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       ADDRESS
BEFORE THE
PHIMDELPHIA COUNTY MEDICAL SOCIETY.
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DELIVEBED
FEBRUARY 11, 1863.
BY
ALFRED  STILLE, M. D.,
AT THE CLOSE OF HIS OFFICIAL TERM AS PRESIDENT.
PUBLISHED BY OEDEK OF THE SOCIETY.
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         PHILADELPHIA:
COLLINS, PRINTER, 705 JAYNE STREET
              1863. 
 
ADDRESS.
Gentlemen :—
  The  rules  of  our  Society  require its  President to  deliver
a public Address at the close  of his official term.  Under  ordi-
nary circumstances, it may be supposed that this  duty is not an
unwelcome  one, since it is the  last which his office  imposes, and
it lends some 6clat to his laying  down an authority which he
may not always have been able to exercise  satisfactorily either to
himself or his constituents.   On the present occasion, I  have no-
thing to recall but what is pleasant; a year of harmony in  senti-
ment and action, and one not unfruitful in knowledge to our medi-
cal brotherhood.  That  I should have  been selected to preside
among  you during such a period, I cannot  but esteem most fortu-
nate, and as giving  zest to the gratitude I feel for the unlooked-for
distinction you conferred in calling me to this honorable place.
   Upon such occasions the Presiding Officer  must usually be
disposed to indulge in sprightly  thoughts and genial emotions.
He cannot have witnessed the scintillations of talent  struck out in
the scientific collision of those around him without having awakened
in himself whatever enthusiasm comports with  his temperament;
and whether, in the intellectual tournament at which he was the
umpire, the combat always maintained  itself within the bounds
of knightly courtesy, or at times degenerated into  earnest or even
angry dispute, he can scarcely  have failed to imbibe  some inspira-
tion  of enthusiasm, nor perhaps, have always escaped  some taint
of the bitterness with which opinions and doctrines may have been
defended and attacked.
   But no such vivid recollections of our last year's  history  stimu-
late the imagination or warm the feelings.  From whatever cause—
whether from the absence in other and more real conflicts of those
who  might have lent the charm of their talents to  our meetings, or 
4
whether the same apathy which so generally affects the profession
detained from our meetings by far the larger proportion  of those
who are competent to teach us from their own experience while
they learn from ours—and I will not venture to decide the ques-
tion—it is still certain that  talent, knowledge, skill, and eloquence
enough exist among the members of this Society to have rendered
their discussions much more engaging and instructive, had they
but overcome the indifference which their absence manifested, or
the timidity which restrained them from communicating the fruits
of their observation and meditation.
   It is very true that scientific societies are far from being useful
in proportion to the number of their members.  The most valuable
papers in the volumes  of  published Memoirs  and Transactions,
which form one of the choicest stores of medical knowledge, have
often been read before the small coterie of a snug back parlor, or
a scattered audience in a more imposing hall.  But it is the very
purpose of this Society to  popularize science within the medical
profession, to bring together those who have had  less and those
who have had greater opportunities for culture and experience; to
harmonize in thought as well as  feeling the magnates who have
raised themselves to fame, and the laymen who  have pursued  the
more  humble and  unobtrusive  ways of  usefulness.   While its
meetings, then, are attended by so few, a principal purpose of its
institution is frustrated, and  the profession in  this city does  not
avail itself of the influences by which the deficiencies and excesses
of its  individual members might  be corrected, and the whole
body made to act harmoniously for the good of every part.
   The only means of attracting together and maintaining the cohe-
sion of these integral parts is to present such motives to  a more
general attendance at the meetings as  would be found in the inte-
rest of the papers and debates.   It would imply a lower estimate
than I am willing to form of my fellow members, to  suppose that
neither the scientific nor the practical interest of the subjects  dis-
cussed, their development by the knowledge and skill  of some, or
their  analysis by the  critical acumen of  others, had attractions
sufficient  to  draw an audience together  ready to profit  by  and
competent to judge of them.   And yet, it must be confessed,
we are either insensible to scientific and literary  attractions, or
else none are presented powerful enough to disturb the equilibrium 
5
of our indifference.  Perhaps both reasons are, to a certain extent,
valid.   Perhaps we are too apt to neglect those studies which raise
the practice of medicine above the level of the routine practitioner's
or the  sick-nurse's experience, studies which make it an aggregate
of problems that none but the most comprehensive grasp of mind,
and, at the same time, the minutest scrutiny, need attempt to solve
—which elevate it  above all philosophies save one, and which,
indeed, are fittest to illustrate the mysteries of religion itself by
the analogy of those  equally  dark and unfathomable problems
which abound in the science  of life.
   Surely to every member of this Society the facts and problems of
medicine must  be  attractive.  If all do not feel able to expound
them, none can fail to  take pleasure in hearing them  expounded,
provided it be done with such attention to  matter and  manner as
proves the possession of knowledge and of due preparation in using
it.  We may rest assured that if we duly prepare for the business
of our meetings, we shall not lack fit audience, nor will the  num-
ber of  those  be few whose  presence  will  applaud our efforts to
secure their approbation.  Soon to assemble in a building dedicated
exclusively to the medical profession, the first of the kind that has
been erected in our city, may we not hope  that the genius of the
place will inspire us with fresh ardor in cultivating the branches
of knowledge sacred to science  and  humanity, and to which we
have devoted our lives ?  Let this period become an epoch in the
history of our Society; and let us all labor to elevate our scientific
character upon the foundation of reason  and experience, the latter
constituting the firm and indestructible  materials, and the former
the cement that unites them.
   Nothing  is more possible, nothing,  I  suspect, is more common,
than for increasing years to bring no  accession to  professional
ability.  Every observant man must have remarked that there is a
certain low grade of attainment which is very early reached, in all
professions, by those members of it who are actively and exclu-
sively engaged in its practical duties, and beyond which they never
venture to rise.   The world never judges men according to  what
they are, but according to what they seem to be.   Not a few, there-
fore, content themselves with  that slender stock of accomplishments
which will enable them to pass muster with the public; and, indeed,
they perform their duties with a certain popular success.  In other 
6
pursuits the tests of proficiency are simpler and more readily applied
than in ours.  The mechanic's work is judged of by the practical
standard of common sense, a standard so notoriously competent to
measure his ability, that it would cost him as much ingenuity to
conceal his deficiencies,  as really  suffices, if properly expended, to
render him a skilful workman.  The preacher soon finds his proper
level;  for among his hearers there  are few who are not familiar
with the doctrines and precepts of religion, and always some with
whom  sound does not pass for sense, nor rhapsody for  eloquence.
At the bar the orator must confront on one side the common sense
of a jury, and  on the other the  stern and impartial  estimate of
judges skilled in the  learning of their profession, and  familiar with
the shifts which plausible presumption adopts to conceal a barren-
ness of argument or  an  ignorance of settled principles.
   In the medical profession it is  different.  It is quite  possible—
unfortunately it is very common—for the busiest and  most popular
practitioner  not  only to  be profoundly  ignorant of those great
principles which anatomy, physiology, and chemistry have estab-
lished, and of  all the results to  which the experimental investi-
gation of remedies and their operation have attained, but actually
to live year after year in constant contact with the sick, with more
opportunities for observation than Hippocrates, or Galen, or Syden-
ham enjoyed, and yet to add nothing to his  stock of  knowledge,
nothing to his  means of cure, nothing by which others can profit,
or which, when  he  dies, will rescue his name from  speedy and
total oblivion.
   We work in the dark where  there is no lynx-eyed critic to dis-
cern our mistakes, and no impartial judge to correct them.   Our
errors in detecting disease, our  blunders in treating it, are all con-
cealed by the  walls of the sick  chamber, are atoned  for by the
almost inexhaustible resources of  a bountiful nature, or are covered
up by the earth which hides perchance the victim of our ignorance.
For us there is not  the same motive to excellence which controls
him whose  works are  judged in the open light  of  day.   The
applause of  interested  crowds  does not await the  success which
crowns a happy application of medical skill.   The prizes are few,
and seldom  great, which  repay the highest exertion of diagnostic
expertness or curative power.  The golden profits of the physician's
labor  are proportioned much  oftener to his popularity than his 
7
 accomplishments, or they are acquired when toil and trouble have
 blunted his sense of enjoyment, and when he values them less for
 himself than for the sake of those who are dependent upon him.
   It is not surprising, then, that so many regard  their profession
 as  the common tradesman does his  trade, merely as a means of
 gaining the largest profits with the smallest expenditure of labor,
 or  that they should be tempted to consider superfluous all  exer-
 tion which does not promise a substantial return.  It  is not sur-
 prising  that they are  prone to abase themselves to the level of
 ignorant patients, who consider the grudgingly paid fee a full
 equivalent for the  preservation of  life or limb, nor that they look
 with wonder, if not contempt, at physicians who sacrifice profit to
 knowledge, and snatch time even from their natural rest to enlarge
 their information by study, by experiments, or  by that analytical
 examination of the results of their own observation which is like
 winnowing the wheat from the chaff, grinding it into flour, and
 converting it into bread,  which shall  become  the  staff of  their
 intellectual life.  How often do we, after the death of these  unas-
 piring  men, hear the question asked, What have they done that
 they should be remembered ?   How often do we find sad evidence,
 in their scanty store of medical literature, that they  were ignorant
 of what every educated physician should know!   How often, dur-
 ing their lifetime, when they venture to relate experience which
 they suppose altogether  peculiar,  or to propose methods which
 they believe original, are they surprised to learn that their observa-
 tions are old and familiar, and that  their inventions are forestalled,
 and have perhaps already been discarded by judges competent to
 decide upon their value!
  To say that these things are natural, is almost to pronounce them
 wrong;  and, as in this life, our chief end is  to rectify and curb the
 evil tendencies that are in us, as for this the whole social system and
 all civil polity exist, so in the more restricted sphere of professional
 relations, we cannot dispense, on the one hand with an impelling, and
 on the other with a restraining influence.  At every step we stand in
 need  of motives to action, which if we do not receive, we  halt in
 our progress towards excellence, or retrograde into sloth and list-
 lessness.  If we had half the greed for knowledge that we have for
place and gold, the desert of our ignorance would soon blossom as
the  rose.   Nature everywhere  offers to teach us, and to make us 
8
ministers and interpreters of her laws;  but we too often refuse to
purchase her wealth of wisdom at the price of patient toil.  Years
roll over  us, and as each one glides into the silent  past, and our
faculties grow duller and feebler, she still offers us the treasures of
knowledge, yet always at the same price, as the Sibyl did to  Tar-
quin the verses which foretold the fortune of Rome.  The treasures
we may hope to gather are perpetually lessening with our years,
and in a like degree our enthusiasm cools, and the high aspirations
that we once indulged in wane.  Such is peculiarly our condition
when our intellectual existence is isolated from that of our fellow-
men.   As it is a general  law that the perpetuation of species
requires the concurrence of more than one individual, so the inter-
course and union of minds are essential to the fecundation of ideas.
Each one brings something to the new creation; one the spirit, the
other the form, or both confer upon it the peculiarities  of each.
In the boys' debating club, as well as in the most august arena of
parliamentary strife  or  of academic controversy, one is surprised
and delighted to observe how thought begets thought and inspira-
tion kindles inspiration, until the subject which was at first obscure,
shadowy, and undefined, stands out in bold relief substantial  and
palpable to every one's apprehension.
   Above all other subjects those connected with practical medicine
and surgery are susceptible of such an illumination.  Every  one,
however remote his habitual field of occupation may be  from the
common sphere of other physicians, may have it in  his  power to
produce  evidence which  will complete a proof long sought for
elsewhere, or to  demonstrate the  virtues of a remedy which his
more  gifted or his  busier brethren have  overlooked.   Into  this
mart of  exchange we may all carry whatever golden  grains of
truth we have discovered, and feel very sure that, however precious
the commodity, it will not long be wanting an equivalent.  Indeed,
the very nature of true knowledge is like gold;  its value begins
from the  moment it is exchanged for  something else  of value.
Who that ever acquired it did  not feel that he enriched himself
while he was  imparting  it to others? that while  he  alone  pos-
sessed it, its existence could hardly be  recognized  as  real—that,
like the embryo in its mother's  womb, with all its powers and
capacities dormant, it  was valueless until it  came forth into the
light of day to play its part for good or evil among mankind.  It 
9
is the prerogative  of humanity alone thus to be more blessed in
giving than in receiving.  In the history of our science and art we
see its most illustrious cultivators eager to share their discoveries
and inventions with their brethren.  Indeed, to such an eagerness
we are indebted for almost all the literature of both departments
of medicine—a literature which, in these latter days, has filled the
whole civilized world.  Nor is such liberality to be attributed to
a thirst  for applause alone.  The tendency to it  is natural and
instinctive, and  is one of the godlike  though sullied  lineaments
which attest our divine parentage.  So instinctive is it that, as we
have witnessed in a recent  example, the attempt to restrict by
legal prohibition the use of a precious remedy, was  met with a
universal and unanimous outburst of reprobation.
   No, there is  strength  in union, not only of the body corporate,
political, or social, against those who would molest it, but there
is strength multiplied to each one by his contact with  the rest
—strength  developed by induction (if  I may be  allowed the
expression), and which  endures  only so  long  as  this contact  is
maintained.  Let  us, then, cultivate the sentiment that the bond
which binds  into one  the many so dissimilar  in tastes, habits,
associations, opinions, and aspirations, is not only most salutary in
its influence upon our  mental development and professional ad-
vancement, but that  it  is also one of  the choicest means at our
command to promote that fraternal  good-will and hearty co-ope-
ration without  which our profession would become  little better
than a horde of ruffians,  and the social edifice itself would crumble
into the ruins of barbarism.
   Philadelphia has a  distinguished reputation as a seat of medical
authority.  For a long  time, and until a very recent period, all
other American schools bore no  comparison with hers either in
their number and  excellence or in the proportion of native physi-
cians whom they educated.   During three-quarters of a century
she  stood facile princeps among  American seats of learning and
science, and her claims to pre-eminence were uncontested.  But how
is it now ?  Gradually, in other cities, and especially in the com-
mercial metropolis, rivals have grown up which threaten to eclipse
her medical institutions,  and to draw away from her a large num-
ber  of the young men who  are pursuing the study of medicine.
There was a time when medical professors were believed to fulfil 
10
their whole  duty if they presented in  an attractive  style and
manner the recognized conclusions of scientific and clinical obser-
vers ; and if  sometimes men of original  genius and of keen investi-
gating powers delighted and  controlled  their classes with eloquent
harangues, it must be confessed that the prelections of all  had about
them a stronger smell of the lamp than  of the dissecting-room, the
sick chamber, or the laboratory, and were better adapted to charm
and instruct  than to incite to original  observation, or to furnish
the best means of cultivating it.
   So evident was this defect, and yet so indistinctly was  its nature
recognized, that on a memorable occasion the members of a medical
faculty in another city—gentlemen distinguished by every personal
and professional excellence—warmly contested  the propriety of
lengthening the medical lecture  term, upon the  ground that lec-
tures are only substitutes for  books, and that, as the latter abound,
the former, if not superfluous, are at least unessential, and, therefore,
that an increase in  their number is to  be deprecated.  The  true
ground of adverse criticism was lost sight of, viz.:  that public
medical  teaching should chiefly concern itself with  what can be
demonstrated and illustrated  by material objects,  whether at the
bedside or in the class-room, because it is that which the physician
will never have  an opportunity to examine under proper direction,
except during his pupilage.
   The scanty provision for hospital instruction in one of our public
institutions, the absolute closure against us for a long while of the
larger hospital which had once afforded clinical experience  to our
students, and the sorry substitute for it which the colleges adopted,
all combined to  diminish the attractions of our city as a school of
medicine, at  the very time when our principal rival was opening
one hospital after another to clinical teaching, and in  two of them
creating independent faculties of medicine. It  is not  surprising
that  these institutions,  which  employ gentlemen of  the very
highest ability and reputation as scientific clinical teachers, should
have  attracted to themselves a large number of  young  men  who
would have preferred to be educated here, and that a medical  edu-
cation in them should have come to be  regarded  by very many as
the best which the country affords.
   The benefits of schools in hospitals are not by any means limited
to their  influence on the  medical  education  of undergraduates. 
11
Perhaps this is not even  the  greatest good which flows directly
from them.  They also awaken scientific rivalry among the teachers
themselves, and stimulate them to make the best use they can of
their abundant opportunities of investigating the pathological con-
ditions which are at once the causes and effects of disease.  I need
not  here enumerate the instances during  the last years in which
discussions  upon various important questions  of medical science
and practice have taken place in the societies of our sister city,
discussions which neither in fulness of matter, nor in skill of argu-
ment, will compare unfavorably with those held under similar cir-
cumstances in  European capitals.  In  a word, these  two cities, in
their medical history, forcibly remind one  of Edinburgh and Lon-
don.  While scholastic learning and  didactic accomplishments in
teaching were  held in supreme regard, the former place enjoyed
the  greatest reputation abroad, and even  at home her graduates
rose to the highest honors in the metropolitan profession.  But,
within the  last quarter of a century, the  period, in  other words,
during which physics have been applied to medicine, and since aus-
cultation, percussion, and their kindred methods of investigation,
microscopical, chemical, and physiological, have laid the phenomena
of life and- of disease open to the senses, the hospitals of London
have become the most  abundant by far  of all the sources from
which the natural history of diseases is being  composed.  Thus,
collectively, as a medical school, they have eclipsed  their former
rival and superior.
   If we are not willing that the ancient fame of Philadelphia should
suffer  a  similar obscuration, we must  take warning  in time, and
do what lies in each of us to  maintain and elevate the scientific
standing of the profession  around us.   Not a  little has been done
within a few years in improving our knowledge of morbid anatomy
and  its related branches.   The members  of a  Society among us
devoted to that subject will, I doubt not, testify to its fostering and
stimulating influence.   Much may also be hoped directly and  in-
directly from  the generous bequest of  the late Dr. Mutter to the
College of Physicians.   Valuable in scientific illustration of the
branch he excelled in practising and teaching, and in the provision
which  it makes for  the  encouragement of original research, and
for the diffusion of pathological knowledge, we may  congratulate
ourselves that its preservation among us, and its  perpetual useful- 
12
ness according to the benevolent wishes of its founder, have been
secured by  the  contributions of our sister  Institution,  and  the
enlightened spirit of liberality which has prompted  not a few per-
sons beyond the  limits of our profession to take part with it in this
very important undertaking.
  But perhaps much more may be anticipated from occasions of
medical experience which we are gaining, alas!  at  the cost of a
wounded if not dismembered nationality.  When, during several
months past, I was reminded that the duty I am now attempting
to perform would be required of me, I confess that I shrank from
thinking of  it, as one shrinks from a trial of  strength to which he
feels unequal, or from scenes of merriment when his heart is heavy
with grief. Flowers of rhetoric do not blossom in the furnace heat
of civil war.  Within all is disquiet and everywhere without is gloom.
Like  lightning, the imagination leaps from cloud to cloud only
to reveal the blackness of the picture; or, like the  stormy petrel,
flits from wave to wave of our sea of troubles, now borne aloft into
the sunshine of hope, now buried in the abyss  of despair, but in no
direction finding rest for  its weariness, and seeing no refuge, even
in the distance, from the  ruin that seems ready to  overwhelm it.
In all national convulsions such  as now affect us, as in the midst
of a natural tempest, it is  indeed difficult to look forward to serener
times, or to realize the thought that an end must come even to the
direst troubles.  It is no  part of  my duty, nor in this place would
it be proper to  suggest  any grounds of a political nature upon
which both  hope and consolation may repose;  but  it will not be
amiss to refer to some considerations of a professional kind which
may help to console us as physicians, leaving to other times and
other tongues to  pronounce those words of cheer which it is
most becoming should  be spoken to us as citizens  and men, and
which are most in harmony with the eternal laws of truth and
justice.
  War brings in its immediate train innumerable causes of disease
and  death.  The battle-field  furnishes to the military surgeon a
hundredfold the  experience which civil practice could  afford, in a
knowledge of wounds and their consequences.   The fatigues, ex-
posures and  privations of the  march, the inclemency of the seasons,
malarial and foul effluvia, the habits of camp  and barrack life, the
insufficient, unwholesome, and ill-prepared food, and  a  thousand 
13
subordinate causes, render the soldier, however vigorous by nature,
far more liable  than the private  citizen to  disease,  while  they
generate a number of affections which, in civil life, occur under
very different forms.  It is  not singular, then, that in  all times of
war the medical officers of land and  sea forces should have made
valuable contributions to our knowledge of diseases and their  cure.
In England  the  Pringles and Heberdens of  the  older time, and
the numerous pupils of  experience  in the Peninsular war   and
other cotemporaneous campaigns,  exerted a very marked, and, it
may be  added, a very enlightened influence  upon  medicine and
surgery.  The continental military surgeons, with Larrey at  their
head, impressed upon the practice  and  doctrines of  the profession
all over  the world  a character  no less decided.  The war in
which we are now engaged  has made it necessary to withdraw
from private practice a very large  number of physicians, most of
them ardent with the enthusiasm  of  early manhood, and  many of
them well qualified to investigate the  laws of disease, and to enrich
us with new  facts  and novel views.  Fortunately for the cause of
humanity and of science, the Medical Department of the army is
under  the control of a vigorous and sagacious  mind,  thoroughly
acquainted with the most recent results of investigation, and himself
one of the most eminent of  American original observers.  He has,
it is well known, determined that his  subordinates  shall contribute
their full share of materials  to illustrate the medical  history of
our civil war, and during  its progress lay the foundations of a
monument which  shall commemorate the beginning of a new era
in our profession.
   It may perhaps be  doubted whether the  medical,  as distin-
guished from the surgical results of observation in military life are
of very great importance except in reference to the  diseases of men
placed in analogous situations and susceptible of  the same influ-
ences.  But as a contribution to military hygiene and military medi-
cal pathology, the experience of our army surgeons ought to possess
incalculable value, for never, in modern times, have so many sol-
diers been simultaneously under arms,  and never has so large a field
been opened for  the  trial of  the various methods recommended
by experience for the prevention  and  cure of  disease.  On the
other hand, the imperfect discipline which has necessarily existed
in an army,  nearly every man of  which  was but the  other day 
14
engaged in  some  peaceful  avocation,  while it has  made  the
selection of skilful medical officers all  the  more imperative, has
rendered  the entrance of too  many incompetent persons into the
medical corps an inevitable evil.  Yet making due allowance for
this  defect, a defect  in  some  degree corrected  by the  patriotic
labors of the Sanitary Commission,  and also for  the  still  more
general one that the literary as well  as the scientific education of
too many is greatly inferior to what it ought to be, there still re-
mains the fact that the medical staff of the regular and of the
volunteer armies is, in general, composed of laborious, conscientious,
and  painstaking men, while many are very  superior in scientific
attainments and in practical skill.  Chiefly from these last we must
expect to receive a permanent, true, and  useful  history of the
medical events of the war.
  During the last seven months I have had an opportunity, in one
of the great  military hospitals of this city, to become somewhat
familiar with several of the forms of chronic disease most prevalent
among the soldiers.  It may not be uninteresting briefly to notice
them on this occasion.  The most common, by far, have been affec-
tions of the bowels, which originated as  diarrhoeas, then  assumed
more or less  of the dysenteric form, and finally in some cases pre-
sented typhoid fever as an intercurrent disease.  These several ele-
ments combined, one  might suppose,  would  certainly involve the
permanent destruction of health, or a very prolonged and vacillating
convalescence.  Such, indeed, is the fact, and it appears  to me a
very unusual thing for the health of the patients I have prominently
in view to be so completely restored as to render their  return to ac-
tive  service a prudent measure.  The least excess of fatigue, a change
of weather from dry to  cold and damp, the slightest  over-indulg-
ence in ordinary food, particularly if crude and bulky, is sufficient
to renew the  characteristic alvine discharges, and render a resump-
tion  of dietetic and  medicinal treatment imperative. It is unneces-
sary to mention in detail the various  medicines I have  used, only
to find them  inefficacious in  diminishing  the frequency of the
stools; it  need only be  stated that the  most useful remedy has
appeared to me to be tannic acid, given  in a pilular form, and in
doses of three grains with one-twentieth  of a grain of sulphate of
morphia repeated three or four times a day.   But neither did this
nor  any other medicine  exert  a beneficial  influence unless  the 
15
diet was regulated in the strictest manner.  As a general rule, it
has been found necessary to confine the patients absolutely to bread
or soda-biscuit and  milk, and to  this strict regimen  I attribute
whatever success in the cure of the disease I have obtained.  In
many cases treated after this simple manner, I have had the satis-
faction of witnessing a gradual subsidence of the alvine discharges,
and a state of emaciation and debility, sometimes extreme, followed
by the  restoration  of flesh and strength. It  must be admitted,
however, that even  after the most perfect cures a state of intestinal
susceptibility has sometimes continued, which very trifling errors of
diet converted into  active diarrhoea.   In  some cases the association
of lime-water with milk, in the proportion  of one-fourth or one-third,
has been manifestly useful.   As the  improvement advanced, rice
and farina have been added to the dietary. I take this occasion to
record my protest against the unfermented bread, so-called, which
is used in  some of the  government hospitals.  However superior
it may be to ordinary camp bread, and wholesome for men of sound
digestion, a  more insipid, not to say unsavory,  food, unpleasant to
eat and hard to digest, was never furnished to the sick; and, as
it must be  used upon the day when it  is baked, it becomes the
frequent cause  of  exciting  bowel-complaints, and  constantly of
prolonging  them.  It is not a wise economy which by  a saving
in the price of food becomes prodigal of causes  of disease.
   It has been mentioned in my hearing by more than one hospital
surgeon that cases of ascites are common in connection with chronic
diarrhoea.   My  own experience has not furnished me with a single
instance of the kind.  In some cases of the  intestinal disorder
distension of the abdomen was occasionally observed, but in all of
them it was  tympanitic, and appeared sometimes to be produced by
the bread, which, being unfermented when eaten, seemed to develop a
prodigious quantity of gas during digestion.  Tympanitis, however,
sometimes  occurred  without  any apparent  intestinal or gastric
disorder, or  even the least alteration of the general  health.  In
these cases no treatment of it was efficacious.
   The two most ordinary systemic complications of diarrhoea were
malarial cachexia and  scurvy.  The former impressed upon the
patient a peculiar sallow or muddy paleness, and seemed  to  be  a
common cause of the gastric dyspepsia  which so frequently ren-
dered its treatment  abortive, or at least  prevented remedies from 
16
being permanently curative.   The preparations of cinchona were
efficacious in curing whatever periodical phenomena arose, but had
no influence upon the fundamental cachexia.  Nor did iron always
exert the specific influence which it usually displays in pure anemia.
Indeed, I am inclined to believe that the return of warm weather
and  regular and active exercise in the  open air will be found the
only permanent remedies for this state of impaired health.  This is
the more likely to be true of those cases, and they are the majority,
in which malarial anemia is maintained by chronic disorder of the
bowels.  The  milder ones, occurring in young men  of a robust
constitution and previously good health, sometimes recover under
the influence of iron and  a milk diet, but many more are rebellious
to every  form  of medicinal treatment.
  This remark is still more applicable to  cases in which,  along
with diarrhoea, or even without it as a  constant symptom, there is
also  a scorbutic taint.   It has shown itself in several instances by
oedema of the lower extremities and ecchymosis of these and other
parts.  No instances of spongy gums and loosened teeth have been
noticed by me, but in one  case the exacerbations of the swelling
and discoloration of the  legs were coincident with an increase of
diarrhoea and  an insufferable fetor of the  breath.  CEdema of the
ankles, without ecchymotic discoloration,  was observed in many
other cases. It is highly probable that a scorbutic condition often
existed when the characteristic symptoms  of scurvy were  absent;
but neither the phenomena themselves  nor the effects of treatment
positively demonstrated it.  As to  these effects, it appeared to me
that  lemon-juice  and fresh vegetables, the  specific remedies  for
scurvy, were less efficacious than their reputation led me to expect;
nor did it seem possible, in the greater number of cases, to  carry
the improvement beyond a certain point much below the average
of good  health.   Of these cases it  may be said emphatically, as
with less positiveness it may be of the  other chronic affections al-
ready noticed, that comparatively few of them can be  expected to
recover in the wards of a hospital.   They stand pre-eminently in
need of fresh air, sunshine, and exercise combined.  Hence I have
believed  and urged that not a few soldiers who are now permanently
invalided would have  been saved to their country's  service had
appropriate provision been made for their systematic exercise in
the open air.  The advantages of a rural site for a hospital, which 
17
in reality are immense, are thrown away if patients of the classes
referred to are not required as well as invited to pass a portion of
every day in the fields or the woods in summer, and during the
cold season in sheds with a southern exposure, where they can be
exercised in the drill or in  gymnastics and athletic sports.  The
authorities who regulate these matters have perhaps too much faith
in drugs, or, wanting that, in some  indefinable sanitary influence
of a hospital residence.  Rest and comparatively excellent food are
powerful  aids in restoring health broken down by the fatigues of a
military campaign, but  the  monotony and indolence of hospital
life are ill suited to restore the constitution to its original vigor.
   As closely connected with scurvy, if we may conclude from the
conditions in which it is found to exist, muscular rheumatism may
be mentioned; but it must not be forgotten that the scorbutic dia-
thesis, as a merely debilitating influence, predisposes to all diseases
excited by external causes, and hence pre-eminently to rheumatism.
The direct causes of the latter affection, indeed, surround the soldier
at every step of an active campaign, and it is  only a matter of
surprise that an army of stalwart men  is not  speedily converted
into a horde of cripples.  Out of some  scores  of cases that  have
passed under my observation, I do not remember a single one in
which the attack began as an acute inflammation.  They were, all
of them,  cases of muscular rheumatism, or else of subacute or
primarily chronic rheumatism of the external  ligaments of the
joints, and often resulted in false anchylosis or in muscular atrophy
of the affected limb.  In some cases of the latter sort the stiffness
of the joints  yielded to a diligent and persevering use of active and
passive motion.  A striking  example  of this result was presented
by a man who for months had been bent  almost double, but who
left the hospital nearly erect.  In cases characterized by fugitive
pains in different parts of the body, I believe that cod-liver oil will
prove  to  be the most effectual cure;  but it exerts only a feeble
power when the joints are stiffened.
   An  affection  confounded with muscular rheumatism by the
patients themselves, and, according  to their statements, by  some
physicians also, is intercostal neuralgia. In private life this affection
is usually observed among delicate and  feeble persons, especially
of the female sex; but the robust soldiers  presented it as often as
the infirm.  It was characterized by tenderness under pressure of
       2 
18
the cutaneous branches of the intercostal nerves on  either side of
the spinal column, or along  the  lateral regions of the chest, and
was attended with aching, burning, or boring sensations  in  these
parts, and by sharp, lancinating pains running to the front of the
chest.   The cause of this affection was alone peculiar,  and fur-
nishes my reason for alluding to  it in this place.   It was uni-
formly referred by the patients  to the action of the knapsack, either
directly  by its contusive blows upon the back in marching, or
indirectly by its  producing a free  perspiration of the part, which
afterwards became chilled on  the  removal of the knapsack  when
the wind was blowing, or else  by getting the back  wet with rain
or in wading streams.  Further than this, which to me was a  novel
cause, particularly upon  so  large a scale, this neuralgia presented
no peculiarities, and was generally  cured by means of stimulating
and narcotic liniments or by superficial vesication.
   In connection, partly, with the action of  the heavy knapsack on
the chest, two  other  affections may be  mentioned  in  conclusion.
These are palpitation of the heart and haemoptysis.   Both were
ascribed by some patients to the cause just referred to; by others
to  prolonged or very rapid marching. The  haemoptysis which
occurred in numerous instances, and  quite independently of any
signs of pulmonary tubercles,  appears generally to have resulted
from direct violence, such as  a fall upon  the  chest, a blow from
some missile, as a spent ball, the fragment of a shell, &c, or from
compression between two heavy bodies. It was surprising that in
several cases the haemoptysis continued long after the general health
appeared to have become very good.  I should have suspected ma-
lingering, had not the physical signs  of a  firm pleuritic adhesion
and a complaint of local pain sometimes given color to the history
 as originally related. The occurrence of haemoptysis independently
 of these cases has been very rare.  In the only case  of phthisis dis-
 tinctly made out and terminating  fatally, there was no discharge
 of pure blood from the lungs.   Several other cases, it may be men-
 tioned  in passing, in which a tuberculous  complication of chronic
 bronchitis  was suspected,  proved by their perfect restoration to
 health, that the suspicion was  not  well founded.
    Palpitation of the heart has been a very frequent symptom among
 the soldiers, occurring in perhaps every case of intercostal neural-
 gia, but often, also, originating apparently in a state of extreme 
19
exhaustion, especially  when  produced by prolonged and violent
muscular efforts.  Its ordinary association with  a frequent pulse,
or one rendered so by the erect posture, seems to prove it to be an
effect of muscular debility of the heart alone, or of that organ along
with  the rest of the muscular system.  It was not  attended with
any  irregularity of the pulse, nor, ordinarily, with any distinct
murmur in the heart, not even with a soft, blowing murmur, nor
was  any such observed  in the arteries as an  ordinary symptom.
Although the number of cases presenting this peculiarity may have
been twenty or thirty, there was but one in which distinct  evidence
of organic disease of the heart was discovered, and that consisted
of hypertrophy alone.  The associated blowing  murmur in the first
sound was soft and probably inorganic.  This form of cardiac pal-
pitation must be added to the catalogue of diseases very rarely met
with in  civil  practice.   Its cure demonstrated its nature;  for
although it was seldom entirely removed, its  improvement gene-
rally coincided with the  patient's improved nutrition and muscular
strength.   Quite different in  its nature  from anaemic  palpitation,
which shows its true character by pallor of the tissues, translucency
of the superficial veins, and a rapid improvement under  the admini-
stration of iron, in this, on the contrary, the complexion and nutri-
tion of the patient were ordinarily good, his  appetite  normal, his
defecation often  regular, and iron proved to be  less useful as  a
remedy than valerian and digitalis; but all of these medicines were
less  serviceable than rest and time.
   The disorders and affections which have been thus summarily de-
scribed, are all that I have had occasion to observe which presented
any  peculiarities distinguishing them from such as are met with in
civil hospitals and in private practice.  Phthisis, Bright's disease,
hepatic dropsy, organic heart disease, and chronic affections of the
brain which  form the majority of chronic cases  in ordinary hos-
pitals were rare, and would probably  have been  still  more so,
if the rules  established for the enlistment  of soldiers had been
rigorously adhered to.   As it is, one cannot refuse believing what
has been  so  often asserted by competent judges, native as well as
foreign, that no finer material for  soldiers was ever collected than
that which forms our patriot army.   That it has failed to accom-
plish  all that was justly expected of it is  plainly owing not to 
20
the muscle and  bone which compose, but to the brains  which
direct it.

  During the present year it is probable  that  your meetings will
often be occupied in listening to the instructive experience  which
our brethren who have  been abroad  in hospitals, and camps, and
on the battle-field, will bring  home for your edification.  May the
knowledge thus gathered at the cost  of toil and danger prove to
be a fitting  aliment for the quickening and support of your pro-
fessional life, fertilizing and  adorning the garden of medical sci-
ence, and illustrating the history of our Society long after the fury
of the conflict shall have  subsided,  and when the bitterness of
fraternal hatred shall have  been forgotten in those gentle feelings
which mutual respect, the ties of kindred, and a common inheritance
of ancestral glory, must sooner  or later inspire.