 
 
<K~
                 SYLLABUS
                        OF  A

        COURSE  OF  LECTURES
                          ON
THE INSTITUTES OF MEDICINE AND MEDICAL
                 JURISPRUDENCE,
                       IN THE
  PHILADELPHIA MEDICAL INSTITUTE.
BY
\/_
JOHN BELL, M. D.
/4-s- ■'.
                                                I.
                      INTRODUCTORY.

        General View of the Institutes of Medicine.
  The subjects  included under  this  head are Physiology Pa-
thology, and Hvgeine.  Of the  comparative certainty of medical
and other sciences and intellectual pursuits.  Changes in  the sys-
te:ns of Natural Philosophy, Chemistry, Mineralogy, Geology and
Natural History.   Revolutions in jurisprudence or in general and
special legislation—reference to  its history.   Physiology, or the
study  of the healthy functions of an organized  living body—its
extent and application—its connexion with Hygeine, or that study
which leads  to a knowledge of all the  agencies by which the
health of man is supported or modified.  Pathology or the study
of diseased function and  altered organization—akin to and  derived
from Physiologv, it furnishes the only sure foundation for suc-
cessful Therapeutics.  Medical Jurisprudence—its objects and
utility.  Extensive range of inquiry allowed to and required of the
student and practitioner of medicine.

            COMPARATIVE PHYSIOLOGY.
  Productions of Nature—their division into two  great classes:
                           1 
                              2

1.  of mineral or inorganic and inert substances.  2. Of vegetable
and animal or organized living bodies.
  Differences between Organic or living, and inorganic or inert
bodies—First, in  their form, volume, chemical composition, and
intimate structure.  Second, in their origin, mode of preservation,
changes during existence and termination.
  Differences  in  Organized Living  bodies—Common  divi-
sion of these bodies into vegetables and  nnimals.  Resemblances
more  readily pointed out than differences between  these two clas-
ses—Compared  under the heads of volume, chemical composition,
intimate structure and organization, and also in their actions.
  The Animal  Kingdom is  composed  of two grand divisions,
viz.  vertebral and  invertebral animals.   The vertebral consists
of four classes:
I.  Mammalia.
2.  Birds.
Warm Blooded.
  3.  Reptiles.      >     Cold Blooded.
  4.  Fishes.       J
  The invertebral animals are constituted into five classes:
  1.  Insects.
  2.  Crustacea.
  3.  Mollusca.
  4.  Vermes or Worms.
  5.  Zoophytes.

  Another classification of the invertebral animals is into 1. The
Molluscous;  2.  The Articulated; 3. The Radiated.  Examples of
each of these classes, and of the orders into which they are subdi-
vided—Peculiarities in their organization  and function.

       PHSYIOLOGY  APPLIED TO  PATHOLOGY.

  Elementary Parts and  Growth—Summary view of the ap-
pearance, properties and  alterations of the tissues or elementary
systems.

      Of  the  Mucous Tissue  or Mucous Membranes.

  Structure and appearance of this tissue—its distribution__its va-
rieties depending  on the cavities which it lines—its general  pro- 
 
 
3
perties and functions—differences between its healthy and diseased
stat es

    Of the Serous  Tissue or the Serous Membranes.

  The appearance, properties and morbid alterations of this tissue—
varying in the different cavities.

                 Of the Nervous  System,

  The  Nervous Tissue in vegetables—in animals.   Divisions of
the Nervous System—the various functions performed by its seve-
ral parts—its organic changes—Illustrations by Drawings.

            Of Organs—Functions—Apparatuses.

  An organ is composed  of a plurality of  tissues  or  elementary
systems.   In physiology it is a vital instrument for the production
of peculiar phenomena, which, when they occur in a regular order
and successive series tending to a certain end, constitute a function.
Apparatus,  a collection  of organs,  the combined  action of which
simultaneously or  successively tends  to  one common  end or
function.   Enumeration of the apparatuses by which human life
is sustained, and the being rendered adequate to the discharge of all
its  functions.

Division of the Functions into those  of Animal Life or
   Relation,  and those of Organic Life or Nutrition.

   Difficulties in  the admission of  this classification.   Exceptions
 to what are enumerated as the distinctive  marks of each  class-
 Connexions between  the Functions of Organic and  those of Ani-
 mal life—they are  not  independent of each other—the differences
 ai their laws are only in degree, not in kind.

                          Sympathies.

   Sympathy, an ultimate fact in physiology, like attraction in natu-
ral philosophy.  The phenomena in physiology,  referred to sym-
pathy, are  no more anomalous than many which we meet with in
 chemistry, especially in galvanism  and electricity. 
                               4

      Of  the Functions of Animal Life, or  those of
                          Relation.
   These functions are divided into those
                  1. Of Sensibility.
                  2. Of Voluntary Motion.
                  3. Of Expression.
   Under  the  functions  of sensibility  are  included the senses of
 Touch, Sight. Hearing,  Smell and Taste; and the Intellectual and
 Moral Faculties.
   In Voluntary Motion  or Locomotility, are comprised the  pos-
 tures and  attitudes of man—his mode of progression, as in walk-
 ing, leaping, running, swimming.
   The functions of Expression  are gestures, including  physiog
 nomy—phonation or the voice—its modifications in the uttering of
 affectiveand conventional language.

   1.  Of the  Sensitive Apparatus  for  Performing the
                  functions of  Sensibility.
   Of the Touch—The skin examined in its double office as one of
 the senses and  as an organ of nutrition.   Its functions in both cases
 modified by the condition of the internal viscera—its morbid changes,
 acute and chronic—the  signs  deduced from its appearance   in
 disease.
  The Pilous  system and its dise >ses.
  Of the Function of Sight—The eye—its structure, sympathies
 and derangements.

     Of the Functions of Hearing,  Smell and Taste.

  The organs or seats of  these respective senses—Intimate connex-
ion between  smell and taste and the digestive functions.   Derange-
 ments of these  three senses—Signs furnished  by them.

         Structure and Functions  of  the brain.

  Growth of the brain—its fibrous structure—proportionate  de-
velopment of its several  parts—their respective functions.  Illus-
 trations by  Drawings.

        Of  Instinct, Intellect, and the Passions.
  The strength and proportionate predominance  of these depend 
 
 
s
 chiefly on the congenital  conformation  and subsequent develop-
 ment of particular portions of the brain ; and the modifications of
 these same faculties, are dependent on the state of the organs of
 nutrition, and on the number and variety of the impressions made
 on the senses by education and imitated habits.

                           Insanity.
   Chief varieties of mental alienation—monomania—mania—de-
 mentia.   Whatever may have  been the exciting causes of insanity,
 the proximate cause is to be sought for in impeded or altered func-
 tion of the brain.

             2.  Of  the  Locomotive Apparatus,
   By which are  performed the functions of  voluntary motion.
   This apparatus includes  part of the osseous,  cartilaginous  and
 fibrous systems,  which are the  passive agents; and of the muscular
 system, which is the active agent in locomotion.   Muscular fibre—
 its properties—how far  independent of nervous  tissue for its con-
 tractility.  The  muscular  a representative of the condition of the
 nervous system—application of this law to disease, as in convul-
 sions and spasms, &c.    Derangements  of the  muscular  system
 arising out of disordered circulation or digestion.

     3. Of the  Vocal and Gesticulatory Apparatuses,
   Or those by which are performed the functions of expression.

                Of Phonation or  the Voice.
   The vocal apparatus consists of three series of structures:
   1. The muscles of Respiration, and the Trachea.
   2. The Larynx.
   3. The Mouth and Nasal Fossa?.
   Mechanism of the production of vocal sounds—ventriloquism.
   Modifications  of the voice for the uttering of affective and  con-
 ventional language.
   Of Gesture, including physiognomy, as a means  of expression.

 Of the  Functions of Organic Life, or those of Nutrition.
   Of the Nerves of the Organic Functions, or the Great Sym-
pathetic—The internal or mucous membranes on which are  per-
 formed some of the most important of these functions, may in  de- 
6
gree be regarded as forming surfaces of relation or internal senses;
as the pulmonic and gastric, the  former for giving  notice of the
various kinds of air, the  latter for apprizing us of the effect of in-
gesta.
  The Functions of Nutrition are divisible into
  1. Respiration.
  2. Digestion.
  3. Chylosis,  or lacteal absorption.
  4. Circulation.
  5. Secretion.
  6. General Absorption.
  7. Nutrition.
  8. Calorification.
  No classification  of the  functions can be  made which is  free
from difficulty.  Thus under the head of absorption, some physi-
ologists include lacteal and general absorption;  while, again,  se-
cretions are subdivided into exhalations, depurations, and secretions
properly so called.

                     1.  Of Respiration.
  Respiratory Apparatus—more  complex in the  higher classes
of animals—its nerves.  The nerves of respiration are of the same
order as those of expression and voice.  Respiration, how performed
in the different classes of animals—its uses—for what purpose is
the atmospheric air inhaled—the exhaled aqueous vapour not form-
ed  by a chemical  process—carbonic acid,  how generated.  Con-
nexion between the action of the lungs and that of the heart, brain
and stomach—asphyxia.   Diseases from derangement of  the respi-
ratory  function.

                      2. Of Digestion.
  1. Digestive Apparatus—various in  different animals.   Di-
gestion is not then performed by the same agencies in all animals__
the process different according to the class or order, as in the mol-
lusca, in reptiles, fishes, the gallinaceae among birds, the ruminating
animals among  the mammalia—hence the different theories of di-
gestion.   In the human species, the gastric juice is not the chemi-
cal  solvent of the food, nor the prime agent of digestion, as taught
by  Spallanzani—opinion of Chaussier and  experiments of Mon-
tegre. 
 
 
7
  2. Abnormal Digestion—Digestion hurried or retarded a cause
of disease—influence of the nervous  system—sympathy at this
time between  the alimentary canal and the heart, lungs,  skin,
brain and liver.   Deductions applicable to therapeutics.

         3. Of  Chlylosis or Lacteal Absorption.
  1.  Chyliferous Apparatus—Alleged elective appetency of the
lacteals inquired into—their absorption of heterogeneous or unassi-
milated substances.
  2.  The  Mesenteric Glands—under what circumstances, and
from  what cause diseased—does such disease ever give rise to ma- '
rasmus.

                  4. Of the  Circulation.
  1.  The Circulatory Apparatus—the heart, arteries, capillaries,
veins, the direct conducting and propelling parts—the lungs, liver
and spleen diverticula for the blood in  hurried orirregular circula-
tion.   The relative  share  of each  of  the  above divisions of the
sanguiferous system  in the performance of the function—the heart
is the grand motific agent of the circulation—to  what extent is at-
mospheric pressure a co-operating power.
  2.  Abnormal  Circulation—Influence of the  nervous system
over  the circulation—how far this function can be called an invo-
luntary one.   Is  disordered circulation either a cause or a  neces-
sary concomitant of fever, or does  this disorder  of itself consti-
tute fever ?  Reference to  the morbid  conditions of the heart and
arteries in aneurisms, of the veins in varices and phlebites, and ot
the capillaries in inflammation.   Of the Pulse—its varieties—de-
ductions drawn from it.

                          The Pulse
         Indicates                       By         It is called
1st,  The strength of the  contrac-  Strength,    Strong.
  tion of the heart,                 Weakness.   Weak.

2dl y, The quantity of blood thrown   Fulness,     Full.
  out at each contraction,            Smallness.   Small.
3dly,  The  number  of  contrac-   Frequency,  Frequent
  tinns.                            Slowness.   Slow. 
8
         Indicates                        By         It '" called
4thly,  The regularity of its ac-   Regularity,   Regular.
  tion, as to strength, quantity, or   Irregularity,  Irregular.
  frequency,                      Intermission.  Intermittent.

5thly, The strength  of the action   Hardness,    Hard.
  of the arteries,                   Softness,     Soft.
                                  Redoubling,  Redoubling.
                                  Trembling.   Trembling.
6thly The irritability of the ves-	Quickness,	Quick.
sels,	Regularity,	Regular
	Slowness.	Slow.
7thly,  The medium diameter of   Dilatation,    Great.
  the arteries,                      Contraction.  Small.

Sthly, The quantity of blood in the    Oppression.   Oppressed.
  vessels,                          Smallness.    Empty.

9thly, The contraction of the capil-    Obstruction,  Obstructed.
  laries.                            Freedom.     Free.

                     V.  Of  Secretion.
  1.  Varieties of  Secretions, and the Apparatus by which
they are accomplished—depuration—exhalation—secretion—the
various fluids formed out of the blood bv the foregoing processes.
  2. Abnormal Secretion—Of  the disordered actions of the or-
gans of secretion, depuration  and exhalation—how far  these are
dependant on the derangement of the stomach and the digestive
apparatus in general—new fluids and new growths.

               VI.  Of General  Absorption.
  1. General Absorbent  Apparatus.—Lymphatics—veins—the
relative office and importance of each of these sets of vessels—the
introduction into the circulation of foreign and noxious matters—
three inlets; the lungs, alimentary canal, and skin.   Pathological
deductions. 
 
 
9
                      VII. Of Nutrition.
    By what system of vessels, and by what process nutrition takes-
 place; the phenomena of nutrition in animal matter not circulating
 or contained in vessels.   Pathological deductions.

                  VIII.   Of Calorification.

   By what agencies animal heat is generated, and under what cir-
 cumstances is its evolution modified.

             Of Sleep.  Of the Temperaments.

   Varieties  of the Human  Species—Five, viz. 1. The Cau-
 casian.  2.  The Mongolian, or Tartar.   3.  The American.   4.
 The Negro, or African.  5.  The Malay.
   Location of these races; influence of climate.

                  GENERAL PATHOLOGY.

   Pathology includes  aetiology, symptomatology, semeiotics, and
 morbid anatomy or autopsia.
   ^Etiology, or  the  knowledge of the causes of diseases,  is sus-
 ceptible of two divisions.  In the first are ranged all the causes af-
 fecting the body in virtue of the impressions produced by agencies
 from without.  These are as follow:
   1.  The  Circumfusa, or the agencies operating through the
 medium of the atmosphere,  as winds, moisture,  dryness, heat,
 cold, and the alternations or extremes of these during the different
 seasons,  and  in certain localities or climates.   Also exhalations,
 vapours, electricity.
  2. Applicata, or things applied to the surface of the body;  as va-
 rious irritants, compression by dress,  by ligatures and  by certain
 trades and labours.
  3.  Ingesta,  or things introduced into the body by the primary
 passages; as  food, solid and liquid, vegetable and animal, drinks
 prepared by  artificial means, pharmaceutical substances and irri-
 tants.
  The second division  of Etiology, is that in which are included
the organic changes in the living body, constituting disturbance of
function; the particular  part thus affected, and the nature of the
alteration which supports the  disease, and which, if not arrested or 
10
removed, ends  in confirmed  feebleness of the part or in death.
To this division also belong,
   Gesta,  Actions or functions, which are exercised in excess by
the voluntary motion of the muscles and organs.
   Percepta, Perceptions, or functions and impressions, which de-
pend upon the sensibility and organization of the nervous system,
and  which in excess become causes of disease, as intellectual exer-
tion, the passions, sleeping, and waking.
   Of the manner in which the human body is affected by agent*
hurtful by their excess, or noxious in their nature.

   Of  Irritation.
   Of  Sedation, or Counter-Stimulation.

   A disease consists  in a lesion  of some of the functions of the
 animal economy.   Rarely are all the organs simultaneously or even
 successively affected  in any one  malady,  however violent or per-
 sistent it may be.  General  or constitutional disease is not accu-
 rate language.
   Order of Parts chiefly affected  in  fevers, in  the phlegmasia?,
 and in eruptive diseases.   It often "happens that the disturbed  ac-
 tion of the heart and brain  is not of itself a disease, but rather a
 sympathetic or secondary disturbance following the organic altera-
 tion of the membranous tissues.
   Of  the Membranous Pathology.—Reference to the prima-
 ry vesicular structure of all  the  organs:  they are more frequently
 and actively affected by impressions on their envelopes and linings,
 than by changes in their masses; many of the grand physiological
 phenomena take place on the membranes.   Deductions applicable
 to the improvement of Therapeutics.

                     Division of Diseases.

    A  classification  of diseases ought to rest on a  physiological  ba-
 sis, that is on  a knowledge of the phenomena and symptoms exhi-
 bited by the tissues and organs during their healthy state, and when
 their structure is altered and functions impeded.   This knowledge
 can only be complete by connecting the study  of symptoms during
  the disease, with that  of the appearances after death.   Necessity
  of separating the anomalous or accidental  sympathies  from  the
  symptoms strictly characteristic  of the  disease; the promptness 
• 
 
11
and violence of sympathies often dependant on temperaments, and
so modified by age and sex as at times to give no measure of the dan-
ger of a disease.   Of irritability.
  The following is an outline of the classification of diseases, ac-
cording  to the tissues or organic systems primarily or more per-
manently affected.

                        CLASS  I.

             Diseases  of  the Mucous System.

           Order I.—Of the Visual Apparatus.
  Genus  1. Conjunctivitis.   Purulent Ophthalmia..
         2. Epiphora.  Stricture of the lachrymal canal.
        Order II.—Of the  Respiratory Passages.
  Genus 1. Epistaxis.
         2. Coryza.
         3. Laryngitis.
         4. Trachitis.
         5. Bronchitis.
         6. Catarrh.
         7. Haemoptysis.

          Order  II.—Of  the Digestive Passages.

  Genus 1. Gingivitis.  Ptyalismus.
         2. Tonsillitis.
         3. Pharyngitis.
         4. iEsophagitis.   Dysphagia.
         5. Gastritis, acute and chronic.  Dyspepsia.
         6. Haematemesis.
         7. Enteritis.   Lientery.  Diarrhoea.
         8. Gastro-enteritis.   Bilious colic.  Cholera.
         9. Colitis.  Colic.  Dysentery.
        10. Haemorrhois,

     Order III.—Of  the Genito-renal Apparatus.

  Genus  1. Cystitis.   Catarrhus  Vesicse.
         2. Urethritis.   Blenorrhoza.  Stricture.
         3. Vaginitis.   Leuchorrhcea. 
                          12

        4. Menorrhagia.
        5. Cysto-urethritis.  Dysuria.  Ischuria.
        6. Haematuria.

              Order IV.—Gastro-pulmonic.
  Genus 1. Pertussis.
        2. Asthma.
               Order V.—Gastro-renal.

  Genus 1.  Diabetes.
        2.  Lithiasis.

                      CLASS II.

            Diseases of the Serous System.

          Order  I.—Of the Cerebral Cavity.
  Genus 1. Arachnitis.  Hydrocephalus.
          Order  II.—Of the Thoracic Cavity.
  Genus 1. Pleuritis.   Hydrothorar.
        2. Pericarditis.  Pericardiac dropsy.

         Order III.—Of the Abdominal Cavity.
  Genus 1. Peritonitis.  Ascites.  Tympanites.

                      CLASS III.
           Diseases of the Cutaneous System.

  Genus 1. Prurigo.
        2. Psoriasis.
        3. Vaccinia.
        4. Inoculated Variola.

                      CLASS IV.

Diseases affecting the  Cutaneous  and  Mucous Systems
      simultaneously, or cutaneo-mucous diseases.
  Genus 1. Variola.
        2. Varicella.
         3. Rubeola. 
 
 
13
         4. Scarlatina.
         5. Erysipelas
         6. Urticaria.
         7. Herpes.

                       CLASS V.

             Diseases of the Fibrous System.

   Genus 1. Hemicrania.   Cephalalgia.
         2. Ophthalmitis Sclerotica.
         3. Periostitis. Syphilitic pains.  Nodes.
         4. Paronychia.
         5. Aponeuralgia.   Chronic Rheumatism.

                       CLASS VI.

                  Fibro-Mucous Diseases.

              Order  I.—Gastro-aponeurites.
   Genus 1. Acute Rheumatism.
         2. Podagra.   Chiragra.

                      CLASS VII.

             Diseases of the Nervous System.
   Genus 1. Encephalitis.  Softening of the Brain.  Paralysis.
         2. Neuralgia.

                       CLASSVIII.
Diseases of  the Mucous and  Nervous Systems, or Muco-
                        Neuroses.

            Order I.—Gastric  Muco-Neuroses.

   Genus 1. Hysteria.
         2. Chorea.
         3. Hypochondriasis.
         4. Epilepsy.
  Diseases of the glandular and parenchymatous organs, usually the
consequence of protracted irritation of their corresponding mucous
or serous membranes.   Pulmonitis going on to Phthisis;  at
times the effect of tracheo-bronchitis,  or inflammation of the mu- 
                             14

cous membrane ; sometimes follows pleuritis  or inflammation of
the serous membrane ; occasionally it may result from the mucous
and serous inflammations conjoined.—Hepatitis seldom a primary
disease—moist commonly is the  sequela of gastro-enteritic  irrita-
tion—more rarely may ensue on partial peritonitis or disease  of the
investii g hepatic serous membrane—Same of the other glands open-
ing on mucous surfaces.
   Of Fevers—usual  classifications  misleading—they cannot  be
characterized by their duration  or periodicity, nor by any fixed
set of symptoms.   Safer to discard all preconceived notions, and to
observe the epidemics of the season  as lesions of function,  some-
times the effect of organic alteration of one single tissue, as the
mucous,  constituting  gastro-enteritic fevers—sometimes of two
tissues mucous and serous, as  where the digestive canal and arach-
noid are simultaneously affected (yellow and typhus fevers); or the
internal surface of the uterus, and the peritoneum, (puerperal fever);
at other times the varieties will depend on the activity of the sym-
pathies of the heart and brain with the altered tissue, without ma-
terially affecting the march or termination of the malady.  These
sympathies will  be various according to the nature of the season,
the manner of living,  the age, sex, temperament, acquired consti-
tution, or previous diseases of the patient.

                  SYMPTOMATOLOGY

  Or the  Study and Knowledge of the Symptoms of Diseases.
   Qualifications of a medical observer, and importance of faithful
observation.  Preparatory examination of the countenance,  ex-
ternal  appearance or habit of the body, of  the tongue, state of
the respiration and digestion.
   The inquiries to be made respecting  the history and condition
of the patient,  are expressed in the following table. 
 
 
15
M
-i
History of the f
 familv  . .  .  '
family
History of the
 patient  . .  .
ascending.
collateral.
descending'.
In a state of
  health.
rHabits.
 Regimen.
 State of the
   functions.
 Sympathies.

 Constitution
 Temperament

 Idiosyncrasies
   as regards  .
''Infancy.
 Puberty.
 Adolescence.
Historv of the
disease studied < Invasion.
Un its
In a state of dis-
 ease in the dif-, .
 ferent periods^. Manhood
 of life ....  | Critical epoch
              l^Old age.
Causes.....5 Predisposing,
              c occasional.
Prelude
 March.
 Development.
..Actual state.
-Skin.
                  "Habit of body
                   Countenance.
                   Intellectual functions
                   Sensitive  apparatus
2. Actual State. ^ Respiratory--------
                   Digestive
Tbiimination
factive.
 (passive.
 abnormal.
 refractory.
 {sanguine.
 lymphatic.
 nervous.
fpatholog. disp.
 thygeinic agents
 medicin. agents.
 Circulatory ■
 Locomotive ■
.Secretory  -
 fin health.
. -^ — another disease.
 i.— death.—Pathological anatomy
   Method of examination in the diseases of the Head—Attention
to the volume  of the brain—configuration of the  cranium—prior
injury  or contusion—insolation—temperament—if in young sub-
jects,  whether  they have worms—or are in the  period  of den-
tition—note the state of the Intellectual Faculties—of the Sensitive
and Locomotive Apparatuses—of  the  digestive  functions—and
whether  vomiting be a symptom—of the respiratory apparatus—
of  the  circulation, especially  observing whether the pulse be pre-
ternaturally slow—conclude by a general view of the countenance.
and posture or decubitus of the patient. 
1G
     Method of examination in diseases of the Thorax.—Ascer-
  tain the existence of pain in any part of the respiratory apparatus,
  as in the larynx, trachea, &c, hear the patient speak, and examine
  in succession,
     1. The phenomena resulting from the act of respiration.
     2. Those depending on the voice.
     3. The product of expectoration.
     4. The symptoms furnished by percussion of the chest.
     5. Those relating to the heart, and its appendages.
     6. The totality of the general or more remote symptoms, which
  are the effects directly or indirectly of the disease under review.
    Auscultation—direct or  immediate, by the application of the
  ear to the thorax; and mediate by means of the stethoscope.
    Method of examining the Abdomen in the diseases of its con-
  tained viscera.—Difference in the form and volume of the abdo-
  men, according to age, sex, and temperament.   In its natural state
  it is not painfully sensible to pressure ; it is yielding  and  supple;
  its temperature is moderate,  and in  relation with  the rest of the
  body—by percussion  it yields a  dull sound—Position of  the pa-
  tient for an examination of the abdomen, and manner of ascertain-
  ing its temperature and sensibility; and whether or no fluid is ef-
  fused in its cavity.
    Examination of the  several viscera of the abdomen—Digestive
  apparatus—appearances of the mouth and tongue—state of  deglu-
 tition—of the appetite—hunger—thirst—whether there be hiccup,
 or nausea, or  eructation—4he odour of the breath—constipation,
 or tenesmus, or diarrhoea—haemorrhoids. The attention is  then to
 be directed to the different apparatuses in sympathetic  union with
 the digestive organs—hence  we are to notice headache—pains of
 the limbs,  or cramps—the appearance of the countenance—colour
 and temperature of the skin, and whether marasmus be present.
   Examination of the Renal  Organs—pain of the loins on one
 or both sides—in the hypogastrium—perineum,—or rectum—ob-
 servation of the colour, density, and depositions of the secreted fluid.
   Of the means of determining the nature and extent of the mala-
 des of the  uterine system, by the touch or by the speculum.
   Of Percussion of the Abdomen.
Examination of the Cutaneous Cellular and Mucous Systems
—to determine the extent and location of the disease of the skin—
the colour of the part—the effect of pressure on  it—the degree of
tumefaction and of pain. 
V 
 
17
  Disease of the mucous tissue often evinced by pain and irritation
at the extremity of the duct or canal which it  lines;  and by the
dryness and  redness of its visible portion—Its secretions—thicken-
ings—ulcerations.
Examination of the Muscular, Fibrous, Synovial,  Vascular,
                    and Nervous Systems.
Semeiotics: or that which treats of the signs of Diseases.
   Of Diagnosis—A disease being before us to determine the part
 or  organ affected,  and in what manner it is affected—Diagnostic
signs of the diseases of the brain, chest, digestive and renal appara-
tuses, and of the different tissues.
   Of Prognosis: or the augury formed of the probable termination
 of  a disease.

    Pathological Anatomy or Autopsic Examinations.
   Method of examination to be pursued in  opening  bodies after
 death.   Rigid comparison between the natural or healthy, and the
 abnormal or morbid appearances of the several tissues—especially
 the serous and mucous—Grounds of fallacy in such cases—Standard
 by which to be regulated.

               MEDICAL JURISPRUDENCE.
    External Violence—committed  with intent to maim or kill—
  Ecchymoses—Extravasations.—Distinguish  marks  of homicide
  from  those of suicide.
    Of   Infanticide.—Great   difficulty of  the subject—caution
  against inferring from appearances guilt on the part of the mother
  —when the infant is found to determine its age—whether it died
  before, during, or after birth—how long it  has been dead—whether
  the death is to be attributed to violence, and if so, of what kind—
  Signs of a child having been  capable of  living—drawn from  its
  size—the proportion among its parts—the texture and condition of
  the internal organs—allowances to be made, in forming an opinion,
  for the accidents which may take place during the process necessary
  for the birth of the child—Signs obtained  from the skin, the umbi-
  lical cord, the internal organs, and especially of the lungs—concus-
  sion and compression of the heads of infants—fractures of the cra-
  nium—Strangulation.
    On  Poisonings.—Of the  classification of poisons  founded on
  their effects;  sketch of the symptoms.  Caution against suspecting
  death from poison on account of there being found erosions and
                                3 
18
 perforations of the stomach and intestines.  These alterations may
 result from other causes, sometimes unknown, at other times the
 same as of febrile and inflammatory disorders.   Necessity in  such
 cases of obtaining a knowledge of all the circumstances which pre-
 ceded  or accompanied death; of examiniug the perforations and
 morbid alterations of the stomach as well as of other parts of the
 body.   Stress more especially to be laid on  the nature of the in-
 gested matters; this to be ascertained  by their sensible properties
 and the changes produced by chemical re-agents.  Example  of a
 medico-legal investigation, instituted on the  suspicion of death be-
 i ng caused by arsenic mixed with the food.

        Of Medical Police, and Public Hygeine.
  Causes affecting the health of cities—air, water, situation, loca-
tion of houses,  manufactories.   Sanitary laws. 
 
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