Remarks Introductory to a 
Discussion on Nosography. 
BY 
ALFRED LUDLOW CARROLL, M. D., 
OF RICHMOND COUNTY. 
REPRINTED FROM TRANSACTIONS OF 
She $eto gork State ftletjical 
1889. DISCUSSION ON NOSOGRAPHY. 
REMARKS INTRODUCTORY TO A DISCUSSION ON 
NOSOGRAPHY. 
By Alfred Ludlow Carroll, M. D., of Richmond County. 
October 9, 1888- 
My first duty is to make a preliminary report from the 
committee appointed at our fourth annual meeting to con- 
sider the views then presented by Dr. Gouley on the subject 
of nosography. 
To elicit in briefest form the general sentiments of the 
committee, the following queries were put to vote: 
1. Is there need of a classification of diseases ? 
2. Should such classification be based on anatomy ? 
3. Should the nomenclature convey accurately the true 
nature of morbid conditions ? 
4. Should the method of classifiation conform as far as 
possible with that adopted in botany and other branches of 
natural science ? 
5. Is it desirable to establish an international system of 
classification and nomenclature ? 
The answers received were unanimously in the affirmative, 
with but one qualification, relating to the practicability, in 
the present state of our knowledge, of classifying upon an 
anatomical basis the exanthemata and parasitic diseases, or of 
satisfactorily conveying the true nature of morbid conditions 
by a nomenclature in strict accordance with anatomy. 
Other mental reservations and explanatory modifications 
of the monosyllabic reply will probably be set forth in the 
papers which we are about to hear. 2 
In debating a theme so intricate and difficult that the most 
enlightened industry of many successive generations has 
failed to satisfy even contemporary demands, it should be 
borne in mind that, from a purely critical point of view, 
classification and nomenclature are, to a certain extent, sepa- 
rable. The latter is, of course, necessary for the recording 
and interpretation of the former, and should convey with 
etymological correctness the ideas which it is intended to 
express ; but, this condition being reasonably fulfilled, atten- 
tion should not be distracted from the spirit by too myopic 
pedantic peckings at the letter. For the very sake of intelli- 
gibility, it may sometimes be expedient to depart from rigid 
pedagogic precept. For example, the Greek prefixes, "hyper" 
and " hypo," are unfortunately so nearly similar that the 
retention of the final "o" in the latter before a compounding 
vowel, though contrary to strict scholarly rule, may be de- 
fensible in the interest of the student of medicine, who, with- 
out a preliminary classical education, might easily confound 
opposite meanings. 
That there is need of a proper classification of diseases 
must be evident, not alone to those who are engaged in 
exploring the labyrinth of mortuary statistics, but to every 
teacher and practitioner of medicine. Under the present 
method-or, rather, lack of method-lesions and symptoms, 
causes and consequences, are so interchangeably confused 
that our literature is robbed of the greater part of its value, 
and the progress of scientific education sadly retarded. 
Until our knowledge of pathology shall be complete, an 
ever diminishing portion of any system of classification must 
of necessity be provisional, and there will remain an excuse 
for the symptomatic naming of unknown pathic conditions, 
such as " myxoedema," " progressive muscular atrophy," 
" glycosuria," and others, as there was in the past for " fall- 
ing sickness," " white swelling," " fungus haematodes," 
" lochial or puerperal fever," etc. But, just as in the bota- 
nist's collection, as soon as the real characters of such doubt- 
ful specimens are ascertained, they should be withdrawn 3 
from their temporary pigeon-holes, labelled with fitting spe- 
cific and generic titles, and ranged in their appropriate order. 
In nosography, hitherto, it has been forgotten that classifi- 
cation should be founded on differences rather than on 
similarities, proceeding from the individual to the variety, 
species, genus, order, and so on successively, as these differ- 
ences become wider and characteristic of larger groups. The 
separation of the largest groups in accordance with their 
agreements is a later affair. This plan is followed in all 
other departments of natural science, and notably in botany 
and zoology (of which latter our study of man is but a high- 
ly specialised branch), and not the least of its advantages is, 
that any changes rendered necessary by advancing knowl- 
edge affect only the terminal members of subordinate groups. 
Evidently, also, as regards nosography, instead of antagoniz- 
ing science and practice in medicine, the very groundwork 
of a scheme so arranged lies in accurate clinical observation 
of sub-varieties and varieties, and each specialist contributes 
what is of essential importance to the whole, as the ichthyol- 
ogist, ornithologist, or entomologist furnishes the basic data 
of zoological tabulation. A correct system of classification, 
therefore, will not only be an invaluable aid to the practi- 
tioner of medicine, but must primarily depend on his trained 
power of differentiation. 
Touching the proposed principle of classification, it must 
be remembered that the word anatomy is employed in the 
work under discussion in its most modern and widest sense, 
as comprising the actions as well as the gross and microscopic 
structure and chemical constitution of the various component 
parts of the body, in both normal and abnormal conditions ; 
and, in this sense, it is impossible to think of any alteration 
or derangement which could not find suitable place, or of 
any clinical phenomenon which could not be satisfactorily 
registered, if it were satisfactorily investigated. It fully 
covers what Hughlings Jackson has called the three-fold 
clinical problem of a disease,-" anatomical, seat of lesion; 
physiological, functional nature of lesion ; pathological, dis- 4 
order of the nutritive process,"1-and gives provisional room 
for what we must be content to term " functional " disorders 
until we shall have discovered the structural alterations 
which undoubtedly induce them. A sorry sort of empiricism 
would result from the general adoption of Moxon's dictum, 
that the physician " must know diseases, not as the zoologist 
knows his species and his genera and his orders, by descrip- 
tions of comparative characters, but as the hunter knows his 
lions and tigers,"2 and he who "goes a gunning" therapeuti- 
cally with such superficial lore will be apt to waste snipe- 
shot on a rhinoceros or explosive bullets on a reed-bird. This 
lion-and-tiger kind of notation almost inevitably degenerates 
into mere symptomatology, and is responsible for the insolu- 
ble ambiguity of many of the death certificates which used to 
bewilder me while 1 was engaged in superintending their 
registration, and for the shallow diagnoses which too often 
discredit the profession and injure the patient. It has led to 
regarding a prominent effect or congeries of effects as a mor- 
bid entity, and afforded ground for the irrational dogma of 
Hahnemann, that " the totality of the symptoms constitutes 
the disease." It is a surprisingly common thing to find 
deaths ascribed to "paralysis," "dropsy," "coma," etc., and 
to hear of " general debility," " biliousness," and " complica- 
tion of diseases," which are really coordinate results of a 
single cause. A patient whom I was asked to examine some 
months ago, suffering from mitral regurgitation and cardiac 
dilatation, has since then passed into the care of another 
diagnostician, who has shamed me by the brilliant discovery 
that she has both " asthma and dropsy," and similar instances 
are doubtless within the almost daily experience of many 
here present. 
If it be admitted, as it is by most modern thinkers, that 
pathological phenomena are but perversions of physiological 
actions, " governed by the same fundamental laws which 
direct the normal processes of life " (Michael Foster,) then 
1 " On Diseases of the Brain," Brit. Med. Jour., July 14 and 21, 1888. 
Quoted by Jackson, loc. citat. 5 
it is manifest that pathology is potentially classifiable by the 
same method as physiology, namely, on an anatomical basis ; 
but it is equally manifest that our knowledge of both of these 
branches of biology must be perfect before our classification 
can be permanently established. The existence of sympto- 
matic titles is a virtual confession of ignorance of the pathic 
conditions which they conceal, as is most remarkably exem- 
plified in the terra incognita of mental diseases, where con- 
tending classifications are founded principally on single 
symptoms. " General paresis," " reasoning mania," " eroto- 
mania," "kleptomania," "folie circulaire," "agoraphobia," 
" aboulomania," etc., mean as little as possible, therein con- 
forming with the amount of our information as to their 
pathogeny; such terms as " folie a deux " mean absolutely 
nothing; and " melancholia " means a superfluity of black 
bile, in survival of the ancient hypothesis of its aetiology. 
"Cholera" is the direct opposite of a flow of bile, and 
"struma" means building up, instead of breaking down. 
Having gained, by observation and comparison, a sufficient 
knowledge of things to begin to classify them, the next step 
-since our knowledge can neither be recorded nor imparted 
to others save by words-is to name them ; and it is a truism 
to assert that the name should convey our notion of the 
thing, epitomising, so to speak, its description. Farther- 
more, for the intercommunication of ideas between different 
nations, it is necessary that names be derived from univer- 
sally intelligible roots ; hence, Greek and Latin, the languages 
of scholarship throughout the world, must, for our purposes, 
supplant vernacular tongues. 
When an artificially assumed meaning of a current word 
has been clearly defined and generally accepted, its retention 
in any branch of science is permissible if it be not grossly 
incorrect etymologically, as in the case of "geometry," which 
has long ceased to signify merely measurement of the earth; 
"electricity," which nowadays has little connection with 
amber; or " politics," whose ravages extend far beyond the 
philological bounds of a city. The very terms which desig- 6 
nate the fundamental parts of our professional education are 
of this kind. Anatomy means a cutting asunder, and is ety- 
mologically as applicable to the trenchant disseverance of 
inorganic matter as to the structure of the animal organism. 
Physiology covers the entire range of natural phenomena, 
from astronomy to cOnchology, and, even in an arbitrarily 
restricted sense, was formerly construed as synonymous with 
physics. Chemistry refers strictly to liquid juices. Surgery 
is an abbreviation of " cheirurgia," and as pertinent to the 
manual labor of the blacksmith or hod-carrier as to the work 
of Astley Cooper, or Dupuytren, or Valentine Mott. To 
cavil at such time-sanctioned technics would be rank hyper- 
criticism. 
Many of the names used in pathology, however, are mis- 
nomers so monstrous, that, while possibly pardonable in the 
past as cloaks for ignorance, later research demands their 
retirement; others never had a valid apology for their exist- 
ence. " Rhachitis," manifested in the long bones and inter- 
nal organs, means inflammation of the vertebral column; 
" gout " means a drop, and is only suggestive of the occur- 
rence of the malady in persons who are in the habit of " tak- 
ing a drop too much ; " " rheumatism " implies a watery 
discharge ; " croupous " signifies " crying out," and " catarrh- 
al," "pouring down," rendering their adjective connection 
with pneumonia ridiculously inapt; and, to cap the climax of 
absurdity, we frequently read of " hysteria in the male " and 
" gonorrhoea in the female." Baseless imaginings of remote 
similitudes to lower animals or to plants have encumbered us 
with a farrago of nonsensical appellations, such as " ranula," 
a little frog; "lupus," a wolf; "cancer," a crab; "scrofula," 
pertaining to a sow ; " sycosis," fig-like ; " molluscum," pri- 
marily from " mollis," soft, and mediately from a so-miscalled 
excrescence on the maple ; " framboesia," from the raspberry; 
" urticaria," from the nettle; and, with consistent inconsis- 
tency, sundry sorts of tumors, either sessile or with a solitary 
pedicle, are congregated under the title " polypus," connota- 
ting a many-footed thing. 7 
Then, to make confusion worse confounded in the over- 
taxed memory of the novice, and to discomfort oftentimes 
the older practitioner, we have a multitude of personal names 
irrelevantly attached to diseases, or even to single symptoms 
of disease. "Paralysis agitans " is indefinite enough, but to 
dub it " Parkinson's disease " is adding insult to injury. 
"Bell's palsy," "Duchenne's paralysis," "Landry's paralysis," 
are unmeaning sacrifices of pathology at the shrines of un- 
canonised saints, who surely would, if they could, spurn the 
offerings. " Dupuytren's contracture " crippled many a hand 
before his day; and it requires some mnemonic effort to recol- 
lect that " Dupuytren's fracture " is only an exaggeration of 
" Pott's fracture; " that this fracture is a totally different thing 
from " Pott's diseaseand that neither Pott nor Colles had 
any passive or active proprietary interest in the solutions 
of continuity which bear their respective names. How many 
of us are likely long to remember that "Weil's disease" is 
a simulacrum of " abortive typhoid fever; " that " Friedreich's 
disease " is a phase of locomotor ataxia, without ocular or 
neuralgic accompaniments; or that "Kaposi's disease" is an 
alias for w'hat Hebra christened " xeroderma " ? It is easier 
to fancy than to depict the state of mind of a student when 
he hears of a patient with a Naegele pelvis, Cheyne-Stokes 
respiration, or an Argyll-Robertson pupil, or is asked whether, 
in a case of suspected Meniere's disease, he would try Val- 
salva's or Politzer's method. 
With such a preposterous and perplexing jargon as has 
been partly sketched,-with Germans writing of " Basedow's 
disease," and Britons of " Graves's disease ; " " carbuncle," a 
little Latin coal, and " anthrax," a great Greek one, both 
applied to a local inflammation of the corium, and the latter 
name, or its French translation, " charbon," assigned with 
equal inaccuracy to the " splenic fever " of cattle (wherewith 
the spleen has no causative connection), and to its inoculated 
effects in man ; " struma," indicating in one place an en- 
largement of the thyreoid body; in another, lymphadenitis ; 
in a third, tuberculosis ; and in a fourth, no one knows what; 8 
numerous mobid malefactors roaming about Europe, each with 
as many pseudonyms as a veteran fugitive from justice,-it is 
quite time to ask if an endeavor should not be made to revise 
our incongruities and to secure international concurrence in 
giving to every known thing a name which shall everywhere 
intelligibly express the same notion. The task is a cumula- 
tive one, involving long labor, close study, and keen debate 
in many lands; but the sooner it is begun the nearer will be 
its accomplishment; for while it embodies present knowledge, 
it must facilitate farther learning. 
Of the precise position to be assigned to microbia in rela- 
tion to disease, it is not possible at present to speak with cer- 
tainty ; but there is a growing opinion, supported by obser- 
vation and experiment, that their intrinsic potency of evil has 
been overrated. The majority of the numerous varieties which 
have been carefully studied apparently exert a beneficent 
power in destroying refuse organic matter, and if an universal 
" germicide " could be effectually employed the human race 
would probably be exterminated by its own waste-products. 
A few infective diseases are unquestionably associated with 
the presence of peculiar micro-organisms; others, from the 
simple analogy of their infectiveness, are presumed to have 
similar relations, but in these, hitherto, microscopists have 
either found no " microbes " at all, or else too many, and 
have quarrelled as to which among several cocci and bacilli 
should bear the special pathogenic blame. Microphytes, 
indistinguishable from each other morphologically, have been 
discerned in both health and disease, until at last the micro- 
scope has been almost set aside, and, as in the examples of 
the " comma-shaped " spirilla and sundry micrococci, specific 
definitions are predicated on assumed physiological actions 
alone, in as direct violation of every principle of classifica- 
tion as it would be to erect flatulent dyspeptics and diabetic 
patients into separate species of the genus homo; although 
cautious bacteriologists have admitted " that changes in the 
nutrient medium may have some effect on the form and size 
of the (protophytic) cells, on their mode of multiplication, 9 
and on their physiological or fermentive properties," and 
that, to induce disease, the viciously disposed intruder "must 
find within the body, and in proper combination, all the con- 
ditions necessary for its growth and multiplication " (Ziegler), 
thus tacitly imputing some morbific influence preceding bac- 
terial invasion. All individuals are not equally susceptible 
to infection, as they should be if certain specific micro-organ- 
isms were the verae causae of disease and capable of disor- 
ganising previously healthy tissues;-the field mouse and the 
domestic mouse reciprocally resist each other's so-called sep- 
ticaemic schizophytes; one animal falls easy prey to an 
inoculation which another of the same genus absorbs with 
impunity; while, on the other band, the same micro-organ- 
ism is credited with producing different morbid effects in 
animals of different genera. In laboratory experiments it 
has been shown that the same ferment may evolve different 
products, or various ferments the same product, according to 
their environment; and from a clinical point of view it has 
seemed to many acute observers that several contagia may 
arise from the exaggeration of common putrefactive processes 
-a belief fortified to some extent by the " intensification " 
or "attenuation" of microbial virus through successive cult- 
ures in varying media. 
Long before the transcendental evolution of modern bacte- 
riology, the seeming analogy between the phenomena of 
fermentation and the manifestations of infectious disorders 
led to the grouping of these under the title of " zymotic dis- 
eases," and early in the career of the "germ theory " the 
minute organisms discovered were called " microzymes "- 
little ferments - the aptest of their ordinal appellations. 
Subsequent experience and the most recent research tend to 
bear out this analogy, and to suggest that the action of the 
bacteridiae is catalytic, and that the chemical product of fer- 
mentation-the real materies morbi-depends as much, or 
even more, upon the character of the fermenting medium. 
One of the first observations in this direction was that 
septicaemia could be excited by a virus which, though proba- 10 
bly the product of a bacterially originated fermentation, was 
itself demonstrably inanimate. Later, it was noticed in sev- 
eral instances that after certain " cultured " (or fermented) 
media had been freed from all micro-organisms, a something 
remained which was sufficient to communicate infection. 
Finally, chemistry is coming rapidly to our enlightenment 
with its already brilliant investigations into the genesis and 
composition of the various ptomaines, leucomaines, and still 
unbaptized " extractives." 
In their clinical relations, it is worthy of passing note that, 
while the production or the ptomaines is presumably due to 
catalytic bacterial intervention, it is held by some of the best 
authorities that leucomaines may be generated by the de- 
graded action of the tissue-cells themselves; and the ques- 
tion may arise, whether the somatic development of some of 
these leucomaines cannot, perhaps, prepare the soil for micro- 
zymotic implantation, thus constituting the individual sus- 
ceptibility to exogenous infection. Again: The fact that 
different ptomaines, some poisonous, others innocuous, are 
formed successively in different stages of the same fermenta- 
tion, may possibly hereafter be connected with the self-limi- 
tation of many zymotic maladies. Of the ptomaines hereto- 
fore catalogued, thirteen are stated to be more or less toxic, 
five to be innocent, and of the remaining nine the action is 
not yet known. It is not inconceivable that some of these 
may counteract others, and if future study shall lend weight 
to the conjecture, it will aid in solving the obscurest problems 
of pathology. Among the leucomaines, there is even now 
alleged evidence that a few, at least, are mutually antago- 
nistic. Of the nature and mode of operation of the virulent 
" extractives " we have little beyond surmises, but a wide 
field is opened for farther exploration. I shall leave to the 
distinguished chemists who have kindly consented to join our 
discussion a definite survey of the boundaries of exact in- 
formation concerning these and the preceding groups of alka- 
loids ; and to my medical colleagues a more elaborate elucida- 
tion of the questions which I have cursorily introduced.