Essentials of the principles and practice of medicine

Front matter

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Preface

This manual is an unambitious effort to make useful the experience of twenty years of private and hospital medical practice, with its attendant study and reflection. Whatever defects the book may have, the author does not concede that it is necessarily a fault that it is small. That science whose facts and laws may be stated in the fewest words, is the most advanced. Even in the complex and still very incomplete science of Medicine, something like the same idea may, at least, justify the briefest statement, compatible with clearness, of its most important and best established doctrines and precepts. While brevity has been aimed at upon all subjects, the most extended consideration has been given to those which especially require the attention of the student, from their difficulty, comparative novelty, or intrinsic importance. In the practical part, however, mere novelty has not been made a ground of selection of the means recommended for the treatment of disease. Bather than to enumerate a long list of remedies which have been proposed or

1*

VI PREFACE.

employed in each case, the author has preferred to give, chiefly upon the basis of his own experience, those which he believes to be the best. A didactic, almost dogmatic method of expression has thus resulted, from the effort to condense within the smallest possible limits the essentials of Practical Medicine.

H. H.

Philadelphia, July, 1867.

Contents

INTRODUCTION ; Systems of Medicine ,

PAGE . 13

PAET I.

PRINCIPLES OF MEDICINE.

Section I. General Pathology

PAGE page

VIorbid States of the System, 25

Morbid States of Organs,

Hypertrophy,

Toxaemia,

Atrophy,

Anaemia,

Irritation,

Plethora,

Degeneration,

SECTI

ON II.

SEMEK

)LOGY.

. Symptomatology,

Mensuration,

Digestive System,

Palpation, Succussion,

Circulation,

Spirometry,

Respiration,

Percussion,

Skin,

Secretions,

Exploration of the Heart,

Motor Apparatus,

Exploration of the Abdomen, 77

Sensory Apparatus,

Laryngoscopy,

Psychical Functions,

Rhinoscopy,

General Vital Condition, 65

Temperature in Disease,

. Physical Diagnosis,

Inspection of the Dead Body,

Inspection,

Medico-Legal Examinations,

Vlll

CONTENTS.

Section III. General Therapeutics

PAGE

PAGE

Classification of Remedies, 83

Medical Electricity,

Balancive Measures, 83

Hot Air Bath,

Antiphlogistic Treatment, 85

Inhalation and

Atomiza-

Febrifuge Treatment, 93 tion,

Supporting Treatment, 94

Hypodermic Medication,

Antidotive Treatment, 100

General Conclusions and

Alterative Treatment, 105

Maxims,

SECTION IY.

NOSOLOGY.

Classification of Diseases, 118

Phlegmasia, 118

Zymoses, 118

AtaxisB,

PAE r ii.

SPECIAL PATHOLOGY AND PRACTICE.

ECTIONS OF THE RESPIRATORY

Intercostal Neuralgia,

System,

Thoracic Myalgia,

Pneumonia,

Affections of the Heart and

Abscess of the Lung,

Aorta,

Gangrene of the Lung,

Emphysema of the Lung,

Endocarditis,

Collapse of the Lung,

Valvular Disease,

Bronchitis,

Dilatation of the Heart,

Hypertrophy of the Heart,

Bronchial Dilatation,

Fatty Degeneration of the

Laryngitis,

Heart,

Aphonia,

Sudden Death in Heart-

Aphasia,

Disease,

Laryngismus Stridulus,

Angina Pectoris,

Croup,

Thyro-cardiac Disorder,

Pleurodynia,

Palpitation,

CONTENTS.

IX

PAGE

Cardiac Exhaustion, 154

Aneurism of Thoracic

Aorta, 155

Aneurism of Abdominal Aorta, 156

Affections of the Alimentary

System, 156

Tonsillitis, 159

Pharyngitis, 160

Retro-pharyngeal Abscess, 160 Stricture of the (Esophagus, 161 Gastritis, 161 Anti-emetic Remedies, 162 Ulcer of the Stomach, 163 Cancer of the Stomach, 164 Cancer of the Bowels, I 64 Dyspepsia, 164 Constipation, 167 Enteritis, 168 Typhlitis ; Peri-typhlitis, 169 Peritonitis, 169 Colic, 171 Obstruction of the Bowels, 175 Common Remedies in

Cholera Morbus, 176

Diarrhoea, 177

Cholera Infantum, 179

Haemorrhoids, 182

Fissure of the Anus, 185

Prolapsus Ani, 186

Affections of the Livee, 186

Acute Congestion, 186

Chronic Congestion, 186

Abscess of the Liver, 187

Jaundice, 188

Acute Yellow Atrophy, 190 Pigment Liver, 191

Cirrhosis, - 191

PAGE

Fatty Liver, 192 Waxy Liver, 193 Syphilitic Liver, 193 Cancer of the Liver, 194 Hydatids of the Liver, 194 Tubercle of the Liver, 195 % Dilatation of the Gall- Bladder, 195 Affections of the Spleen, 195 Affections of the Kidneys and

Bladder, 196

ftenal Congestion, 196

Uraemia, 196

Nephritis, 197

Bright's Disease, 197

Lithiasis, 200

Diabetes Insipidus, 201

Diabetes Mellitus, 202

Hydronephrosis, 204

Pyonephrosis, 204

Cancer of the Kidney, 205

Tubercle of the Kidney, 205

Hydatids of the Kidney, 206

Cystitis, 207

Retention of Urine, 208

Enuresis, 208 Affections of the Brain and

Nervous System, 209 Inflammation of the Brain, 209

Hydrocephalus, 212

Ramollissement, 213

Spinal Meningitis, 213

Softening of the Cord, 214

Spinal Irritation, 215

Ophthalmia, 215

Otitis, 218

Heat-stroke, 219

Insomnia, 220

Night-terrors, 221

Epilepsy, 230

Catalepsy, 232

X CONTENTS.

PAGE

PAGE

Convulsions,

Prophylaxis of Malarial

Chorea,

Typho-Malarial Fever,

Yellow Fever,

Hysteria,

Relapsing Fever,

Neuralgia,

Cerebro-Spinal Fever,

Delirium Tremens,

Methomania,

Insanity,

Erysipelas, ^

Hemorrhage from the

Puerperal Fever,

Mouth,

Haemoptysis,

Pulmonary Apoplexy,

Gout,

Haemateinesis,

Scurvy,

Hematuria,

Scorbutic Dysentery,

Hemorrhage from the

Syphilis,

Bowels,

Syphilization,

Vicarious Hemorrhage,

Gonorrhoea,

Uterine Hemorrhage,

Cachectic Diseases,

Dropsical Affections,

Scrofula,

Acute General Dropsy,

Spinal Caries,

Ascites,

Coxalgia,

Ovarian Dropsy,

Anaemia,

Chlorosis,

Variola,

Beri-beri,

Varioloid,

Leucocythaemia,

Vaccination,

Pyaemia ; Septicaemia,

Varicella,

Embolism ; Phlebitis,

Angeioleucitis,

Measles,

Whitlow,

Hybrid of Scarlatina and

Onychia and Onyxis,

Measles,

Carbuncle,

Mumps,

Addison's Disease,

Hooping- Cough,

Goitre,

Diseases of the Skin,

Glanders,

Exanthemata,

Influenza,

Papulae,

Dengue,

Vesiculae,

Malarial Fever,

Bullae,

Intermittent,

Pustulae,

Remittent,

Squamae,

Pernicious Fever,

Maculae,

CONTENTS.

xi

PAGE

PAGE

Hypertrophic,

Menorrhagia,

Tubercula,

Leucorrhoea,

Haemorrhagiae,

Spermatorrhoea,

Entozoa ; "Worms,

Parasitic se,

Epizoa,

Syphiiida,

Poisons ; bites of serpents

, 365

Poison- Vine Eruption,

Asphyxia,

Chilblains,

Foruul^:,

Burns and Scalds,

Medicines referred to,

Miscellaneous Affections,

Miscellaneous,

Amenorrhea,

Aliments,

Dysmenorrhea,

Disinfectants,

Index of Diseases and Formula .

.

General Index

.

PRINCIPLES AND PRACTICE

OP

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.' 7 " 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, 11

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 Vedas and from Pythagoras and Plato, downward, had more confidence in the truth-compelling powers of their own reason ; and even Hippocrates himself often forgot his own maxims, and became dogmatic beyond his knowledge. 2

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 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 had 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 ; TU hwtva, tup hv<xvtu#v iaiiiv iyj^ia'ta. 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 Aretaeus ; 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 Rome. Dismissing the expectant study of the course of diseases inculcated by Hippocrates — which they laughed at, as a " meditation upon death" — and denying his theory of " coction" and " crises," 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 ; * striatum, " they simplify 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 his 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, Caesalpinus. Campanella, and Bar-on 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, the archquack, had made still more extraordinary pretensions — chemistry was now ripening into a great science. In the seventeenth century, its influence upon physiological and pathological theory 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 Chemzater, iatro-chemists, 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, mech a nics likewise found a place in the study of the functions of the body, in health and disease. An Iatro-mechaniccd school may be thus said to have existed, to which the distinguished Senac, physician to Louis XIV., 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 the 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 psychovitalism of Stahl, and the SolidismvLnd neuro-pathology of Hoffmann. Stahl's doctrine was, in brief, that the soul of man governs health and disease. An expectant or do-nothing 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 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 Montpelier, have reflected or refracted, with various modifications, the Brunonian ray.

What have we had since, in fact ? Easori, 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 over-excitement 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 "unity 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 this city, 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.

Now. — let us look back. Who have been the larpo-TCpo^tai, 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. Permit me to hazard their enumeration. Hippocrates, Serapion, Asclepiades, Celsus. Sylvius, Harvey, Borelli, Sydenham, Boerhaave, Stahl, Hoffmann. Haller, Cullen. Avenbrugger, Brown, Jenner, Hunter, Bell. Bicbat, Barthez, Pinel, Rasori, Rush, Hosack, Laennec. Broussais. Louis, Liebig, Virehow.

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 homoeopathism, 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 systematic 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. Quite recently it has been conspicuously illustrated and defended in the lucubrations of Sir John Forbes, following those of Dr. Bigelow, of Boston, upon "Nature and Art in Disease;" to the former of which the soubriquet of "Young Physic" has been applied.

Empiricism is strict adhesion to experience ; the accumulation of

1 We may add, now, the gn.nglio-tlierapy of Dr. John Chapman ; built upon the vivisections of Bernard and Brown-Sequard, and an ephemeral (though now current) physiological speculation, in regard to the circulation.

2* means of treatment simply by observation and experiment, independently of physio-pathological reasoning. The most favorable example of this among the ancients, was Aretaeus ; 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 strictum, was urged to its farthest limit in the meclianicism of Borelli, and in the neuro-pathology of Hoffmann, Cullen, and Henle. It was taught in this city 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, of Giessen, and the other chemical physiologists, Lehmann, Moleschott, &c.

Meclianicism, 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-pathology 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 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 sthehia and asthenia, which I have named under the title of stimulism. 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

SYSTEMS OP MEDICINE. 10

of growth and development itself; since to this a certain degree of heat at least is essential.

Rasori was, moreover, right in saying that excitement is not a unit for the whole body, but may be unequal in its different parts ; and, moreover, that excess of excitement of one or more organs or functions, is at least as frequently present in acute disease as the reverse.

So, too, Broussais made a just amendment of the same scheme, to a certain extent, in noticing the sympathetic and secondary effects of local irritation ; although he, as well as our Chapman, undoubtedly exaggerated the relative importance of irritation of the stomach and intestinal canal.

We need not pause for a moment over the Stahlian theory of the organic soul or autocrateia ; although very lately a view much like it has been again taken, by Laycock and Morell, under the cognomen of the "unconscious soul."

The last phase of revolution in the scientific basis of medical opinion, has been that which, in the language of its most eminent leader, Virchow, of Berlin, we may designate as cellular pathology. Associated in similar, although not quite identical views, have been Prof. Bennett, of Edinburgh, and the late Dr. Addison, of London.

It has been a favorite idea with the physiologists of our period, that in the general law of organic cell-genesis, in the fact that every living being, human, animal, and vegetable, springs from a globoid germ-cell, while most of the separate tissues also have the cell for their first starting form ; that in this we have the great central radical Fact of physio-pathology, out of which (as in physical science out of the Newtonian law of gravitation) all truth in the history of the animal organization, and thus in medicine, must grow. But Dr. Bennett, one of the most earnest students and teachers of the cell doctrine, 1 denies that to it can be awarded such a place or potency ; as it is not a universal law, but has its manifest exceptions. Dr. Beale, also, a leading British authority in histology, insists upon some essential modification in Yirchow's theory.

It does not belong to me to discuss this point here; but. as it bears largely on the theory of medicine, I will merely say, that if there be one fact or idea which more than any other is the gravitative centre of all truth in physiology, pathology, and medicine, it is that of the peculiarity and supremacy in the body of the life-force, and of its intimate relations with the other physical forces ; 2 of its being, in fact, capable of degrees of life temperature, like those of heat temperature, in the body as a whole, and in its various parts and organs ; of its possessing attributes, like the other forces or phases of impetus and molecular movement in nature ; which must be much more patiently and thoroughly studied than they have yet been, before we can be said to understand the human economy, even so well as astronomers now do the solar and sidereal systems.

This brings us towards the conclusion of our inquiry. We have been examining, in this brief manner, several schemes of rationalism.

1 Clinical Medicine, Introductory Lecture.

- See Grove, Carpenter, and others, on the Correlation of Physical and Vital Forces; himan, Foundation for a New Theory and Practice of Medicine; Chambers^ Renewal of Life ; &c.

But, as the use of facts and ideas in the practice of medicine is our stand-point, we must now ask, Is rationalism available for the treatment of disease? Is physiology perfect? How much of it is positive?

"We are compelled to answer — Physiology, and with it necessarily pathology, is one of the least-matured, because one of the most complex of the sciences. What would be said, then, were a man to undertake to repair a watch, when he had never seen its works in motion, and had no proven knowledge of the mode of action of nearly all its machinery? If he should find, on trial, that hanging it up, or laying it down, or shaking it when it stopped, or keeping it warm or cold, promoted its good time-keeping — very well; let him do so. But if, in this state of uncertain knowledge, he should seize and alter, with fingers or forceps, the delicately arranged and complicated wheels and springs, would not the chances be, that he would do more mischief than good ? Nor would reasoning about possible or probable watches, theories in chronometry, avail him much toward the medication of the particular timepiece in his hands. Yet this is our position, as physicians, regarding the present relation of physiology and pathology, to the actual treatment of disease. It seems, therefore, only a slight over-statement of Trousseau's, that "La rationalisme ne conduit en medecine qu'a des sottises." Rationalism in medicine leads only to absurdities.

We might easily confirm Trousseau by other authorities, early and late. Stahl spoke of the materia medica of his time as a "stable full of ofifal." Sydenham complained that practice was " pestered with too many eminent remedies." It is said, that when Sydenham was asked by Sir R. Blackmore, what book to begin his medical studies with, he replied, Don Quixote. Bichat denounced the vague theories of medication prevalent in his day, and declared that but little was really positive in our knowledge of the action of remedies. Pinel had so little confidence in therapeutics, that his only study of disease was for a naturalistic classification: "Given a certain malady — to find its place in the nosological system." Laennec considered physiology and pathology "vain amusements of the mind." Says Lebert, "We cannot yet, unhappily, construct therapeutics on the basis of scientific medicine ; and with the best intentions in the world we can regard the greater part of its precepts but as the result of empiricism."

But, some may exclaim, this is treason ! This would remove the practice of medicine from science altogether, and leave it at the mercy of Paracelsus, and Cagliostro, and the old women ! Not so. We have only to turn back to the grand platform of Bacon, on which all modern science is built, to see that to found the practice of medicine on observation is to make it eminently scientific. What science can do without empirical observation ? Can physics, or astronomy, or chemistry? None of them. How irrational, then, to attempt to reason out. a priori, therapeutics, or to place it upon any other principal basis than clinical observation ! Blind, uninstructed, unsystematic empiricism is a bane to society, and a disgrace to the human intellect. 1