38

muscles, and the sensibility of the nerves, than with the per.formance of all the secretions. I have not marked the abovepassage as a quotation from " Consolations in Travel ; or.the Last Days of a Philosopher," because I find it on aslip of paper written some years ago, and not so marked. Ihave not now the volume at command; but I believe it is aquotation, and underneath I have written-Sir Humphry isparticularly cautious; he would not have ns to believe thathe thought this subtile matter to be electricity, and nothing,he says, can be more remote from his opinion than to con-jecture the cause of vitality.

The modern doctrine imputes the change of colour to theabsorption of oxygen gas by, and the removal of carbonic acidfrom, the blood. "The blood, whilst circulating through thecapillaries of the lungs, is divided into an innumerable multi-tude of minute streamlets, each so small as- to admit but asingle layer of its corpuscles; and in these, therefore, the sur-face which is placed in contact with the air is so enormouslyextended as to be almost beyond calculation. Hence, then,we can at once understand how a change may be instantane-ously effected in it, which would occupy several hours, whenthe blood is less advantageously exposed to the influence ofoxygen. (Carpenter.) This view would appear much clearer,could we believe that the fresh air at each inspiration reachedthe cells. The quantity of vitiated air remaining in the lungsafter expiration is not less than a hundred cubic inches, andthis must occupy the cells; the change of colour after each in-spiration is instantaneous, which must baffle all attempts atexplanation by the laws of diffusion of gases. No such objec-tion can be raised to the electric doctrine; for the separationof the electricity from the oxygen may take place in thebronchial tubes, the electricity passing readily through themoist air of the cells into the blood, which, from the iron it

contains, is admirably fitted to attract it. The particles of theblood, having become similarly electrified, repel each other,giving rise to a stream which necessarily flows towards theleft auricle. Nor does this doctrine interfere with that of theabsorption of oxygen. It is now known that the oxygen con-sumed exceeds that necessary for the production of carbonicacid, so that a part may be absorbed by the lungs.

I agree with Dr. Moran that the electricity which entersthe blood in the lungs becomes nervous power, but I wouldconfine the operation of that power to effecting the functions Iof animal life. I agree, also, with -Nfr. Lake, that electricityis elicited in the body by chemical decompositions and com-binations ; but not that that so elicited is carried to the brain, and thence dispensed. I take it, that the electricity from de- ’,composition is of the nature of galvanism or magnetism, andpasses to the ganglionic system of nerves, there to effect thefunctions of organic life. ISome years ago, in a communication to THE LANCET, I sup-

posed that the sympathetic system of nerves was composed oftwo divisions, the one furnishing contractility to all the musclesof the body, the other effecting the chemical changes in

growth and repair. Thus the muscle derives its contractilityfrom organic nerves, but the nerve conveying the stimulus tocontraction comes from a different source. Now, let us seehow this nerve enters and traverses the muscle :-" Thetrunk of a nerve and its first branches penetrate between themuscular fasciculi in a tortuous course, the exact direction ofwhich appears indifferent. But the minute filaments on whicheach branch ends are found invariably to traverse the mus-cular fibres at a right angle, and at short distances from eachother, and then either to return to the same nerve, or to joina neighbouring branch. Thus, a nerve terminates in musclesby innumerable delicate loops; or the nervous filaments dis-tributed transversely through muscular substance communi-cate equally at either end with the brain or spinal cord. Thebranches of the portio dura are found to unite by slendertwigs with those of the three divisions of the fifth nerve uponthe face; and in the tongue the union is equally distinct oftwigs of the ninth nerve with twigs of the gustatory. It isremarkable that in many of these familiar instances thejunction that takes place is between sentient nerves andnerves of motion."

In this nerve, which enters and traverses the muscle in adirection perpendicular to that of the fibre, and which com-municates equally at either end with the brain or spinal cord,I see nothing more nor less than a conducting wire inducingcontraction of the muscle, which, in its turn, may be comparedto the magnet of an electro-magnetic machine. By the innu-merable filaments by which the nerve traverses the muscle,the inducing force is multiplied in the same manner as we

multiply the elpctrical intensity by making our conductors intothe form of helices.

In the above quotation from Mayo, it is said to be remark-able, that in many of these familiar instances, the junctionthat takes place is between sentient nerves and nerves ofmotion; but I think it would be remarkable were such notthe case, for by such junction we become conscious of thestate of the muscle.

Portobello, N. B., Dec. 1846.

Reviews

The Moral Aspects of Medical Life; consisting of the Ak:esios ofProfessor K. F. II. MARX. Translated from the German,with biographical and illustrative remarks. By JAMESMACKNEss, M.D. London : John Churchill, 1846. pp. 348.

WE resume, with pleasure, our notice of the interesting workpresented to the English reader by Dr. Mackness, of Hastings.

In considering the epistle to Dr. J AMS GREGORY, theffth ofthe series, we were led to an estimate of the value ofclassical knowledge to the medical profession, and we gave,and would still give, our voice in favour of science as thestrength, and the classics and general literature as the orna-ment, of medical education. In writing thus we are notconscious of underrating the value of classical knowledge ; itmust always be a high indication of culture, and a key to the

nomenclature of the medical sciences. But those who set a

disproportionate, and indeed unjust, value upon these things,produce in the bulk of the profession, not a general taste forsuch studies, but a positive contempt for them. And this isa serious injury. In the College of Physicians classicalattainments are made of greater importance than either inthe law or the church. Candidates for the licence, lookingforward to the fellowship, think more of passing a goodclassical, than a sound medical, examination. Scanty phy-siology and pathology, decked out in respectable Latin,will stand higher than mere professional excellence, marredby a false concord or fault of prosody. Such manifest

injustice produces an unfortunate reaction against politelearning in the body of the profession. The good time,we trust, is coming, when these anomalies will be set right.The tendencies of the medical age are preeminently in

- favour of intrinsic, in preference to extrinsic, ornament.Ours is the -era of poetry of act, rather than of word. Eventhe commencement of our prescriptions no longer stands forthe 1l., the sign of Jupiter, but for the simple word Recipe:this hieroglyphic has passed from an invocation of almightyJove into a plain word of action ; human skill takes the

place of the favour of the immortal gods. We have had ourpoets and classical authors, and we are proud of them, but dis-eases would not now be charmed away even by the lyre ofApollo himself: we no longer sacrifice in the temple of theDea Tussis, like the Romans, or inquire of the oracles ofDelphi and Dodona, like the Greelis; but we bow the ear tothe pleximeter, and we listen to the voice of the science-inspired tube of the illustrious Laennec, and there is nothingvague or mysterious in the answers of the sibyl. We have novestal fires to preserve for the good of the commonweal, butto us is given with faithful care to tend and sustain thatIIygeian flame first kindled by the genius of Jenner, andalready and for ever the aegis of millions. If we might ven-ture on an humble imitation of the peculiar humour ofProfessor Marx, though our foil may tell somewhat

against the argument hid beneath his playful wit,we should insist, that to tIfe medical man, strictly consi-dered as such, glossology is of more importance than phi-lology, and the study of the scapulary regions more usefulthan turning over the leaves of the ponderous scapula: tothe physician, the rhythms of the heart and nerves are har-monic’s as delicate as the music of iambics, and chorea SanctiViti is properly the subject of more interest than the prepa-ration of the festive chorus of antiquity; the study of talipesvalgus and varus is a higher duty than the scansion of poetic

39

feet; and it is a better part to make the lame walk, than Latinand Greek verse run, be it ever so trippingly.The sixth letter is dedicated to ALBERT THAER: it treats of

a momentous subject, the abandonment of the medical profes-sion by its followers, and, by implication, also of medical,treason and apostasy. ,

According to Professor Marx, Albert Thaer changed " thedoctoral hat for the straw hat of the agriculturist," in theprime of life, and at the pinnacle of his professional reputa-tion, because lie failed to realize the ideal excellence he hadset before himself in his youth; retiring, from a conscientiousdistrust of his professional skill and ability, and from a sensi-tiveness so morbid as to be unable to enter the chambers ofthe sick without pain and sensations approaching to faintness.According, however, to Dr. Mackness, and according, also, toKijrte, the biographer of Thaer, there must be added to thesecauses a sense of the uncertainties of medical knowledge; apoint which opens up to our consideration the whole questionof medical scepticism.In this letter the general constancy of medical men to their

profession is contended for. As witness to the truth of this,we believe history might be confidently appealed to; but in- the present age, and especially in our own country, there aremany in the profession who manifest, if not an open unbelief,a too general tendency to medical doubt and heresy. Thereare amongst us many reeds shaken by the wind. We wish,rather than believe, the following to be the truth :-" It is a matter of frequent experience in universities, thatstudents of law or divinity quit their professional studies tochoose the study of medicine, but it very seldom occurs thata medical student is unfaithful to his flag."

" How much must usually precede the breaking the bondsof friendship or marriage? One’s profession is likewise asacrament, if not of the heart, of time and mind. Before onecan bring oneself to such a parting, the peace of the soulmust be endangered, trust broken, and hope irretrievableviolated."

Let us examinein to some of the causes of medical sceptic-ism generally, and as it exists amongst ourselves. The studyof disease and its cure differs essentially, in many particulars,.from that of any other branch of natural knowledge, and thisconsideration merits the first importance in any justification ofOfr assault upon medicine. For the basis of our art, we have thestudy of the living body, anatomy, and physiology; as a super-structure, we have pathology and diagnosis; and lastly, thera-peutics, or the action and administration of remedies. In

each of these departments of our,science, it must be grantedthat great progress has been made. Even in recent times,enough of law, and order, and design, to furnish a new Paley,has been worked out. In the eye is embraced all the scienceof optics; in the ear, of acoustics; in the animal tissues, che-mistry ; and in the living motions, mechanics; in the nervoussystem we have begun to trace the actions of imponderableforces; and respecting the still more hidden phenomena of lifeand development much has been ascertained. Within the rangeof anatomy and physiology everything, as far as we understandit, is harmonious and clear. In pathology and diagnosis,also, which include the chief phenomena and laws of disease,we possess a large fund of accurate knowledge. In the ma-

jority of cases of organic disease, we can predicate, from thesymptoms, the lesions going on within the body; and in agreat proportion of cases, a certain number of phenomenabeing given, we can foretell the changes which are tofollow. There can be no surer signs of definite, positiveknowledge than these. Then, again, in therapeutics, it cannotbe gainsayed that medicine has gathered from the ends of theearth, and from every available science, a great number ofappliances and remedies, the objective influence of which

upon the living economy, and even upon special organs, andin specific diseases, is well understood. We believe, that bythe steady consideration of such truths as these, medicinecannot fail to be in the end justified of her children. Timid men

will come to distrust themselves rather than their art. Surely,even now no physician need fear to look his fellow men in theface, because of the suspicion that his art alone is behind otherarts in advancing the welfare of his species. We need notmultiply examples; but the New World could not have beenpopulated as it is, nor could our own population have increasedto their present numbers, or our fens and marshes have becomefruitful fields, without the discovery of Quinine; nor could ourcommerce have covered the globe, nor our naval superiorityhave extended beyond our own shores, and the home seas, butfor the discovery of Citric acid and its curative powers. Be-fore the advent of the one, much of the muscular power now

given to the loom and the plough was prostrated by theshakings of ague; while before the knowledge of the otherour mariners were forced to pass much of their time baskingupon green islands, seeking for anti-scurvetic fruits and

juices. We suppose this to be quite sufficient for those whopresume to say that our philosophy is at zero, and our practicea system of guessing.But we must candidly admit the shortcomings of our art,

and examine its deficiencies. We fully believe they are notsuch as to justify the sneers of the laity, or to make the faith-ful mind either sceptic or renegade. Take a case of diseaseunder treatment, and look at the elements at work, strivingeach for the mastery; physiological laws labouring to modify thepathological changes, and therapeutic actions striving to in-fluence both, so as to make them subservient to recovery.

Watch, for instance, a case of severe local inflammation of theintestines. Pathology, taking its departure from physiologicalconditions, may destroy the intestine, but in effecting the de-struction, lymph, possessing physiological properties, is thrownout, and this unites the diseased intestine to the abdominal pa-rietes, so that, if pathological action goes on,the intestine bursts,not into the peritonæal cavity, which would be fatal, but ex-ternally, which is not incompatible with life. And what does

therapeutics attempt in such cases ? ? It endeavours to pre-vent the extreme pathological and physiological changes, sothat there shall neither be death, adhesion, nor perforation ofthe intestine; and failing in this, it comes in subsequently ina surgical form, as in that beautiful operation devised byDupuytren for the cure of artificial anus, and the restorationof the natural channel, in which physiology and pathologyare both invoked. In such cases, the different phenomenaare tolerably simple. We can understand the pathological,physiological, and therapeutic changes, and the termination inhealth or death, according as either element obtains the

mastery. However, in more complicated cases, affectingmany organs, or even the whole economy, the principles oflife, and death, and cure, wage a more mysterious struggle;we can see some signs of order and law at intervals; butit is almost as difficult to separate and trace the elements ofthe different actions in their progress, as it would be to tracethe separate forms of a number of serpents coiled and movingtogether. This is enough to shake the courage of any fearfulmind, and can only be removed by reference to the simplercases, the alphabet of our art, where our knowledge and ourpower are indubitable, by remembering that advances areconstantly being made into the darkness that lies before us,and by considering that the cases in which the accomplishedphysician sits hopelessly by, are few in number, even at thepresent. There is no problem in the physical world so com-plex, no path so labyrinthine, as that the physician has tosolve and tread; hence it is scarcely wonderful that someshould shrink from the effort and the responsibility, asdreamers shrink from an ocean of numbers or space.Some authors, who assume to be philosophical, talk and

write a great deal about Nature, and with as much conse-quence as though they had specially been taken aside andadmitted within the veil. With them, physiology is Nature,pathology is Nature, therapeutics is Nature; and they sum upall in the vis medicatrix Naturœ, as the great healer of diseases;

40

human knowledge and human skill being made to play a veryhumble part in the matter. And these writers, calling diseaseNature, tell us of the fixed laws which disease follows, and ofthe respect we should pay these laws, as of divine ordinance,our province being, as they say, never to oppose and thwart,but servilely to step after and wait upon them. And if wedare to do more than this, that cant of an older ignorance islevelled against us,and we are straightway accused of infringingon the prerogatives of the Deity. Formerly it was held to beblasphemy by the ignorant that we disappointed Nature of adisease; now, the learned seem to have taken the same ground.Doubtless it was the intention of Nature, if disease be Nature,that we should all have small-pox; but the time is gone wheneven the vulgar complain of "presumption," because thelaw of Art has thwarted the law of Nature and stayedthe virulence of the malady. The following are the opinionsof one of the most eminent of this school of writers,Dr. AndrewCombe:-

" We must be profoundly impressed, or I may say saturated,with the great principle or truth, that all the operations andactions of the living body, whether healthy or morbid, takeplace according to fixed and discoverable laws, and that Godhas left nothing to chance. With this grand fact before us,it becomes palpably evident that we can do nothing rational,in the way of either prevention or cure, except in so far aswe act in accordance with these laws. Many medical menhave, however, a very different impression from this. Agood physician will always seek to be, and never aim at beingmore than, Bacon’s ’servant and interpreter of Nature.’ Agreater than he created man and ordained the laws of hisbeing, and no surer road can be found than that traced bythe hand of his Creator. Overlooking this truth, and viewingdisease as an entity ungoverned by any definite laws, and notdestined to run through any definite course, many medical Imen talk as familiarly of their curing’ and arresting disease’as if they had an absolute control over the whole animal func- ’’,tions, and could alter their laws of action at pleasure. Tomy nxind, no clearer proof of presumption and philosophic igno-rance can be found than this usurpation of the prerogatives ofDeity; and its results are often very unsatisfactory."*

" In all cases and on all occasions, Nature is truly the agentin the cure of disease ; and that, as she acts in accordance withfixed and invariable laws, the aim of the physician ought alwaysto be to facilitate her efforts, by acting in harmony with, and notin opposition to, those laws. Disease, as already remarked, isa mode of action of a living organism, and not an entity apartfrom it. In accordance with this view, experience showsthat when we favour the return to a normal action by simplynatural means, recovery will ensue, in most cases, withoutthe use of drugs at all. So far from being always necessaryto a cure, drugs are required only where the power of Natureto resume her normal action proves inadequate, or is impededby a removable obstruction. Even then it is still Natureacting in accordance with her own laws that brings about thecure. She may be aided, but she ought never to be thwarted;and medicine will advance towards the certainty of othersciences only in proportion as we become saturated with thisguiding principle.’’As far as there is any precise meaning in this passage, it

inculcates great respect for the natural progress of disease,and great delicacy on the part of the medical man in

interfering with any of its phases; and it assumes, that to

attempt at " curing" or "arresting" disease, as is the goodhabit with many of our brethren, is a crime amounting to"usurpation of the prerogatives of Deity." Incalculablemischief would flow from such pseudo-philosophic twaddle ifit could ever enter the minds of medical men generally.Doubtless there are cases in which a disease runs a certaindefinite course, as in the mild exanthemata, where gentleguidance is all that is proper or required; but to make such ageneralization respecting disease as a whole, is a very " mid-summer madness." Such, however, is the way in which somereputed thinkers have, by the aid of Nature, edged themselvesoff to scepticism in physic.This respect for Nature, as seen in disease, is not new; the

* British and Foreign Medical Review, April, 1846-509, 10.t Loco, cit., p. :1B, 90.

illustrious Sydenham’s first aphorism, in his essay on acutediseases, is to the same effect. He writes-----″ A disease, in myopinion, how prejudicial soever its causes may be to the body,is no more than a vigorous effort of Nature to throw off themorbific matter, and thus recover the patient." We must becautious how we let even such an authority as Sydenham biasus unduly on so vital a point, seeing that the tendency of suchdoctrines is towards a total medical scepticism. The argumentwas natural in the time of Sydenham, when there was, strictlyspeaking, but little physiology, and no pathology; it was oneof the theories upon which he hung valuable facts, as preciousjewels are often strung upon the meanest threads.By the term Nature, the elder medical writers meant a very

comprehensive agent. It was the anima, the archseus, whichpresided over every operation of the living body, from con-ception to death, whether for good or for evil tendencies.And in the form of scepticism which we wish to illustrate,much the same meaning is forced upon this term. We aretold in so many words, that Nature is disease, and diseaseNature, and that she is all-sufficient, or sufficient but withslight aids, to the cure of her diseases. We are minute onthese points, because we believe it will be a serious mischief ifeven one medical practitioner should be led to look on diseaseas a friend rather than as a foe, and as having resources forpurposes of self-rectification far beyond any which medicinecan bring into play.Now, as regards the propriety of allying physiology and

pathology together, under the term Nature, and treating heras a benign power always working with regularity and at-tempting the safety of the individual. We would say of

physiology, that it embraces all the functions and powers oflife, nutrition, and strength. Physiology includes all the

operations of the vis vitse, and the vis formativa, by whichorganic and inorganic matter are drawn, in opposition tophysical laws, into the living organism, and appropriated tothe healthy support of all its organs and functions. Wewould say of pathology, that it includes all the phenomenaoccurring within the living body, as the result of the visnecatrix, a principle of decay within the living body as evi-dent as the vis vit2e, being acted upon by physical andpsychical causes, so as, in the end, to produce the inevitabledestruction of the body either by disease or slow decay.Physiology, then, if what we have said be correct, is synony-mous with life pathology, with death the one is health, theother is disease. Physiology builds up, pathology destroys; ;physiology is busied in elaborating the healthy animal tissues;pathology works, it is true, in a definite way, but it is to

produce morbid elements, such as pus, or tubercle, or mela-noma, which are directly antagonistic to health.

In disease, as we have already said, there are attemptsvisible enough on the part of the economy to preserve itself.But all this sanative action is physiological action. There is,too, in all diseases, an attack on the integrity of the body,and all this destructive action is pathological. So, since that

" mortal taste

Brought death into the world "-

hath it ever been. The unerring tendency of pathology isto the destruction of the living body. It is mischievous,therefore, to class physiology and pathology together,under the term Nature, as one benign influence. Nature,as far as she is curative, as far as she deserves the titleof vis medicatrix Naturœ, is purely physiological, either

acting in the ordinary manner; or physiology, acting, under the new circumstances induced by disease, just as

in experiments we place physiological actions under new con-ditions. From that Nature, then, which may be made synony-mous with Hygeia, we must exclude all pathology; and thoughpathology be as natural and inevitable, under certain circum-

. stances, as health, we must not hesitate to thwart and oppose itto the utmost, and without any fear of coming under the banof interference with the ways of Providence. The true place

41

for the serpent-rod of Esculapius is between life and death,to give support to the one, and opposition to the other, withall the wisdom and strength of which it is the emblem. So

much, then, it seemed necessary to say respecting the misuse ofthe term Nature, as a lure towards professional scepticism.The seventh letter of the series appeals to Dr. LETTSOM : it

treats principally of toleration, of quackery, of the publicrecognition and reward of great medical services, and ofmedical history.Medical toleration comes very appropriately to be considered

after the subjects of medical scepticism and secession. ThatProfessor Marx considers some limit must be given toprofessional latitudinarianism would appear evident by hisimmediately passing from an eulogium on the liberality ofLettsom in matters of religion, to a warm commendation ofhim, because he contended for true medicine against quackery.Yet the author of the " Akesios" would seem to approve thedoctrine of Reimarus, the discoverer of the use of belladonnain dilating the pupil, who maintained that no restrictionsor penalties should exist to deter unqualified or ignorant per-sons from the pursuit of medical practice. The same idea is

pursued in this country by some medical and some non-medicalpersons, and by the whole herd of charlatans; the watchwordsof the motley crew being, " No medical monopoly," " Freetrade in physic," " The medical liberty of the subject," and soforth. If such cries are worth answering, the answer is

easy. There exists no such thing as "medical monopoly,"there being no limit to the number of medical men, andno bar to the introduction of medical knowledge from anypart of the world. Science is cosmopolitan. ’Tn reality,medicine is in pretty nearly the same state as in the days ofchivalry, when a learned degree was equivalent to knighthood,and the diploma of the physician, like the golden spurs of theknight, passed current ubique gentium. It tells forcibly uponthis point, that the very last physician elected to the Fellow-ship of the College of Physicians-Dr. Baly-is a graduate ofBerlin. When foreign degrees are complained of, it is not asforeign but as incompetent degrees. Formerly, as is wellknown, the utmost laxity prevailed, both at home and abroad,respecting diplomas. The medical mind had become so deadand leaden, that what we now consider criminal passed asmatter of course. Even the excellent Denman, father of thepresent Lord Chief Justice, in his graphic memoir of himselfsays, with the utmost simplicity :-

111 then (1764) came to London, and lodged at Mr. Norton’s,a surgeon and apothecary in the Strand, with whom I alsoboarded. I attended dissections and lectures in anatomy, andbegan to think it might be useful if I took my degree as M.D.,and got a diploma from the University of Aberdeen, on therecommendation of Dr. Kelly and Dr. Kirkpatric."As though the M.D. was as easily procurable as a baptismal

name at the font; sponsors and fees being the only essentials.We have now, however, a natural horror of degrees which

may be purchased for mere money, the parchment and thetitle being as much a matter of merchandize as the grossestarticles of trade. The traffic in medical degrees, happilybanished from this country, but still existing in Germany,where degrees may be had for money, and in some of theItalian universities, where a handsome present of food formsthe chief requisites-this traffic is, we say, to the medicalfaculty, what the sale of Indulgences was, in the dark ages, tothe church; quite as vicious and quite as censurable. With

respect to " free trade in physic," it would not be freedom, buttyranny, to force the regular physician, or the surgeon, to evena Poor-law Union to be legally and highly qualified, while theignorant empiric should be allowed to attend the rich, with-out any qualifications save those of impudence and presump-tion. "Medical liberty of the subject," too, strictly analyzed,is merely the horrible assertion, that any man ought to beallowed to call himself surgeon or physician, and poison orassassinate his fellows ad libitum, so he but commit his crimes

nder the pretence of treating their diseases.’ For medicalaen to sanction unqualified practice is little else than frater-Lizing with knavery. We may truly say to the proposition oftciuiarus, that if paralyzing the irides admit light into theyes of the blind, paralyzing the portals of the profession wouldmly admit darkness and confusion of the most deplorable kind.Of quackery, having laboured and intending to labour hard

’or its discouragement, we feel some right to speak. Dr.Lettsom’s example was, indeed, a noble one. Would that we;ould have him amongst us again. When shall we see another

nan, high in practice, giving himself with energy to the de-fence of his profession and his brethren against this Briareanmonster ! t The men of our time, who fill the high places ofmedicine, are sadly degenerate ; yet we have no doubtLettsom looked forward with a belief, that every generationof medical advance would render quackery more impossibleand degrading; instead of which, there has recently been ahopeless yielding to quackery as to an inevitable and incurableevil.Let us examine into the source of this anomaly. Time was

when medical practice consisted entirely of the recognition ofsymptoms, or sets of symptoms, grouped into diseases, and ofthe influence of therapeutic means in relieving or exaggeratingthem,-the whole of such knowledge being of a purely empi-rical character. Hence it was that certain compounds,medicaments, or nostrums, were the idola of the older phy-sicians. After the philosopher’s stone had been given up,men still thought Nature held hidden within her bosom specificremedies for all diseases, and it was considered the duty ofthe physician to search and find them out. Even Sydenhamconfesses to have spent some years in this kind of labour;but with so little success, that he deemed it prudent not tocommunicate the results to the world. The feeling still

blindly lives on with a few medical men even in the presentage, and the system of quack and patent medicines is thehideous fabric in which its relics are now preserved. Thatsome remedies should be made out in this way was as naturalas that the alchemists should, in their mysterious antics,make some real chemical discoveries; hence several nostrumsthus derived usefully remain in our pharmacopoeias; but thatmedical men should now pursue the same paths, and foster inany way such empiricism, is not less extravagant and absurdthan it would be for chemists to return to alchemical spellsand manipulations. WE desireto produce such a revival ofprofessional feeling, that all vestiges of this barbarity may berooted out from amongst us. The Mithridatic formula, contain-ing more materials than we have chemical elements, was notmore absurd than is the prescription of the present day whichcontains a quack medicine, whether it be pulvis Jacobi orpilula Morisoni. Medical men ought neither to testi-monialize quack medicines, nor prescribe them, nor be-come proprietors of such things. Yet all these faults

really exist. Physicians sin after this manner, and they meeta singular reward. Pythagoras taught that the souls of menentered the body of inferior animals after death; and quackery,by a moral Pythagoreanism, so soon as one of our eminentmen dies, seizes his name and- fame, and attaches it to somevile nostrum or other for public advertisement.Medical men ought to know of no such things, and to suffer

no such things, as quack medicines. The profession and thepublic ought to be defended from ignorant and unqualifiedpractitioners, and this defence should be the national feeto the profession, to let all its discoveries be open and forthe good of all. In ordinary cases, men who make improve-ments must be satisfied with this and the fame and professionalreputation thence accruing. It is most preposterous that atherapeutist should acquire any special right or property,when there is no possibility of patenting or reserving mentaltreasures of equal and far greater importance. Only fancyHarvey attempting to make the circulation his own property,

i or Jenner taking vaccination to the patent office,—such things

42

would be absurd; and yet a clamour is continually beingmade about a patent for some extract, solution, or residuum,as though the very rights of property were involved in itspreservation intact. We say that, in ordinary cases, pro-fessional privileges are the legitimate rewards of discovery,and in extraordinary cases, there should be special rewardsfrom the state and public bodies, and these rewards shouldneither be as few nor as niggardly as heretofore.The last point treated of in the letter to Lettsom is, medical

history; and here everything remains to be accomplished. Ahistory, not of books nor of men; of countries, or of schools ofmedicine; but a philosophical history of the ideas which have Ibeen age after age evolved and made definite by the medical mind, would be of incalculable benefit to medicine. We wantthe same philosophic light thrown upon our professional lifeas that which has been thrown in recent -times upon generalhistory, and which has made it scientific instead of didactic,a detail of the functions, instead of the facts, belonging to thehuman race. We want medicine treated as one great whole,from the votive tablets in the early temples of Esculapius tothe latest pages of Science. Then we are convinced that me-dicine would prove to be a fabric of fair if not of perfect pro-portions ; its outline presenting proofs of symmetry, and itsorgans performing appropriate functions; all being animatedby scientific ideas as by a soul; and then we are persuaded itwould appear plain also, that its various imperfect institutions,its fleeting theories, and its temporary systems, were but asexcreta, mean and worthless in themselves, but necessary for’the health of the body medical, and indications of progressivegrowth and nutrition from facts and conceptions becomingmore and more perfect in every succeeding generation.

Medical Societies.

WESTMINSTER MEDICAL SOCIETY.

SATURDAY, DECEMBER 12, 1846.-MR. HANCOCK, PRESIDENT.

CASE OF STRANGULATION OF A PORTION OF THE ILEUM, FROM A CON-GENITAL BAND OF FIBRES PASSING FROM THE APPENDIX CÆCI TO

THE MESENTERY.

MR. MARSHALL stated, that cases of strangulation of the intes-tine were comparatively of rare occurrence, one or two onlybeing related previous to the commencement of the last cen-tury. Cases of intus-susceptio, however, were much morefrequent. This might be inferred from the numerous spe-cimens in most museums of pathological anatomy in this andother countries. Dr. Copland was the first who had treatedthe subject systematically. Mr. Marshall proposed to dividecases of strangulation into two kinds-viz., those arising froma band or bands of lymph thrown out during inflammation ofthe peritonaeum, and remaining quiescent, so to speak, until afold of intestine becomes incarcerated by these bands. Thesecond kind consisted of those arising from adventitious bands,produced by a prolongation of peritonaeum, or mesentery, as inthe following case, which occurred to himself:-Mrs. O—, twenty-four years of age, a woman of good con-

stitution and healthy aspect, in the eighth month of her firstpregnancy, was seized on Saturday morning, March 21st, withsevere pain, extending over the whole of the belly, of an inter-mitting character, becoming aggravated at intervals, varyingfrom a quarter to half an hour. The pain was accompaniedby sickness and vomiting; but there was little or no tender-ness on pressure on the abdomen. Pulse 80; skin moderatelycool; the bowels had been acted upon by a dose of castor oiltaken some hours previously. This woman had had twice orthrice during the time of her pregnancy similar attacks ofpain; but described them to be of a more severe nature nowthan on any former attack. A grain and a half of opium wasadministered, together with a carminative mixture. In theevening the pain had somewhat abated, and the vomitingnearly ceased.22nd.-She had slept very little during the night; the pain

was as severe as yesterday morning, with shorter intervals ofintermission, and the sickness and vomiting returned. Opiateswere continued at intervals, and a saline effervescing mixture,together with aperients, and fomentations to the abdomen.

In the evening, the pulse was upwards of 100; slight distentionof the bowels from flatus, and the breathing became ratherquick. An enema was administered, and followed by a copiousand healthy evacuation. The thirst was now considerable.23rd.-She had passed another restless night, with general

aggravation of the symptoms; the pulse had increased in fre-quency to 120, and full; the breathing became extremelyhurried, the thirst intolerable, and the countenance anxious.Sixteen ounces of blood were abstracted from the arm, whichgreatly relieved the difficulty of breathing. The pulse becamesmall and weak after the bloodletting, but was not diminishedin frequency. A grain of calomel and half a grain of opium werenow ordered to be given every four hours, and the salineeffervescing mixture continued. The glyster was again re-peated, but no faecal evacuation followed.24th.-Ten A. M.: Had vomited a considerable quantity of

a dark-green fluid during the night, but not possessing anyfmcal smell. The pain was somewhat abated, but was stillgeneral, and not local. A state of collapse soon followed, andthe patient died in about four hours after, and about eighty-six hours after the time of her being first attacked.

Post-mortem examination. twenty-four hours after death.-Theabdomen was found much distended by gaseous matter; a con-siderable quantity of fluid escaped on making the first in-cision into the abdomen. The gravid uterus was found occu-pying the lower part of the abdomen, extending upwards tothe umbilicus. The transverse arch of the colon towards theright iliac fossa was considerably distended; a portion of theileum, in an abnormal position and highly inflamed state, wasfound strangulated by means of an adventitious band formedby. the peritonaeum, and extending from the appendix cceciabout its middle to a separate part of the ileum superiorly. Aspace was thus formed, large enough to admit the thumb,through which the strangulated portion of the ileum passed,abouceigiateen inches of which, doubled on itself, were thusenclosed. On examining the degree of tightness with whichthe band pressed upon the ileum, it gave way under the finger,but had been tied again by a thread, and could be examinedin the preparation which was before the Society. On a minuteexamination of the strangulated ileum, the whole of the coatswere found highly congested, and pervaded in their entirelength by a dark colour, indicating a near approach to gan-grene, although no solution of continuity and softening wasobservable in any part of the tissues. Immediately to theright of this ligamentous band, a portion of the peritonæumwas observed, passing from the caecum itself to the ileum,forming a pouch by its curved free border, into which thefinger for about two inches could be insinuated. Mr. Marshallthought it difficult to assign any cause for this displacementof the ileum, but that it probably arose from the gravid uterushaving displaced the small intestines, and that during an effortto expel the faeces the strangulation took place, or that somemechanical violence had been the cause; for it was stated toMr. Marshall, that about a fortnight previous to this lastattack of illness, her husband had thrown a large book at her,which struck her on the abdomen. As to remedial measures,Mr. Marshall said there were none, except such as are offeredby an operation, which the profession seemed now to regardmore favourably than formerly, more especially since thenumerous successful operations for ovarian dropsy; but hethought the cases scarcely parallel, for in the one instance wehave a disease in which a sure diagnosis can be formed, whilstin the other, a very doubtful one is all that can be arrivedat. Dr. Copland, however, was inclined to believe that atolerably accurate diagnosis could be made, in most cases ofintestinal strangulation, by means of percussion, as the soundemitted by the strangulated portion of the bowel would besufficiently indicated by dulness; and that the diagnosis wouldbe strengthened, if there were pain, accompanied by tendernesson pressure. Mr. Curling, in his case read at the Medico-Chirur-gical Societv last week, was inclined to cut down on the stric-ture ; as was likewise Mr. C. IIawkins. Mr. Marshall consideredmercury, in its crude state, in cases of intus-susceptio, a veryquestionable remedy; but in cases of strangulation wholly in-applicable : that lie once witnessed the exhibition of it to apatient labouring under intus-susceptio, and that the greaterpart of it was immediately vomited up again, with excruciat-ing agony to the patient.

Dr. SNOW considere it a congenital malformation, as therewere no signs of old inflammation, and but a very little recentlymph. The appendix was adherent by a mesentery of itsown, leaving an aperture through which the thumb could pass.The strangulation, however, was caused by a separate band.In the " Memoires de 1’Academie do Chirurgie,’’ lie found acase exactly resembling this, where a band three fingers’