* ■M,i*™^*mmmm
Medical Problems  op the  Day.
THE
ANNUAL  DISCOURSE
BEFORE THB
MASSACHUSETTS  MEDICAL  SOCIETY,
JUNE  3, 1874
BY
NATHAN ALLEN, M.D., LL.D.,
        LOWELL, MASS.
          BOSTON:
A. WILLIAMS & CO.....135 WASHINGTON STREET.
       1>avid Clapp & Son, Printers.
            1874. 
 
 
 
Medical  Problems of  the Day.
the
ANNUAL  DISCOURSE
BEFORE THE
MASSACHUSETTS MEDICAL  SOCIETY,


             JUNE 3, 1874.


                  BY

        NATHAN ALLEN, M.D., LL.D.,
                LOWELL, MASS.
                  ■■A

          BOSTON:
A. WILLIAMS & CO.....135 WASHINGTON STREET.
       David Clapp & Son, Printers,
            1874. 
 
THE  MEDICAL  PKOBLEMS  OF  THE DAY.
BY NATHAN  ALLEN, M.D.,
          OF LOWELL.
Read at the Annual Meeting of the Massachusetts Medical Society,
                   June 3, 1874.*
Mr.  President  and Fellows
      of the Massachusetts Medical Society:—=
Gentlemen :
      To be the mouth-piece of the largest and one
of the oldest medical societies in this country is an
honor and position of no ordinary character.  In
1781, ninety-three years ago this very month, was
organized the Massachusetts Medical Society.  This
occurred  in the  midst of the Revolutionary War,
and its founders were among the leading surgeons
in that war.  The object of the Society, as speci-
fied  in its  charter and  by-laws,  was not  only to
foster and build  up  a  skilful, learned and honor-
able profession, but to protect the community from
imposition and quackery.   Since its  organization
it has  had enrolled  in  its fellowship over three
  * At an Adjourned Meeting of the Mass. Medical Society, held Oct. 3,1860, it was
  Resolved, "That the Massachusetts Medical Society hereby declares that it does
not consider itself as liaving endorsed or censured the opinions in former published
Annual Discourses, nor will it hold itself responsible for any opinions or sentiments
advanced in any future similar discourses."
  Resolved, " That the Committee on Publications be directed to print a statement to
that effect at the commencement of each Annual Discourse which may hereafter be
published."
               2 
4
MEDICAL problems of the day.
thousand physicians, and has at the present time
over thirteen hundred members. Its first President
was the celebrated Dr. Edward A. Holyoke, and
the first annual dissertation read before it was in
1784, by Dr. Isaac Rand.  For over half a century
an  address has  been  given before the  Society
every  year, except  1830  and  1831, when the
appointees  failed by reason of illness.  To describe
the usefulness of this  organization, and its past
and present influence in this commonwealth, would
be no easy  task.
  One year ago I accepted with many misgivings
a duty from its hands which I attempt  this day to
discharge, realizing in  some measure, I trust, the
importance  of  the occasion,  and the favorable
opportunity it  affords  to say  something which
may advance the  interests of a noble  profession.
In entering upon  this duty,  I  find the following
sentiment of Lord Bacon most appropriate and
expressive:  "I hold,"  says he,  "every  man  a
debtor to his profession; from the  which  as men
of  course  do  seek to  receive countenance and
profit, so ought they of duty to endeavor them-
selves  by  way of  amends to  be a help and
ornament thereunto.  This is performed in some
degree by  the honest  and liberal  practice of  a
profession, where  men shall carry a respect not to
descend into  any course  that  is  corrupt and
unworthy thereof, and  preserve themselves from
the abuses  wherewith   the  same  profession  is
noted to be infected;  but much  more  is this
performed,   if   a  man be  able   to   visit  and 
        MEDICAL PROBLEMS OP THE DAT.      5

strengthen  the  roots  and  foundations  of  the
science itself,  thereby  not  only  gracing  it  in
reputation and dignity, but also amplifying it in
profession and substance."   The  first  sentiment
expressed here,  that is, an  "honest and  liberal
practice of a profession," with honorable conduct
and elevated  motive, is far easier  of  attainment
than that in the latter part of the  quotation, viz.,
to "visit and strengthen the roots and foundations
of the science itself."
   This is not easy.   The roots and foundations of
medical science have their germs,  their bases in
the primary laws of nature.   Her secrets must be
carefully  explored and closely scrutinized.   Thus
William  Harvey, one  of the most distinguished
lights  in  medical history, in bequeathing  a rich
legacy to advance this science, exhorts his  breth-
ren above all things  "to study and  search out the
secrets  of nature by observation  and experiment."
Though  we may be  unable to  follow in  the
footsteps  of these  illustrious expounders of  na-
ture's laws, we may, in some slight degree, catch
their spirit  and  imitate  their  example in  our
earnest researches  after truth.   Fully endorsing
the  sentiment contained  in these  quotations,
permit  me  to  invite your  attention  upon  the
present occasion  to what may properly  be  consi-
dered some of
     THE  MEDICAL PROBLEMS OF THE DAY.
  All periods  in  history are marked  by  some
particular events.   These  events may  be  trivial 
 6       MEDICAL PROBLEMS OF THE DAY.

 in  their character,  or  may involve  interests of
 great  magnitude.   In the history of  nations  it
 may be a  revolution  in  government, a  signal
 victory in  war, or the brilliant  achievements of
 individuals.  In the  history of science it may be a
 new discovery,  or a new  application of a great
 principle.  The whole history  of civilization has
 been marked by changes  of one  character * or
 another: but in  no  department  of  this history,
 perhaps, do we meet  with changes more  significant
 or  striking than in  that of medicine.   Having
 its  origin   some  three  thousand  years ago in
 Egypt, its  earliest records are involved in much
 obscurity,  and  made up of fabulous statements.
 It was intimately blended with the mythology
 of  the  times;  and  as  diseases  then  were sup-
 posed  to be  the visitations  of  evil spirits,  or to
 be  caused  by some offended deity,  their removal
 could be effected only by  a propitiation of such
 deities.  Among, the Grecians possessing a high-
 er  degree   of   refinement  and  culture,  more
 sensible  views   of- medicine obtained.    Hippo-
 crates, one of   the  most  remarkable   men that
 ever lived,  by introducing a more correct know-
 ledge  of the human body, as  well as of  the
 character of disease, was very justly styled  the
 "Father of Medicine."  Still, the philosophy,  the
mythology  and  superstition of the Greeks entered
largely into  all medical theories and  practices.
And even  though   the  boundaries of medical
knowledge  were extended by  experience  and
 observation,  and more  rational views  gradually 
       MEDICAL PROBLEMS OF THE DAY.      7

prevailed, speculation and  empiricism shaped and
controlled, in a measure,  all  investigations upon
the subject.
  The next great  light in medicine was Galen, a
man of commanding genius and profound learning.
He made still further advances in medical know-
ledge  and practice.   As  an illustration  of  the
state of medicine and of  the times, the opinions
and the  authority of Hippocrates and Galen
directed and controlled the  public mind in  all
such matters for over fifteen hundred years.  Then
came the pall of the Middle Ages, when the lights
of civilization were more or less obscured.  Nearly
all   medical  knowledge  was  engrossed by  the
Priesthood, and was confined to the cloister and
the monastery.  But early in the 16th century a
new era dawned  upon medicine.  For  the first
time, so far  as we have   any account, a  careful
dissection of the  human  body was made, and a
description of  it published.   This  honor belongs
to  Vesalius.   From  that period,  new  interest
sprang up with reference to the construction and
proper uses of the various  parts of the body; and
for three hundred years  the science of Anatomy
has  been  constantly  progressing,  so  that  the
structure of every organ in the body has come to
be very correctly understood.
  About the  middle of the 17th century, certain
important discoveries were made respecting  the
true functions of particular organs in the body,
so that the science of Physiology  then  took  its
start.  As this science progressed, the evidences 
8       MEDICAL PROBLEMS OF THE DAY.

became more and more marked, that alteration of
structure, and  also  of  function, constituted  or
followed a  morbid  and diseased  state of  the
system.  Hence we have the science of Pathology,
which  in the present century has made wonderful
strides.   There  is still another science—new,
comparatively,  and  more  important,   in  some
respects,  than   either of  the  others—that  of
Hygiene.    Upon these  four  pillars  must  be
reared the whole structure of  medical science.
Surgery and Therapeutics  are   distinct  depart-
ments of medicine, and may be regarded in their
practical application each as an art.  But medicine
as a science, strictly, is based upon Anatomy, Phy-
siology, Pathology and  Hygiene.   These have
their foundation in the  primary and unchangeable
laws of nature, and should be ranked among the
sciences, as much so as those of Natural History,
Geology,  Chemistry,  &c.    And  the   principal
reason  why  medicine  in its early history  made
so little progress was  because  the  facts  and
principles of these sciences were so imperfectly
understood.   The same reason still exists why its
progress is  so  slow, and  why  there is  such  a
diversity of opinions  on most medical  subjects.
"When  the  facts and laws  of Pathology and
Hygiene become thoroughly unfolded and applied,
it will make a wonderful  difference in all matters
appertaining to medicine.  In the opinion of some
writers, it will  make  an entire  revolution in  its
practice.  Both these  sciences are now in their
infancy, but have a brilliant prospect before them. 
        MEDICAL PROBLEMS OF THE DAY.       9

Physiology, too, in  some  of its most  important
applications, may be  regarded  as  also  in  its
infancy.  True, it may be said, that the functions
of all, or  nearly all, the organs in the body are
correctly  understood; but then  they have  been
studied chiefly with reference to distinct diseases,
and their  treatment in individual cases.   But the
principles of this science have a far wider range,
in their application to the laws of life  and health
as  developed in the community at large.   The
cure  of disease has hitherto  been  considered as
almost the sole object of medicine; but when the
principles  of  Physiology  and  Hygiene  become
generally understood, the means for the prevcntion
of disease will be sought  and demanded as well
as those for its cure.  The call, will not, perhaps,
come from individual cases, so much as where the
health and lives of multitudes are involved.  Here
is a momentous work  to  be performed, in which
the members of the medical profession must take
a  leading part.  From their education and daily
avocations they are presumed to understand these
laws, and are  the proper guardians of the public
health. But these principles include other things
besides mere health and disease.  They extend to
every department of society, and  enter more or
less into every subject which affects the physical
or mental welfare of man.   It is proposed here to
notice some of the relations which these  sciences
sustain to the public.   They embrace, it will be
seen, many of the living  questions of the day—
problems yet to be solved.   First in order is 
10     MEDICAL PROBLEMS OF THE DAY.
               STATE MEDICINE.
  This phrase refers to the employment of mea-
sures for the  promotion of public  health and the
prevention of disease by means of legislation.  It
is only about thirty years since any decided steps
were taken  in  this direction, §ither in Europe or
in this country.  It is true that for a much  longer
period there had been legislation with reference to
quarantine and the establishment of  Boards  of
Health,  but  no  decided  and active legislative
measures had been taken directly for  the good of
the people  at  large.   In Great Britain  much
progress has  already been made in sanitary reform.
The reports  of the Registrar General, of Royal
Commissions, of  local Boards of Health,  papers
read before  scientific associations, together  with
discussions in Parliament, in Journals and books,
have  attracted  very  general  attention to this
subject.  Parliament has  scarcely held a  session
for  twenty years without  having had  some dis-
cussion,  or passed  some act referring to  health.
The principal topics upon which legislation there
has taken place are drainage, sewerage, water sup-
plies, removal of nuisances, construction of lodging
houses, hours of labor, public baths, epidemic and
contagious diseases.   In  1872, several of these
laws were remodelled, making  them more  practi-
cal;  and new acts were passed, providing for the
appointment  of health officers to see that these
laws were more efficiently executed in all parts of 
        MEDICAL PROBLEMS OF THE DAY.     11

the kingdom.  So general has been the interest
created upon this subject, it was predicted by
the present  Prime Minister that the next great
political agitation in  England would be on Sani-
tary Reform.
   In  this  country our  own  commonwealth  has
taken the lead in legislation.   In 1841, acts were
passed  establishing  throughout  the State a  uni-
form registration of births, marriages and deaths,
which has been continued for over thirty years.
These  reports embody  the most  valuable docu-
ments upon vital  statistics  that  can be  found
in the  country.   In 1849  an act was passed
providing for a sanitary survey of the State, which
brought together many valuable facts and statistics
relating to health, especially in several of the lead-
ing cities of  the  commonwealth.  In 1869 a State
Board of Health was created by our legislature.
In each step  of this legislation it should be stated,
that the project was first started in the Massachu-
setts Medical Society, memorializing the legislature
upon the subject.  To the credit of this Society it
should also be stated, that for thirty years or more
it  has made repeatedly special efforts for  the  pro-
motion  of public health,  either at  its  business
meetings, or  by addresses and papers published in
its name.   But a great work  yet remains for the
Society to do in this same direction.  We should
not omit to state that in 1850 two  very important
acts were passed by the legislature, requiring  that
physiology and hygiene  should  be taught  in all
the public schools of the commonwealth, and  that
             3 
12     MEDICAL PROBLEMS OF THE DAY.

teachers  should be examined ■ in  the elementary
principles of these sciences; but as the enforce-
ment  of  those  acts  was  left  discretionary with
School Committees,  the  results  have  not been
altogether satisfactory.
  But the act creating a State Board of Health is
the most  important step  taken in legislation.
This Board has now published five reports, which
are an honor to the  profession and  a credit to the
commonwealth.  It  has a very  difficult work to
accomplish,  and should  be  sustained  by  every
member  of this  Society.  New questions in sani-
tary science are coming up for consideration, which
will require  some  positive legislation.  The pecu-
niary interests  of  individuals and  of the public
are found to be in  open conflict with the lives  and
health of the people.  For instance—have indi-
viduals or companies a  right  to  poison the air or
the water, which  may destroy the health or the
lives of multitudes?  Shall poisoned or adulterated
food be offered in  our markets and shops for sale?
How  long shall it be permitted  to construct and
rent  tenement houses in  such  a  manner as to
breed disease and pestilence?   Legislation  has
always placed great powers in Boards of Health;
but either for the want of sufficient intelligence,
or from  some political motives, they are frequent-
ly very  dilatory  in enforcing the  law.   Within
a  few   years  we  have  had   several  marked
illustrations of this character.   In 1871 and '72
the small-pox prevailed as an epidemic in Lowell
and Boston, which might easily have been checked 
       MEDICAL PROBLEMS OF THE DAY.     13

in its first stages.  The Boards of Health in both
cities shamefully neglected their duty;  and, while
they for months were  contending about  minor
points, and shuffling for place and power, the  epi-
demic raged with great violence.  Public opinion
finally compelled  the formation of new Boards
of Health, which, by introducing  efficient mea-
sures, arrested  at once the progress of the  epi-
demics.  But by this  delay more than a thousand
lives were sacrificed, a great  amount of sickness
was  caused,  and  an immense bill of expense
incurred.   These two cases show the vast impor-
tance of having competent and efficient Boards
of Health.   Human life and  public  safety  and
interests should never be thus  jeopardized.   As
extraordinary powers are conferred by legislation
upon such Boards,  placing  in their  hands   the
health and lives of the community, it  becomes a
matter of  the highest moment that they be com-
posed of men thoroughly qualified for the duties of
the place.  The medical profession should always
be here represented by  its  best men, who, by
advice and influence,  should take the lead in all
measures for preventing or arresting the progress
of disease.  The voice and influence of the  pro-
fession, too, should be felt in  the halls  of legisla-
tion, and in the management  of our public insti-
tutions.  Medical  knowledge  should be brought
into  requisition in these high places of  power and
influence to a far greater extent than it has been
hitherto.  The  chief  cause of  our defective  and
dependent classes  may be found in the  violation 
 14     MEDICAL PROBLEMS OF THE DAY.

 of physiological laws.   The  causes of idiocy,
 blindness,  mutism  and  insanity arise  obviously
 from this  source;  and the causes of pauperism
 and crime may be  traced, more or less, to the
 violation  of  physical  laws.    And the  more
 thoroughly the primary causes  of many  other
 evils that afflict society and require legislation are
 investigated, it will be found that they arise from
 some  violation or  perversion of  physiological
 laws.   No radical or permanent reform can be
 reached without going back to the primary sources
 or causes of the evil.   In aiding to  accomplish
 this great work, the medical profession sustain a
 most intimate and important relation to what may
 be denominated
                PUBLIC HYGIENE.
   This includes not merely prevention of disease,
 but  every  agency that renders  the  growth and
 organization of the body  more perfect, and  its
 decay less rapid.  By reference  to the organization
 of the Massachusetts Medical  Society it  will be
 seen, that  this was one of  its principal objects.
 The very first sentence  in its charter reads, "As
 health is essentially necessary to the happiness of
 society, and as its preservation or recovery is
 closely connected  with  the  knowledge  of the
 animal economy, and of the properties and effects
 of medicines,  &c, Be it therefore enacted," «fcc.
 And then in  specifying its  objects in  another
 place,  it says,  "to increase and  diffuse  medical
knowledge."   It would seem, therefore,  that one 
      MEDICAL  PROBLEMS OF THE DAY.       15

of the primary objects in  the organization of this
Society  was to promote the health of the  commu-
nity, to  prevent  disease and diffuse medical know-
ledge.  It is impossible to accomplish this object
without making the  public generally acquainted
with  the  laws of physiology and hygiene.  The
objects  intended by State Medicine  cannot effec-
tually be attained without a general understanding
of those  subjects.   The  practical  application of
legislation, and the execution of law in a republic,
where especially personal rights and  interests are
involved,  depend upon knowledge as  well as  a
sense of justice.   It has been repeatedly  demon-
strated that the  ravages of small-pox, cholera and
yellow  fever  can be  jDrevented or  checked by
applying sanitary law; but in order to do  this, the
people themselves must be made acquainted with
the means of doing it.   They must become par-
ticipators in the work;  otherwise it  cannot  be
accomplished.   Without  referring to  facts and
figures  on the subject, it may be safely stated, we
believe, that  fully one-third of all the prevalent
diseases of the  day may  be prevented by faithful
application  of  hygienic  laws;  but  the  people
themselves  must first understand  these  facts.
Once there might have been a difference of opinion
among the members of the profession  about  the
expediency of diffusing such information,  alleging
that a bad use was made of it—that a little learn-
ing, a smattering of such knowledge, was a dan-
gerous thing.  Illustrations of this  character are
constantly occurring; but if some abuse and per- 
16      MEDICAL PROBLEMS  OF THE  DAY.

vert this knowledge, all do not—multitudes make
a good use of it.  The evils are only incidental to
a higher good.
  Besides, much depends  upon the manner  in
which  this information is  communicated.   The
objects  and agencies  by which this has at times
been attempted are of a very  questionable charac-
ter.   Almanacs, circulars,  advertisements  and
obscene publications  have  been scattered  broad-
cast, professedly to promote health; but the lead-
ing  motives and objects  deserve the severest
censure.  It  may be  said that such  a bountiful
supply would not exist, if there was not a demand
for knowledge of this sort—that the public are
bound in  some way to obtain it.   Accordingly we
find in  newspapers  and periodicals an increasing
demand and supply  of articles on  health; also
journals and books, that are  devoted more exclu-
sively  to  the subject, are constantly  multiplying.
It is very important, in communicating this infor-
mation, that a proper direction be given to it, and
that it  should be tempered  with the right spirit
and motive.  In diffusing a knowledge of hygiene
it is not expected that every person  will become
familiar with the details of physiology, or with all
the relations it sustains to the laws of life and
health.   If the more intelligent and. influential
members of society obtain this  information, they
will direct public opinion, and gradually enlighten
the masses as to their duties and dangers.
  Inasmuch as such knowledge properly applied is
calculated to prevent a vast  amount  of suffering, 
       MEDICAL PROBLEMS OF THE DAY.      17

sickness' and mortality, is it nof clearly the duty
of the profession and the  press to use all suitable
means  for its diffusion?   The more enlightened
the community  become, generally, upon this sub-
ject, the less exposed they will be to imposition and
quackery.  Instead of blind  superstition and cre-
dulity, a rational faith will grow up in the study
and observance  of the laws of health and life. The
demand in  the  use of remedial means will be
directed to the best skill and experience which can
be found, that grows out of a profound knowledge
of physiology and hygiene.   Let the principles of
science and  the exercise  of  good common sense
direct and control in all these matters.  For it is
in this way, and by this means only, that all kinds
of empiricism and quackery,  root and branch, can
be eradicated.   The public have infinitely more at
stake in attempting to effect such a reform than the
medical profession.  The visions of the Alchemist in
search after  the " elixir of life " or the " philoso-
pher's stone," may yet in some measure be realized
by  the diffusion of hygienic knowledge.   For
whenever the laws of hygiene have been faithfully
observed, it  has greatly improved  not only indi-
vidual health, but diminished the amount of sick-
ness as  well as of mortality.  In certain localities
in Great Britain, where these laws have been test-
ed for a series of years, the  Registration reports
show a' diminution of mortality from one-third to
one-half.  Such a result we should naturally ex-
pect.  The more thoroughly  the causes of disease
are understood, the more and more are they found 
18      MEDICAL  PROBLEMS OF THE DAY.

traceable to a violation of hygienic laws.  If the
ravages of cholera, of yellow fever and typhoid
may be controlled in a great measure by the ob-
servance of such  laws, why may not scarlet fever,
measles and whooping cough —those scourges of
infant life —be prevented, or very much limited?
The prevailing sentiment that all children must
necessarily have these diseases once, finds no sup-
port whatever  in the nature of physiology or in
the principles of hygiene.  The fact is already well
established, that the spread and violence of scarlet
fever, by isolation, cleanliness  and ventilation, are
very much modified, and, in some instances, en-
tirely prevented.   We believe the time will come
when scarlet fever, measles  and whooping  cough,
which now destroy such multitudes of children,
will become, in  a measure, things of  the  past.
It is not only the great amount  of sickness and
mortality occasioned directly  by these diseases,
but the  impaired constitutions  and  other  com-
plaints consequent upon them, that may  also be
prevented.  When the community  realizes fully
that the means of preserving health, especially in
early life, are  placed, in a great measure, in its
own hands, a far higher estimate will  be  placed
upon the value of human life, and the responsibility
for its  preservation will be found to  depend in a
great  measure upon human efforts.  For this sen-
timent of responsibility, which harmonizes with all
the great principles of justice  and accountability,
increases just in proportion as the laws of physical
organization are thus  brought  out and applied. 
        MEDICAL PROBLEMS OF THE  DAY.     19

When disease, instead of being wrapt up, hi its
origin and progress, in a kind of mystery, can be
traced to  an intelligible source or cause ;  when it
shall be clearly perceived  that sickness and  pre-
mature mortality are  the results of violated  law,
then will our own interest in the subject be greatly
enhanced  ; then will the responsibility be transfer-
red from a " divine Providence " to human agency.
  If the general diffusion of a knowledge of phy-
siology, together with an application of hygienic
laws, is to place in the hands of people themselves,
to a far greater extent,  the  means of  preserving
health and thus diminishing  disease, the problem
ai ises, what is to be its effect upon
             PRACTICAL MEDICINE.
  This presents a question of particular interest
to the medical profession, especially to its younger
members.   In  the  minds of some,  doubts  may
arise whether any such changes  will ever occur.
But when we consider what great progress, within
twenty or thirty years,  has already been made in
the diffusion of such knowledge, both in Great
Britain and in our own country, that the interest
is rapidly increasing in all matters pertaining to
health, particularly with  leading minds* and  that
there is a  growing disposition on the part of peo-
ple  to take such matters Into  their own hands, it
is very evident that it  must  result in  important
changes with reference to medicine.  The seeming
imp rob ability of this statement vanishes when we
take a retrospect of some points in the history  of
             4 
20     MEDICAL PROBLEMS  OF THE DAY.
medicine for the last forty or fifty years.  What
a surprising improvement has taken place m  oui
knowledge of the nature and causes of disease !
Pathology is comparatively a new science.   The
same may certainly be  said of hygiene.  It  may
safely be affirmed, we believe, that the nature, the
causes, the laws or natural history of diseases, in all
their forms and tendencies, cannot be  thoroughly
understood without a correct knowledge of these
two sciences.   It is not sufficient to understand the
structure and function  of an  organ diseased, but
what were all the agencies, internal and external,
operating  to produce this abnormal state; and the
more thoroughly wre understand these agencies, the
more  correct  will be  our  diagnosis  of disease.
 Such knowledge is, moreover, indispensable for its
 successful treatment.
    The old theory that disease was some mysterious
 entity or unseen  agency for evil, introduced into
 the body, has  had a most pernicious influence.  As
 one of its bad effects, it has tended to produce too
 much faith in the use of (h ugs alone.  It has bl nd-
 ed inquiry as  to  the true nature of disease—h?s
 produced confused notions of its real causes, and
 led the mind  to  cast around every where,  exter-
 nally,  to  find some  drug  or compound  for  its
 cure.  When the  causes and the natural laws  of
 disease were so  imperfectly  understood, not only
 the public demanded,  but the profession inclined
 to depend too largely on drugs.   As a result there
 was over-medication,  and the evil has not  alto-
 gether subsided.   Some discriminating minds, see- 
         MEDICAL PROBLEMS OF THE DAY.      21

ing the evils of excessive  drugging, have been in-
clined to go to  the  other extreme—to  decry the
use of medicine and the  profession  altogether.
Some very prominent medical  men  have come to
such a conclusion, and expressed opinions which in
the estimation of others have done injury* If .phy-
sicians have erred in over-medication,  and people
have  injured  themselves  by too  much  dosing, it
affords no evidence that medicines are not, at this
day, just as  good and necessary  in  the  treatment
of disease as they  ever were.   This  depends upon
the manner in  which they are used.    The   true
character of disease  should first be  clearly appre-
hended, together with the recuperative  powers of
nature;  then  let medicines come in as   aids  and
helpers in overcoming, checking or alleviating dis-
ease,  and not to violate or interfere with natural
  * " I will venture to say this, that if every specific were to fail utterly,
if the cinchona trees all died out, and the arsenic mines were exhausted,
and the sulphur regions were burned up, if every drug from the vegeta-
ble, animal and mineral kingdom were to disappear from  the market, a
body of enlightened men, organized as a distinct profession, would be re-
quired just as much as now, and respected and trusted as now, whose
province should be to guard against the causes of disease, to eliminate
them, if possible, when  still present, to order all the conditions of the
patient so as to favor the efforts of the system to right itself, and to give
those predictions of the course of the disease, which only experience can
warrant, and which in so many cases  relieve the exaggerated fears of suf-
ferers, or warn them in season of impending danger."—Dr. 0. W. Holmes.
  " I sincerely believe that the unbiassed opinion of most medical men of
sound judgment and long experience is made up, that the amount of
death and disaster in the world would be less, if all disease were left to
itself, than  it now is under the multiform, reckless and  contradictory
modes of practice, good and bad, with which practitioners of adverse
denominations carry on their differences at the expense of their patients."
—Dr. Jacob Bigelow.
  " As a physician advances in age, he generally, I think, places less con-
fidence in the ordinary medical treatment than he did, not only during
his early but even middle period of life."—Sir James Clarke.
  " I declare as my  conscientious opinion, founded on long experience
and reflection, that if there was not a single physician, surgeon, apothe-
cary, druggist nor drug on the face of the earth, there would be less sick-
ness and less mortality than now prevails."—Dr. James Johnson. 
22
MEDICAL PROBLEMS OF THE  DAY.
laws.  There should  be the  utmost harmony be-
tween all the restorative  powers of nature and the
administration of drugs.  In no one thing is the
skill of the  physician exhibited so much as in the
wise adaptation of the kind and quantity of medi-
cine,to the exact nature and state of disease.
  For thirty years or more a warm discussion has
been carried on by different writers, as to the rela-
tive powers of nature and art in the cure of dis-
ease.  Great good has already resulted from this
discussion;  but when we come to understand more
fully the nature and causes of disease as develop-
ed  by pathology  and hygiene, the  recuperative
powers of nature will be found far greater than has
hitherto been conceded.  Sanitary  agencies will
be brought to bear far more  effectually upon the
treatment as well as the  prevention of disease.
For illustration: what improvement has been made
in the treatment of the  " self-limited diseases," so
styled, by a better knowledge of their nature, and
of the laws by  which they  are governed!  May
there not be other diseases, or even classes of  dis-
eases in which similar changes will be required in
the administration of medicine?   When the laws
of inheritance are more correctly  and thoroughly
understood, it will be found, Ave believe, to throw
a flood of light on what are denominated " heredi-
tary diseases."   The  constitutional  or hereditary
influences will be found  to be very powerful,  and
to be governed by forces that do not yield readily
to medical  treatment.  The  constitutional  or in-
herited tendencies must be taken  into account far 
       MEDICAL PROBLEMS OF THE DAY.      23

more than they hitherto have been.  The physical
weaknesses and idiosyncrasies peculiar to patients
will then be better  and more readily  perceived.
This will lead to a more skilful adaptation of hy-
giene as well as medicine in the management of
all such cases.
  One of the  boasted  improvements of modern
surgery is to " save  limb and life."  Why  should
not the public obtain a similar advantage, though
on a  much  larger scale,  in the  improvement of
practical medicine, viz., in the prevention as w'ell
as cure of disease?   With the general diffusion of
sanitary  science, the inquiry will  be for the best
means not only for preserving health, but in case
of disease, for such treatment  as will, as  far as
possible, prevent its recurrence.   If the tendency
of a general diffusion of sanitary knowledge be to
diminish faith  in drugs alone, it will greatly in-
crease confidence  in the  use  of all those means
based upon the laws of physiology and hygiene.
It will be a rational faith for which a good reason
can be given and exacted.  It will  be a faith that
will grow stronger and brighter, in proportion as
the great laws of health and  disease  are  better
understood.   It may require  somewhat different
qualifications on the  part of the medical attendant
— a higher degree of intelligence upon all sanitary
and hygienic agencies, and a more careful discri-
mination in the use of  drugs.   It  will lead  to  the
most effectual means to root out all kinds of  em-
piricism and quackery, which  find a congenial soil
in ignorance  and prejudice, credulity and super- 
24     MEDICAL PROBLEMS OF THE DAY.

stition.  It is because these qualities every wire re
abound, that medical impostors and quack medi-
cines find such support and patronage.  A rational
faith in the use of those remedies which harmonize
with the laws of nature is altogether more desirable
than a blind faith in the wonderful virtue of some
drug or compound that only disturbs and deranges
the whole system.  Counsel and skill, based upon a
profound knowledge of health and disease, will be
considered, in the way of advice and medical treat-
ment, of far more consequence than the long array
and numerous mixtures  of drugs.   The object of
medicine is three-fold, viz.: cure of disease,  alle-
viation of disease, and the prevention of disease.
This last is not only the safest and  most moment-
ous as regards the wTeal  of the patient, but the
surest index of  skill, judgment and fidelity in his
counsellor.
   There is a most important physiological prob-
lem to be solved in

            PHYSICAL DEVELOPMENT.
   A gradual change is taking place in the organi-
zation of our New-England people, with which the
members of the medical  profession cannot but be
conversant.  This is very manifest from the change
in the type and character of  disease.  Formerly
there was relatively more acute  disease and less
chronic —more violence in the attacks,  with a high-
er grade of inflammation.  It required in its treat-
ment  frequent  venesection  and  more  powerful
medicine.  At  the  present day we  have a larger 
      MEDICAL PROBLEMS OF THE DAY.      25

class  of diseases  arising  from general debility,
from indigestion,  anaemia, scrofula, neuralgia, &c.
This change indicates the existence of less muscle
—more nerve—less physical vitality—more ner-
vous  energy—less power of endurance, but more
mental activity.  This same  change is  also  indi-
cated .in  the anatomy  and physiology  of  the
person.   The framework of the  body generally
is  not so large—is not so compact, nor so well
proportioned; the  countenance is paler, the fea-
tures are more pointed and  not  so expressive of
health, though more so of intelligence.  The tex-
ture or  quality of organization is more  delicate
and  refined;  the  brain is becoming developed
more and more  relatively, and too frequently at
the expense of the body; or, in other words, the
nervous temperament, with all its advantages and
disadvantages, is becoming  too predominant for
other parts of the body.  As  one of the  conse-
quences we have more diseases of the brain and
nervous system, more sudden  deaths from  apo-
plexy, paralysis,  and  also  from  diseases  of the
heart.  The  average duration of life may  as  a
whole be longer, but this arises from less exposure,
better care and improved medical treatment.
  This change' of organization  has occurred prin-
cipally within the last  two or  three  generations.
Some of its causes  are very obvious, while  others
are more  obscure  and complicated.  Among the
principal causes may be mentioned less exercise of
the'musclcs out-doors, on the farm and in mechani-
cal  pursuits, but more exercise of the brain in the 
26      MEDICAL PROBLEMS OF THE DAY.

school-room, in  the shop, in the store, in the fac-
tory.   The change in the construction and manner
of heating our dwelling-houses, causing  a much
higher  temperature — the increasing  strife and
competition in business, the general style  of liv-
ing and modes of dress, &c, have  also had much
to do in producing this change.   These and other
causes have  exerted  a pernicious influence upon
the female constitution, and so  upon the laws of
inheritance.  It  is through this medium or  chan-
nel especially, and by means of these laws, that, in
the course of two or three generations, great phy-
sical changes are effected.  The laws of heredity
constitute the most  important agency whereby the
vital forces, the  vigor and soundness of the physi-
cal system are changed for better or worse.   Thus
in the course of time is  determined the peculiar
type and character of a people.
  There is  nothing of such transcendent impor-
tance to a race  or nation as physical  stamina —
strong, vigorous, healthy constitutions.  How did
the Germans, in the late war, gain such signal vic-
tories over the French? Why does that people now
stand at  the head of all the European nations  in
power and statesmanship?   Why do the Germans
take the lead at the present time in the cultivation
of the sciences, and in almost every department of
literature?  Is it not owing to their grand phy-
sique more than to anything else? 
MEDICAL PROBLEMS OF  THE DAY.      27
               MENTAL CULTURE.

  In  the  advancing knowledge of physiology it
has been discovered that all mental culture should
be based upon the brain—that education should be
pursued  in  harmony with the  laws of life and
health,  and that where these  are  violated,  the
advantages  of  the  former afford poor compensa-
tion.  Formerly no  attention, or scarcely any, was
paid by School  Boards and teachers, in the matter
of education, to  the condition of  the  body or
the development  of the brain,  and even at  the
present day very little is paid them,  compared
with what should be given to those great physical
laws which underlie all mental culture.  The lives
of a multitude of children  and youth are sacrificed
every year in this commonwealth by violating the
laws of physiology and hygiene, through mistaken
or wrong  methods of mental training ; besides, the
constitution and  health of a multitude of others
are thus impaired or broken down  for life.   No
where else in society is a radical reform needed
more than in our educational  systems.   Inasmuch
as the laws of the body lie at  the foundation of
all proper culture,  they should receive  the  first
consideration.   But in educating the boy or girl,
from the age of five to fifteen, how little attention
is  given  to the  growth  and  physical changes
which  necessarily occur at this most important
period of  life!   The age of the child  should be
considered ; the place of schooling,  the hours of
            5 
28      MEDICAL PROBLEMS OF THE DAY.

confinement and recreation, the number and kinds
of studies, together with the modes of teaching,
should all harmonize with physical laws—espe-
cially those of the brain.
  The system or mode of treating, in  education,
all  children  as  though  their organizations were
precisely alike, is based upon a false and unnatural
theory.  Great injury, in a variety of ways, results
from this wrong treatment; in fact, injuries are
thus inflicted upon the sensitive organizations and
susceptible minds of young children, from  which
they  never recover.   That many  of our  most
independent  and clear-headed educators  them-
selves express so much  dissatisfaction with the
working and results of our schools, affords evi-
dence that  something is wrong in the present
system.  As we contemplate the great improve-
ments made in  education for the last thirty or
forty years, and are surprised that educators were
content  to tolerate the state of things then ex-
isting,  so  will  the next  generation, when  still
greater and  more radical changes shall have been
introduced,  look back with  astonishment  at this
generation,, and wonder that  it was so well satis-
fied with its own methods.  When our educators
become thoroughly convinced that physical de-
velopment as a  part of education is an absolute
necessity—that  a  strict  observance of the laws
of  physiology and hygiene  is  indispensable to
the  highest  mental culture, then we  shall have
vital and radical changes in our  educational sys-
tem ; then the brain will not be cultivated so much 
      MEDICAL PROBLEMS OF THE DAY.      29

at the expense  of  the  body,  neither  will  the
nervous temperament be  so unduly developed in
proportion to  other parts of the system, now so
often bringing on a  train of neuralgic diseases
which cannot easily be cured, and exposing the in-
dividual to the keenest and most  intense suffer-
ing which all  the advantages of  mental culture
fail, not unfrequently, to compensate.
  The more this whole subject is investigated, the
more reason we shall find for making  allowances
or some distinction in scholastic  discipline with
reference  to  the   differences in  organization  of
children, and  for  adapting  the hours of confine-
ment and  recreation, the ventilation and tempera-
ture  of school-rooms, the number and kinds  of
studies, the modes of teaching, &c, to the laws of
the physical system.   But another and still more
important change must take place.  Some time—
may that time be  not far distant—there will be
a correct and established  system of mental science,
based upon physiological laws; and until this era
arrives, the modes and methods of  education must
remain incomplete and unsatisfactory.  The prin-
ciples of this science, in the very nature of things,
must rest  upon a  correct knowledge of the laws
and  functions  of the  brain;  and  until these  are
correctly  understood  and reduced to a general
system, all education must be more or less partial,
imperfect  and  empirical.   While the old theories
of metaphysicians are very generally discarded,
they still have practically a  powerful influence in
directing  and shaping  our educational systems 
30      MEDICAL PROBLEMS OF THE DAY.

and  institutions.  In the selection  and arrange-
ment of studies very little attention is paid to the
peculiar nature or operations of the various facul-
ties  of the mind, or the distinct laws that govern
their development and  uses.  For  illustration—
instead of educing, drawing out and training, all
the mental faculties in then' natural order and in
harmony,  each in proportion  to  its  nature or
importance, the memory is almost the only faculty
appealed to in every stage of education;  and this
is so crammed and so stuffed that frequently but
little of the knowledge obtained can be used advan-
tageously.  Instead of developing the observing
faculties by  "object teaching," appealing to the
senses of sight and  hearing,  those  two great
avenues of knowledge,  or  giving much  instruc-
tion orally, we require the  scholar to spend most
of his time in studying and poring  over books,
mere boohs.  The mind is treated as a kind of gen-
eral  receptacle into which knowledge almost indis-
criminately must be poured, yes, forced, without
making that  knowledge one's  own,  or  creating
that self-reliance which is indispensable to its pro-
per use.   In this way the brain does not  work so
naturally   or  healthily  as  it ought,  and a  vast
amount of time, labor  and expense is wasted—
nay, worse than wrasted.  From this forced and
unnatural  process  there  often results not only a
want of harmony  and complete  development of
all parts of the brain, but  an  excessive  develop-
ment of the nervous temperament, and not unfre-
quently an irritability and  morbidness which are 
       MEDICAL PROBLEMS  OF THE DAY.      31

hard to bear and difficult to overcome.  And not
unfrequently  it ends  in a permanent disease of
the brain, or confinement in a lunatic asylum.
  When we take  a careful  survey of  the various
discussions  and diverse theories  on this subject,
considered metaphysically, and then compare them
with the  great  improvements and discoveries in
the physical  sciences  for  the   last  fifty  years
bearing  upon the same subject, the  change or
progress looks mainly in one direction,  viz., that
all  true  mental  science  must ultimately be based
upon  physiology.   Here is  a great work  to be
performed, and when accomplished it will consti-
tute  one of the  greatest,  most  valuable  and
most   important  achievements   that  was  ever
wrought in the history of science.   A vast amount
of positive knowledge has  already been accumu-
lated on this subject by various writers, but a great
work,  by way  of analysis,  observation and in-
duction, and of  further discoveries as to the func-
tions of the brain, remains to be completed.   This
work  must  be performed  in a great measure by
persons profoundly versed in the physical sciences;
and no small proportion of it must come from the
observations, labors and contributions of medical
men.*
  There  is another problem  which for  some time
has agitated  the  public, and which  intimately
 * For illustration, such works may be mentioned as Dr.  John
Abcrcrombie  on the  Intellectual  Powers ; Dr. Andrew Combe on
Physical and Mental Culture ;  Dr. Henry Maudsley's Lectures on Body
and Mind, and Dr. \V. E. Carpenter's Principles of Mental Pathology. 
32      MEDICAL PROBLEMS  OF THE DAY.

concerns the  members of our profession.   We
refer to

         THE  TEMPERANCE  QUESTION.
  Probably there  is no one subject agitating the
public mind at the present day so important as
that of temperance.   Aside  from its  economical,
political and  moral bearings,  it sustains  a most
vital relation to medicine.  In  some respects  it is
really  a physiological  question, the  solution of
which belongs to the experts in this science; but
unfortunately  there is  not here a  general agree-
ment  of opinion.   Before  this reform  can be
carried on very successfully, the exact relations
of alcohol  to  health and disease must be  better
understood and positively settled.   What is the
physiological  action  of alcohol on  the  human
system  in  health  and disease?  Does it increase
or impart  force in the process of  digestion?  Is
alcohol in  any of its forms absolutely necessary
as a therapeutical  agent?  Is there  such a  love of
stimulants  hnplanted  by nature among our in-
stincts, that man  cannot well  resist temptation?
Does  health require  as a  common beverage, at
mealg, or other times, the use of a mild stimulant?
These and  kindred questions must  be settled, not
by mere authority, nor by individual opinions, but
by  such  an  accumulated  amount  of evidence
derived from the study of physiology and patho-
logy,  that it cannot be disputed or resisted.   How
important  that the members  of the  profession,
who are the proper expounders of these sciences, 
      MEDICAL PROBLEMS OF THE DAY.      33

should become safe teachers and guides in settling
these grave questions!  But  whatever differences
of opinion may here exist,  there are points of view
in regard  to this reform upon which there should
and  must be entire agreement, viz., its sanitary
aspects.  That  intemperance  is productive of a
vast  amount of disease, all will admit ;  that it is
one of the most powerful causes of physical de-
generacy  now in operation, no one will probably
question.  If to alcohol we  add tobacco, opium
and  other stimulants and narcotics,  no pen can
describe the terrible injuries which they inflict
upon the human race.
  From a hygienic point of view, of what avail are
the benefits of good air,  pure water, wholesome
food, healthy occupations  and dwellings, when the
laws of the physical  system  are being constantly
violated by the poison of alcohol and  tobacco?
It is not alone the present or temporary effects of
these agents,  but the permanent,  such  as are
incorporated into  the  organization  itself  and
become a part  and  parcel of it—these are the
seeds of  evil tendencies and diseases, which are
transmitted to  successive  generations.  It is only
when we take into account the power and extent
of hereditary influences that  we can fully appre-
ciate the importance, the magnitude and the gran-
deur of the temperance reform.
  This  leads us to  the consideration of another
problem, namely, the laws of inheritance. 
34      MEDICAL  PROBLEMS OF THE DAY.
          THE LAWS OF INHERITANCE.

  In a hygienic point of view, no  agency is so
powerful in the prevention of disease as hereditary
influences.  To the experienced physician, it re-
quires  no array of facts or  arguments  to prove
what a wonderful difference there is in the amount
of disease in individuals and families, arising from
the differences in original stamina or soundness of
constitution.   Then in the treatment of disease, it
makes a  surprising difference.  In sound, healthy
stock we have developed in a far higher  degree
the recuperative powers of nature, and  generally
one single disease  at a time  to combat ; whereas,
in case the original constitution is feeble, and the
respective parts of the body  are ill-balanced, dis-
eases of almost every kind become far more com-
plicated, and their treatment more  difficult as well
as doubtful in result.
  Besides, there is a large class of diseases which '
may be strictly considered hereditary, as the seeds
or predispositions are transmitted.   If these innate
predisposing causes of disease could be obviated
or removed, it  would undoubtedly diminish the
actual amount of sickness and of early mortality.
But to effect any great improvement in this direc-
tion would  require  a  favorable operation  of the
laws  of inheritance through several generations.
There are,  if we mistake  not,  special reasons
why these  laws   should receive  more  attention
at the present day ;  and who should take the lead 
       MEDICAL PROBLEMS OF THE DAY.       35

in their investigation if not the members of the
medical profession?  Within a  few years several
writers have discussed points  or topics  bearing
directly on these laws, and others have made favor-
able references to them.  Besides, the public at large
are becoming more and more disposed to seek in-
formation  and instruction on this subject.  The
increased attention to physiology and biology seems
to prepare  the way, and demand that such investi-
gations should be  more vigorously and thoroughly
prosecuted.  When we  consider, too, that it is not
the mere physical properties of the body alone that
are transmitted, but the dispositions, the propensi-
ties, the mental capacity, the moral sentiments, &c,
these laws assume  an  importance,  a magnitude
that can scarcely be over-estimated.  In fact, the
character of every individual, of every family and
race depends very much upon the material or ele-
ments provided by  these laws.  For  what  can
family training do, what can education accomplish,
without  favorable material for operation,  or in
other words the right developments of brain?  We
venture the assertion, that all permanent improve-
ment  or progress in the civilization of any people
or nation is more dependent on these laws  than
upon  any other agency whatever.  If one fourth
the attention or one tithe of the expense was given
to the  improvement of the  human race in  this
direction, that is now expended on that of domes-
tic animals, it wrould result in the most surprising
changes.
  It is impossible  to estimate the value and  im-
             6 
36      MEDICAL PROBLEMS OF THE DAY.

portance of the relation which these laws sustain
to other improvements.   Their application affords
not only the  most powerful  assistance to all the
improvements and advantages of civilization, but
serves to render them more fixed and permanent.
For unless the physical  organization of a people
or nation is kept good, or improved from genera-
tion to generation, there are bounds or limitations
to all progress.  In fact the whole  structure of
society, the advantages  of education, the improve-
ments in  science, in  arts, in literature — to  say
nothing of the  foundations  and advancement of
morality and religion—are all powerfully affected
by these laws.   The subject is too  vast, too com-
plicated to be  discussed in a brief essay, but it
presents two or three  phases to which I wish to
call particular attention.
   There are  certain agencies operating at the pre-
sent day, which in the course of time must produce
marked effects upon the organization and charac-
ter of our people. The removal of so large a pro-
portion of the  population from the  country and
rural life to cities and large towns ; the change of
employment  from farm wrork — from out-door ex-
ercise and the more laborious mechanical pursuits—
to lighter kinds  of business, with increased exercise
of the  brain;  add to this  the  greatly increased
strife, excitement and competition in every depart-
ment of business and society—all these changes
must serve gradually to diminish muscular power
and  the general  vitality of the system.  ~No truth
in vital statistics is  better  established than  the 
       MEDICAL PROBLEMS OF  THE DAY.      37

fact, that large cities and a dense population tend
to diminish the physical energies of the body and
shorten human life.  Then, the  increasing use of
alcohol in its various  forms, and  especially of
tobacco among young men, must have a most per-
nicious influence upon physical organization.  But
it is in the accumulated, the intensified effect pro-
duced by the law of inheritance, that the  most
striking and destructive results are to be witnessed.
Could the evils of alcohol, tobacco  and opium, as
transmitted by hereditary influences, be fully real-
ized, what more powerful motives  could be pre-
sented for a reform in their use, or for their abso-
lute prohibition?  We believe the fact is generally
admitted, that there is a constant increase in the
use  of stimulants and  narcotics throughout the
country ; that this question is settled, beyond con-
troversy, by the greatly increased manufacture and
sale of these articles.  No true physiologist, who
understands the terrible effects of these poisons on
the system and  their transmission to  the second,
third and fourth  generations,  can look on such a
state of things without  apprehending the  most
serious results.
   But there  is  another  point  of view whence
these laws of inheritance may be considered, which
sustains a most intimate and important relation to
human welfare ;  we refer to the

              POSITION OF WOMAN.
   The question  might naturally be  asked, why
discuss the  position of woman more than that of
• 
 38     MEDICAL  PROBLEMS OF THE DAY.

 man ?  The answer is  obvious :  his rights and
 claims  have not  been agitated, or  attracted the
 same attention as  those of woman.
   Within a short period new questions have sprung
 up for consideration in respect to the rights, the
 employments and position of woman.  While her
 wrongs in the past are generally admitted, as well
 as the desirableness of some radical reform, there
 are certain physiological problems involved in the
 issue, which should  not be  overlooked or ignored.
 If we are not mistaken there are principles or laws
 involved, which underlie the very foundations  of
 society.   They are not the opinions of individuals
 or the resolves of public bodies, but the laws  of
 the Almighty implanted in human beings for their
 highest welfare and happiness.  Can these laws
 be understood—can they be correctly interpreted
 and properly applied?  Most  of the discussions
 upon this subject have been conducted with very
 little reference to physiological laws.  A majority
 of the parties engaged in  them do  not seem to
 consider  or  realize  what effect, if the  points at
 issue are carried to the extent advocated, may be
 produced  on the marriage institution, and the phy-
 sical welfare of the  race.  Any changes or agen-
 cies that  threaten in  any  way the  security  and
 permanency  of the family,  should be approached
 with all the  care, intelligence and wisdom that are
possible.  That the  marriage  and parental  rela-
tions constitute the groundwork, the main  pillars
of human society, requires  here no  argument to
prove.   The physiological law of se.v  is the coiner- 
        MEDICAL PROBLEMS OF THE DAY.      39

 stone of these relations, and has, we believe, a far
 more direct and powerful influence upon organiza-
 tion and character than is generally considered.
 Inasmuch as woman  is so created that  her own
 health is very much affected by this feature in her
 organization—inasmuch  as the physical  devel-
 opment of offspring is also  very much dependent
 upon her constitution, these  two  considerations
 have an important bearing upon  her  education,
 employment and relations to the public.   There is
 a normal and healthy standard for every organ in
 the  human body ; and whatever  influences tend
 to change or violate the laws that govern any one
 of these should  be  carefully guarded  against.
 Thus in the matter of education it has been very
 clearly demonstrated  by a distinguished member*
 of our profession, that the boy and the girl  cannot
 be  educated just  alike.  ~No  one but  an experi-
 enced physician can realize or describe  fully the
 powerful influences which the  function of men-
 struation has upon the health of woman; and this
 effect, in extent and character,  depends much upon
 the early stages of its development.  For the peri-
 od of some thirty years there is certainly a marked
 difference in the sexes, which  must materially in-
 terfere with employments and public duties.  Such
 is the relation, too, of this function to the nervous
 system, that any derangement or morbidness  of
 action here may affect the disposition and charac-
ter of the individual.
* Dr. E. II. Clarke. 
40      MEDICAL PROBLEMS OF THE DAY.

  All writers on physiology agree that too much
importance can scarcely be attached to the healthy
action of the uterine functions ;  and when we pre-
sent the testimony of one writer,  it expresses, we
believe, the opinion of all.   Says Colombat : " The
extreme sensibility of  the uterus, its physiological
importance, its peculiar irritability, and  especially
its more or less sympathetic connection with other
parts of the body, render  it a centre  of  action
which in the sex  seems in a measure to domineer
over  the whole economy,  and form  the  principal
basis upon which the edifice  of the whole organiza-
tion rests."
  In settling, then, the points involved in the ques-
tion of " Woman's Rights," so called, the physio-
logical  bearings  and  tendencies  should  receive
primary  consideration.   The  immediate  change
produced, however, may not be so noticeable, but
in the course of two or three generations its effects
become very striking and powerful.
  That in the present state of society there is need
of some changes or  reform looking to improve-
ment in the health of woman, is evident.  The very
general ill-health of American women is often as-
serted.   There should certainly be a reform in the
fashion or style of dress; it should harmonize with
the laws of  the  physical system.   In the early
training of girls the greatest care should be taken
to secure the best possible development of  the
body ; and in the whole course of their education,
whatever interferes with healthy action or violates
physiological laws,  should be most scrupulously 
MEDICAL PROBLEMS OF THE DAY.
avoided.  As to the higher departments of educa-
tion and a more extended range of employments,
there are substantial reasons and arguments  de-
duced from physiology itself why woman  should
have these advantages.  Let her have the highest
culture—physical  and  mental—consistent with
her whole nature.   But then, that she should share
equally with man in all the strife and competition
of business, in the excitement and rivalry connect-
ed with political and public life, including suffrage,
is physiologically unnatural, abnormal, a violation
of the laws of her physical  system.  In the lan-
guage of the most distinguished writer on psycho-
logy in Great Britain, " she will then have lost her
feminine attractions, and probably also her chief
feminine functions."  One of the cardinal points in
attachment between the sexes is, that certain oppo-
site qualities or traits of character attract each other
and form the most  happy unions.  Now if  the
qualities and traits of character in  woman are to
be  assimilated  to  those of man, what will be its
effect upon  matrimony and  harmony in married
life?
  In  all the situations and pursuits  of life  the
Almighty has  established bounds or limitations
beyond which woman  cannot go without  defeat-
ing the  primary objects of her creation.   The
reasons are  obvious.  It gradually changes  her
organization.  By a physiological  law of supply
and demand, nature, in the case of  woman, makes
certain drafts  monthly  upon  her constitution.
That this law of periodicity  be properly observed 
42      MEDICAL PROBLEMS OF THE DAY.
is indispensable for good health and the highest
development both of body and mind.  Again, if
the brain is relatively exercised too much, the body
suffers; so of the brain  alone, there cannot be a
steady strain  upon certain portions of  it without
impairing the  functions of other parts.  Maternity
is a primary  law in  her creation.  Physiology,
pathology, records of health, disease and mortality
establish the fact that this is her  normal state.
In  the  observance of this  law, certain physical
conditions  are indispensable;  there must  be  a
proper development of those portions of the  body
concerned  in this function ;  neither can they an-
swer the demands nature makes, if kept constantly
impoverished.
  For illustration:  if that  portion of the  brain
whose functions  include attachment to the  other
sex, love  of offspring and  domestic life—those
strong instincts that centre in the family and in
the home—is not properly developed or trained,
but other  portions of the  brain,  embracing the
selfish faculties,  are  continuously  exercised, and
strained  to their utmost capacity, the result is
that it  changes organization and  character.  It
tends to undermine the foundation of the marriage
and maternal relation, which rests  on the purest
and most powerful instincts of nature,  and trans-
fer  it  to  one  of self-interest  and convenience.
The relation,  in  fact, is already  coming to  be
viewed more and more in the light of a partner-
ship, as a matter of business and necessity, or, in
other  words,  to  be  based upon the  supremely 
       MEDICAL  PROBLEMS OF THE DAY.      43

selfish traits or elements of human nature.   That
such large numbers of our young married women
should be so disinclined to assume the duties of
maternity, indicates something wrong.  However
desirable or important may be the cultivation of
any  or all the  mental  faculties, the reason,  the
judgment,  the imagination,  and  even  the con-
science and veneration,  these alone  never bind
and cement society permanently in the home and
in the  family.   In  such cases children  are a
burden, confinement at home is irksome, domestic
labors and relations are not  the most agreeable.
What is wanted, and what accords with the order
of nature, is a  balance of organization—a har-
mony of action in all the functions of the brain—
not an excess of the mere animal, nor all intellect
nor moral feeling.  If a practical test of this law
is demanded, what is the testimony of history and
the experience of the  present age?  Let a careful
investigation be made as to the productiveness in
offspring, and the character of the family relation,
of those who have been, or are, supremely devoted
to intellectual  and business pursuits.  How often
do we find difficulties  and  not unfrequently sepa-
rations  between married couples, where  both are
highly educated and strong-minded?  And as for
offspring,  they certainly are not very  abundant
with this  class of people. There may be found
exceptions to  the  last remark, but the facts gen-
erally  confirm  it.  It should be stated, that in
order to make a fair trial, and  witness its  full
effects,  two  or three  generations must be  taken
           7 
44      MEDICAL PROBLEMS OF  THE DAY.

for the comparison.   It is this permanent result in
an intensified form, that makes these changes so
important—so fundamental.
  It may be said that the argument here employed,
as to the position  of woman in its relations to
marriage and maternity, does not apply to that
class who do not  assume  these  relations.   But
this class composes  only  a small minority of the
whole,  and  the  course  pursued  by them  is  an
exception to  the   general law   of  womanhood.
Besides, they cannot change  materially the  phy-
sical functions of their nature without  injury to
their health,  or without  affecting, more or less,
their character.   The remark was made by one
of the most  distinguished  female writers  in this
country, that the nature of woman was not fully
developed without sustaining  the relation of wife
and mother.  How then can the  class alluded to,
governed by their own consciousness, judge pro-
perly and correctly  of  all the relations referring
to the family  and  domestic life?    Can  their
teachings be safely followed?
  Again, what effects would the reforms advocated
by many have more directly upon the body itself?
In some  respects they would tend, undoubtedly,
to improve the general health—to  increase the
muscular power, vigor and strength of the system.
In some  cases they would decidedly improve the
organization, produce more harmony  of action in
all the organs—a better development of the great
laws of life  and health.  But while they might
increase the  muscular power and strength, might 
       MEDICAL PROBLEMS OF THE DAY.     45

they not  unduly develop  the  nervous tempera-
ment?   If there is to be  a constant strain upon
the muscles and the brain, what will be the effect
upon those organs connected with the functions
of gestation and lactation?  Would it not tend
to prevent their proper development and healthy
action, by withdrawing from them  the nutrition
which  should  go to their  support?  The better
the laws of inheritance are understood, the more
directly certain effects may be traced to the phy-
sical and mental state of the system at the time
of conception  and during the period of gestation.
JSTow if all the energies of the body and brain of
woman are to  be  incessantly taxed, what will be
the effect  upon offspring ?  It should be borne in
mind that physical and mental habits, when fixed
for many  years, cannot  be  easily  changed or
modified.    Then in the  matter of  furnishing
proper nutrition to offspring — which can  come
from the human breast alone — it  is vastly impor-
tant that  the  organization should not be so exer-
cised or changed  that this provision cannot be
counted  upon.    The  community  is  suffering
seriously from defects of this kind already, with-
out liaving them increased or aggravated.  This
brings  us  to the consideration of another problem
— intimately connected writh the one under dis-
cussion, but far more important in its issues.  It
is  what may be  denominated  a  general  law of
increase  or propagation, in discussing which the
organization of woman will be further considered
with reference  to  its bearing upon that law.  It 
46      MEDICAL PROBLEMS OF THE DAY.

will appear that there are  certain  physiological
conditions in her constitution that are indispensa-
ble for the observance of this law  in its  highest
or most healthy development.

         THE LAW  OF HUMAN INCREASE.*
   The remark is  frequently made that we live in
an eventful period.  Some  events or occurrences
make  a great impression  upon the public  mind,
and are being  constantly  discussed;  others, far
more important, are transpiring, that attract little
attention, but will be noticed by the historian with
intense interest, if not with surprise.  In this latter
class of events will be ranked the changes in our
population, especially the decrease of numbers in
our ]STew England  people, which,  if continued
another hundred years in the same proportion as in
the past, will, in all probability,  remove them from
the  stage.  Their  record will  exist only  in his-
tory.  Here in this quiet, gradual decline of pop-
ulation  is one of  the gravest  problems of this
age.   What is its solution ?  Must we lie supinely
by,  and leave that solution to the lapse of years,
simply watching or aiding  professionally the ebb
and flow  of life, as one generation  after another
rises and  disappears ?  Xo  persons  can be more
cognizant of the facts, or feel a deeper interest in

  * Having been led to adopt some novel views upon the law of increase
or population, and having  published several  papers upon the  same in
journals and pamphlet form, it seemed proper to present here a  synopsis
or summary of those views.  If there is truth in  them, tliey should
certainly be made known ; and no class in the community  is better
capable of judging of .their correctness, or should be  more interested in
their diffusion, than the members of the medical profession. 
       MEDICAL PROBLEMS OF THE DAY.      47

their results, than medical men. Their professional
duties  are  closely  identified with  the  two great-
est events in life—birth and death—that occur to
any human being.
  What, then,  are  the  facts  in the  case, and
what  are the  causes?  On account  of the rapid
increase  of a  foreign  element  in  our midst, this
change going on  in our  population has not been
so perceptible, nor created much interest. Had
no such additions ever been made to our numbers,
the change would have  excited  universal atten-
tion, and some explanation of the causes would
certainly have  been demanded.   There are two
methods  of testing the character and extent  of
this  change:  first, by ascertaining  the average
number of children to each family in a community;
second, by  comparing the differences between the
birth-rates  and the death-rates of a people.  With-
out attempting  to solve  these   questions with
mathematical  accuracy, a task of difficulty, the
facts  stand very  nearly  as  follows.  The early
parish and town records of ~New England show
that  the first settlers had large families, num-
bering on  an  average from seven to nine chil-
dren; but  soon after the first generation  a slow
decline commenced.  For the last two or three
generations this  decrease has  continued  at   a
more  rapid rate, so that from the best estimates
that can  be made,  it is thought that the  present
average number of children to each married couple
will  certainly  not  exceed  four, and may  not be
much over  three.  From statistics  on mortality,  it 
48      MEDICAL  PROBLEMS OF THE DAY.

is found that only about three-fifths of all infants
born, live to adult age.   After, then, making the
necessary allowances for death, and  the fraction
who do not marry, it will be seen at once, that the
original stock is scarcely kept good at the present
time in numbers.  It is safe,  we believe, to state
that the  average number  of  children  to  each
marriage has diminished nearly one-half since the
present century commenced.
  In  respect to  the birth-rate and death-rate of
our ~New England people proper, it is difficult to
obtain them exactly,  inasmuch as all  the  foreign
class  born in this country are generally returned
in the reports  as native American.   But in some
places the reports of the two classes have been
kept  separate,  while  in  others,  by  a  careful
analysis  of  the   Registration  Reports, and  the
nationality of the  population, a very correct result
can be reached of the birth-rate and death-rate of
each.  It is very evident that these two great
points in vital statistics, viz., birth-rate and death-
rate, have been ajiproximating, with  Xew Eng-
enders,  for the  last  half  century,  nearer  and
nearer each  other.   This statement is confirmed
by the fact, that in  towns peopled almost entirely
by Americans, the deaths frequently exceed  the
births.   This relative  decrease in  population is
admitted  by the  highest authorities,  the  U. S.
Census, the ]STational Bureau  of "Vital Statistics,
and  the  State Registration   Reports.*   Now,

  * " The character of our population is undergoing a great change.
Surely,  and not very slowly, a mixed stock of Irish, German and 
MEDICAL PROBLEMS OF THE  DAY.       49
judging by the past, what are we to expect in the
future?  Should the  same relative decrease con-
tinue two  or three generations more,  what will be
the result?  That there should be, in the course
of two or  three generations, so great  a falling off
in the  birth-rate of  our New England people, and
that  the Irish, English, Scotch, German and Cana-
dian-French women living in our midst should have,
to say the  least, twice as many children, are cu-
rious facts which must in some way  have a solu-
tion  or explanation.   That  this wide difference
arises  wholly from violating the laws  of nature in
conception, and by abortion in pregnancy, we can-
not believe ;  but other  causes  also  exist in the
peculiarities and changes in physical organization.
All medical observation and experience teach that
there is in women a wide difference in the matter
of fertility, and that  it must  have its foundation
in differences  of constitution.   That this differ-
ence exists  in  communities  where,  in   order to
prevent increase,  the laws , of nature are not in
the least violated, all  must admit.   In what, then,
Canadians is taking the place of the purely English stock which has
possessed Massachusetts lor more  than two centuries.   The tide of
immigration flows the stronger with  an increasing wealth and general
prosperity.  There is much hard work to  be done, unskilled labor is in
demand, and Americans are not ready or willing to supply it from their
own ranks.  These are facts for the statesman, the  educator and the
moralist." — Massachusetts Registration Report, 1870.
  " No one can be familiar with life in the  Eastern  and Middle States
generally, and in the Western cities, and not be aware that children are
not born to  American parents  as they were in the early days of the
country.  Luxury, fashion, and the vice of ' boarding,' combine to limit
the increase of families to a degree that in some sections has  threatened
the perpetuation of our native stock.  This tendency is not_ one that
requires to  be brought out by statistical  comparison.  It is patent,
palpable, and needs no proof."— U. S. Census, 1870. 
50     MEDICAL  PROBLEMS OF THE DAY.

does it consist ?   What is the peculiar type of
organization  most favorable to fertility ?   Is  a
particular temperament, or a predominance of a
certain class of organs, requisite ?
  Some of the causes of this difference are very
obvious in the ill  health of women, particularly in
the weaknesses and  diseases connected with the
reproductive organs.   That these  are very preva-
lent with American women,all will admit; but why
should they extet to  such  an extent?  What are
their primary causes?   Do not most of them arise
from previous violations of law, from wrong habits
and practices, from  perverted  and false notions ?
Besides, have not  these  agencies  or primary
causes prevailed  so  long and  to  such an extent
as to  change, in some measure, not only the form
of  body and  type of organization, but to  affect,
in some  degree,  the disposition,  the  habits  and
the character of the  individual.
   Commencing medical practice more than thirty
years ago, in a mixed population, embracing seve-
ral distinct nationalities, my attention was early
called to this difference in  birth-rate.  Careful
comparisons  were  instituted in respect  to the
female organization of the Irish, the English, the
Scotch, the German, the Canadian-French and the
American, and then between  those of each  race
who were prolific and those who were not.   Then
a thorough review of all books treating upon  pop-
ulation was  resorted to, together  with investiga-
tion into all the principles of physiology that could
throw any light upon this subject.  In this inquiry 
        MEDICAL PROBLEMS OF THE DAY.     51

we were surprised to  find, that among all the wri-
ters upon population, there was  scarcely one who
had  been thoroughly educated in the science of
physiology, or  in the  practical  application  of
medicine to the law^s of life.  In all the discussions
and theories of the early writers who attempted to
account for the increase or decrease of population,
the human body, the most important agent, re-
ceived  but little attention.   The systems  and
theories they advocate are based  upon causes or
grounds entirely external to the body, and some of
-them sustain very slight relations to it.  But with-
in a  few years new  inquiries have started up as
to physical agencies  affecting different races and
nations, and also  in respect' to origin of species,
laws  of life and  health, &c.  The principles of
physiology, biology and anthropology are assum-
ing  every year greater and greater importance.
In these new  inquiries  and discussions  upon the
laws of life, health and disease, and other changes
that  affect  physical  organization,  the  laws  that
govern its increase or  decrease must ere long re-
ceive far more attention.  For it stands to reason
and common sense, that there must be, in the very
nature of things, some great primary law of  pro-
pagation, and  that such a law must have its seat
and foundation within the body itself.
   After extensive observation and no small amount
of reading  and  reflection, I became  thoroughly
convinced that there  was a great primary law of
propagation founded  in  nature.  This  conviction
has  been  every  year strengthened by  new  and
             8 
52      MEDICAL PROBLEMS OF THE DAY.

striking evidences from a variety of sources.  This
law, expressed in the fewest words  possible, may
be thus defined:  It is based upon a perfect stand-
ard  of  organization,  or consists in  perfectionism
of structure and harmony of function; or, in
other words, that each organ in the human body
should be perfect in structure, and that each should
perform its legitimate functions in harmony with
others.  It presupposes that other conditions are
favorable,  such as the  age,  health, union  and
adaptation of the married parties — that no laws
of nature are violated or interfered with — that
there will be uniformly found, with  such  a stand-
ard of organization, not only the greatest number
of births, but children  endowed with the highest
amount of physical vigor,  strength and health.
Taking this, then, as  a standard, we have a gene-
ral  law  or principle that furnishes a guide  by
which all  deviations from  this  model, and  the
manifold changes that  follow, may be explained
and understood.  While this law is subject to the
influence of certain agencies, as those of food, cli-
mate, exercise,  &c,  all these act  as  secondary
agents or factors.  They may modify the opera-
tion  of the law, but cannot change its nature or
general character.
  It is true  we have no such perfect standards or
models of human organization now  existing,  but
only approximations towards them.  Still  the law
may  apply to such as  we have, just as well as the
general law  of  gravitation  or attraction  to  the
smallest sized bodies.  We can readily conceive 
       MEDICAL  PROBLEMS OF THE DAY.      53

of such  standards,  and  how the  same law that
governs them may be applicable to  their represen-
tatives of whatever  grade or character.  As the
subject opens up so many new  points of inquiry
and observation — is so vast in extent and so com-
plicated in all its parts—it would require a life-time
to investigate and discuss it with  any degree of
justice or satisfaction.   We can here only present
a brief outline or  synopsis of some of the evidences
which may be adduced in the support of such a
law, premising that it would  take volumes to give
the details.   The facts and arguments in support
of the theory must be  derived mainly from physi-
ology, pathology and psychology, while  many
proofs and illustrations may be obtained from his-
tory ; still, these would be only the practical appli-
cation of principles embraced in one or all of those
sciences.  From  the  past history  of physiology
and pathology, it is certainly reasonable to expect
the discovery of  new truths, or new applications
of old ones.
  The most  distinguished writers  on physiology
speak of the science as being in its infancy, and
of " the rich harvests that await the physiological
laborer," and that " it  is destined  to attain pro-
portions far more gigantic than  it now presents."
In taking a cursory survey of the subject, the first
impression made upon  the mind is, that there must
be, in the very nature of things, some general law
of propagation, of continuance, of existence ; and
that,  whatever agencies or influences  there are,
extraneous to the body, which might in any way 
54      MEDICAL PROBLEMS OF  THE DAY.

affect its development, the most important law of
all, the law that shapes its  character, life and des-
tiny, must have its seat and foundation in the body
itself.  Such would be the  experience, or the com-
mon judgment, in case of other organic structures,
as well as in science generally.
  What, then,  are the teachings  of physiology
and  pathology?  Unfortunately, in  no  medical
books or journals have the principles of these sci-
ences been very fully  discussed,  with any particu-
lar aim to account  for the increase or changes in
population.  It  is comparatively a new  field of
inquiry,  and most difficult of investigation.  The
great object of the cultivators  of these sciences
has been to discover  and point  out the structure
and functions, or the  diseases  and cure  of every
individual  organ, rather  than their normal  and
combined action in any one direction.   Thus, in
respect  to  the reproductive organs, the leading
inquiry has been as to their particular diseases and
treatment—not their healthy action, and the rela-
tions in  a normal state which they sustain to all
other parts of the body.
  As far as  any testimony from medical works can
be gathered, it favors some such theory.  The fol-
lowing   expressions,  quoting from Hippocrates
downwards,may be given as a sample.  " The want
of fruitfulness arises from  sedentary life, want of
exercise, profuseness  in living,  fatness and mus-
cular weakness."  " The poorer and most labori-
ous part of mankind  are the fruitfullest, and the
most voluptuous, idle,  effeminate  and luxurious are 
       MEDICAL PROBLEMS  OF THE DAY.      bb

the barrenest."  " High refinement is  an obstacle
to propagation."  " The condition most favorable
to procreation is a habit of body inured to labor."
"Low diet and moderate  exercise are  the  best
restorers of the breed."   " The rate of increase of
population  is  the slowest  in the  most opulent
classes."  "Repletion is an enemy to generation."
Many more and  longer testimonials, similar  to
the above, could be adduced, but these are a fair
specimen.   To the physiological inquirer, they are
full of instruction.  Each one has an application,
and when analyzed physiologically, they all  look
towards   some  uniform type  or  general law  of
propagation.
   One of the cardinal points in the theory of  pro-
pagation here proposed is, that every organ in the
system, in order to secure its proper development,
as well as perform its  appropriate functions, must
receive its due  proportion of nutrition and exer-
cise.  Dr. Carpenter, in his work on  Physiology,
says :  " There is  a certain  antagonism  between 9
the nutritive and  reproductive functions, the one
being exercised at the expense of  the other.   The
reproductive apparatus derives the materials of its
operations through the nutritive  system and its
functions.  If it is therefore in a state  of excessive
activity, it will necessarily draw off from the indi-
vidual fabric some portion of the element destined
for its maintenance.   It  may be universally ob-
served that when  the nutritive functions are  par-
ticularly  active in supporting the individual, the
reproductive  system  is  undeveloped,  and  vice 
 5Q      MEDICAL PROBLEMS OF THE  DAY.

 versa."   Here is a strong argument from the high-
 est physiological  authority,  and the principle set
 forth is susceptible of a wide application.  Let any
 one organ or part of the body be unduly or exces-
 sively exercised, and it  requires more nutrition to
 support it, thereby withdrawing what should natu-
 rally go to other organs.   The general law which
 this  principle goes to sustain  is,  that nature has
 established  an equilibrium or balance of organ-
 ization, wherein all the organs of the body should
 be harmoniously supported  and exercised ;  and
 that such a standard is the most natural, most nor-
 mal  and perfect type which  can be  furnished by
 physiology.   Such, we have  good reason  to be-
 lieve, was the development of the  human body at
 its creation, and in such  a state it is found most
 exempt from disease, is capable of performing the
 greatest amount of labor,  of receiving the greatest
 amount  of  enjoyment, as well as  reaching  the
 greatest longevity.  The chief objects of existence
, are thus intended to be secured in the highest de-
 gree, and to the utmost extent.
   Inasmuch as this theory of propagation is based
 upon a  perfectly sound organization, all diseases,
 derangements and weaknesses of the system inter-
 fere more or less with its operation.  Some diseases
 or certain weaknesses, such, for example, as  ste-
 rility, impotence and barrenness, do this far more
 directly  and effectively than others.   All those
 diseases that have a decidedly hereditary tendency
 violate  this  law especially, as their  transmission
 multiplies diseases, increases  early mortality, and 
        MEDICAL PROBLEMS OF THE DAY.     57

shortens human life.  If both the  married parties
possess this organization, the germs of disease are
transmitted in an intensified form, and such fami-
lies are sure to become extinct in the course of a
few generations.           L
  Closely allied to disease are unnatural structures
and  abnormal conditions of the body, which are
found to become less and less productive the fur-
ther they deviate from a perfect standard.  A dis-
tinguished writer on Anthropology states, that
giants and dwarfs are rarely prolific, and that per-
sons of very large or small intellectual powers are
generally deficient in fertility.   The fact is pretty
well established that the defective classes, such as
the insane, the deaf and dumb, the feeble-minded,
are not generally prolific, and if left to intermarry
exclusively among themselves they would run out
entirely.  There may be apparent exceptions in
these classes, but the general rule will, in the long
course  of events, hold  good.  It  would seem as
though infinite wTisdom  had  intended that all such
abnormal characters  should not long or upon a
large scale be propagated,  and that they  must,
by the very conditions of their  existence, tend to
extinction.
  The  same general  law holds good, too, when
applied to  the most  vicious and  abandoned, the
notoriously intemperate and  licentious,  that, in
the course of a  few generations, their progeny
become extinct.  For a somewhat different illus-
tration, upon  a large scale, take  a people or race
whose native increase  for  many  years  has  been 
58      MEDICAL PROBLEMS OF THE DAY.

slight, or who,  at times, have been declining in
population,  such as  the French, the Spanish and
the  Italian nations;  what is the  present type
of their physiology ?  Is  there  not  a similarity
of temperament, or are not their leading  physical
developments in some respects much alike ?  On
the other hand, and in contrast, take a people
or race, which, for several generations, has been
rapidly increasing in numbers, such as the Ger-
man,  the  English and the Irish.   In certain fea-
tures  the physical organization of these nations is
identical, and is certainly very different in its type
from that of the three nations first mentioned.
  In this same department of physiology is a class
of facts which  furnish most positive evidence in
favor of some general law of increase, and cannot,
we believe, be  explained satisfactorily  upon any
other  hypothesis.    Some of these  facts  were
noticed in the early history of the world, long be-
fore anything wras known of this  science.   The
sacred  Scriptures clearly intimate that  there is
something wrong in the  intermarrying  of blood
relations, and by the law of Moses it was forbidden
" in the third degree."  Both the Greeks  and the
Romans observed these facts, and proclaimed that
such intermarriages were prejudicial to the healthy
propagation of the species.  The Catholic Church
very  early  opposed  it, and  adopted a standing
order or  canon against all such  alliances.  The
Mohammedans  of the  present day, and  various
other  religious  sects, have very positive opinions
upon this subject.  For several thousand  years a 
      MEDICAL  PROBLEMS OF THE DAY.      59

great store of facts has been accumulating, which  ,
go to show that  there are some fixed laws in physi-
cal organization which should in some way receive
a satisfactory solution. All the new discoveries
and  modern researches in  physiology have only
confirmed  these phenomena, without explaining
their rationale.  But this fact has been discovered,
and  its truth is generally admitted, viz.: that there
are  exceptions  in the intermarriage of relations
where no evil effects have followed, as, for instance,
in that of cousins.   Why these  exceptions  occur,
or why  bad  effects  follow at  all,  are  questions
which cannot easily be explained upon any of the
old theories of population.
   Closely identified with this same  topic, may be
found a most fruitful field of  inquiry, in  which
facts of  the greatest interest and importance may
be gathered  bearing directly upon this subject.
We refer to the laws of inheritance.
   ]N~o truths in physiology are more patent or more
generally admitted, than that certain physical and
mental  qualities are transmitted  from parents to
children.  The  fact that resemblance  or likeness
is thus communicated, is becoming more firmly es-
tablished every  year, not only in a general sense,
but  in its application to every organ and  tissue in
the  body.   All advances  and new discoveries in
physiology, pathology and psychology confirm and
illustrate, more and more, this law of hereditary
influences.  It is true the operation or working of
the law depends upon certain conditions, such as
two distinct agents concerned in the union—their
           9 
 60      MEDICAL PROBLEMS OF THE DAY.

 adaptation, peculiarities, state of health, and other
 conditions of the system.  If the organization  of
 both parents were perfect, or very nearly alike, we
 should find  the  same or very similar qualities  of
 organization exemplified  in their offspring.  On
 the  other hand, if there  are great  differences  or
 striking  peculiarities in the  parents,  the  same
 qualities, modified, perhaps, in  some degree, will
 characterize  their children.   And the  effects  or
 qualities thus communicated will extend through
 successive generations, sometimes becoming more
 marked and significant.
   Now, why this  resemblance or relation between
 parent and child; why should  certain sequences
 uniformly follow certain antecedents?  The facts
 are admitted. We have certain effects  traced di-
 rectly to certain  causes, implying that there are
 necessarily and invariably certain relations between
 them.   The  admission of one  relation,  the evi-
 dences to prove the existence  of any laws here  at
 all, go just so far to prove that there are more,
 and that there may be  one  general law covering
 the whole.  In no other way can all these heredi-
 tary influences be explained or reconciled, as far
 as we  can discover, except by a general law  of
 propagation, and that, too, based upon  a perfect
 organization.
   Connected with hereditary influences, the ques-
tion naturally arises as to man's  free agency and
responsibility.  A very strong argument may be
adduced from this source in favor of the theory
here advocated.   In  a law of population, where 
       MEDICAL PROBLEMS OF THE DAY.     61

the agency and interests of man are so much con-
cerned, the highest dictates of justice and wisdom
would teach us to  expect that, while he ought to
act voluntarily and with perfect freedom, he should
also be governed  by a strong  sense  of responsi-
bility, by high motives of improvement, and by
regard for the increase of human  happiness.  If
man is therefore a free moral agent, accountable
for all his acts, the law providing for the propaga-
tion of the species should certainly be of such a
character that he can clearly understand its nature
and sanctions, a law which he can and should obey
under the  highest possible motives.  Whereas, if
the law of  population is based  upon  food or
climate,  or  upon outward  circumstances  over
which the individual can have  but little  or no
control, or if  it is  a law of which, in  its character
and application, he  can have only vague and in-
definite notions, what becomes of his responsibility
in the matter?  Where is any motive for improve-
ment? It certainly could not have been the inten-
tion of the Almighty that man should be, morally,
a mere passive agent in such  a transaction, or
should always remain ignorant of one of the most
important laws relating to his being!  . But how
different the theory or law of increase based upon
physiology!   Here  the nature and  character of
this law are  clearly made known, together with
the conditions upon which its  operation depends,
as well as its  effects, by hereditary influences.  It
explains how  improvements may be made, not only
in the family, but extended  from generation to 
62      MEDICAL PROBLEMS OF THE DAY.

generation, thus elevating and perfecting the race.
Here in this law we have combined  free agency,
moral certainty of action, and the highest possible
order of motives.
  If there is a great law of human increase, what
are the facts in the animal and vegetable kingdoms?
The same  general laws that govern all organic
matter in these  lower orders, it is believed, govern
and  control all the changes that take place in the
human system.    It is true, there are some  points
of variance, and some modifications  that are not
strictly analogous; but,  in  the main,  the general
principles operating in these several departments
are the same.   A little over one hundred years
ago, the  first systematic attempts were made in
Great Britain to improve domestic animals, since
which time, by a series of experiments and ob-
servations,  the most surprising improvements and
changes have- been made.   Certain results were
uniformly found to follow certain  conditions ; and
so sure have these relations been  considered, that
if there was any slight  exception or variation in
the result, some cause or explanation readily pre-
sented itself.  To such  an extent have these ex-
periments been  carried, that they have resulted in
what may  be  considered  as settled  principles.
Now, when these principles are all carefully ana-
lyzed and  traced back  to  their primary sources,
they will be found based upon the laws of physio-
logy, and when  summed  up  or reduced to a system,
they all  centre in one general law of propagation.
Facts and arguments  of the most positive char- 
       MEDICAL  PROBLEMS OF THE DAY.     63

acter might here be adduced by way of proof and
illustration, to show  that  it is  the same  law of
increase which we have described as applying to
the human race.   And by such a law, and by no
other theory, as we conceive, can these improve-
ments and changes be satisfactorily explained.
   Among vegetables and plants, similar principles
prevail.   All the improvements and changes  here
made are  governed by the application of physiolo-
gical laws ;  and these laws, when scientifically ex-
amined, will be found to be part and parcel of one
general law.
   The records of history strongly corroborate this
theory in various  ways; yet there is great difficulty
in making here anything like a proper test or ap-
plication  of this  law, inasmuch as  history fur-
nishes no formal account or description of what
was the physical organization of any people where
such changes  were taking place.  Even the  vari-
ous works treating expressly of population seldom
make any reference to physical qualities  or  phy-
siology, as though the great organic laws of the
system had comparatively little agency in the  mat-
ter.  But let us gather up  some facts from differ-
ent points of view.   As a  general rule,  families
and communities have multiplied most where there
was the greatest aggregate amount of health; and,
on the other  hand, the sickly and diseased, as  a
whole, have increased much less.   It is an estab-
lished fact that consanguineous marriages, if  con-
tinued for some time, and also the  intermarrying
of certain  orders,  like that of the nobility or peer- 
64      MEDICAL PROBLEMS  OF THE DAY.

age, carried on through several generations, result
in less and less offspring, and  sometimes in entire
extinction  of  families.   Such unions,  in   fact,
beget too much likeness or sameness of qualities
in organization; and if there  are  weaknesses  or
predispositions to disease  in the contracting par-
ties, they are transmitted  in a more  serious and
dangerous form.  It is  also an  established  fact,
that all those families in which are found genius,
great talents, and supreme devotion to intellectual
pursuits, are not prolific; and if both the heads of
such families  are thus distinguished, the case is
more marked, the offspring growing less in num-
ber, and the  name soon becoming  extinct.  Such
has  been  generally the family history  of  great
scholars,  authors, poets, of nearly all who   have
been eminent or distinguished in any department
of science.                               •
   There are three points of view,  referring to the
present  construction of society,  as well as to its
past history, from which important evidences bear-
ing upon the subject may be obtained.  It should
be borne in mind that this law of increase, in  its
highest  development, is based upon a  perfectly
well-balanced  organization, sound  in   structure
throughout,  with every organ performing its ap-
propriate function.  If we take, then, this type of
organization as a physiological standard, let us see
what would be its practical  application  in the ex- -
treme deviations from this model.   It is a fact no
one wrill  dispute, that there is a  great  difference
in  the number  of  children  in different  classes 
       MEDICAL PROBLEMS  OF THE  DAY.      65

and communities.  It is found that just in pro-
portion as  we  ascend  the scale  in refinement,
education and all the higher elements of civiliza-
tion, there will be, in about the  same  degree, a
diminution of  offspring.  It is well known that
the families in what are  called the  upper classes
become, from generation to generation, less pro-
ductive, and in the course of time extinct, unless
replenished from the lower walks in life. Hence,
in nations most highly civilized, those standing at
the head of government, and occupying the high-
est positions in power and influence, have, in the
course of time, few to represent them.  If we ad-
mit the foregoing statement as a well-established
historic fact, we naturally seek an  explanation of
it.  The simple reason  is,  as we  conceive, that
their  style  of living taxes  the  brain altogether
too  much ;  it  developes a great  predominance
of  the nervous  temperament  at  the  sacrifice
of other parts  of the  body, which by inheri-
tance is increased from generation  to genera-
tion.   The  balance  of   structure  and harmony
of function in organization is radically changed,
and carried  to  an intense development of nervous
tissue,  which in its very nature is unfavorable to
the procreation of offspring.   It  illustrates the
principle of Fourier,  that "just in  proportion as
individuals or a community become perfected in
civilization,  in  the  same  proportion  the  race
inclines to run  out."
  If now we pass to the  other extreme of society
and  physical  organization, what  are the facts ? 
66     MEDICAL  PROBLEMS OF THE DAY.

The first impression might be that the birth-rate
here would be large, and that there might be from
this  source  a steady and  permanent  increase of
numbers.  There may be individual cases of this
character, and temporary  increase of  a race  or
community;  but in the long run these are  the
exceptions.  For nowhere do we find any account
of  a  tribe  or race, living in a  purely savage,
barbarous state,  leading  a coarse,  low, sensual,
animal life, that has been at all fruitful in children
through  several  successive  generations.   It is
true,  such  classes  are  always  changing,  and
sometimes increasing in numbers by immigration;
but  seldom do they multiply  extensively from
their  own  resources.  Such  is the verdict,  we
believe, of all history, both ancient and modern.
The laws of  nature have  wisely fixed limitations
to the increase as well as to the prosperity of
such a people.  Illustrations of this may be found
in certain portions of Asia and Africa, among the
South Sea Islanders,  and  in the Indian tribes of
our own coraitry.  It may, perhaps,  be alleged,
that the reason for this limitation is  not  in  the
birth-rate so much as in the manner of living.   A
careful examination of  all the circumstances will
show, we  believe, that  the  primary  and chief
causes arise from violation of physiological laws.
The nutrition here goes  either  to support  the
body of the individual  alone, or is  consumed in
the mere gratification of the animal propensities.
When the lower and  grosser parts of the body
become  too predominant  and  active, they soon 
       MEDICAL PROBLEMS OF THE DAY.     67

become  exhausted,  and  cannot  propagate  the
healthy germs of life.  It will be found, too, that
where there is not  a fair  development of  the
nervous  temperament, and  a healthy  exercise of
the brain, such a people or race tend to die out.
   The  third point of view  is that  position in
society  and  physiological  standard  half way
between these  two extremes — the golden mean;
or, in other words, that type of  organization the
most healthy and best balanced that can be found.
We may not find perfect specimens, but approxi-
mations in great numbers towards such standards.
As history nowhere  describes definitely the phy-
siology of a people, and we cannot take an
extensive view  of that now existing, the facts
cannot here be given  with the precision and detail
that are desirable.
   According to the law of propagation proposed,
the people included  in this  class will have  the
greatest number of children, combined with  the
highest  degree of strength, vigor  and health,
provided  the laws of nature are  not interfered
with.  It wrill be  found that classes or communi-
ties, possessing such an organization, increase the
fastest in numbers, and so  continue  for several
generations.    As  representatives  of  this  class,
may  be  mentioned  the   first  settlers of  New
England, the  better  portion of the  Irish race,
whether  living in Ireland or  America, together
with a middling class  of  the German, the Scotch
and English,  living either in Europe or in  our
country.   And when any two  of the races in
             10 
68      MEDICAL PROBLEMS OF THE DAY.

those classes  are united, we find a more rapid
multiplication of numbers;   as,  for   instance,
among  what are   called  the  Scotch-Irish  or
Canadian-French.   A careful examination will,
we  believe,  most  conclusively  confirm  these
statements.   From  a  professional experience of
over thirty  years among some of these classes,
with particular  inquiries and observations in this
direction, these  facts have proved so  clear  and
abundant, that  we  could  arrive at  no  other
conclusions.   After making thorough  investiga-
tion into particular  cases and families, we never
have found  exceptions  to this general  statement
without, at  the  same time, finding a satisfactory
explanation  of them.   All doubts and questions
can in  this  way,  we believe,   be  decisively
settled.
   Closely connected with this point of view is
another feature  of the subject, challenging careful
inquiry and investigation.  This  point  must be of
special interest  to  medical men.  In the work of
propagation,  greater  consideration  is  given  to
woman,  inasmuch  as  her  organization performs
the more important agency, particularly in the
matter of gestation and nursing.   The physiology
of  woman,  the  history of her diseases and the
rate of mortality, demonstrate that married life
and the production of children  are among the
primary objects of her  creation.   Dr.  James
Stark,  of Edinburgh,  by  a  careful  examination
of  over one hundred  thousand  cases  in  the
Registration Reports of Scotland, for  1861  and 
        MEDICAL PROBLEMS OF  THE DAY.     69

1862, showed most conclusively that the married
women of  that country, on an average, lived
longer  and enjoyed better health than the unmar-
ried.   The same fact  has been confirmed by other
writers, and by statistics in other countries.  There
can be no question that the fulfilment of this law
is found necessary for the most complete develop-
ment and perfection of woman's organization, for
her longevity, and her greatest amount of health
and happiness.  Exceptions there may be to this
general rule, but it is a law which God has made
applicable to all races and nations; and whatever
institutions, habits and  practices interfere with its
execution  are abnormal, are deviations from the
laws of nature and of God.
   If the truth of these views as to the laws  of
life and health be admitted, or if their correctness
should  be  deemed probable,  the importance  of
their inculcation will  be seen at once; for some
moderns,  in their teaching,  insist  upon widely
different doctrines and  practices.   The physio-
logical laws involved in the relations of marriage,
of family, and of maternity, cannot very safely be
trifled with or set aside.  No permanent improve-
ment  or reform  can  be made in these relations,
except  as based upon  and in harmony with the
physical laws of the system.
  If, then, this is a primary design in the organi-
zation  of woman,  upon  what particular type  of
development, condition or feature of the system is
this law found to operate best,  or in its highest
degree?  That there is a difference, a wide  differ- 
70      MEDICAL  PROBLEMS OF THE DAY.

ence, in the fecundity of women, must be admitted;
a difference, physiologically, in the susceptibility
to conception,  in the effects of pregnancy, in the
ease and safety of delivery, in the physical quali-
ties for nursing, in  the constitutional healthiness
of offspring.   In what, then, does this difference
consist?   To  settle this  question, we naturally
seek some standard to which to appeal;  and both
nature and analogy would lead us to the conclu-
sion, that such a standard or model  exists some-
where, and that we shall  not seek for it in vain.
Reasoning a priori, we should naturally infer that
it would be found in the highest type or most per-
fect organization in structure and  function.  For
such is the nature, importance and complication of
forces required in propagation, that for its success-
ful results, it  seems to demand the  aid  of every
part of the system.   This  is certainly the first, the
highest and most  important law in the whole ani-
mal economy.
  Again, we should infer  from analogy that this
law. was based upon the most perfect development
of the system.  All primary laws  or the  funda-
mental principles  of science take their start from,
or are  based  upon, perfect standards  or models.
Nature in her  primeval state is perfect, and all her
laws must be tested by such standards.   The laws
that govern the human system cannot  be  an ex-
ception to this rule.  If there is, then, such a gen-
eral law of propagation, it is of the highest impor-
tance that it  be  known  and understood.   The
knowledge of such a law would be fraught with 
        MEDICAL  PROBLEMS OF THE DAY.     71

the greatest  possible interest and  benefit to the
community at large, but especially to the medical
profession it would  prove of incalculable value.
Let us, then, inquire briefly what are some of the
evidences of the  existence of such a law derived
from this source,  and what would be some of the
advantages  of understanding it.   Our remarks
will  be confined  to  two or three points of view.
As the field of inquiry is new, and  nothing com-
paratively can be  found in medical works bearing
directly on  the subject, we  would bespeak the
charitable consideration of our brethren.
   Provided there is such a law (of which we our-
selves  entertain no doubt), what  relation does  it
sustain to  the pregnant state?   Considering the
change produced by pregnancy in the system, it
might  be expected to disturb somewhat the func-
tions of certain organs; but the extent and danger
attending this disturbance become sometimes very
weighty considerations.  If,  in  accordance with
physiological laws and  experience,  parturition as
a whole has proved favorable to the life and health
of women, does  not the  existence of  grave  and
dangerous diseases arising from the  pregnant state
indicate something wrong in those particular cases?
In works treating of diseases of women, we have
generally a long chapter under the head, "Diseases
of Pregnancy," discussing from twenty to thirty
distinct complaints.   They are described as caused
by, or incidental to, this state of the system, and
occasionally some of them  become very serious
and dangerous.  It is very evident that in certain 
72      MEDICAL PROBLEMS OF  THE DAY.

individuals, there is far greater liability or predis-
position to some disturbance than in others, and
that the type or character of the disease depends
mainly upon the constitution and habits of the in-
dividual.  It is well known that the health of some
women  is  greatly benefited, too, by the pregnant
state; and not unfrequently, after bearing several
children, the constitution is actually strengthened,
the general health is decidedly improved, and life
prolonged.  But in other instances the very first
stage of this change operates unfavorably; it may
induce a little nausea  or a slight headache, or it
may result in  the most violent inflammation or
convulsions.   Sometimes the  change  may  affect
this organ, sometimes that, and again almost every
organ in the system becomes more or less affected.
The more nervous and sensitive the individual, the
greater  the effect.  It would require a volume to
describe in detail the multiplicity, the variety and
the character of these changes.   Now, why should
there be this  difference, why these disturbances?
What are the causes, the constitutional weaknesses,
the  particular  predispositions?   What  is  there
peculiar in  structure,  in function or  in  habit?
Why should there be such sympathy between this
change  in the reproductive organs and other parts
of the body?   How can we account, physiologi-
cally or pathologically, for these  changes?   What
laws have been violated?  May there not be a
great general  law of propagation, whereby  all
these phenomena  can  receive a satisfactory ex-
planation or solution ? 
      MEDICAL PROBLEMS OF THE DAY.      73

  Let us admit the existence of such a law, based
upon the perfectionism of structure and harmony of
function—in other words, the perfect anatomy and
physiology of the system—and it may throw new
light on all these intricate changes.  The ill effects
of pregnancy, in kind and extent, may be traced
directly, in every case,  to deviations  from this
standard.   The nearer the organization approaches
it, the less it is disturbed; and the further any one
organ or class of organs have diverged from this
model, the  more  marked and generally serious
may be the  consequences.
  In some cases, where pregnancy causes a change
in the circulation and in the action of the stomach,
certain diseases may be essentially relieved, or at
least their progress for a time be  arrested ;  while
in others,  certain  weaknesses may be permanently
cured.   Here nature attempts to  improve the  or-
ganization by bringing about a better balance or
harmony of functions, which proves favorable both
to the woman and her offspring.  In other cases
this  change so increases all the nutritive forces,
that  the woman  in  this state gains in flesh and
becomes corpulent to such an extent,  that it ope-
rates injuriously at confinement;  it may be in the
shock or in the resistance of the  muscular tissue,
or in- the increased danger of inflammation.
  Again, in case the nervous system becomes  in-
tensely sensitive  and the brain  morbidly .active,
thus  removing the system' farther away from  a
normal well-balanced state, it is found to operate
unfavorably in a  variety of ways both upon the 
74      MEDICAL PROBLEMS OF THE DAY.

woman and upon her offspring.  The state  of the
mind has also a great influence upon pregnancy,
and  vice versa.  If the  hereditary influences ex-
erted in all  the stages  of pregnancy upon the
physical and  mental condition  of  offspring could
be fully traced, they wrould be  found, we believe,
far more positive and powerful than have usually
been considered.  A general law  of propagation
aids us essentially in understanding those agencies.
  In making an application of this  law to the
matter of delivery, time will not allow us to  enter
into .detail.  But there must be some standard of
organization, not only of the pelvis and the inter-
nal viscera, but of the whole  system,  wherein or
whereby to account for differences  in  pain,  ease
and  safety in this  process.  May not that stand-
ard consist in perfectionism of  structure and har-
mony of function?   While in lectures  and works
on  obstetrics,  great stress  has  been laid very
properly upon the construction of the  pelvis and
the position  of the foetus, has not the relation
which other parts of the body, and the constitution
generally, sustain to parturition in point of effect
and result, been altogether too much overlooked?
  After delivery, a different relation arises between
the mother and the infant—that is, the depend-
ence of the latter upon the former for sustenance.
It was  evidently intended  by the  laws of nature,
that the child, for months, should be chiefly, if not
wholly, supported froni  this source.  No  fact in
vital statistics is more firmly established than that,
in order to promote health  and save life, the infant 
       MEDICAL PROBLEMS OF  THE DAY.      75

must be nursed at the mother's breast.  The in-
genuity of nurses and physicians has been taxed
to the  utmost, the principles of chemistry and the
results of experiments have  here been brought
into frequent requisition; but no substitutes have
been, or can be, provided equal to pure breast-milk.
Accordingly, we find that nature, in its normal
state or highest development, has made ample pro-
vision  in the structure of the organization of wo-
man for nursing her offspring.  But in order to fur-
nish this nourishment, pure in quality and abundant
in quantity, she must possess a good development
of the  lymphatic and sanguine temperaments, to-
gether with vigorous and healthy digestive organs.
The mammary  glands  should be large, and the
powers of  lactation, assimilation  and digestion
should be strong, or equal to the  demands which
nature makes upon them in this direction.  What-
ever other qualities, physical or mental, the mother
may possess,  these  physiological conditions  are
indispensable.    A careful  examination into  the
organization of women who best nurse their off-
spring will  confirm  this statement.  And if we
extend our observation to women  of  different
races and nationalities, who thus  rear their  chil-
dren, the same type of organization will be found
to prevail.   The same observations hold good in
the lower families or genera of the animal creation,
so far  as  they  admit of comparison, especially
among the mammalia.
  Probably in  no country and at no former period,
have these differences in the qualities for nursing
           11 
76      MEDICAL PROBLEMS OF THE DAY.

appeared more marked or striking than among our
women at the present day.  Formerly our New-
England mothers, as a body, found but little diffi-
culty in nursing  their  offspring.  It was only
occasionally, in case of some radical defect in or-
ganization, or where sickness of some kind had
overtaken the mother, that it became necessary to
resort to the wet nurse or to feeding by hand.,
But how widely different is the condition at the
present day !   It has been supposed by some, that
all or nearly all our American  women  can nurse
their offspring just as well as not; that the dispo-
sition only is wanting;  and  that they  do not
care about having the  trouble  or  confinement
necessarily attending it.  But  this is a great mis-
take.  While there may be cases here and there
of this indisposition (which in itself shows some-
thing wrong), it  is a fact that large numbers are
anxious to nurse their  offspring,  and make the
attempt.   They persevere for  awhile, perhaps for
weeks or months, and then fail.  They find that
their milk does not satisfy the child, or that it does
not thrive ; and they conclude there must be defi-
ciency in the quantity, or defects in the quality, of
the nourishment.   In many cases, after  repeated
trials, it is  decided  to give up nursing  entirely;
while others, depending partially upon  nursing,
resort  also to  artificial  feeding.  There  is still
another class that cannot nurse at all, having nei-
ther the organs nor nourishment requisite to make
even a beginning.  The  proportion of American
mothers that have an abundance of good milk, and 
       MEDICAL PROBLEMS OF THE DAY.      77

can thus  support the  child well till the time of
weaning, is  not large.  The statement has been
made that not more than  one half of our New-
England  women, particularly in cities, can pro-
perly nurse their offspring.   What a contrast does
this condition  present to  that of  the English,
the German, the Irish, and the  Canadian-French
women!
   Why should there be such a difference between
the  women  of our times  and their mothers or
grandmothers ? Why should there be such a dif-
ference between our New-England women at the
present day,  and those of  foreign origin residing
in the same localities, and surrounded by the same
external circumstances ?   The explanation is sim-
ple : they have not the right kind of organization;
there is a want of proper development of the lym-
phatic and sanguine  temperaments ;  or, in other
words, there  is a marked deficiency in the organs
of lactation, nutrition and secretion.  The brain and
nervous system have, for a long  time, made rela-
tively too large a demand on the organs of diges-
tion and  assimilation, while the exercise and de-
velopment of certain other tissues in the body have
been sadly neglected.  There are also other causes
to account for this change of organization;  among
these  are found the fashions of the day or style of
dress, the neglect of physical exercise, and the
want  of  proper attention  to  the great laws of
health and life.
  We have here presented twTo  classes of  facts :
first, that  our New-England women  of the pre- 
78      MEDICAL  PROBLEMS OF THE DAY.

sent day  cannot nurse their  offspring as  their
mothers and grandmothers did ;  and,  secondly,
that there is a marked difference in this  respect
between them  and women  of a  foreign origin.
It is   evident, that this  change  or  difference
must be accounted for in the physical  organiza-
tion.  And  the natural inference  is, that the or-
ganization which  is found best adapted to afford
proper nutriment  to the  infant must be the  best
for  its production; or, in  other  words, must be
regarded as the physiological standard upon which
the law of propagation would be engrafted.   The
conditions  found  indispensable  to  support   life
should exist in the organization that produces it.
Such, we believe,  is the provision or law of nature
in her highest state of development.
  That there has  been a decided change in female
organization in New England  within  fifty  or  a
hundred years, there can be  no question.  For-
merly, there was more  muscle, a larger frame,
greater fulness of form, and a better development
of all those  organs that are classed under the san-
guine  and lymphatic temperaments.  The brain
and nervous system, relatively, were not especially
predominant;  neither  were they  taxed continu-
ously  or  excessively above any  other class of
organs.  The German, English  and Irish women
at the  present day possess, as a body, an organi-
zation similar to  the one here described.  There
are, of course, exceptions;  our reference  to them
is simply as a class.
  Nearly forty years ago, Sir Astley Cooper made 
        MEDICAL PROBLEMS OF THE DAY.      79

 this statement:  "It is melancholy to reflect that a
 life of high civilization and refinement renders the
 female less able to bear the shocks  of parturition;
 it has a tendency to lessen her attention to her off-
 spring, and really diminishes her power of afford-
 ing it nourishment;  so that  she is often a worse
 mother in these respects than the  female  of the
 middle ranks of life or even the meanest cottager."
 This remark was made  undoubtedly as the result
 of extended observation and long experience; and
 it implies not merely a change in  disposition, but
 also a change in organization, from the fact  that
 such mothers could not  properly nurse their off-
 spring.   Sir Astley  Cooper  observes, that  the
 proper development of  the  mammary glands is
 often  prevented by  a constant pressure.   We
 might go further, and say that continual compres-
 sion of the chest and abdomen by the  fashions of
 the clay is such  as greatly to  impair the develop-
 ment and healthy action  of the lungs, the heart,
 and digestive organs, as well as those in the pelvis.
 If we  consider that this compression commences
 with the girl or young woman, when the system is
 in a  state  of  growth  and most  susceptible  of
 change, that it is continued for a series of years,
 and, by the laws  of inheritance, intensified, it shows
 very clearly how such effects upon the system dis-
 qualify women  for  some  of the more  important
 duties  of maternitv.  It  would seem as  though
 fashion and self-love had both conspired together
to defeat as far as possible the  objects of repro-
 duction, both in  number and quality. 
80     MEDICAL PROBLEMS OF  THE DAY.

   Now, with an organization like that possessed by
our mothers and grandmothers, or by the German,
English and Irish women, we have all the physical
conditions requisite for good nursing.   And when
we carefully analyze all its  constituent parts, we
find  that it is a close approximation to a perfectly
sound and healthy standard;  that it is the same
type  or standard  upon which is based the great
fundamental law of propagation.  It furnishes a
certain amount of evidence, that these physiolo-
gical conditions harmonize with the laws of nature,
and when traced back to their fountain head, they
all centre in one  perfect standard or model.  As
above intimated, if we pursue our inquiries  into
the character and  condition  of American women,
we shall find that condition marked by an exces-
sive  activity  and  predominance of  the nervous
system;  that, with less physical stamina, they
possess more brilliancy and excitability.  This  is
what the science of physiology would  lead us to
expect, because it  shows that those parts which
are most exercised require the greatest amount of
nutrition, and become, in some respects, abnormally
developed.  It  is  a law of physiology, also,  that
the brain and nervous tissue demand, relatively, a
much  larger proportion of nutrition  than other
parts of  the system.   So  then, when there  is
coupled with this  abnormal  state a general defi-
ciency or an impaired  condition of the organs of
lactation,  assimilation,  &c, the reasons why our
American women cannot properly nurse their off-
spring become very obvious. 
        MEDICAL PROBLEMS OF THE DAY.      81

   There is still another point of observation closely
 allied to the one just described, from which a most
 forcible argument may be deduced in favor of the
 theory of propagation here  advocated.   In  all
 medical works treating of nursing, we  have very
 minute directions as to the physical qualities for a
 good wet-nurse.  The first thing indispensable is
 good milk,  pure in  quality, plenty in quantity.
 But to  secure this, certain physical qualities  or
 conditions are insisted upon.  A good nurse  must
 have  well  developed  mammary glands,  strong
 digestive organs, an  even, uniform  disposition ;
 she must have good health, freedom  from  all dis-
 ease, no  particular weakness nor excessive  ner-
 vousness.   In fact, the  nervous temperament is
 described by several writers as particularly unfa-
 vorable.   The secretion of an abundance of healthy,
 nutritious milk is laid  down as  one  of the  best
 tests or  indices of a good physical  constitution.
 If we should quote the various descriptions given
 for selecting a suitable wet-nurse, from different
 writers, in their own language, we should find that
 they correspond almost precisely with that  stand-
 ard of organization upon  which, we believe,  is
 based  the great physiological law  of increase.
 Such evidence is the more valuable,  for two  rea-
 sons : first, the writers on the subject have  given
 their descriptions from then own  experience  and
 observation, without any theory of  their own to
maintain, or any design of  contributing evidence
to establish a general law or principle; and second-
ly, these  descriptions of what  constitutes a good 
82      MEDICAL PROBLEMS  OF THE  DAY.

nurse come from a large number of medical writers,
of diverse  character, living in different countries,
and writing at different periods. And what is par-
ticularly noteworthy, there is a remarkable agree-
ment or uniformity in all their statements, showing
that the great facts  or truths  in nature,  wherever
carefully studied  or collected, all harmonize  one
with another.
  The laws of nature, when correctly interpreted,
do not only always  harmonize, but  are also  found
complete in design—never disjointed or fragment-
ary.   Wherever nature  has  made  a demand, a
natural supply has been provided. There are, then,
two logical inferences from these facts:  first, that
the  physiological  conditions  or standard  found
best or necessary for furnishing the proper nutri-
ment for its productions, must  also  constitute the
same standard of organization upon which nature
in her normal  state, or highest development, has
established  the law of  production;  secondly, as
there is found such a general deficiency among
our New-England women in the natural provisions
for properly nursing their offspring, there must
exist some radical deviations  in their present or-
ganization from that normal, perfect standard upon
which nature has placed her laws.
  That this marked change from natural  nursino"
to artificial feeding of  infants, greatly endangers
the health and the life of the child, requires here
no proof.  A great  amount of disease and mor-
tality can be traced, by every physician, directly to
this  source.  But the injury does  not stop with 
        MEDICAL PROBLEMS OF THE DAY.      83

the  immediate effect  on the body, but frequently
extends through life.   The  early start of the in-
fant in vigorous, healthy growth, with good blood,
exerts a powerful influence  upon  its whole future
health and constitution.
   The  profession and the public have  had their
attention of late called especially to the great mor-
tality of infant life.  That in a civilized, christian
community there should be such a waste of human
life — that one-third or more of all children should
die under five years  of age—suggests the idea
that there must be in it something wrong and
unnatural.  Where, then, is the blame?  What is
the cause of the evil?  Is it  not traceable, in a
great measure, to human agency? We apprehend
the principal  causes,  upon  careful  investigation,
will be found  to arise from these sources :  1st,
Inherited weaknesses and diseases ;   2d, Want of
suitable nourishment, or plenty of healthy milk
from the  mother's breast ; and 3d,  Violation  of
hygiene, with  respect to food, ventilation,  cloth-
ing, &c.  If this is  admitted,  it is very apparent
where the responsibility rests, and that this infant
mortality cannot be materially diminished till the
laws of inheritance, maternity and  hygiene are
better understood and obeyed.
  The question naturally  arises, can these evils be
corrected or checked?  We  answer, not  easily  in
the present state of society.  The chances are, we
fear, that they are to increase more and more.
Great organic evils cannot be cured, any more than
diseases, till their causes are  fully understood and
            12 
84     MEDICAL PROBLEMS  OF THE DAY.

the sufferers are disposed to apply the right reme-
dies.

     DUTTES OF THE MEDICAL PROFESSION.
  This  topic  has so  often  been the theme of
address upon similar occasions, that it has become
hackneyed,  and nothing new,  perhaps, can be
suggested.  But here we need "line  upon line,
precept upon precept."   Such is our position in
the community, and such are our relations to it,
that they impose upon us the most sacred  duties
and obligations.     Inasmuch  as  our  personal
interests,  as a  profession, are  so bound up and
identified  with those around us, it becomes us
often to draw the line of demarcation, and look
beyond and outside of ourselves.
  Duties  depend, both in nature and extent, upon
the means or power possessed.  The more  valua-
ble the possessions, and the more extensively they
can be employed for human  welfare, the greater
the duty, and the more sacred the obligation.  The
medical profession are in possession of the most
valuable   knowledge and  precious trusts with
which human agency can be charged.   Not only
are the health and  lives of individuals directly
entrusted  to their  care, but the highest wTelfare of
the public depends very much upon their agency
and influence.
  Once it was regarded  as the chief duty  of the
physician  to  cure his patient, or  to use  the best
means  in  his power for  that purpose; and when
that was  done, his duty  terminated.  It was only 
        MEDICAL PROBLEMS  OF THE  DAY.     85

in relation to the sick, and while they were sick,
that he was supposed to be charged  with  any
responsibility.  Very little interest was manifested
for the prevention of  disease, or the preservation
of  health.    Nothing comparatively  was  then
known of sanitary or hygienic  laws.   Seldom
was any  consideration  given to  the  wide  and
practical application of the principles of physiology
to every-day life.  The fact  that disease in all its
diversified forms depended  in  a  great measure
upon human  agency,  was scarcely conceived or
realized.  But the more thoroughly we investigate
the principles and  laws which spring from phy-
siology and  hygiene, the more  deeply are  we
impressed  with  the  resources which  God  has
placed in our hands  for the prevention of disease,
for the improvement of health and the increase of
happiness.   They  permeate  all the  ramifications
of  society.   They  enter  into the  situation, the
employment,  and  the circumstances   of  every
individual  and  every family.  Wherever there
is food, or water, or  air  to  be used, or  exercise,
or rest, or sleep required, their influence is  felt.
They  should  be a  guide in all the social  and
domestic relations of life, as  well as in the objects
and modes of education.  Upon  certain depart-
ments  of  legislation they have a most important
bearing;'for  in  no  other  field or direction  what-
ever can the  legislator prove himself a greater
benefactor to  his constituents-or the race, than in
the enactment of wise  sanitary laws.
  These principles  sustain, too, a  most  intimate 
86      MEDICAL PROBLEMS OF  THE DAY.

relation to  sound  morals and  healthy religious
development.   In  fact,  till physical and mental
laws are correctly  expounded  and observed, the
teachings  of divine revelation can never be fully
carried  out or properly applied.   It is only when
we take this broad and comprehensive view of the
application of these sciences, that the duties and
obligations of the members of our profession can be
properly estimated.  They should be the teachers
of these sciences, the almoners of this knowledge,
the  guardians of public health.   They are here
emphatically the high priests of nature,  having
free  access to all her inner shrines, and should
prove themselves  true  to their  calling, faithful
to the  trusts  confided  to them.     To  every
individual  and  family that call upon them for
advice and treatment in  the cure of disease, they
should give instructive  hints as  to the nature of
their complaints.   In all matters pertaining  to
hygiene and sanitary improvement, the members
of our profession should make their influence felt
in every village, towm and city in the land.  And
wherever  there  are sources of  disease  in over-
crowded tenements, in  filthy localities, in badly
ventilated  dwellings and public buildings, in the
use of poisoned food, water or air, the physician,.
of all others, should raise a warning voice.  When-
ever, too, the laws of life or health are violated by
excessive labor  or too  close confinement, by false
fashions, habits  of dissipation, vice and crime, the
physician  should  by all  means  prove himself a
genuine reformer. 
       MEDICAL PROBLEMS OF THE DAY.     87

   In the matter of education, great  improvement
is everywhere  demanded in  the proper develop-
ment and  culture of the body as well as  of the
mind;  and no class of men can point out the way,
or explain the principles whereby this  can  be ac-
complished so well as medical men.  Then in the
halls of legislation  and in  the management of
public  institutions, where the  health and lives of
multitudes are concerned, the  voice and  influence
of our  profession should always  be recognized,
and  possess  far greater power and authority than
have been given them hitherto.  Complaints have
been made that unjust  prejudices exist in some
portions of the community against the regular
profession of medicine, that it does not command
the respc'ct and influence in New-England that is
found  to exist in the West and South,  and that in
point of rank and character it  falls much below
the  position  assigned to it in Great Britain and
other European nations.  Whether there may be
any just cause for this complaint or not, one thing
is very certain—the time is approaching when the
relations between  the  profession and  the  public
must in some respects  change.  With the rapid
increase of intelligence in the community,  with a
more general diffusion  of physiological and sani-
tary  knowledge, accompanied  by a disposition on
the part of the people to form their own opinions
in all medical matters, a higher and broader edu-
cation will be required.   The  demand Avill be  for
those  means  and  qualifications,  which can be
applied directly for the  prevention of disease as 
88      MEDICAL PROBLEMS OF THE  DAY.

well as  for its cure;  the physician  must  become
the medical counsellor and teacher, as well as the
adviser and administrator of drugs.
  As a consequence, the services of men thus edu-
cated will be  more  highly appreciated and better
compensated.  The higher a people  rise  in true
civilization, the greater the value attached to life;
and the more clearly they understand that the
means for preserving health and  prolonging life
depend upon human agency, the more readily will
they seek, as  well as appreciate, those means.
  Is not the preservation of life as important and
valuable as that of property?   And can any rea-
sons  be given why services for  protecting and
saving  the one  should not be as  well compen-
sated as those for preserving the other?
  Wherever in Great Britain the most interest has
been awakened in reference to  health and sanitary
reform,  such remedial services  have  been  in
demand.   In 1872,* when certain new and impor-
tant laws on sanitary reform were passed  by Par-
liament, in which liberal provision was made for
the employment of a large number of medical men
to  see that these  laws were enforced in all  parts
of  the kingdom, a singular fact became apparent
that, in many localities, it  was  difficult to find
physicians fully competent for the  service.  Should
  * It seems, by recent intelligence, that some reaction is taking place
in sanitary reform in Great Britain, in consequence of the Acts passed
in 1872 undertaking to accomplish so much, together with changes of
membership in the new Parliament.  As the objects intended by this
reform are so important, and have enlisted so many able advocates, this
reaction can be only temporary. 
        MEDICAL PROBLEMS OF THE DAf.      89

our national or state government take similar steps
in legislation, we fear the same fact would prove
true in our own country.
   Within a few years we have had very able and
warm discussions upon the importance of a higher
standard of education for admission into the pro-
fession.   This  is all well; but would not the influ-
ence and usefulness of  men, who have been for a
longer or shorter period engaged in medical prac-
tice, be more widely extended if they could  gene-
rally take a still higher stand in all matters per-
taining to education, to literature, to the sciences,
to the  arts, and in every department of culture
and  refinement?  In an age  and amidst a people
very much devoted to  worldliness and the accu-
mulation of wealth, there is  great  danger of our
prostituting the principles of a noble  science  to
mere gain.  Inasmuch as material  interests and
external display too often constitute at the present
day  the standard of influence and  association, a
strong temptation is presented to lower the  aims
and narrow the bounds of our professional duties.
While following an avocation  upon which we must
depend for support, and in which there are power-
ful inducements to  resort to such means and
expedients as will afford the largest income, let us
show that we can be governed by a nobler aim, a
purer motive.   In no way can this be so effectually
exhibited as in diffusing such  knowledge as is
calculated to preserve health—to prevent disease.
At no former  period in  the  history of medicine
has such a field for doing good been laid open  to 
90      MEDICAL PROBLEMS  OF THE DAY.

the profession.   The demand  for  useful know-
ledge, the increasing interest in science and the
spirit of reform—all  favor  improvement in this
direction.  A review also of the past affords en-
couragement.  For no  class of  men  have ever
done  so much to promote the interests of humanity
or of physical welfare as the medical profession.
There is scarcely a practitioner of medicine any
where, in city or country, who does not give, every
day, more or less of his services to the  poor.  As
a citizen, the physician is called upon to  give his
share of time and  labor, either with others or
alone, to promote in various ways the interests of
the public — interests, perhaps,  connected  with
some  association, school or  church.   In  cities,
most valuable services are contributed gratuitously
towards  the support of dispensaries,  infirmaries,
hospitals, and other similar institutions.   Besides,
in all philanthropic and  benevolent organizations,
the profession has had its full share of representa-
tives ; and in the  higher fields  of education and
literature, it has always  had its earnest workers;
while in the  cultivation  and advancement of the
sciences  generally, we may say, it has uniformly
taken the lead.   In fact, without disparagement
to any other class or profession, we  may  safely
state that our profession has been first and  fore-
most  in  the promotion  of every department of
science, whether useful or ornamental.   The pub-
lic owe to it a debt of gratitude, which cannot be
repaid or easily cancelled, for some of the  most
valuable  discoveries and applications  of science. 
      MEDICAL  PROBLEMS OF THE DAY.      91

This work of discovery, of philanthropy  and of
benevolence, we trust, is not wholly done.   If the
happiness and welfare of man have thus been, to
any extent, promoted, if the interests of civiliza-
tion have been advanced by such discoveries and
services in the past, richer and more inviting fields
of usefulness  await  the  profession in the future.
Language  cannot describe  the  value, the impor-
tance, the  utility of the  application of physiolo-
gical, hygienic and sanitary laws.  It is the special
duty and privilege of the medical profession to
expound these  laws and take  the lead in their
promotion.

Mr. President and Fellows :
     As we celebrate this Anniversary, we should
not overlook the changes that death is making in
our ranks.  In the congratulations and  festivities
of the day, let us then call to mind the memories
and  services  of our comrades,  our brothers who
have fallen !   The names of twenty-five Fellows
and  three Honorary Members of  the Society are
reported as having deceased  since  our last  annual
meeting.   That great Destroyer, whose power
they had long and faithfully striven to  avert from
others, has at  last triumphed in their own  persons
over all the  art and skill  which they or loving
friends  could  command.  In the case of several,
death   came   suddenly, apparently  without   a
moment's warning, while  others were forewarned
by pains so often repeated and long continued, that
they prayed to  be relieved from their sufferings.
           13 
92      MEDICAL PROBLEMS OF THE DAY.

Of the five who had passed their three score years
and ten, one, an Honorary Member, Sir Henry
Holland, reached the  great  age of  eighty-five.
He stood at the head of the  profession in  Great
Britain  for  almost half  a  century, and  was the
author of many valuable papers on Medicine and
other topics.  Rarely is  any  one individual per-
mitted to see so much  of the world, and at the
same time to possess  so much of genius and learn-
ing, combined with  the highest refinement  and
culture, as was  Sir  Henry Holland.   Only four
Fellows  died  under the  age  of forty, among
whom was  Dr. E. M. Johnson, the village physi-
cian of Williamsburg, who, being suddenly warned
by the roar of the late freshet in that  region, and
while rushing with his  children in his arms to a
place of safety, was overtaken by the angry  flood
and found a watery grave with his whole family —
his wife, his mother and his three children!
  A majority of our departed brothers were called
away in the meridian of life, with harness on, and
at the height of their usefulness.  Many of them
were present at our last anniversary, buoyant with
hope and flattered by success.  So there may be
those here to-day, full of life  and bright anticipa-
tions, who, ere another revolution of the seasons,
will in their turn have followed them!   Let us be
admonished by these providences!   Thankful for
whatever was bright  and beautiful  and honorable
in the lives of those whose memories we revere, let
us be incited to renewed zeal and efforts in the im-
provement  of time, the cultivation of talent, and
the discharge of duty. 
* 
• 
 
■N>