ADDRESS 
ON 
MORBID ANATOMY. 
KY 
J. B. S. JAC&SON, M.D. 
May 25, 1853. ADDRESS 
ON 
MORBID ANATOMY, 
DELIVERED BEFORE 
THE MASSACHUSETTS MEDICAL SOCIETY. 
AT Til KIR 
Annual Meeting, May 25, 1853 
BY 
J. B. S. JACKSON, M.D. 
3£vEjprtnteli from tfje “ ptetrical CComniuntcations.” 
BOSTON: 
PRINTED BY JOHN WILSON & SON 
22, School Street. 
1853. MORBID ANATOMY. 
Mr. President and Gentlemen, — 
Morbid Anatomy has now, for many years past, 
received a large share of attention in every country 
where medical science can be said to exist; and I have 
thought, without any feeling of partiality, that its 
claims to such distinction might be worthy of consi- 
deration upon the present occasion. 
The general practitioner may well ask, and still 
more may the public, why post-mortem examinations 
should be made. They require much time, and often 
when we can but ill afford it. They are often very 
fatiguing. They are sometimes dangerous to life. 
And still further, the idea is one from which our feel- 
ings naturally shrink ; however wanting some persons 
would seem to be in all such feeling, and even in 
the common sense of decency which belongs to the 
occasion. There are some who can never make up 
their minds to allow an examination of their deceased 2 
friends; and, when such is the fact, we should not 
press them with our solicitations, though the “ case ” 
may be never so “ interesting.” But, on the other 
hand, as the friends often desire to have an autopsy 
made, and at the same time feel a reluctance to allude 
to the subject, it is perhaps best, that we should, in 
every case, on their account as well as our own, so far 
refer to it as to enable them to express their wishes; 
and, on the other hand, to give us whatever chance 
there may be of making the examination ; for I main- 
tain that examinations should always be made if pos- 
sible. 
They should be made, because they give a precision 
to our knowledge of disease that we do not obtain 
from the study of symptoms alone. They lay a surer 
foundation for medical science than these last. They 
show us, as it were, a stamp set upon the organs, and 
which seems to indicate something of the nature 
of disease. We feel satisfied that we have made a 
step forward, and upon sure ground. Sometimes we 
do not wait for the autopsy, but take this step upon 
the living body ; and, though the idea to which I refer 
seems at first sight rather startling, it may be per- 
fectly justifiable, I think, in some cases of external 
disease and of questionable diagnosis. The old ob- 
servers often drew the most perfect picture of disease 
as manifested in the living body; but it was too often a 
dissolving view. It wanted the substantial reality that 
would have been given by a knowledge of the physical 
as well as the physiological changes that were going 
on within the body. Disease was not localized, but 3 
organic were confounded with mere functional affec- 
tions ; and symptoms were grouped together with 
but little variation, when they were, in fact, referrible 
to a variety of internal organic lesions. In illustration, 
we have the case of dropsy, of asthma, and of some 
forms of fever; the disease now, in such cases, often 
receiving its name from the structural changes that 
are found on dissection. Thus, in the case of dropsy, 
we speak of disease of the heart, of granulated liver, 
or of Bright’s disease; and, instead of dropsy of the 
brain, a child now dies of tubercular meningitis. The 
term asthma has been applied to such a variety of affec- 
tions of the lungs, and even of the heart, that some are 
half disposed to do away with it altogether. As to the 
class of fevers, one of the most valuable discoveries 
that has ever been made in medical science, of late 
years, is, that in typhoid fever, commonly so called, 
there exists very generally, if not always, a certain 
affection of Peyer’s glands. I shall speak presently of 
the relationship of the morbid appearances and the 
symptoms. Suffice it to say here, that the appear- 
ances so far characterize the disease, that we generally 
say that it had existed when they give us positive 
evidence, and without reference to the symptoms that 
may have existed during life. If, for instance, we find 
the affection of Peyer’s glands just referred to, we 
say that the patient had typhoid fever, whatever the 
diagnosis may have been. How many diseases have 
been shown to be confounded with tubercular con- 
sumption ! as, for example, bronchitis, pneumonia, gan- 
grene of the lungs, or pleurisy; and any one of which 4 
may have, from the first, the characters of a chronic 
affection. Many years ago, and before the introduction 
of auscultation, the physician in attendance at the 
Alms-house in this city remarked, in a clinical lecture 
on consumption, that, though he could not account for 
the fact, he had often observed, that, where there was 
an abundant expectoration of purulent and foetid mat- 
ter, the patients generally got well. Now, those cases, 
we may be pretty sure, were cases of gangrene of the 
lungs; and, by the aid of our dissections, we have 
come to be about as familiar with this disease as with 
consumption itself. By the aid of physical signs also, 
we are now familiar with it upon the living body ; 
and, as the prognosis above given may seem to have 
been altogether too favorable, I would say that it is not 
more so than many amongst us would give at the 
present day, whatever may be thought of it elsewhere. 
Symptoms must be studied, so far as they go; and, if 
the ancients did not connect them with structural 
changes, it is not by any means certain that they did 
not appreciate the value of these last. 
It is not by the study of symptoms alone, nor of 
morbid anatomy alone, that the science of medicine is 
to he advanced to the highest state of perfection of 
which it is capable. They must be studied in connec- 
tion, in the sick chamber and in the dead room. As 
physiology is to healthy anatomy, so is pathology to 
morbid anatomy. Indeed, the relationship between 
these two last is such that many persons seem to have 
a vague idea that the terms are synonymous. This, 
however, is far from being the case, and a proper dis- 5 
tinction should be made. As physiology teaches the 
laws of life, and a knowledge of it is to be obtained 
by a study of the healthy functions and organs; so, 
on the other hand, pathology, which teaches the laws 
of disease, is the science above referred to, and must 
be studied upon the functions and upon the organs in 
a state of disease. It is a great point to ascertain the 
laws of disease by an observation of its phenomena; 
and it would be well for science if we should know 
where to stop in our pathological investigations. The 
tendency, however, to theorize is so strong, that we are 
constantly liable to be led away into dark and unknown 
regions, where we lose ourselves, and but few are in- 
clined to follow us ; few, at least, who can afford us the 
light and support we need. We should keep upon 
the open track, see our way before us, and pursue it 
steadily. Certainly there are many points in pathology, 
as in every other science, that we would wish very much 
to determine ; but if they are, in the nature of the case, 
fairly beyond our reach, it becomes us to know it. To 
show the futility of this kind of inquiry, we have only 
to compare together upon such points the opinions of 
authors of the highest reputation, of those who are 
equally learned, equally gifted by nature as observ- 
ers, and equally desirous of the truth; and we shall 
often find the greatest diversity; and not merely 
upon some of the difficult questions in pathology, but 
upon some that would seem to be of comparatively 
easy solution. How much preliminary knowledge is 
to be acquired, before we can investigate, with any 
chance of success, many of the abstruse questions that 6 
are often agitated! How much do we know of phy- 
siology and of general anatomy beyond what the plain 
observation of facts teaches us? Now, if we cannot 
understand the healthy processes, how' can we expect 
to know any thing of the mode of action by which the 
various structural changes are induced, or by which 
the natural functions are disturbed ? I have enlarged 
upon this tendency to theorize in matters of pathology, 
because it is not confined to the medical philosopher, 
but is carried by the general practitioner to the bed- 
side, where it conjures up bugbears that are often 
more difficult to contend against than the enemy 
itself. 
Anatomical appearances vary more or less, and it is 
sometimes impossible to decide, upon their evidence 
alone, as to the disease that had existed; but, more 
frequently, mistakes are owing to inattention. Soften- 
ing of the brain, for instance, is not always very obvious 
at first sight, and yet it would betray ignorance or 
inattention to overlook it. How was it that so marked 
a structural change as Bright’s disease, or the charac- 
teristic lesion of typhoid fever, should have been so 
long unobserved ? Simply because the organs could 
not have been thoroughly examined. A few years 
ago, I remember to have seen a tumor that had been 
removed, and that showed upon incision a yellowish 
disorganized appearance that led many who examined 
it to regard it as a tubercular affection. Upon further 
examination, however, a narrow border of greyish 
encephaloid was found about the opaque deposit, 
which last then was nothing more than the tuber- 7 
culoid substance so frequently found in cancerous 
growths, and which happened in this case to exist in 
an unusually large proportion. 
When the gross morbid changes fail us, have we 
any further means of determining the character of 
disease ? We have, to a certain extent, in the micro- 
scope. This instrument, though its application to 
pathological investigations is only of comparatively 
recent date, has come now to be so generally used that 
a knowledge of its powers may be considered as indis- 
pensable. And when we see the striking and often 
beautiful appearances it exhibits, we cannot but feel 
that they must have an important signification; and 
that they must bring us nearer to the source of dis- 
ease than a mere examination of the gross structural 
changes, as the last bring us nearer to it than the 
symptoms. Much, undoubtedly, has been done ; and, 
from what we know of the capabilities of the instru- 
ment, it is impossible to say what is yet to be the 
extent of its revelations. In the present state of 
science, however, its results, in regard to the determi- 
nation of morbid structures, should be received, it seems 
to me, with caution. It requires, I am sure, a great 
deal of practice before one can become accustomed to 
seeing with his powers of vision increased several 
hundred-fold. A great deal of time also is required 
for these examinations, when one has become skilled 
in the use of the instrument; and it is not every one 
whose eyes will endure it. In order to settle a nega- 
tive, it is not always enough to take a few specimens 
here and there from a diseased mass; the examination 8 
must be thorough, and I have known hours to be spent 
in a single investigation. I have already referred to 
the case of an encephaloid tumor that was mistaken 
for tubercular disease; and I would say that the 
microscopists here were as much at fault as those who 
judged by the gross appearances, having taken only 
the central portion for examination, and overlooked 
that which surrounded it, and which essentially cha- 
racterized the disease. Much has already been done 
that will require to be undone, and even by those most 
skilled in the use of the instrument. 
The above remarks are strikingly illustrated in the 
case of cancer; a disease for which, of all others, we 
should wish to have, if possible, some certain test. 
The gross anatomical appearances too often leave us in 
the dark. But here, it was said, was a new mode of 
observation by which we might decide whether a 
structure was cancerous or not. Cells of a certain 
specific character were said to exist in growths of 
this nature, that were not to be found in any other; 
and this statement, having been made by some of the 
highest authorities, and abundantly confirmed, it was 
thought, by further observation, had come to be 
regarded as an established fact in medical science. It 
is now found, however, that the character of the cell 
is far from being so specific as it had been supposed; 
the form which had been regarded as so peculiar is 
not a universal, if indeed it is a common, appearance ; 
and, on the whole, I doubt if we could, in a given 
number of cases of questionable cancerous disease, 
and in the present state of microscopical science, come 9 
much nearer to the truth with the aid of the instrument, 
than we could without it. 
The microscope, again, shows that some structures 
are not strictly cancerous, though they may appear to 
be so to the naked eye; and, in the case of a tumor 
removed by a surgical operation, the observation is 
received as very encouraging in regard to prognosis. 
It is well to establish the scientific difference; but 
there is only this difference practically, — that true 
cancer generally destroys life by attacking the internal 
organs; whereas the diseases in question effect the 
same object locally, returning sooner or later in the 
part or near it, however thorough the extirpation may 
have been. I do not refer so much to epithelial 
cancer, the tendency of which, as it affects the lip, skin, 
and other external parts, is sufficiently well known ; 
but to what has been described, I think, as the local 
recurrent cancer, and which, I fear, the microscopists 
not very unfrequently mistake for a non-malignant 
disease, as it would have been formerly called. 
The character of the tubercular deposit is another 
subject to which the microscope has been especially 
directed; and it has often enough been asserted, if it 
is not yet generally believed, that its character is 
specific. But this again is getting to be a disputed 
point; a very eminent morbid anatomist and patholo- 
gist saying to me, not two years ago, that in his opinion 
the tubercular corpuscle was nothing more than a 
shrivelled-up pus-cell. The disease also has been 
generally regarded as something sui generis by those 
who observed only its gross anatomical characters and 10 
its general pathological history. I have, however, 
long been disposed to consider it as a form of in- 
flammation ; and the microscopic characters would 
now, I think, rather confirm that view of it, as tending 
to show the alliance of the tubercular deposit to the 
product of inflammation. I would say that the appear- 
ances, in the case of pneumonia and of one of the forms 
of tubercular disease of the lung, are sometimes so simi- 
lar, if we examine the organ only to a limited extent, 
that it would be impossible to distinguish the one dis- 
ease from the other. Secondly, I have seen a strongly 
marked case, to show that an extensive tubercular 
deposit in the lung might be absorbed, as the inflam- 
matory deposit must be in the case of pneumonia ; the 
existence of the disease was proved by the local and 
constitutional symptoms, and by the physical signs ; 
and the entire absence of it was proved, when the 
patient died, two years afterwards, of tubercular dis- 
ease of the brain. The bronchial glands, however, 
corresponding to the upper lobe, which was the one 
that had been diseased, were extensively tubercular; 
but this fact rather tended to prove the point in ques- 
tion. Thirdly, in the experiments of Baron and Jen- 
ner on rabbits, upon the absorption of the tubercular 
deposit, there must have been an absorption of some 
morbid deposit; and if the microscope shows that the 
granulations probably did not contain the characteris- 
tic corpuscle, and were therefore not to be regarded as 
proper tubercles, still I cannot but think that they 
were closely allied pathologically to this form of dis- 
ease. I should be disposed to say further that all 11 
the different forms of tubercular disease of the lungs 
are essentially the same, however much they may 
differ in their gross anatomical appearances ; the 
product we see is the result of inflammation, modified 
by some morbid state of the part affected or of the 
system; and it may be absorbed in an early stage of 
the disease, if the general health is improved; or it may 
go on to suppuration, and even then show occasionally 
a tendency to recovery that would ally it to the pro- 
cess of inflammation. I have digressed thus fully 
upon the subject of tubercle, because its microscopic 
characters have been particularly studied; and, as at 
present received, tend to confirm, as I have already 
said, the views I have long entertained of the disease, 
and which certainly have differed considerably from 
those generally adopted. 
The study of morbid anatomy establishes the dis- 
tinction between functional and organic affections; or 
disorders and diseases, as they have been called. Some 
persons seem hardly to realize the amount of functional 
disturbance that may take place independently of struc- 
tural change; and yet there are familiar and striking 
examples enough, as in the case of hysteria and 
neuralgia. The class of neuroses are essentially unac- 
companied by any characteristic lesion; and, though 
appearances may be found which are the result of 
disturbed function, or which are no more than compli- 
cations, there is nothing constant and characteristic. 
The nervous system seems to be, if any one is, the 
direct medium of communication with the vital prin- 
ciple ; and it may, by its mere derangement, exhaust 12 
the patient by keeping up a long-continued irritation 
of some one important organ ; or it may be more or 
less general, as in the case of tetanus, hydrophobia, 
epilepsy, the convulsions of children, &c. We must 
learn what morbid anatomy will not do, as well as 
what it will do. Again, as the most grave, symptoms 
may exist without organic disease, so, when this last 
does exist, death may occur suddenly, and nothing 
be found on dissection more than what had evidently 
existed for a long time; as in the case of disease of the 
heart. 
In this place the operation of physical and chemical 
causes, in the production of disease, might be consid- 
ered. The humoral pathology of former times might 
be alluded to, which fell through, as a mere hypothesis, 
but has been again raised, and now stands upon a 
more sure foundation. 
As the study of morbid anatomy shows the localiza- 
tion of disease, when it is characterized by anatomical 
changes; so, from the study of these changes in a suc- 
cession of cases, we learn the tendency of disease, 
whether to recovery or to death; its natural history, 
so to speak. This is illustrated in the case of simple 
inflammation and of cancer: we recognize the disease 
when it exists, judge of its duration, and look forward 
to the different stages through which it would have 
passed. The structural changes are as significant to 
the pathologist as the natural organs and tissues are 
to the comparative anatomist. Another striking ex- 
ample is that of tubercular disease, of which I have 
already spoken, and which is not very unfrequently 13 
met with in different stages of arrest. Phthisis has 
been generally regarded as an almost necessarily fatal 
disease ; and, if it is now looked upon in a more favor- 
able light, it is due mainly to the revelations of morbid 
anatomy. 
The adaptation of the organs to the functions they 
are to perform, as displayed in a comparative survey 
of man and the lower animals, is a favorite idea with 
the moral philosopher as well as the physiologist; and 
the treatises that have illustrated it are full of the most 
satisfactory and interesting proofs of design. Yet in 
what respect is the evidence of design more marked 
in the healthy system than it is in what we witness 
every day in the case of disease, from the mildest to 
the most severe form ? A thorn in the flesh gives rise 
to a process of suppuration, by which it is finally 
expelled; or, in another case, a foreign body is buried 
in the deep-seated parts, perhaps in the internal organs, 
and it may there become surrounded by a thick, insen- 
sible membrane, within which it may ever after remain 
perfectly harmless. The tendency of abscesses towards 
the surface of the body, or, when situated internally, 
towards some natural outlet; the adhesions that are 
formed, with thickening of the tissues, to prevent an 
opening into the serous cavities, or to limit the inflam- 
mation if an opening does take place; the adhesions 
formed about a chronic ulcer of the stomach; the 
means used to arrest hemorrhage; the processes by 
which a dead part is safely separated from the living, 
— these are a few instances of the exercise of a power 
that we may find manifested in every part of the sys- 14 
tern; and it is perhaps never more apparent than in the 
efforts to arrest the progress of a disease that must 
ultimately prove fatal. 
Occasionally, this power is exercised without any 
external manifestations ; and the disease is then said 
to have been latent. The animal functions are not 
disturbed, though nature feels the danger. Thus a 
patient, apparently in good health, dies suddenly from 
peritonitis; and, on dissection, we may find that a 
chronic ulcer of the stomach has perforated; the 
parietes of the organ have been destroyed; and death 
must have occurred long ago, had it not been for the 
adhesions that had taken place. Latency in this case 
is certainly quite exceptional, but then it is sometimes 
observed; the death being the result of the accidental, 
rather than of the primary disease. The consequences 
of a neglect on the part of nature to attend to these 
precautions is sometimes strikingly shown. A small 
tubercular cavity, for instance, may happen to form 
near the surface of the lung in the early stages of 
phthisis; and, if the usual adhesions have not formed 
over it, it may burst into the pleural cavity, and 
destroy the patient at once, whereas he might otherwise 
have lived for months: one of the first cases of pneu- 
mothorax that I ever saw was an example of this. In 
the ulceration that occurs in typhoid fever, such 
adhesions do not take place, and probably for some 
very good reason: the consequences, however, that 
now and then follow, we know but too well. 
Sometimes nature seems to overreach herself in these 
efforts. The means she uses are disproportioned to 15 
the object to be effected, and cost too much: they are 
intended to be ultimately restorative or protective, but 
they have come essentially to constitute the disease; 
and all the danger of the case, if there be any, depends 
upon them. Perhaps no more striking illustration of 
this remark could be found than in the case of tuphlo- 
enteritis, so called. A foreign body gets into the 
appendix coeci, or a calculus forms in it; and there it 
may remain for a long while, perfectly quiescent. This 
little offset to the intestine, which is almost peculiar 
to man amongst the mammalia, seems to be of no 
especial use; and, so far as wTe can see, the foreign body 
might as well remain there as not. Sometimes, how- 
ever, nature seems to be seized, as it were, with a fit 
of capricious intolerance, and a determination to get 
rid of the offending cause, if so it can be called when 
it had been borne with so long and so patiently; and, 
to effect this object, a train of processes is then set up, 
which, however, interesting to the pathologist, are but 
too certainly fatal to the subject of them. The case 
of inflammation of the serous membranes may also 
be mentioned: a moderate effusion might relieve it, 
when a larger amount would perhaps compress the 
organs so as to destroy life. 
Morbid anatomy may be studied with great advan- 
tage upon the lower animals. The powers of nature 
in the restoration of injured parts are often wonder- 
fully well shown; and it is not much to the credit of 
human therapeutics to find how well they often bear up 
under disease; though it is true that the power of en- 
durance may be greater in them than it is in man. 16 
Endurance, however, has not much to do with the 
union of a broken bone; and certainly the most regular 
unions are sometimes met with in the lower animals. 
There are those who seem to feel that the study of 
comparative pathology is rather beneath their dignity ; 
but, if such a feeling should arise, let them think of 
the origin of vaccination, and of what that alone has 
done for mankind. Truth is sacred, and we never need 
feel ashamed to receive it, from whatever source it 
may come: disease should be studied in the lower 
animals, and still further in the vegetable world. A 
curious subject of investigation, that may be alluded 
to here, is the analogy that exists between some of the 
morbid conditions in man and the normal condition of 
the same parts in the lower animals: the idea has 
been ingeniously developed by a German writer, and 
his work contains many striking illustrations. 
Supposing, now, that the structural change repre- 
sents the disease, how are we to recognize its presence 
in the living body, or the absence of it in mere func- 
tional affections 1 We must transfer to the sick- 
chamber the knowledge we get in the dead-room. 
Autopsies are very interesting scientifically; but they 
will not be generally made, nor their results read, and 
still less will the public permit them, unless it can be 
shown that they are practically useful. The morbid 
changes must be connected with the symptoms and 
physical signs manifested during life; so that, having 
the one given, the other may be inferred. We thus 
acquire the means of diagnosis, so far as it can be 
done. Diagnosis, above all other things, characterizes 17 
scientific medicine; and the public, as well as the 
practitioner, appreciate the value of it. A patient 
wishes to be told, and in a manner that shall command 
his confidence, what ails him; if he will get well 
or not, and how long he will be sick; and this quite 
independently of treatment. As I heard it remarked 
lately, if physicians did nothing more than to answer 
such calls, the profession would still be supported. 
The diagnosis of disease will become positive by the 
above mode of investigation, so far as it is possible; 
and yet, after all, there is a very great uncertainty in 
deducing the existence of organic lesions from the 
symptoms. As we may have functional disturbance 
without structural change, so the reverse is not unfre- 
quently met with ; and there is no organ perhaps that 
is hot more or less subject to these latent affections. 
I have already referred to the latency of disease; it 
may be entire, or there may be constitutional without 
any local symptoms ; it may exist in any degree, and 
may be quite marked where there is extensive organic 
disease; it is not confined to chronic cases, but is 
sometimes met with in the most acute inflammatory 
affections. Peritonitis, for instance, is generally sup- 
posed to be a well-characterized disease; but I have 
seen several dissections where it was entirely over- 
looked during life, though the cases occurred in the 
practice of some of our best observers. On the other 
hand, we are sometimes overpowered with symptoms; 
they are out of all proportion to any organic change 
that may exist; and it is difficult to say whether this 
case or the first requires the greater power of discrimi- 18 
nation. To meet these cases, the mind must be well 
trained to observation; and the focus of medical vision 
arranged so that we may see in an imperfect light, and 
not be blinded when there is too much. 
Physical signs, when they exist in a positive form, 
are perhaps more to be depended upon than symp- 
toms as diagnostic of internal organic disease. The 
whole science of physical signs has, in fact, grown out 
of that of morbid anatomy. We do not see the struc- 
tural changes as we do in the dead body; but we 
have the evidence of other senses of their existence, 
and sometimes almost equally positive. This is es- 
pecially true of some of the thoracic affections. In 
the abdomen also there are various organic diseases, 
of which we have pretty satisfactory physical evidence, 
though the diagnosis of tumors in this region lias 
generally been thought obscure. We are now, how- 
ever, better acquainted than formerly with uterine and 
ovarian tumors, cancer of the stomach, cancer of the 
liver, &c.; and we are therefore able, in many cases, to 
recognize upon the living body the physical characters 
with which we have become familiar in our dissections. 
On the contrary, a certain disease of the liver often 
induces ascites: now, we know from dissections, that 
the organ in this case is generally smaller than natu- 
ral: if, therefore, it should be felt in this form of 
dropsy, and still more if it were felt to be enlarged, it 
would be a reason, negatively, why this disease of the 
liver should be declared not to exist. Further, if, 
under the same circumstances, the spleen should be 
enlarged, it would be a reason for diagnosticating the 19 
particular disease of the liver here referred to, inas- 
much as obstruction of the portal system tends very 
naturally to produce a congestion, and, at last, a per- 
manent enlargement of the spleen; as, on the other 
hand, it explains the serous accumulation in the peri- 
toneal cavity. Here, then, a disease of one organ is 
diagnosed in part by the enlargement of another. 
Physical signs, however, sometimes lead us astray, as 
in the case of the various murmurs heard over the 
heart and large blood-vessels in nervous subjects. In 
an emaciated subject, the head of the pancreas, and 
even the bodies of the lumbar vertebrae, may be mis- 
taken for a tumor; and, upon two different occasions, 
at a post-mortem examination, I have felt a small but 
very distinct tumor before opening the body, which 
proved to be the pylorus in a perfectly healthy condi- 
tion. A woman once consulted me for something 
that she said was growing in her throat, and which 
she had felt with her finger: it was the epiglottis. 
Physical signs are, of course, explained directly, by 
the changes that take place in the internal organs, 
and according to physical laws. But what is the 
relation of these changes to the symptoms of disease ? 
The explanation here again is sometimes physical, and 
so far satisfactory. That beautiful optical instrument, 
the eye, is rendered as useless by any cause that 
intercepts the rays of light, as a microscope would be 
with its diaphragm closed; and so of some of the 
other special senses. In the case of thoracic disease, 
numerous examples might be found; the healthy 
performance of the functions in this part of the body 20 
being so far dependant, more or less directly, upon the 
operation of mechanical laws. The lungs, for instance, 
are compressed by pleural effusion, and dyspnoea must 
ensue; or the air-vesicles are over-distended, and the 
same effect is produced. In the one case, the air can- 
not be got into the lungs; and, in the other, it cannot 
be got out of them. The diseases of the larnyx, acute 
and chronic, also afford striking examples. In valvu- 
lar disease of the heart, the circulation throughout 
the whole system is liable to be more or less obstructed; 
the organs labor in the performance of their functions, 
and the vessels often strive to relieve themselves by a 
discharge of the watery parts of the blood; or they may 
even give way, and pour out the blood itself. Ob- 
structive disease of the alimentary canal, or of the 
excretory ducts, the pressure of morbid growths on 
the surrounding parts, &c., may be alluded to; in a 
word, there is hardly an organ from which illustrative 
cases might not be taken. The weight of a diseased 
organ is an important element, and one that has not 
been sufficiently regarded; the lungs, for instance, 
become sometimes very heavy in pneumonia, and 
also in tubercular disease; the liver may increase 
in weight three or four fold; and an encysted ovary, 
or a collection of fibrous tumors developed in and 
about the uterus, may, it is known, almost equal the 
weight of the patient herself. 
If many of the symptoms of disease can be explained 
physically by the structural changes, still more must 
be referred physiologically to the derangement of 
function that is induced. A machine that is out of 21 
order does not generally work well, and so it is with 
the animal machine. Now, the different organs and 
tissues of the body have different degrees and kinds 
of sensibility; and so the symptoms vary. The sensa- 
tions experienced under an attack of bronchitis, pneu- 
monia, pleurisy, or pleurodynia, for instance, will be 
very differently expressed; and the only explanation 
that we can give is the one above referred to. The 
disturbance of the functions is generally more or less 
marked in acute inflammation of the internal organs, 
and is certainly not to be explained by any other 
than vital laws, — as in inflammation of the brain, of 
the stomach, or of the kidneys. And, if such is the 
explanation of the local symptoms, still more must it 
be of the constitutional, and of the special disturbances 
in remote parts of the system. How, for instance, 
irritation of the stomach is induced by disease of the 
brain, or by the passage of a calculus down the ureter, 
is more than we know; and we only cover our igno- 
rance by saying that it is from sympathy: nor can 
we say how general febrile symptoms are excited by 
local inflammation. We are, perhaps, too much dis- 
posed to explain the symptoms by structural changes, 
when these last should often be regarded as only the 
anatomical character of the disease. It is often asked 
whether the affection of Peyer’s glands is the cause of 
typhoid fever: certainly it is not, any more than an 
exanthematous eruption is the cause of the fever 
that attends it, however it may produce some of the 
secondary symptoms. The inflammation of the lungs 
in pneumonia is generally regarded as the cause of the 22 
constitutional symptoms; and yet I am sure that I 
have seen cases where these last had preceded the lo- 
cal disease, as shown negatively by physical signs and 
by symptoms. 
If it is asked what has morbid anatomy done for 
the treatment of disease, I would refer to what has 
already been said upon the subject of diagnosis, and 
upon which all sound treatment should be based. If 
a machine is to be put into working order, we must 
first know where and how it is out of order; and we 
must know too when it is beyond repair. Treatment 
is empirical or rational. By the first, as we learn by 
experience, we may sometimes do much good; and, 
though we cannot explain the operation of the means 
we employ, we are bound to use them, if we are sure 
of their efficacy: this is very properly called rational 
empiricism. The true, rational method, however, 
should of course be adopted, so far as it goes. If one 
localizes the disease he is to treat, and knows the 
course it will probably take, he proceeds understand- 
removes the obstacles to recovery, follows the 
guidance of nature, and trusts mainly to her efforts 
and resources: he knows when to interfere, and when 
to let alone. The difference between the scientific 
practitioner and the empiric, regular or irregular, is 
never better seen than in the treatment of incurable 
disease; where the one desists from all active measures 
that have not some definite object, whilst the other 
harasses his patient to the last with worse than use- 
less experiments. 
In the study of morbid anatomy, there is some cause for apprehension that its importance may be over- 
estimated ; that we may think too much of the physical 
effects of disease, and not sufficiently discriminate 
between the different states of the system under which 
they are produced. We know, for instance, that 
certain forms of external inflammation yield to a 
mode of treatment which in others would only ag- 
gravate the disease; and so it would seem to be with 
some internal affections. Puerperal peritonitis, for 
instance, may require active depletion in the sporadic 
form; and the very opposite course, of tonics, when 
epidemic. 
Morbid anatomy has so far been considered in its 
relation to pathology; but it is interesting, in another 
point of view, to the philosophical anatomist. Struc- 
tures are developed under disease that we know to 
exist in the lower animals, and infer in man from the 
functions performed, but which we cannot detect in 
the healthy state of the organs. A striking illustra- 
tion of this remark I once met with in the case of the 
gall-bladder, a muscular coat being developed in it that 
to the naked eye was quite as distinct as it would have 
been in the intestine; and this development took place 
in consideration of the general law in morbid anatomy, 
that, when a mucous membrane is inflamed, the 
muscular coat external to it tends to hypertrophy: in 
this case, the mucous membrane was in a state of 
intense acute inflammation, and the cavity of the organ 
was filled with pus. The muscular coat is palpable 
enough in the intestine and in the trachea, but in the 
case of inflammation it becomes still more so: in the 24 
trachea, however, this result may be owing to the effort 
made in coughing and expectoration. Another very 
striking example of muscular development is to be 
found in the case of the uterus: this structure, which, 
in the unimpregnated condition of the organ, is not 
apparent to the naked eye, becomes sufficiently deve- 
loped in the gravid state; but I have never perhaps 
seen it so marked as it has been in some cases of 
fibrous tumor of the organ of long standing. 
An entire organ even may be hypertrophied, and 
developed in all its parts, as the result indirectly 
of disease, and directly in consequence of an addi- 
tional duty that it has to perform. This is a case of 
simple hypertrophy, and as much so as that of the 
voluntary muscles, which become so developed by 
exercise; the cases to which this term is usually 
applied being generally complicated with structural 
changes. If one kidney is destroyed, the other is said 
to enlarge; though I have never seen an instance of 
it. Hypertrophy of the lung, however, I have more 
than once seen ; and some years ago I met with a very 
remarkable case of it. A young man died of tuber- 
cular disease of the right lung ; in infancy he had had 
some disease upon the left side, which so entirely 
destroyed the lung that nothing remained, in its place, 
but a layer of compact cellular tissue, in which the 
bronchi still ramified to some extent, but in which 
probably no trace of an air-vesicle had existed for 
years; the heart lay far back in the left side, by the 
side of the spine; and the right lung, which was not 
very extensively diseased, was about double its usual 25 
size; the structure of this last, except for the tuber- 
cular affection, being as perfectly normal as the biceps 
muscle would be in a blacksmith’s arm. 
As general anatomy is illustrated by an examination 
of the organs in a state of disease, so is physiology; 
parts that we may suppose to be essential to a healthy 
condition of the system being destroyed, and without 
any manifestation of disturbance during life. The 
serous cavities that seemed to be so admirably adapted 
to the constant play of the organs may be obliterated 
by adhesions; and, in the case of the lungs and heart 
at least, I think it may be said that the freedom of 
action seems often to be not at all impaired. One lung 
or one kidney may be destroyed, and the individual 
thrive nearly as well as if he had two. The spleen 
is an organ about which we know very little, physio- 
logically: it may be supposed to be of some use, 
however, and yet its extirpation upon animals has been 
rather a favorite experiment, and no very serious con- 
sequence has seemed to follow; and so it may become 
completely atrophied, as the result of disease, with 
nothing to indicate it during life. I have seen it so 
reduced in size that it was with difficulty found; and, 
from its appearance, it must have been in the same 
condition for a long period before death. The gall- 
bladder is an organ that exists in some of the 
mammalia, and not in others; and there is no general 
physiological law connected with its presence or 
absence. A priori, then, we should not expect any 
great disturbance of the functions, if it should happen 
to be cut off from its connection with the liver; and 26 
such is shown to be the fact. The cystic duct may be 
obliterated by adhesions, and the gall-bladder is then 
as completely wanting to the individual as if he had 
been born without one; and yet the functions may be 
sufficiently well performed, so far as I have been able 
to ascertain in these cases. Some structural changes, 
like malformations, seem to be experiments designed 
by nature for physiological observation. 
The method of conducting a post-mortem examina- 
tion is a point of considerable importance. It should 
be done with all possible neatness and despatch. It 
should be done with decency, both in respect to our 
own deportment, and in regard to the subject of exami- 
nation also; personal exposure being generally quite as 
unnecessary and improper in the dead as it is in the 
living; though I am sorry to say, that, in the examina- 
tion of the latter, this point is not always regarded 
as it should be. There is no reason why the body 
should, in any way, be disfigured; but, on the contrary, 
it should be left in a better condition to be viewed, 
in consequence of the examination having been made. 
An examination should be made methodically. It 
does not matter so much what the method is; but all 
the organs should be examined in every case when 
possible, and in a way to show best the structural 
changes if there be any. Parts are sometimes removed 
in so bungling a manner that very little can be made 
out afterwards respecting them. I once saw a most 
distinguished pathologist mistake acute pneumonia for 
tubercular disease; and he maintained his point obsti- 
nately until the different parts were put together in 
their proper relation, and the disease was shown in its 27 
successive stages; the two diseases, as above remarked, 
sometimes resembling each other most strikingly, if, 
as the mineralogists would say, we take only “ hand 
specimens ” for examination. We should trace the 
origin and progress of disease as well as its seat. We 
naturally look to the part where it is most advanced ; 
but on the confines we sometimes see it in the bud; 
and it is with these slight variations of structure that 
we should particularly familiarize ourselves. All 
the organs should be examined if possible, I say, as 
appearances are often found that had not been expect- 
ed ; and the case of our illustrious fellow-citizen, the 
late Secretary of State, is in point. He died from 
disease in the abdomen; and, though there had been 
cerebral symptoms, they were slight and ill-defined, 
and had hardly been thought of. The head, how- 
ever, was examined, and appearances were there 
found which showed that he had undergone, at some 
former period, a most severe attack of disease within 
the cranium. 
It may seem hardly necessary to insist upon a 
knowledge of healthy anatomy, before one undertakes 
to examine and decide upon the organs in a state of 
disease; and yet the most gross mistakes are occasion- 
ally made. In medico-legal investigations especially, 
the liberty and even the life of an individual may be 
endangered by the incompetence of the person who 
makes the post-mortem examination. I have known 
the nerves to be mistaken for the lymphatics, the kid- 
ney for the spleen, and that too after a scrutinizing 
examination, and an ovarian cyst to be described as a 
urinary bladder. A great deal of anatomy is taught 28 
that seems to be of no use, physiologically or practi- 
cally; the physical character and relations of the 
internal organs, and the appearance of the different 
tissues, being comparatively neglected. 
The pseudo-morbid appearances, as they may be 
called, deserve especial attention, as they often lead to 
error. There are, I believe, natural variations in the 
organs as there are in the external parts. They vary, 
too, according to the age of the subject. They 
vary according to the character of the disease of 
which the patient has died; as it is more or less 
chronic, as the blood is more or less impoverished, and 
as the vital powers are more or less reduced. They 
vary according to the mode of death ; changes taking 
place sometimes just previously to or during the act 
of dying, or even after death, that may be mistaken 
for disease. Of these changes, congestion is perhaps 
the most frequent; and so nearly does it sometimes 
resemble the first stage of inflammation, and especially 
in the lungs, that I believe it would be impossible for 
the most skilful anatomist to distinguish the two if 
taken apart, though it might generally be done if all 
the circumstances of the case were considered : as the 
public are deceived by the cadaveric discoloration of 
the depending parts of the body externally, so we 
often are ourselves by a corresponding condition of 
the internal organs. The redness of the stomach 
sometimes observed in persons dying suddenly during 
the process of digestion, and first described by Dr. 
Yelloley, is very important to be noticed; as, consid- 
ering the circumstances under which it is observed, it 
might be mistaken for the effects of a corrosive poison. 29 
Redness of Peyer’s glands I have also several times 
noticed under the same circumstances, though the 
observation has not been confirmed by others, so far 
as I am aware: the appearance is similar to one that 
is occasionally met with in various infantile diseases, 
as in the exanthemata, croup, pneumonia, and convul- 
sions. Cadaveric softening of the stomach by the 
action of the gastric juice is, to a greater or less ex- 
tent, an extremely common appearance ; and it is very 
often misunderstood, or mistaken for the effects of 
disease. The whole subject would seem to have been 
sufficiently set at rest by Mr. Hunter’s original obser- 
vations, and to have rendered the abundant confirma- 
tion they have received since his time unnecessary ; 
and yet many of the continental pathologists seem 
hardly to realize the true state of the case; the appear- 
ance in question having been generally attributed by 
them, until of late years, to inflammation, and being 
still so regarded by many at the present day. A few 
years ago, I saw a stomach that had been removed from 
a person who was suspected to have been poisoned, 
and who was disinterred for examination: softening 
of the mucous membrane was found; and, the nature 
of it being misunderstood, the discovery did but little 
towards allaying the excitement that already existed. 
And here may be mentioned those impostures which 
nervous females sometimes practise, and which a know- 
ledge of morbid anatomy will enable us to detect. 
In concluding my remarks upon the subject of this 
address, I feel how inadequately I have performed my 
task, and how much more forcibly the importance of 
the subject might have been set forth. Medicine is 30 
not one of the exact sciences, and the attempts that 
have been made to place it in that rank have suf- 
ficiently shown its imperfections. There are too 
many elements at work; and we must observe their 
operations, but not undertake to draw the line of 
action for them too closely. We must be content, 
then, to take medicine as it is. It has made a great 
advance towards exactitude of late years ; and I can 
see no course more likely to carry it forward than the 
one we are now pursuing, and in which Morbid Ana- 
tomy holds so prominent a rank. 
Before closing this address, Mr. President, I can but 
allude generally to those of our members who during 
the past year have been taken from amongst us ; many 
of whom were not merely honored by the profession, 
but most highly esteemed by the community. 
I should do great injustice, indeed, to my own 
feelings, and should be guilty of neglecting a sacred 
duty that belongs to me, in the position I here occupy, 
should I pass unnoticed an event that has so recently 
occurred in this community, and with which the mem- 
bers of our profession were so particularly connected. 
Of the crowd of human beings who were, on the occa- 
sion referred to, so suddenly hurried from life into 
eternity, three were Fellows of this Society; and they 
would probably, except for this melancholy catas- 
trophe, have been with us at this time. They have 
departed; but they leave behind them a name to 
which such a community as the one in which we live 
will ever do honor; honor due to them not merely for 
their high professional attainments, but for what makes 31 
the true man, — their moral worth. Two of our friends 
were past the meridian of life, but were still actively- 
engaged in professional practice, and with all the ad- 
vantages of a long course of personal experience; one 
of the many proofs of the estimation in which they were 
held being shown in the fact that they were each of 
them, at the time of their death, President of the 
Medical Society of the District in which they resided, 
and were thereby officially Vice-Presidents of the So- 
ciety at large. One of them, particularly, had been for 
many years a most active and influential member of this 
Society, and his loss must be sincerely felt. Their com- 
panion was younger in years; but, being highly quali- 
fied to gain and to maintain the respect and confidence 
of the community and the profession, he had already 
received a large share of public favor; and, if his life 
had been spared, there is no doubt that he would have 
held a high rank amongst us. It is not for me, how- 
ever, to eulogize the dead: those who knew them well 
have offered such a tribute of respect to their memory 
as they fully deserve, and as, I am sure, will be most 
acceptable to the Society. But, whilst we deplore the 
loss of those who were taken away, we cannot be suf- 
ficiently thankful that so many are here met together 
whose lives were in such jeopardy upon that sad 
occasion; and with what a fearful chance against 
them. Especially would we remember those of our 
associates, who, with three exceptions only, so entirely 
and miraculously escaped, when death in such an 
awful form was all about them. Hovering, as it were, 
upon the verge of eternity; and feeling, during those 
two or three moments of dreadful suspense, that amidst the crash and destruction the very gates of 
another world were opening before them, what must 
have been their sensations when they found that they 
had passed safely through the terrible crisis, and that 
they were once more amongst the living! It must 
have been a scene which they never can recall with- 
out a thrill of horror; but their lives were spared; 
and, in the name of this Society, I would offer to 
them our most sincere congratulations, as I would to 
the friends of the deceased our heartfelt sympathy* 
* This terrible accident occured on the 6th inst., at 10 o’clock, a.m. 
The railway train for New Haven had proceeded but forty miles on its way 
from New York, when it came to an open drawbridge at Norwalk, and was 
precipitated at once into the river below. As it was going, at the time, at 
full speed, the consequences may be imagined; but they were too awful 
to be described. The connection of the medical profession with the accident 
was owing to the fact that the annual meeting of the National Medical 
Association had just been held at New York, at which meeting it was esti- 
mated that there were present from the New England States not less than 
sixty or seventy members. 
The names of those of our profession who were in the cars at the time of 
the accident wrere as follows, so far as I have been able to ascertain them : — 
From Massachusetts — Drs. Abel L. Peirson, of Salem ; James M. Smith 
and James H. Gray, of Springfield; Ephraim Buck, J. Mason Warren, and 
George Bartlett, of Boston ; William D. Lamb, of Lawrence; Jonathan W. 
Bemis, of Charlestown; Joseph Roby, of Newton (Professor of Anatomy at 
Maryland University) ; Lemuel Dickerman, of Medfield; Daniel Thompson, 
of Northampton; and Charles H. Brown, of Ipswich. 
From Connecticut — Drs. Archibald Welch, of Hartford ; Samuel Beach, 
of Bridgeport; and Levi Ives, of New Haven. 
From New Hampshire—Dr. Josiah Bartlett, of Stratham. 
From Maine — Dr. Benson, of Waterville; and Dr. Tallcott. 
From the State of New York — Dr. William C. Dwight. 
There were also given the names of Drs. Evans, Bissell, Gloss, Nevins, 
Russell, Romer or Rainer, and George Elizur. 
Of the killed, there were Drs. Peirson, Smith, and Gray, of Massachusetts; 
Welsh and Beach, of Connecticut; Bartlett, of New Hampshire; and 
Dwight, of New York. 
Of those who were more or less injured, there were Drs. Bemis, Lamb, 
Dickerman, and Brown, of Massachusetts; and Ives, of Connecticut: but 
they are all understood to be doing well. 33 
OBITUARY. 
Since the last Annual Meeting of this Society, the follow- 
ing members have died: — 
Admitted, j 
NAME. 
Residence. 
Date of Death. 
Age. 
1803 
Winship, Charles W. 
Roxbury. . . 
Sept. 1852 
79 
1809 
Robbins, Peter G. . . 
Roxbury. . . 
May, 1852 
73 
1811 
Nichols, Andrew . . 
Danvers . . . 
March, 1853 
70 
1812 
Wellington, Timothy 
West Cambridge 
Mav, 1853 
70 
1821 
Peirson, Abel L. . . 
Salem . . . 
May 6, 1853 
58 
1824 
Clark, Shepard . . 
Hubbardston . 
October, 1852 
58 
1825 
Baker, George . . . 
Chelsea . . . 
Dec. 25, 1852 
56 
1825 
Shed, Joseph .... 
Danvers . . . 
April, 1853 
70 
1826 
Smith, Samuel . . . 
Williamstown . 
June, 1852 
73 
1832 
Bemis, David .... 
Chicopee. . . 
October, 1852 
54 
1832 
Atkinson, John . . . 
Newbury port . 
August, 1852 
53 
1835 
Clarke, Prancis . . 
Andover . . . 
July, 1852 
38 
1835 
Partridge, Warren . 
Princeton . . 
Feb. 1853 
55 
1839 
Glazier, Amory . . 
Pall River . . 
1852 
69 
1841 
Smith, James M. . . . 
Springfield . . 
May 6, 1853 
1841 
Savery, Phineas . • 
Attleborough . 
May 19, 1853 
53 
1844 
Stanly, Selim A. . . 
Attleborough . 
Oct. 18, 1852 
43 
1844 
Stevens, Justin E. . . 
Boston . . 
Dec. 17, 1852 
30 
1846 
Chapman, Thomas L. . 
Springfield . . 
1853- 
1847 
Gray, James H. . . . 
Springfield . . 
May 6, 1853 
34 
1847 
Wadleigh, John B. 
Haverhill . . 
June 11, 1852 
32 
1849 
Bartlett, Benjamin D. 
Lowell . . , 
Peb. 1853 
63 
1849 
King, Charles A. . . 
Abington . . 
Dec. 1852 
26 34 
ABEL L. PEIRSON, OE SALEM. 
Boston, May 23, 1853. 
My Dear Sir,— I readily comply with your request that I 
should give a brief sketch of the life and character of Dr. 
A. L. Peirson. I must premise that I may do it with a 
partial hand; for he was a friend to whom I have been 
warmly attached for forty years. 
Dr. Peirson was the son of the late Samuel Peirson, Esq., 
of Biddeford, Maine. He was born on the 25th of Novem- 
ber, 1794, and was therefore in the fifty-ninth year of his 
age, at the time of his late lamentable decease. He entered 
our College at Cambridge, as Sophomore in 1809; and ac- 
cordingly was graduated in 1812, not yet eighteen years 
old. He then became a pupil of mine to study medicine, 
and was graduated Doctor of Medicine in the University at 
Cambridge in 1815. I can testify that he pursued his 
medical studies with industry and hearty zeal. He did not 
look to the letter only, but sought out the spirit. Without 
austerity, he was strictly moral in his course of life, and he 
acquired the esteem of all to whom he was much known. 
Before his pupilage was ended, a friendship was formed 
between us, over which there has never passed a cloud to the 
day of his death. Our intercourse was always unreserved, 
and exceedingly pleasant; and I was frequently indebted to 
him for kindnesses, which I shall always love to remember. 
Dr. Peirson entered on the business of his profession in 
the town of Vassalboro’, Maine; but he did not remain 
there quite a year and a half. His success was as great 
as he expected, yet he felt that he was in too small a 
place. He wished also to be near those with whom he 
might hold useful professional intercourse. Early in 1817, 
he removed to Salem, where he spent the remainder of 
his life. He had very respectable relatives, on his moth- 
er’s side, in that ancient town. Before his removal, or 
soon after, he became attached to his cousin, Miss Har- 35 
riet Lawrence; and to her he was united in marriage in 
1819. He did not obtain a large share of the most 
lucrative business in Salem; but he was always well em- 
ployed, and maintained a highly respectable character in 
his profession. He never ceased to study, and always 
kept himself well informed as to the useful additions made 
to medical science. He was among the first to become 
acquainted with Laennec’s method of exploring the chest 
for the physical signs of its diseases. At the same time, 
he gave great attention to surgery; and he acquired, very 
justly, a high reputation in that branch of practice. He 
was industrious in business, careful in his investigation of 
the cases to which he was called, skilful and judicious in 
his treatment of them. He loved his profession, and most 
especially the opportunities it gave him to exercise his 
benevolent feelings. He gave his heart to his patient; and, 
forgetting himself, he thought only of what might aid 
and comfort the object of his care. For many years he 
was very much employed in consultations throughout the 
larger part of Essex County, more especially in surgical 
cases; and probably he performed more operations in that 
county, within the last twenty years, than any other man. 
Dr. Peirson was an active Fellow of the Massachusetts 
Medical Society, and for many years was one of its Coun- 
cillors. Their records will show that he was almost con- 
stantly serving on the committees of the Councillors. He 
was also an active and useful member of the Essex South 
District Medical Society. He was for some years President 
of that Society; and he was in that office at the time of his 
decease. Among his brethren he was highly esteemed, 
and by many of them much beloved. He was a member 
of the American Academy of Arts and Sciences, and for 
several years one of the Consulting Surgeons of the Mas- 
sachusetts General Hospital; and he was as attentive at 
the meetings of the one, and to the duties of the other, as 
if he had resided in the city. 
Dr. Peirson was an active and useful citizen, and always 36 
agreeable in private society. He was much interested 
in every cause which promised benefit to the public, and 
was always ready with a helping hand. He loved social 
intercourse. He was joyous, and promoted joy in others, 
while he encouraged every thing which could elevate and 
improve the community in which he lived. He was open- 
hearted and frank, warm and generous in his feelings, and 
always faithful in his attachments. He was sagacious in 
discriminating characters, but was more disposed to praise 
than to condemn others, and was especially ready to give 
full credit to his brethren who were his competitors for pro- 
fessional rank. 
Dr. Peirson’s death was sudden, and made so strong an 
impression on the feelings of the community, that it is 
needless to recapitulate the particulars respecting it at the 
present time. The bereavement to his family cannot be 
stated too strongly. He was tenderly alive to every sensa- 
tion and every wish of his wife and children. But I forbear 
to say more of them. His fellow-citizens manifested the 
warmest sympathy and the deepest sorrow on the melan- 
choly occasion of his death: hence it became necessary to 
have the funeral solemnities performed in the church where 
he had been a worshipper. The Rev. Dr. Worcester gave 
a sermon on the occasion. The church was thronged, and 
had not room for all who sought admission. The commu- 
nity justly felt that they had lost a true man, who had 
lived for others, not for himself. 
His widow and five children survive him; three sons and 
two daughters. The oldest son has been several years 
engaged in the practice of medicine in Salem. His young- 
est has very nearly completed his education as an engi- 
neer at the Scientific School in Cambridge. They all feel 
that they have lost their best earthly friend; but they all 
submit, without undue repining, to the will of God. 
I am affectionately yours, 
James Jackson. 
Dr. J. B. S. Jackson. 37 
JAMES M. SMITH, OE SPRINGFIELD. 
Baltimore, May 18, 1853. 
My Dear Sir, — I thank you for the interest which you 
kindly take in what relates to my poor brother, and shall 
cheerfully comply with Dr. Jackson’s request, in furnish- 
ing such facts as I possess. My brother and myself have 
been, as you know, located remotely from each other nearly 
all our professional lives; and, therefore, professionally, I 
know less of him than do his other brothers. 
Dr. James M. Smith graduated in Medicine, March, 1827, 
from Jefferson College, Philadelphia, while I was Professor 
in that Institution. He was the office-pupil, first of my 
father, and subsequently of myself. 
Soon after his graduation, occurred the death of our 
father; and my brother was then thrown upon his own 
resources. 
He first settled in the town of Westfield, Mass.; and, 
after the probation which all young physicians toil through, 
he succeeded in acquiring a respectable practice, and, with 
it, the respect and confidence of a discerning community. 
Soon after settling in Westfield, he married Miss Page, 
of Massachusetts. 
In the autumn of 1839, at my solicitation, my brother 
came to Baltimore for the purpose of taking charge of' my 
practice, during a considerable period of my absence from 
the city. On my return, I found him possessing the entire 
confidence of my patients, as well as their cordial esteem. 
So favorable and lasting an impression, indeed, did he leave 
in this community, that his untimely and dreadful death 
has here created a sensation scarcely less vivid than in the 
place of his late residence. In this community he was 
remarkable for conscientious zeal in the acquisition of 
knowledge, and the application of it for the benefit of his 
patients. That which does more toward inspiring confi- 38 
dence than any thing else, — his patients soon discovered 
that he was deeply interested in their safety. After each 
period of my absence from the city, he restored my practice 
to me undiminished. 
He would have remained in Baltimore, and would un- 
doubtedly have acquired a large and lucrative practice; but 
the delicate health of his wife, and her earnest desire to be 
near her relatives in Massachusetts, induced him to return 
to New England; and, on doing so, he located himself in 
Springfield. The prestige of a good name, already estab- 
lished in that vicinity, commended him at once to the good 
offices of that community, and he soon acquired an envia- 
ble rank as a practitioner and as a man. At the time of his 
death he was, I believe, regarded in that town as at the 
head of his profession. 
While my brother was in Baltimore, he furnished to the 
“ American Medical Journal ” a paper on Necrosis, the 
principles advocated in which, were illustrated in several 
cases appended. He contended for the necessity, at an 
early period in the progress of the disease, of dividing the 
periosteum, and often perforating the bone, for the purpose 
of giving issue to pus, the confinement of which, in the 
cavity or cancelli of the bone, is the immediate cause of its 
death and sequestration. His cases presented striking in- 
stances of the success of that practice. 
While my brother was resident in Baltimore, there oc- 
curred a remarkable occasion for the exercise of qualities 
which mark the judicious and intrepid surgeon. A lad had 
suffered terrible compound fracture of both thighs by a rail- 
road car. The council of surgeons present were divided 
in regard to the propriety of amputation. My brother 
strongly urged the operation, on the ground that speedy 
death was the inevitable result of the omission of it, and 
that recovery was the possible issue of the bolder course. 
He declared his willingness to assume the responsibility of 
the operation; and the case was placed in his hands. He 
amputated both thighs in quick succession; and, although 39 
the exhaustion of the patient was extreme, reaction resulted,, 
and the patient recovered. The amputations were per 
formed so high as to be almost equivalent to amputations 
at the hip-joints; and I regard it as one of the most remark- 
able cases in the history of amputations. 
The subject of the operation is now living, an industrious 
and useful citizen, although without a vestige of a lower 
extremity. 
With great respect, yours truly, 
G. C. Shattuck, Jun., M.D. 
N. R. Smith. 
JAMES HARRISON GRAY, OF SPRINGFIELD. 
For the following notice the Society is indebted to Mr. 
David A. Wells, the editor of the “ Scientific Annual,” and 
a personal friend of Dr. Gray : — 
Dr. Gray was born at Portsmouth, N.H., in 1819. His 
father was Harrison Gray, Esq., long a resident of Boston, 
and a leading partner in the formerly well-known publishing 
house of Hilliard & Gray. Dr. Gray removed to Boston 
when he was seven years old, and was for some time a 
member of the Academy at Exeter, where he completed 
a preparatory collegiate course, but afterwards relinquished 
the design of entering college. His medical studies, which 
were commenced with the late Dr. Henry Tuck, of Barn- 
stable, were afterwards pursued in Boston; and he took his 
degree in 1840, at the Medical School of Harvard College. 
Dr. Gray commenced the practice of his profession in En- 
field, Mass., in 1842, and remained there until the year 1844, 
having secured a large country practice, when he removed 
to Springfield, which became his residence up to the period 40 
of his death. For the last few years, Dr. Gray’s general 
practice in Springfield as a physician and surgeon has been 
very large; and he had greatly endeared himself to a nu- 
merous circle of friends and citizens. As a consulting 
physician, his services were often called into requisition in 
the towns on the east of the Connecticut River, in the 
vicinity of Springfield, perhaps to greater extent than any 
other physician of that district, especially after the death of 
Dr. Gridley, of Amherst. 
Dr. Gray was a man of great refinement of manners, 
highly cultivated in his tastes, and most ardently devoted to 
his profession. He was well read, not only in professional 
learning, but also in various other branches of literature 
and science, particularly in chemistry. In 1851, Dr. Gray 
was elected a member of the American Association for the 
Advancement of Science. At the time of his death by the 
catastrophe at Norwalk, Dr. Gray occupied the same seat 
with Dr. Smith of Springfield, in the immediate vicinity of 
Drs. Pierson and Bartlett; the four being probably engaged 
in conversation together. Dr. Gray had left the rear car of 
the train, and joined the above party, about ten minutes 
only before the occurrence of the accident. 
His age, at the time of his decease, was thirty-four. His 
family consisted of a wife and four children. 
TIMOTHY WELLINGTON, OF WEST CAMBRIDGE. 
The following notice of Dr. Wellington was furnished, 
at my request, by Dr. B. E. Cotting, of Roxbury: — 
Dr. Wellington was born at Lexington, of respectable 
but not wealthy parents, October 8, 1781. Early desirous 
of an academic education, his youth was passed in self- 
culture, and in earning the means for further progress. He 41 
entered Harvard University, at an advanced standing, in 
1803. Performing there with cheerfulness and alacrity the 
services then required of beneficiaries, he maintained a 
respectable position in his class, and graduated in 1806. 
In his senior year, he was permitted to attend a course on 
anatomy by Dr. John Warren, on condition of taking care 
of the lecture-rooms. Becoming deeply interested in these 
lectures, he abandoned his original intention of studying 
divinity, and, on leaving College, commenced the study of 
medicine with Dr. Waterhouse, at the United States Marine 
Hospital in Charlestown. Subsequently he studied with 
Dr. John Gorham ; at one time having charge, under that 
gentleman’s direction, of the Boston Almshouse; then, as 
since, a most desirable situation for the faithful student to 
acquire practical knowledge in all the branches of medi- 
cal science. During College vacations, he had taught 
district schools ; and he now maintained himself by instruct- 
ing private classes, while pursuing his professional studies. 
In 1809 he received the degree of Master of Arts. The 
same year he took, according to the custom of that period, 
the degree of Bachelor of Medicine: that of Doctor of 
Medicine was conferred upon him in 1811. He became a 
member of the Massachusetts Medical Society in 1812. 
In 1809 he commenced practice in West Cambridge, a 
town not long before formed of the north-western, or Meno- 
tomy, precinct of Cambridge. The place was then quite 
small; and its lucrative business, if any, was included in the 
extended circuit of Governor Brooks, the leading practi- 
tioner in that section of the country. The inhabitants gave 
him a kindly reception ; but it was necessary for him to eke 
out the first year’s scanty subsistence by teaching the village 
school in the winter season. Nevertheless, he struggled on 
hopefully; and in a few years his practice embraced the 
whole town and neighboring villages. Ever active and 
untiring, through the forty-four years of his practice, he 
never failed to answer speedily and faithfully any profes- 
sional summons, however unimportant. 42 
He took a deep interest in all the concerns of the town, 
contributing his time and energies to its advancement; 
but he would never consent to public service beyond its 
limits. He loved the science of agriculture for its own 
sake, having in youth labored on his paternal acres; and he 
cheered on its humble followers by precept and example. 
In the midst of his varied labors and duties, he found time 
for much reading and study; not confining himself to pro- 
fessional works alone, but making an acquaintance with all 
standard English writers, and keeping fresh his knowledge 
of the Latin classics. Very many of the more elaborate 
works on History he read aloud to his children. Delighting 
greatly in communicating knowledge, he generously ex- 
tended a helping hand, and unweariedly gave encouraging 
assistance, to such as he found striving for a better educa- 
tion ; a timely aid, which many now in useful and honorable 
life gladly acknowledge with heartfelt gratitude. In him the 
schools and other literary institutions of the place found 
their most active advocate and firmest supporter. He has 
left a legacy to the public library of the town. His love for 
his Alma Mater was ardent and unabating. He defended 
her with energy and effect when assailed by popular preju- 
dice ; and was always to be seen at her anniversaries and 
festive occasions. He was a staunch advocate, and an active 
member of the Massachusetts Medical Society. He was 
Councillor of the Society for more than twenty years, and 
its Delegate to the American Association on several occa- 
sions. He was also the President of the Middlesex District 
Society. 
He wrote but little, and published almost nothing; yet 
the manuscript volumes of some of his favored medical 
pupils, of notes of his discourses to them on the whole 
round of medical subjects, attest the extent and thorough- 
ness of his acquisitions. It is to be regretted that he could 
never be induced to make more public the results of his 
ripened experience and accurate observations. Though 
educated in the old school, he early became an advocate of 
the expectant method of practice. 43 
Dr. Wellington was twice married. By his first wife he 
had one son, now a physician of high respectability and in 
full practice. Two other sons and two daughters, with 
their mother, also survive him. By careful frugality he 
accumulated a moderate property, sufficient to continue 
to his family a respectable competency. He gave freely, 
but with discrimination; and maintained an unsullied honor 
in all his dealings. He never ignored the friends of his 
youth, and held ingratitude in utter abhorrence. 
Eminently social in his disposition, happy to the utmost 
in his family relations, the delight of the young and the old, 
the appearance of his silvered locks and radiant counte- 
nance was the signal for spontaneous gaiety and unreserved 
sociability. 
In the sick chamber, that unaffected sympathy with 
human suffering and apprehensions, which at once secures 
the confiding reliance of the afflicted; that gentle kindness 
of manner, which deprives of their terror the most fearful 
appliances; that unpretending and unostentatious aban- 
donment of self to the emergencies of the endangered; 
that cheerful, trusting serenity, which “ allures to brighter 
worlds” when hope faileth, — these, all of these, were his, 
and gave to his professional visits the highest charm and 
most potent efficacy. 
On Monday, the 2d inst., while preparing to go to New 
York, as a Delegate to the American Medical Association, 
he was seized with a severe pain in the left thorax, near the 
heart. This increased in severity during the night, but 
abated on the day following. On Wednesday he was able 
to go out. On Thursday he resumed his professional labors, 
visiting his patients till late in the evening of that day. 
At midnight he was awakened by a storm raging without; 
and, while remarking that it would have been a bad night 
to have crossed the Sound on the return-passage from New 
York, he was again seized with the pain in the heart, and 
almost immediately expired. In the midst of life, he was 
in death; departing, as he had always wished, before his 
usefulness had ceased, and without a struggle. 44 
Thus passed away a devout man, pure in heart, and 
of exemplary life. The community where he dwelt have 
met with an irreparable loss. The guide and kind adviser 
of the young, the wise counsellor, the peacemaker, the 
faithful and enduring friend, the good physician, has been 
taken from them. That beautiful town will henceforth 
bear a saddened aspect to its returning children as they 
cross its borders; and many a tear of heartfelt sorrow will 
be dropped at the grave of its greatest benefactor, Dr. 
Wellington. 
May 28, 1853. 
PETER GILMAN ROBBINS, OE ROXBURY, 
A friend of Dr. Robbins has sent the following no 
tice: — 
Dr. Peter Gilman Robbins was the son of the Rev. 
Dr. Chandler Robbins, of Plymouth, Mass., and was born 
at Plymouth, December 10, 1779. He entered Harvard 
University; but in 1799, while in the junior year, was 
deprived of the means of continuing there by the death of 
his father. He left College, therefore, and went a voyage to 
Calcutta. On his return from the East, he studied medicine 
for a time with Dr. Thomas Kittredge, of Andover. In 
1808 he commenced the practice of his profession at Lynn, 
and became a member of the Massachusetts Medical So- 
ciety in 1809. 
In December, 1817, he removed to Roxbury, and there 
continued to practise, more or less, until the year 1850. 
In January, 1850, while on his way to Plymouth, he was 
severely injured in the hip-joint by a railroad accident. 
Thus made a cripple, he never fully recovered his previous 
health; and he died May 18, 1852, aged seventy-three 
years. 45 
ANDREW NICHOLS, OE NORTH DANYERS. 
We are indebted for the following sketch to Dr. Samuel 
A. Lord, of Danvers : — 
Andrew Nichols was born in North Danvers, Mass., on 
the 22d of November, 1785. He never received a collegiate 
education; but from his earliest life manifested a mind of 
strong powers, of great inquisitiveness, and a restless ear- 
nestness to know more and more. He knew no idle hours. 
He had no indolent nor indifferent feelings and habits. He 
was active, attentive, thoughtful, generous even to a fault, 
honest, persevering, ardent in his temperament, so that 
some might have called him impulsive and hasty. 
His time and attention were wholly devoted to his busi- 
ness, not merely his practice, which was always large, but 
to all those collateral branches of science which would in- 
terest and aid him in the varied duties of his profession. 
He studied medicine principally with the late Dr. Water- 
house, of Cambridge, of whom he always spoke with great 
respect, and of whose professional zeal he largely partook. 
After receiving his degree as a medical practitioner, he 
commenced practice in South Danvers, in 1806, at the early 
age of twenty-one. 
He was one of the early Councillors of the Massachusetts 
Medical Society, of which he became a member in 1811, and 
retired in 1846. 
He was, for many years, President of the Essex (South) 
District Medical Society, and was succeeded by the late 
lamented Dr. Peirson, whose great worth as a man and 
physician will be spoken of by another. 
For thirteen years he was Treasurer of the Essex Agri- 
cultural Society, and one of its most valuable members. 
In 1833, at the formation of the Essex Natural History 
Society, more recently styled “the Essex Institute,” Dr. 
Nichols was elected President; which office he held until 46 
his resignation in 1845, and since which time he continued 
to be an active and valuable member till his death. 
He was frequently appointed to places of trust and 
responsibility in his own town, giving evidence of the great 
confidence which his fellow-citizens always had in him. 
He possessed a strong physical constitution, was of large 
frame, had a fine head, with a strikingly marked benevolent 
countenance. He continued in full vigor of mind and body 
until his last sickness, with which he patiently lingered for 
several weeks, until the evening of the 80th of March, 1853, 
when he expired at the age of sixty-seven years. 
Such was the more public life of our late friend. 
But he possessed other qualities which will far outlive 
those we have mentioned, in the memory of his friends. 
He had a power of character, an activity of mind, and a 
noble and widely known kindness of heart, which will affix 
a more lasting monument to his memory than all the names 
and emoluments of earthly honor could do. 
He had from the first an extensive practice. He was to 
very many the beloved physician. Throughout his entire 
course of practice, he was always prompt and ready at his 
bidding to the sick-chamber. He started as quickly and 
willingly for the poor as for the rich. In season and out of 
season, by day and by night, he gladly went forth to do 
what he could to alleviate the sufferings of the sick, and to 
soothe the agonies of the dying. And, despite the slander 
which many cast upon our profession, I have known him, 
in these later years, to mourn as a child, at the sick and 
dying bed, at the sorrows and grief of the afflicted. And 
it was no false feeling. For he was remarkable for the 
depth and truth of his feelings. They were so strong, that 
oftentimes, when duty called him to scenes of suffering, he 
would gladly have hastened the other way. But he would 
never flee from duty. He was true and steadfast to his 
trust even to the end. Many who have known his kind- 
ness, and enjoyed his watchful attention in their distressful 
hours, will fondly and long think of him, and mourn that 47 
his presence and skill can no longer relieve their pains, and 
heal, their sickness. 
He loved, almost with a reverential feeling, his profession. 
He was kind and honorable in all his relations and inter- 
course with its members, whether young or old. He never 
harbored resentment nor suspicion, but was ever ready to 
assist by his counsel, and benefit by his advice. 
He grew in his profession. He kept pace with its pro- 
gress. He studied till he died, that he might know more 
and better of the intricacies of disease, and be more skilled 
in the best and most approved methods of treatment. 
He may, at times, have been over-confident in the proba- 
ble success of newly discovered therapeutical agents; but, 
at all times, he was considerate and cautious. He was not 
without zeal; but his zeal was generally regulated by an 
intelligent judgment. He was the author of several articles 
on medical subjects, which appeared in different medical 
journals. In 1836 he delivered the Annual Address before 
the Massachusetts Medical Society, on “ Irritation of the 
Nerves,” which was regarded as an able discussion, and is 
preserved in the printed volumes of the Society. 
Botany, both general and medical, was a favorite and 
absorbing study with him; and it was his delight to with- 
draw from the trying and frequently fatiguing scenes of the 
sick-room, and ramble in the fields and forests in search of 
plants and flowers. He made such recreations his study, 
and thus attained to that knowledge of botany and natural 
history which gave him an enviable reputation among sci- 
entific men. Many of our most eminent men in these 
branches of science sent to him for information and instruc- 
tion ; and his name is frequently found connected with some 
society or organization whose object was the advancement 
of Natural Science. His mind seemed to be invigorated 
by such pursuits, and his heart was thus often touched with 
reverence and wonder; and so from Nature he would look 
up, and humbly worship the author, the God of its creation. 
It would be a lengthy but pleasant task to give the full 48 
character of Dr. Nichols in his relations to these studies; 
but there is not space in any brief sketch. 
His example should be studied and imitated by those 
who would rightly regard the importance and interest of 
such pursuits. Nature never ceases to instruct the willing 
mind. The careful and constant study of her varied works 
will continually open rich fields of inquiry and useful 
knowledge. 
Dr. Nichols was possessed of a large degree of literary 
taste. He read and thought much. In conversation, 
especially on a subject of interest to him, he was usually 
both animated and instructive. He has left behind many 
printed addresses on a variety of subjects. 
In 1811 he delivered an address to the officers and breth- 
ren of the Jordan Lodge of Freemasons, in Danvers, of 
which body he was the first Master. And from the begin- 
ning of his connection with them, he held a high and 
esteemed rank as a worthy and faithful member. In 1831 
he wrote and published a poem on the “ Spirit of Freema- 
sonry.” 
In 1819 he delivered an address in his native town on 
“ Temperance and Morality,” which was printed, and which, 
at this day, might again be delivered and read with profit; 
for it must be doubted whether any great advance has been 
made in these respects since that time. Dr. Nichols was 
always warmly interested in whatever would tend to im- 
prove the social and moral condition of his fellow-citizens. 
In 1852, June 16, at the centennial celebration of the 
town of Danvers, he took an active part. He wrote a poem, 
adapted to the occasion, entitled “ Danvers,” which is pub- 
lished, and contains matter of much interest to all who were 
interested in that day, or who look upon Danvers as their 
home and native town. It possessed great merit, and 
reflected much credit upon its author. All who were pre- 
sent at that time will remember his appearance, and how 
animated, cheerful, and happy he was. 
But we will close our sketch by a brief allusion to his 49 
more private character. Dr. Nichols possessed, what is so 
rare in many, an unusual sense of personal honor, and self- 
respect. He was very scrupulous of saying aught against 
the rights of his fellow-men. He could never wound the 
feelings or confidence of any one by a miserable, and des- 
picable suspicion. No unkind feeling, no slander, no malice, 
ever reached his heart. This was impossible. No harsh 
or unkind expressions, or mean insinuations, could escape 
his lips. He could harbor no resentment. And if ever, in 
times or scenes of excitement, he lost his natural good tem- 
per, it was but for a moment. He would quickly forgive. 
He would forget, that he, too, might be forgiven. That 
charity which suffereth long and is kind was his, and sel- 
dom failed him through his long life. How many, how 
many, have been the recipients of it! 
A religious character, which is the summit of true great- 
ness, was not wanting in him. When not prevented by the 
imperative calls of business, he was always in his place at 
church, and took an active interest in its welfare. 
He venerated the truths of his religion. An interesting 
fact with regard to him was his habit of noticing his birth- 
days : he would often celebrate them in verse ; and, on his 
very last, he wrote at some length on the probable shortness 
of his life, and all in a very humble and devotional strain. 
But the honored physician, the respected citizen, the kind 
friend, has gone from us. May his example ever be fresh 
in our memory; may his good deeds stimulate us to the 
same; that when we, his brethren, shall go to our rest, we 
can look back upon lives as well spent as his. 50 
The two following notices were received from Dr. Thad- 
deus Phelps, Secretary of the Bristol District Medical 
Society: — 
Selim A. Stanly, M.D., aged forty-three years. Dr. S. 
was born in Attleborough; practised his profession in Bel- 
lingham and Franklin; and finally came back to his old 
home to die of consumption, Oct. 18, 1852. 
Phineas Savery, M.D., aged fifty-three years. Dr. S. 
was bom in Wareham, and graduated at Brown University 
in 1824. He practised his profession in Attleborough for 
twenty-six years, and died of paralysis, much esteemed and 
universally regretted by a large circle of friends and pa- 
tients. 
The “ Boston Medical and Surgical Journal,” for June 1, 
1853, contains a notice of Dr. Savery; and also one of Dr. 
Welch, of Hartford, Conn., who was killed, at the time of 
the accident, at Norwalk. ERRATA. 
Page 32.—The whole number of Delegates from the New England States, who 
attended the late meeting of the National Medical Association, was 163, according to 
the report of the proceedings of the meeting, published in the “ New York Medical 
Times ” for the present month, June 8. 
Page 33. — The name of Dr. Thomas L. Chapman was placed upon the list of 
deceased members, upon the authority of a physician from his neighborhood. It 
appears, however, that Dr. Chapman attended the late meeting of the Medical Asso- 
ciation at New York as a Delegate.