitis, pharyngitis, &c. In one case there is something tangible, intelligible, and susceptible of cer- tain and speedy relief; in the other, or where the prescription is made to the symptom alone, all is confusion, uncertainty, and death. Or.it may be some organic affection of the heart, or gastritis, or enteritis. or little more than moderate degrees of indigestion, upon which the cough or dyspnoea depends and yet where, from want of a proper anatomical knowledge, or of physiological and pathological science, the most unhappy mistakes are made with the expectorants, but where the better informed are often greatly aided, in their embarrassments, by tbe stethescope." But great as is the acquisition of the 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 lesion of the heart, or, others THERAPEUTICS.--EXPECTORANTS. 641 detect m the supposed cardiac 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 of the mucous tissue of the lungs, however mild or chronic, is liable to become exasperated, and to give rise to pneumonia, or to croup, or what is extremely common, to phthisis pulmonalis. And when we again consider how often the last 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 mem- bers of that group of remedies excepting those which belong to the first of the foregoing subdivision (§ S92§-, c). Independently of the di- rect practical results, attention would be turned upon bloodletting, antimonials, Sec, 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 of the 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 of the prejudices against loss of blood. The practitioner will soon imbibe the conviction which experiment produced in the dis- tinguished Cleghorn, that bloodletting can scarcely be misapplied under any conditions of pneumonia, and be led to avoid tbe 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-stimulatinu- 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 staning 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 tbe 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 shall be much happier in our inquiries into the means of cure. Who- ever, therefore, perfectly understands the nature of a pleurisy, or peri- pneumony, will easily perceive what immediate relief may be had from opening a vein; for, upon this point so depends the whole safe- ty of the patients, that, if you should depart from this kind of medi- cine, in vain will you seek for any other." But, I would finally say of pneumonia, that however the disease may abate under the direct effect of loss of blood, it not unfrequently happens that the symptoms recur with more or less violence. It is this which we are to anticipate and watcb, 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, e,f,g, h, 1007 b, c, d, 1008, 1068 c). 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. That vesicants and leeches operate in the foregoing manner was ex- pressed by me in the London Medico-Chirurgical Review in 1834. See p. 827, § 1056. 893 b. Counter-irritants are embraced in my eighth order of 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, Colly ria. Of the 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, &c. As in respect to all other general or partial groups, the several members of tbe 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 without 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 tbe 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 skin, 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 may be 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 display of reflex nervous actions 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 may be THERAPEUTICS.--COUNTER-IRRITANTS. 645 salutary, while another less intense, but spreading over a greater sur- face, will be often fatal. In all these cases, however, the effect is morbific, and they exemplify the very close analogy between the op- eration of morbific and remedial agents (§ 901). It is, indeed, the amount of the agent, whether physical or 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. In the case of vesicants, their action should be so circumscribed as to operate mostly through local nervous centres, or by contiguous, not by remote sympathy; and hence a use of these terms (§ 497, 638$). Bloodletting will secure this by lessening irritability and general reflex nervous action. In the long journey which 1 have thus far traveled, I have been ex- tensively employed in seeking out the provisions which the Author of Nature has so bountifully, however intricately, ordained for the re- lief of those principal diseases of mankind, fever and inflammation. And yet we have often had occasion to see that many of the most val- uable agents for these purposes are directly productive of inflamma- tion when unskillfully applied. This is often exemplified by many of the cathartics; and the Peruvian bark, and its analogous tonic asso- ciates, will relatively cure or exasperate intermittent fever, according to the exact conditions under which they are administered. We have seen, indeed, that even wine, brandy, &c, now and then become rem- edies for fever, and even for inflammation (§ 752, &c, 892 g,p). The apparent contradictions I have endeavored to reconcile, and to show that the occasional coincidence in the results of agents which are opposed to each other under ordinary circumstances is due to a com- mon law which governs the operation of all causes upon organic life. The causes operate upon those properties in which life fundamentally consists, and thus give rise to healthy, or morbid, or curative effects, just as they happen to affect those properties (§ 137 d, 150, 151, 177, 189 b, 350$, 350^, 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 iriost simple form of common inflammation (§ 721, 722, 729 a). These means are, prm- 546 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 of the great principles of solidism and vitalism, and of the stupendous laws by which healthy and morbid processes are earned on, and illus- trate that connecting medium between them which is constituted by the various gradations of the restorative movements as instituted by remedial agents under the great recuperative law of organic beings. The whole is but an intimate chain of analogies from the most perfect- ly healthy state to the gravest conditions of disease (§ 901). We see, also, distinctly exemplified, by the mode in which blisters, setons, &c, produce their favorable results, that absolute remedies in- stitute the process of cure in virtue of their morbific qualities; and this becomes the more striking when we associate with the alterative influences of vesicants upon internal inflammations, through the arti- ficial disease which is established in the skin, those natural cutaneous inflammations, as erysipelas, &c, that are subdued by the direct con- tact of the vesicant with the inflamed surface. 893, e. We may now pause, for a moment, to observe how clearly the various effects of cantharides prove the operation of curative agents, either by a direct action upon the organic properties of a dis- eased part to which they may be applied, or through the instrumen- tality of the nervous power when they extend their therapeutical sway to distant organs, and how, also, the nervous power is variously mod- ified, and variously reflected upon remote parts, according to the na- ture of its exciting causes (§ 227, 228, 230, 233£, 497, 500). The common mode in which cantharides, setons, moxa, scalding water, burns, &c, relieve or increase deep-seated inflammations, or disturb the system at large, is clearly manifest; and since only one of the foregoing agents is liable to absorption, every precept in philosophy divests the coincident effects of cantharides of a shadow of possibility that they are due to an absorption of the agent. We have seen, too, how erysipelas may be removed by the direct action of cantharides upon the part inflamed ; and this (especially when associated with the remote effects of all other remedial agents) assures us, as a next link in the demonstration, that a modification is imparted to the nervous power, according to the special virtue of the remote cause, which op- erates, in that particular instance, upon the remote part in a mode corresponding more or less with that which is observed in the primary action. And now if we look at what is often going forward in the blad- THERAPEUTICS.--COUNTER-IRRITANTS. 641; der, we shall see yet farther (something for the senses, something for u 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 are dependent on reflex nervous actions, it would be a dis- creditable violation of the 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; and hence, by reflex nervous action. But, though the cantharides supply an apt illustration of the whole philosophy of our subject, and, like the natural developments of in- flammation which follow each other by reflected nervous actions, de- note a modification of the nervous power in great conformity with 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 mariner in which the nervous power is reflected with salutary or morbific effect through certain motor nerves by the peculiarities of each exciting and modifying cause (§ 233f, 500 g), while there is simultaneously pre- sented by the operation of cantharides a curative influence upon all parts that are affected by disease, and a morbific one upon a special part that was antecedently in its natural state (§ 150, 151, 188 a, 190 a). But they act usefully only through local nervous centres. 893,/ From what has been now said, it is manifest that vesicants 648 INSTITUTES OF MEDICINE. ssues, setons, and other counter-irritants do not produce their favora- ble effects through the discharges to 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. It relates to the nervous power, and is explained in fy 479. But, in no respect is the influence of time so remarkable as seen in the difference of results in the treatment of acute and chronic diseases; in which respect counter-irritation is on a par with other remedial in- fluences. When inflammation is recent, the usual rapidity with which cantharides operates is best suited to almost all forms of the disease; 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 the 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, &c, are more or less apt to establish a morbid habit peculiar to the modifying agents; and, although it be a first step in the series of changes which are necessa- ry to establish the full recuperative process, the pace is retarded by the habit induced. To break this force of habit, it is only necessary to intermit the agent during the time required by the healing of a blis- ter. The curative impression remains, and the irritability of the or- gan diseased undergoes an increased susceptibility to the agent at its successive renewals. Each repetition gains upon the last, and often presents the aspect of cumulative influence. The principle is shown in relation to many things, and may be seen in the action of antimo- ny, opium, &c, in former sections (§ 550-556, 558 b, 889 m, 902 i). 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), and in which reflex nervous action is equally concerned. 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 1 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 tbe extent of the surface over which an artificial irritation should be established. This will manifestly depend upon a variety of circumstances; upon the nature of the irritant, upon the extent, force, and situation of the disease, &c. [f the usual agent, cantharides, be employed, and the surface 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 reflex nervous action may be morbific, although the artificial irritation be not intense. The difference in effects is of the same nature as that which attends the small, deep burn of moxa and an extensive superfi- cial scald ; the former being of no importance, while the latter may be speedily fatal through a sudden and violent reflex nervous action. But, there is a great 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 reflex nervous actions, and may be but little disturbed, while, in the latter, the violence of the impression upon the system is proportioned to its instantaneousness ; and the extent of the surface irritated being great, a violent shock 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 tbe 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 (§ 479). If the disease be of a different character from inflammation, as the suddenly painful affections of the stomach that are incident to indiges THERAPEl TICS.--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 desperate 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 may be necessary to determine a sufficiently powerful nervous influence, of which six inches would fail (§ 479). But, in respect to inflammation of the brain, it should be distinctly understood that vesication of the scalp is entirely inadmissible, un- less the imtability, and therefore the susceptibility, arising from the morbid state, be greatly lessened by abstractions of blood, cathartics, Sec 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 of the seat of disease. Their salutary effects, like their morbific, depend more upon this approximation than upon any special sympathetic relations between certain parts of the surface and the particular internal organs ; since it is mostly through local centres of reflex nervous action that these agents produce their curative effects (§ 497). 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 of the 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 of the same organ, or to other parts, is by remote or by contig- uous sympathy (§ 497, 498). It is also particularly true of certain tissues that they are apt to extend the violence of their remote influ- ences upon 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 mammas. 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 of the disease, which has led to a very com- mon error in practice. It is supposed that there is a translation of the disease from one part to another, an actual movement of the complaint —something, probably, after the manner of the gases, as represented in a former section (§ 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 of the affection, but from which disease has taken its de- parture. And so, also, counter-irritants are applied to the parotid gland, should the testes, or 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 reflex actions of the nervous system, and nothing is want- ed to render the treatment appropriate and intelligible but a knowl- edge of physiology and pathology. All the ambiguous results are di- rectly referable to the laws which govern the operation of the nervous power, which now presents itself in the compound aspect of a mor- bific and remedial agent among parts which have either strong natu- ral relations, or which are especially susceptible of morbific influences that result in the condition which is the supposed subject of transla- tion from one part to another; while, in its turn, the sympathetic dis- ease propagates, after the manner of vesicants, curative impressions upon the primary seat of the disease by like reflex nervous actions, Secondly, the artificial irritation excited with a view 'to recalling the disease (as in vesicating the joints when gout attacks the stomach, and this, too, even when that organ maybe the primary and only seat of the affection) is very different from the modification of inflamma- tion which constitutes the pathological state of the disease itself, and therefore would not become, by any reflected influence upon the parts beneath, a substitute for it; while it is certainly an anti-pathological mode of recalling the specific, or any form of inflammatory disease, in deep-seated parts, since counter-irritation is one of the principal means by which we remove inflammation of these parts. The foregoing practice, as founded upon the doctrines of metastasis and revulsion, is contra-indicated not only by physiological laws, 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, 5\, 5$, 349 d, 3504-350J). But, let us have an example in rela- tion to the effects of counter-irritation by cantharides, as propounded by the great head of the Necroscopic School. Thus : " Blisters," says M. Louis, " ought to 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 ]" ! " 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, 3503 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- flammation, &c, let them be directed to the organs which are the seats of disease, by applying them over, or in the vicinity of, their regions, to obtain the advantage of local centers of reflex nervous action. As to the doctrines of metastasis and revulsion, which have had their origin in the phenomena of reflex nervous actions (especially as witnessed in the successive development and subsidence of disease as they obtain in gout, rheumatism, and mumps), the whole system is constantly supplying examples of the accession of one disease as the sympathetic consequence of another, and the subsequent decline of the primary affection as a sympathetic result of the secondary de- velopment. And here, by-the-way, we are presented, in the natural process, with a perfect exemplification of the principle upon which counter-irritants operate in subduing diseases remote from the seat of their application ; and we may thus readily comprehend how it hap- pens that the discharge from an ulcer, or a seton, or blister, &c, will be suddenly arrested, or the superficial parts turned into the worst conditions, by the occurrence of disease in some internal part. 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 lv 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 m 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 reflex nervous ac- tions of diseased parts,—between the rise and decline of diseases, in certain parts, as consequences of each other, and the curative effects of many internal agents, that a vast number of therapeutists, overlook- ing the relations of the alimentary canal to all other parts, confound these internal remedies with the external counter-irritants ; classing them all under tbe 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 tbe 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 tbe 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 ao 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. But I have shown that counter-irritants exert their good effects only through local centres of reflex nervous action, while they are injurious Avhen they develop a gen- eral reflex action of any intensity through the brain and spinal cord however those organs may otherwise participate, and such is the perni- cious effect attending this counter-irritation of the intestinal canal. Opposed to metastasis, revulsion, derivation, &c.,'is the doc- trine 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 of the 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, and general reflex action reduced. In connection with the last remark, it is also worthy of observation, that free bloodletting, in acute rheumatism, is strongly opposed upon the ground of its tendency to involve the heart in rheumatic inflam- mation. But, in all the reputed cases, the inflammation had probably already affected the heart before tbe abstraction of blood, and consti- tuted cases for a very extensive application of the 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 of the circulation. THERAPEUTICS.--COUNTER-IRRITANTS. 657 893, o. Among the evil consequences of vesication is a bad condi- tion of autaneous 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 bladder has no strong physiological relations beyond its own system of organs, and pain is not apt to prove morbific, of itself (§ 140, 422, 891 m). There is no way of preventing its occurrence in particular subjects with any certainty. 893, p. The foregoing are the most obvious injuries which are produ- ced by vesicants, especially by cantharides (§ 893, 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 (fy 893 c). It is the last condition which is the most frequent cause of the un- favorable effects of blisters, and which, in the hands of superficial ob- servers, have led to the denunciation of this important antiphlogistic. The inauspicious states for vesication depend, especially, upon too exalted irritability of the parts diseased, or of other organs ; particu- larly of the heart and general circulatory system. If blisters, or oth- er counter-irritants, be applied to the skin in this state of morbid irri- tability, the diseased parts are roused to a greater intensity of morbid action, and the whole vascular system to a more violent movement; so that a series of untoward results is thus instituted, which sympa- thetically and mutually, aggravate each other, and give rise to new morbid developments, till the multiplying 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 feaiful ef- fects in the complicated malady which will be long celebrated in the annals of medicine (§ 893 c). Tt 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, of the direct and immense advantages of bloodletting, cathartics, antimonials, &c, we realize more sensibly the force of their importance, in acute inflammations, at least, when we consider that without the antecedent aid of one or another, but of bloodletting especially, we are 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. Moderate, first, general reflex nervous action. In all grave inflammations loss of blood is indispensable to the most useful effects of cathartics, or to their safety, and is absolutely the only condition under which counter-irritation should be attempted. Just as long, also, as the disease may remain in force, or general or local abstractions of blood may continue to be useful, vesication should be delayed. This remedy may then succeed with the most happy effect upon any remaining disease, even though it have passed into some other form than that of inflammation. In the 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 of the stomach, and where, too, the liver has generally become more or less involved in morbid action. Vesication will not reach this condition, till general bloodletting or leeching shall have been duly pre- mised ; and cases are not uncommon, where, after repeated and large abstractions of blood, such is the force of morbid habit, that the dis- ease finally issues in copious haematemesis. There are, also, many of the fluctuating states of the stomach in chronic indigestion, where no inflammation has invaded this organ, in which blisters over the epi- gastric region, and without any other remedial agent, bestow great relief. The appetite and digestion are at once improved, and the pa- tient started along upon the road to health, and placed in a state for the full and rapid influence of change of air, exercise, Sec The anal-, ogy, too, in these cases, with the useful effects of tonics and stimulant^ in others, contributes farther light upon the therapeutical influences of the latter remedies (§ 890$). Again, among the sequelas 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 of the 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 of the true counter-irritants, and, if we now turn our attention to the large group of agents under the denomination of local alteratives, as set forth in my Materia Medica, we shall see, that, in all the instances, each substance has an altera- tive action 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 of the true counter-irritants. These, however, will of course de- pend upon the amount of absolute irritation which the several agents may produce in the skin; some, as gum ammoniac plaster, proving a very positive 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 of the liver, spleen, &c, that almost any one of these local alteratives will sometimes yield complete relief. We see it following tbe 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 (§ 892J-1, 904 c). In connection with the foregoing subject, it may be useful to sonify who may 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, &c, may ultimately prove efficient, when they might have been powerless without the antecedent influences of leeching. The tumors, indeed, may not apparently have yielded in the least to the virtues of the leech; but this remedy will have placed the diseased part in a state of susceptibility to the action of other agents. The principle has been variously before us (§ 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 fg in the early stage of the disease; and when, at more advanced periods, Nature takes on this recuperative effort, vesication is the principal re- maining means by which wre may contribute an aid that timely blood- letting would have greatly surpassed, and would have given to art what ultimately belongs to Nature (§ 805). 893$. Before entering upon the following Summary Review of the General Philosophy of the modus operandi of Remedial Agents, whose operation I have resolved, essentially, by alterative influences of reflex actions of the nervous system, and with a reference, also, to what I have said so extensively of this universal agency in the organic life of animals, I will recall an important ground by which the reader may be aided in his conclusions upon this subject, and which had escaped ob- servation till the publication of the Medical and Physiological Comment- aries. Even Dr. Philip, in his experiments (§ 476-493), neglected the analogy of which I am about to speak, referred the modified secretions to chemical agencies, and sacrificed his great labors to the interests of chemical physiology and the humoral doctrines. This analogy is the admitted operation of reflex nervous influences in exciting muscular movements. But that is the only result that is witnessed. There is no obvious change in the muscular action from what is natural. Not so, however, with the results in the great processes of organic life. Here the secretions are not only increased or diminished, but modified in their nature, and various morbid conditions produced or removed; and hence it is assumed that these results must be owing to very differ- ent causes from that nervous power which simply produces contractions in the muscles. It is entirely neglected, in this rationale, that the vas- cular systems are totally different in their functions from those muscular fibres upon which the nervous power makes its obvious demonstrations, as in convulsions, vomiting, respiration, contractions of the iris, of the sphincters, etc.; and, although there is a vague apprehension with some that blushing is owing to nervous influences, yet as there is seen only a transient redness, even this ground of analogical reasoning to changes of vascular action that give rise to increased, or diminished, or otherwise modified secretions, or the production or removal of disease, etc, is equally regarded as an abstract fact that supplies no information upon the less obvious problems. Neither is it considered that the vascular apparatus manifests a far more exquisite susceptibility to the direct ac- tion of common stimuli than the muscular fibre, and therefore that the vessels may be equally sensitive to that nervous influence which so read- ily excites the fibre in muscular organs. Another difficulty consists in comprehending the modifying influences of the nervous power upon se- creted products, and in its production and removal of diseases, etc., ac- cording to the nature of the remote causes; and this grows out of the habit of neglecting the phenomena and of reasoning alone from what is physically demonstrable. An attentive perusal, however, of what I have hitherto shown of the mutable nature of the nervous influence, and what remains to be farther expounded upon the subject, I cannot doubt, will remove all obscurities from this profound problem in physiology- (See Indexes, Arervous Poiver, Reflex Action, Nervous System, Mental Emotions, Will, Causes Morbific, Remedies, Secretion and Excretion, Milk, Bile, Salivary Glands, Respiration. 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^us. " Natura malum sentiens gestitat magnopere mederi."—Galen. "natura repugnante, nihil prof1c1t med1cina."—celsus. "natura defic1ente, quicquam obtinet medica ars, perit .eger."—hlppocrates. 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 summary review of the relative facts and doctrines contained in former sections. 894, b. In approaching, again, the modus operandi of remedial agents, I may first repeat the most essential points,—that the vital principle is a real substantive agent, of which the vital properties, irritability, mobility, 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 I have denomina- ted sympathetic sensibility; that the nervous powrer 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 principle is due its alterative effects according to the nature of the exciting causes; and, finally, that a common principle is at the foundation of the philosophy, wheth- er the manifestations of the nervous power be displayed in maintain- ing the concerted action of the healthy organism, or in derangino- that action, or in restoring disordered movements, or as the power maybe 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 variousnatural mod- ifications which they sustain in different tissues and organs,—to the variety of those organs, and the differences in their respective func- tions,—to their intricate connections and dependences by means of sympathy,—and to the endless variety in the nature of the virtues of foreign agents which are capable of inducing modifications of the or- ganic states of every part, and according to the 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 its laws of reflex action, as hitherto set forth, and through which I interpret all the influences produced by morbific and remedial agents upon parts that are remote or but slightly 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, 495-529, 855, 895, 902/). 896. The whole philosophy of the operation of morbific and reme- dial agents rests, as we have seen, upon physiological principles. Exactly the same philosophy relates, also, to the corresponding ef- fects of 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 of the iris, the irritation of faeces or of urine which maintains a contraction of the sphincters, the food which excites the muscular action of the stomach or the contraction of the pylorus, the cathartic which purges, the emet- ic which vomits, the narcotic which arrests diarrhoea, or allays irrita- bility, or induces sleep, the gastric stimulant or 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 either through reflex or direct action of the nervous system. Anatomy and experiment confirm what each phenomenon, and all united, proclaim the work of that mystic power, operating on those organic properties which are the moving springs of every action, the proximate cause of every ef- fect; nor can another intelligible solution be rendered for a single phenomenon now expressed, or thousands of similar import, while every other must be in conflict with the pronunciations of Nature and the demonstrations of art. Nor will an attempt be made (an attempt that shall commend itself to the understanding) now, or hereafter, to controvert the philosophy which is here presented. The first step in its overthrow must be the overthrow of Nature. All must bow to this conclusion, however unacceptable to the humoralist, or unpalata- ble to the materialist (§ 1034, 1039, 1040, 1075). 897. It has been seen, also, that the fundamental philosophy of dis- ease is perfectly simple, as also that which concerns its cure; that dis- ease is essentially nothing more than a deviation of the properties of life from their natural standard, and a consequent corresponding change in the functions over which they preside; that the artificial cure consists in a restoration of those properties and functions by making upon the former certain impressions which enable them to obey their natural tendency to a state of health ; that remedial agents of positive virtues operate like the truly morbific, but less profoundly in their therapeutical doses, and that the philosophy of their cure con- sists in establishing, in a direct manner, certain morbid alterations in the already diseased properties and actions of life which are more conducive to the natural tendency that exists in the vital properties to return from morbid to their natural states. 898. It follows, therefore, when disease subsides under the influ- ence of remedial agents, that it is only in consequence of the great law of recuperation, which is brought into sensible operation by the production of morbid states which are favorable to its development. But, if disease terminate fatally, it is owing either to morbid altera- 064 INSTITUTES OF xMEDICINE. 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 frouuthe opera- tion alone of that natural principle which has been established for the preservation of health, and the perpetuation of organic beino-s. 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 sots 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 of the natural ten- dency of the properties and actions of life to return to their healthy state, a very few remedial agents may be all that are requisite to the attainment of that result; while experience shows that our materia medica is encumbered with superfluities. Take a large variety of pathological conditions, such, for example, as are presented by inflam- mation, it is not necessary that a certain uniform change should be established by the remedies, but only such as shall favor the recupera- tive tendency. Bloodletting brings about one kind of change, cathar- tics another, antimony 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 tbe 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, Sec, whose influences are of the mildest alterative nature, and appear to co-operate in a di- rect manner with a tendency to restoration which had already begun; or, as in hooping-cough, where the restorative process is often easily introduced. Our remedies, therefore, are curative by substituting new pathological conditions, and nature does the rest; and it is only with a view to a right interpretation of their modus medcndi 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 evidently, also, contiguous sympathy, are conducted by the nervous power through the medium of the cerebro-spinal and gangli- onic systems; while, as I have also endeavored to 6how, 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 mariner, from the organic properties of one point to tlie next in apposition. 9Q2, b. I have variously shown that the nervous power is capable of acting as a vital stimulus to tbe organic properties, is liable to be variously developed by morbific and remedial agents, and to be so modified in its nature according to the virtues of such agents, that it produces, more or less, in diseased parts, remote from the direct seat of the morbific or remedial action, the changes which the agents them- selves would exert were they applied directly to the remote organs. The nervous power may be, also, equally determined with a morbific or cu- rative effect upon the organic properties and actions of the great ner- vous centre ; or upon any of its radiating parts. The philosophy is also exactly the same when one diseased part gives rise to disease in parts that are remote; and when disease in remote parts, that has been maintained by affections of other parts, subsides in consequence of the restoration of the latter, it is owing to the removal of a perni- cious modification of the nervous power that had been constantly propagated by means of the latter upon the former. 902, c. The type of the foregoing philosophy exists in various pro- cesses which are naturally going forward in the animal body. A sin gle example of this nature is a key to the whole labyrinth. Thus : " The whole system of respiratory nerves can be excited to action by irritation of any part of the mucous membrane, from the mouth to the anus, from the nostrils to the lungs." Mechanical irritation alone is adequate to the greatest variety of effect, as broadly stated in the foregoing law of sympathy. Tickling the fauces provokes vomiting, irritating the anus produces purging, and thus are the muscles concerned in respiration, and those of the stomach and intestine, and even the liver and the salivary glands, brought into unusual action by slight mechanical irritation of the fau- ces or anus. Irritate the same tissue in the nose, and the respiratory muscles are thrown into another mode of action; irritate the larynx, and another mode is excited; call up the recollection of the finger in the fauces, and the mind may determine all the sensible results of an active emetic. There is the great principle. It is greatly the work of the nervous power, excited in one series of the cases by impressions transmitted from distant parts to the nervous centres, and in the other by the di- rect operation of the mind upon tbe 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, &c. It is the same as concerns the respiratory movements, which, as I have said, may be regarded as an elementary exemplification of the most entangled operations of the nervous pow- er. The modus operandi may be repeated in its exemplifying rela- tions to this subject. The point of departure, in. the process, is the 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 (§ 233J, 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 of the action of light upon the eyes (§ 514, I), the process is more complex, and shadows forth the far more intricate movements that are in progress,—the almost end- less reflex nervous actions which are taking place,—during the progress or decline of disease, or those which are set up by the operation of an emetic, a cathartic, &c. (§ 1040). 902, d. Physiological examples of the foregoing nature abound in the animal organization, and supply the most ample ground for the in- terpretation of the effects of remedial and morbific agents in their wide range of influences. The modifications of the 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 stomach, with the special relations of this organ to the central parts of the nervous sys- tem and to the respiratory muscles, &c. (§ 138, 149, 150, &c), while the nervous power is also modified in its nature according to the pe- culiar virtues of the emetic (§ 227). The most sensible result, as in respiration, depends upon the reflection of the nervous power upon the respiratory muscles, while another current descends through the motor fibres of the pneumogastric and sympathetic nerves to the mus- cular tissue of the stomach. If the emetic operate also as a cathartic, then a new chain of actions is established, in the same way, upon the abdominal muscles, while a current of the nervous power is propaga- ted upon the muscular coat of the intestines (§ 233£, 889 a-f). 902, 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, of the deep effect which the modified nervous power exerts on the diseased parts, they may return, at once, to their natural state (§ 841, 2, b, 143, c, 148-151, 855, 895). 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 antimony, and often from ipecacuanha, it is only one of the consequences, and a minor one, of the peculiar irritation of the gas- tro-mucous membrane. Other and far more powerful influences are determined, simultaneously, upon the organic properties and actions of distant and diseased parts (perhaps as distant as the most remote extremity), by the same nervous power that shook the respiratory organs during the act of vomiting. And often, indeed, does it happen that those influences are propagated with the most profound effect, when the act of vomiting fails of being consummated; and nausea, alone, shall send with prostrating 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 the evacuation of the flu- ids, after the manner of an active purgative,—these very effusions, also, instituting other circles of reflex action, which join in the great THERAPEUTICS.--REMEDIAL ACTION. 669 woik 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 reflex actions,—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? 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 eights, offensive odors, loss of blood, and even their recollection; while the nature and effect of the greater number should lead the phil- osophical inquirer to pause at the physical doctrine of absorption, and survey the other difficulties with which it is fatally encumbered. 902, i. When the alterations, of a sympathetic nature, are more slowly produced, as when mercury 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, Sec, the nervous power is developed and modified at each suc- cessive dose, and the repetition of its rertection 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 of the cumulative effect of remedial agents, some of which are much more remarkable than others, and the ultimate results are pronounced with varying degrees of suddenness. This is also influenced by pe- culiarities of constitution, or of susceptibilities of the organic proper- ties to changes now under 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 of the 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 of the animal fabric, as in the sphincters, supplies an elegant parallel with the foregoing uninterrupted influences of the same pow- er as developed by remedial or morbific agents. This power oper- ates as a perpetual stimulus to the organic properties of the muscles just mentioned, in the same way as blood does to the heart 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 tbe 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 (§ 479). 902, m. A more intricate example may now be presented relative to those natural means of cure which occur in a former section; such as change of air, exercise, &c. (§ 855). These are all positive rem- edies, and, of course, they have their modes of operating. One ex^ ample will open the philosophy of the whole. How, then, does change of air suddenly arrest an obstinate form of the hooping-cough] There is gastric as well as pulmonary disease, and the mucous tissue of the stomach is preternaturally susceptible to the influence of many causes. The air exerts its impression upon the lungs, and upon the general surface of the body. But, there must be other agencies in operation before the lungs will experience relief. These agencies appertain to the nervous power, which is developed by the foregoing impressions, and reflected upon the stomach and other abdominal organs. If there be disease here, it is more or less relieved, and the more so, the great- er will be the ultimate salutary impression upon the lungs. The abdominal impression is transmitted to the nervous centres and the nervous power reflected with its alterative influence upon the pulmo- nary mucous tissue, and thus ends the disease. The spasmodic ac- tion of the respiratory muscles is, of course, arrested by withdrawing the preternatural operation of the nervous power from those muscles,as a consequence of the subsidence of disease in the pulmonary mucous THERAPEUTICS.--REMEDIAL ACTION. 671 tissue (§ 902, 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 of the utmost im- portance in medicine. Its laws are precise. Their knowledge will lead to a greater dependence upon the functions of organic life (§ 878, 905 b, 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 system, 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, or by reflex nervous action. 904, a. In considering the philosophy of the effects of the nervous power, it is important to regard its nature as liable to modifications from the slightest influences, both physical and 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 ihe 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, tbe 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 ex/site 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 alterative reflex nervous actions 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 (§ 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 of the hydrocyanic acid, within a single sscond, 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 of the hydrocyanic acid, " after two or three hurried inspirations." Pereira says that he " once caused the instantaneous death of a rabbit by applying its nose to a receiver filled with the vapor of the pure acid. The animal was killed without the least struggle." And so did Magendie. Pereiraadds, 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 that it immediately arrests the peristaltic move- ments. Apply it to the surface of the brain, and it instantly lessens the action of the heart and capillary blood-vessels, &c. Now combine these phenomena, when opium exerts its direct action upon the stom- ach, and indirectly upon the heart, capillary system, &c, and consider the natural relations between the stomach and nervous centres. Take a 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 of the 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 of the body a scarlet efflorescence" (§ 891, e).—Ibid. Is not this phenomenon due to the same principle as that which is concerned when indigestible food occasions analogous eruptions, or when they spring up, as in infancy especially, from 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),* that they depend upon alterative reflex nervous actions. The following are other facts which demonstrate the local operation of remedial and morbific agents, and tbe 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 of the pupil." Now consider the effect of this " imponderable quantity" in connec- tion with the analogous effect of imponderable light (§ 514, k), and the modus operandi of the latter will be found to coincide with that of the former. The cases are remarkably parallel, and the more in- teresting as showing the transmission of influences through sympathet- * In connection with what I have incidentally said in a former section of the advanta- ges of opium in the cerebral congestion which is induced by the intemperate use of alco- holic 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 of the disease, should be well aa 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. Uu 674 INSTITUTES OF 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 throuo-h different sensitive nerves, while in all the cases, the motor nerve and the part which is impressed by the nervous power, are exactly the same (§ 233f). It is also worthy of remark, as exemplifying the modification of the nervous power by preternatural agents, tnat 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 piecn of the herb to his eye, when the effect remained for three weeks." He states, also, that a dilatation of the pupils may be prouueed 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 band, 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, Sec). "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 rectum ] Most remedial agents, indeed, produce con- stitutional effects according to the natural vital modifications not only of the mucous, and other tissues of different parts, but of one contin- uous tissue, as the mucous membrane of the. eyes, nose, fauces, oesoph- agus, stomach, small and large intestines, larynx, trachea, and lungs. Where would philosophy be; where our interpretation of these vari- ous consequences, if we followed the chemist in his physical views of life 1 What would tobacco affect in such a case ] 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 understanding1? 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 opiurn smoking,—especially as the whole volume of smoke is drawn into thd lungs'?—(Mat. Med., p. 1293.) Shall we not rather look to what is known of the natural modifications of irritability in the mucous tissue of different organs 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 reflex nervous actions. But the distinguished author above quoted shall lay down our principle him- self. °Thus: " Sir B. Brodie," he says, " found that an infusion of tobacco, thrown into the rectum, paralyzed the heart, and caused death in a few*min- utes. But if the head of the animal be previously removed, and arti- ficial respiration kept up, the heart remains unaffected ; proving that tobacco disorders this organ through the medium of the nervous sys- tem only" (§ 484, b).—Ibid., p. 869. 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 of the eyes, nose, mouth, stomach, or lungs. And so of the spirituous extract of nux vomica. If absorption be good in some of the cases, it should be equally so in the others. Consider, too, how the habitual use of narcotics reduces the susceptibility of the stomach to the influence of each one, respectively, and not to the oth- ers, and how the constitutional effects go on, pari passu, in the ratio of the local effects. And consider, also, how music assuages suffer- ing, or the expectation of the dentist relieves toothache. And why, according to the doctrine of absorption, should not medicines produce the same constitutional effects when injected into the bladder, as when administered by the stomach 1 Are you doubtful as to tbe manner in which certain substances produce their constitutional effects, when applied to the skin, as mercury and tobacco, for example 1 Consider the foregoing case of hydrocyanic acid ; or how an issue relieves deep- seated inflammation ; or, again, how belladonna, or hyoscyamus, when applied to the lids of the eyes, as when to the stomach, produces dil- atation of the pupils (§ 1066). 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 not 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 jn 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 stomac, proving that its effects depend on reflex nervovs actions. 904, c. Pereira has rendered our best standard work on Materia Medica liable to the objection which I am now considering, as he has, also, to that of reasoning from the effects of remedies on man in health, and even upon the naturally modified constitution of animals and plants, to the altered susceptibilities of man as they exist in disease. Of tartar emetic, he says, we do not know " the mode in which it pro- duces its curative effect." And again, a universal opinion'— " Shall we deny the efficacy of bloodletting in inflammation, of mer- cury in syphilis, of cinchona in intermittents, and of a host of other remedies, simply because w*e cannot account for their beneficial ef- fects ] The fact is," he continues, " that in the present state of <>ui 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 1 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 of the great principles in medicine, and to the revival of the 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 minute 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 of reflex actions of the nervous power in the nat- ural conditions of the body, and as modified by a vast variety of ex- periments, and by the morbid processes that are perpetually before us. 904, d. Again, take the grand characteristics of the cinchonas, arse- nic, calomel, and the whole group of agents for intermittent diseases. Of cinchona, Pereira says (after having expounded its operation as a tonic through the process of absorption), that in intermittent diseases its " methodus medendi is quite inexplicable."—(Ibid., vol. ii., p, 1002, 1006. 1840.) But, is not its mode of operation just as intelligible in one case as in the other 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, Sect If we refer, as does Pereira, to the effects 678 INSTITUTES OF MEDICINE. of cinchona as a tonic, 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 mav 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 (S 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 of their peculiar attributes, as to alter the natural condi- tion of the organic properties and actions; and this alteration consti- tutes disease. All that follows are but mere " sequelae." Remedial agents, as we have seen, are capable of doing the same thing; and when direct in action, they operate upon the same principle. It is for this reason, therefore, that they produce disease in the healthy or- ganism ; and when they contribute to the cure of disease, it is in vir- tue of that morbific action which they exert on healthy parts. They are a class of morbific agents, however, which produce only such dis- eases, in health (if not administered in great excess), as are of a tran- sient nature; and when, therefore, administered for the cure of dis- ease, they induce a morbid state more favorable than the pre-existing to the natural tendency of morbid organic properties and actions to return to their healthy standard. 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 of the eyes. In this instance, nothing can possibly enter the circulation, but the whole influence of the se- ton upon the eyes must be exerted through reflex actions of the nervous, system. By tracing out all the effects of which this seton is capable, we may show that it involves all the principles which are concerned in the production of disease and its cure (§ 63-81). In the first place, the seton establishes an inflammation in the part of the skin in which it is inserted. Here we have the whole inter- pretation of morbific agents in producing their 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 of the seton upon the inflamed eyes. Let us, then, suppose that the seton is permitted to remain in the neck after it has accomplished the cure of the eyes, till, finally, it ex- 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 (§ 233f). 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 (fy 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 of the ligaments or other tissues, may, after having greatly fulfilled their purpose, ultimately keep up a degree of the disease, or increase its intensity. But, if the skin be now healed, the disease will subside spontaneously,—the very healing of the skin reflecting salutary influences. This is often verified by tho effects of remedies when administered internally; disease being ulti- mately aggravated by the means which were at first curative, but again yielding with rapidity as soon as the remedy is discontinued. In all the cases, the ultimate subsidence of the aggravated conditions of disease is owing to the artificial modifications of their pathological cause. This recupNerative law lies at the foundation of therapeutics, and it shows us that the first and greatest step in the treatment of dis- eases is to remove their exciting causes; when the natural physio- logical constitution may require no other aid from art. 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 wbidi 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 reflex nervous influences. This, in fact, is more or less the case, in most diseases, after the morbid state is propagated from the primary seat. In the example now stated, all the diseased parts act and react upon each other, each becoming a point of departure for the develop- ment of a morbific nervous influence, and each affection, therefore, contributing to maintain and aggravate the others. Other organs join in, though perhaps not essentially disturbed, and take their part in the disease, according to their degrees of affection, and more or less, also, according to their relative vital importance and constitutional rela- tions ; while the great movement of diseased action may be variously influenced by the contingencies which grow out of constitution, tem- perament, age, habits, external influences, &c. (§ 512, &c). And so, on the other hand, when the curative process begins, wheth- er instituted by nature or by art, the whole organic system may con- cur in the salutary change which is started at a single point (§ 143, c, and references there). 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 1o 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^ 752-756). Tbe example supplied by erysipelas, in which blisters and leeches may afford relief, when ap- plied to the inflamed surface, either separately or conjointly, is only another impressive evidence of the close approximation of the various pathological states of inflammation ; and the variety in the remedial virtues of the curative agents which have now passed under review 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 sa on; but each one induces a change from which the morbid properties are capable of passing to their natural state (§ 892J, 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 tbe 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" objects of each group, respectively. Since, therefore, emollient poul- tices and warm fomentations effect the greatest amount of relief, and are far more generally applicable in practice than all the rest, as local sedatives, they should hold the first rank in the arrangement, notwith- standing the activity of their virtues is immensely less than that of the other substances which I have mentioned. It is the effect of all, how- ever, to lessen irritability and sensibility, and thereby to moderate or subdue inflammatory action. But 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 of the group of local seda- tives. Poultices and warm fomentations produce the least of this change in kind ; their effect scarcely reaching beyond that of reducing an exalted state of irritability and sensibility, or of keeping it down THERAPEUTICS.--REMEDIAL ACTION. 683 where it is liable to ensue. The acetate of lead follows next, in this simple but most valuable effect. The foregoing moderate influences, with little or no specific altera- tion in kind of the morbid properties and actions, is just what is want- ed in a vast number and variety of morbid states, as in superficial in- flammations, abdominal irritations, sprains, bruises, piles, &c, or as means of prevention in the hands of conservative surgery. There is nothing comparable, for these purposes, with warm poultices and warm fomentations. Their immense services in the healing art, 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 tho 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 Avhich they are in contact. In conservative surgery, poultices have even less participation in all those temble 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 of the 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 tho 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 (§ 892f, 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 around 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 ergotce. 3. Cantharis vesicatoria. 4. San- guisuga. 5. Guaiacum officinale. 6. Juniperus sabina. 7. Ferrum, et ferri sales. 8. Aloe socotrina. 9. Balsamodendron myrrha. 10. Hydrargyri sub-murias, etc. 11. Hydrargyri iodidum. 12. 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 tho other. We have already seen how ergot is mainly useful in parturition; and its ob- vious effects through reflex nervous action supply a clear analogy for expounding the effects of the other agents (§ 893£). The other members of the Class of Uterine Agents are such as are denominated emmenagogues, with the exception of the fourth. But, leeches should evidently follow cantharides, in the order of importance, as capable ol yielding relief, not only in the next greater number of cases, but in very difficult pathological conditions of the uterus; while the high place which they occupy is significant of irritable and inflammatory, or con- gestive affections of the uterus which may often call upon their aid, and admonishes the practitioner to beware of most of the other agents which follow. It is not, however, to such cases alone that leeches to the perinseum ar3 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 stimujating emmenagogues, if admissible, will affect the condition of the organ ; though its susceptibility to these agents may be estab- lished by leeching (§ 137 d, 892| 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 892|, 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 (Ev, in, firjv, 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 of the digestive organs, to sympathize with inflammatory, or ir- ritable states of the uterus, that these cases soon become complicated, and we may then turn to the example of the seton for the principles of treatment, nor waste our efforts at unavailing attempts with em- menagogues addressed to the symptom, or to a more rational view of the pathological state of the 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 of the 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 of the 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 of the 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 1 But which, and how much, what the pathological shades, what the ex- act condition of the uterus, how far it receives and reflects sympathet- ic influences, are matters for critical inquiry (§ 894 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 of the 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 maybe 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 of the uterus, or again for some general plethoric habit, or some ob- stinate chronic gastritis, and where the functional derangement of the uterus is of very little importance. In many of these cases, general bloodletting should take the lead in the treatment; and the menses may start under the beginning impression of the remedy (§ 872 b, 89.2$ 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, how 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 reflex nervous actions, 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 of the 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 of the failures of art, and have contributed to swell the nomenclature of " nervous diseases (§ 659, 855, S56, 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 Fiance, 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, and a just appreciation of the rel- ative therapeutical value of the various means which may be the sub- jects of his transient inquiry. But, the group now under considera- tion, being exclusive, and, withal, not as liable to morbific effects as are most other classes, the uninformed has less chance at mischief than when he approaches the cathartics, &c.; where physiological and pathological knowledge is far more important. It is readily seen, therefore, that one, or more, of the foregoing agents may be exactly adapted to a given modification of disease, in- flammation, for example, affecting either the mucous tissue of the va- gina, or of the bladder, or of the urethra, while it would be very un- suited to another modification ; and, from what we have seen of the natural modifications of the vital constitution in the same tissue as it may occur in different compound organs, and in different parts of a continuous tissue as it traverses different organs (§ 134-137), it is ev- ident that great circumspection is often necessary in the application of these agents; and farther, also, that what may be immediately useful 688 INSTITUTES 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- rhoea. Here, again, the inflammatory states, which constitute that af- fection, vary constantly, not only as to force and habit (§ 535, &c), but more greatly in the absolute modifications of inflammatory action. For all this knowledge, we must go to our general principles, then to all the minutiae of symptoms (§ 685, 686). Among the last, none are so important as the exact character of the discharge, which varies, by gradations, from purulent to mucous, and from this last to a bloody, or a brown watery, or a more simple watery fluid; just as we have seen of analogous phases in the condition of ulcers, or of intestinal inflam- mation (§ 693, 740). Now, it is clearly wrong to treat any one of these several conditions exactly in the same manner; and where the differences are broadest, so, also, must be the variations of treatment. In indolent states of the disease, and where the discharge is mostly purulent, if the general health be tolerably sound, we may proceed, at once, to the exhibition of cantharides; and, as soon as slight stran- gury takes place, the disease will generally surrender. But, should it, in the cases supposed, refuse to submit, or should the individual be insusceptible of the special action of cantharides, as will common- ly be denoted by the failure of its effect upon the bladder, we may safely, and commonly with certainty of success, resort to vaginal in- jections of the best nitrate of silver, in proportions varying from three to eight grains in an ounce of water. But, if the discharge consist of mucus, or any other than the puriform matter, cantharides will ag- gravate the affection, and the nitrate of silver, at most, will do no good. If it be mucus, it denotes an intensity of inflammation, which calls, at least, for a simple vegetable diet, and, probably,for leeches to the perinaeum, along with the general antiphlogistic treatment. In these cases, therefore, we have nothing to do with the genito- urinary agents. Equally inapplicable, also, 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 of the science. Tlrs last remark leads me to another more important than the rest j 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, through alter- ative influences of reflex action of the nervous system. 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, tly THERAPEUTICS.--REMEDIAL ACTION. 689 the sympathetic affection will react upon the system at large, espe- cially in the more intense form which is denoted by the mucous pro- duct ; and this, whether the genital affection be primary or secondary. Here, then, we must apply ourselves to the general health, attack what may be the citadel of disease; but, to do this efficiently, and that our prescriptions may carry with them the combined virtues of tuto, cito, et jucunde, the practitioner may not undervalue the Insti- tutes of Medicine. Whenever the uterus is the seat of disease in its mucous tissue, like all other organs which may be especially affected in one of its parts, the other component parts suffer, more or less, sympathetically (§ 138, 141 b, 5Uf, 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; and as two agents of similar virtues in rela- tion to a specific object, and of nearly equal pretensions, and both of them stimulant, lead off in a general class of remedies, they are, by the position they occupy, standing mementoes of the frailty and vul- nerability of man, and incentives to study well the varying conditions of 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 of the 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 of the Heme dy and the various Circumstances of Disease. 906, a. " The serous portion of the blood, or even pure blood, may escape from the over- distended vessels, just as toater transudes through the permeable sides of a vessel, in which it svjfers compression. To this source are to be referred several hemorrhages and dropsie« produced by simple transudation in a tissue mechanically congested; and although these af- fections have really nothing active in their nature, yet are they considerably diminished and sometimes altogether removed, by bloodletting-, which, in such cases, acts in a man- ner purely mechanical, by removing from the vessels the fluid by which their parietes were kept in a state of over-distention."—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 tho 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. " K we have to deal with an extensive and violent inflammation, we do not abstract blood by a minute opening; we make a large orifice, or we open a vein in both arms at the same time; we place the patient in an erect posture, and endeavor to produce deli- quum. It sometimes happens that the patient faints frem fear, or before any considera- ble quantity has been lost; and this faintness, as Dr. Arnott remarks, answers as well as that which results from venesection" (§ 960, a).—Graves, in London Med. and Surg. Journal, vol. iii., p. 391. e. Ad extremos morbos extrema remedia exquisite optima."—Hippocrates (§ 960 h). 906, f. Whether the father of medicine, or his modern descendants, oe right or wrong in their medical precepts, especially in relation to the therapeutical uses of bloodletting, it will be an object of the pres- ent inquiry to ascertain (§ 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 of the right, and, in so doing, to ascertain, also,how far philosophy and practical habits have outstripped the Ancestor. We may also, perhaps, come to some determination whether a knowledge of the principles upon which bloodletting operates be worthless, or necessary to its just and intelligible use (§ 893, n), Whether we should know what absolute influences it exerts, or how it exerts them, before we can appreciate its applicability, and its ap- propriate extent, in many important morbid states where the remedy may be more demanded than in other conditions whose phenomena clearly indicate its necessity (§ 857). Perhaps, also, it may be useful to science, as well as humanity, to strip this remedy of its mechanical interpretations, and to place it upon that dignified ground surrounded by those hallowed laws of the Godj 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 of the vital influences of the loss, and of the whole theory of the asso- ciate influence of the nervous power, appeared for the first time in the Medical and Physiological Commentaries (§ 222, b). Copyists, it is true, have appeared, especially of the accumulated facts, without the slightest reference to him who performed the labor (§ 435, b). Although, therefore, the same philosophy, and the same practical applications of loss of blood, are preserved in the Institutes as set forth in the Commentaries, they are now rewritten and presented in anoth- er shape, with greater brevity, and with reference to that systematic order which shall best subserve the young Inquirer. The same is also true of other subjects which may have been investigated in the Commentaries. 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 of the 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 of the affected vessels, and stagnation of blood within them, and extend the hypothesis to the hot stage of idiopathic fever. The philosophy, therefore, is vitiated by the pathological views upon which it is founded. Moreover, were the 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 1 & founded upon any rational principle. 912. How, then, does bloodletting operate! How are dise*ijed parts immediately and permanently unloaded of their blood, in „ome instances, by the abstraction of two or four ounces of blood, wh«n, in other cases, under apparently the same circumstances, a great extent only, of the remedy will effect the same result ! Why, in such cases, may the former quantity induce syncope, when the latter has .io such effect ! " Syncope," says Robert Jackson, " occurs sometime in yel- low fever from the loss of a few ounces of blood, sometimes scarcely from tbe loss of six pounds." Why does this coincident obtain i with so many other remedial agents ! Why do we see the >edness of an inflamed eye give way permanently while the blood is flowing from the arm, and why does the same change take place as rapidly, and even more perfectly, in any of the great organs when equally inflamed and loaded with blood! 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, l)% 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 have said of the modus operandi of every other remedial and morbific agent—nay, even with the natural stimuli of life. 913. The inquiry now proposed will extend from the beginning 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 of the 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 vita, 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-susceptib?e organic properties of the small vessels (§ 189, 931, 935 b). THERAPEUTICS.--LOSS OF BLOOb 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 reflex nervous action begins upon the heart as soon as the changes have somewhat advanced in the capillary ves- sels to which the leeches are applied, and a rapidly-increased amount of this cardiac influence ensues as soon as the whole capillary system is involved in the contractions which the leeches institute at the place of their application. The effect, as expressed in section 917, is originally propagated along ihe extreme vessels by continuous sympathy, but reflex action is noon brought into operation, when both modifications concur together; hut it is chiefly by reflex nervous action that the heart is influenced (§ 933). 920. 6th. Such are the simple elements of the processes which take place in leeching. But, during their progress, they become more or less compounded. The reflex nervous influence which is propagated from the extreme to the larger vessels reacts from the latter upon the former, and this reacting sympathy increases the contraction of the small vessels. So, also, as soon as the vital changes in the extreme vessels throw their reflex nervous influence over the heart, the changes which take place in this organ reflect back a sympathetic influence upon the extreme and capillary vessels, by which their power over the heart and larger vessels becomes multiplied (§ 514 h, Sec, 526 a, 934). This complex circle of reflex nervous actions continues to ad- vance till the heart becomes overpowered in its action, and syncope takes place (1039). 921, a. 7th. An artificial change being instituted in the extreme vessels to which leeches are applied, where the organic properties are most strongly pronounced, and that change being more or less permanent, it continues to excite a powerful reflex nervous action upon the whole capillary system, and thence upon the heart, long af- ter the blood has ceased flowing (§ 514 g, 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 Aaken by the process of cupping (f 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), and therefore no persisting reflex nervous influence. 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, thouah 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 or«-;inic 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. The nervous power is differently developed. Although, therefore, in these cases, nature institutes a chance 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 tbe enormous losses of blood which are often necessary, by tbe natural process, to the cure of inflam- matory and congestive diseases (§ 136 c, 150-152, 524 a, no. 3, d, 890 c). 923, a. Besides the foregoing play of vascular sympathies, a strong impression may be propagated by the whole organ to which leeches are applied, to another organ with which it has strong natural sympa- thetic relations. In low inflammations and venous congestions of the liver, four ounces of blood taken from the verge of the anus by means of leeches may break up those obstinate hepatic affections, when 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 498, f, g ; and this continuous sympathy gives rise to alterative reflex nervous action. 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 mora 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 THKRAPKUT1CS.--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 reflex nervous action, by the instrumentality of the mucous mem- brane, to the viscera of the abdomen, and that the head is as well re- lieved by thus removing this source of morbid sympathies, as by the more direct impression (^ 524 a, no. 2). 923, d. Hence it follows, as shown also by experience, that leech- ing will generally exert the greatest effect upon diseased organs when applied to some part with which the organ affected may have strong physiological relations (§ 129, 139,140). For this reason, and for the advantage of continuous sympathy, leeches should be applied to the anus in muco-intestinal inflammation; but, to the cutaneous region when inflammation affects the peritoneal coat of the intestines or ab- domen. There are greater natural sympathies between the skin and peritoneum, than between the mucous membrane and the peritoneal. Where no remarkable relations subsist among organs, the leeches should then be applied near the vicinity of the part affected, as when the pleura, or parenchyma of the lungs, or the joints, are the seats of inflammation. In such cases we obtain the advantage of local reflex actions as in the case of blisters, &c. (§ 497). 924. And now a word more as to the doctrine of Revulsion, or that, for example, which supposes that when leeches are applied to the feet for the relief of cerebral disease, the effect depends upon the diver- sion of blood from the head toward the feet. And so of cathartics in their action upon the intestinal canal, and of blisters by diverting the blood to the skin, &c. (§ 893, n). Nothing can be more unfounded. But, do not leeches, when applied to the feet, exert a greater influ- ence upon diseased conditions of the uterus than upon any other part! They probably do; and it is a forcible illustration of remote sympa- thy, and coincident with that which is supplied by the suspension of the catamenia from exposure of the soles of the feet to cold, or by the production of 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 head ! " In affections of the head and thoracic vis- cera," says Dr. Wardrop, " I have, in many instances, recommended patients to apply leeches on the head, chest, and on the feet, alternate- ly ; and almost universally, I may venture to say, a decided prefer- ence has been given to the feet." The philosophy is the same in all the cases, and revulsion is reflex nervous action. Dr. Wardrop, how- ever, had already preferred the application of leeches to the nasal •eptum, or to the temples, in affections of the head ; though his obser- vations as to the feet are also founded on sound experience. As to leeching in amenorrhoea, the remedy has the greatest effect when ap- olied to the perinaeum, or to the upper part of the 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, pt 927), or untill the excitiing nervous action is subdued. 925, b. Nevertheless, if the chance of leeching alone be taken in these cases, the number of leeches should be very large for adults that the benefits of general bloodletting may be more or less obtained through a rapid and copious abstraction of blood. This practice will often succeed in 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 of the vital influences of leeching, and of the effect of habit in maintaining disease (§ 549, 560). In these cases, the impression, being frequently repeated, maintains the salu- tary change which may be produced, more perfectly against the mor- bid influence of habit, than greater losses of blood at distant intervals (§ 514 g, 535, 540, 542, 548, 549, 557). We see the same principle more frequently exemplified in the effect of blisters upon chronic in- flammation ; where it is better to apply them frequently, and to a moderate extent, than more rarely and over a larger surface. The philosophy is the same, also, in respect to the relative effects of a large dose of calomel, and that dose divided into four. Analogies likewise subsist between the salutary effects of copious leeching, extensive vesication, and a large dose of calomel, in acute inflammations (§ 559, 893 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). The philosophy of the whole is alone re- solvable through reflex actions of the nervous system (§ 893 h). THERAPEUTICS.--LOSS OF BLOOD. 697 927, a. Notwithstanding, therefore, the last proposition in respect to leeching, it often happens that the force of diseased habit is so great as to demand a more decisive and more frequent resort to leeching. It is even not unfrequent that the force of morbid habit attendant on chronic inflammations requires the previous abstraction of blood from a vein, and perhaps repeatedly and largely; not only with a view to the special physiological influences of general bloodletting, but that a large diminution of the general volume of blood may be suddenly effected (§ 925, a). The utility and necessity of this practice are fre- quently seen in the treatment of those chronic inflammations of the mucous tissue of the stomach which follow long-protracted indiges- tion, and especially if the liver also have become invaded by the same condition of disease. The advantages of general bloodletting in these cases relate as much to the general condition of the system over which a morbific influence has been established as to the seat of inflamma- tion. The general modification exerts a reacting effect upon the part inflamed, and adds to the obstinacy of the diseased habit of the part, and leeching will not reach these influences (§ 143 c, 847 g). Here it is, particularly, that we witness corresponding, and even more suc- cessful, 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 exciting reflex nerv- ous actions have been subdued by general bloodletting, local bleeding by leeches is pre-eminently useful. In either of these cases, general bloodletting continued to a large extent, by the suddenness and vio- lence of its impression, may so disturb the system at large, that the in- flammation may be kept up by influences produced by this artificial derangement of the whole 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 ot 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 leeching by the exigencies and the peculiarities of each individual case; and it is especially important with infants, upon ,whora 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 noon 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 may be sometimes a means of relief in those inflamma- tions that are now and then induced by a misapplied or an excessive loss of blood. In these rare affections, the triumph of art is beauti- fully illustrated when accurately guided by the light of science. 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($ 1024 a, Dr. M. Hall). 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. Tbe 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 vessels, 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 reflex nervous actions 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 reflex nervous action over thev 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 excites a powerful reflex influence that falls 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, theiefore, as in leeching (§920), the contraction, and other charges, which take place in the small vessels, grow out of a double influence; namely, that which is exerted by the direct impression from loss of blood, and that which is reflected upon them by the changes that arise in the heart and larger vessels. And so, as in leeching, reflex nervous action between the heart and blood-vessels passes and repasses, and increases in an increasing ratio as the blood flows from the arm, till its prostrating effect reaches the point of syn- cope. In leeching, however, the sympathies between the heart and blood-vessels are not as reciprocal as in general bloodletting; but a greater influence, in the former case, is exerted by the small vessels upon the centre of circulation (§ 921). 935, a. That the failure of the heart's action does not arise, as com- monly supposed, from a mechanical diminution of the volume of blood, is shown by the frequent occurrence of syncope from the loss of two or three ounces; nor does it depend, in the least, upon with- drawing the stimulus of blood from the heart. On the contrary, as it respects both hypotheses, the blood is actually accumulated about the heart, in consequence of the contraction of the capillary vessels; and this accumulation, from the beginning, is a cause of the failure of the heart's action, and is at its greatest extent when syncope takes place (§ 936). 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 reflex nervous actions which it exerts upon the heart (§ 916, 917, 932, 937). 935, c. In like manner, the diminution of the volume of blood in in- flamed parts is only a remote effect of lessening the quantity of the circulating mass. The blood is not only temporarily, but permanent- ly expelled from the injected vessels. This shows that its expulsion is effected by a vital change in the condition of the vessels; otherwise, they would not contract in a ratio exceeding that of the correspond- ing vessels of other parts, nor would their contraction be permanent. Vessels that are enlarged in inflammation to many times their natural diameter are often reduced to nearly their natural volume while the operation of bloodletting is in progress (§ 910, 977, 1056). Various circumstantial facts might be adduced to show the vital na- ture of the contraction which attends the capillary vessels. The fol- lowing are relative to idiosyncrasy; and the principle which I have set forth is an evidence of the accuracy of the reporter's interpreta- tion of the phenomena, throughout. Thus : Dr. Paige, " of large ex perience and great respectability," states, in the November numbei (1845) of the "New York Journal of Medicine," that, on bleeding " a woman about forty years of age, and after having drawn a very few ounces, and while the blood was still flowing from the vein, she was taken with very severe pain all over the external parts of the sys- tem, and extending to the most remote extremities. I suffered the blood to flow, however, but the pain increased instead of diminish- TOO 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 ure 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, especially the agency of the nervous influence. 936, a. When general bloodletting is practiced in health, the action of the heart begins to fail as soon as the vessels begin to contract; but it is the tendency of inflammation to delay or prevent the vascular changes under an equal loss of blood, while, on the other hand, those changes are often promoted by venous congestion, or by numerous adventitious influences, either moral or physical. 936, b. Again, it frequently happens, after the action of the heart is more or less subdued by loss of blood, that it speedily recovers its force, on account of the removal of the prostrating influence of some morbid condition, or of nausea, or of mental disturbance, which re- moval may be suddenly effected even in the case of some depressing form of disease, and perhaps as soon as the blood begins to flow from the vein (§ 938, b), just as the nervous power may be modified. 937, a. Since the influences of general bloodletting are exerted,from THERAPEUTICS.--LOSS OF BLOOD. 701 the beginning, simultaneously upon the whole capillary system (§ 930) the amount and rapidity of the primary change will depend on the suddenness with which the blood is abstracted ; and whenever loss of blood produces a great and sudden contraction of the whole capillary system, however small the quantity, syncope will approach (§ 935). 937, 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. T ravers, " 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). It is due to sudden excitement of reflex nervous action. 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 of the patient. 938, a. Again, the ratio, in which the various influences that arise from general bloodletting will succeed each other in disease, will also depend on the existing condition of the organic states, especially of the heart and blood-vessels (§ 143, 149, 150, 152). It often happens that an increased and uniform susceptibility pervades the whole san- guiferous system; and when this peculiar state exists, the abstraction of a very small quantity of blood may instantly determine a paroxysm of syncope (§ 526 a, 961), the nervous power then acting intensely. 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 of the 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 nervous influences of the adventitious causes generally make but little or no impression upon disease ; and the loss of too little blood often adds violence to inflammation and fever by imparting greater energy to the action of 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 of the general and local effects depend (§ 921, 922), from its exciting a reflex nervous action. 939, c. The distinction is also explained by the persistence with which the blood continues to be discharged long after the leeches have performed their office, although smaller and fewer vessels are divided than in 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 reflex nervous actions 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. Of the Nervous Power in its Relation to the Effects of Loss of Blood. 940. This very important element in the phenomena which arise from loss of blood must now be considered. It 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 same power that exerts so vast a range of influences in directing the effects of all other remedial, as well as morbific agents, and whose 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 capillary blood-vessels (§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, both by establishing a contraction of the small ves- sels of the nervous centres, and by effects transmitted there by vas- cular contractions in other parts, 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 of the 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 of the 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 then reflected 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 tbe 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 nervous centres are influenced by loss of blood, the nervous influence is felt as well by the stomach as by the heart and blood-vessels. This gastric irritation is propagated back to the brain and spinal cord, and increases their depressing influence on all the organs. This is especially manifest immediately before the occur- rence of syncope, which it contributes to hasten. Hence, also, the frequent nausea and eructations, and the intestinal evacuations, which supervene upon the impressions made on the brain and spinal cord, or as syncope approaches (§ 902, g-). It is for this reason that cathartics often operate during the 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 whether bloodletting should precede the exhibition of a cathartic or an emetic. 943, b.. But, it is also true that the intestinal disturbance is often owing to the effect of nervous influence excited by some emotion of the mind (§ 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, 1067). 944, a. When syncope arises from the depressing emotions, or from other causes whose primary impression is upon the brain, the action of the heart is directly prostrated through the nervous influence, and indirectly by its sympathy with the stomach; while a certain depress- in o- effect is exerted by the nervous power upon the extreme and cap- illary blood-vessels, and an influence from this change is propagated by reflex action to the heart. The succession of changes then, as re- spects the heart and blood-vessels, begins more on the side of the heart than when they are determined by loss of blood ; the contrac- tion of the capillary vessels being also more consequent on the failure of the heart's action than on the alterative influence of the 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 when death is suddenly produced by any of these causes, it is owing either to a sudden extinction of the cerebro- spinal functions, or to a powerful determination of the nervous influ- ence upon the heart, &c, by which the action of that organ is arrested (§230, 480, &c, 510, 511). The same is true of the prostrating ef- fects of nausea, and many other accidental influences which spring up during the operation of bloodletting. 944, b. Since, therefore, in the case of bloodletting, its influences THERAPEUTICS.--LOSS OF BLOOD. 7.05 are profound, not only on the instruments of disease, but upon the whole capillary system, and the failure of the heart's action is greatly due to this deep impression on their vital constitution, while in the case of the accidental causes the effect consists mostly in a direct de- pression of the heart's action, and a consequent failure of supply to the capillary vessels, without essentially affecting their vital states, it is obvious that we may not depend on syncope as a test of the influ- ences of loss of blood (§ 959). 944, c. 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 of the 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, 8i7 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 of the cold stage. 945. If syncope be obstinate, the means of relief will be such as operate through the medium of the nervous centres, and should be of such a nature as will subdue the depressing character of the nervous influence, and render it stimulant to the heart and blood-vessels. Pungent vapors to the nose, cold air, cold water dashed upon the surface, stimulants introduced into the stomach and intestine, and ex- citing means of a corresponding kind, as well as perfect rest, will therefore be tbe proper remedies (§ 481, e, 891^ k). In tbe 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 b.xly 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 .he heart, and " its ina- Yy 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 of the 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, through reflex actions of that power. 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 of ihe en- cephalon that is suspended; it is the influence of this organ upon the heart which is diminished." We have seen, however, in the ordinary state of the body, that the nervous system has little other influence upon the organic functions than that of contributing to their fundamental action ; these functions being all carried on by the organic properties, which are maintained in operation by stimuli peculiar to each, but mostly by the blood. The nervous power becomes a stimulant, or depressant, or modifying cause, to the organic and animal functions only 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 (§ 480, &c), even when the cerebral cir- culation is destroyed, and the whole inferior portion of the organ re- moved, we shall better understand, in this way, how loss of blood, odors, offensive sights, and 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 of the brain, while in syncope the action of the heart is only di- minished. Nevertheless, even in the former case, a pernicious ner- vous influence is suddenly determined upon the whole circulatory system (§ 479, 509, 510). Again, it is only the depressing emotions, like fear, grief, disgust, and such causes as in any degree exert a sed- ative influence on the circulation, that are known to produce undoubt- ed syncope, while those like joy and anger, which always excite the action of the heart, alone extinguish life instantaneously. One affec- tion, too, is common, while the other is rare; and when the latter takes place, it is probable that there exists an apoplectic predisposi- tion. In one case, the action of the heart is suddenly depressed; in the other, it is powerfully excited. Doubtless, loo, 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 on reflex nervous influence, or remote sympa- thy, and that this influence is greatest when syncope ensues (§ 481, h). Nor is there at any stage of that complex series of changes, from the first impression that follows the loss of blood to their end in syncope, a deficiency, but a redundancy, of blood at the centre of circulation; and, if death ensue, the vital fluid is always found accumulated in the cavities of the heart (§ 1039). 949. Summarily, also, we have now seen that it is the effect of loss of blood, per se, to so modify the vital states of the capillary blood-vessels as to result in their contraction, and that when this con- traction begins in the vessels as the effect of the loss, it excites the nervous influence in proportion to the extent and suddenness of the impression ; that this influence is then propagated abroad, and in- creases the contraction of the capillaries at large; that this effect of the nervous influence is reflected back upon the nervous centres, by which the nervous influence is still farther excited ; that circles of 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 reflex nervous actions, and the multiplying causes of nervous influence, become, therefore, exceedingly complex, and in- crease in their ratio till the heart is prostrated by that influence and by the central determination of blood, when syncope takes place as an immediate consequence (§ 476£ h, 481 h). But, we have also seen, tbat 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 he 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 (§ 476£ 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 of the 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^f this agency in the operation of bloodletting. It will be observed tnat 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 may be 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 of the 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 of the brain being overthrown in the former case, and an inflammation of the 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 of the 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 the case of the pleuritic inflammation by fear alone; while either case is a conclusive proof of the philosophy which I have propounded of the modus operandi of bloodletting, and that it is in no respect of a mechanical nature. These examples also demonstrate my position that the nervous influence is most profoundly felt when syncope comes on. 952, a. Some of the finest illustrations of the effect of bloodletting 71.0 INSTITUTES OF MEDICINE. upon the organic properties of the extreme vessels of the arterial sys- tem, either directly through the loss of blood, or, by alterative reflex nervous actions, are shown by the changes which take place in the blood while flowing from the arm in inflammatory diseases. 952, b. Some of the most remarkable of the foregoing changes may be induced by a very small loss of blood. Thus, a patient of mine was attacked with pneumonia, after convalescence had begun from a protracted fever. She was placed in an erect posture, and an ounce of blood was drawn, in a full stream, into each of three wine-glasses; when syncope took place. In the first glass, the blood had a thick, strong, indented, buff, and a fimbriated edge; in the second, the buff was sensibly less, and the other peculiarities were diminished ; in the third, they had disappeared. 952, c. On the contrary, however, in a case of inflammatory fever, Hewson observed the unusual phenomenon of the appearance of the inflammatory buff only on the fourth cup. 952, d. " There is a very considerable difference to be sometimes observed in the quantity of coagulable lymph in blood taken in differ- ent cups from tbe 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 bow 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,/ Blood, drawn from a person, or from an animal about to faint, coagulates very rapidly. In this case, the rapidity of coagula- tion appears to bear a remarkable ratio to the depression of the or- ganic properties of the solids; as may be readily seen in slaughter- houses. But, again, on the other hand, when death is suddenly pro- duced through the nervous system by blows on the stomach, apoplexy, 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 generaly, though not always, remains fluid. These seeming paradoxes are resolved by supposing peculiar influ- ences of the solids upon the blood, according to the specific modifica- tions of their organic properties; these, as well as all the other dif- ferences and changes, being, therefore, an evidence that bloodletting produces its effects upon the vires vita 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" (§ 1087). 952, h. How futile, therefore, the recent observations of Andral as to the relative quantity of lymph in inflammatory diseases ! The most bloodless subjects are often liable to inflammation, and the loss of one or two ounces may affect, essentially, the proportion of lymph in the next two ounces, 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, ee). GENERAL AND PRACTICAL OBSERVATIONS ON BLOODLETTING. Of the General Extent of the Remedy. 953. The vital influences of loss of blood originate in the vital re- lations of the blood to the organic properties of the solids. The blood being the pabulum vita, 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 of the 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. 1 cannot, therefore, accede either to the dry cupping of the distinguished mechanical phy- sician, Dr. Arnott, or to his opinion " that it is a great modern im- provement in the practice of the healing art, in bleeding for the cure of inflammation, to take the blood away as quickly as possible ; since 712 INSTITUTES OF MEDICINE. intense inflammations of the brain, lungs, bowels, Sec, 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 earned 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 of the statement in section 951, b, that it is exceedingly rare that the loss of a sino-]e ounce of blood, by venesection, will subvert inflammation of any or- gan, especially of the brain, even though the nervous influence be so intensely developed as to establish syncope (§ 961, c). The following are common examples, and go with the others to illustrate my doc- trine of the nervous influence. Thus, Dr. Armstrong: 955, b. "A patient, at the point of death from acute inflammation of the pleura and lungs, was bled to the extent of fifty ounces, when he had obtained no relief. If we had stopped here, in two hours the patient would have died. After abstracting about six ounces more blood, syncope came on, from which he recovered convalescent." If this patient had been bled in an erect posture and from both arms, and had syncope followed the loss of fifteen or twenty ounces of blood, it is scarcely probable that he would have been saved. Again, another patient of Armstrong's " had been once bled, af- ter which the inflammation of the pleura and lungs returned. He had nearly expired from the bleeding ; but the symptoms were so ur- gent that I determined to bleed him decisively, and I told his friends that he might perhaps even die under the operation. I bled him de- cisively, and syncope came on suddenly and continued some time, so that I thought he would have died. He recovered afterward with small doses of calomel and opium" (§ 892|, i). 955, c. Examples of the foregoing nature have been of constant oc- currence, in the hands of enlightened understanding, from the time of Hippocrates, who began the example. The proper rule in extreme cases was observed, as above, by Armstrong, and was thus laid down by Celsus: " It may happen," says Celsus, " that a disease may re- quire bloodletting, when the system seems unable to bear it. Yet, if ( there appear no other remedy, and the patient must perish unless re- lieved by a rash attempt, it is then the part of a good physician to de- clare that bloodletting is the last resource of his art, but that it may precipitate death. Having done this, he should bleed, if desired. There can be no room for hesitation in cases like this, since it is bet- ter to try a doubtful remedy than none at all. And this ought espe- cially to be done, when a paroxysm of fever has nearly destroyed^ patient, and another equally severe is likely to follow. So, also, in palsy, and, again, when angina suffocates" (§ 892 c, 8924, i). 955, d. Hero the importance is fully shown, not only of abstracting a certain quantity of blood, but of obtairing a full impression from the THERAPEUTICS.--LOSS OF BLOOD. 713 cerebro-spinal influence, in many cases of inflammatory affections, as, also, the error of Marshall Hall's recommendation that " bloodletting should never be carried to actual syncope, but only to the very first signs of approaching syncope, which is, in fact, to be prevented by im- mediately laying the patient in the recumbent position." Many exam- ples of the foregoing nature are presented in the Commentaries, and others will follow in the present work. 955, e. Where bloodletting has been already carried to a large ex- tent, yet the original disease still perseveres; or when we are called at the advanced stages of inflammation or fever, or where inflamma- tions may spring up in subjects exhausted by long confinement, or in broken-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 may be 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 far as, and no farther, than the institution oj 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 sano-uif- erous organs ; thereby relieving, at once, the instruments of disease of a redundant quantity of blood, and immediately reducing the force with which the blood is distributed. There is also thus obtained a farther important advantage from the potent reflex nervous influence which is determined upon the instruments of disease by a great and sudden change of action throughout the arterial system, as well as from influences exerted upon the general vital conditions of numer- ous organs ; the very effect upon the skin, for example, and especially upon the intestinal canal, reflecting a nervous influence upon other or- gans which may be the seats of disease ; just as when antimony or ip- ecacuanha send their influences abroad in a more direct manner through the intestinal mucous tissue, or call up the co-operation of the skin with that tissue in subduing pulmonary inflammations (S 614, h), by exciting a complex circle of reflex nervous actions. 714 INSTITUTES of medicine. 957. On the other hand, if the treatment have been begun by 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, tbe 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.Y 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, leechinw 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 sase, 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 of the 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 blood 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 of the remedy should be the measure of the 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 tbe 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 of the Writings of M. 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- % tutefor 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 Bafest 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 acquiescence 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 of the 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 have4 superseded it, than because it has really been weighed and found wanting." In this respect, the able writer is manifestly at fault; and if we only turn over this same leaf from which I have made the quotation, we shall read on the next page as follows: " This powerful medicine has been also employed with some pal- liative effect in hydrophobia, and certain other spasmodic diseases. Its internal use, however, requires great caution, since patients have, 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 active class. The great prostration of strength, excessive giddiness, fainting, and violent affections of the alimentary canal, which often at- tend its internal use, make it proper that so potent a drug should be resorted to by medical men, only in restricted doses, and on occasions of magnitude." Here, then, we are justly told that tobacco should be used with caution even in hydrophobia. And, suppose it could be said of bloodletting, as the writer affirms of tobacco, that " patients have, in various instances, been destroyed by improper quantities," even though a part of the injury might be ascribed to " the hands of the unskillful and unwary;" the advocates of the remedy would scarcely allege, on seeing it fall into disuse, what the foregoing writer does of tobac- co, that "it has passed into neglect rather because more fashionable remedies have superseded it, than because it has really been weighed and found wanting." No; they would acquiesce upon the ground that it "had been weighed and found wanting." And now suppose, again, that such " weighing and wanting" were plausably affirmed of bloodletting, as is conceded, in reality, by its best advocates, of tobac- co, even in the hands of the best practitioners,—in their own hands,— or only through ignorance and carelessness alone, the remedy would be so hunted down, that the rational treatment of 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 tbe 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 of the intestine, which is so apt to be produced by strangulation. Besides the immediate hazard of life which is incident to enemas of tobacco, there is the 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 witnout much reference to those ulterior results, and since it is no proof that a remedial agent does not destroy because the patient sur- vives its immediate operation, I may also say that its pernicious ten- dency reaches these cases in the obstacle which it places in the way of subsequent bloodletting, which is often important to the patient soon after the reduction of the intestine, if k have not preceded it fS 576, e).* K But, it is not alone this or that agent, or other individual means which has been attempted as a substitute for bloodletting in the treat- ment of inflammations. The whole class of poisonous agents, to which tobacco belongs, has been declared on high authority, as we have seen (§ 891, c), to be "the most important medicines we possess." And to justify yet farther what I have said of British therapeutics, and to sus- tain the contrast with American philosophy and practice (§ 349 d, 350f k, kk, 709, note), I shall quote Pereira's Materia Medica rela- tive to his opinion of opium when compared with the uses of blood- letting, cathartics, antimonials, &c. " Opium," he says, " is undoubtedly the most 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). There could be little doubt, upon principle, that the various modes of using tobacco would be detrimental in most conditions of disease, on account of the increased suscep- tibility of organs (§ 137 d, 150, 151). But it would be still a question of facts in relation to this particular agent (§ 650). The requisite facts are before us, and are decisive against the luxury in morbid conditions. But, this does not prove that the moderate use of tobacco will injure the health of those who are in possession of health (§ 137, d). We cannot reason, as I have endeavored to show, from the effects of remedies upon man in health to man in disease; excepting as it respects their violence when manifested in healthy subjects. Of this principle tobacco affords a very full exemplification, and shows that the principle is equally true in its op- posite aspect, and that we may not reason from the effects of an agent which is deleteri- ous in disease to its effects under the condition of health; as, indeed, is shown by food itself. We must, therefore, take the facts in all the cases, and what other facts teach us as to the constitution and laws of organic beings, and as agents operate upon different parts. With this kind of philosophy, we are enabled (unexpectedly, according to the usual method) to decide that the moderate use of tobacco is rarely deleterious in health, and has, therefore, but little, if any, tendency to abbreviate life. The law of vital habit, at 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 diseasf (§ 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 tbe vital constitution of different parts of the mucous system, and the examples are clear il- lustrations of those distinctions ; since, in the case of the poisonous agents of the Materia Medica (including tobacco), they exert their influences upon the mucous tissue of the 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 aa a luxury and as a poison, against the doctrine cif opera- tion by absorption. THERAPEUTICS.--LOSS OF BLOOD. 719 remedy of the 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 of the Materia Medica ;"—and certainly not by bloodletting. And now suppose that the Author of these Institutes had made the same affirmation of opium, instead of having bestowed the like com- mendation upon bloodletting in his former work ; lie would have cheer- fully acquiesced even in the misrepresentations of his Commentaries by the British Medical Press, and in the countenance afforded by the British Medical Profession of the great injustice inflicted upon himself, as an atonement for the injury he might have done. Nor did I scarcely do justice to the cause which I endeavor to ad- vocate, when, in a former section, I spoke of the influence of the Brit- ish " Association" in their concerted action to overthrow the fabric of Medicine, and to raise upon its ruins the absurdities of a foreign Chem- ist (§ 349, d). The record should have been also made that the work on " Organic Chemistry applied to Physiology" had been a year be- fore the Profession, ere its successor, the work on " Animal Chem- istry applied to Pathology and Therapeutics," was " communicated to the British Association for the Advancement of Science," and " Edited from the Author's Manuscript, by William Gregory, M.D., Pro- fessor of Medicine in the University and King's College," and before other distinguished British medical writers became the systematic In- terpreters of the Author's meaning, as well as Champions of his nonsense (§ 350|, 350|, 447\f). The hurricane, I say, swept over the Nation, and such was its force upon the Continent, and even in America, that the learned in those Countries had serious doubts of the stability of any science, and that the great bulwarks, which had been slowly and progressively reared by the observation and wisdom of a long series of ages, would be, hereafter, at the mercy of any as- pirant. For all this, the British Nation must and will be held respon- sible (\ 1062^-1065, 1068, a.) l And now, let us remember, that when radical and enduring chano-es may be wrought in any science which is built upon the foundations of Nature, and when, especially, the phenomena have been open to all, they will hereafter advance as slowly, at least, as the errors had sprung into existence. The wisdom of one generation is, at most, but a shad- ow in advance of the last; and, however discoveries may come up in the open field of Nature, the great laws which have been educed from what was known in the past will be of no easy subversion. Nor can I doubt, that come what may to Medicine, we shall sooner or later go back to Hippocrates, and begin a reconstruction upon the founda- tions which his genius and observation had laid. 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 tbe tardy pace of tbe 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 of the 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 Dlood.—(Med. and Phys. Comm., vol. i., p. 325, 326.) Finally, I hold that the internal use of aconite is inadmissible in all ac- tive forms of inflammation, and endangers life under all circumstances of health or disease. Had Dr. Male, of Birmingham, who employed this remedy to the extent of some eighty drops of the tincture in four days, in augmented doses varying from five to ten drops, for the re- lief of simple, chronic pain in the back, from the recommendation set forth in the work by Dr. Fleming, been as obviously the victim of bloodletting as be 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 of the pupil. It is evident, however, that this reasoning is fallacious ; for, if belladonna be given in any of the common forms of cerebral dis- ease, that disease will be aggravated in proportion as the pupil dilates under the influence of this agent. In justice, also, to the remedy which I advocate, I may say, if its applicability rested on no better foundation, and if, especially, surrounded by the same objections as belladonna, its recommendation would be justly regarded as rash and unphilosophical (§ 469, 476 c, 487, 488^, 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 of the kid- neys." Medicine was cut up, in the Parisian hospitals, into numerous fragments, and brought under all the details of the 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 tbe intrinsic nature of the fundament- al evil which has introduced the new system of teaching medicine. There never was a time when so many zealous aspirants were com- mended to places either by clamors, or by the force of industry. The revolution was also only a part of the fashion of the day ; and its pre- cipitation harmonized exactly with the achievements in medical chem- istry, and other analogous varieties in the wide field of philosophy. Fortunately, this corruption has not yet fastened itself upon the Medi- cal Colleges of Great Britain or America; and the hope may be there- fore entertained that the worst of it has passed (§ 1008). 960, e. Nor will I leave the foregoing allusions to the comparative value and abuse of the great agents for disease, without referring to the general apathy which is manifested at the havoc which the whole band of empyrics are dealing out with their domestic engines of death ; while, were the lancet equally common in their hands, and only now and then a startling slaughter, that solitary result would rouse the in- dignation of the profession, and disturb tbe peace of society. 960,/. The advocates of bloodletting have sometimes affected its reputation by the mere language in which it is recommended. They are said to be rash; and bloodletting shares the odium. Thus, Dr. Elliotson, in speaking of enteritis, remarks, that " The first thing one has to do is to bleed the patient well. You 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 of the immediate importance of the " vital fluid" to the life of every animal; and this conviction has been farther roused into operation by perverting the authority of Holy Writ, that " in the blood is the life thereof;" though, had Scripture said that in Calomel, Jalap, and Emetic Tartar, or Tobacco, Aconite, Lobelia, and Bran- dreth's Pills, is the death thereof, the quotation would have been hourly apposite. We are, also, dead in a few seconds from the divis- ion of a large artery; and we scarcely see a difference in the rapidity of the result when this method, or a division of the medulla oblonga- ta, is employed for the destruction of life. Hence, many come to as- sociate bloodletting, as practiced for the relief of disease, with the ex- treme method of effecting death. I shall not dwell upon this wantof 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 Bhock 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,/). 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 of the Materia Medica. One will alter the vital states, either in health or disease, more profoundly and more permanently than others. Such, also, is the principle upon which depend the hereditary predispositions to dis- ease. Then we have those dormant changes which constitute the pre- disposition to idiopathic fever, and which may be in a state of incuba- tion for a year or more.before the final explosion. In all such cases, the properties of life are more or less permanent- ly affected, though not profoundly, till an explosion of more absolute disease shall follow; but often as the result of a long and impercepti- ble series of morbid changes. In tuberculous phthisis, cancer, syphilis, &c, the properties of life are deeply, as well as more permanently and obstinately affected, and it may be impracticable for art to induce 6uch 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 of the 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, 675, 685, 686, 847 g, 854 d, 856 b, 857, 858, 859 J, 861, 863, 868 b, 870 aa). The application of the rule will depend, I say, in a general sense, upon the nature of the remote causes, the organs affected, and the extent in which the restorative principle is impaired. A vast variety of diseases require no aid from art. Others, again, like pneumonia, enteritis, &c, require a prompt and energetic interference. But, again, there are maladies of great violence, as in the examples already mentioned of small-pox, measles, scarlatina, &c, in which the same 724 INSTITUTES OF MEDICINE. treatment cannot be pursued, in a general sense, as in many diseases whose symptoms are much more violent ($ 961, 964, 976, c). It might, therefore, seem that Nature is here contradicting herself. But it is far otherwise. The apparent contradictions are only illus- trations of her perfect consistency, and of the great laws, that morbific causes alter the nature of the properties and functions of life accord- ing to the virtues of each cause, and that artificial impressions can be salutary only in proportion as the morbific causes impair the recuper- ative principle. But, owing to constitutional peculiarities, and vari- ous incidental influences, the disposition to the restorative process in the self limited diseases may be more or less impaired, or inflammation of important organs may supervene, when Nature will require the in- tervention of art, according to the existing modifications and compli- cations of disease. Again, as in the hot stage of fever, the very recu- perative efforts of Nature, if I may say so, are often so excessive as to result in actual increase, or in developments of, disease, and there- fore require the interposition of art for a certain degree of restraint (§ 675). 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,/). In all the congestive forms of disease, es- pecially when of an acute nature, the general susceptibility of the system to the loss of blood is increased. I may also say that the pros- tration which is induced by venous inflammation is quite different from that which results from inflammations of any other tissue (§ 135-137, 140, 150). It is also greatly different from that which attends the cold stage of fever. In the first case, very morbific nervous actions are reflected upon many important organs, and, unless artificially re lieved, the powers of life may sink rapidly to a state of extinction. Nature is, as it were, knocked down, and is incapable of a recupera- tive effort. In the last cases, however, the impression is manifested chiefly in the circulatory system. There is not that profound lesion, in the absence of venous congestion, which prevents the recuperative effort; and hence it probably always happens in pure fever that reac- tion soon follows the stage of depression (§ 675, 764). Something like the converse of this is seen in those erysipelatous inflammations of the throat which sometimes give rise to an apparently great com- motion of the system. But, if there be no great amount of abdominal disease attendant on these cases, the reflex nervous action is ex- pended upon the circulatory apparatus ; when any remedy that will relieve the throat will be followed at once by a subsidence of the ar- terial excitement (§ 140, 927 b). But, these cases are apt to be com- plicated with obscure, though severe congestive disease of the abdom- inal organs, especially of the liver, which has thrown deeply a morbific predisposition over many other parts, and which, in consequence, feel more profoundly the influences propagated by the intense inflamma- tion of the fauces. In such instances, however, the general arterial THERAPEUTICS.--LOSS OF BLOOD. 725 excitement is less than in some of the violent affections of the fauces which may be greatly of a local nature, or where any accompanying abdominal disease may be of a different nature frorr congestion (§ 689 I, 973), and according to the nature of the reflex nervous actions. 961, b. Venous congestion, independent of fever, is a common form of disease, and manifests the same tendency, as when connected with idiopathic fever, to embarrass the organs of circulation. But, this is only a contingent effect; since the general manifestations of the disease in respect to the circulatory apparatus exist in a subdued form of that excitement which attends the ordinary forms of inflammation (§ 390 b, 688 c-k, 786, Sec, 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, through a peculiarly alterative reflex nervous action. It is, however, in congestive fever that we witness the strong dem- onstrations of venous congestion in generating extensive and profound lesions through its very morbific reflex nervous actions. This is espe- cially true if the local disease exist at the invasion of the constitution- al malady. It has then already shed a malign influence in connection with the predisposition to the general disease; and, as these influen- ces progress together, they come in with intense force when the explo- sion takes place, and, unless art should now interpose, the diseases go on mutually exasperating each, other, and calling into existence other congestions, or inflammations, which make all haste to join in the circles of disordered movements (§ 143, 514 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 in 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 of the cases (^ 1056, 1068, a). As a preliminary step, I must refer the reader to what I have said of the pathology of venous congestion (§ 786-818), and especially to the Medical and Physiological Commentaries, for the proof of the in- flammatory nature of venous congestion, and its dire effects upon or- ganic life. It is also important to add, in this place, that although there exist more or less apparent prostration of life in the aggravated conditions of venous congestion, and of active phlebitis, as, also, in congestive fever, the term is here employed in a conventional sense and not as significant of debility, or of anv 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, 740, 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, 476| 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 detei- mination of blood upon the heart; and it is in part, as I have said, for this reason, that a small loss of blood often overpowers the circulatory organs. But, when syncope passes away, this state of the circulation, and other morbid phenomena, will have been more or less subdued. The influence of loss of blood which results, as a primary effect, in increasing, or producing a contraction of the capillary blood-vessels, is so essentially different from that of the morbific cause which deter- mines, apparently, the same phenomenon in the cold stage of fever, as in the analogous conditions of venous congestion, that it alters the morbid state, and thus places the vessels in a way to undergo an ac- tive expansion; or reaction, as it is called. And herein we witness a critical instance of the alterative nature of loss of blood, and how its influences are exerted, and how apparently the same phenomenon is not the same, and may be, therefore, due to evf 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 Beem 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 of the supposed hepatic sugar in the lungs is very unsatisfactory, even in a chemical sense; and, farther, that there is scarcely any agree- ment between him and Lehmann as to the uses of sugar in the animal economy. 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 had detected semen in the blood, 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 ha?ma- 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 hasmatin 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 physio- 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 of the 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, Leqons, &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 6hall 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 of the English Philosopher's (§ 476-494, &c). But again: if it be assumed that the influences were exerted, in the experiment, upon the liver, and that the kidneys merely "strained off" the redundant sugar, how does it happen that no sugar ever appears in the urine during the digestion of food, 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 of the indications of cure as supplied by Organic Chemistry, when we contemplate the successful treatment, by bloodletting, of the remarkable case recorded in § 1007, c ? Since the foregoing was written, information has reached us that later observers have shown, that, whatever may be the influences exerted by the injury of the fourth ventricle, as it respects the hepatic blood, they have no bearing upon the functions of the liver, but of the lungs. From these observations it would result that the special condition of the hepat- ic blood is owing to some modification of the respiratory function, which is rendered farther probable by the injury being inflicted at the origin of the pneumogastric nerve. 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, apres avoir pique chez un Chien ou chez un Lapin l'origine des pneumo- gastriques, nous lui avons ouvert la ventre au moment ou la surexcitation portee sur la foie pre'sentait son summum d'intensite, nous avons vu qu'alors il y avait une plus grande activite de la circulation abdominale, le syst^me 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-m6mes tres surexcites, les ureteres sont tr£s irritables; il suffit de la toucher avec la pointe d'un bistouri pour les voir se contracter energiquement."—Bernard, Lecons, &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, 376± 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, due to the combination of albumen with ulmate of potash." Becquerel and Rodier say, that the chemical processes relied upon are " almost exclusively" the last two—B. and R.'s Patholog. Chem., p. 72, 73. Lehmann commends Trommer's test, which consists mostly of caus- tic potash and sulphate of copper, but which has been disputed. " But if this test be not admitted," he says, " equal objections may be advanced against all the reagents employed in mineral chemistry; the application of most of them demanding more precaution and skilful manipulation than this test." He thinks well of the polarizing apparatus; says that "Pettenkofer's test is not available for the detection of sugar;" and he would not trust the fermentation-test, nor Maumene's. After mention- ing these, and their attendant qualifications, we have the farther discour- aging remark, that " all other tests which were formerly employed for the discovery of sugar are open to so many sources of fallacy, as com- pared with the methods we have already indicated, that we may pass them over in silence."—Lehmann, ut cit., vol. i., p. 251, 256. 1033, b. Now, all the foregoing (§ 1033, a) would be commendable, did it end, so far as Chemistry is concerned, with the experiments them- selves; although, as we have seen (§ 1029, 1030), it can rarely supply any reliable ground for induction. But it is an example only of a vast amount of experimental Chemistry which has been carried far into the labyrinth not only of the physiological but morbid states of the body, and commended to Physicians under the illusory name of " experimental medicine." Organic Chemistry.—APPENDIX.—Animal Sugar. 795 But, 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 of the blood, or secretions, not even of the urine. In chronic affections, a few simple observations upon the latter, and which are alone reliable, will sometimes inform the physician of the presence of some unusual substances as the products of disease; but this knowledge can never aid him much in the treatment of the mal- ady (§ 427). Take the strongest of all examples, diabetes mellitus; a knowledge of the existence of sugar in the urine has neither contributed to a knowledge of the pathology of the disease, nor given the slightest direction to an enlightened practice. An exclusively animal diet has not reached the pathological condition, and the sugar has gone on as usual whatever the food consumed. Nor is it any better with the " urea- diathesis," or with " albuminous urine," whether the latter respect the kidneys or dropsical conditions; but, on the contrary, it has led to many blunders between the presence of disease and the ingesta, or between one disease or another (§ 426, 427, 639, 673, 675, 679, 686 d). If the Phy- sician rely upon these superficial and uncertain, or imaginary signs, if he have not the sagacity to discover the nature of disease through the ready and intelligible signs supplied by Nature, or cannot avail himself of experimental observations upon the 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\, f). 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 between * 796 institutes of medicine. the Physiologist, as he looks upon animated nature in its healthy and morbid aspects, and the Chemist, who is, or should be, concerned alone with dead matter, it is sometimes difficult to maintain a perfect modera- tion of style when the Laboratory becomes dogmatic, and especially when exclusive (§l,b, 350, Mottoes). And I may be now permitted to at least correct a misapprehension of Professor Lehmann's, who, in the seclusion of the Laboratory, like all others of the same laborious and abstract pur- suits, is evidently uninformed of the doctrines of the vital Physiologist, or does him an injustice which I should be unwilling to surmise. I al- lude to the following paragraphs, although there is much more of the same nature: "We have not hesitated to avow that we have assumed a 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 poeti-y 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 Chemistry, 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."— Ibid., 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, 350-i, 350f#, 351, 360-364, 366, 376t, 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 of the nerves of sense, but its cause cannot reasonably be sought for in any other than a chemical change, experienced by the conducting substance of the 798 INSTITUTES OF MEDICINE. nerves. Such a chemical metamorphosis of the nerves of sense from external impressions can no longer greatly excite our astonishment, since we have witnessed the unexpected phenomenon of a picture produced sud- denly, and as it were by magic, from the chemical changes effected by the 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 of the object?" !! —Ibid., vol. i., p. 30. (Also § 349 e, 350| n,p, 350f e,f, 350f 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 Physiolog 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 unwearingly 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. 97 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, 376i, 376^, 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 (§ 5^, a) that they are worthy of his rebuke, and that the true philosophy of medicine can be acquired only through an implicit dependence upon the Labora- tory of the Organic Chemist (§ 376 J). 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 & 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 (§ 5-*- 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 of the past, whether the phrensy of a morbid ambition is not most likely to react upon themselves ? (§ 6, 376^.) And I put it, also, to Physicians, whether they will continue to follow the wake of Organic Chemistry, or assume the independence of thinking and acting for themselves ? And here I shall take the liberty of repeating a pas- sage from the Commentaries which covers a greater range of the fictions that have been substituted, in recent times, for philosophical medicine. The Author was referring, specifically, to M. Louis's attempt to prepare the way for his anatomical and numerical methods by proclaiming that " Medicine is noiv 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. i upon this dark spot on the brightest escutcheon of the world, it must be regarded without sympathy, and as an act of voluntary humiliation (§ 376^, 530, 819 b)"—Medical and Physiological Commentaries, vol. ii., p. 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 of the medical world his own admiration of the labors of Becquerel and Rodier, and particularly of those researches which are presented in their work on " Pathological Chemistry in its application to the Practice 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 arid 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 fibrin, 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 of the com- position of organic nature, nothing of those elementary combinations which so forcibly distinguish it from the inorganic kingdom, and many other relative details, nor could these Institutes have been written, with- out the revelations afforded by Chemistry (§ 376|, b). PROGRESS OF PHYSIOLOGY. structure of organs. 1036. Many interesting disclosures have been recently made in the minute anatomy of some of the complex organs, and the microscope has been brought to bear advantageously upon the subject in connection with improved methods of minute injection. The structure of the kidney, whose rank in organic life I have advocated in foregoing sections (§417, 422-427, 892f a-c, 1032), has been subjected to much critical inquiry, md although the exposition of its elaborate organization call up an as- sociation with the most complex mechanism of art, it reminds us as lit- tle of " a strainer" as it does of a musical instrument (§ 1032). But the most curious and intensely interesting discovery relative to this organ is Brown-Se'quard's development of a startling function appertaining to the renal capsules, and which should silence forever all attempts to " deduce the incidental differences between organic and inorganic bodies from the principles evolved from dead matter" (§ 1034, Lehmann). The anatomical details of the nervous system, especially of the spinal cord, have been also ably investigated by Lenhossek, Van Der Kolk, Brown-Se'quard, and others, and impart a great interest to the study of the organic life of animals. All this, and much more of a correspond- ing nature, opens very widely the wonderful mechanism of organic be- ings, develops more forcibly that incomprehensible variety of Omniscient Design which is apparently excluded from the mechanical constitution of inorganic bodies, and thus, and in other ways, aids in placing the chemical and physical doctrines of life and disease upon their proper level. (See Index, article Design.) Nevertheless, it must be conceded that this knowledge does not indi- cate the functions of organs, or their modus operandi, or the physiologi- cal laws which they obey, nor ever will. It simply enables us to trace out the channels through which the properties of life carry on their stu- pendous work (§ 130, 131; Bichat, Liebig, Milton). As it affects, there- fore, in no other respect the facts and the doctrines set forth in this work than to give them confirmation, I shall not advert specifically to the dis- E 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-Sequard whose genius and industry have also enlightened the physiological world upon special influences of the nervous system, which, if not as important in their relations to the laws of that system, are more attractive. Among these may be mentioned his remarkable experiment of producing epilep- tiform convulsions, through a special association of the nervous influence with a particular point in the skin by sections of the spinal cord, and an extension of the researches begun by Petit, Magendie, and Flourens, upon turning and rolling, developing, apparently, as in the auditory nerve, centres of nervous influence in the nerves themselves; which appeared in a collation of his writings, entitled " Experimental Researches applied to Physiology and Pathology, p. 18, 36, 80, 84, 99 ; 1853. These experiments, therefore, like Bernard's, of pricking the medulla oblongata (§ 1032, d), not only possess a refreshing novelty, but consti- tute 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 nave designated as sympathetic sensibility, and which belongs especially to the organic life of animals (§ 197, 201-204, 451 d, 903). The conclu- sions at which Dr. Brown-Sequard arrived are summarily and well ex- pressed by a Reviewer as follows: " 1. The idea that the sensitive impressions are conducted to the en- cephalon along the posterior columns is entirely erroneous. 2. The gray matter of the spinal cord, although itself deprived of sensibility, is an organ of transmission of the sensitive impressions. 3. There^are two kinds of sensitive fibres in the posterior columns of the spinal cord, some going up towards the encephalon (centripetal or ascending fibres), some going in the opposite direction (centrifugal or descending fibres). 4. There are also ascending and descending fibres in the posterior gray horns, and very likely in the posterior parts of the lateral columns. 5. These as- cending and descending fibres in the posterior columns come mostly, if Reflex Action.—APPENDIX.—Organic Properties. 803 not entirely, from the posterior roots of the spinal nerves. 6. The pos- terior roots send also fibres to the posterior gray horns, and very likely to the posterior parts of the lateral columns. 7. All these fibres soon leave the posterior columns, the posterior gray horns, &c, in order to go into the central gray matter. 8. All 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 of the spinal cord, so that the impres- sions on the left side of the body are transmitted by the right side of the spinal cord, and vice versa; 2d, that the assumed function of the cross- ing of fibres in the pons Varolii, and the neighboring parts, does not be- long to these fibres, but to the fibres of the spinal cord, all along which they cross each other" (p. 67, 68). The foregoing, and other experiments, were repeated by Dr. Brown- Se'quard in some of the Medical Colleges of this country during the win- ter of 1856-7, at many of which the present writer was so fortunate as to be a spectator. § 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#, 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 docu trine inculcated in these Institutes upon the main ground of the phe- nomena of life, that the whole Capillary System possesses the power of an active dilatation and contraction (§ 384-387, 392 a, d, 393-399, 410, 411,746,747,914-920,929-934,940,947,950,951,961,974, 975, &c.). " My experiments prove," says Brown-Se'quard, " that the 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. This doctrine was advanced by me in 1834, in Med. Chir. Rev.—See p .827. Experiments of the foregoing nature have, indeed, been multiplied by Physiologists to an incalculable extent; but perhaps no one of them ha* revealed the prodigious influence of the nervous power upon the capil lary bloodvessels and the secreting apparatus so impressively, or mad* 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 workv 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, aa it respects the functions of life, to those which were performed by Wih 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. and 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 of the right posterior limb. Fifteen minutes after the beginning of the injection, local life, i. e., irritability, was restored in the limb receiving blood, and cadaveric rigidity had disappeared."—Experimental Research- es, fyc, 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 of the nervous power," to express conditions of the 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 of the limbs which take place in decapitated an- imals, is very different from the contraction of the intestines, the heart &c, which take place even after the extirpation of the organs (§ 259- 265); and I am happy to quote Brown-Se'quard as sustaining an im- portant doctrine in these Institutes, that, " contrary to the general opin- ion, a nervous action is not necessary for these contractions" (§ 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 of the iris to contract when stimu- lated by light lasts extremely long, particularly in certain animals. In eels it lasts sixteen days in eyes taken out of the orbit." Muscular 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, I apprehend that Nature has not adopted any such multiplication of causes, but that she has placed that muscle entirely at the disposal of the nervous influence, and by which the direct action of light upon it is counteracted; nor will it be an easy matter to disprove a conclusion so well sustained by all analogy (§ 500 I, 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 aa 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 of the 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 of reflex nervous action in its relation to animal heat, and it is peculiarly valuable to the Vital Physiologist, since it is the same as concerns any other organic product (§ 446, a), places the whole on common ground, and as fully pronounced by Bichat, Hunter, and Phil- ip, and as set forth at page 270, § 447, d, &c. Secondly, the experiment is not less important in showing that the cooling of the hand in the at- mosphere was not at all owing to the general reduction of the heat of the body, and therefore effectually contradicts the law of slow commu- nication of caloric which obtains with dead matter, as applied to animal heat by Edwards, Liebig, Roget, Billing, and others, who cultivate the chemical hypothesis (§ 438 a-c, 440 e). It is also an exception to our Author's doctrine that " a great many facts prove that the degree of temperature and of the sensibility of a part is in close relation with the quantity of blood circulating in that part." (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 of the 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. Sequard has, also, many observations to show the difference of temperature in different parts of the body, which correspond with those of Bichat, Hunter, Davy, and others (p. 270, § 447, d, &c), and which I have employed as another proof that there is no analogy between the laws which regulate the temperature of warm-blooded animals and dead matter; for it had been well determined that every part has not only its own independent heat, but, when not exposed to the contact of the air, the temperature is without change in the several parts respect- ively, however much it may differ in any two contiguous parts (p. 270, § 447, 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 J 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 place, Dr. Kane presents a general fact which corresponds with what I have said of acclimation and constitution, in their relation to organic heat and vital habit (§441 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, &).-»kKane'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 60° Fahrenheit below zero—often 90° below the freezing point. In the first of these enterprises they were cheered on by the depots before them, but soon to suffer the chill of disappointment, and an unsatisfied hunger. Nor did Summer bring them relief; for, in its 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 for eking out our winter fuel; and willow stems and stone-crops, and sorrel, as antiscorbutics, collected and buried in the snow." (Vol. i., p. 343, 348.) The party entered upon the second winter " a set of scurvy-riddled, broken-down men; our provisions sorely reduced in quantity, and alto- gether unsuited to our condition;" and the Engraver has added a por- trait of the spectacle. (Vol. i., p. 349.) October 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 30th, 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 of the sick more full rations, consuming a rabbit and a half" (§ 440, bb, No. 9). " My journal tells of nothing but sick men, profitless hunts, re- lieved now and then by the signalized incident of a rabbit killed or a deer seen, and the longed-for advent of the solar light." (Vol. ii., p. 21, 37,41,42,43.) The party lived on much in the foregoing manner till March 10th, 1855, when one of them returned from a distant Esquimaux hut with some walrus meat. Thermometer now at 72° Fahrenheit below freez- ing. This meat was soon exhausted. But, March 24th, there had been another windfall, of which he says, " Our ptarmigan gave the most sick a raw ration, and to-day we killed a second 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—Tea."—-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 of the question be- fore us. Thus, in the " Asiatic Researches" there is a description of the Island of Nicobaras, in the Bay of Bengal (mean annual temperature 70° F.), by G. Hamilton, in which he says of its inhabitants, that " They are 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 raw" (§ 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 of the revelations of the microscope; though it is not difficult to understand that the chem- ical doctrines of life and Lamarck's transmutation of species have had their share in the doctrine (§ 350f-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 ia 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 effec*. 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 Palmoglata 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. Wenham 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. He finds that when a new leaf is being formed from the main stem, it commences, not as is commonly supposed, in a single cell, but in the simultaneous development of some hundred at once, 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 cavities are next observed to be lined with a definite membrane; and within this, protoplasm, chlorophyll, and cyclosis-currents subse- quently become indistinguishable." " Turning now to the Protozoa, we find in the Amoeba, and in the Ac- tinophrys, types of animal existence, Avhich, in so far as we are yet ac- quainted with them, may be legitimately ranked on the same level as the Palmogla?a, although placed on the other side of the boundary-line. The body of each of these creatures is a minute mass of a substance which long since received from Dujardin the appropriate name of'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. § 10*52, a (Refers to § 1051). It will now be interesting to the student of Physiology to observe the Universality of Nature's laws in any one of her great departments, in the manner in which she has established a rad- ical distinction between the vegetable and animal kingdoms, and carried out from the lowest to the highest, in both kingdoms respectively, the fundamental plan of rendering one the Producers of organic compounds out of the elements of matter, and the other Consumers of those com- pounds, and how this characteristic will readily distinguish the lowest species of one kingdom from the lowest of the other (§ 13-14, 18, 173, 185, 298-303 ; and Index, article Plants). By this brief recurrence to the subject, which is made for the sake of the following quotation, which brings into view the great economy of life as manifested in the boundary- lines of the Animal and Vegetable kingdoms, and which confirms the principles expressed in this work (in the references to sections just made), we shall refresh our knowledge of the wonderful elaboration of living be- ings, enlarge our conceptions of the peculiar properties and laws by which they are governed, obtain a renewed evidence of Creative Power, and be quickened in our adoration (§ 409, 493 a; and Index, articles Design and Creator). The foregoing Writer (§ 1051) goes on as follows: " If we now compare an Amoeba 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 we look at their physiological actions, how wide is the distinction. The Protophyte, like the Phanerogamic plant, obtains the materials of its nutrition from the air and water that sur- round it, and possesses the marvellous power of detaching oxygen, hy- drogen, carbon, and nitrogen from their previous binary combinations, and of uniting them into chlorophyll, starch, albumen, and other ternary and quaternary combinations; 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 the Vegetable kingdom" (§13-14, 17, 303-304). "Again, the Proto- phyte obtains its nutriment by the absorption of liquid and gaseous mole- cules which penetrate its body by simple imbibition (§ 289-295, 303 d, 303 j) ; 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 ?" 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, 22x65, 23x66, 23i x 67, 68, 69, 70, 25, 26, 26£, 27 x71, 72, 73, 74, 75, 76, 77, 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, 664-666, 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 strict conformity with the foregoing anal- ogies, that the semen has lost its impregnating virtue and the ovum its susceptibility to the action of semen. Or, if hybrids be sometimes ca- pable of fruitful intercourse for one or two generations, it only shows a correspondence in the ultimate extinction of the procreating faculty, through repeated impressions upon the constitution, with the frequent necessity of repeated vaccinations to extinguish the susceptibility to the farther production of the disease. And so of occasional repetitions of small-pox, measles, and scarlatina, before the susceptibility disappears (§ 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. We 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 (§ 51 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 of the subject upon absorption and circulation as carried on in animals, and to thus, also, extend the anal- ogy to the philosophy of vegetable heat, indicate the harmony in the laws which govern absorption in Plants, the circulation of sap, and the secreted products of vegetable organization, and the analogy between these and the corresponding phenomena of animals (§ 293-295, 381, 445 d-g, and references in 1052 a; also 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, § 3501), 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 upon " The Soul and Instinct." It is the circumstance, also, of these fundamental doctrines being still the current Medical Phi- losophy that has prompted another part of the Appendix (§ 433, 1034). I cheerfully conceded that the foregoing " summary principle, were it true, would be truly beautiful." I therefore felt the importance of show- ing that " it was not only deficient in every necessary element, but was contradicted by all the phenomena of Sympathy, and by all that is known of Pathology and Therapeutics. I am thus provided with a vast series of facts in advance, which must be taken in connection with what I am now to say of the corollary from the fundamental doctrine. This corollary consists in the application of the general doctrine, above, to the circulation of the sap and the blood. It supposes that The movement of the sap, upward and downward, is generated in the leaf by the action of light in promoting the decomposition of carbonic acid gas, that " marvellous power possessed by Plants" (§ 350, Nos. 68, 73, 74, 76, § 1052). The imperfect ascending fluid is thus converted in the leaf into perfect sap, and the change is supposed to institute a pro- pelling force in the imperfect juice, by which the perfected sap is driven out of the leaf and through its downward course. The force, generated in the leaf, is also considered, from the motion which ensues in that part, as the most essential cause of the ascent of the sap, or that the fluid is thus lifted from the roots to the summit of the most lofty trees. Such, then, is the ingenious doctrine which it has been found necessary to sub- stitute for capillary attraction in expounding the circulation of Plants; as the illustration drawn from a " lamp-wick" was found to be applica- ble only to the radicles in their supposed office of " simple imbibition" (§ 289-293). Absorption. —appendix.—Circulation. 819 This principle has the merit of appearing to be equally applicable to the circulation in animals as to that of plants (§ 350, No. 73, &c), and it forms a remarkable instance of consistency in a somewhat comprehen- sive range of a purely factitious hypothesis, though it is regardless of all the overpowering facts which declare its artificial character. The pul- monary circulation is said to depend upon the union of the oxygen of the air with the carbon of the venous blood, in consequence of which this blood drives the decarbonized into the left auricle. But, in the case of the systemic or greater circulation, the order of things is reversed ; for here the motion is supposed to be generated by the union of oxygen with the "structures formed out of the food." The same order of events ob- tains in the 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 ajfluxus,' " and that it is made the grand basis of all Pathology and Therapeutics (§ 350, No. 10, § 350|-350|). The latter, indeed, should naturally flow from the main physiological doctrine, if Nature be truly represented by this (§ 1 a, 2 b, 383, 447-^ a, 638, 1089). Doubtless, this remarkable doctrine of the circulation of the blood might have been left to itself, had it not been incorporated in the lead- ing works upon Physiology, as in Dr. Carpenter's, and even carried into popular systems, as by Mrs. Willard, whose appropriation of the philos- ophy is regarded by Dr. Cartwright (in Boston Medical and Surgical Journal) as singularly ingenious and original (§ 349 d, 433). It is simply my remaining object, however, to inquire into the sup- posed condition of the circulation in plants, as in all other relative top- ics concerning man and animals the ground has been sufficiently ex- plored, and since, also, if the hypothesis can be contradicted here, it must equally fail, as is admitted, in respect to animals. I shall also endeav- our to avoid a repetition of whatever I may have hitherto said, and limit myself to the statement of a few simple facts. In the first place, then, it appears to me that the hypothesis contains a fatal element—the prodigious amount of force which is said to be gen- erated in the leaf, as well as in the lungs and'other soft structures of an- imals. On this point I am bound to abide by the decision of the Chem- ists, who say that such must be the consequence of the chemical changes which are supposed to be in progress for the production of motion. As expressed by these Philosophers, who designate it as " an inexpressible force," or compare it, like Liebig, to a "steam-engine" (§ 350, No. 15), it would be abundantly sufficient for any purposes in artillery or in blast- ing rocks (§ 392, c). In the next place, there are many other circumstances attending the circulation in Plants, as well as Animals, not hitherto considered, which it would not be easy to interpret by the Chemical doctrine, but which are readily explained by the Vital. Where, for example, is the auxili- ary power to capillary attraction (if the latter be included) ? where, the leaves, or even buds, when vegetation starts from its hybernating state in northern countries? Observe the Acer saccharinum—the remarkable 820 institutes of medicine. vigour of its circulation before there is a development of the bud. In- deed, the harvest of maple-sugar often takes place in the Northern States while the earth is covered with snow to the depth of many feet. The circulation, too, is most vigorous after frosty nights succeeded by warm mornings ; and when the temperature of the air rises, for a night or two to some 40° F., the flow of sap is apt to be greatly diminished, but is restored in profusion on the return of frost. What in Chemistry will explain such a phenomenon ? And, if it retreat before obstacles of this nature, must it not abandon the whole ground ? Nay, how palpable the force of a single fact, when it is considered that the phenomenon is due to the effect of heat as a vital agent on the irritability of vegetable or- ganization, and, singularly enough, as admitted by Liebig (§ 350 No. 65); and whether operating at the higher and more uniform degrees, or alternating at the freezing point, the exact explanation is involved in the law of Vital Habit, as set forth in these Institutes at pages 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 was the subject of observation. There was wanting, therefore, every thing that could contribute to the fundamental requisite of the Chemist, and, indeed, I may say, what is considered indispensable by all the physical Philosophers to the simple doctrine of capillary attrac- tion as it 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 of the sap 38 inches, equal to 43 feet+3 inches-f^- 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 Ivour, 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 conflictino- fact would justify a special hypothesis. Let us therefore hear the doctor upon this troublesome point. Thus : "Now, since the flow of sap ceased at once, as soon as the vine was cut off the stem, the principal cause of its rise must, at the same time be taken away, viz., the great perspiration of the leaves." That is the doctrine, along with capillary attraction, of a large section of the physical school; but it supplies no aliment to Chemistry. In all the cases, the blunders arise from a defective observation of facts, and from an ignorance in the difference between the physiological condition of the vine and of other plants, before and after leafing (§ 1034). In the experiments first recited, the vine was in its budding season, when vege- table life is in highest activity, and hence the profusion of sap, the force of its circulation, and the development of heat (§ 445, e,f). On the con- trary, in the last experiment Nature had accomplished her greatest of objects in the development of the leaves ; and Dr. Hales might have am- putated the largest limb, with all the other leaves remaining, and there would have been no bleeding. The same descent of the sap would have occurred, and prompted a different hypothesis. And now contrast the foregoing experiment with his conclusion as expressed in 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 tbe 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.xx\i.). Will the Chemist explain ? In one of his experiments he attributes an effect to the " sun's warmth," in making the vessels " dilate and contract a little." This is what he means by " the energy of the root and stem." Had he adhered to that explanation, and had he a competent knowledge of the physiological laws of vegetable life, he would have had no difficult problems to expound, no conflicting experiments, no contradictions of himself. Few Philosophers, however, as little informed in the philosophy of organic life, have been as accurate in their experiments, or more capable of reasoning upon the facts, than Dr. Hales. But thus it ever is with all who depart from their main field of operations to build up the difficult parts of other sci- ences. Hales was a divine, and, although adroit in experiments, and better qualified by impartial habits than the Chemist, it is no detraction from his (or their) exalted merits to say, that he knew so little of Phys- iology he was incapable of applying or even perceiving the facts which the student of organic nature may readily seize and convert to the phi- Absorption.—APPENDIX.—Circulation. 823 losophy of life, and turn against the conclusions of the original ob- server. Am I not, therefore, entitled to conclude, from these few observations alone, that organic beings are contradistinguished from inorganic by what is popularly known as life, or vitality, and with the summary remarks of one of the greatest scientific Botanists of the age, Professor Lindley, of the London University, as expressed in his able analysis of the " First Principles of Botany," that, 1st. " The movement of the sap depends upon a vital irritability, and is independent of mechanical causes" (§ 185,188,188|). 2d. " The proximate principles are formed by the vital powers of the plant acting, in conjunction with air and light, upon the fluids contained in its system." 3d. " All the phenomena connected with the growth of plants are caused by an inherent vital action" (§ 293). § 1055. I shall conclude the foregoing subject relative to the circula- tion in Plants (§ 1054) by a quotation from Liebig's " 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 of the conclusion, that " The employment of these results upon the processes in the animal body scarcely requires a more detailed explanation. " The surface of the body is the membrane from which evaporation goes constantly forward. In consequence of this evaporation, all the fluids of the body, in obedience to atmospheric pressure, experience mo- tion in the direction towards the evaporating surface. This is obviously the chief cause of the passage of the nutritious fluids through the walla of the bloodvessels, and the cause of their distribution through the body. We know now what important function the skin fulfils through evaporation" ! (§ 350jj, n-q.) Our Author did not even think so far as to consider the perpetual vicissitudes of the skin in that respect, nor how wonderfully the blood becomes concentrated in the great internal vessels in the sweat- ing stage of the malignant cholera, or as the same phenomena distin- guish a paroxysm of fear. It is also worthy of remark that this distin- guished Leader in Physiology here loses sight completely of his universal chemical doctrine of motion, which had been put forth in his " Animal Chemistry" (§ 1054). It forms, therefore, another antagonism for the Parallel Columns. If we may have sometimes appeared deficient in dignified sobriety on similar occasions, we have not thought it necessary to render an apolo- gy, but 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. EXPERIMENTS 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 of the body, and from what is respired from the lungs. It must, therefore, be far more strongly pronounced in the cavity of tho The Brain.—appendix.—Experiments. 825 cranium in consequence of the exclusion of atmospheric pressure, except- ing so far as this operates through the openings in the skull.' " To get rid of sources of ambiguity, connected with the otherwise un- determined question, whether such vapor existed naturally, or was pro- duced during changes in the condition of the brain, experiments were performed (on calves), so as to exhaust the system of its blood. With the results of 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 of the vapour has taken place after the death of the animal, the blood has rushed into the brain to supply the vacuum. Such, indeed, would be a necessary consequence of vapour so condensed, and of any blood remaining in the aorta, the cava, or the great branches connected with those of the head. For this reason we shall always find the cavity of the skull, in the hu- man subject, fully occupied by solid and fluid matter, to whatever extent depletion may have been carried, unless the patient may have been tre- panned during life, or before any reduction of the natural temperature. It does not, therefore, follow that vapour cannot have existed within the cavity of the skull during life because it is fully occupied by incompress- ible matter after death.' " The calves were experimented upon in this way: The aorta near the heart, or the descending cava, was opened, when so rapid was the hemorrhage that the heart's action ended only on the vessels' being fully emptied. Lest condensation of vapour should possibly have arisen from reduction of temperature, the head was instantly removed after the ani- mal died. On examination, Dr. Paine ' uniformly found the vessels of the brain and of the membranes nearly deprived of their contents, and the organ perfectly blanched.' No disproportion in the quantity of the blood was observed, whether the animal had been trepanned, or the external air excluded. The serum exhibited only ' a tinge of red' when the brain was opened up, and, therefore, there could be but very little blood in its vessels, or those of the pia mater. Not more than half a drachm, and ' always quite as much when the animal had been trepanned,' was ob- served in the sinuses of the dura mater. Calves were judiciously select- ed in preference to dogs, being less troublesome, and probably less liable to cerebral excitement during ' an operation requiring some dissection.' " The cranial contents were determined by comparing their weight with a bulk of distilled water equal to the capacity of the cavity. The dura mater was not included, and its sinuses were not disturbed so as to admit of the entrance of water. Here are the results: 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 6 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- t 82G INSTITUTES OF MEDICINE ver, on injection into the brains of animals bled to death, was 'two pounds in brains weighing ten ounces' (?x) ; 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 ?' 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-e, 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 sympathetic nerve along the arteries of the brain; that the topical abstraction of blood by cupping and leeching, if not also vesication, operates by producing a sympathetic contraction of the ves- sels within the brain; that inflammation of the brain is relieved on a common principle; and that opposite inferences would involve the re- markable exemption of a part from the operation of general laws, and a violation'of the usual simplicity of Design?' (§ 516 d, 756 b, 893 d-i, 915-921, 939, 974, 1039). " 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 98D 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 of the vessels themselves (§ 392 c, &c). The experiments tend to show that, if vapor exist naturally, its quantity must be small. A small quantity, however, is quite sufficient for meeting the exigencies of its purpose. The vapor may yet be found, it is supposed, by subsequent 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 Physiologie 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 (See, particularly, p. 583-593). I understand by Sedatives those remedies whose general tendency is to diminish vascular action in a direct manner; though in some instances 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 d, 950, 974 b, 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, we are presented with agents which illustrate, by their opposite virtues, the common attributes of the Sedatives; since it is the direct and equally uniform tendency of the former to increase vascular action in a direct manner. As examples of the two Classes, bloodletting, antimonials, hydrocyanic acid, and cold, may be reckoned as standards of comparison for Sedatives, and alcoholic liquors, spices, mints, the vegetable and mineral tonics, animal food, and dry heat, as representing the virtues of Stimulants. There are many things, however, which may increase vascular action, and induce inflammation, which operate in virtue of some irritation they exert (such as aloes, scammony, &c), but whose action is very different from that of stimulants. Indeed, 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 of the body. There must be a pathological condition which shall be in relation to the peculiar virtues which are denominated sedative, or no sedative effect may arise from the action of the remedy, and even an opposite result may be the consequence, as often witnessed of opium when administer- ed in high states of arterial excitement. And I am now led to remark that the 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 of the group may be in the high- est degree salutary. Take two of the most powerful. Loss of blood, for example, will often save life where opium would be destructive; and, vice versa, opium will relieve the subject of gastric spasm induced by drinking cold water, when loss of blood might destroy him. Even in some conditions of inflammation, remedies which are commonly stimu- lating and tonic will prove sedative when bloodletting may be at least useless. Such is the case in intermittent inflammation, after suitable de- pletion ; since Cinchona may then succeed, when loss of blood, antimo- nials, &c, have ceased to be curative (§ 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 of the 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 of the fSenso-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 A'auseants, refers to such agents as are sedative only when they produce nausea. There are many of this de- nomination, but none of them are of much use in medicine as nauseants; but, on the contrary, they are apt to produce an injurious irritation of the gastro-intestinal mucous membrane when carried to the extent ot 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 of the agents now before us, which has prompted the substitution, in otherwise enlightened quarters, of opi- um, digitalis, tobacco, aconite, veratrum viride (§ 891 c, 960 a, 1005)— 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 very little participation in the effects. (See Index, Nervous Poiver, Sympathy, Organic 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 fury is expended upon the organic constitution of the brain, and venous congestion of that organ is one of the invariable consequences. But this is effected through a very different process from what has been 832 INSTITUTES OF MEDICINE. hitherto supposed. The result is partly due to the 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. (§ 476^ 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, 891^ k). § 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 (§ 892|, 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, 892f 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 of alterative reflex actions of the nervous system. § 1057, h. I have placed Tartarized Antimony in a subdivision by itself, though many would probably arrange it with the Nauseants. But the former produces very powerful sedative effects without exciting nausea, as seen in the manner in which inflammations and fevers yield to its quiet influence. But the principles concerned are exactly the same in all the cases ; 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 Tendered 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 6hall 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 Ggg 834 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 large mass of the wool should be applied, so as to form at least an inch in thickness when bound down by a bandage; and thus far in my experience it should not be disturbed till there is reason to think that it has fulfilled its purpose. But, having never been in pursuit of new remedies, my experience in this particular is less than it otherwise would have been. I think, however, that there can be no doubt of the great superiority of cotton-wool to other means in the foregoing and analo- gous affections, even if it be necessary to remove the dressing frequently, as in cases of inflamed and chapped nipples. But even in these cases the cotton should be closely applied by means of a bandage. In the ease of ulcers, it appears not to be of much importance that they should be in a favorable state for healing, though I fegret 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 to, 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, especially 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.—Alteratives. 835 its special action upon the liver, and its cumulative effects, you will not find in the books. It is that of exerting a soporific 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- ing a cathartic effect till some two or three doses shall have been admin- istered—for the sake of its slowly alterative action upon the liver and intestines (§ 857, 859 a, b, 863 d, 873, 902 i, 905 a). This method is pur- sued in susceptible states of the intestines, and often in the advanced stages of all diseases, and during convalescence. The ultimate result is generally a copious production of bile. ALTERATIVES. § 1057^. 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, colehicum, &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 reflex action of the nervous power, the Alteratives bring it into action somewhat differently from those agents which, like Cathartics, and Emetics, and Loss of Blood, operate suddenly and with 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 (§ 222-238|, 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 of the class of Antiphlogistics. Those Alteratives which are of this universal nature I have assembled, in the order of their general therapeutic value, under the denomination of General Alteratives adapted to inflammatory and febrile diseases in a gen- eral sense. They are more or less suited to all the varieties of inflamma- tion, whether acute or chronic. There occurs another general assemblage which are more especially adapted to specific forms of inflammation and fever, and these are ar- ranged under subdivisions according to the specific forms of disease for which they are employed, and in the order of their relative value. The following are the subdivisions: 1. Adapted to scrofulous, and some other specific chronic inflamma- tions. 2. Adapted to syphilis, and certain other specific chronic inflamma- tions. 3. Adapted to syphilis complicated with scrofula. 4. Adapted to rheumatism and gout. 5. Adapted to intermittent fever, intermittent inflammation, and other intermitting diseases. 6. Adapted to obstinate and chronic cutaneous diseases, carcinomar 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, 818|, 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. bla^e does not appear as an order, but as a division under an Order of Culaneous 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. 642-648, § 893a-/, p. 652-655, § 893 m, p. 657-659, § 893^, p. 679- 681, § 905 a). Other remedies included in the group appear to operate upon internal parts through local centres **>f 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. § 1057|. I shall now introduce a series of important remedies, not only for the purpose of examining their special uses, but particularly for a farther illustration of general principles in Medicine, and the Philoso- phy of Organic Life, for which this work is especially designed (* lOb^)- 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 fi* 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, ^^f1' indee^ is true of most other remedial agents (§ 516 d, No. 6, § 638, 863 d, b9o, 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 i b commonly associated either with Jalap, Aloes, Rhubarb, Podophyllum, Colocynth, Scammony, Gamboge, or Extract of Butternut, or it exhib- ited by itself, some other cathartic is generally prescribed within a tew hours afterward. The combinations, too, with the several articles are most useful, in a general sense, in the order in which I hav/^J™,* them. Thus, Calomel and Jalap are more extensively useful thani i,«u omel united with any other cathartic. Podophyllum resembles J amp m its action, but is much inferior; so that Aloes comes next in utility o account of its adaptation to a great range of chronic affections ot the oi- 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 generally surpasses all others (§ 1057, /); 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 hale 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-lol, 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 cornmon 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- nouncedthan 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 of the London Cholera Hospitals in 1832, where Mr. Bennett is said to have treated successfully 17 of 18 cases by exhibiting to each patient, as soon as admitted, 120 grains of Calomel, and afterward 60 grains, every hour or two, until some relief was ob- tained. Several of the patients took from three to four ounces. Its di- rect effect was that of restraining the vomiting and purging. These 17 patients recovered, and the record so far is undoubtedly true; but, from what we know of the fatality of the malignant cholera in the hands of others, after the accession of those symptoms which are diagnostic of the disease, we are bound to believe that, in most, and probably in all, of these cases there existed only the premonitory stage, as it is called, when the disease is always very easily controlled, and by much milder treatment. It has been long known that large doses of calomel—such as 20 or 30 grains— 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. Itv equally denotes, also, an error in the imputed sedative effects of the remedy, as will be more distinctly seen in the entire failure of such doses, and of others far more moderate, in the 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 of the virtues of remedial agents without referring to their effects in various conditions of disease; nor can we obtain any correct view of their remedial capabilities by considering the operation of a particular remedy abstractedly from other means which may be associated with it in the treatment. A full dose of Calomel, for exam- ple, may be very salutary in some given form of disease, if it have been preceded by Bloodletting, as is often witnessed in congestive fevers, but without which it may be very pernicious. At another time, its good effects, or at least its best effects, can be secured only by associating with it other remedies, or, by applying others after its administration. The same, also, is more or less true of all other remedies ; each one influ- encing, more or less, the effects of the others (§ 859 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 of the mucous tissue of the large intestine, though all the digestive or- gans are more or less involved in morbid action. But the burthen of the disease is upon the mucous membrane, where it probably consists at all times of a peculiar modification of inflammation, though 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 of the 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 muco-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 of the treatment, from 10 to even 20 grains of Calomel, and not un- frequently to repeat this dose from time to time. When the disease is of the milder variety, if other things go right, it will often succeed in 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- V 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 Blue Pill, but more probably well-regulated doses of Castor Oil (§ 1057, I). So much for the milder, or sporadic form of dysentery. Coming to the miasmatic variety, especially when prevailing epidemically, the Practitioner who does not regard the modifying nature of the remote predisposing cause, and the exact pathology, will prescribe empirically, and be apt to administer large doses of Calomel, which, in this condition 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, er 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, h. When Calomel is employed in the treatment of Scarlet fe- ver, it should be with great caution after the disease has advanced some- what into, the eruptive stage. At this period, Calomel, Senna, and Rhu- barb have done a vast amount of mischief. At or near the invasion of t 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. 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- pf the 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, /. 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, j). The least important part of the disease is also generally considered the most important, since, in all severe cases, the inflammation of the skin is comparatively of little moment. Now and then, however, when erysipelas springs up epidemically, 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 of the abdominal con- gestion) spring up, a large abstraction of blood will be indispensable. I have never known Calomel injurious in erysipelas; but it must be added that I have almost always begun the treatment by abstracting blood, which, as I have said, is a great means of preventing the morbific effects of Calomel and Blue Pill; and no fatal case has occurred in my practice (§ 1005, j). § 1058, n. And now, as to acute rheumatism. Here, too, in all severe cases, especially of articular rheumatism, there is much attendant dis- ease of the abdominal organs, which contributes powerfully to maintain the rheumatic affection; and it commonly happens, in such cases, that, after the inflammatory condition is subdued, there will be still remaining a considerable amount of visceral disease, which will require, at least, great simplicity of diet. In all severe cases, it will be often observed that the abdominal affection precedes the rheumatic, but becomes much aggravated as soon as the latter supervenes. Calomel is a very useful remedy in acute rheumatism, in one or more 846 institutes of medicine. full doses, or yielding soon to Blue Pill, or Castor Oil, and rarely does any harm. But, in all severe cases, a free abstraction of blood should be the 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, nn. The same general principles of treatment apply to acute gout as to acute rheumatism (§ 1058, n), though in a moderated degree. A full dose of Calomel, or of Blue Pill, is generally useful at the onset of the treatment, one or the other, according to the derangement of the abdominal organs. But here, if the paroxysm be at all severe, and we would most speedily relieve the patient, he should be first bled. 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 (§ 892| 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 TJierapeutics.—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 I, 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, f, g). Calomel, Blue Pill, Jalap, and Castor Oil are alone wanted, so far as cathartics are concerned. The Drastics have been commended upon the fearful doctrine 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). Leeching, and Tartarized Antimony in its small doses, which are so valuable in other acute inflammations, are of little or no use here ; and Blisters should be avoided till at least a decisive ascendency is obtained over the disease. The latter remedy should never be applied to the head, but to the neck and shoulders, unless the abstraction of blood have been carried to a great extent. In some four or five cases, after having bled the patients till the remedy became unavailing, I have rescued them by covering the entire scalp, neck, and upper part of the shoulders with a Blister. The effect 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 t"he 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 mellilus. § 1058, t. Where inflammation of any of the tissues of the eye is com- plicated with gastric and hepatic disease, as is often the case, especially in epidemic ophthalmia, the occasional exhibition of Calomel, in a deci- sive dose, along 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 § 990-990^ § 1058, v. Calomel, in one or more full doses, is indicated, generally, in epilepsy, if bloodletting be also necessary. But, if loss of blood be not required, Blue Pill is entirely preferable. Much will depend, in these respects, upon the condition of the abdominal organs. If there be much derangement here, a large blister over the epigastric region yields much relief, though these are cases which are often greatly benefited by Loss of Blood. A rigid attention to diet, and other natural habits, are the great preventive means. But a reliance is apt to be placed upon some fancied specific, and when the paroxysms come on the symptom is often in the ascendant (§ 163, 884, 887, 891L e). I see, however, by a late Re- port of the Chairman of a " Committee on the effects of Bloodletting in Epilepsy, Convulsions, &c," embraced in the able " Transactions of the Indiana State Medical Society," that a Dew 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 (§ 891^,/). § 1058, x. As in epilepsy, asthma, and hysteria, so in chorea, the treat- ment is apt to be suggested by the prominent symptom, and the patient accordingly treated by antispasmodics. But they are rarely of any use, and generally injurious in these diseases, which are constantly supplying instances of the importance of addressing our remedies to the exact path- ological conditions (§ 668, 672, 673, 675,681 c, 685, 891£ 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 fhe 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 iff 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, z. In puerperal fever, Blue Pill, whatever may be the dose, is more or less useful for its local effects, and much preferable to Calomel, which is liable, in this disease, to irritate the abdominal organs injuri- ously (§ 1058,/). 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 B50 institutes of medicine. be indispensable that other remedies should have prepared the way for their favorable operation, as bloodletting to secure their salutary, or to prevent their morbific, effects either as cathartics, or emetics, or gradual alteratives; or a preliminary cathartic to render useful the emetic or the slowly progressive 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 aoain, in the same full dose, will rouse the irritability of the stomach from apparent torpor, and set in motion the whole mechanism of vomiting—besides nu- merous other potent influences which Calomel is capable of exerting in its higher doses. And turning next to the agents of emetic virtues, we may trace out their unperceived operation as gradual alteratives by con- sidering what has been said of the emetic effects of Tartarized Antimo- ny in § 902, e-g, and by a reference to that philosophy of the operation of all these agents, through reflex action of the nervous system, as vari- ously set forth in this work, and a glance at which may be obtained by simply referring to § 150, 151, 228-233f, 500, 506, 514, 516 d, No. 6, § 549-557, 841, 854, 857, 863 d, 873, 889 b, 892f g, 902 e-h, 904 b. In the work on Materia Medica and Therapeutics, and under the denom- ination of General Antiphlogistic Alteratives, or those remedies which, in certain therapeutical doses, produce their effects in a more or less insen- sible manner, I have arranged Calomel and Blue Pill, respectively, as first and second in general importance, and Tartarized Antimony and Ipecacuanha as third and fourth. But, from what has been already said in these Institutes of their general uses, and as an elaborate exam- ination of the special uses of each would carry me far beyond my limits, I shall content myself with this summary of references, and with repeat- ing a few remarks which occur in the Therapeutical Arrangement, and which will fulfil my present purpose of indicating their relative value as gradual antiphlogistic alteratives. 1. Calomel.—Dose, gr. ^ to grs. ij., repeated once in two to twelve or more hours. Especially adapted to chronic inflammation, common or specific, but particularly the former; less useful in acute inflammation, especially the specific forms, to which it is not often adapted, but better suited to both than any other mercurial preparation. More useful in continued fever than in other types of fever. Its full constitutional in- fluence will often suddenly arrest the progress of the former, but rarely the latter, which it is apt to aggravate. A valuable alterative in intes- tinal diseases attended by watery discharges, especially in children, as in cholera infantum, but which are scarcely inflammatory, in doses of TVh to ^th of a grain, once in 4 to 12 hours, with or without opium or the compound powder of ipecacuanha. Much less useful, and often injuri- ous, where the discharges are slimy. 2. Blue Pill.—Dose, gr. ^ to grs. v. Applied to the same general conditions as Calomel, and employed when a milder preparation is want- ed. Often preferable in chronic diseases; less so in acute. 3. Tartarized Antimony.—Dose, gr. -^ to i, once in an hour to three hours; generally increased gradually, often to half a grain, seldom to one grain, and rarely to two grains without occasioning nausea or vom- Therapeutics.—APPENDIX.—Jalap. 851 iting. It may be often useful in fevers and inflammations, attended by high arterial excitement, to carry this remedy, and also Ipecacuanha, oc- casionally, though but for a short time, to the point of nausea; but if nausea be kept up longer, the stomach is injuriously irritated, morbid sympathies propagated to the liver and other organs, and the whole con- dition of disease aggravated. The arterial excitement, it is true, will abate; but that is only a minor and deceptive symptom (§ 526 a, 714, 716). Where the excitement does not exist, prolonged nausea is more detrimental (§ 516 d, No. 6, § 526 a, 549-556, 841, 857, 863 d, 873 a, 902 e-i, 904 b, 1005 k, 1057 I). Tartarized Antimony ranks here in value after Blue Pill. Others would place it as the first of the alteratives, from its almost universal adaptation to fevers and inflammations, and its great curative power. But, though far more unexceptionably applicable to these affections than the mercurials, it will not, in like manner, suddenly arrest continued fe- ver, or acute inflammations, and, although gradually succeeding where the mercurials may fail, the latter not unfrequently have the same ad- vantage over the Antimonial. But this comparison holds more with Calomel than with Blue Pill. Again, the mercurials exert a profound influence upon chronic inflammations, of which Tartarized Antimony is far less capable, though sometimes greatly more so, as in chronic rheu- matism. The proper rank of Tartarized Antimony is probably immedi- ately after Calomel. 4. Ipecacuanha.—Dose, gr. ^ to gr. 1, once in four to six hours. The repetition of one grain oftener than once in four hours will, in a majority of cases, soon produce vomiting (§ 549-559, 841, 873 a). Ranks after Tartarized Antimony. Is adapted to all the inflammatory affections to which the antimonial is suited, but is much less efficient in most, though far more so in a few, as in dysentery, where Tartarized Antimony, in- deed, is inadmissible. May be also employed in many irritable condi- tions of the alimentary canal in which the antimonial cannot. It is of comparatively little use in chronic inflammations, excepting of the lungs; and renders very little service in idiopathic fever- Its advantages in some cases of indigestion have procured for it a place among the tonics. But it has no shade of a tonic virtue, though it will sometimes bring about corresponding results by its peculiar alterative action (§ 890^, d). JALAP. § 1060. In the work on Materia Medica and Therapeutics, I have given to Jalap, in conformity with the results of general experience, the third rank among the cathartics. There is no other, excepting Calomel and Blue Pill, that is so powerfully alterative in inflammations and fevers, and none so safe in connection with the curative virtues which are re- quired in the early stages of these affections, and it is an early stage of acute diseases to which I always refer. This comparative exemption from objection is rather remarkable, when it is considered that, like Scammony, the active principle resides considerably in a resinous sub- stance, and that the resin of Jalap is an acrid cathartic. But this only shows us that we must consult the direct effects of remedial agents upon morbid conditions to ascertain their actual virtues as remedies (§ 5^ a, 675, 686, 837 cc, 854 bb, c, 904 c). All that is of any value in this respect has been the result of experimental observation—observation limited to effects upon diseased states of the body (§ 137, d). And what 852 INSTITUTES of medicine. a rebuke is this to the pretensions of Organic Chemistry! Doubtless, it is greatly owing to analogical conclusions from the apparent coinci- dence in the resinous principles of Jalap, Scammony, &c. (§ 1063), that many have considered Jalap as unsuited to the acute stages of inflamma- tion and fever as the other resinous cathartics. But experience shows it otherwise. In making this discrimination, however, in favour of Jalap, it must not be entertained that it will supersede the necessity of Bloodletting in acute inflammations of important parts, and in numerous cases of fever, especially of all the congestive varieties, or that all the favourable effects of Jalap, like those of other cathartics, will not be as often promoted by previous Bloodletting in these affections; though it may be less morbific without. When acute inflammation affects the intestinal canal, neither Jalap or any other cathartic can be employed till the disease is essentially overcome by other remedies. But even in these conditions, it will pro- duce less injurious irritation, than any other active cathartic, excepting Castor Oil; and it may be a good deal divested of its irritating effects by combining with it some proportion of Tartrate of Potash. With the exception of the Saline and Mercurial, it is the effect of most cathartics, especially of such as are called Resinous, and of Rhu- barb, and Senna, to excite the general circulation during their direct op- eration ; and this particularly if acute inflammation or febrile excitement be present. But the usual effect of Jalap is the reverse, if any present arterial excitement be not very high, and the intestine be not in a mor- bidly irritable state. Under these circumstances, the action of the heart and bloodvessels diminishes in force and decreases in frequency during the direct action of Jalap, which, in respect to uniformity, is a remark- able property of this cathartic, though frequently witnessed of Castor Oil (§ 1057, I). But Jalap is recommended in the early stages of acute inflammations and fevers, with the qualification already made, not only by its compar- atively unirritating effects, and its depressing influence upon the organs of circulation, but by its direct alterative effects upon diseases of all parts, under appropriate circumstances. Indeed, its alterative action is not especially manifested in any one organ; but it appears to distribute its effects more equally than any other active purgative upon all.parts that may be the seat of disease. So far, it is singularly adapted to idio- pathic fever, and to inflammation of all parts, excepting of the intestines. The copious secretion which it determines from the intestinal mucous membrane, and quite freely from the liver, is, also, another recommend- ation of this remedy in the diseases under consideration (§ 143 b, c, 148, 163, 847 g, 863 d, e, 871, 889/ h, i, n, 900, 902 g, i). But Jalap is rarely given uncombined. It has not, as I have said, any remarkably greater effect upon one organ remote from the aliment- ary canal than upon another; but by combining other remedies with it, we may not only increase its own remedial influences, but produce spe- cial effects upon particular organs. For this purpose Calomel is gener- ally the best adjunct. The effects of this combination, when appropriate, are well known to be remarkably great, each remedy contributing to the effects of the other, extending them with greater force than either, indi- vidually, to every organ of the body, and exerting a more special sway over the liver, breaking down disease wherever it exists in a direct man- Therapeutics.—appendix.—Saline Cathartics. 853 ner, and indirectly by influences that are exerted upon organs that are not diseased, through salutary sympathetic impressions reflected, through the nervous power, from these parts (as the skin for example) upon or- gans that are diseased (§ 143 c, 514 h, 674 d, 676, 889 n, 902 g, m). This knowledge of the virtues of Jalap enables us to understand how it is that the addition of a* grain or two of Ipecacuanha often improves its excellent qualities, especially when Calomel is also associated in the compound. Ipecacuanha is not less remarkably universal in its influ- ences, though determining a more special action upon the skin, and upon the lungs in their inflammatory conditions (§ 2 b, 143 c, 148-151, 855, 895, 902 /), contra-stimulant, powerfully alterative, especially when thus appointed, and tributary to the purgative effect. When, therefore, brought into union with Jalap and Calomel in the dose of a grain or two, or, if a more powerful effect as a cathartic, depressant, and alter- ative be wanted (§ 227), then the Ipecacuanha in the dose of five or more grains forms a compound which is truly wonderful in its curative effects, so only the remedy be suited to the exigencies of the disease. In all that I am now saying of the uses of cathartics, or, indeed, of any remedy, the remarks must not be taken in an abstract sense, but they suppose that other remedial agents have been already employed, whenever necessary, to place the disease in a proper condition for the remedy under consideration (§ 1058, e). I have now stated the most useful combinations which Jalap is capa- ble of forming with other remedies. The only other of much import- ance is its union with Tartrate of Potash (the bitartrate being often injurious by the excess of acid). This and Castor Oil are, in a general sense, the most useful adjuvants to Calomel, when the latter is admin- istered in advance (§ 1057, I). THE SALINE CATHARTICS. § 1061. In the Author's Therapeutical Arrangement of Remedies, Cas- tor Oil and Aloes follow successively after Jalap, and there appear five saline cathartics in the following order: 1. Tartrate of Soda and Potash. 2. Sulphate of Magnesia. 3. Sulphate of Soda. 4. Phos- phate of Soda. 5. Tartrate of Potash. This order of arrangement is intended, as throughout the whole plan, to indicate their supposed general relative usefulness. I will here remark that Podophyllum is placed as the fourth in order, on account of its analogies to Jalap; but it should go down below the Juglans, as it is so fully superseded by Jalap. It yields, however, a useful extract, which Jalap does not. The virtues of these saline cathartics are very analogous, yet each one is marked by certain peculiarities, but less individually characteristic than such as distinguish most of the other members of this family of medicines. In a general sense they are also distinguished from other cathartics, excepting Jalap, by often directly lessening any general ar- terial excitement which may exist at the time of their exhibition, and they have obtained, in> consequence, the appellation of Antiphlogistic Cathartics. And yet their range of influence over severe forms of inflam- mation and fever is greatly less than that of the Mercurials, and Jalap, and Castor Oil. But their adaptation to a vast range of mild fevers as ultimate reme- dies, and to inflammations of comparatively unimportant parts, gives to them the relative value which I have assigned them in the Systematic 854 INSTITUTES OF MEDICINE. Arrangement. But, in all inflammatory and irritable conditions of the intestines, these cathartics rarely fail of being injurious. Nor should they, as a general rule, be exhibited as a primary remedy in any disease of much importance ; for, although they moderate general arterial excite- ment, they are but feebly alterative, and are liable, by an irritative action, to aggravate severe conditions of disease. Examples of this nature are often presented to our observation in cases where some one of these salts has been administered before summoning the attendance of a physician. These are particularly the cathartics which render much of their service by the secretion which they elicit from the intestinal mucous membrane (§ 863) ; and least of all do they reach the function of the liver. It is seen, therefore, to be a peculiarity of these cathartics to irritate the intestinal mucous membrane without propagating an irritation to the general circulatory organs, even in their excited conditions, so long as they produce no injurious irritation of the intestines. On the con- trary, under favourable circumstances, they will often greatly moderate arterial excitement during their direct operation; and it is this circum- stance which has given them a factitious importance in the treatment of severe forms of disease. But the reduction of arterial action and of heat is mostly due to the free elaboration of intestinal fluids, and the absence of irritative virtues in the remedies. There is little or no alter- ative action exerted upon the immediate instruments of disease, where disease is at all profound. There is but little of that alterative sympa- thetic influence propagated abroad from the alimentary canal which con- stitutes the most valuable effect of remedial agents (§ 150-151,163, 228, 526 a, 714, 716, 854 c, 859 b, 860, 870 a, aa, 902, 904 a). Although, therefore, the heat of the skin, and the excited state of the pulse, be moderated by the saline cathartics, it is often so only to return soon with equal or increased intensity. The remedy has not, in such cases, estab- lished salutary impressions ; and, in this way, the days steal on, but each succeeding day bringing some ascendency of disease over what is gained by the illusory " cooling effects," as they are called, of the saline cathartics. Those who depend upon their cooling effects are also apt to employ lemonade and oranges to aid in the cooling process; and, although these vegetable acids are set down in the books under the hypothetical denom- ination of refrigerants (§819, a, Mottoes), and are strongly recommend- ed for the purpose of cooling down inflammations and fevers, it is not less certain that it is only an old relic of the humoral pathology, and that these acids have not the slightest tendency to diminish febrile or inflam- matory action; but, on the contrary, they rarely fail to aggravate and prolong both. They produce an injurious irritation of the gastro-intes- tinal mucous membrane, thus inflicting a direct injury upon those organs through which we endeavour to convey relief to others. Such, then, is the deceptive nature of the whole of this refrigerant system. Thousands are its victims; when one good Bloodletting, and a dose of some suitable cathartic, at the beginning, would effectually cool down the patient, and probably save the necessity of any farther active treatment in a great proportion of the cases. It is comparatively a small evil, however, with that which arises from an indiscriminate and excessive medication. All this arises from the want of sound principles in physiology and pathology—the want of medical philosophy—and a consequent leaning upon the impracticable' and visionary doctrines of the physical schools. Therapeutics.—APPENDIX.—Rhubarb. 855 RHUBARB. § 1062. Rhubarb follows next in our Therapeutical Arrangement, and, doubtless, there are many who think it entitled to a higher rank. But, with all its reputation, its uses are comparatively circumscribed. It is not suited to any conditions of acute inflammation or fever, till, at least, they are far on the decline (§872, a); nor is it, at any time, a proper purgative when an active effect is required. Indeed, the real advantages of Rhubarb, as a cathartic, are limited almost to cases of diarrhoea un- attended with intestinal inflammation, to indigestion, and to the stage of convalescence from most diseases, whether acute or chronic; and, I may also add, to scrofulous subjects when affected by indolent conditions of inflammation. I am speaking of it in its relations to disease as a cathar- tic, though it may exert simultaneously other very desirable effects. In smaller doses, other objects are in view, and they can have no participa- tion in assigning the rank as a cathartic (§ 890, b). Now, the reasons of this limitation are rendered obvious by consider- ing the effects of Rhubarb upon certain diseased states of the body. When exhibited in fevers and acute inflammations, which make up the great amount of diseases, it aggravates them like stimulants and tonics; and it is also well known that it exerts the useful effects of tonics where these remedies are appropriate, as in dyspectic affections (§ 1065). Whilst, therefore, we thus learn that Rhubarb is not suited to febrile and inflammatory conditions of an active nature, the objections show us that it is well adapted to the periods of convalescence from those affections. Its mild tonic and cathartic virtues, as then manifested in small doses, give to it, under those circumstances, a high value as an auxiliary to Nature in her recuperative efforts. But in these cases, even, it should not be given uncombined (§ 872 a, 1064). By its frequent effect in arresting diarrhoea, it is known to possess, also, what is called an astringent property. But of this I have already spoken (§ 890, b). We have now seen that Rhubarb is cathartic, tonic, stimulant, and astringent; a combination of virtues which distinguishes it remarkably from all other cathartics. These united virtues impart to it a high value as a cathartic in certain conditions of disease, and a good substitute could not be supplied for it in those conditions. It enables us, also, to employ rhubarb most advantageously in many forms of disease where we do not desire its cathartic, but only its laxative effect that arises from small doses. In these small quantities, too, as a grain to five grains, the tonic effect of the remedy, which is then commonly desirable, is more strongly pronounced than in large doses. On account of these numerous virtues of Rhubarb, according, in part, to the quantity administered and the nature of the disease, I have ar- ranged it not only among the cathartics, but among the alteratives, and tonics, and astringents. For the first of these purposes it is most useful when combined with Calomel, or Calcined Magnesia, or the Tartrate of Soda and Potash, or the Sulphate of Potash; as an alterative it is often useful, in small doses, in chronic inflammations, on account of its useful effect upon the alimentary canal and liver; as a tonic in dyspeptic cases, and in convalescence from acute diseases, when its action upon the liver, and its laxative effect, are also tributary to the cure; and, as an astrin- 856 INSTITUTES OF MEDICINE. gent, in cases of diarrhoea unattended by intestinal inflammation, and in large or small doses according to the precise nature of the disease. Great mischief is done by the exhibition of Rhubarb in dysentery and scarlet fever. It is employed theoretically in the treatment of the former disease, on account of the astringent as well as cathartic virtue of this remedy, while the tonic and stimulating are completely neglected, as well as its pernicious effects (§ 892^, g). SCAMMONY, ALOES, COLOCTNTH, SENNA, COLCHICUM. § 1062 J. Three of the foregoing remedies, Scammony, Senna, and Col- chicum, are produced here, not only for the purpose indicated in § 1057£, but to exemplify the manner in which remedial agents of powerful mor- bific virtues are commended to an indiscriminate use in those enlight- ened quarters where Bloodletting is nearly or altogether proscribed, and to thus institute a farther contrast between the abuse of the Materia Medica and the neglect or denunciation of the "Remedium Principale" (§ 819 b, 891 c, 954 b, 960 a-h, 1000,1001,1003,1005-1006, 1007 b). SCAMMONT, ALOES, AND COLOCYNTH. § 1063, a. The cathartics following Rhubarb (§ 1062) in our Thera- peutical Arrangement are, respectively, Calcined Magnesia, Carbonate of Magnesia, Colocynth, and Scammony, the last of which, therefore, occupies the 15th rank as a cathartic of general usefulness, Aloes hold- ing the 5th. Scammony is a more irritating cathartic than Aloes or Colocynth, to which it is a good deal allied in its effects upon morbid conditions, al- though, unlike the former, it contains a large proportion of resin, which is the active principle (§ 1060). It operates with energy upon the whole intestinal canal, and exerts a considerable sympathetic effect upon the liver, often inducing a redundant flow of bile in the inactive conditions of that organ. It is well suited, therefore, when properly combined, to habitual and obstinate constipation, where no intestinal inflammation is present. It is, for like reasons, and, like Aloes and Colocynth, curative of chronic diseases of organs situated remotely from the abdominal vis- cera, and which owe their origin to those abdominal affections of which I am speaking, or, having a different origin, become complicated with them (§ 905, a). These three remedies, indeed, are mutually adapted to like conditions; though Aloes is much the best, and Colocynth is more alterative and remedial, and less irritating than Scammony. Each is pernicious in all inflammatory and irritable states of the intestinal canal, as well as injurious in all fevers, and in all acute inflammations of important organs. Nevertheless, Scammony, like Aloes and Colo- cynth, is more or less adapted to mild inflammations of the mucous tis- sue remote from the abdomen, as in catarrhal affections. § 1063, b. An important error prevails in regard to the action of Scammony and Aloes upon the intestinal canal, it being supposed that they exert their effects (particularly Aloes) upon the lower tract of the large intestine. This conclusion has grown out of the irritation of the anus which often attends the operation of Aloes ; but it is mostly due to the morbid bile which Aloes elicits from the liver. The Mercurials and Castor Oil have often the same effect in hepatic congestions, and it often occurs when no cathartic has been exhibited. Either for this reason, or because, perhaps, Aloes contains no resin, Pereira remark?. Therapeutics.—APPENDIX.—Aloes, Senna, &c. 857 in his great work on the Materia Medica, that " Aloes irritates less pow- erfully than Jalap" ! The misapprehension has led to a great extent of malpractice, particularly to the administration of these cathartics in fevers and acute inflammations, and even in morbidly irritable states of the small intestines. Aloes is, also, for the same reason, in part, with- held from pregnant women, lest its supposed action upon the rectum should give rise to abortion, a result which was denied by Denman, while, also, Aloes is an emmenagogue of some pretensions. As to the lat- ter fact, it restores menstruation in two principal ways: 1st, by its spe- cial sympathetic action upon the mucous tissue, remote from the intes- tine, in its morbidly susceptible conditions, as witnessed in catarrh and gonorrhoea; and, 2d, by its removal of indolent hepatic troubles and con- stipation, of which amenorrhoea is so often merely symptomatic. The simple fact that Aloes affects readily and powerfully the hepatic function in its morbid states, should leave no doubt of its special action upon the upper portion of the intestinal canal; but, that this is truly so may be rendered evident, and Pereira's comparison of Jalap and Aloes contradicted, by the following experiment, which may be readily tried by the advocates of Aloes and Scammony, bearing in mind that, when constitutional excitement ensues, or when allayed, by the opera- tion of cathartics, it is mostly in consequence of their action upon the small intestine. Let us, then, regard two patients, affected as nearly alike as may be with remittent fever. The skin of both is preternaturally warm, the pulse moderately full, and 100 beats in a minute. This is so far their corresponding state; the disease in its incipient stage, and there has been no treatment. Now, to one we will give 30 grains of Jalap, to the other 12 grains of Aloes; and let us take an observation of their symp- toms at the time of the second alvine evacuation. The pulse of him who is purged by the Jalap has descended in frequency from 100 to 80 beats in a minute; while the Aloes has carried it up in the other to 120, be- ing a difference of 40 beats. The skin of the former patient has become cool, and soft with an insensible perspiration. This patient is also placid, and feels himself relieved. On the contrary, the skin of the other is ardent and dry, his face flushed, his eyes wild, his head annoyed with pain, and his whole system in an agitated and harassing state. This is the test, and by this should we be governed both in practice and in theory. § 1063, c. The objections which I have made to Scammony as an ir- ritating cathartic lead me now to fulfil the purpose expressed in § 1062 J, as I shall have occasion to do, also, when I come to the merits of those popular remedies, Senna and Colchicum. For this object I shall look into Pereira's elaborate and standard work upon the Materia Medica (as I have done on former occasions, § 891 c, 960 a), as one, among others quoted to the same effect, which represents the opinion of many. " Scammony," says Pereira, " is principally valuable as a smart purga- tive for children, on account of the smallness of the dose necessary to produce the effect, the slight taste, and the energy, yet safety, of its operation." I shall not speculate upon the probable consequences of this eulogium upon one of the most irritating and drastic of the purgatives that are entitled to a reputable place in the Materia Medica, nor inquire how far it may have contributed to the success of homoeopathy (§ 878). But I am entitled to assert, in the first place, that such is the great liability 858 INSTITUTES of medicine. of Scammony to produce constitutional irritation, and excite intestinal inflammation in Children, that it should never be exhibited to them un- der any circumstances (§ 576 rf-577); and for the ordinary purpose of cathartics it is entirely unsuitable at any age. Again : as to the attractive " taste" of medicines, which appears to be often of paramount consideration. Calomel, even, is recommended for Children upon this worse than mere empirical ground; and, of one of the most valuable remedies, and most appropriate for Children, Pereira says, that, " As a purgative for Children, Castor Oil has been used on account of its mildness; but its unpleasant taste is a strong objection to its use." Compare this with what he says of Tobacco at § 960, a. Nei- ther is the " smallness" of a requisite dose to be for a moment weighed against the virtues of a better remedy. SENNA. § 1064. The popularity of Senna as a domestic medicine, and the ex- tensive use of it by the Profession, lead me to some comments which would not be otherwise made. If Bloodletting, in the treatment of in- flammations and fevers, is to receive no quarter from those who build their hopes upon a more popular practice, or lose sight of pathology in the novelties and promises of Organic Chemistry, let us see to it that they do not escape without rebuke for their lavish use of the violent ar- ticles of the Materia Medica (§ 819, b). Pereira, in bis able work upon the Materia Medica, supplies the best authority as to the general estimation in which Senna is held. "Taken by the stomach," he says, " Senna acts as a sure and safe purgative;" and again he repeats, " It is a very safe purgative, and may be given to Children, Females, and Elderly persons with great security." That Senna is a " sure purgative" is as true as the same affirmation by our Author of Scammony (§ 1063, c); but it is nearly as far as Scam- mony from being entitled to the same general commendation of being "very safe." On the contrary, in my judgment, there is no other ca- thartic, in the hands of Physicians, which has been more extensively in- jurious than Senna; and this being so, I shall indicate its bad qualities before speaking of its good. In the first place, Senna is rarely capable of any very salutary effect upon inflammations, either acute or chronic, or upon fevers. By its ir- ritative virtue, it excites the general circulation ; and as it is profoundly irritating to the whole mucous tract of the bowels, it rarely fails to ag- gravate idiopathic fever, or to exert injurious sympathetic influences upon any inflamed organs. We have already seen how Rhubarb is mis- applied in this manner, especially in dysentery (§ 1062). But that rem- edy inflicts its injuries in active forms of inflammation and fever by its tonic and stimulating properties—Senna, by its irritating (§ 889, a). And here, by the way, it is apropos of the Author to whom we are now paying our respects, that he says of Rhubarb that, " Given at the com- mencement of disease, it is a very popular remedy; and though doubtless it is often employed unnecessarily, it rarely if ever does harm." True, he also says that " it is not fitted for inflammatory or febrile cases." But, as to this Senna, it may be safely said, that it should never be employed but with a simple view to its purgative effect, and then only in constipated states of the bowels when unattended with any inflammation of those organs. The griping of Senna is proverbial; and Physicians ♦ Therapeutics.—APPENDIX.—Colchicum. 859 have vainly flattered themselves that this effect may be counteracted by uniting Manna, or the Saline Cathartics, or a purgative Tincture, or some carminative, like Coriander or Anise, with an infusion of Senna; nor does a moderated heat in its preparation lessen the evil. What, then, does that griping imply, considering its universality1? Certainly, an excessive irritation of the intestinal mucous membrane, and such, too, as is very likely to result in disease of the intestines, if these organs be in a morbidly irritable state. If any disposition to inflammation be present in any one of the tissues of the intestines, the action of Senna will be very likely to develop an attack of that disease. If any venous congestion affect the liver, it will be aggravated by the irritating prop- erties of Senna. And, as it regards inflammations of other parts, and idiopathic fever, it is very likely, as is known in the best experience, to send its morbific influences abroad from the abdominal organs over those affections. Among the worst and most common manifestations of this are the sad effects of Senna in the treatment of scarlet fever. The objections to Senna grow out of its radical fault of possessing very little alterative virtue of a useful nature, and a great deal of a mor- bific (§ 854, d). But a difference in this respect obtains in different cli- mates ; which applies, also, more or less, to other irritating cathartics, and to Tartarized Antimony in emetic doses. In latitudes north of about 40° these remedies are better borne than in the more southern; the rea- son of which is, that in New York and South there either exist in most complaints, or there is a great tendency to, derangements of the abdom- inal viscera. Having, therefore, so little to say in commendation of this notorious member of the Materia Medica, and having dwelt sufficiently long upon its demerits, it only remains to be added, that it is most salutary when it takes along some one of the meritorious neutral salts. COLCHICUM. § 1065, a. The most obvious effect of Colchicum, in small and repeat- ed doses, is that of irritating the intestinal mucous membrane, as evinced by a purgative effect. In larger doses it produces nausea, vomiting, and hyper-catharsis. Indeed, this remedy is commonly arranged with the cathartics, though it is rarely employed with the usual intentions of a purgative. I am quite satisfied, however, that it will not often afford much relief in gout or rheumatism (to which its uses are mostly restrict- ed) till it produces some purgative or laxative effect. For this reason, particularly, I have given it a low rank among the Cathartics in the Therapeutical Arrangement of the Materia Medica. This effect, indeed, is what we are to carefully watch; since, when it begins, if the dose have been large, or the intestines unusually susceptible, the purging is liable to be excessive and injurious. Various incidental results are stated by Authors as following the use of Colchicum, such as occasional sweating, occasional increase of the flow of urine, &c. But these are only contingencies to which almost all remedies may lead, under particular circumstances of disease, and are of very little importance in an abstract sense (§ 422 b, 863 d, e, 892|). It is worthy of remark, however, that Colchicum often reduces the frequency of the pulse, though at other times it exerts an opposite effect. But the interesting fact relates to the diminished frequency, which has been taken hypothetically as a ground for the administration of Colchicum as a 860 INSTITUTES OF MEDICINE. remedy for all kinds of inflammation, and is one of the expedients that have been devised for getting rid of Bloodletting. This brings me to one of the objects set forth in § 1062£. " Mr. Haden," says Pereira, "was the first to direct attention to the advan- tages to be taken of this effect in the treatment of inflammatory diseases (ut cit., § 1063, c). I know not to what extent this very limited view in Therapeutics may have prevailed ; but it has been, probably, the occasion of an effort now making in the United States to substitute for Bloodletting that very violent agent the Veratrum Viride, which has been long known to less- en the frequency of the pulse by an acrid narcotic virtue which it pos- sesses, and which belongs to some of the acrid cathartics. The whole of this practice appears to have been suggested by a similar error in respect to Digitalis, and by the attempts that have been made to substitute To- bacco and Aconite for Loss of Blood (§ 960, a). Neither Colchicum nor Veratrum exert any antiphlogistic effect ex- cepting upon those specific forms of inflammation which constitute rheu- matism and gout; and both of them will aggravate these diseases in their acute condition till they are effectually moderated by Bloodletting, Tartarized Antimony, or other direct Antiphlogistics. In that respect they are upon common ground with quinine in its relation to intermit- tent inflammation, and with iodine to the scrofulous. They are very remarkable exceptions to all the general antiphlogistic means which are alike adapted to the early stages of the specific and common forms of inflammation, and which are indispensable at that stage, as prehminary remedies, to the favorable action of the specific ones upon the special modifications of inflammation to which they are alone adapted (§ 662, 671, 892 m, p, 892^ c, e, u). More remarkable exceptions occur in guaiacum and other substances of allied virtues which are peculiarly suited to chronic rheumatism, while they aggravate any other form of inflammation. Nor is it an uninteresting fact, that all these things, Colchicum, Guaiacum, Veratrum, Asagra?a, Delphinium, Xanthoxyl- lum, Aconite, Mezereon, Savin, are acrids. § 1065,6. These, however, are only strongly pronounced character- istics ; for the critical observer will find the same distinctions prevailing in various degrees throughout the Materia Medica, and they show us that experience, and not theory, is, or should be, at the foundation of all our knowledge of the virtues of remedies (§ 2, c) ; and not only so, but that we can have no just apprehension of their relations to disease with- out a long series of trials in the endless variety of pathological condi- tions, their fluctuations, their localities and sympathetic influences, or as they may involve the universal body, according to the range of inquiry which pervades these Institutes; and when the student shall have ex- amined its details and principles, and seeing that there is not a conflict- ing fact or induction, but that it is a perfectly consistent and harmoni- ous whole (§ 1, a), let him interrogate himself as to whether he can sum- mon a fact or a doctrine from Organic Chemistry that will disturb that relationship, or withstand its united force. § 1065, c. But, however this may be, so long as the Chemical doc- trines are in the ascendant, we may not hope that experiments of the foregoing nature will cease to occupy the place of rational Medicine. Nay more; failing in these, and considering the unpopularity of anti- phlogistic remedies and the acceptable nature of the invigorating, we Therapeutics.—appendix.—Colchicum. 861 need not be surprised that the Chemical treatment of disease is so ex- tensively governed by the Brunonian philosophy. Of that philosophy I have said something in these Institutes, and adduced an example of its prevalence in the British Army when Robert Jackson undertook to demonstrate its real merits (§ 621a, 890^/960a, p.717, §569^,1006/ 1068). But how little would this Reformer rely upon human efforts could he now read the brief paragraph which follows: "Costly Medicine.—A London (Eng.) paper says: 'The consumption of wines in our public hospitals constitutes one of the heaviest items of their expenditure. The wine account at Guy's Hospital last year,£1083; the spirit account, £376—total, £1459 ($7295). At St. Thomas's, the wine account was £629; spirit account, £521—total, £1150; or £2609 ($13,045) in one year in the (two) borough hospitals alone.' "—Boston Med. and Surg. Journal, July 2,1857, p. 448. § 1065, d. Again, as to Colchicum. This is also one of the many vio- lent remedies that have been employed not only as a substitute for Bloodletting, but commended in doses at which Bloodletting revolts (§960, a, p. 717). Thus: " In some experiments," says Pereira, ut cit. (made with Colchicum on a healthy individual by Dr. Lewins), " debility, a feeling of illness, and headache were experienced. This feeling of debility is not, however, to be referred to the evacuations produced, for, as Dr. Barlow has observed, the number of motions is sometimes considerable without any propor- tionate diminution of strength. I have known, says Dr. Barlow, even twenty stools occasioned by a single dose of Colchicum, the patient not complaining of the least debility." Now here is something of which we have a right to complain. In the first place, that Dr. Barlow should isolate a case of this nature, and put it forth to show that we have nothing to fear from " twenty stools" by a single dose of this most violent substance; and, secondly, that Pe- reira should quote it for the same purpose, and in opposition, even, to Dr. Lewin's experiment upon a healthy individual. Having done this mischief, Pereira ultimately relates instances of death from over-doses of this medicine, and remarks that," in poisonous doses, Colchicum acts as a powerful poison." Now, to my apprehension, when " a single dose" of any " powerful poison" produces " twenty stools," it is verging very closely upon its poisonous effects; and when- ever Colchicum may treat our patients in that reckless manner, we may fear, at least, some troublesome intestinal inflammation as a consequence. There never was, and never will be a patient purged twenty times by "a single dose" of any cathartic, without being the worse for the violence inflicted upon his intestines (§ 960, a, p. 717). Commend me, rather, to the Homoeopath, who meditates on death! But I have been actuated in this disquisition only by a sense of the importance of considering well how the violent agents of the Materia Medica are often commended to our rash and indiscriminate use; and in so doing, to show, also, how probable it is that the same inconsider- ate view of the subject has led to protestations against the most import- ant of all remedies in the treatment of inflammations. § 1065, e. There can be no doubt that Colchicum manifests a much greater control over gout than rheumatism; and, although this is gen- erally conceded, all practitioners do not agree as to the extent of its in- fluence. Some of the most able and accurate observers, such as Sir E. 862 INSTITUTES OF MEDICINE. Home, and Dr. Paris, pronounce it a specific for the disease; while others, like Sir C. Scudamore, consider it, at best, only a palliative. In- deed, Scudamore, in his treatise on the gout, is disposed to look upon Colchicum with great suspicion, believing that, although it be a present means of relief, it increases the tendency to a repetition of the paroxysms. He thinks, also, that it loses its remedial effects by frequent use, al- thoufh considerable intervals intervene between the attacks. Very much, however, will depend upon the particular circumstances of the case when the remedy is exhibited. If given at the onset of acute gout without antecedent Bloodletting, or when the abdominal organs are in a morbid state, we may look for disappointment. ON THE ACTION OF CHLOROFORM, AND ANALOGOUS AGENTS IN PRODUCING INSENSIBILITY WHEN INHALED. § 1066, a. The general prevalence of the Chemical or other physical doctrines of life, and the consequent interpretation of Pathology and Therapeutics upon the same principles, has necessarily led to as exten- sive a revival of Humoralism, and, as one of its dicta, that the causes of disease, and the curative means, so far as the nature of things will admit, are absorbed into the circulating mass of blood, where they effect their results in the blood or the solids through some chemical process (§ 40-46, 350, 350i-350f, 821 c, 828 d, 830, 837 d, 840, 893 e, 904 b, 905 a, 1034). All but Setons, Cold, Mental Emotions, &c, are carried to this account (see Indexes) ; and even some of the soundest Physiolo- gists in other respects maintain that the poison of the Viper, Hydrocyanic Acid, and the spirituous extract of Nux Vomica are absorbed when the last two destroy life in a second of time, notwithstanding, also, it is pal- pable that their fatal action must begin on the instant of their contact with the lungs or the mouth (§ 350^, 441/ 492 g, h, 494, 826, 827, 828 a-e, 829, 904 b, &c). And so, to question the assumption that chloroform and analogous agents produce their effects only after being combined with the circu- lating mass of blood, according to Liebig's or some kindred hypothesis (§ 350 J, n, p), is held to be an evidence of ignorance in Physiology, and unworthy a moment's consideration. But, before this doctrine can be sustained, the facts in the foregoing references, and a multitude of others contained in this Volume, must be disproved. True, the blood is said to be changed in its colour, but that would necessarily arise not only from the exclusion of atmospheric air, but from the morbific action of the ana?sthetic through the ordinary laws of sympathy, and is upon the same ground as the supposed absorption of Carbonic Acid Gas (§ 419, 827 b). Again: some may have supposed that they have smelt those agents in the blood (§ 282). But the sense of smell is apt to be fallacious, especially when in pursuit of some particular odour or some favourite hy- pothesis, and it is difficult to contradict it. But this would prove noth- ing as to their mode of operating; since, especially, others have failed of detecting the odour of the most fragrant and fatal (§ 494, 827 d, 904 b, c). Moreover, the odour of chloroform and of sulphuric ether is very diffusive and impressive, so that if even a minute quantity of either sub- stance entered the circulation, it should be detected without the aid of the imagination. A drop of ether will impregnate the air of a large room. We have had reports of alcohol having been.thus observed, and they have been appropriated by the Chemist accordingly (§ 440 bb, No. Anaesthetics.—appendix.—Chloroform, &c. 863 9, § 441 c, 1048-1049); nay more, of the blood burning like a flaming current as it issued from a vein, and even of the spontaneous combus- tion of inebriates. (See all the reported cases in Medical and Physiolog- ical Commentaries, vol. i., p. 576-581, where each one is shown to be without foundation.) The veins of different organs have been, also, found congested after respiring the Anesthetics, but less frequently of the brain than of some other parts. But this, too, proves nothing of absorption ; for the same is the case when Hydrocyanic Acid, or the spirituous extract of Nux Vomi- ca, whether taken by the stomach, or applied to the mucous membrane of the eyes, or nose, or mouth of rabbits, destroy life in a second of time (p. 675, § 904 b, 494 dd, 826 d), or the virus of a snake in a minute (§ 828, c). And let these observations be taken in connection with Gir- tanner's experiments and those of others (§ 494, b-dd), and with the re- markable results which arise from pricking the floor of the fourth cere- bral ventricle (§ 1032, d). It is urged, also, that the blood is apt to be fluid and black when death follows the respiration of the anesthetics. But this is equally true when death is instantly produced by hydrocyanic acid and the extract of nux vomica, or by blows upon the epigastric region, by excessive ex- ercise, &c. The phenomena, therefore, are against the hypothesis. As the whole of this ground, however, has been gone over extensively in these Institutes, it is mostly the purpose of the present Article to bring the question under the trial of facts embraced in the foregoing sec- tions, and others to which they refer, along with our demonstrations of the nervous power and the laws of sympathy; though the subject might have been left to a single consideration, which appears to me to be con- clusive against the doctrine of operation by absorption, and which I shall now address to the Physiologist. § 1066, b. In the first place, then, it is conceded that the blood ia from one to two minutes, at least, in going the round of the circulation (§ 904, b). It should, therefore, occupy nearly that time after the res- piration of the Anesthetics is begun before insensibility takes place, which is equally true, also, of Hydrocyanic Acid and the extract of Nux Vomica (the latter of which is not volatile, § 494 dd, 826 d), which have been known to destroy animals in a second of time (§ 904, b). But this is not the specific fact to which I have adverted, though it should be taken in connection. I say, then, if insensibility depend upon the absorption of the Anes- thetic agents, there should be no necessity for their unceasing respiration, or quick repetition, to maintain their effects. The blood once changed, or however modified, should be capable of prolonging insensibility far beyond any thing that is observed in experience. But if, on the con- trary, the effect arise from the influence of the agent upon the pulmonary mucous membrane, and be thence propagated by the nervous system, it would be quite likely to subside soon after atmospheric air is freely ad- mitted to the lungs, as in § 481, a-h. Precisely the same peculiarities attend the respiration of the nitrous oxide gas (§ 827, c). The subject is quickly brought under its power, and his faculties are often fully re- stored in less than half a minute after atmospheric air is substituted. This is as true of Amylene as of chloroform and sulphuric ether. Thus, Dr. Orton, of Binghamton, N. Y., on administering 3iij- of amylene, produced " complete insensibility in about two minutes." " Just as I was 864 INSTITUTES OF MEDICINE. about to perform the surgical operation intended, the flexible tube with mouth-piece separated from the inhaler, and before I could adjust it my patient had completely recovered her usual sensation." The inhalation was repeated, and " the larger nail torn from the toe without the slightest Uneasiness."* (New York Journal of Med., Sept., 1857, p. 286.) Now, will any one believe, with his logical powers awake, that such a sudden transition, in either of the cases, could possibly happen were the phe- nomena owing to an incorporation of these substances with the circu- lating mass of blood! Give to the Chemical, or any other physical hy- pothesis, the greatest possible latitude of construction, or expound the results upon the vital theory, it is plain that when these agents are once circulating in the labyrinth of the organism, and in sufficient quantity to produce the astonishing momentary effects, they would continue to do so, in gradually diminishing degrees, until ample time should have elapsed for, at least, their elimination by the emunctories. Again : the doctrine of absorption is contradicted by the necessity of diluting the anesthetics with atmospheric air to prevent immediate death, which may happen so quickly as to preclude the hypothesis. This necessity of dilution supposes, therefore, the action of the Anesthetics upon the nervous system of the lungs, and their transmitted influence over the entire organism by the reflex action of the nervous power; and this is farther seen in the fact that a greater amount would be absorbed during a long-continued respiration of the diluted agents than could hap- pen when only momentarily exhibited in a concentrated state, and there- fore death should as certainly follow in the former case. Moreover, all the earliest phenomena denote the direct action of the agents upon the lungs. The whole philosophy, therefore, is perfectly explicable through what is known of the different susceptibilities of the various tissues, and in their various parts to the action of external and internal causes, and the wonderful attributes of the nervous power; and which enable us to com- prehend the reason why the Anesthetics so rarely affect the organs of organic life (§ 233f, 481 a-h, 500 g, m; also Indexes, Articles Structure and Nervous Power, § 1088 c). By the same philosophy, we as readily comprehend the reason why the respiration of the fumes of Hyosciamus, and of Opium, establishes pro- found effects upon the whole organism, when no such result arises from smoking tobacco (§ 904, b). A summary of the whole philosophy is em- braced in that and in sections 150-151, 226-230, 894-895 ; and to this conclusion we must all come at last. * I have introduced this case for the purpose, particularly, of referring to the remark- able fact that " the eyes of the patient were not closed at any time during the operation, but she seemed to amuse herself with an examination of the apparatus, bhe answered questions put to her with considerable promptness, and, in fact, conversed with my as- sistant during the period of insensibility." nor "was she aware that the nail had been removed when she recovered her sensibility. The pulse was but slightly accelerated ^ There is no contradiction between this statement and that " complete insensibility was effected. The latter refers to common sensibility, the source of pain; and the ex- periment illustrates admirably the distinction between common and specific sensiDiiity (§ 197-201). The experiment, in thus showing the limitation of the anaesthetic influence to the nerves of common sensation, and in leaving the mind unaffected, as, also, tne ac- tion of the heart, goes with our other facts in disproving the doctrine of operation oy absorption. . - 'v/iitv The analysis which the experiment has supplied as to the modification of ?ensl™"£ may be carried analogically to the organic properties, and be thus employed in corrou- orating our analysis of those properties (§ 170 a, 172, 175 a, b, 183-193, 205-^1;- Remedial Action.—APPENDIX.—Mental Emotion. 865 THE INFLUENCE OF THE MIND UPON THE ACTION OF REMEDIAL AGENTS. § 1067, a. Much has been said in this work upon the influence of the Mind in the production and cure of diseases ; and it is now my purpose to extend this inquiry, very briefly, to the influences of the mind upon the action of physical agents, both as predisposing the body to the action of foreign morbific causes, and as modifying the operation of remedies. It will thus form an Appendix to what is said of the " General Philos- ophy of the Modus Operandi of Remedial Agents," or, rather, a group- ing of many relative observations that are disseminated through the In- stitutes. (See Indexes, Articles Remedial A ction, Remedies, Mental Emo- tions, Mind, and Will.) The subject is practically important, and goes far in denoting the laws which govern the operation of physical agents upon the body, and in drawing a broad line of distinction between Chem- istry and Physiology. I say practically important; for who, indeed, of the Medical Profes- sion has not suffered the experience of seeing the useful effects of reme- dies defeated by the despondency of his patient, or by some saddening emotion awakened by the indiscretion of friends, and often by a brief at- tention to business engagements, or by far simpler occupations of the mind? But there is great variety in these respects, according to the pathological conditions and the mental influences. The differences in results coincide, also, with such as are witnessed of physical agents ; the same philosophy interprets the operation of both; and the same careful regulation of one is often as important as that of the other. It is a matter of daily observation, in acute diseases, that the casual visits of relatives and friends, however much enjoyed by the sick, leave them for the worse; an effect entirely the reverse of what is witnessed of the same excitements in chronic forms of disease. But this corre- sponds with what is seen of the difference in the results of bodily exer- cise and tonics and stimulants in acute and chronic maladies. On the other hand, however, the subject of acute disease may be essentially ben- efited by the subdued cheerfulness of an habitual attendant. He may be, in like manner, seriously disturbed by listening to a page from a Ro- mance, when, on the contrary, he would derive an advantage from an appropriate Chapter of the Bible ; and yet both of these are remedial i» chronic diseases. Nevertheless, there is a perfect consistency in the phi- losophy which attends the effects of moral causes in the two cases— whether Nature be embarrassed by mental troubles and pleasurable ex- citements, or aided by placid cheerfulness and buoyant hope. The moody dyspeptic is invigorated in his digestion by every kind and degree of men- tal enjoyment, and his laxative and tonic medicines are sure to serve him best when his constipating melancholy is occasionally broken by hilarity of mind; while the subject of fever, though lacerated by exhilarating emotions, is started along by every smile of his Medical Attendant, and every remedy yields a boon to Nature under the influence of that smile, when a solemn countenance may make all the odds between recovery and death. In acute diseases, it is the tranquil emotions that do the service, while all of a joyful nature are scarcely less embarrassing to art than they are instrumental in the cure of chronic maladies. So nicely graduated is this principle in its operation, that it often happens that the subject of fever will make greater improvement in the hands of a com- mon nurse than in those of a sympathizing friend. And yet there never In 866 INSTITUTES OF MEDICINE. fell from the lips of the Medical Attendant a word of encouraging pity that did not tell favourably on his Castor Oil or his Narcotic. It is, of course, impossible to analyze the precise influences of the mind upon the action of remedies in mitigating or aggravating disease. The principle is abundantly pronounced in morbific effects of the mind that are independent of other causes, in embarrassing the favourable action of remedies; and it not unfrequently happens that the mental condition may baffle the best efforts of art, not only as a fundamental evil, but as crippling the curative means; while, on the other hand, when the same mental trouble is supplanted by happier thoughts, its baneful conse- quences not only yield as a spontaneous effect, but are hastened in their decline by the new mental influences. From these premises we may reason to all the transient and infinitely diversified affections of the mind that spring up in the progress of diseases which have their origin in phys- ical causes alone, and calculate, with much exactness, the effect of one passion or another in aggravating or moderating disease, and how far they may embarrass or facilitate, through those modifying influences, the effects of remedial agents. But, to carry this analysis into practical ef- fect in the treatment of acute diseases, there must be the same reference to their nature and fluctuations that is demanded for the right applica- tion of the Materia Medica, though it may be comparatively unim- portant. We have variously seen how the susceptibilities of organs to the ac- tion of physical agents are increased by morbid states, and it is exactly the same with mental emotions as with the physical causes; and with what prodigious power, especially in acute diseases, the latter may oper- ate, can be readily inferred by considering how, in healthy states of the body, one passion, as fear, will agitate the voluntary muscles, depress the circulation, but impart a bounding motion to the heart, give rise to vomiting, open the floodgate of the kidneys, expel the contents of the bladder, protrude the eyeballs, drive the blood from the face, and bathe the skin with perspiration ; or, how anger braces up the voluntary mus- cles, rouses a vehement circulation, &c.; or, how shame strikes at the capillaries of the face and injects them with blood; or, how marvellous- ly love plays with its shafts ; or, how hope ever gladdens the heart; or, ^iow joy and anger may be instantly fatal. So far, therefore, as the mind can have a bearing upon the action of remedies, it is by its direct influences upon the pathological states, through which it renders them more susceptible of either salutary or morbific impressions from physical agents, or renders them inoperative; while, also, it co-operates simultaneously, as an independent means of cure, or proves a direct morbific cause. If the inquiry be extended to many of the familiar phenomena of the organic life of nian, it will be seen that the mind is more or less in- terested in all the healthy functions; and it goes to supply more delicate illustrations of the influence of the spiritual part upon morbid states of the body. This, for example, is habitually seen in the improved appe- tite and more vigorous digestion, on occasions of festivity. Nor is it alone the unflinching manner in which the stomach meets its unwonted task (and much to the admiring wonder of the chemical philosopher), but it yearns for the multitudinous variety as the odour regales the nose, or the clattering of dishes delights the ear, and under the influence of which the mouth overflows with saliva. And now, if we reverse the Remedial Action.—appendix.—Mental Emotion. 867 case, and suppose .the Party, as soon as completing the repast, to be thrown into a paroxysm of fear of a few hours' duration by some im- pending catastrophe, it is certain that digestion would have made but little or no progress. Observe, again, how some remedies of active vir- tues are more or less governed in their effect upon comparatively healthy individuals by the varying conditions of the mind, as seen in the sus- pended or defeated operation of cathartics by any close attention to the daily affairs of life, and how, on the other hand, their effect is promoted by giving the attention to the anticipated results. The constipating effect of stage and rail-road travelling is mostly owing to the restraint which the mind imposes upon the natural functions; and it is well known that the will may, under any circumstances, delay or hasten the operation of cathartics (§ 500, e). What is thus seen of the natural condition of the body is alike true of its morbid states, as it respects the influences of the mind. But in the latter case those influences are much more strongly exerted on ac- count of the increased susceptibility1. These illustrations may be continued through an incomprehensible va- riety of examples relative to the influences of the mind upon the body, while those which result in the production or aggravation of disease, and as their effects are diversified in the different temperaments, and at different ages, and according to the occupation and habits of individu- als, pour a flood of light upon the instrumentality of the mind in modi- fying the action of remedial agents. A survey of all this ground, how- ever, could be embraced only in the compass of a volume, and the sub- ject would be incomplete without it. And yet these Institutes embrace an outline of all that is essential to the inquiry; and this brief Article is intended to assemble together what is most interesting among the inex- haustible elements, and leave the student to the profit of adjusting the fragments of a great chain, and thinking out its practical bearings, as variously presented in the following sections: 129, 130, 137d,e, 143- 151,163,167/, note, 188a, 188%d, p.95, §215, 227-230, 232, 234 c,e,g, 237, 239, 240, 241-246, 266, 285, 330, 422 b, 423, 446 a, 450 e-451 a, 473 c, No. 6, 476 c, 479, 481 b, 485, 486, 487 h, 488J, 492f, p. 631, §500^,509,510,512, 514c, 564-568, 577c, 578 c,579 5,581 c-e, 593, 597 d, 598 d, 600 b, 601c, 631, 740 a, 844, 853, 863 d, 890|d, 891 g,h, 892^, 902g,h,l,m, 904:a, 938 b, 9435,944a, 947,951d, 976c, 1040,1072. § 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 through 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), their resulting influences will, as in the case of the passions, depend upon their precise nature, and the special manner in which they modify the nervous pow- er, as set forth in the foregoing sections. § 1067, c. From what has been now said of the coincidences between the effects of the mental emotions and remedial and morbific agents, and that they all operate upon a common principle (§ 854 c-857,859 5-860, 894-905), and as the former are in perpetual operation, either for 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 of the 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 of the 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 [s 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 lor contesting with the Chemist the field of Physiology. , HAVE DISEASES UNDERGONE CHANGES OF TYPE WITHIN THE LAST FORTY YEARS, OR HAVE NEW ONES APPEARED? § 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 Medicince, 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, 5. 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 cathartics. 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 j-ellow 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). Similar 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 of the preference which I have hitherto given to the experience of others as being of greater weight than my own, to repeat (§ 1025), that I have, doubtless, seen as much of the 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 (§ 660, 653 cir-d). Diseases.—appendix.—Change of Type. 871 also, the experience which prompted the remarks just antecedently pub- lished in § 892f 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 184$ 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 of the brain and spinal cord may be thus transmitted directly to the voluntary and in- voluntary organs (§ 473-494,1039) ; and the Passions, but not the Will, by their direct action upon the brain, may readily affect these essential or involuntary organs through the sympathetic nerve (Index II., Men- tal Emotions). The influence of irritations of the expanded extremities of the sympa- thetic nerve may be also transmitted to the voluntary organs through the circuit of this nerve and tbe great nervous centres, as seen in the 874 institutes of medicine. convulsions of children arising from dentition, intestinal irritation, &c. So, too, on the other hand, from the same intercommunication of the cerebro-spinal and sympathetic systems, irritations or other affections of the voluntary organs may be felt by the involuntary through influences transmitted by the sympathetic nerve (§454-475, 500-5'24). 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 of the two orders of nerves are wholly or mostly of one kind or the other—either excito-motory or sensi- tive—a very large proportion of the nerves are composed of fibres of both orders, though perfectly distinct from each other in arrangement and function. This double order pervades the entire body, and has brought the physiology of the nervous system within the range of the most ex- act experiment, and has become the foundation of many important laws, which are as clearly ascertained as any in astronomy. The two orders of nerves, or fibres of compound nerves, never interchange their func- tions, one of them being always employed in transmitting impressions to the brain and spinal cord, and the other as purely centrifugal in its 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 both orders of nerves are interested, the influences are circuitous. With these last, however, I shall be employed only for supplying illustrations in proof of the sub- stantive existence of the Soul and Principle of Instinct, and of their mo- dus operandi through the excito-motory nerves. § 1072, a. Having thus stated our anatomical and physiological prem- ises, I shall next endeavour to render the demonstration of ready compre- hension by the uninstructed in the physiology of the nervous system, by stating many illustrations derived from the operation of physical causes to serve as parallel examples with the operation of the Soul and In- stinctive Principle. We have seen that influences may be transmitted from the brain and spinal cord towards the circumference by impressions made directly upon The Soul.—APPENDIX.—Instinct. 875 those centres, as when they are irritated by mechanical or other agents, or when the Will or Passions operate (§1071, No. 4). We have seen, also, that impressions may be made upon these centres through irritations produced in distant organs, and then reflected from the nervous centres upon other distant parts, and even upon the parts from which the irrita- tions proceeded originally (§ 512-524, 1071, Nos. 4, 5). This transmis- sion of influences from remote parts to the nervous centres, and which is perpetually going forward between those centres and all other parts, in natural states of the body (§ 111-113, 455-458, 500), evinces the great and inscrutable susceptibility of the brain and spinal cord, and en- ables us the better to comprehend the action of an Immaterial Substance upon the brain, and its transmission of influences to all parts of the body. An immense proportion of the natural influences upon the great nervous centres (and they are unceasing and manifold beyond the compass of imagination) proceed from distant parts, and are circuitous in their ulti- mate destinations. They begin in the expanded extremities of the sen- sitive nerves, or sensitive fibres of compound nerves, in all parts, by which they are transmitted to the nervous centres, where they make their won- derful, and, as it were, infinitely complex but unfelt impressions, which are then reflected from those centres upon other parts through excito-mo- tory nerves or the motor fibres of compound nerves (which are also called, in such cases, nqrves 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, «fec., 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 of the Will. But, in the case of the direct im- pressions, it is particularly important to remember that the motions which are produced by 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 nervous 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 such as follow their direct irritations by mechanical causes, and the coin- cidences between the effects of indirect irritation of the nervous centres, as in involuntary respiration and vomiting by emetics, with, the same ef- fects of the mind in voluntary respiration and vomiting occasioned by disgust, and the coincidences, also, between the 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, 500/-*, 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, in princi- ple and results, evince an individuality that renders them equivalent to elements or properties of the Soul and Instinctive Principle. They are as precise and peculiar in their phenomena as any admitted faculties, and their results are far more strongly pronounced. They must, there- fore, be taken as equivalents, and as the only practical ground of discus- sion. All beyond is, at least, metaphysical (§ 243-246). But the question which is thus raised, in anticipation of any caviling, has no bearing upon our demonstration, nor upon any of the topics dis- cussed in these Institutes. It is equally immaterial whether the Pas- sions and the Will be distinct elements of the Soul and Instinctive Prin- ciple, acting independently, or summoned into operation by the higher faculties, or whether they be, respectively, the concurrent results of those faculties. In the latter case, they would be employed in a collective sense ; and, as the results are the same as if they were distinct entities, and entirely different from other manifestations of Reason and Instinct, they are as properly designated by the specific names of Passions and Will, and the former resolved into Love, Hatred, Anger, &c., as any of the Faculties upon which they may depend are known by other names. They may be called mere Emotions; but still they would belong to men- tal processes, and that is enough for all the purposes that can bear any 878 INSTITUTES OF MEDICINE. relation to physiological inquiries, or to our present objects. It would be, indeed, equally to our purpose, were it conceded that the stimulus which gives rise to the Passions emanates from other organs than the brain, since they operate through the medium of the nervous system, are under the control of the mental faculties, and are palpably associated with them either as co-ordinate elements or as resulting emotions. The remote stimulus, upon this hypothesis, simply rouses the mind into ac- tion. The conclusions, therefore, which I shall have predicated of them can not be affected by any hypothesis of a metaphysical nature, nor by any supposed involutions of other organs with the brain (§ 167/, 175 b, 183, 188 a, 227, 230, 232, 241-245, 476 c, 500/-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 characteristic of the Instinctive Principle through- out the animal tribes (§ 476 c, 500 h). § 1073, a. It is allowed by all that some invisible, intangible principle exists in the Nervous System, commonly known as the Nervous Power, which is extensively concerned in the processes of animal organization; and I have endeavoured to show that this power is a vital agent, which is very 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 be hypothetical (§ 234). But all that is embraced in this Section, whether as to the nature of the nervous power, or its mode of development and action, or whether it have any existence, is unimportant to my demonstration (§ 234, e-h). It simply facilitates an understanding of the phenomena upon which the demonstration depends. (See Indexes, Articles Nervous Power, Sym- pathy, Remedial Action, 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 of the analogy between the effects of those elements of the 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 see that the Will is even capable of imitating that convulsive affection. Here is another whose brain is ir- ritated by the application of alcohol, and you see the heart beating more actively as a result; and here is a third whose heart is as quickly enfee- bled in action by the application of tobacco to the brain, just as it is excited by joy and anger in the one case, or 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 of the Passions as arise from mechanical causes when affecting the brain (§ 486, 487 g). Consider, for example, a paroxysm of hysteria, where convulsions of the voluntary muscles are brought on by some mental irritation, and where they are ex- actly the same as when produced by disturbing the brain mechanically. 880 INSTITUTES OF MEDICINE. Consider, also, how greatly analogous are these mental 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 of the 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 of the skin and the copious perspi- ration, the flood of urine, the hurried movements of the intestinal canal, the ghastly countenance and frightful eyeballs, the trembling of the vol- untary muscles and the prostration of their power; or, compare the re- sults of many physical causes, such as constipation of the bowels, with the effects of Grief, either so influencing the nervous centres as to un- dermine digestion, or so acting upon the brain as to overthrow the men- tal faculties; or consider how Hope, succeeding to Grief, will, like ton- ics, cathartics, shower-bath, change of climate, &c, influence the nervous centres in yet another manner so as to restore that digestion which Grief had impaired. And what makes the tears flow, when Grief, or Love, or Joy, or Anger, is in the ascendant, just as they do when snuff or other physical agents irritate the nose? Why does the mouth water at the sight of a bountiful feast, or on scenting its odour, or from its expecta- tion alone, just as it will on chewing horseradish or tobacco 1 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, 892| 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 of the Soul and Instinctive Principle, and of all physical causes, and is utterly fatal to materialism. The self-acting nature of the Soul and of Instinct, and especially of the rational faculty, transcends greatly 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 Kkk 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, n, 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,/, 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 of the elements of the brain, just as when hydrogen ' and oxygen gases are submitted to the catalytic action of the metal. And so of any other given chemical change. It always terminates in one way. Whenever, therefore, oxygen unites with the phosphorus of the brain, according to tbe 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 of the Laboratory. They are so far on common ground; and, if the Soul can promote combustion in the brain, or in any way modify its results, Or the Principle of Life subserve the chemical hypothesis of organic re- sults (according to Liebig), they should be equally competent out of the body, so only they could be brought into external operation. But no imagination can surmise the possibility of applying them in a chemical manner, and, least of all, eliciting by the aid of the Soul the phenomena of mind from the most ingenious devices of Organic Chemistry. On the other hand, however, there is no 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. If the doctrine stand, it must be upon its own merits, and not through any sophistry that may seem like a leaning towards the common faith of mankind—no gilding the material device—no concession to what may be considered the innocent but obstinate belief of the spiritual theorist, in the trust that he may finally discern the reality of his delusion. Again, farther: the Organic Chemist maintains that all the processes of life are owing to the same combinations of oxygen with phosphorus, carbon, hydrogen, and nitrogen, as are supposed to give rise to intellec- tion. The brain is thus placed on common ground with all other parts. Why, then, are there no manifestations of mind or instinct in the liver, intestines, or in the bones where phosphorus abounds ? Or, turning to the accommodating Chemico-Spiritualist, I may ask, if the Soul or Instinct make all the difference as regards intellectual and instinctive manifesta- tions, what makes the difference in respect to the corporeal phenomena ? Nor is that all. If the brain be considered the source of intellection in its organic condition alone, how are facts treasured up, and ever present from childhood to decrepit age ? As the brain, like all other parts, is constantly subject to renewals, the facts should go with the parts upon g§4 INSTITUTES OF MEDICINE. which they are impressed, if the organ alone be their receptacle. Why, again are the events of childhood fresh to the Octogenarian, when those of the day are speedily forgotten ? Why may memory be trained with a special reference to particular subjects, and to a forgetfulness of others, or disciplined to a general compass of knowledge? Materialism must here be consistent and stand on its own philosophy. ^ But the Soul, on the other hand, as also the Instinctive Principle, being one of an un- changing nature (as proved by these very facts), holds fast the treasury of knowledge, or the improvements it may gain (§ 180). And here we come upon a demonstration which, were there no other objection, would be fatal to materialism in either of its shapes; for one hypothesis supposes that intellection, &c, is the result of the combustive process, and the other, of secretion. In either case, therefore, all ideas should be as evanescent as the processes themselves. Finally, such as are disposed to follow the Author any farther upon this particular question will find in former parts of this work many sug- gestions which have a direct bearing upon it, as in § 350| &-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 of the organic functions of the brain. I have there shown, also, that the supposed analogy is desti- tute of foundation. -It might be sufficient, in proof of this, to simply say that the Mind and Instinct are wanting entirely m every known attribute of the products of other organs, and are sui 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, it 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 seeretion 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 tbe 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, AVhat 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 of the supposed combustive or secretory process, and at the next a greatly increased amount of one or the other, and this requiring as much a cause as the excitement of the brain in the involuntary act ? And here we may again advert to the sphincter muscles as supplying a parallel example. Take another illustration — the acts of voluntary and involuntary laughing. When the feet or arm-pits are tickled, laughing follows irre- sistibly in many, as the effect of an irritation propagated to the nervous centres by sensitive nerves supplying the skin of those parts (§ 514 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, 455,476J h, 478,479, 500 f-n, 507-509, 634, 902 /, 951 c, d.) A case precisely parallel in its physiological rationale with death from mental emotions (last references) occurs in syncope, when it arises from seeing or hearing SDmething 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, 892| 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, with a concurring sense of uneasi- ness propagated from the voluntary muscles; or, if the Mind participate, as in its efforts to relieve a sense of weariness, the physical and mental causes act in co-operation, just as happens in severe cases of asthma. At other times, a very different chain of causation may be observed, and where, also, the mental and physical causes appear to identify them- selves, as it were, with each other, as in sympathetic yawning, where one yawns on seeing or hearing another yawn, or in talking about it; for, in one case, an irritation is propagated both to the brain and Mind through the optic nerve, and in the other case through the auditory nerve, and simultaneously the Mind conspires with the physical irrita- tions in exciting the nervous influence, and directing it upon the muscles of respiration. But a paroxysm of yawning may be readily consequent upon simply thinking about it, as will probably be the case with many on reading this statement; when the reader will, doubtless, feel quite assured that his mind is as exclusively the cause in this instance, as the physical irritation commonly is in 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 of the throat (§ 233|, 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 of the Will to resist sea-sick- ness will often prevent its occurrence, especially the act of vomiting; while, on the other hand, if one has made up bis 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 514,1, 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, /). 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 tbe spinal cord alone ; and the example is another clear illustration of the substantive, self-acting nature of the Mind (§ 451, c, d). Let us next suppose that the Materialist will demand of us an explar The Soul.—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 of the 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 whicli determines upon them an unceasing nervous influence af- ter the action of the AVill 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 tbe voluntary muscles, is often eluding the knife of the anatomist (§ 233|); and well may he sometimes despair of success, yet rest in the conviction that Na- ture operates by general laws, when he considers tbe 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 of the subject. We might have rested the demonstration upon the operations of the Mind in its function of willing alone, were there a ready acquiescence in the logic of facts. Through these endless manifestations we almost see the Thinking Being enthroned upon the great centre of the nervous system, wielding at its inexpressible pleasure, and through the instrumentality of its or- gan, that amazing power which as far surpasses electricity in the com- pass and variety of phenomena, as the effulgence of Reason transcends the glimmerings of Instinct. The Will but commands (§ 1072, b), and Reason may be chained for hours to some abstract process, or tumultu- ous passion settles down in tranquil submission. With inconceivable rapidity of action it directs all the muscular movements which form the various feats of dexterity, the flight of animals, and the melody of song. 892 INSTITUTES OF MEDICINE. And let us consider, also, as we ponder upon these things, how exactly the mind graduates the force of every muscle which it brings into action, varying through every imaginable degree from the slightest touch to the death-struggle of the combatant (§ 234 c-h, 235). Who, then, shall be so unjust to his 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 of the distinct nature of the Soul and Instinctive Principle, and of their connec- tion with the main central part of the nervous system, my remarks have referred to their immediate relations to the body, as established through the cerebro-spinal and ganglionic systems (§ 234/, 241, 500, &c). At section 500, p, the deductions are made from a variety of facts, though not altogether susceptible of direct proof. They involve a critical anal- ysis of the various phenomena of which they are predicated, both in their relations to Reason and to the mere Principle of Instinct. But, however some acts of intellection in man may require the co-operation of the brain more than other mental processes, 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 tbe functions of the higher faculties as it demonstrably is in tbe 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 of the 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 of the body. The untutored Savage has all the perfection of life that is enjoyed by a Newton, and greater instinct. He may become a Newton without a gain to his physical wants, but with some loss of his well-disciplined instinct. Here, in the exercise of Reason, all physiological analogies fail, while every impulse of Instinct demonstrates its subordination to physiological laws. When Reason operates, there is no participation of the nerves, as in the case of Instinct, no influences seen upon any part of the organism. We look upon its manifestations as emanating apparently from itself alone. And since there is nothing in the manifestations of the Will when it operates alone in the processes of Reason that denotes any influence upon the animal mechanism, as is always the case in animals, and since, also, that influence is strongly displayed in man 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 my knowledge, been hitherto indicated. It is only, however, a display of the common law of analogies which prevails throughout organic nature. The coincidences and distinc- tion between Reason and Instinct are far less remarkable than the cor- responding analogies and distinctions which are supplied by organic life in its greatest extremes; for there is not a single organic function of a comprehensive nature performed by man that is not equally so by the lowest plant. With greater reason, therefore, should we argue the iden- tity of Man and Plants than of the Soul and Instinct.* * As an example of the assumptions and sophistry of those who reject the Soul, take 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 organ, but the influences which it is capable of exerting upon it in con- sequence, and thence upon the whole organism, are among the facts which 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 of the human famity 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 equally reject it in man." _ This argument is often staring us in the face, and it is quite time that it should he silenced, although "prepared to admit the existence of immaterial principles in all the cases." But, waiving the assumptions upon which the conclusions are founded, it is evi- dent that the 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." The Soul.—appendix.—Instinct. 895 " cultivation of Instinct" is, in reality, no such thing,' since it subserves no useful purpose, and manifests itself only under the special influences, respectively, by which the several impressions were originally produced. The " tricks," &c, of the animal, whenever there is a deviation from the natural operation of Instinct, require suggestions from the associate causes. Unlike the improvements of the Rational Faculty, the artificial conditions of Instinct do not operate without the excitements of the primary causes, or their equivalents, and then always in exact conformity with the nature of the external cause. In other words (for the distinction is important), Reason acts independently of remote causes; the artificial conditions of Instinct require the agency of such causes to bring them into renewed manifestations. In the former case the senses may not be interested; in' the latter, impressions must always be made upon sense (as in seeing and hearing), and transmitted to the brain, or some equivalent nervous cen- tre, when Instinct will operate in an automatic manner. It is only a display of those low analogies between Instinct and the Soul to which I have referred. Imitation, in a higher sense, as seen in parrot-talking, belongs to the same principle. But in these cases it is more constitu- tional, on account of the natural prating of the bird. It thus becomes ingrafted upon its notes, and will therefore display itself as an offspring of nature, and as a matter of habit, and without any extraneous prompt- ing. What is thus acquired from man by the parrot and magpie, and which has been supposed, even by Mr. Locke, to evince a Rational Fac- ulty, is derived by other birds from other songsters, particularly by the American mocking-bird and cat-bird, who 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 unappeased. Again : as soon as Reason obtains its development, it displays an end- less variety of inventions for the sustenance of life, which are wholly irre- spective of associations with the original physiological incitements, but which must be forever a recurring cause to the animal. Whatever simili- tude may seem to exist between the acts of Reason and the acts of In- stinct in procuring food, or in providing for the future, organic influ- ences are interested in the latter as often as hunger returns; and, so far as the processes are dependent in animals upon the inscrutable constitu- tion of Instinct, they are contradistinguished from all the analogous man- ifestations in man by their undeviating uniformity in animals, and ac- 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 of the brute crea- tion. If we may any where detect the Rational Faculty among ani- mals, it should be found in the phenomena that are relative to their means and modes of subsistence. Now it will be found that, in 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 of the stomach and the peculiarities of the gastric juice, we shall see how far it is related in its peculiarities to other varieties in the mechanism of organic life, by considering how all these varieties in every species, respectively, have an equally direct reference as the peculiarities of Instinct, to the special organization of the stomach, and special con- stitution of the 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 foregoing is also true of man as it relates to organization. But who could surmise from any part, or from the whole of his organism, that he is endowed with Rational Faculties, or with any thing more than what is common to brute animals ? Here begins, abruptly, a total distinction between man and animals—nothing whatever in the mechan- ism of either to denote the ending of one or the beginning of the other. Nothing, indeed, but analogy, founded upon observation, enables us to affirm with certainty all that I have stated, of extinct species of animals. Nothing but observation informs us of either the physical or moral func- tions ; for neither could have been deduced from structure alone. And yet analogy is so perfect a guide where the continuity of the chain is unbroken, that no error can arise in scanning the Designs of Infinite Wisdom, so far as they are submitted to human inquiry. But analogy in relation to Instinct snaps in man. This might render it difficult, if not impossible, to know the great fact, had all the species of quadruma- nous animals become extinct before man began his observations in nat- ural history. The subsequent discovery of the skeleton of a chimpanzee would doubtless have been regarded as an unanswerable proof that there had been, at least, other beings upon earth besides the human race who 898 INSTITUTES OF MEDICINE. had enjoyed the prerogatives of Reason, and so a descending analogy imagined down to the polypi. But, the chimpanzee is a thousand times less endowed with Instinct than the honey-bee; and we have seen that the sense of instinctive promptings throughout all animal tribes is con- cerned about objects which Reason regards as only tributary to those immeasurably higher occupations of the Soul which have no relation whatever to those of the Instinctive Principle. § 1078,/. However the foregoing branch of our inquiry (§ 1078, e) may be pursued, it will always result in the same uniform way. Con- sider, for example, the correspondence between the Instincts of animals and their weapons of offence and defence; each species of animals, and all the individuals of a species, acting defensively or offensively accord- ing to the special weapons with which they are provided. These means of preservation have a direct reference to organic life, and Instinct, there- fore, is adapted to the nature of the means. The various provisions are not only such as are actively employed, both for the purpose of procuring food and for self-preservation, like the weapon of the sword-fish, claws, the poison of serpents, &c, but others for the simple object of self-pro- tection, such as horns, the quills of the porcupine, the armour of the rhinoceros, the sting of bees, the galvanism of the electrical eel, the ink of the cuttle-fish, &c. Again, certain animals, and many of them of inferior orders, as some species of cockroaches, some of worms, often af- fect the appearance of death when closely pursued; and when this is seen in one animal, it is, as in the preceding cases, common to all the individuals of the species. Many other animals that keep near the ground are protected by their colour, and the animal, when alarmed, lies close. In all the cases there is a manifest unity of designs which con- spire together for the well-being of organic life. Whatever may be the means of defence, of offence, of flight, or of whatever variety or modifi- cation, they are adapted to all the mechanism in animal life, to special sensation, &c, and according to the whole will be the special prompt- ings of Instinct. § 1078, g. Fear, therefore, operates in animals impulsively, while in man it is the result of judgment, reflection, comparison, and his modes of defence are suggested accordingly. Observe, also, another fact rela- tive to fear, which equally separates Instinct from the Soul. The young animal will turn from danger about as impulsively as the adult, while the human infant will thrust its hand into the blaze of a candle sooner than it will seize the nourishment that is simultaneously offered. In ani- mals, indeed, the most exquisite sensitiveness to danger prevails, transcend- ing even the promptings of hunger. Its predominance is designed alone for the preservation of organic life, and such are their exposures, and so limited their conceptions, that it is made to operate with great uniform- ity and instantaneousness. In man, on the contrary, its impulses are comparatively feeble and slow, and so far as it obtains, it aims at a va- riety of objects which are determined by the decisions of Reason. The principle, in animals, is evidently allied to that characteristic which di- rects their migrations, and the homeward flight of the bee. The manifest dependence, in man, of a sense of danger, and his expe- dients for self-protection, upon the Rational Faculties, has led to compar- isons of certain Instinctive perceptions of danger in animals, with a view to the identity of Instinct and Reason, of which one of the strongest is often seen in the elephant on crossing a bridge, or embarking on a steam- The Soul.—appendix.—Instinct. 899 "boat, as he first presses the bridge or the boat with a single foot to learn their stability. But this example is peculiarly adapted to our purpose, since Instinct is here constituted with a reference to the weight of the animal, who would be otherwise exposed to frequent injuries; and the associations that are indispensable to safety are early formed. But they go no farther, and this particular demonstration is seen only in animals that may break a bridge or sink a boat. It is, therefore, only an instance of the ordinary impulsive associations which are always in operation in cases of danger, and is exactly similar to the careful tread of the smooth- shod horse when about stepping upon ice, or the wariness of the fox and the rat in eluding the trap, or the various expedients of the squirrel in dodging the sportsman, or the cautious nibble of the fish, &c. The va- rieties in these examples are almost as great as the species of animals, and they all belong to the exquisite intuitive principle which warns them of approaching danger. It is often seen, indeed, in the aspect of mutual protection among animals of the same species, when it always operates according to the nature of the species. The crow has his sentinel, and the affrighted ant communicates its alarm by a peculiar touch of its companion, which spreads with rapidity from one to another, till the whole hive is quickly thrown into this paroxysmal movement. And now, if this analysis be pursued through an obvious series of analogies, it will be found that the habits of bees in relation to their queen, and many other remarkable problems, in the history of Instinct, are allied to the principle which I have just considered. § 1078, h. Another shade of difference in the general principle occurs in an example which has been presented by Metaphysicians to illustrate the supposed identity of Instinct and Reason. It is that of a dog, who has appeared, when making for a drifting boat, to lay out the plan of first ascending the bank of a stream above the boat, that the distance between himself and the object may compensate for the motion of the water, which would otherwise carry him below his destination. I pre- sent the example in its strongest light, and as implying all that can be surmised of a rational process in animals. But, with all instances of a similar nature, it falls within the common laws of the Instinctive Princi- ple, which are just so far operative, according to the species of animal, as shall subserve the exigencies of life. In the case of the dog, this ani- mal is more or less addicted to the water (especially the individual in question), and his Instinct is therefore adapted to the emergencies that may attend that temporary mode of life. He early acquires, in conse- quence, an impulsive apprehension of the effects of strong currents of water, and is so far capable of forming associations as may be necessary to his safety, or to his natural wants. The instance of the boat is one of safety and of want, and is exactly parallel with that where all dogs will elect a bridge of 500 feet in preference to swimming the width of a dozen. The knowledge of the effects of a current of water exceeds but little that of its quality ofavetting; and when, therefore, a dog is moved by the desire of bathing, he neglects the bridge and takes to the water. Various prejudices and misapprehensions relative to supposed instinct- ive acts abound in the community, who are prone to the most favourable comparison of the brute with his lordly associate. The rarity of appa- rent evidences of Reason in brutes, and the enjoyment of what is thus unexpected and wonderful, lead the multitude to seize upon, what is ac- cidental and carry it to the account of Instinct. An example of this, 900 INSTITUTES OF MEDICINE. % which has often gone the round of the public, is that of the elephant and the apple, where the tempting morsel, being just beyond the grasping range of the animal's trunk, was made, by a forcible projectile blow, to rebound within its reach from an opposite wall. This has been thought to be but little inferior to a game at billiards. But it was simply an act of irritation, the blow being designed in the same resentment as when an angry man loses all reason, and castigates a stone that has caused him an injury. § 1078, i. The Speculatist points to the care with which animals pro- vide for their young, and the apparent analogy between them and man in parental attachments, as an evidence of the supposed identity of Rea- son and Instinct. But I answer that the analogy is more seeming than real, and that however the principle may have an ultimate reference to the well-being of organic life in the infancy of man, it embraces in him far loftier objects, and prompts to an endless variety of useful purposes in the care of his progeny which have not the least connection with the exigencies of life, but which, on the contrary, are relative to the culture, the enjoyments, the morality, the Religion, the eternal welfare of the Spiritual part. It follows them through all the stages and vicissitudes of life, rejoices in their happiness, and grieves for their adversities. When intercourse fails, every expedient is devised, from the tardy mes- senger to the electric telegraph, to impart renewed expressions of affec- tion, and fresh hopes of prosperity. And how is it on the part of the offspring? Does not every heart beat responsively to the Divine com- mand to "honour thy father and thy mother?" And can there be a broader distinction between the attachments of animals and of mankind than what Scripture implies and what man pursues? The very attach- ments which man contracts for favourite animals flow from the Divine sentiment which is impressed upon his Soul. And then all that display of sympathy and friendship among companions of mutual thoughts, or of heartfelt kindness towards the faithful and trusty servant, or the univer- sal characteristic known as the sentiment of humanity—where, I say, shall we look for the dawning of these mental attributes in the constitu- tion of Instinct ? And wherein are the instinctive movements of ani- mals towards their offspring related to human affections? Simply for the preservation of life, and thus incidentally for the perpetuation of the species, as conclusively shown by the total and abrupt disappearance of brute attachments as soon as the offspring can provide for and protect themselves, and this, too, at ordained times according to the species of animal. Nay more ; parents and offspring mutually abandon each other at allotted times, and turn upon each other. The principle is seen in full operation, and in its largest extent, in the bird while hatching her eggs. She may be in expectation, though she may have had no more experience in the final result than the bee on its return after its first wandering from the hive; nor is there any more similitude with the ope- rations of reason in the one case than the other; she will as readily sit upon counterfeit eggs as her own till her time of " reckoning" is up, and then abandon them. § 1078, k. The same distinction (§ 1078, i) exists between the love of the sexes in the human race and what is observed of the sexual rela- tions in the brute creation, and is not less opposed than our other facts to the assumed identity of Reason and Instinct. Like all else in relation to the latter, the impulse is totally restricted to the perpetuation of or- The Soul.—appendix.—Instinct. 901 ganic life. In the human species the same impulse is as a spark in a blaze of fire. The principle of love takes in its scope the loftiest senti- ments of Mind, and anticipates all the intellectual endearments of domes- tic society, and yields a grateful tribute to its munificent Author. If there be a low analogy, it is of the lowest grade, and is nearly lost in the sublimity of its intellectual accompaniments. Nor can there be a paral- lel suggested between Reason and Instinct more degrading to man, or more unjust to his Maker, or more characteristic of a perverted mind, than that which is so often drawn in respect to human and brute affec- tions. Yet he who makes it has a better opinion of himself, and only thinks so of the rest of his race. § 1078, /. And this leads me to speak of the very remarkable distinc- tion between the Soul and Instinctive Principle known as Conscience. I employ the term in its popular acceptation, as meaning the ability and the impulse of man to decide on the lawfulness or unlawfulness of his own actions and affections, and to instantly approve or condemn them according to their nature. Nothing like this has ever been observed in animals. It is purely intellectual, and has a clear reference to the moral, Religious, and social condition of the human race. It may be said, how- ever, to be apparent in some animals, as when the dog, for example, mani- fests a sense of wrong when he surprises the game in a manner opposed * to his instruction, or does other analogous acts. But this manifestation happens only under the influence of those physical causes which led him to act more habitually in a different manner. The sense of wrong does not originate from the act, or on account of the act, but is excited by the presence of his master, whom he associates with the suffering which he endured when his Instinct was undergoing discipline, and thus re- solves itself into a dread of punishment. It is therefore exactly analo- gous to all the other functions of Instinct which I have indicated, and forms the limit of associations of which animals are capable. § 1078, m. And what shall be said of that other principle, scarcely less universal and impulsive than conscience—a love of Fame and a de- sire to live in the memory of posterity ? The question becomes ridicu- lous in its application to animals, and is hardly less so, in an abstract sense, as it relates to man. But, as an incentive to laudable action, it is a noble offspring of Reason, and as significant of the Soul's immortality it rises into sublimity. § 1078, n. And what of Religion ? WTiat of the universal desire of immortality? What of a sense of dependence upon a Superior Being? It may be safely affirmed that animals have no other knowledge of their own existence than what arises from present sensations; and should a chimpanzee be seen bowing even to an idol, it would be a greater phe- nomenon than the expostulation of Balaam's ass. § 1078, o. Even memory, as it belongs to animals, is nothing but an association awakened by some present impression upon the senses. It ia indispensable, however, to many of their wants and habits, and hence is so strongly pronounced in many species that they will recognize objects after a separation for long intervals of time, particularly where strong impressions had been made, as between the dog and his master, and wild beasts and their former keepers. In man, on the contrary, memory is often relative alone to acquirements which the mind has made through its own processes of reflection, and they may be as vast and profound as the elaborate inductions which led to the discovery of the universal law 902 INSTITUTES OF MEDICINE. of gravitation, and thence to the calculation of the existence of the planet Neptune. Nor does memory, in man, require any extraneous aid, like the apparently corresponding function in animals. It is a rational function in one, independent of sense ; an instinctive one in the other, and depend- ent upon sense. In one, it always involves an exercise of Reason and often a vast complexity of ideas ; in the other, it is simply relative to the single impression whicn had been transmitted to the brain by some ex- ternal cause, and which can be recalled only by renewed applications of the same or analogous causes. By extending the analysis in this man- ner, it will be seen that it is all Soul in man, and all Instinct in animals. § 1078, p. But the most curious problem in the history of Instinct is its natural mutations in certain animals, and which carry with them an abundant proof of the radical distinctions between that Principle and the Soul, and that the former is designed for the mere purposes of organic life. I shall therefore give to the subject a greater consideration than would be otherwise expedient. This characteristic is seen, especially, in animals that are subject to metamorphosis, though in many of the instances the changes (of organiza- tion and the modifications of Instinct are far greater than in others. The strongest examples occur in insects, a large proportion of which have four stages of existence: the egg, the larva, the pupa, and the imago, with corresponding instinctive habits in the last three. Where the metamor- phoses are most remarkable, as in the foregoing examples, some of the organs undergo mutations that require a change in the stimuli of life which could not be realized without corresponding adaptations of In- stinct. This is also more conspicuously illustrated by the difference in the wants and habits of those animals which at one period breathe in the water with gills, or analogous organs, and subsequently in the air with lungs. Now these metamorphoses are as much the exact result of determinate laws, ingrafted upon an original constitution of life, as the development of the human ovum, or the seed of a plant; nor are they in any respect more fluctuating or less circumscribed (§ 72,1051); and so a correspond- ing law obtains in respect to Instinct, through which the promptings of Instinct shall harmonize with those modifications of organic life that dis- tinguish the several stages of metamorphosis. In all the cases, from the plant to the insect, and from the insect to man, the metamorphoses or other developments, and modifications of life, take place in one uniform way, according to the species of animal or plant. A potential whole, embracing all the special conditions necessary to the progressive changes from the ovum, through the larva and pupa to the fly, and in all analo- gous instances, is as perfect in the most mutable tribes as in the ova of the highest order of animals, or in the seeds of plants; and, since there can be no departure from a precise and uniform succession of develop- ments in any of the species, respectively, we also learn that there is no transmutation of species, nor even an introduction of varieties (§ 1051, primordial cell). In respect to the various physical agents required by animals subject to metamorphosis, according to their several stages, the principle is alike ingrafted upon the ovum, and equally so in the case of man, by which his development is started by one kind of vital stimulus, and is farther conducted through foetal life by another kind, while a variety obtain af- ter independent life begins. It is a metamorphosis in all (§ 63-81). The Soul.—APPENDIX.—Instinct. 903 This brings us to the particular application of our subject, the simple subserviency of Instinct to the exigencies of organic life. Here it is, in the well-marked metamorphic animals, that it is distinctly seen that all its modifications keep pace, pari passu, with the changes of organization, and that the law is exactly coincident with that which respects the changes of structure, and is designed alone to fulfil the necessities of the latter. They equally spring from a common principle of mutation im- planted in the germ. § 1078, q. There remains to be considered the comparative independ- ence of the Soul in the exercise of its highest functions; when, also, cer- tain anatomical facts between man and animals will be reviewed for the purpose of contrasting them in yet other relations to the Soul and Instinct. Although there be a co-operation of the brain with the Soul in all acts of intellection, it does not follow from what has been said that the Rational may not act in greater independence of the organ than the In- stinctive faculty. Just otherwise, indeed; for my argument to this ef- fect is founded, in part, upon the distinctions which I have indicated be- tween the Soul and Instinct, and upon what I am about to say of the analogy which obtains between the brain of man and of the highest or- ders of animals, though an opposite conclusion has been deduced from this analogy. But the inference as to the equal dependence of the oper- ations of the Soul and Instinct upon a concurrent action of the brain or its equivalent has also depended upon a neglect of the distinction in their attributes, or an assumption that there is no difference. The analogy in such a case would be sound and conclusive so far as it respects man and the approximate animals. But our premises are indisputable, that all the higher acts of intellection, everything which falls within the province of Reason, have no existence in animals. It is the only thing, indeed, which essentially distinguishes man from the brute, and would be in itself conclusive against the somewhat prevailing doctrine that man was once a member of the quadrumanous race. We have also seen that Instinct is more comprehensive in many insects where a ganglion takes the place of a brain, and far more allied in its operations to the plans of Reason, than in the highest order of animals, and is often as mature in the new-born as in the adult being; and since, also, the organization of the brain of the higher animals is greatly like that of man, but with- out any of his intellectual functions, we must logically conclude that what is so absolutely peculiar to the Soul, and, as generally granted, allied to God Himself, acts in greater independence of the brain than does simple Instinct. But, so inscrutable are its connections, as well as those of Instinct, with the organ in which it resides, that I shall not trespass beyond the limits which are prescribed by observation. Our facts terminate abruptly at this point, and mystery begins. But we may pursue the facts, and reason upon them as upon the most tangible evi- dence. We will therefore interrogate other proof in support of my con- clusions. We have seen that eveiy variety of cerebral structure, from its approx- imation to man's in the higher animals, to its disappearance in a scarcely appreciable ganglion in the lower tribes, is attended throughout with un- deviating and perfect manifestations of Instinct, though according to the nature of the animal, while they are only dimly seen in the human spe- cies. This, in respect to Instinct, is conformable with all analogy as it regards other organs where the results depend upon anatomical structure 904 INSTITUTES OF MEDICINE. acting through the principle of Organic Life. There is every variety, for example," in the organization of the liver, from its greatest elabora- tion in man and the higher animals until we meet with it in the lower orders as a bundle of tubes or a simple sac. Yet in all it generates a product which is nearly the same, and which performs the same office throughout. And so of the kidneys, salivary glands, stomach, &c. So far the analogy is complete between Instinct and its organ and the < Principle of Life and all parts of the body which that Principle animates. But Instinct, as we have seen (§ 1076, a-c), must not, therefore, be con- founded with organic products. The analogy, indeed, goes with our other facts in showing that it is the cause of certain results through the instrumentality of the brain, or its equivalent, and the nervous system, as the Principle of Life is the cause of other results in and through that same system of organs and every other variety of structure. Coming to the brain of man, the foregoing analogy totally fails as it respects the manifestations of Reason and Instinct. There is an endless variety of the former, but scarcely a real exhibition of the latter. We see all in the structure of the fully developed animal brain that can be detected in the human, or with only the modifications that are incident to approximate species, but a perfect blank as it respects the Rational Faculties. The analogy, however, is complete in man's so far as the brain subserves all that Instinct can discharge among the animal tribes, and all that is relative to the latter in the contributions which the nerv- ous system makes to organic life. The only difference here is the substi- tution of the Intellectual for the Instinctive functions; and whatever re- lates to the manifestations of Instinct, and all the influence of the passions upon the organs of organic life, are demonstrative of the co-operation of the brain with the Soul. But the moment we leave this ground, and approach the abstract operations of the higher faculties of the Soul, there is not the slightest indication that the brain has any functional connec- tion with the processes, however much its integrity may be necessary; and the only foundation for the conclusion that such connection exists is the analogy which is supplied by Reason in its exercise of the Instinct- ive functions of animals (§ 1078, a, &c). Again: we have seen that in the infancy of man the Mind is inoper- ative, while the Instinctive Principle of animals is nearly as active and comprehensive in their earliest as in their latest stage of existence. We have also seen that Instinct is susceptible of artificial impressions, resem- bling education, in the infancy of animals, and only then. This distinc- tion can proceed only from a radical difference between the Soul and Instinct; and the attendant final causes of that difference consist in the special design of the Soul for Rational functions when the body is suffi- ciently mature for any practical purposes, and of Instinct for the simple uses of the body. The necessity of Instinct, it may be farther said, is not only superseded in man by the endowments of Reason when it comes into individual operation, but by its delegated offices before its develop- ment takes place, while no such protective care, as a general fact, can be extended by the Instinctive Principle to the new-born animal. Hence, therefore, as there are no superfluities in Nature, Instinct is in full op- eration at the birth of animals, when there is no display of it in the hu- man race, nor is the Soul only slowly developed in its Rational faculties. And thus do the physiological facts, the manifestations of Reason and of Instinct, and the final causes concur together. The Soid.—appendix.—Instinct. 905 And now comes up the remarkable anatomical fact, which goes also to the same conclusions (although supposed to be in opposition to them), that Instinctive acts are irrespective of the progressive stages of cere- bral development, while those of the Human Mind await that develop- ment. This corresponds, in respect to animals, exactly with what we know of the general maturity of the functions of all other parts at all stages of life, and with what we have seen of the objects of Instinct and Reason, since the former must be in early operation for the exigen- cies of Organic Life, while the Soul, in the complexity of its functions, and according to its objects, is only ready to act when the brain shall have acquired sufficient maturity for those endless physical impressions which come through the medium of the senses, and from which the Soul gathers its earliest treasures of knowledge. Such, then, is the relative aspect in which must be regarded the cor- respondence between the progressive development or hardening of the brain and the operations of Mind in early life; the development or ma- turity of the brain having as well a reference to the multifarious physi- cal contributions from the Senses, as to their appropriation by the Soul; while, also, the admirable Design obtains of rendering the brain complete in all its relations to the organs of Organic Life from the mo- ment of birth, and, on the other hand, its endowment for the uses of the Soul exactly progressive with those physical developments of other parts that are indispensable to the objects of Reason at the different stages of advancing life. The Design is inexpressibly sublime in its numerous, yet distinct involutions as they relate to organic and animal life and the uses of Reason. The Soul, therefore, may be, abstractly considered, in as perfect a state in infancy as at any stage of life. Thus it appears, that, besides the physical development of the brain which is requisite for the impression of natural objects, that maturity of the organ is, also, as a part of the design, a necessary medium through which the Soul may appropriate the impressions. Having made these advances, the Soul comes to act in more or less independence of sensa- tion, and to multiply knowledge by its own efforts. Nevertheless, it is peculiarly useful to my purposes that aberrations are seen of occasional displays of Reason in early childhood which are surpassed at adult age only by genius of the highest order. In some of these rare instances there had been only the most slender antecedent relative knowledge ac- quired through the medium of the senses, but the Soul itself originated its own vast conceptions, carried them into a variety of practical appli- cations without the instrumentality of foreign aid, and to an extent where erudition, with all the appliances of sense and the facilities of instruction, falls far short of equal achievements—as witnessed in the institution of mathematical principles and processes. And here we strengthen our position by the converse rule, since in none of the cases has there been a ratio in the advances of Mind corresponding with the advancing maturity of the brain, while in some the early intellectual ability has settled down at adult age to a common mediocrity. In the latter case it cannot be doubted that the progress of the brain has em- barrassed the Rational Faculties. Again, there is every gradation in Reason from the Hottentot to the highest order of genius. There are no two individuals alike either in its compass or in the manner of its exer- cise. How different is all this with Instinct, which directs every indi- vidual of every species of animal in one uniform way, and no one of. 906 INSTITUTES OF MEDICINE. them enjoys, throughout all generations, any different or greater endow- ment than all the rest. And thus do the contrasts between the Soul and Instinctive Principle correspond with the anatomical contrasts, both as they relate to the brain of man and of animals, and to the human brain and other organs in the state of infancy, and with the coincidences in function, instinctive and organic, between the brain of animals or its equivalent and other organs at all stages of life. And here, too, should be brought into review what has been said of the injuries which are inflicted upon the Mind and its associate organ, and through those influences upon the whole organism, by overtasking the Mind in early life, while no such injuries are sus- tained, but the contrary realized, by a severe exercise of Instinct in the infancy of animals (§ 563-568). § 1078, r. It may be now well to inquire into what is meant by ideas, and whether there be generally any definite conception of their nature, and, by ascertaining the facts, endeavour to show by this method that the earliest acquirements through the instrumentality of the senses demonstrate the self-acting and originating endowment of Mind, and that it is distinguished, at its very dawning, from the Instinctive Principle, by the characteristic of forming ideas of the nature of objects. This in- quiry, like the rest, belongs alone to the Physiologist. How, then, does sensation give rise to what are recognized as ideas by Reason ? The impressions transmitted to the brain through the organs of sense, or such as may arise from internal causes, do not, certainly, constitute the ideas, as is apt to be supposed; and, according to my demonstration, the im- pressions made upon the brain cannot, through any physical or chemical influences upon the organ, elicit the ideas from the organ itself. The impressions must, therefore, of necessity, call into action a Principle or Agent by which the ideas are alone formed; from which it appears that the process, by which the Mind seizes and appropriates impressions trans- mitted through the organs of sense, is similar to that by which it multi- plies and originates ideas. It is true, animals have the capacity of form- ing ideas so far as they depend upon the promptings of sensation, and upon impulsive associations with the past that may be awakened by re- newed sensations of a more simple nature. But they stop there. They are merely ideas of sensation; while, on the other hand, the results of sensation in man terminate in intellectual images which have no analo- gies in the brute creation, and these are the essential final cause of the human Soul. It is the Soul, therefore, which, mainly, does the work in acts of intellection, while, in respect to the simple ideas of sensation, ex- ternal objects, or internal causes like that of hunger, supply the materi- als. This is enough for my purposes; and it will be as vain to inquire into the modus operandi of the Mind in its abstract operations, or in its perception of external objects, or how impressions are made upon the nerves of sense, or what their nature, or how they are transmitted by the nerves to the brain, or how they call the Mind or Instinct into action, as to interrogate the modus operandi of Creative Energy. § 1078, s. In drawing to the close of our subject, we are naturally led to inquire whether there be more than one species of the human race—a question which is unusually agitated at the present day. Taking the extremes of the race in physical and intellectual develop- ment, it appears to have been definitively shown that there are no ana- tomical characteristics which distinguish them as different species, but, The Soul.—appendix.—Instinct. 907 on the contrary, mark them as one. All the differences are susceptible of ready explanation through the influences of climate, habits, &c, un- less, perhaps, the black color of the African (§ 604-611). The Malpi- ghian rete is abandoned as fallacious, and the color of all the races is now known to depend upon carbonaceous matter deposited upon the surface of the true skin, differing only in degrees of intensity. The greater tint of the Negro has been referred, in a very ingenious Essay by Professor Muller of Brussels, to the hot and arid climate which the dark- est of that race inhabit. But, with all his experience in those regions, he is mistaken in his important point that the newborn Negro is white; and his doctrine of the influences of deficient oxygen and dryness of the air in occasioning the deposition and fixedness of the cutaneous carbon is inapplicable to the North American Indian, whose skin is as dark in his extreme Northern as Southern limits; nor has a Northern climate exerted a bleaching effect, in many generations, upon the Negro in America. Miller's theory, therefore, of excess of carbon in the blood from an inadequate supply of oxygen by the rarefied air of the tropics, is invalidated by the exceptions before us. Nevertheless, peculiarities of climate have, doubtless, given rise to all the shades of color, unless that of the Negro form an exception (§ 610); but this once impressed by cli- mate may be as indelible as the physiognomy of the Jew or of other races who do not intermingle. § 1079, a. Such are the conclusions (§ 1069-1078) to which the evi- dence of anatomical and physiological facts have successively led; nor have I any doubt that others will see in the demonstrations that man is an animal only in his physical being; that in Mind he is far less allied to the things of the earth than he is to their Author; and will realize a corroboration of their own conceptions, that the Soul and Instinctive Principle are so far differently constituted as implied by the ultimate ex- istence of one in an abstract condition, while the other shares the destiny of organic life. They will see, I say, a new ground of belief in the im- mortality of the Soul, and in the perishable nature of Instinct. And if this be so, they will see in my premises and conclusions a contradistinc- tion between God and Nature, and what is equivalent to a demonstra- tion of the existence of a Creative Spirit, in which alone the Thinking part of man can have had its origin. And, coming to other details in relation to man, they will realize in the Mosaic declaration that " the Lord God formed man of the dust of the ground, and breathed into his nostrils the breath of life, and man became a living Soul," an Inspiration from Him Who "created man in His Own Image," and repose with equal confidence in the assurance that, although " the dust shall return to the earth as it was, the Spirit shall return unto the God Who gave it." They will abide in the emphatic distinctions between the dust, the breath, and the Soul, and regard the Spirit as a special gift, a new Cre- ation, and the body as referring to materials already in being, and which were designed in their organic state, and kindled into life, to connect the Spiritual part with the material world ; and they will also see in the lim- itation of the statement as to the Soul of man what is the ultimate des- tiny of Instinct. Hence it follows, if Revelation be received as to the immortality of the Soul and the death of Instinct, it must be received, also, as revealing a fundamental distinction between them, and should operate as a perfect barrier with all those who uphold the Scriptures against the common 908 INSTITUTES OF MEDICINE. prejudice of identifying Instinct and Reason, as confounding the revealed distinction, and therefore promoting infidelity in its aim at materialism and annihilation. § 1079, b. The foregoing subject has been pursued by the Author in a long Article upon " Theoretical Geology," in the "Protestant Episcopal Quarterly Review," New York, April, 1856, in which he has endeavoured to defend, upon scientific, philological, and geological grounds, the literal interpretation of the Mosaic Narratives of Creation and of the Noachian Flood; and, should he think that the spirit of the times will justify the publication of the larger work- to which he referred in the original edi- tion of the Essay on the Soul and Instinct, and which is now completed, he will submit it to the press. His main difficulty is the general concur- rence of the Religious press in the revolutionary views of Theoretical Geology, though, in saying this, nothing( more is intended than a simple representation of the facts. It is doubtful, therefore, whether a hearing can be obtained—certainly not a publisher at his own risk. The Author makes this statement in consideration of his former announcement that such a work was on hand. The "Review of Theoretical Geology," to which reference is now made (extending to 120 pages), is an epitome of the larger work, and is believed by the Author, and by better judges, to be incontrovertible. This is said, however, simply for the purpose of inviting a criticism which may either discourage the Author in a farther attempt, or prove to him an incentive to go on with his solitary work. He acknowledges, how- ever, some encouragement in a critical review of Hugh Miller's posthu- mous work on the " Testimony of the Rocks," which occupies five pages of the Westminster Review for July, 1857, and which is remarkable for its contrast with an otherwise apparently universal shout of applause. § 1080. Again: such is the nature of our premises, that, if the Soul of man be immaterial, so is the Instinct of animals. There are, more- over, no violent transitions in nature. The material existences, especial- ly the organic, pass gradually, as it were, into each other* And so, it cannot be doubted, it is with the immaterial, from brute to man, from man to angels, from angels to God. " Of systems possible, if 'tis confessed That Wisdom Infinite must form the best, Where all must fall or not coherent be, And all that rises, rise in due degree; Then, in the scale ot reasoning life, 'tis plain, There must be somewhere such a rank as man; ■And all the question (wrangle e'er so long) Is only this : if God has placed him wrong?" But we have also seen from our premises that, as soon as Instinct shall have fulfilled its objects, it perishes with the life of the animal; since,, especially, all its present uses are limited to the wants of the body. Nor will its extinction affect the analogy of which we predicate its im- materiality, nor contradict in the least the immortality of the Soul. We deduce the latter, apart from Revelation, not from the Soul's immaterial- ity, but from some of the facts which contradistinguish it from Instinct, that all its higher faculties have no relation to the uses of the body, and from the analogy which subsists between them and the Attributes of the Creator. We infer, also, the immateriality of the Soul, in part, from the same analogy; though it is essential to this analogy that it be conceded that the Omniscient, Omnipresent, and Omnipotent Being is as different The Soul.—Appendix.—Instinct. 909 from the inert matter of which He is the Author as their manifestations are different from each other. And again, if these premises be admitted, it follows that immateriality, or something totally distinct from matter, is indispensable to the indefinite duration of the Almighty, and therefore that it must be rendered equally so to the Soul. Strange, indeed, that man should have seen in the manifestations of matter such allurements as to induce him to resist all the opposing phenomena of mind, and to assimilate the Soul to the nature of those materials of his body which existed originally and will again exist in the form of gases or other sim- ple minerals. (See this subject examined under other aspects in Med- ical and Physiological Commentaries, vol. i., p. 86-90, 94-106.) It need not be repeated that the immateriality of Instinct is inferred from its feeble analogies to the Soul, though not in the least to any man- ifestations of those attributes which ally the Soul to its Maker.* § 1081. It will have been seen that materialism, in its proper accepta- tion, and the question as to the materiality of the Soul, are distinct from each other, since the former denies the existence of the Soul as a sub- stantive agent, while the latter admits it. My object has been to sub- stantiate the existence, more than the immateriality of the Soul. But the proof of the latter has constantly attended all that I have shown of the self-acting nature both of the Soul and Instinctive Principle, which con- tradistinguishes them from every known attribute of matter. The near- est approximation, in the light of analogy, to what may be material, is to be seen in the Principle of Organic Life; and here the resemblance consists in action alone. But the Principle of Life requires the opera- tion of numerous physical causes to bring and maintain it in sensible action. It is impossible, therefore, to adduce a single phenomenon of the Soul or of Instinct that bears a resemblance to the manifestations of matter. § 1082. Our inquiry may be variously pursued, especially upon the great basis of analogy. It is one of no little moment at the present day, and materialism must abide its own facts and method of reasoning; a ground, however, which nothing can shake when presented according to its ordination in nature. In the present case, the admitted facts are co-extensive with all animal existences, and they are bound together in the different races by close resemblances. Indeed, in each of the series the facts differ only by shades. The evidence here is of the strongest possible nature, not only on account of the universality of the facts, but because they are founded in the unchanging character of organic beings. Resting, therefore, in the conclusions which I have now expressed, and anxious for their greater prevalence against a progressive and al- ready widespread materialism, I have been led into this discussion in the hope that it may remove some of the obscurities of the subject, and also advance the great truths in Physiology and Medicine. The province of the Physiologist extends beyond the mere physical relations of matter and Mind. Of those relations he is the only expounder. But it de- volves upon him, also, to seek in the depths of Physiology for the con- stitution of Mind as distinguished from matter; and thus, also, contrib- ute towards a right faith in a future state of being. Wherever, indeed, * We have seen, 8 168, that Professor Muller, in discussing the nature of the Vital Principle, concedes that even this may be an immaterial substance, and that "there is nothing in the facts of natural science'which argues against its possibility, and its inde- pendence of matter, though its powers be manifested in organic bodies—in matter." 910 INSTITUTES OF MEDICINE. he turns his inquiries into organic nature, he sees in the mechanism of every part—individually and collectively as a harmonious whole—in every function and product, separately and relatively—in the properties by which they are carried on, and in the laws by which they are gov- erned, the most perfect evidences of consummate Design. It is the duty of the Physiologist to turn all this immense weight of proof against those crude doctrines of materialism, mental and medical, which have had their origin either in the closet of the speculatist or in the laboratory of the Organic Chemist. And thus, also, shall he secure from Mankind that homage for Medicine which is due to " the Divine Art," and again restore the Hippocratic axiom that " a philosophical physician is like a god" (§ 235). § 1083. Before concluding our subject I shall avail myself of the proof which it supplies against the doctrine of spontaneity of living beings, now extensively prevalent in the scientific world, and against which I have alleged many objections in the Medical and Physiological-Commen- taries (vol. ii., p. 123-140), and again in the original Essay on the "Soul and Instinct," and in that upon "Theoretical Geology" (§ 1079, b), and in these Institutes (§ 14 c, 170, 350| a-m). As it respects the Soul and Instinctive Principle, we have now seen that they are substantive existences, and all organic beings are made up of the common elements of matter. But there is no element known in the inorganic kingdom which affords any of the manifestations which char- acterize the Soul and Instinct, or any of the results of the organic mech- anism. The latter, therefore, was endowed with new properties when the elements were brought into organic union. To say that such prop- erties were "slumbering in the elements," is a frivolous assumption (§ 14 c, 175 d, 250| b, c, f-k), and necessarily involves the conclusion (which has been probably intended) that the Soul, also, is equally in- herent in the elements, which is the worst kind of materialism. But the manifestations of the Soul and Instinct are, as we have seen, not only totally different from those of every organic process, but cannot be gen- erated by the material part. These principles,4herefore, were as much created as the elements of matter, and, as they exist in union with the organized structure of man and animals, it is inferable that the structure was created simultaneously, and by a common act, with the spiritual part. Or, if the material elements were first combined, it would equally follow that it was a direct Creative Act, since the Soul and Instinctive Principle must have been created for the distinct purpose of being asso- ciated with the material body. The rule, of course, applies, through the analogies of structure, to the vegetable kingdom, and which it is equally consistent to suppose was created in the form of plants as of seeds, or as that man and mammiferous animals were created in a state of ma- turity, according to my demonstration in theJEssay on the "Soul and Instinct" (p. 158-173). I have also said in relation to the common opinion that intestinal worms are of spontaneous origin, that, if this be admitted, it must be also conceded by all that is sound in analogy, that the door is equally open for any other animal, and for man himself. The hypothesis is without a plausible fact, while the ovum of these parasites, and of such as are found in the organization of the body, even in the fcetus, may require, in the natural external condition of the animals, a magnifying power of some hundreds of times to render them visible. They may, therefore, The Soul.—appendix.—Instinct. 911 be absorbed into the circulation, where their new mode of existence, as well as in the intestinal canal, may so modify the condition of the ani- mals that they shall lose all resemblance to their characteristics in the external world. The animal and vegetable tribes abound with equally remarkable aberrations, that arise from climate, domestication, and cul- tivation alone. But more than this. From whence comes the elaborate organization of these so-called parasites and their wonderful systems of Design? How and from whence do they obtain, at their start into be- ing, the seventeen or eighteen elements of which they are composed, and which are indispensable, in every species of animal and plant, to the be- ginning of existence? And should not this objection have been urged against the pretended creation of the Acarus Crossii out of a simple so- lution of silex in water (§ 350J, h) ? Is there any thing in Chemistry that will expound the intimate union of such a number of elements into compounds of the most exact nature, or these compounds, by any thing known in physics, into systems of Design, and this for every species of animal and plant, if you had all the elements to begin with ? Or, take oxygen, hydrogen, nitrogen, and carbon alone, the Chemist completely fails to fabricate the most simple organic compound (§ 350, No. 39, par- allel columns). But by no possible contingency can the seventeen or eighteen elements have been assembled for a single individual plant or animal; and when all the species are regarded collectively, the supposi- tion becomes palpably absurd. Nothing but Creative Power could have gathered them together in a single instance. This disposes, also, of the "parturient faculty of the earth," as it is called in the "progressive devel- opment" system of theoretical Geology. Nor can the pretence be set up that the so-called intestinal parasites grow out of a previously organized part, for they are perfectly independent beings, and have no attachments to the intestine. Or, if attachments exist in other cases, they are precisely upon common ground with parasite plants as it respects their original independence. The doctrine which ascribes Muguet " to the production of a parasite plant within the epithelial cell" is open to the same objections as apply to the spontaneity of animals, and is contradicted by all the physiological, pathological, and therapeutical facts. It is alone worthy of the most imaginative of the microscopical school, setting aside its per- nicious tendencies in Religion. We cannot but think, after all, that whoever regards the animalcule, that can be discerned only through a high magnifying power, in all its wonderful complexity of organization, seemingly existing in nothing, in all its close analogies in composition and structure to man himself, and often with a large development of the Instinctive Principle, and pon- ders upon the same analogies as they are only less complex in worms, and only still less in parasitic plants, and considers the stupendous De- signs which each part, and all together in unison, fulfil for the growth and well-being of each individual, and how there is no deviation in structure and functions among all the individuals of the species respectively, must concede the descent of the whole from progenitors that had been brought into being by an Intelligence higher than that which is enabled to ex- plore the labyrinth and trace out the Designs (§ 1051), and that thus informed, he must bow with reverential awe under the inspiration of such contemplations. (See Index I., Article Design.) 912 INSTITUTES OF MEDICINE. THE EIGHTS OF AUTHORS. § 1084. Upon all questions of priority that concern the advancement of Science and Art, there is, doubtless, a general understanding that the principle should not only be sacredly observed, but that, whenever vio- lated, there should be a common effort to repair the injuiy. This is alike due to the individual, to the principle, and to the common good. Nor is it less the privilege of the individual, who may have good reason to think that the principle has not been extended to himself, to vindicate his rights, and to appeal to that sympathy which forms the bond of union among honourable men. It is a common cause, and not seldom demands protection. The Author of these Institutes (and it will soon appear that he acted wisely) has sometimes thought it expedient to assert his claim of origin- ality, in advance, to many doctrines promulgated in the work; as, for example, all that is most essential in the application of the Nervous Power, or Reflex action of the nervous system to Pathology and Thera- peutics, and to much of what is most important in the natural state of the functions. This may be readily seen by consulting p. 106, § 222 b, p. 107-116, § 225-234, p. 295-318,