Essentials of the principles and practice of medicine : a handbook for students and practitioners

Front matter

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Preface To The Fourth Edition

In the original preparation of this work ("issued in 1867), having chiefly in consideration the wants of the medical student, but little reference was made, upon practical questions, to late authorities ; the basis for the opinions and conclusions set forth being mainly the experience of the author in private and hospital practice. The acceptance which the book has met with amongst practitioners has led, in succeeding editions, to a partial modification of this plan ; so far as to embody the most important suggestions, as well as results of observation, presented iff recent medical literature. If an appearance of polypharmacy -he thus occasionally produced, the reader must be referred, for the exoneration of the book from such a charge, to the principles set forth in the Introduction, and in the section on General Therapeutics.

Comparing the present aspects "of medical opinion with those prevailing at the time of issue of the last edition, it may be remarked, that the discussion of the pathological relations of Tubercle has not yet quite ended ; the weight of authority which may be now cited against indiscriminate stimulism has increased ; the occasional abstraction of blood in practice finds a somewhat larger number of advocates ; the objection alwaj'S urged in this work to the " current theory " concerning the exclusive propagation of Cholera by fecal contamination of drinking water, has recently acquired strength, from Pettenkofer's opposition to that theory, and from man}- observed facts ; while amongst the topics whose special prominence before the profession at this time makes

(hi)

IV PREFACE TO THE FOURTH EDITION.

needful their consideration, are the use of Cold Baths in Fever, Pneumatic aspiration, Transfusion of blood, and Recto-abdominal exploration. Some pages have been added in Part I. upon the diagnosis, and in Part II. upon the treatment, of Diseases of Women, so far as they come under the notice, and require the attention, of the general practitioner. Illustrations appear for the first time in this edition. They have been carefully chosen, with the view of elucidating to the student a number of subjects of especial interest and importance.

Having endeavored, as far as possible, to bring the work fairly up to the level of the present hour, writh the design that it may differ from " extended text-books" rather in its mode of arrangement and condensation than in the amount or value of the information conveyed, the author is encouraged to hope that it may continue to prove of service, in assisting the arduous labors of advanced students and busy practitioners of medicine.

H. H.

September, 1874.

Contents

INTRODUCTION : Systems of Medicine

PAGE

. 13

PAET I.

PRINCIPLES OF MEDICINE.

Section I. General Pathology

PAGE

Morbid States of the System 26

Fever 26

Toxaemia 27

Ansemia 30

Plethora 30

Morbid States of Organs . 39

Hypertrophy . . . . 39

Atrophy

Irritation

Inflammation . . .

Chronic Inflammation Degeneration . . .

Morbid Growths . .

Neuropathology . .

Modes of Death . . .

PAGE

40 41 42 49 50 51 55 57

Section II. Semeiology

1. Symptomatology.

Digestive System Circulation . .

Respiration . . • Skin ....

Secretions . .

Motor Apparatus Sensory Apparatus Psychical Functions General Yital Condition

2. Physical Diagnosis . . 84

Inspection 85

Mensuration and Palpation 86

Spirometry 87

Percussion 87

Auscultation .... 89 Exploration of the Heart 95 Exploration of the Abdomen 99

VI

CONTENTS.

PAGE

Diagnosis of Diseases of

Women 100

Laryngoscopy .... 102 The Opthalmoscope . . 104 The Sphygmograph . . 106

PAGE

Temperature in Disease . 109 Pneumatic Aspiration . 112 Inspection of the Dead

Body 113

Medico-Legal Examinations 115

Section III. General Therapeutics

Classification of Remedies 116 Balancive Measures .

Antiphlogistic Treatment 119 Febrifuge Treatment .

Supporting Treatment Calmative Treatment Antidotal Treatment.

Alterative Treatment Medical Electricity .

Hydropathy

Hot Air Baths . . . .

Movement-cure . . . .

Inhalation and Atomization

Hypodermic Medication .

Transfusion of Blood . .

General Conclusions and

Maxims

SECTION IY.

NOSOLOGY.

Classification of Diseases 160

Phlegmasia^ 160

Zymoses 160

Cachexias 161

Ataxias 162

PAET II.

SPECIAL PATHOLOGY AND PRACTICE.

Affections of the Respiratory System . . . 163

Pleurisy 168

Abscess of the Lung . . 171 Gangrene of the Lung- . 172

Emphysema of the Lung 172

Collapse of the Lung . . 173

Bronchitis 173

Bronchial Dilatation . . 178

Laryngitis 179

Vll"

PAGE

Aphonia 180

Laryngismus Stridulus . 181

Pleurodynia 186

Intercostal Neuralgia . 186 Thoracic Myalgia ... .187 Phthisis Pulmonalis . . 187 Affections of the Heart

and Aorta . . . .198

Pericarditis 198

Endocarditis . . . .200 Valvular Disease . . . 201 Dilatation of the Heart . 203 Hypertrophy of the

Heart 203

Patty Degeneration of

the Heart 204

Sudden Death in Heart

Disease 206

Angina Pectoris . . . 207 Thyro-cardiac Disorder . 207

Palpitation 208

Cardiac Exhaustion . . 209 Aneurism of Thoracic

Aorta 209

Aneurism of Abdominal

Aorta 210

Affections of the Alimentary System . . .211

Stomatitis 211

Tonsillitis 215

Pharyngitis 215

Retropharyngeal Abscess 216

Stricture of (Esophagus . 216

Gastritis 216

Chronic Gastritis . . . 218 Anti-emetic Eemedies . 218 Ulcer of the Stomach. .219 Cancer of the Stomach . 220

Constipation .... 225

PAGE

Enteritis .226

Common Remedies in

Obstruction of the Bowels ...... . 234

Cholera Morbus . . .236

Diarrhoea 237

Cholera Infantum . . . 239

Dysentery 240

Hemorrhoids .... 243 Fissure of the Anus . . 246 Prolapsus Ani .... 247 Affections of the Liver . 247 Acute Congestion . . . 247 Chronic Congestion . . 2*48

Hepatitis 248

Abscess of the Liver . . 249

Jaundice 250

Acute Yellow Atrophy . 252 Pigment Liver .... 253

Cirrhosis 253

Fatty Liver . . . . .255

Waxy Liver 255

Syphilitic Liver . . .256 Cancer of the Liver .' . 257 Hydatids of the Liver . 257 Tubercle of the Liver . 258 Dilatation of the Gall-bladder 258

Affections of the Spleen . 259 Affections of the Kidneys

and Bladder . . .259 Renal Congestion . . . 259

Uraemia 260

Nephritis 260

Bright's Disease . . . 261

Lithiasis 267

Diabetes Insipidus . . 268 Diabetes Mellitus . . .269 Hydronephrosis . . . 272

Vlll

CONTENTS.

PAGE

Pyonephrosis .... 272 Cancer of the Kidney . 273 Tubercle of the Kidney . 274 Hydatids of the Kidney. 274

Cystitis 275

Retention of Urine . . 276

Enuresis 277

Affections of the Brain

and Nervous System 277 Inflammation of the

Brain 277

Hydrocephalus .... 281 Eamollissement . . . 282 Spinal Meningitis . . . 283 Softening of the Cord . 284 Spinal Irritation . . .284

Ophthalmia 285

Otitis 288

Heatstroke ..... 289

Insomnia 290

Night-terrors . . . .291

Locomotor Ataxy . . 303 Infantile Paralysis . . 304

Catalepsy 308

Chorea 312

Hydrophobia .... 314

Aphasia 322

Methomania 323

Insanity 324

Epistaxis 326

Hemorrhage from the

Mouth 327

Haemoptysis 327

Yicarious Hemorrhage Uterine Hemorrhage .

PAGE

Pulmonary Apoplexy . 328 Haematemesis .... 328

Haematuria 329

Hemorrhage from the

Bowels 329

329 329

Dropsical Affections . . 330 Acute General Dropsy . 330

Ascites 330

Ovarian Dropsy . . . 331

Variola 333

Yarioloid 335

Varicella 338

Measles 343

Rotheln 344

Mumps 344

Hooping-Cough . . . 345

Diphtheria 347

Glanders 352

Influenza 352

Dengue 353

Malarial Fever .... 354

Intermittent . . . 354

Remittent .... 358

Pernicious Fever . 365

Prophylaxis of Malarial

Typho-Malarial Fever

. 367

Yellow Fever . . .

. 369

Relapsing Fever . .

. 373

Cerebro-Spinal Fever

. 375

Typhus Fever . . .

. 379

Typhoid Fever . . .

. 382

. 389

Erysipelas ....

. 389

Puerperal Fever . .

. 391

. 393

CONTENTS.

IX

PAGE

Rheumatism .... 412

Gout 415

Scurvy 418

Scorbutic Dysentery . .419

Syphilis 420

Constitutional Syphilis . 422 Syphilization .... 423

Gonorrhoea 424

Scrofula 425

Rickets 427

Spinal Caries .... 427

Coxalgia 429

Anaemia 429

Chlorosis 430

Beriberi 431

Leucocythaemia . . . 431 Pyaemia; Septicaemia . 432 Thrombosis ; Embolism . 434 Mucous Disease . . . 436 Angeioleucitis .... 436

Whitlow 437

Onychia ; Onyxis . . . 437

Carbuncle 438

Addison's Disease . . . 439 Goitre 440

Diseases of the Skin . . . 441 Exanthemata .... 441

Papulae 442

Yesiculae 443

Bullae 446

Pustulae 446

Squamae 447 page

Maculae 450

Hypertrophiae .... 451

Tubercula 453

Hemorrhagiae .... 456

Parasiticae 458

Syphilida 462

Poison- Yine Eruption . 463

Chilblains 463

Burns and Scalds . . .463

Unclassified Affections . 464 Amenorrhoea .... 464 Dysmenorrhoea .... 465 Menorrhagia .... 466

Leucorrhoea 467

Irritable Uterus . . . 467 Ulcers of the Uterus . . 468 Uterine Tumors . . . 469 Spermatorrhoea . . . 473

Entozoa 475

Cestoid Worms . . . 475 Trematode Worms . . 478 Nematoid or Round

Worms 478

Epizoa 482

Poisons 482

Bites of Serpents . . . 485 Asphyxia 486

Medicines referred to .489 Miscellaneous .... 513 Aliments 520

Disinfectants 523

Index of Diseases and Formula 525

ILLUSTRATIONS.

VIQ. PAGE

1. Yellow Tubercle . . 33

2. Gray Tubercle ... 33

3. Tubercle Corpuscles . 34

4. Miliary Tubercles . . 35

5. Apex of Tuberculous Luug 36

6. Cicatrix of Lung . . 37

7. Hypertrophy of Heart . 40

8. Pus Corpuscles . . 47

9. Bands of Lymph, in Peri-

tonitis .... 48

10. Fatty Infiltration . . 51

11. Cells of Cancer of Tongue 52

12. Colloid Cancer, exterior . 52

13. Colloid, interior . . 52

14. Myeloid Sarcoma . . 53

15. Colloid Cancer ... 54

16. Foreign Bodies in Urine 67

19. Carbonate of Calcium, and

Hippuric Acid . . 70

20. Octahedral Oxalate of Cal-

cium Crystals . . 70

21. Dumb-bell Crystals of Ox-

alate of Calcium .

22. Tyrosin ....

24. Nitrate of Urea

26. Urate of Sodium

27. Urate of Sodium

28. Urate of Ammonium

29. Triple Phosphate .

30. Cystine ....

31. Vaginal Epithelium in

FIG.

33. 34. 35. 36. 37.

41. 42. 43. 44. 45.

50, uG

PAGE

Epithelial Cells from Bladder, Ureter, and Kidney ....

Lithic Acid Calculus Mulberry Calculus .

Area of Hepatic Dulness Anterior Thoracic Regions Posterior Thoracic Regions Diagram showing Physical Signs in Pneumothorax ....

Pericardial Distension .

Medical Anatomy of the Heart ....

Sims's Speculum Sims's Depressor Fergusson's Speculum .

Laryngoscope .

Laryngoscopic Diagram,

Yocal Cords apart .

Lai-yngoscopic Diagram, Vocal Cords approximated ....

Ophthalmoscope Tubercle of the Choroid .

Sphygmograph, applied . 51, 52. Sphygmographic Pulse-tracings Typical Ranges of Temperature in Typhus and Typhoid Fever Pneumatic Aspirator Aveling's Apparatus for

Transfusion .

Red Hepatization of Lung, Magnified .

(xi)

77 79 79 88 90 91

98 101 102 102 103

104 105 105 107

110 113

XI I

ILLUSTRATIONS.

FIG.

57. 58.

59. 60. 61. 62.

66. 67. 68. 69. 70. 71.

73. 74. 75. 76.

Lung Tissue, Hepatized .

Elements in Gray Hepatization ....

Vesicular Emphysema .

Dilated Bronchi

(Edema of Glottis .

False Membrane in Trachea ....

Pericarditis, with Effused Lymph ....

Eibroid Thickening of Mitral Yalve .

Atheroma of Aortic Yalve ....

Fatty Degeneration

Rupture of Heart .

Aneurism of Aorta .

Aneurism of Aorta .

Ulcer of Stomach

Perforating TJlcer of Stomach ....

Sarcinse ....

Gall Stones

Calculi in Gail-Bladder .

Cholesterin Tablets .

Eatty Degeneration of Liver ....

Deposit from Urine in Renal Hyperremia

Renal Cysts

PAGE

165 172 178 179

FIG.

79. 80.

82. 83. 84.

y PAGE

Casts in Bright's Disease 262 Incipient Granular Degeneration of Kidney . 263 Renal Epithelium . . 264 Waxy Casts . . .265 Sugar Fungus . . . 271 Hemorrhage in Right

Hemisphere of Brain . 294 Cerebro-spinal Fever (decubitus) .... 376 Ulceration of Glands of

Peyer . . . .385 Syphilitic Teeth . . 422 Blood in Leucocythremia 432 Thrombosis in Saphenous

Yein . . . .434 Embolus of Pulmonary

Artery .... 435 Bronchocele . . 440

Elephantiasis Arabum . 452 Sarcoptes Hominis . . 459 Microsporon Furfur . 460

Hairs in Tinea Tonsurans 462 Echinococcus Hominis . 475 Taenia Solium . . .476 Trichina in Muscle, Natural Size . . . .480 Trichina Encysted in

Pork . . . .481 Trichina, Magnified . 481

THE

PRINCIPLES AND PRACTICE

OF

MEDICINE.

Introduction

SYSTEMS OF MEDICINE.

Before Lord Bacon, and before, in fact, all others whose writings have come down to us, Da Vinci, the architect, painter, and engineer, proclaimed in the first half of the sixteenth century, that in the study of natural truth we must consult experience, experience rather than reason. " Those," said he, " who in the study of the sciences do not consult nature, but authors, are not the children of nature; they are only her grandchildren." "Nature begins from the reason and ends in experience, but we must take the reverse course, begin from the experiment and try to discover the reason." "Theory is the general, but experiments are the soldiers."

Not that these were the first utterances in all time in favor of the value of observation and experiment in acquiring a knowledge of nature ; but only that now, for the first time, these began to be the governing ideas of science and philosophy. Aristotle was a naturalist, although still more emphatically a dialectician ; Leucippus and Democritus founded a school whose dependence was almost exclusively on the evidence of the senses ; and even Cicero, who paid little attention to natural science, wrote this wise sentence : "Praestat naturae voce doceri, quam ingenio suo sapere." But it is especially interesting to us to recall the fact that most clearly, perhaps, of all the ancients, was this reliance upon nature enunciated, and most practically was it exemplified, by Hippocrates of Cos. He asserted again and again in his works that "nothing should be affirmed concerning the nature of man, until after having acquired a certainty of it by the aid of the senses." And, although this may seem very obvious indeed to us, yet it is a familiar fact that the great intellects of antiquity, from the sages of the Yedas and from Pythagoras and Plato, downward, had more confidence in the truth-compelling powers of their own reason ; and 2 ( 13 )

even Hippocrates himself often forgot his own maxims, and became dogmatic beyond his knowledge.

It is not my purpose here to go into any historical discussion of philosophy ; which would be inappropriate in this place. Nor will I attempt to crowd into a few pages the history of medicine itself. But it appears to me that I cannot better occupy space, in this introduction, than by endeavoring to place before the mind of the reader such a succinct view of the most essential phases and mutations of medical opinion, in times past and present, as will enable us to apprehend all that bears upon the aspects and prospects of the theory and practice of Medicine.

In the midst of the multitude of authors who have written upon medicine, in every age which has possessed a literature, the number of cardinal ideas, of distinctive methods, opinions, or principles, has not been great. Those who may be considered to have been original thinkers or leaders in medical philosophy have been few ; or, if we cannot refuse to a larger number the credit of originality, yet that of actual novelty is not often theirs, as they have merely started anew an idea, a principle, a system, or theory, which had long ago its propounders, its advocates, and its opposers, although it may have been again forgotten.

Yet, few as these essential ideas have been, it will be impossible to do more than mention them, as it were, in catalogue at present.

A work, for example, might be, and more than once has been, written upon the doctrines of Hippocrates, and of the writings classed under his name alone. Suffice it for us to recollect, that the leading idea of this greatest of physicians was reliance upon, and observation and imitation of nature. Yet he theorized upon health and disease, upon the four elements and the four humors, and his system has, therefore, been styled Dogmatic. To him, also, is traced the principle of medication by contraries ; -m svavtia. ifuv ivavtiav iativ irjjuvta.. The greatest value of the Hippocratic writings undoubtedly consists in their numerous and admirable descriptions of the symptoms of disease, and of the relations of symptoms to prognosis. The study of hygienic laws and influences also received from his school much attention.

Contrasted with the Hippocratic reflective or dogmatic method of studying nature, was the more detailed and less systematic plan of the contemporaneous Cnidian school.

Later, with Philinus and Serapion of Alexandria, the distinctly Empirical method was promulgated ; in which observation, and this alone, especially as to the use of remedies, was urged. No reasoning about why or how, but only what, engaged the minds of these industrious men ; whose materials thus accumulated only too fast for their limited powers of classification. Their most elegant writer was Areteeus, who is not always credited to them, but whose descriptions of disease have seldom been equalled, even down to our own day.

It is less easy to characterize, in a few words, the school curiously called Methodist ; which originated with the opinions of Cleophantus of Alexandria, and of "Asclepiades the Bithynian, the friend of Cicero, and was established by Themison, their disciple, at Borne. Dismissing the expectant study of the course of diseases,

SYSTEMS OF MEDICINE. 15

inculcated by Hippocrates — which they laughed at, as a "meditation upon death" — and denying his theory of "coction" and "crisis," they dogmatized in a different way, upon the changes occurring under disease in the condition of the solid structures of the body, and in the movement of its atomic components. Making but two essentially different pathological states, the " laxum" and the "strictum," they simplified the theory of medicine very much. Chiefly, however, was Asclepiades distinguished for the moderation of his practice ; rejecting complex, violent, and perturbatory remedies, and aiming, as he said, to cure "tuto, cito, et jucunde. " A somewhat complicated course of alterative treatment is, however, ascribed to his successors, by Ccelius Aurelianus, under the name of the " metasyncritic circle."

The most judicious, as well as one of the most learned of physicians, was Aulus Cornelius Celsus. He selected, from the opinions and practice of his predecessors and contemporaries, those of the greatest soundness ; so that, not having propounded any exclusive dogma, nor yet being limited by the narrow results of observation alone, he may be justly styled eclectic; or, as that term has been made odious of late by the usurpation of a set of pretenders, episynthetic, or comprehensive might be a preferable title.

Galen, less carefully selective, although undoubtedly an admirable man, excellent practitioner, and learned writer, renewed and added further strength to the hypothetical as well as the practical views of Hippocrates.

From this time, but little of original force appeared in medical literature, until after the period of eight or nine centuries of mediaeval darkness had been broken in upon by the revival of learning and intellectual activity, in the fifteenth and sixteenth centuries.

In this revival, it was natural that much recourse should be, at first, had to the treasures of the ancients. Plato and Aristotle divided the newly-revisited realm of philosophy ; while Galen, as the exponent of Hippocratic doctrine, almost monopolized that of medicine — until Da Vinci, Telesius, Csesalpinus, Campanella, and Bacon established the inductive method of observation and experiment, most obviously necessary for advancement in the physical sciences, of which medicine is one ; one, too, which, as Lord Bacon expressed it, had been previously " more labored than advanced."

Chemistry, which had already received much attention from the Arabians, and which, under the fascination of alchemy, had reached valuable discoveries — which, in fact, in the hands of Albertus Magnus, Roger Bacon, Basil Valentin, Isaac Hollandus, and others, had performed wonders ; and, in the trumpetings of Paracelsus, had made still more extraordinary pretensions — chemistry was now ripening into a great science. In the seventeenth century, its influence upon physiological and pathological theoiy much increased ; and the practice of medicine could not fail to be consequently affected. By Sylvius, of Amsterdam and Leyden, and by Thomas Willis especially, a school of Chemiater, iatrochemists, or chemical physicians, was instituted.

Following the discovery by Harvey of the circulation of the blood, in the investigations of Sanctorius and Borelli, of Pisa, "mechanics likewise found a place in the study of the functions of the body, in health and disease. An Iatro-mechanical school may be thus said to have existed, to which the distinguished Senac, physician to Louis XIY., among others, contributed, in a work of great ability.

Boerhaave, professor at Leyden, endeavored to combine these, the chemical and mechanical modes of studying the body, and its disorders, into an ingenious but complex eclectic system of his own ; which his influence, as a man of genius, and one of the first of modern clinical lecturers, enabled him to extend far and wide. It was rather a dogmatical than an empirical eclecticism.

The latter was admirably exemplified in the writings of Sydenham ; who has been well called the modern Hippocrates. Certainly there was a great resemblance between the methods of the Greek and English fathers of medicine.

At the beginning of the seventeenth century, there grew up, in the University of Halle, two opposing theories : the Animism, or psycho-vitalism of Stahl, and the Solidism and neuro-pathology of Hoffmann. Stahl's doctrine was, in brief, that the soul of man governs health and disease. An expectant or do-ncthing practice naturally followed from such a view. Hoffmann taught a less simple scheme ; but that part of it which seemed to the renowned and learned Cullen, the nosologist of Edinburgh, to be the most worthy of his adoption, was his appreciation of the importance of the nervous system in the production of the phenomena of disease.

But the most brilliant of the meteors that have crossed the horizon of medical science, not disappearing, indeed, any of them, without leaving some solid precipitate of knowledge, was the Sthenic system of John Brown, of Edinburgh ; the pupil, friend, rival, and enemy of Cullen.

All life, according to this bold and able, although too reckless dogmatist, depends upon stimulation ; all disease upon too much or too little excitement, causing direct or indirect debility. Ninetyseven cases of sickness out of a hundred, in his therapeutics, require stimulation for their relief or cure. "Wonderfully simple this ! Haller's doctrine of the irritability of organic tissues was, very possibly, its source ; but so nearly akin was it to the great idea of vitalism, dimly seen by Pythagoras, announced by Hippocrates, but lost for ages until revived and distorted by Yan Helmont and Stahl, and afterwards rendered more positive by J. Hunter and Bichat — so near was it to this imperishable idea, that Brown's theory, thus supported at once by ancient philosophy and modern discovery, had an unprecedented influence upon medicine. All theories, and theorists, during and since his time, unless we except the discreet vitalism of Barthez, of Montpellier, have reflected or refracted, with various modifications, the Brunonian ray.

What have we had since, in fact ? Rasori, in Italy, adopted Brown's physiological basis, but considered that excitability and excitement were multiple, and unequally distributed, in disordered states, in different organs ; and, moreover, that oi-er-excitement

SYSTEMS OP MEDICINE. 1?

was much more frequent, and demanded more attention in practice than Brown had supposed. Hence arose his sedative or " contro-stimulant" method, by large bleeding and tartar emetic ; so famous once, especially in the treatment of inflammatory affections of the chest.

Broussais, in France, proceeding upon the same original basis, saw in local irritation and inflammation, mostly of the alimentary canal, the seat and centre, the fons et origo of the dynamic or excitational error which caused all diseases. His practice varied from both Brown and Rasori ; his whole object being to calm and allay the central irritation by diluents, demulcents, local depletion, and counter-irritation, avoiding all heroic treatment.

In this country, which can hardly be said to have had a system before Rush, that noble and independent mind was also influenced by the Brunonian radiation ; although a still different view of pathology and therapeutics resulted from his reflections and observations. The " unit}'- of disease" was, with him, a favorite idea. Although his strong good sense did not allow this to exclude from his appreciation remedies and modes of treatment not easily reconciled with such a scheme, Rush evidently leaned much toward the opinion that all acute diseases were but different " states of fever ;" for the mitigation of most of which the lancet was the most potent and indispensable remedy. In this he resembled Rasori rather than Brown or Broussais. Even earlier than the universal dissemination of the teachings of the latter, the distinguished successor of Rush, Dr. Nathaniel Chapman, of Philadelphia, claimed and afforded evidence that he had first taught the theory of the local origin of fever, in irritation of the alimentary canal ; but he did not allow it to modify his practice in the same manner as Broussais. A part of the practice of Brown has, under the teachings of the late Dr. Todd, of London, constituted a medical "fashion" of the day, as an almost undiscriminating alcoholic stimulism.

Now, let us look back. Who have been the iaT?p6-7tpoq>rjf(u, the great leaders in medical speculation, the reformers and deformers of medical practice ? The list is not a long one, although its scope of time reaches over two thousand years. Let me hazard their enumeration. Hippocrates, Serapion, Asclepiades, Celsus, Sylvius, Harvey, Borelli, Sydenham, Boerhaave, Stahl, Hoffmann, Hailer, Cullen, Avenbrugger, Brown, Jenner, Hunter, Bell, Bichat, Barthez, Pinel, Rasori, Rush, Hosack, Laennec, Broussais, Louis, Liebig, Yirchow.

And what have been their essential ideas, stripped of all their complexities and environments ? Naturalism, empiricism, eclecticism, humoralism, solidism, chemicism, mechanicism, neuropathology, stimulism, phlogisticism, pyrexism, vitalism, and latest, of the present date, cellular pathology. I leave out of the list the Thomsonian extravaganza of thermalism, and the Hahnemannic homceopathism, as, however serious may have been their detrimental effect upon the welfare of the public at large, they have scarcely influenced the progress or present status of medical science either for good or evil.

By naturalism I mean dependence upon nature, and sj'stematic

2* imitation, in practice, of her spontaneous curative processes. We have already referred to this as the leading Hippocratic idea. It was rejected by the early Methodists, practically repudiated by Cullen, and systematically excluded by Rush. More recently it has been conspicuously illustrated and defended in the lucubrations of Sir John Forbes, following those of Dr. Bigelow, of Boston, upon "Mature and Art in Disease ;" to the former of which the sobriquet of "Young Physic" has been applied.

"Expectancy" is a term now frequently used, to dignify what amounts sometimes to absolute inertness of practice ; upon an idea, latent or declared, that all medicines are impotent, and that active interference with the self-limitations of disease is never justified by science. This is but a reaction, certainly extreme, from the polypharmacy and hypertherapy of the past.

Empiricism is strict adhesion to experience ; the accumulation of means of treatment simply by observation and experiment, independently of physio-pathological reasoning. The most favorable example of this among the ancients, was Aretseus ; of distinguished moderns, Sydenham, Laennec, and Louis.

Eclecticism or episynthetism is, of course, the selection or combination of what is deemed best in several methods, as, in practice, of means or measures, some of which have been obtained by mere observation, and some from physiological reasoning or deduction. Celsus afforded the most beautiful early example of this ; it has been exemplified, although at the same time, somewhat paradoxically, derided, in our own period, by Trousseau, of Paris.

All of the other systems which I have named are phases of ■Rationalism, which is the proper antithesis of Empiricism.

Solidism, first broached perhaps by the ancient school of Asclepiades, with its laxum and striatum, was urged to its farthest limit in the mechanicism of Borelli, and in the neuro-pathology of Hoffmann, Cullen, and Henle. It was taught in Philadelphia for twenty-five years by Professor Chapman.

Humoralism, the older view, which saw in changes of the fluids all that was essential in disease, pervaded the system of Galen, and the Galenists of the fifteenth and sixteenth centuries. The chemicists generally have had a natural leaning towards it. In this country it was represented at one time by Dr. Hosack, of !New York. A very distinguished example of it has lately been known and respected in England, in the lamented Robert Todd, of London.

Chemicism was boldly inaugurated by Sylvius De Lebo, in the seventeenth century, but has received its ripest contributions in the two last decades ; especially from Liebig and the other chemical physiologists, Lehmann, Moleschott, etc.

Mechanicism, as an exclusive system of physiological or pathological reasoning, was never permanently established ; its influence, as affording even a predominant bias, having been always confined to a few thinkers during a brief period.

Neuro-patholoijy has had a more important place ; dividing with a modified humoralism the domain of medical theory, even down to the present hour. We can never dismiss the consideration of the nervous centres and their communicating nerves, from the

SYSTEMS OF MEDICINE. 19

study of the human functions, healthy or morbid. So, that, although it is decidedly an error to say, as some do, that man is all brain, or that the "nervous mass" is the animal, yet the nervous system must be made prominent in all medical inquiries.

Enough has been said already to explain the nature and powerful influence of the Brunonian theory, of excitement, or of sthenia and asthenia, which I have named under the title of stimidism. It was one step toward the application to pathological and medical truth of that dynamic physiology, that study of the forces of the living body, in connection with the constantly acting forces of external nature, which is now, or soon, destined to rule supremely, not as excluding, but as guiding our investigations of the chemical and mechanical changes both of the solids and of the fluids. Life is not merely excitation ; but normal excitation is one of the requisite conditions of the performance of all the functions of the body, not even excepting that of growth and development itself; since to this a certain degree of heat at least is essential.