—^     """remarks  #  $1.3~~^
RELATIVE TO
DR.  PAINE'S  COMMENTARIES
THE  WRITINGS OF  M, LOUIS,
By H. I. B. J^/J~iA'->-Ly^j
//
'*.t&JYl
          BOSTON:
D. CLAPP, JR. —184 WASHINGTON STREET.
     Office of the Medical and Surgical Journal.
            1840. 
PREFACE.
  The following remarks were  originally published in the Boston Medi-
cal and  Surgical Journal.  I  wrote them under the influence  of  the
keen feelings produced by the unfairness, as I thought, of Dr. Paine, in his
criticisms upon Louis's writings.   A German monarch,  it is said, though
he has established a strict censorship of the press, allows all huge volumes
to circulate with perfect freedom—knowing, as he does, that such will be
read by few.  Perhaps it would have been  as  well to  have allowed  Dr.
Paine's works to remain  unnoticed, except by the few,  who  would,  I
doubt not, soon have discovered their value ; but I felt that an absent friend
had been attacked unjustly, and I could not forbear rising and doing some-
thing towards his defence.  At the same time I do not  wish any  one to
suppose that I offer these few pages as a complete review  of Dr. Paine's
work, even so far as M. Louis is concerned.  The remainder of  his Com-
mentaries I leave to others.                                 H. I. B.
  Boston, Sept.  16, 1840. 
REMARKS.
 Dr. Paine's volumes* are heavy tomes  indeed, so far  as size is con-
 cerned—but in examining them with reference to the special object  we
 have in view, we have been forcibly reminded of the mushroom.   We
 have seen other volumes  equally large  and  containing as much dogma-
 tism, which were intended for the destruction  of heresies—but notwith-
 standing the zeal  and learning of the  opponent, the damnable heresy
 has  risen triumphant.   We  have no  fears  that Dr.  Paine's  volumes
 will have much effect; but though we have no fears for  the foundation
 of Louis's main ideas, viz.,  1st, the accurate observation  ; 2d, recording
 of cases ; 3d, the analysis of them by tables—still we feel unwilling to
 allow  any writer, under the  pretence  of examining  the philosophical
 views of M. Louis, to traduce his character.   If all  that is said  by Dr.
 Paine of the former physician of  La Pitie be true,  M. Louis deserves
 to be treated not merely as one wholly unworthy of confidence in medi-
 cine, but as an individual  of a  base private  character.  We  use harsh
 terms, we allow—but what  worse  accusation can  be brought against
 any person than that he is untrue, that  he is willing, for  merely selfish
 motives, to mislead the medical world ?   The  whole tenor of Dr. Paine's
 criticisms upon Louis's writings leads to such an accusation.
   Dr. Paine never suffers his reader  to  lose sight of the  main object of
 his two  volumes, viz., a  violent attack upon the numerical,  or, as  he
 chooses to call it, the anatomical school.   Consequently, there is scarcely
 a hundred successive pages  in either volume, in which this opposition
 does not manifest itself—and in the second volume, a whole  chapter of
 134 pages is dedicated to  " The writings of Louis ;" and after quoting
 from books of every nature—some of which have as much connection
 with the  subject as  Mother Goose's Melodies  would have with an intro-
duction to a dissertation on the writings of Franklin—he concludes, with a
self-complacent stroking of his beard, thus—" If what we have  now said

 * Medical and Physiological Commentaries.  liy Martyn Taine, M.D, A.M. 2 vols., 8vo. pp. 716—
814=1530, New York : 1810, 
4
of the estimation  in which the fathers of medicine have been held by all
learned successors should, in some measure, counteract the growing pre-
judice against this source of much  of our  best experience and many of
the best principles in  science, we  shall consider  ourselves justified  in
having  made this defence."   Oh that  the venerable  forms of Hippo-
crates, Galen and Celsus could appear and duly thank their  " learned
successor,"  Dr. Paine, who in this  19th century thinks  that his mission
is to defend their memories from the attacks of the " bigoted numerai-
ists "!   How much ought  medicine to be  grateful  that its fathers have
been preserved from oblivion  by such a  cogent writer!
   But let us commence with the special object of our labors—a review of
Dr. Paine's ideas upon the effect of Louis's writings, and of the numeri-
cal (or  anatomical, according to Dr. P.) school.
   The  first sign we  have of  the  terror of our commentator in conse-
quence  of the prevalence of the writings of the " anatomical school," ap-
pears in Vol. 1, when criticizing Marshall Hall's views of venesection, for
the London and French pathologists are both classed  under one head,
although in our opinion entirely distinct characters.   However, we will
not quarrel with his classification of authors.   Dr. Paine quotes the fol-
lowing from Armstrong's Lectures on Fever.   The  quotation will serve
to show the  " generalizing"  powers of the Dr., as well as his dislike
for Louis.   " A  patient, at the point of death from acute inflammation
of the pleura and lungs, was bled to  the extent of 50 ounces, when he
obtained no relief.  If we had stopped here, in  two hours the patient
would have  died.  After abstracting six ounces  more  blood, syncope
came on, from which he recovered  convalescent."    We might complain
of  some dogmatism  here, but listen to Dr.  Paine : " If this patient had
been bled in an erect posture, and from both arms, and had syncope fol-
lowed the loss of 15 or 20 ounces of blood, it is scarcely probable that he
would have been saved.   Here  the importance is fully shown [no gene-
ralizing here, we presume], not only of abstracting a certain quantity of
blood, but of obtaining a full  impression  from the  cerebral influence, in
many  cases of inflammatory  affections,"   &c.  Dr. P.  continues, and
speaks  of Marshall Hall's recommendation  not to bleed to perfect synco-
pe, as being erroneous.  In a  note to all this, he says that he (Dr. Paine)
has known many to die " from  neglect or  the inefficient use of"  the
lancet,  since our author's [Dr. Hall's] and  M. Louis's works have been
extensively circulated  amongst us.   (p. 230.)
   We have  a few remarks to make.   Considering our commentator is so
very wroth, as we shall see hereafter, at Louis's love of generalizing from 
5
one or two cases, we think it very strange that Dr. P. should not merely
draw  an inference from one case in regard to  the effect of bleeding upon
pneumonia, but likewise that the same influence is exerted upon " many
cases  of inflammatory affections."   We really cannot see any proof of
the truth of this  proposition, though Dr. P. of course expects us to take
his assertions, as  he kindly consents to take  Dr. Hale's  assertion for the
truth  of the results of 197 cases.   (Vol. 2,  page  690.)   Again, how
does  he know that Dr. Hall's  views are wrong ?   Has he tried Dr. H.'s
plan and found it wanting ?  If so,  let us know the  number of  his  facts
pro and  con—for we are unwilling to take the assertion of  any man.
   We may make the same remark in reference to his cases in  which
death occurred from want of care in bleeding.  We  want to see some of
his cases,  in order that  we may  compare  them with  some in  which
bleeding was omitted, or " perhaps used inefficiently,"  and  yet the pa-
tients recovered.   We would  not,  however, have any one suppose that
we disapprove   of venesection in  inflammatory diseases.  Far from it.
Our own experience, even if Louis's cases did not  prove it, would con-
vince  us  that this remedy has very great influence in alleviating  the
general symptoms of inflammatory  diseases of the chest.  But  we have
never seen an acute inflammation " strangled " by it.
   Again.   The tongue, that favorite  organ for doctors  to look wise
over, and  therefrom divine the state of the system, becomes  next the
source of trouble, because, forsooth, according to  Dr. Paine, Louis says
that the indications to be drawn from the state of the tongue are  " the
least  important " of any.  (Vol. 1, Fevers, page  238.)   But we beg the
reader to mark well, though this is  but the commencement of misstate-
ments,  Louis never stated this, that we can find,  in  his work on typhus,
or in fact in any of his  works, so  far  as we  can discover.  He states,
and to our mind, proves, that  there is no necessary  connection between
the condition  of the  tongue  and   that  of the  stomach (Vol. 2,  page
55 to 90) ; but  that certain secondary lesions are consequent upon any fe-
brile  excitement, and lesions of the tongue are among them.  Louis never
even said that the  indications  from the tongue  were unimportant, but
merely that from  the tongue  alone we  cannot infer  so  much  as  is
usually supposed, in regard  to the  general  system,  and that it does not
indicate the condition of the stomach.
   The next remark we have  to  notice, is  this:—(Vol.  1, p.  282)
" We shall see that Mons. Louis and  his followers have little or no con-
fidence in the curative effects  of bloodletting  in  pneumonia, and  some
other equally severe inflammations."  Let us see  how the facts stand. 
6
Louis says that from his own investigations  he is led to  believe, " 1st,
That bloodletting has  a happy effect on the progress  of pneumonia;
that it shortens its duration; that this effect, however, is much less than
has been commonly believed, but that patients bled during the first four
days recover, other things  being  equal, four or five days sooner than
those bled at a later period.   2d, That pneumonitis is never arrested at
once by bloodletting, at least not on  the first day of the  disease.   If an
opposite opinion is maintained,  it is because this  disease has  been  con-
founded with  another,  or because  in  some rare cases the general symp-
toms rapidly diminish  after the first bloodletting.   But then the local
symptoms, crepitation, &c, for the most part, continue to be developed
not the  less for this evacuation."*
   We are fully convinced, from  examination of the physical signs, that the
local disease goes on when the general symptoms are very much improved
by venesection.   Now Louis would willingly allow  that by subduing the
fever we do much towards saving  our patient, though the local disease
apparently progresses—in the same  way that erysipelas  progresses after
the first febrile action is subdued.  But we do not see why Louis or his
followers should be considered  as  " having little or no confidence "  in
bloodletting, because they have less faith than some others.
   Moreover, let us look at the  appendix to the American edition of the
pamphlet on bloodletting—and  which our author quotes with  approba-
tion, though it was written  exactly according to the numerical method.
" But this would  not be representing the subject in a light sufficiently
favorable for our  remedy.  *   *  *  Again—so  that  the  advantage
derived  from bloodletting in our practice is greater  than that derived
from the same treatment in the hands  of M. Louis."—(Bloodletting.
Appendix by  Dr. Jackson.)
   Our author progresses in his zeal, and devotes  three pages (Vol. 1,
p. 293) to  the improprieties of the  numerical school.    " M.  Louis, in
his ' numerical'  treatise  on bloodletting, endeavors to  set  aside  the
practical results of all  other eminent men, whose observations probably
were not less  accurate, though  not  reduced to  a  tabular form.   The
latter observers had found themselves more usefully employed  in giving
their whole  time to the study of nature, and in  recording general  facts
and general results, or  in  presenting examples in  detail, which  should
most clearly illustrate the ordinary conditions of disease, and  thus form
the luminous basis of general principles."
   Study of nature ! forsooth.   We  presume, then, that it  was  from
* Bloodletting, Bowditch's Translation, p. 48. 
7
pure folly, for a mere pastime, that  Mons.  Louis, after  having been
many years in actual practice, gave up  his business and entered as clini-
cal  aid  to his  friend Chomel—and at La Charite devoted his days.
Here was no studying  of  nature !   It  is much easier to write commen-
taries and  talk about  the  study of nature, than  it is  to observe accu-
rately.   But really, when  one denies Louis the credit of having recourse
to the strictest study of nature, we must smile at the critic.  He knows
not the  man he is dealing  with.
  Again—"  It is the complaint of the  ' numerical school,'  that general
affirmations cannot be trusted without the tabular view before us."  Dr.
P. is correct  in the first part  of this sentence.  The  adherents  to  the
numerical school say we have had full  enough of such words as  " very
often,"  "frequently,"  "almost  always;"  we  want something more de-
finite.   Give us your numbers.   But  numeralists  will be, by no  means,
satisfied with all tables  or all numbers ; they wish to  see a book which
bears internal  evidence of being supported  by well-investigated facts,
and  facts observed, as  far  as possible,  without bias.   Many times has it
been repeated by the  apologists  of the numerical  method, that tables
from ill-recorded facts  will lead to error.  The numeralists must have an
analysis of facts recorded as they actually occurred, and at the time of
their occurrence, or they  will not be  satisfied.   Dr. P. complains that
thereby the honesty of all previous medical writers is called in question.
Does the chemist trust to his memory when making his different analyses ?
Does not the astronomer  record at the moment of observation, and ana-
lyze afterwards ? Is this discrediting the character of previous observers ?
This is what Louis wishes the physician to do.   No man can remember
all  his  cases.   He recollects merely  those  that are  most  prominent;
hence arise errors in  his  writings  in  the  closet.   But Dr.  P.  in con-
clusion, says, " this method, while it  offers the general results, supposes
that the figures of one man are as full of accuracy as those of another."
We differ from this opinion in  toto (as  may be inferred from  our pre-
vious remarks) ; and we wish not to be exclusive, but we really believe
that some men are from their constitution incapable  of " observing na-
ture " accurately, and the consequence is  that all tables made by such
persons we should  be sceptical about.   Already in France such  persons
have arisen.   Our commentator quotes from them.
   We might criticize more on these  pages, but we will terminate with
only one assertion which  our author makes—" Others who have carried
out M. Louis's ' numerical method,'  have come to  entirely different re-
sults."   Every science is progressing  ; especially is this true in  France, 
8
where there is  more intellectual activity  at the present time than in any
other country.   One law is good until a higher one is discovered ;  when
that higher one is found out, the lesser  of course  is  put aside.   Louis,
in his preface to the work on typhus, says,  " The best book is good only
in relation to the epoch at  which it appears, and  another must be anti-
cipated that will be more  exact and more complete."  This  we pre-
sume every  reasonable person  would admit.   Even  now Louis would
not be satisfied with the want of minuteness of some of his former obser-
vations.  Moreover, the  attention of the scientific  world is always more
or less strongly bent to one object.   Every tyro now has his microscope,
and  hopes to learn  the arcana of the human  frame.   In a  few years
this  will be supplanted by another  method  of  investigating.   If, in the
process of time, facts may be  elicited which  may clash  with  some of
Louis's results, we  ought not to blame him—much  less  the method by
which he arrived at his results.
   We now approach the most important part of our author's volumes—
for it is evident that  Dr. Paine  regards M. Louis as the  most formidable
opponent of medical  truth  of the present era, and therefore a chapter in
the second volume, of more than 100 pages, is  devoted to the " Writings
of Louis."   Four of these pages are occupied with  quotations from many
authors, and such a medley we have never seen or read of before, save,
as Shakspeare has it:—
                    " Eye of newt and toe of frog,
                    Wool of bat and tongue of dog,
                    Adder's fork  and blind worm's sting,
                   Lizard's leg and owlet's wing. "
   Our readers may think that  we  give  them  an  incorrect idea of the
matter ; and  the quotations, it  is true, are most of them extremely good
—but their inapplicability to the main subject is  what we object to.  Plato
and Lord  Byron, Hippocrates  and  Cowper, Baglivi  and Pope, are all
simmering together  with Louis and his contemporaries.
   Our author commences  thus heroically and   self-cornplacently.—" In
approaching the works which  we have selected for the subjects of this
commentary, we have been actuated by  various  motives.  These will
appear, from  time to time, as   we  advance  with our undertaking.  But
we may say now that we have especially  in view an exhibition of the
ascendancy which false philosophy may  obtain, in  the intricate  science
of medicine,  at  the most   intellectual era  of man,  and to  exemplify
the inductive and practical  results  which spring  from morbid anatomy
when assumed as a paramount  guide in pathological inquiries." 
9
   Before we pass a step farther, we  wish to deny entirely the truth of
the assertion, that Louis or the numerical school do  make  pathological
anatomy a paramount guide  in pathological inquiries ; and Dr. P. must
know little of the matter when he accuses Louis of thus using it.  We
must say that we are devoted lovers of the plan originally proposed by
others, but first fully developed by Louis, viz., the Numerical Method.
We hereby give in  our  faith, and  believe  that as alchemy taught much
of chemistry, so medicine gained  much  from the early fathers of medi-
cine ; but as  chemistry  has made rapid strides of late  years from a more
philosophical method of study, so medicine will gain under the  numeri-
cal method.   While we thus declare our entire  faith, we have a right to
protest against the assertion by Dr. Paine, that we depend upon patho-
logical anatomy for our  entire knowledge of diseases.  We  look  upon
pathological anatomy as only one means  of deciding  the question, and
not more  important than symptomatology.   They stand upon  a par;
one explains  and is connected with the other,  and the  man who neglects
either is a one-sided philosopher and will be  wholly incapable  of any
general views.   Louis says*—" I do  not fear to say that  pathological
anatomy has  been neither too much boasted of, as some declare, nor too
much depreciated,  as others say, but  its  uses have often been little un-
derstood.   It is a mode of explanation which no other can  supply.  It
is  no other thing, but it is certainly of  much worth, and because it is one
mode of learning about diseases,  a mode of verification applicable to all
diseases, it seems to me we ought not  to make it a science by itself, any
more  than diagnosis or  prognosis."  In other words, Louis would use it
as one of the means of  arriving at truth, but  not as  the sole or funda-
mental one.
   But we go still further, and declare that there  is  no  one  from whom
we could  have learned  more  real  diffidence in  anatomical alterations than
from M. Louis.  In his lectures  and at the bed-side  of the  patient, he
is  perpetually reminding us  that  there  is something which escapes our
senses, even  with the most minute investigations—and for the truth of
this, we  appeal to any  one  who  has followed this author in his visits, or
has had personal intercourse  with  him.  But  as  our  readers  may wish
for some  more tangible  proof, we quote the  following remark  of his
when speaking of pain,  loss of appetite, febrile symptoms, lassitude, &c,
as precursors of all  local diseases.  "  We should be obliged to refer the
commencement of the disease to  the period at  which these symptoms
 * Proper method of examining a patient.  Bowditch's Translation from Mam. de la Soc. Med. d'Ob-
servation, Paris, 1837.  Dunglison's Med. Intel., p. 160.
2 
10
first  made  their appearance, and to draw  the  conclusion that an affec-
tion  wholly local  in  its appearance may be preceded by general symp-
toms which can neither be explained nor referred entirely to the local
disease, even when they arise at the same moment.,>—(Ibid. p. 154.^)
   It would seem, then, that our commentator raised up  nothing but a
spirit; and we find him fighting as a fundamental point of the numerical
method, a chimera of his own brain.  This two-fold error of supposing
the numerical and " anatomical"  schools identical, and that the former
trusts to pathological  anatomy as the ground work of its  system, runs
through  the  whole  of the  hundred pages of criticisms.   Alas ! that
there should  be so slight a foundation  for the following  pathetic excla-
mation, when speaking of the present reputation of Louis's  method, &ic.
" When after ages shall look back upon this dark spot on the brightest
escutcheon of the world, it must be regarded  without sympathy and as
an act of voluntary humiliation."
   But let us come to details.   Dr. Paine  seems to think  himself called
upon to defend the reputation  of Chomel, and assures  the reader that
Chomel acted a very subordinate part, and should  be in  no respect as-
sociated with our author's performance in  his work on fever, or typhoid
affection.   We presume that there are scarcely two men in Paris more in-
timate, and more mutually respectful, than Louis and Chomel.  They are
very near friends.   But it remains for Dr. Paine to find out that Chomel
ought to be ashamed of his co-laborer; at any rate he endeavors much to
persuade  his  readers  that Louis  was  the acting man and Chomel had
nothing to  do with the matter.   Now, the  facts are these.  Louis, dis-
gusted with the uncertainty prevailing in all branches of medicine, re-
turns from  the foreign country where he was settled, resigns his profes-
sional duties, enters the wards of the hospital which are  under the care
of his friend  Chomel, determined, like a sincere seeker for truth, to re-
cord the facts he  sees there with  perfect indifference as to the results to
which a future investigation would lead  him.  Chomel bids  him enter
and  pursue his studies freely ; but Chomel (notwithstanding Dr. Paine
takes it upon  himself to  declare  to the  contrary) is always the chief
physician.
   In order to prove how much ashamed Chomel  is of his friend, and of
the  work  which  originated in  his own wards, we quote  the following
from his Lecons de Clinique Medicale,  Vol.  1, which treats of typhoid
fever.  "In  speaking of the  history of this disease, upon which the
labors of Messrs.  Prost, Petit, Serres,  Bretonneau, and  especially the
model  work  by Mons. Louis, have thrown  much light," &c.  (p. 2). 
11
In  quoting  Louis's  results, he says, " Those  which Mons. Louis  has
given in his  learned work upon the subject" (p. 76).  Again  he says—
" Also in the ten cases of this kind which were collected and published
by  M. Louis, this able observer,"  he.  (p. 128).   And  finally, as  if it
were written especially  to  refute  Dr.  Paine, we  find  the following—
" If  we judge of them  from more  numerous  cases observed  by  M.
Louis, in our service [or wards] at  La Charite," &c.
   We perhaps have spent more time than was necessary upon this, but
as  our author thought it necessary to  devote two pages to the subject we
were unwilling to pass it by unnoticed.  Moreover, there is  one assertion
which is wholly untrue, and as it bears upon the point, we quote it.  "  It is
also of constant recurrence,  ' I prescribed ' "—meaning thereby to state
definitely that Louis  prescribed.  Now there is no such expression in the
work on typhoid fever—and we challenge Dr. P.  to cite it.  Dr. Paine
thinking (we know not why) this point a very important one to be settled,
returns to it at  the  latter  part  of  his chapter, and  gives  another spe-
cimen of his unfairness.   We quote  from page 800—" Although it is
everywhere  apparent that he [Louis] is  alone  responsible,  we will now
state his direct  affirmation  to this effect.  ' We  abstained from  blood-
letting, &c.' "   Now we have always thought that  common honesty of
heart would tell a man that he  should look at the original text,  and  not
trust to any  translation.   Dr. Paine attempts to prove Louis a  liar  (we
are  aware  of  the  meaning of the  word), by  quoting  a translation;
whereas, if  he had taken the trouble   to  look at the original, he  would
have found  that he  by no means could  prove what  he wished.   "  On
abstint" are the  two words in  the original French.   Now we appeal to
any one who has the  merest smattering of that language, and ask whether
Dr. Paine has  done rightly.   It is, however, quite  in accordance with
the greater part of the whole chapter.
   But enough of this.  These are mere  trifles in  comparison with the
false statements  that follow.
   Having premised  thus much about  Chomel, our  author continues,
and finds an inconsistency between the motto from Emile  and  the  ad-
vertisement  (page 686 Com.).   Louis says (quoting from Jean Jacques
Rousseau),  " I know that truth lies  in facts, and not in the  mind that
judges of them,"  &tc.   "The reader" (thus  remarks Dr. P.)  "will
ultimately feel the whole import  and intended  force of the foregoing
paragraph;  and  whilst our author is everywhere engaged in drawing the
most unqualified generalizations from these  limited  observations,  the
reader is as  constantly drawn into the belief that our author is only con- 
12
cerned about the exhibition of rigorous facts.  And yet be it said that
our author, to carry the  only purpose which could render these  ' 138
observations ' in the least instrumental  to  his  fame  beyond the day of
their promulgation, announces in  his ' advertisement'   what  is  every-
where the final  object of his analytical investigations, ' the hope of  arriv-
ing at conclusive results.'"
   The above is a fair specimen  of Dr. Paine's method  of  quoting from
our  author.  The  following is  the  passage  to  which Dr.  P.  refers.
"Bien  que  mon  ouvrage ne soit  pas un traite de 1'affection, qu'il  ne
doive etre considere que  comme l'expose des faits qu'  j'ai  recueillis sur
cette maladie,* l'espoir d'arriver a des  resultats concluants  m'a conduit
comme on vient de voir a. l'analyse d'un grand  nombre  de faits relatifs a,
des affections d'une autre espece."   (Although my work is  not a treatise
on the  typhoid  affection,  as it ought to be considered  merely an account
of the facts which I have observed  relative to this disease, the hope of
arriving at conclusive results has induced me to analyze a great number
of facts relative to other diseases.)—Pref.  to Typhoid  Fever.
   Now we ask, has Dr. Paine acted  fairly  in quoting, as he has quoted,
a few words from the middle of a sentence  ?   One would suppose, from
the  quotation, as given by this commentator, that Louis meant to say that
he considered  he  had settled the  whole affair  so  far as typhous fever
is concerned—that he had  arrived at  conclusive  results, and  therefore
there  would be  no need of further investigations.   Whereas he  ex-
pressly states  that  he does  not  consider his work  "  a treatise upon the
typhoid disease," but merely an  account  or  summary (expose)  of the
facts which  he  had observed.  But  let us search for  Louis's opinions
upon this point elsewhere.   In his preface to  his volume of  Memoirs,
he says,  " Although the number  of  facts we have collected  is far from
being sufficient to definitely  fix  this  proportion, still they may aid in the
attainment of this object—and if every one followed the same plan,  we
could discover  the truth after a  few  years—and the same  method, con-
tinued for a still greater lapse of time, would enable us to decide," &c.f
 In these two quotations  there is  certainly  sufficient deference paid  to
others, and not any extraordinary  degree of arrogance  on his part.
   It must be always kept in mind that Louis collected  his facts in Paris,

  * We must add Louis's note to this passage, and the following is a literal translation.
  " This is likewise the reason why I did not think  it necessary to examine the opinions of those au-
thors who have devoted themselves most successfully of late to the study of fevers.  I would add that
I could not have done so without increasing the bulk of my  volume;  and moreover the time for this
examination is perhaps not yet come, and it would be done perhaps better by another than by myself.
Nothing less than all these considerations could have prevented me from using this  opportunity of
rendering a just tribute of respect to my brethren, and of repaying with my thanks those who have
shown so much kindness to me in their publications."
  f Memojres, ou Recherches Anatomico-Pathologiques, &c. par P. Ch. A. Louis. Paris : 1826. 
13
and from them deduced his results.  He did not, because  he could not,
observe in England or America.  Hence  all that Louis  or any of his
friends would contend  for, is, that an  analysis of his facts gives the re-
sults for the disease known under the name  of typhus or typhoid fever
in Paris.
   Our commentator  proceeds, and  states  his  astonishment at finding
Louis  generalizing too quickly.  " The first  thing,"  he says,  " that
excites our surprise, is the broad  affirmation that a lesion  of the glands
of Peyer may be taken as the anatomical characteristic of typhoid  fever,
because, he.   *****   Here, in this second generalization, is
one important foundation  of our author's renown.   He  had thus iden-
tified  himself with an  unexplored disease, and presented  it  as an isolated
affection which may always be distinguished from the group with which
it is allied by a comparatively unimportant lesion of structure.   *   *   *
*  #  #   gut jet ug inqUire how  far  our  author has been sustained in
the foregoing  generalization  by the observations  which he has elicited
from others.   We allow that this may seem a work of supererogation to
the most enlightened  of  the profession in Europe, but it is necessary to
the purposes of this essay that the subject should be considered."   How
truly  condescending on the part of our learned commentator to be thus
willing to instruct us  simple  Americans  in what, were we  all as learned
as Dr. Paine, or as "the  most enlightened of the profession in Europe,"
we should doubtless  be  very well versed !   But we  will not quarrel
with the self-complacency of the  doctor, but  proceed to criticize some
of the quotations from the authors whom he cites to prove bis position.
   First,  we  shall speak of  "this  unimportant lesion  of structure."
Among the ablest and worthiest, and the one  upon  whom Dr. P. rests
his greatest hopes, is Chomel.  In the first place Chomel everywhere, in
the volume  before us,*  speaks of Louis as the " savant," and " able
observer," and  of his  work on typhous fever  as " a model."   And
what  are his results ?   Let us listen to Dr.  Paine's description of  them,
and afterwards learn the truth.  He says  (p. 688) that Chomel " has
seen the same alteration of the glands of Peyer as attend typhus, in
scarlatina and other affections (sujets morts d'affections differentes.)"
   We are sorry to see such a lamentable deficiency in the fairness which
we expect in one who quotes.   The reader doubtless will  suppose, from
what  we have extracted  from  Dr. P.'s remarks, that Chomel believes
that the  peculiar lesion  of  the intestinal follicles ascribed by Louis to
the typhoid affection, can  be found  in  many diseases.  Now we deny
* Lecons de Clinique Medicale, par le Prof. Chomel. Paris : 1834. 
14
that Chomel ever said so, or meant to be understood so to say; and we
assert that he declares exactly the  contrary, and that it  is Dr. Paine's
garbled quotation that has led  the reader into error.   That he has made
exactly the same inferences that Louis has,  we do not wish to state.
What two men are there that  will agree wholly, when there is any room
for difference of opinion ?   But the differences in the present case do not
affect the point under consideration.   Chomel  divides  the  anatomical
lesions into those that are constant and those that are  accidental.   In the
first class are reckoned, as is done by  Mons. Louis, the lesion  of the fol-
licles of the small intestine (with this difference, that under this expression
Chomel  includes both Peyer's and  Brunner's glands), and he continues
thus:   " We conclude from these researches, depending upon numerous
observations, agreeing in the most important particulars with those made
by Mons. Louis in Paris, and  Dr. Bright in England, that the alteration
of the intestinal follicles is a condition wholly peculiar (tout a  fait par-
ticulier)  to the  typhoid affection, the different  periods  of which we can
follow as we  can those of  an  abscess  or  a cutaneous exanthem."—
(Lccons, page 222).   Truly  this looks very much as if Chomel thought
the follicular affection, in the typhoid disease, was "a comparatively un-
important lesion of structure."
  But our  author  says, Chomel has seen the same alterations in other
diseases.  We  deny  even this.  On  the  contrary, in  the three diseases
mentioned by him as having something similar, viz., cholera, phthisis and
scarlatina, he makes two very evident distinctions—for instance in cholera :
1st, "There is less  prominence of the follicles than in typhoid.  2d,
The lesion  is the same at every epoch of the  disease—whereas there
is  a  regular change  in them  in  fever."  In reference to  scarlatina,
Chomel  says  that  the disease  of  the follicles  resembles  that   in
cholera,  and  therefore is  not like that  of the typhoid disease.   More-
over,  let any   one  peruse  the cases  collected by Jackson*  while the
cholera  was raging  in Paris, and  he will  find  nothing to  confirm
him  in  the  idea  that in  the  two diseases is the  same anatomical
change.   In cholera  the congregated  glands, or Peyer's patches, were
not diseased in comparison with Brunner's or the isolated follicles.   With
regard to phthisis, Chomel makes  similar statements.  We  have our-
selves had  some opportunities of comparing the   intestinal  lesions  of
phthisis and typhus—and  we  must say that the idea of confounding the
two when we examine the  whole  track of the canal, never could have
been  entertained  by  us.   The anatomical differences are much  more
* Cases of Cholera collected at Paris, &c, by James Jackson, Jr., 1832. 
15
distinct  than  many cutaneous  affections—for  instance,  measles and
scarlatina.
   But in order to lay the whole truth before the reader, we must inform
him  that  Chomel  announces  that  he does not  agree  with  Louis
in regarding this affection of the  patches  as absolutely  necessary  to
the  typhoid affection,  because  he thinks that,  1st, sometimes  it is
absent in cases where the symptoms are those of the typhoid disease ;
and 2d, because sometimes the severity of the symptoms  does not accord
with the  slight lesion  of the follicles.   This  opinion is drawn  not from
his own facts, but from those of others.   But he seems  in  doubt about
any previous step in the disease, and  as he  is ignorant he is willing to
confess it,  and  waits until further facts are collected.  Dr. Paine may
think he has gained his  end, and  that  Chomel  and we both allow that
Louis generalized too quickly—and that in stating  the anatomical cha-
racteristic of the typhoid fever to be a lesion of Peyer's patches, we de-
clare that the symptoms are dependent upon this change of these patches.
Now let  us examine  Louis's  works  and see what he says upon the
subject; and first,  we must say that in stating the foundation of Louis's
assertions, Dr. Paine, as usual,  gives an unfair impression of his labors,
and leads the reader to  believe that  all the  cases of any  disease that
Louis examined in order to  arrive at definite  conclusions in reference to
the characteristic lesion of the typhoid disease, were " 50 cases of acute
disease having certain  other analogies, and 83 other cases where these
analogies are said to have been more or less wanting."  After speaking
of the state of doubt in which  physicians were in reference to fever—
some calling it  a gastro-enteritis, others a  putrid adynamic, ataxic and
typhoid fever,  Louis continues thus :  " In order to make  up  my mind
 upon a question which simple discussion would  not tend to elucidate, I
 examined  and  recorded, between the  years of 1822 and 1827, the his-
 tories of all the patients affected with acute disease, that were  admitted
 to the hospital of La Charite in the apartments under the supervision of
 Mons. Chomel.  During  this period  I obtained, with the exception of
 some imperfectly recorded facts, 138 observations of the typhoid fever,
 50 of which related to  individuals that died.   I  analyzed  both, and in
 order to know, among the numerous lesions  found  in  those who died,
 those that were peculiar to the typhoid  affection,  I compared them with
 the alterations observed in  consequence of other acute diseases, in 83
 subjects, whose cases 1 carefully recorded.   I did  the same  when
 examining the symptoms in  patients affected with the typhoid disease or
 any other acute affection terminating fatally, or by return of health.  So 
16
 that in fact I have analyzed the alteration in the viscera of 133 subjects
 who died,  and the symptoms of nearly 900."
   One would think that these facts were  sufficient to enable one to come
 to some definite (we will not use "conclusive," as it offends our commenta-
 tor so much) results.  " in  my analysis," continues Louis, " I have wholly
 left out  any facts which  were not sufficiently exact—and when I have
 deduced  any consequences, I  have always  kept before  me  this  idea
 by the author of Emile, '  I know that truth resides in things, &c.'':   In
 a note to this paragraph Louis  informs us that he threw aside  as incom-
 plete all  the " observations" made during his first eight months of de-
 votion to these studies.  One would think that the accurate examination
 of about 1000  cases, and the  autopsies  of 1-10 of them, would  have
 enabled  any accurate  observer to decide  whether a lesion was  unimpor-
 tant or not.
   So much for Louis's data and accuracy of  observation of nature.
   We now return to  the subject of the anatomical characteristics of ty-
 phus, typhoid affection,  or continued  fever.  The reader will bear in
 mind  that anatomical  characteristics are  very different  from the causes
 of disease.   The anatomical characteristics are, comparatively  speaking,
 easily discovered by careful examination—and in common, but somewhat
 inaccurate  language, we allow they are called the causes.   For instance,
 Louis says  inflammation of  the lung is the cause of  the  various groups
 of symptoms usually  accompanying and  giving us  information of the
 existence of that disease.   But there is a  step still farther   back, and
 which is  hidden,  for  the most  part, and to  this  step must we go  for
 the real causes.   These are the most  hidden subjects we have to deal
 with.   In the present age, and  with our  actual  knowledge of the phe-
 nomena of  life, it will be long ere  we shall be able to know much upon
 etiology—yet upon nothing do medical authors " tax their imagination
 for their  facts "  more  than upon this same topic.
   The anatomical characteristics of typhus, according to Louis, are of
 two kinds,  primary and secondary (a similar  opinion to  Chomel's).  In
 the first  rank, Louis  places the affection of the congregated follicles
 (Peyer's patches), because  " they were  more or less seriously changed
 in  structure in all  the patients."*  But there are other secondary cha-
 racteristics—" Ulcerations of the pharynx and  oesophagus  having oc-
 curred only in  a small number  of typhoid  patients, and  in  no other
disease, may be considered as among the  anatomical characteristics of
the former, though they  are secondary."!   Now  we cannot see how
           * Louis on Typhoid Fever, Vol. 1, p. Yr2.           t Ibid., p. 383. 
17
Louis could have  drawn  any other  inference.  We beg  the  reader to
remember that Louis's work was written  from cases collected some time
ago, between 1822 and '27, and that he pretends " not to give a perfect
treatise on the disease."*  He examines his own cases collected in Paris,
and in wards devoted to adults.   Doubtless,  he never  intended  to say
that there might be no difference observed between the typhus of Paris
and that of England or America.   He left that  for others and future
observers to decide.   Doubtless, moreover, he would have made a more
perfect work had he studied the disease  in children and old age, and in
other countries.   He  would have had a larger number of facts.   But
supposing he had devoted 6 years to children,  6 to the aged, 6 to England,
&.c.; his life would have terminated, and we should  not  have had  the
" model"  work by M. Louis.  But ought we  to complain of a  man
who makes inferences from the facts he has in his possession ?
   Dr. Paine states (p.  169)  that the follicular  affection is denied to
exist by Louis and his followers in genuine typhus.   We know not to
whom Dr. P. refers under the title of followers; but as it regards Louis,
we deny that he ever made such an assertion, and challenge Dr. P. to
produce any proof to that effect.
   Dr. P. quotes from Lombard and several English and American wri-
ters in regard to the characteristics  of fever.    Even if  it  be certain that
in the course of fever in England and America  there  are other lesions
than those described by Louis,  we  can  derive  no  argument from this
fact against Louis's  results—inasmuch as he  limits these results to the
disease  as  actually existing in  Paris.   The subject, in our opinion, is still
sub judice as it regards these characteristics, when fever is viewed as an
affection liable  to occur in every part of the world ;  but this does not
lessen our confidence in M. Louis;  and though we may differ from him,
we may respect  his  method  of  investigating, believing, as  we  do, that
some higher law will eventually reconcile all  differences.  But  at pre-
sent, we must conclude, both  from Chomel's  and Louis's researches  (82
fatal cases collected during  a  space  of 12 years by two  eminent men),
that the anatomical characteristics of typhus in  Paris are as have been
described.    But  Dr. Paine  has no right to use such  an expression
as  this,  when criticizing Louis's results.  " They  are," says  Dr. P.,
" designed for every  climate, constitution, habits, and other predisposing
and exciting causes."   As  much right  have we to complain of Mons.
Louis for having said that ulceration of the intestines in chronic  diseases
is never found except in combination with tubercles in  the lungs.  Now
                         * Preface to Typhoid Fever.
                  3 
18
we  have seen two cases, at least, and  if we  had resided farther south
should probably have seen  many more, of chronic diarrhoea  from  long
residence in the West Indies;  and in these cases, in which we examined
the lungs with  the  utmost caution, making  the minute subdivisions of
them  with especial reference  to  Louis's remarks, we  found no trace of
tubercle, but the intestines were studded with ulcers.   We explain  the
fact of the  error of Louis  from this circumstance, that the diseases of
warm climates rarely, if ever,  appear in the Paris hospitals.  We never
saw one during our residence in that metropolis.  We do not, however,
consider  Louis as being unworthy of confidence because he has chosen
to say—" It is now more than 8 years since my Researches [on phthisis]
were  published, and  I have  not met, during  that period, with  a single
subject who has died of a chronic disease, and  with ulcers in the small
intestines, in whom there  was not at the same time tubercles in  the
lungs."*
  But the climax  is coming.   We cannot forbear smiling to view  the
overweening self-complacency of our  commentator when  commencing
his  plan of " rapidly glancing at the prolific results of those 50 cases of
typhus."  Observe the bathos!   "  But it is indispensable to the success
of our enterprise, and when we shall  have brought them to the solemn
consideration of the reader,  yet leaving them mainly  to his intelligence,
we  cannot but think  that  they will  be  regarded as a  fearful  beacon to
the present  and coming generations  " !  (Page 694.)   Let us see how
Dr. Paine  has succeeded  in proving that  he  deserves  immortality for
having proved that Louis is an arch traitor  to truth, and that his works
ought to be regarded as a warning to all future generations !
   In  the first paragraph after  this  flourish of  " solemn " trumpets, we
find a radical  error in the  statement  of Louis's  opinions—as follows.
" Our author, for instance, has no conception  of disease which he cannot
trace  out through some lesion  of structure ;  and when he  endeavors to
insinuate the belief that  diarrhoea cannot  exist  ' without appreciable
lesion of the intestinal mucous membrane,' he  fears that his hypothesis
may find some opposition from analogies supplied by the natural condi-
tions  of the body."   (P. 695.)
   Our  readers would  scarcely believe us  if we were merely  to  state
that all this assertion by  Dr.  Paine  is radically false,  and  that in the
above paragraph in  which Dr. P. pretends  to  quote  from Louis's  work
on  phthisis, Louis really says  exactly the reverse of what Dr. P. states
that he does, and that instead  " of having no conception of disease  which
* Examen de l'Examen de Broussais.  Paris : 1834. P. 18. 
19
he cannot trace out through some lesion  of structure," he  declares, in
this identical paragraph, that he  does  believe in disease of function
without appreciable alteration  of structure.   Dr. Paine may hope to
escape  the  imputation of falsehood, by  using the word "insinuate."
But let any candid reader read the sentence which Dr. Paine has written,
and he  would say  that Louis really believed  that diarrhoea could not
occur without lesion of structure, but that he was afraid to say it openly,
and therefore  merely  " insinuated " it.   We  must say that we feel in-
dignant when such accusations are  made  against this author, for they
show either  wilful blindness or total ignorance on the part of the accuser.
But  let us see the original  and translation.
   " Observons que ces sueurs si  copieuses indiquent un derangement
des fonctions de la  peau, aussi remarquable  par son  degre  que  par sa
duree ;  que ce derangement, qu'il  soit  sympathique  ou  du  a une  autre
cause, n'en  est  pas moins reel, et a lieu sans alteration sensible de la
structure de l'organe qui en est le siege ; qu'ainsi qu'une fonction peut
etre  plus ou moins  alteree  pendant long temps, sans que  l'organe qui en
est charge offre de changement appreciable dans  sa texture.   Remar-
quons, encore, qu'a defaut  de  faits qui prouvassent d'une maniere directe
que  le devoiement  peut avoir lieu sans lesion appreciable dela membrane
muqueuse de l'intestine, cela serait a. presumer a raison de l'analogie qui
existe entre des sueurs copieuses et une diarrhoea plus ou  moins  forte.
Nous ne disons pas evident, parceque, dans notre maniere de  voir l'analo-
gie ne peut servir qu'a indiquer de nouvelles rechercbes, a aller a. la ren-
contree des faits, et jamais a.  les suplier—autrement, ce seroit conclure
de la possibility d'une chose a son existence, ce qui est absurde."—(Re-
searches on Phthisis, s. 259.)  " We remark  that these copious  per-
spirations indicate a derangement in the functions of the skin, as remarka-
ble  in  degree as in duration ; that this derangement, whether it be the
result  of sympathy or of any  other cause, is  not the less  real on that
account, and occurs without any appreciable alteration  in the structure
of the organ in which this derangement occurs.  And  thus we find that
a  function may be more or less seriously altered  for  a long while, and
at the same time the  organ, which is the origin  of the function, may
present no  appreciable change  of structure.   We  would likewise ob-
serve, that in  the absence  of facts  which directly prove  that diarrhoea
may occur without any appreciable lesion  in the  mucous membrane of
the intestine, we might presume that to be true in consequence of the
analogy which exists between copious perspiration and severe diarrhoea.
We  do not say that this is proved (evident, Fr.),  because we think that 
20
analogy serves only to point the  way to new researches;  it teaches to
seek, in a certain direction, for new facts, but it never supplies  the want
of them;  for if it were otherwise, we  should deduce the absolute exist-
ence of a thing from the simple possibility of such existence, which is an
absurdity."
  The inference we draw from the above perversion of Louis's words,
is one of these :  1st, Dr. P. has wilfully falsified a remark of an  au-
thor whom he wishes to hold up to scorn ; or, 2d, Dr. P. reads so care-
lessly that he did not observe his mistake.   Upon whichever horn of the
dilemma the Dr. may place himself, the  inferences  are not very plea-
sant for a man  who writes such  full  commentaries upon the  medical
theories of the day.  But  our commentator may not choose  to think
himself placed as we think he is.   Be it so, and let us hear him  in his fu-
ture remarks.   After a long defence of analogy as a source of evidence,
he concludes thus  triumphantly !   " Thus  in the example  which  our
author fears may encroach upon the dominion of morbid anatomy, who
is there that will not concede that 'profuse perspiration' arising from
disease without ' any appreciable  lesion ' of the  skin, is  not a substan-
tial ground for induction that  ' diarrhoea'—aye, and  many other morbid
results—may take  place independently of  any  ' appreciable lesion' of
structure?   And to show  you [mark  well  the Dr.'s earnestness] how
analogy may grow  into a  matter of fact, and in  this  very instance, we
will point you to serous effusions in the brain, thorax, abdomen, where
the secreting membranes often exhibit their perfectly  normal  state."—
(P. 695.)   Heaven defend medical art from the  " facts "  which grow
up in this way.  A man has  sweated, and  no  change of structure  of
skin is  observed—therefore, says Dr. P., we  are certain  that  a  man
may have hydrothorax, dropsy of the brain, hydrocele, &tc. &c, without
evident change of structure  in  the organs  implicated.   We  must say
that we should prefer to  examine the chest and  head and see whether
these things are so, rather than to infer  that these diseases exist merely
from what passes upon the skin.  It is  a long  while since we studied
logic under the venerable Dr. H.  Would that we could appeal  to that
learned man.   Even he, with all his logical acumen, would be shocked
at such unwonted use of  analogical reasoning.
   We hasten to another instance of our commentator's unfairness.   On
page 696, he says—" Our author has  no difficulty with analogy where
a lesion of structure may embellish the philosophy  of disease.  Thus :
• Analogy,'  he says, ' is  in  favor of what we  advance.   For, when
haemorrhage occurs in any internal organ, it is almost constantly a symp- 
21
torn of more  or less  considerable alteration of structure.'   From this
assumption, he reasons analogically that ' haemoptysis (with certain ex-
ceptions), whenever it occurs, renders  tubercles in  the  lungs infinitely
probable.'"
  So much  for Dr.  Paine's assertions.  Let us see how the matter
really  stands.   Louis  commences  the  paragraph  upon haemoptysis
(Phthisis, s. 231)  by stating that 57  out  of 87 patients  had  it.  He
then states, 25 had it copiously.  Again he asks (s. 233),  " Are we,
however, to  consider the haemoptysis, especially when  copious, which
precedes cough and expectoration, as a precursor of tubercles, or simply
as a symptom  which  reveals their presence?"   He  then states, that for
nearly three  years  he had constantly asked all  his patients in reference
to this symptom, and  he  found, that except  in the phthisical  patients,
and  those who had received injuries of the  chest, or in whom the cata-
menia  were disordered, none had haemoptysis.  And he continues  thus:
" We  think,  therefore,  that  haemoptysis,  except in the  cases  above
mentioned, at whatever period  it may occur,  makes it infinitely  probable
that tubercles exist in the  lungs.   We do  not say that this is certain,
because  there  have been  many well-attested  facts  which are fortunate
exceptions."   Moreover (he continues, in the next paragraph), " analogy
favors  this proposition.   For when  a  haemorrhage," &c.  And he ter-
minates  the  paragraph thus : " But  let us cease with these few remarks
[that is,  reasonings from analogy] which are intended much less to supply
facts, than to excite to investigation."
   Really, if Dr. P. did  not put  forth such  pretensions to learning and
candor, we might  apply  to him much  harsher epithets than those we
have already used.  Does not that  man deserve  severe  rebuke,  when
under  pretence of stating an argument  in reference to a subject, he dares
entirely  to reverse the order, and uses a remark made by the author for
the  purpose of exciting others to  investigate, as if it were  the chief
corner stone  of the author's  argument ?   We  heartily detest such
trickery.
   Our commentator seems  to be unwilling that M. Louis should  dare
use the word experience, unless he has numbers to prove it—so bigoted
does he  seem to suppose our author is  in regard to the numerical method.
For instance—on p. 699, we find, " Here is another example of  adhe-
rence to 'rigorous facts,' and  of the uses which our author makes of analogy,
where questions of the most vital and general nature are concerned. Thus :
' Experience shows us, that in spite  of these striking  and indisputable
differences between persons most resembling one  another, 999  out of 
22
 1000 who differ in age, sex, temperament, &tc, live on  the same food,
 prepared  in the  same manner.'—(Bloodletting, p. 58.)"
   On  page 700, the commentator quotes several passages.  In reference
 to one, he says that Louis  regards structural disease as the essential pa-
 thology of disease.   We have  already denied  this assertion; but we
 quote the  following:  " If the senses do  not  appreciate everything,  if
 there is anything else in the typhoid affection than what the eyesight can
 discover,  such is also  the case in  almost all internal diseases, which in
 this respect "  (in having something more than structural lesion)  " are
 scarcely less mysterious than fevers."—(Page 394, Typhoid,  Vol. 2.)
 Our commentator returns to the charge  afterwards (Vol. 2, p. 762), and
 quotes various passages from  Louis's works, tending to prove (as Dr. P.
 thinks) that Louis regarded the  lesion  of Peyer's patches as the cause
 of the symptoms in typhus.   Now the sum and substance  of the  whole of
the quotations may be illustrated thus.  A case of very severe pneumonia
 occurs, accompanied  with  delirium.  Death ensues—chiefly, as  Louis
 thinks, in consequence  of  the mania.  Yet  upon examination, we find
 both lungs extensively hepatized, but no appreciable change in the brain.
 Louis says, that in the present state  of our  knowledge  we must  refer
 the mania to the disease of the lungs, and  not  to  any material change
 in the  brain.  Now it really seems  to  us that Louis is correct, though
 we see no sufficient reason  for his urging the  point so much.  We have
 no doubt  that no delirium would  have existed had not the man  been
 affected  with  pneumonia.   Just so does Louis regard the delirium in
 typhoid fever ; believing, as  he  does, that the lesion of  the alimentary
 canal is as characteristic  of  the typhoid  disease, as hepatization  is of
 pneumonitis.  In one  sense, pneumonia was the cause  of delirium—yet
 how different our ideas of causation when it  is regarded in  this  lio-ht,
 from those previous  causes which  give  origin to the whole phenomena
 of disease ; and upon these, hear what Louis says.  " The deepest ob-
 scurity hangs over the causes of the affection  under consideration."—
 (Vol. 2, p. 393.)
   Below  we have another  specimen  of  our commentator's unfairness,
 with either a disposition to  lead the reader astray, or great carelessness in
 quotations.  After quoting  from the Typhoid Fever (Vol. 1,  p.  152),
 " that Louis thinks that the symptoms of disease  of  the  stomach are
 very obscure "—and in another  place  " that the mucous membrane of
 the stomach was more or less seriously altered  in the greater proportion
 of cases," Dr.  Paine  triumphantly  compares  them with  another pas-
 sage (Vol. 2, p. 131-2), and thinks he has discovered  an inconsistency 
23
between it and the two  previous  ones.   This sentence is as follows :
" It is nearly correct to  state that the apparent condition of the brain
cannot explain the symptoms of  which it is the  source, any more than
the mucous membrane of the stomach can account for the  anorexia and
other  gastric symptoms  in  the  great majority of  cases."   Now the
reader may think that there is inconsistency.  Let  him read the follow-
ing, from Vol. 2,  p.  39.  "Thus we see  that out of 30 subjects from
whom I  was able to learn anything about  the gastric symptoms, twenty
had vomiting,  nausea, or pains in the epigastrium, and out of these only
eleven had any serious alteration of the  mucous membrane of the sto-
mach "—in other words, a  proportion of one  half had symptoms, but
no  corresponding lesion.  Dr. Paine  should have  quoted  this passage,
and not have brought together two sentences upon  entirely different
subjects.   But this, as we have  already frequently  seen, is but too often
the course  pursued by  Dr. Paine
   We are  almost fatigued with  the numerous instances of unfairness—
but the following extract affords  another specimen.   Louis, from exami-
nation of the  heart, thought  it  was not  inflamed, and he describes it
thus.   " At the same time that  it was softened, it  had less color than
usual in many cases.   It was of an onion-peel color, which varied in in-
tensity, and (was generally livid and purplish on its surface as  in its sub-
stance.  The  internal  face of the ventricles  and auricles  was, on the
contrary, of a deep violet red color) which color sometimes penetrated
beyond the lining membrane, and appeared owing  to an imbibition of
blood, which it resembled more or less in color."*   Afterwards he states
that the walls were thinner than usual.  Hence he concludes that inflam-
mation did  not cause this  affection.  But Dr. P. quotes the part  of the
sentence only  that is included in the above parenthesis,  and when Louis
says " that if  we know any cause of disease directly the reverse of in-
flammation, it  would be proper to refer this softening to it,"  the com-
mentator says  " our author refers to the absence of pus in the walls of the
heart, as a  special  proof of the foregoing doctrine;" whereas Louis uses
this fact, and likewise the non-existence  of pericarditis in  any  of the
cases, as merely considerations  to support, in some measure, his pre-
vious  arguments, and which to any fair mind are sufficient.   But, as we
have seen  in the  case  of analogy, Dr. P. takes what Louis uses as
merely supplementary to the  main argument,  and  puts it forth as the
chief groundwork.
  Here is another specimen of the misstatements by our commentator.
* Italics our own, in order to mark what Dr. Paine suppressed. 
24
 We are sorry to be obliged to use such  terms towards a medical  asso-
 ciate, but nevertheless the truth  must  be told in this case at least, let it
 be never so pungent.  Dr. Paine (p. 703) attempts to convict our au-
 thor  of something worse than  inconsistency in stating  that softening,
 thickening and ulceration may occur  without  inflammation, when tuber-
 cles exist in the alimentary canal; and in order to gain this end, Dr. P.
 makes these remarks.  1st, His  inductions are founded wholly upon the
 debris of the body;  2d,  The  inductions  rest chiefly upon the  fact that
 the foregoing alterations in structure  are  white  in  one case and red in
 the other.   And after two or  three  pages of quotations from Louis's
 writings, in  which additions in the way of comments and subtractions are
 made to suit the fancy of the  commentator, he finishes with a quotation
 from  Cowper's Conversation, and applies it to the " Numerical Method."
                " Such continual zigzags in a book,
                Such drunken reelings, have an awkward look,
                And  I had rather creep to what is true,
                Than rove and stagger with no mark in view."
 " This may be very philosophical;" but let us  see how our commenta-
 tor has convicted Louis  of inconsistency on  this subject.   In regard to
 the first statement above, I would ask how, a priori,  without "examina-
 tion of the debris of the body,"  can  we determine upon the existence
 of  inflammation of an organ under the skin ?  How originally did we
 arrive at the idea of hepatized lung, except by post-mortem appearances,
 or, as Dr. P. says, " from the debris of the body ?"  The symptoms might
 lead us to infer the phenomena of inflammation, but we never could do
 so unless from  previous study of  the parts  in  an  inflamed  state, and a
 comparison of  this  state with the symptoms.   So much  for  this;  and
 with regard  to the second, we join issue entirely, and declare that Louis
 never did propose to  decide that  a part was  inflamed from the exist-
 ence  of redness  merely.   Moreover,  as  we  deny the premises, so we
 deny all the inferences drawn therefrom in reference  to  the credibility of
 Louis ; for we  beg  the reader to  observe that Dr. Paine accuses our au-
 thor " of occasional guarded contradictions," for the purpose of gaining
 " a reputation for candor," as " that more  effectually secures to him a
 successful propagation of  his favorite, though conflicting hypothesis."
   This subject will occupy considerable space.  Let us first quote  from
 the commentator, and afterwards compare with it Louis's remarks upon
the same subject at the latest period  of his life, viz., when writing his
 work on the  typhoid  disease.
  " Here we pause  to  consider how far  our author has supplied  any 
25
ground for his principle that  softening, thickening and ulceration, of dif-
ferent tissues, sometimes depend upon inflammation, and at other times
on  an ' exactly  opposite  condition of disease,' and  what, also, is the
probable motive  for introducing  this confusion into the most important
branch of pathology.
  " In the first place, the inductions are founded wholly  upon the debris
of the body.  There is  no where, that we have been able to discover,
any essential reference to the phenomena of the disease  during its actual
existence.   Even  the  remarkable similarity  of those  phenomena ap-
pears not  to have been held in consideration, in forming  the conclusions.
Secondly, the inductions rest chiefly upon the fact that  the  foregoing
alterations of structure  are  white in one case, and red in the other.—
(P. 548, Andral.)   This may be very  philosophical;  but let  us see
what our author thinks of it when he is engaged in  reasoning the reader
into his problem, and  in supplying  the  appearance of an  impartiality
which never fails of a prepossessing influence,  and carries us along  with
greater confidence  to the  never-failing  act of generalization.   But we
have even more than this—a  direct contradiction of his  own philosophy
as it  respects the  very important tests  of color, by which our author
comes at last at  the conclusion that  the  foregoing  lesions are owing in
' the typhoid  fever,'  at  different times, to exactly opposite pathological
conditions.   Thus:  ' Paleness  of inflamed structures  takes place
sooner or later,  as is exemplified in the  various shades of color of he-
patized lung.'  ' It ought to  be noticed,  that continuous with a red and
softened  portion of mucous  membrane,  we often find  another equally
softened, but without redness.  If the first, therefore, is inflammatory,
it is probable that the other is also.'   Here, too, he allows that ' thicken-
ing of the sub-mucous cellular tissue '  was ' an evident  result of inflam-
mation,' although ' recent' and ' retaining its natural paleness.'   Where-
upon, our author lays down a rule which  it  was convenient to abandon
in  expounding the lesions  of ' the  typhoid affection.'  Thus :  ' This
fact [the foregoing], with many others, shows  that the thickness of our
tissues is one of the most important circumstances to  be  noticed, and
that to confine ourselves  to the description of the color of membranes is
often useless and even a cause of error  to those who  might draw con-
clusions from imperfectly described facts.'*  And again, in his Preface,
1 redness, considered by itself, offers much less  interest,'  than ' thicken-
ing, softening,'  See.
  " Such  was the opinion of our author when  reasoning abstractedly
                         * On Phthisis, sec. 135,136.
                   4 
26
upon  the results of inflammation, in his work on  Phthisis.  But, he
was  also  simultaneously engaged about  ' the typhoid affection ;' and
hence we have in the work  on Phthisis some ambiguous conclusions as
to the dependence of the foregoing  lesions  of structure upon  ' exactly
opposite conditions of disease,' as their color might happen to be red or
white.   When, however, we come to the work on Typhus, the obscurity
is cleared up ;  and, in  a general sense  we  are told that red and white
must be  taken as the  ground of an absolute distinction between the
pathological causes  of  such  lesions  of structure  as may be otherwise in
all  respects  alike,  and  characterized by the same vital phenomena.
Nevertheless, it was important to attempt a consistency  of doctrine  with
what had been laid down in the work on Phthisis; and this could readily
be done by those  occasional guarded contradictions which give to an
author  a reputation for candor that more  effectually secures  to him a
successful propagation  of his favorite,  though conflicting hypothesis.
Having said  this, we  are now bound to cite an instance  in illustration;
and  this we do  the more readily, as it exhibits, in  connection with what
we have  hitherto  quoted from  our  author, the true foundation  of the
new philosophy in respect to inflammation and its products, and explains
how far morbid anatomy, and  specific objects, have been the source of
certain  existing collisions with the  fundamental laws of nature.  Thus,
then, our author :   ' I refer to the  sub-mucous membrane  of the large
intestine, which was  very firm, and  at least six times  thicker  than na-
tural, and of a whitish color.   This  thickening, we cannot doubt, was
consequent upon an inflammation of the mucous membrane, but not recent,
for the  white color is inconsistent with the idea of acute inflammation.'*
The reader should here regard in their proper connection and involution,
the  expressions, ' but not recent,' and  ' acute inflammation.''
   Let us now see the reverse of Dr. Paine's picture.  Under the title of
"Consistence of the mucous membrane of small intestine," Louis says:f
   "But what was the  nature of this softening?   We can  solve this
question only by comparing together the thickness, the consistence, and
the  color of  the mucous membrane, about which  we  are now treating.
 Let us now  examine  the  elements of this  question thus brought into
 comparison with each  other.
   " In 8 of  the 12 cases in which the softening existed to a greater or
 less degree through the whole track of the  intestine, the mucous mem-
 brane was pale or greyish;  it was more  or  less red  in the others, at the
 end or in the latter half, or through the whole extent of the ileum, and

          * On Typhoid Fever, Vol. II., page 280.       t Ibid., Vol. I., p. 170. 
27
the softening  was not  greater in the  latter  cases than in the  former.
There was manifest thickening in two  cases only, in  which the mucous
membrane was white, or had merely some pale red spots in some points.
What deduction shall we make from these facts ?   Must  we admit that
the white and red softening have each their  own causes, the one wholly
different  from  the other ?  that one is of an  inflammatory and the other
of a different nature ?   This question, which  1 stated  in  another  work
(Phthisis), without being able to decide it, seems to me may now be de-
cided affirmatively, at least, in certain cases.   For if it is true that soft-
ening is the ordinary effect of acute inflammation, and that, when we find
redness,  thickening  and softening  combined,  inflammation is certain  to
have  existed, and that  when the softening and redness  exist  without
thickening, this is still probable ; it is not, by any means, probable when
the softening is found under different circumstances, that is to say, with-
out redness  and without  thickening.  Any other view  of the subject
appears to me incorrect, until it be proved  that nature has  only one
mode  of producing  the softening of which  we are  speaking, and the
contrary seems to me positively established  with  regard to the  softening
with diminished thickness of  the mucous membrane of the stomach, and
of the corresponding cellular tissue,  as we have stated previously, and, as
we shall see shortly, this is the case in other organs, in many cases.   I
am far from admitting, therefore, that the softening of the mucous  mem-
brane of the small intestine is always inflammatory ;  on the contrary, it
seems to me necessary to admit that it is of an entirely different charac-
ter in certain persons."
   Again, in connection  with the  above,  he says (Vol.  1, p.  170),
" One of these, redness,  thickening, or softening,  is  not, when  alone,
sufficient to prove that inflammation existed."
   Compare these quotations from Louis's works with what Dr.  Paine
says of Louis  in the quotation  above, viz.,  that " the  inductions rest
chiefly upon the fact that the foregoing alterations of structure are white
in one case and red  in the other."
   Thus  we  believe that  we  have refuted  the  second of our  com-
mentator's statements.   It is very singular, but almost constantly the
grossest misconceptions  and misstatements made  by our commentator in
regard to M. Louis's views, we are able to contradict from some personal
conversation we have had with the French physician.   Usually it  would
be scarcely worth while  to  mention these incidents;  but we cannot for-
bear stating the following, as it is so directly connected with our subject.
We had read a paper in his  presence, and in  describing the state  of the 
28
 mucous membrane, we stated merely the color.   Louis, with his charac-
 teristic frankness, declared "that  color alone  indicated nothing—we
 ought to have described the thickness, consistence, &c, of the part, and
 therefore our description was really of no kind of value."
   But we would ask whether Dr. Paine, learned as he is, is really will-
 ing  to  say that softening must  always be  the  effect of inflammation.
 Let him read  John  Hunter and  Dr. Carswell, and he will have proof
 enough to  the  contrary ;  and  he  will find  that softening of mucous
 membranes is not  an uncommon result of causes wholly the reverse
 of inflammation.
   We pass over many pages, and come to the following passage.   Dr.
 Paine says (p. 728), " But, says our author, * the  tongue was almost
 always natural.'   Now this, and all that follows in immediate connection
 with it, is contradicted by every one of his exemplifying cases."   The
 last  part of Dr. Paine's  remark  is very true, because, forsooth, he  has
 misquoted Louis, and the facts in Louis's book, of course,  do  not agree
 with his commentator's false statement.  But let us see the facts.  Louis
 states the results of his examination of the tongue to have been as  fol-
 lows :   " It was almost always natural," in 19 cases;  almost constantly
 of a more or  less  vivid red at  its  edge, rather frequently dry at apex
 and centre, in 9 cases ; almost constantly dry and coated brownish, but
 rarely of a bright red, in 8 cases  ; more or less  thickened, cracked or
 furrowed deeply, in 3 cases; and was covered with a pultaceous whitish
 coat, in 2 cases."   In other words, in more than  half the cases  the
 tongue was unhealthy.  Dr. Paine's own carelessness or want of candor
 has led him into an important  error.  At the  commencement  of the
 chapter, Louis says—" Elle  fut presque  constamment dans l'etat naturel;
 c'est a dire, sang rougeur, hurnide, et quelquefois  seulment jaunatre et
 blanchatre chez dix neuf sujets."   In Bowditch's translation we find it
 thus—"It was almost always natural; that is, it  had not  any unnatural
 redness, it was moist, and was  at times only a little yellowish and whitish
 in nineteen patients."
  What can we  think of the candor of such a writer, when he takes the
 first  line  of a sentence and  makes pages of commentaries  upon an
 isolated assertion, without ever deigning to look at the context to  learn
 the  real meaning of  the  author?   Our commentator may complain
 that the sentence was badly constructed.  We affirm that this is no ex-
cuse ; for, in the original, the meaning is perfectly plain, if the punctua-
 tion in the translation  is faulty.   Moreover, if Dr.  P. had taken  the
trouble to read through the chapter, which evidently he never has  done, 
29
he would have found that Louis tells him, " the tongue was natural or
nearly so in a little less than half the subjects."   (Vol. 2, p. 73.)
  When a man proves false in one position, we suspect him in regard to
others ; but we have  already quoted enough  to  prove that  Dr. Paine
was utterly unfit for  the task  he has  undertaken—that nothing but a
great want of self-knowledge, to use the mildest term, could ever have in-
duced him to throw out before  the world  such criticisms as now lie be-
fore  us.   We may seem to be unduly severe, especially as our commen-
tator tries to be very good humored, nay,  almost  witty, and  says he has
" laughed at " the  various  errors that are prevailing, and yet  he " has
no cold-blooded envy of their champions."  Yet we think there is some-
thing more than raillery  in such  expressions as the  following, which Dr.
Paine uses when speaking of Louis, viz., " he  is warped  by an ambi-
tion  which knows  no road to fame  but over  the ruins  of others," &tc.
The duplicity of " the  Frenchman " is likewise perpetually rung in our
ears.  How very probable  it is that a man would  throw aside his prac-
tice and devote himself for seven years to a task for which ridicule was for
a time his sole reward—how very probable, truly,  that such  a  man
wished to play a  double part; and " that nothing  fats him but other
men's ruin " !  Yet such are  the epithets  bestowed, with no sparing
hand, upon Louis by Dr. Paine.
   Having thus far  acted on the  defensive, we feel  disposed to try the
opposite course, and  shall quote  some specimens of  the  results of our
author's mind as applied to medical  researches.   He  lays down his pro-
positions, however absurd they may be, as if  he meant, without further
ado, to have all men reverence them as the ipse dixit of a  great father
in medicine.  Observe,  for  instance, the following:    " Place side by
side, the victims of enteritis and typhus fever, and, forgetting the to-
kens by which they were once distinguished, our scalpel may reveal no-
thing but one perfect coincidence in morbid lesions.   Each may have his
'rose-colored,  lenticular spots,'  his  'sudamina,'  his 'ulcerated epi-
glottis,' his ' specific alteration  of the glands of Peyer,' his  ' intesti-
nal  perforations,'  and  even his  'meteorism;'  all,  and each  one of
which, being assumed as pathognomonic of  typhoid  fever, places  our
science, according to our author, in a state of ' infancy.'   And  so  our
author farther on."   (P. 710.)
   What consummate folly !   What insufferable dogmatism !   We  want
nothing more than this to prove that whatever our author may be  as a
reader, he has had little practice in medical  investigations, and that his
learning is of the closet.  The passage, however, needs no commentary. 
30
Dr. Paine has  completely answered  himself—and perhaps the citation
of this passage would have been a  sufficient review of the whole book.
To our mind  it shows most conclusively  the exact character of Dr.
Paine's intellect.
   We cannot  forbear, however, quoting one or two passages more, in or-
der to expose  still farther the peculiar character of Dr. P.'s commentaries.
So desirous is he, and so confident is he likewise, of " sapping the founda-
tion of the numerical system," that he declares that not one of Louis's
cases are entitled to the least credit—because, forsooth, Louis had to trust
to the memory of his patients in regard to the early history of their cases.
Now  really  this is almost silly, and  if our commentator were not so very
learned, we should apply the epithet to him.  Pray did not Louis see and
examine the patients daily after entrance ?   Moreover, suppose Dr. Paine
had been the observer—how would he have learned about the previous his-
tory, except from the patient and his friends ?  The argument, as is un-
luckily the case with others used by the Dr.,  goes too far ; it is a two-
edged sword, and applies  as  well  to his own methods  as  to  Louis's.
Perhaps Dr. Paine, with his favorite rule  of analogy, would determine
from the latter symptoms of disease, what  the earlier ones were!   We
have  said the  argument  is a two-edged sword—but to  carry out the
metaphor, we  must add that it is very dull  at  both edges.   Really we
wonder at the folly  which led him to use it.   But supposing every one
of Louis's cases were inaccurate, we cannot see bow the " foundations of
the numerical system " are "sapped"  thereby.   The system does not
rest upon Louis or any other  man.   Thank heaven, no truth  rests upon
one man alone !
   But  again—and  to this extravagance of our commentator  we  beg
special attention.   Will it be believed that any man at all acquainted
with the history of  fever could be  so strangely deluded as to  say that
those  phenomena which have been presented  to the world by Louis as
the anatomical characteristics of fever, and confirmed as such by men
like Chomel and Jackson—can it be believed, we repeat, that any intel-
ligent American would state that these lesions cannot be known, because
all the organs in Louis's cases were in a state  of putrefaction when the
examination was made ?   Had any  one asserted  this in our presence,
we should have considered him either  as a madman or a jester.   Yet
Dr. Paine  has actually printed  it—as  the following quotation  proves.
" And we purpose showing, by his  statement in  this particular,  that his
cases  cannot be allowed to form the  basis of any of the pathological
conclusions at which he arrives.  The objection consists  in the lateness 
31
of the period after death at which cadaverous examinations were made;
since absolute putrefaction must have advanced considerably in most  of
the subjects, and  ' meteorism ' must indeed have  become formidable."
(P. 798).  After this remark, follows a  table, whereby it appears that
Louis allowed (average time) 29  hours and a little over to elapse before
making his autopsies.   It is true that the commentator applies this rea-
soning to  certain views which he says our author has about the non-in-
flammatory character of the lesions—but  the argument proves too much,
viz., that the observations themselves were wholly worthless.  If, as the
Dr. says, he has before proved that Louis  " had no just knowledge  of
the symptoms" (p. 798), and now is satisfied that the post-mortem  ap-
pearances are nothing  but " such a light  as  putrefaction breeds "  (p.
799), why then we must yield the point, and confess ourselves humbled
and covered with shame—for we have  really believed that though Louis
has some errors like other men, still he is not a complete dunce.  More-
over, he has noble companions—Chomel, Jackson, Hale, &tc,  for they
have arrived at the same conclusions that Louis has in regard to the patho-
logical  appearances.   How utterly absurd  for Dr.  Paine to write thus!
Louis knows nothing of the  symptoms of fever, and as for his pathology,
it is all dependent  upon putridity !  Most men  would have been afraid
to make such bold  assertions.  Old JEsop comes  up before us, and sug-
gests as an illustration  of the relative position of our commentator and
the object of his criticism, the  poor conceited  frog and the ox.  The
former, foolish thing, burst himself when at the height of presumption.
So it seems  to  us  that our commentator has done by this last specimen,
this climax of  his folly.
   Finally, we must thank  Dr. Paine for  one thing, viz., his long-con-
tinued protest against  an error  which we  allow is gaining ground, the
 neglect  of the  rational  signs, while very great  attention .is paid to the
 physical ones.   This is  very pernicious,  and needs a protest from every
 lover of truth.   But we do not accuse Louis  of being the author of this
 error.  It is the fault of the age.  Louis examines with minute care
 every symptom he can think of,  and no  one  who  was  acquainted with
 him would ever accuse him of doing otherwise.
    We have  now finished a catalogue of  a few of the unfair statements
 and strange dogmatisms of Dr. Paine.   We  have sometimes regretted
 that  we had undertaken the task, for  we  have felt that by his extrava-
 gances and his Dr. Pangloss method  of quoting, he would bring " the
 bane and antidote " in his own pages.    The only circumstances that in-
 duced us to do thus much,  were those  misstatements of Louis's views 
32
which exist throughout the Commentaries, and of which we have given to
the reader  merely a  portion.  We might make more numerous quota-
tions, and likewise might enter into a labored defence of the numerical
method ; but inasmuch  as  that  method  would not be  materially inter-
fered with, even  if all that Dr. Paine says of Louis's works  were true;
inasmuch, moreover, as Dr. Paine does  not in  fact bring a single argu-
ment against it, except what  he calls the hasty generalizations of one
man—we shall say nothing upon  the subject.   We wish, however, dis-
tinctly to state that we coincide entirely with these remarks  by Dr. Jack-
son, in his Appendix  to Louis's  pamphlet on Bloodletting, page  170—
and we  extend them  to  all of Louis's works; least of all, however, to
his last, viz., on Typhoid Fever.
   " In conclusion, many readers  may ask if it  is thought that the re-
searches, of which this volume contains the results,  are to be  considered
as leading to any positive conclusions.   Certainly not.   M.  Louis has
done us great service  in  stating his own  accurate observations.   They
must have great  weight in  the  minds  of reflecting men.  We have         j
added all  the observations that  we have of sufficient accuracy to be
compared with his,  which  will be  received  for  what  they are  worth.
The whole  are to be  regarded as materials, to which others are solicited
to make additions from time to time; that, at length, so many cases, im-
partially collected, may be brought together, as shall justify entire confi-
dence in the inferences to be  made from them.  Ten hospitals, under the
care of  honest physicians, may settle the questions discussed in this work
within five  years, so that our posterity will not for ages be able to make
any material correction  in the  answers.   Seasons  and  epidemics will
vary, no doubt; but  the general  laws will be found the same, and little
else would  remain  for  future ages than  to settle the  allowance to be
made for disturbing forces."