Ulliiiii;:;iii:,-, NATIONAL LIBRARY OF MEDICINE Washington.D.C. Wm. GENERAL THERAPEUTICS MATERIA MEDIC A: ADAPTED FOR A MEDICAL TEXT-BOOK BY ROBLEY DUNGLISON, M. D., PROFESSOR OF INSTITUTES OF MEDICINE, ETC., IN JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA: FORMERLY PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE UNIVERSITIES OF VIRGINIA AND MARYLAND, AND IN JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA. WITH ONE HUNDRED AND EIGHTY-SEVEN ILLUSTRATIONS. FIFTH EDITION, KEVISED AND IMPROVED. IN TWO VOLUMES. ,< jb s > \ », * it j>:\ T L j VOL. I. JUPGEON-GFNERAL'S OFFICE | DLw.-7—1901 i A i i n PHILADELPHIA: BLANCHARD AND LEA. 1853. PREFACE TO THE FOURTH EDITION. In preparing the present edition, the Author has subjected the work to a thorough revision, both as regards its style and matter; and has endeavoured to render it a more exact and complete exponent of the existing state of knowledge on the important subjects of which it treats. The favour with which the former editions were received de- manded of him that the present should be rendered still more worthy of the patronage of the profession, and particularly of the student of medicine, for whose use it was more especially destined. "With this view, the remedial agents of recent introduction have been incorpo- rated in their appropriate places; the number of illustrations has been greatly increased; and a copious index of diseases and remedies has been appended; which can scarcely fail to add to the value of the work to the therapeutical inquirer. When a second edition of his work on General Therapeutics was called for by his publishers, the Author deemed it advisable to incor- porate with it an account of the different articles of the Materia Medica. To this he was led by the circumstance, that the departments of General Therapeutics and Materia Medica are always associated in the medical schools. In preparing the details on the latter depart- ment, he did not consider it advisable to go farther into the natural and commercial history of drugs than was indispensable for the medi- cal student. He would fain hope, that the time may arrive when an acquaintance with the different branches of Natural History may be esteemed an essential preliminary or accompanying study; but as the medical schools of this continent are constituted, any lengthened in- vestigation of these subjects by the Professor would be manifestly im- practicable. In the short time allotted to a session of medical lectures, VI PREFACE. there is scarcely opportunity afforded to teach that which is indispen- sable to the therapeutist. In all cases, the Author has referred to the position held by the drug as an article of the organized, or of the inorganic kingdom; as well as to general matters of interest relative to the place where it is found, the manner in which it is obtained, and to certain points con- nected with its commercial history; but next to therapeutical applica- tions he has dwelt more at length on the sensible properties, by which the physician may be enabled to judge of the various articles from his own observation. In another work,1 he has remarked, that "it would, doubtless, be well that the physician should know the natural history of the animal whence he obtains his castor, his musk, &c, and that he should be acquainted with the botanical relations of the plants, whose preparations he prescribes; but such a knowledge is no more indispensable than Greek is to an acquaintance with medical technology. The argument may, indeed, be extended to the consumer of the pro- ducts of the animal and vegetable kingdoms as articles of diet. It would be well for him, no doubt, to be acquainted with the natural history of the ox, the sheep, the hog, &c, whence he derives his sus- tenance; yet, notwithstanding his ignorance on this point, universal experience demonstrates, that he has no difficulty in appropriating them to his dietetic necessities." Moreover, there were already valu- able works in which all these topics, so interesting to the apotkecary especially, are given at such length as almost to exhaust the subject; and of these one of the most remarkable is that of Dr. Pereira re- published in this country under the competent supervision of Dr. Carson, Professor of Materia Medica in the Philadelphia College of Pharmacy.2 Of this the Author largely avails himself in the pre- paration of the second edition of the present work. He was like- wise greatly indebted to the full and accurate Dispensatory of Drs. "Wood and Bache—his learned colleagues in the revision of the Phar- macopoeia of the United States (1842); to the Dispensatory of Dr. Christison; and—in a minor degree—to the work on Therapeutics and Materia Medica of MM. Trousseau and Pidoux. Nor did the modern German publications on the subject escape his attention. His great object was to prepare a work on General Therapeutics and Materia Medica, which might aid the medical student in acquiring the main results of modern observation and reflection; and, at the same time, be to the practitioner a trustworthy book of reference. 1 The Medical Student, second edition, p. 161, Philadelphia, 1844. 2 Now Professor of Materia Medica and of Pharmacy in the University of Pennsylvania. PREFACE. vii The views of General Therapeutics are essentially the same as in the former editions. The Author has been pleased to find, that the period which has elapsed since their first promulgation, has but strengthened his belief in their general accuracy ; so that he has not deemed it necessary to make many or great modifications. Through- out, he has adopted the nomenclature of the last edition of the Phar- macopoeia of the United States;—a work, which ought to be in the hands of every practitioner as a guide in the preparation of medicines; and he has endeavoured to arrange the articles in each division, as nearly as he could, in the order of their efficacy as therapeutical agents. EOBLEY DUNGLISON. CONTENTS OP VOL. I. CHAPTEE I. GENERAL CONSIDERATIONS. Therapeutics defined—Instinctive action of recuperation—Importance of bearing it in mind in the treatment of disease—Cure by sympathy—Expectant Medicine- Efforts of nature—Crises—Medical experience—Science of medicine demonstra- tive—Pre-eminence of therapeutics—Therapeutical indications vary with medical theories—Necessity of discovering the pathological lesion—Rational therapeutics founded on rigid physiologico-pathological deduction—Importance of discovering the cause of the lesion—Etiology obscjire—Early medical practice—The Ascle- piades—Empirics and Dogmatists—French medical school of observation—Nume- rical methods—Necessity for observation and reasoning—Hematology—Import- ance of principles in Medicine ....... 33 CHAPTEE II. CIRCUMSTANCES THAT MODIFY THERAPEUTICAL INDICATIONS. Age—Sex—Original conformation—Habit—Tolerance—Climate—Mental affections —Races, Professions, and way of life—Causes, seat, period, &c., of the disease 1. Age . 2. Sex . 3. Original Conformation 4. Habit 5. Climate 6. Mental Affections 7. Races, Professions, and Way of Life 8. Causes, Seat, Period, &c, of the Disease 61 61 63 65 73 75 80 89 91 CHAPTEE III. OF MEDICINES. A medicine defined—General action of medicines—Various modes of action—By simple, direct, or local action—By indirect or general action—Through the nerves —Through absorption—Changes experienced by medicines in the stomach and elsewhere—Medicines divisible into Excitants and Sedatives—Classification of medicines—Barbier's—A. T. Thomson's—Pereira's—The Author's 1. Modus Operandi of Medicines a. By Simple, Direct, or Local Action b. By Indirect or General Action 1. Through the Nerves 2. Through Absorption 2. Classification of Medicines . 93 94 94 95 95 105 116 X CONTEXTS. SECTION I. AGENTS THAT AFFECT PROMINENTLY THE ALIMENTARY CANAL OR ITS CONTENTS. PAGE Emetics.—Definition of emetics—Nauseants—Their modus operandi—Thera- peutical application—Physiology of vomiting—Modus operandi of emetics — Effects on the stomach, and general system—Evils of their too fo- ment—Therapeutical application—Special emetics I. Nauseants .... Therapeutical application of Nauseants II. Emetics .... Therapeutical application of Emetics Special Emetics .... a. Direct Emetics b. Indirect Emetics equent employ- 123 124 125 127 134 142 142 144 II. Cathartics.—Definition of cathartics—Effects they are capable of inducing— Organs on which they act—Divided into laxatives and purgatives—Drastics— Abuse of cathartics — Glysters — Suppositories—Therapeutical application—In fevers—In inflammatory disorders—In hemorrhage—In the neuroses—In dropsies, &c.-"-Special cathartics Enemata Suppositories Therapeutical application of Cathartics Special Cathartics . I. Laxatives, or Mild Cathartics II. Purgatives, or Brisk Cathartics Saline Cathartics III. Drastic Cathartics III. Anthelmintics.—Definition of anthelmintics—Experiments on worms out of the body—Different kinds of anthelmintics—True anthelmintics—Mechanical an- thelmintics—Anthelmintics that expel worms by acting on the intestinal canal— Anthelmintics that prevent the formation of worms—Ectozoa—Special anthel- mintics ........ 1. True Anthelmintics ...... 2. Mechanical Anthelmintics ..... 3. Anthelmintics that expel worms by acting on the intestinal canal 4. Anthelmintics that prevent the formation of worms . Special Anthelmintics ...... I. True Anthelmintics ...... II. Mechanical Anthelmintics . . . . 162 172 172 175 184 184 192 214 223 236 238 239 239 240 241 241 251 SECTION II. AGENTS THAT AFFECT PROMINENTLY THE RESPIRATORY ORGANS. Expectoeants.—Definition of expectorants — Organs on which they act__Modus operandi—Are indirect agents only—Inhalations—Special expectorants Inhalations .... Special Expectorants I. Excitant Expectorants II. Demulcent Expectorants III. Nauseant and Emetic Expectorants . IV. Topical Expectorants—Inhalations . a. Excitant Inhalations . b. Sedative Inhalations . 253 256 257 257 270 287 287 287 293 CONTENTS, XI SECTION III. AGENTS THAT AFFECT PROMINENTLY THE FOLLICULAR OR GLANDULAR ORGANS. PAGE I. Errhines.—Definition of errhines—Sternutatories—Modus operandi—Dangers of sneezing—Special errhines ....... 294 Therapeutical application of Errhines. ...... 295 Special Errhines ......... 296 II. Sialogogues.—Definition of sialogogues—Their employment limited—Modus operandi of sialogogues—Mercury as a sialogogue—Special sialogogues . . 299 Therapeutical application of Sialogogues ..... 299 Special Sialogogues ........ 300 III. Diuretics.—Definition of diuretics—Their modus operandi—Mental diuretics —Therapeutical employment of diuretics—In dropsies—In various chronic dis- eases—Special diuretics Therapeutical application of Diuretics Special Diuretics . I. Excitant Diuretics II. Sedative Diuretics 302 307 308 309 321 IV. Antilithics.:—Definition of antilithics, and of lithonthryptics—Calculous dia- thesis—Lithic and phosphatic diatheses—Different varieties of calculus—Thera- peutical application of antilithics to those varieties—Lithonthryptics—Special antilithics .......... 326 1. Antilithics ......... 326 Therapeutical application of Antilithics ..... 329 2. Lithonthryptics . . . . . . . .332 Special Antilithics ........ 333 1. Acid Antilithics . . . . . . . .333 2. Alkaline Antilithics ........ 334 3. Tonic Antilithics . . . . . . . .336 V. Diaphoretics.—Definition of diaphoretics—Largely invoked in Therapeutics— Disease not often induced by suppressed perspiration—Modus operandi of diapho- retics—Are indirect agents—How their operation may be aided—Their therapeu- tical application—Special diaphoretics Special Diaphoretics I. Sedative Diaphoretics II. Excitant Diaphoretics III. Topical Diaphoretics •etics . 341 . 347 . 347 . 352 . &6& SECTION IV. AGENTS THAT AFFECT PROMINENTLY THE NERVOUS SYSTEM. Narcotics.—Definition of Narcotics—Maybe used as excitants, and as sedatives —Their action elucidated by that of opium—May act locally as well as generally— Mental narcotics—Anesthetics—Therapeutical application of narcotics—in febrile diseases—In the phlegmasia, &c.—Special narcotics. .... 368 Therapeutical application of Narcotics ..... 381 Special Narcotics ......... 383 II. Tetanics.—Definition—Modus operandi—Therapeutical application—Special tetanies .......... Special Tetanics ........ 427 428 xii CONTENTS. III. Antispasmodics.—Definition of antispasmodics—Spasm considered—No direct antispasmodic—Modus operandi of indirect mental antispasmodics—Therapeutical application of antispasmodics, in tetanus, chorea, epilepsy, asthma, hooping-cougn, ^ colic, hysteria, &c.—Special antispasmodics . .„„ Therapeutical application of Antispasmodics . . • • '441 Special Antispasmodics ....•• .... Excitant Antispasmodics ...•••• SECTION V. AGENTS THAT AFFECT PROMINENTLY THE ORGANS OF REPRODUCTION. I. Emmenagogues.—Definition of emmenagogues—Modus operandi—No direct em- menagogues—Special emmenagogues ...-•• 451 Special Emmenagogues .....••• 45o I. Cathartic Emmenagogues .....•• 45o II. Excitant Emmenagogues .....•• 458 II. Parturifacients.—Definition of parturifacients—Most of them indirect agents —often destroy the mother—Aristolochics—Special parturifacients . . 462 Aristolochics ......... 464 Special Parturients ........ 465 SECTION VI. AGENTS THAT AFFECT VARIOUS ORGANS. I. Excitants.—Irritation, not debility, the great lethiferous agent—Causes of death in cases of extensive abscess, phthisis pulmonalis, &c. Debility in one organ may suggest irritation in another—Cases of really diminished action—Division of excit- ants—Definition of excitants—Carminatives—Chiefly derived from the vegetable kingdom—Simple direct action of excitants—General effect of excitants—Excite- ment and collapse defined—Excitants act also as revulsives—Therapeutical appli- cation of excitants—In gastric and intestinal affections—In fevers—In inflamma- tory diseases—catarrhs—In the neuroses, hysteria, epilepsy, paralysis—In topical inflammation—Mental excitants—Special excitants .... 471 Therapeutical application of Excitants . . . . . .477 Special Excitants ......... 486 LIST OF ILLUSTRATIONS. VOL. I. FIG. 1. 2. 3. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 81. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. PAGE. Cephaelis Ipecacuanha . . 147 Brown Ipecacuanha root . .148 Striated Ipecacuanha root; Undu- lated Ipecacuanha root . . 149 Richardsonia Scabra . . . 150 Ionidium Ipecacuanha root . . 150 Gillenia Stipulacea . . .152 Lobelia Inflata .... 154 Sinapis Alba . . . .155 Sinapis Nigra . . . .155 Sanguinaria Canadensis . . 158 Anthemis Nobilis . . . 159 Apocynum Androsaemifolium . 160 Phytolacca Decandra . . .160 Erythronium Americanum . .161 Ficus Carica . . . .189 Tamarindus Indica . . .190 Ricinus Communis . . .192 Rheum Palmatum . . .195 Rheum Compactum . . . 195 Rheum Emodi . . . .195 Aloes, various species of . . 199 Aloe Socotorina .... 200 Cassia Lanceolata . . . 203 Cassia Acutifolia . . . 204 Legume and leaflet of Acute-leaved Alexandria Senna . . . 204 Legume and leaflet of C. Obovata 204 Tinnevelly Senna . . . 205 Cassia Marilandica . . . 208 Podophyllum Peltatum . . 209 Ipomaea Purga .... 223 Cucumis Colocynthis . . . 225 Hebradendron Cambogioides . 226 Croton Tiglium . . . .230 Momordica Elaterium . . . 232 Momordica Elaterium . . 233 Apocynum Cannabinum . . 235 Triosteum Perfoliatum . . 235 Chenopodium Anthelminticum . 243 Spigelia Marilandica . . . 243 Nephrodium Filix mas . • 245 Ncphrodium Filix mas . . 246 Punica Granatum . . • 247 FIG PAGE. 43. Melia Azedarach . . 249 44. Plocaria Helminthocorton . 249 45. Mucuna Pruriens . 251 46, 47. Inhaling Bottles . 256 48. Polygala Senega . 257 49. Myroxylon Peruiferum . 261 50. Styrax Officinalis . 263 51. Balsamodendron Myrrha . 266 52. Acacia Arabica . 271 53. Althaea Officinalis . 272 54. Olea Europasa . 275 55. Saccharum Officinarum . 277 56. Glycyrrhiza Glabra . 279 57. Linum Usitatissimum . . 281 58. Astragalus Verus . 281 59. Cetraria Islandica . 284 60. Chondrus crispus . 285 61. Plocaria Candida . 286 62. Inhaler . 290 63. Cochlearia Armoracia . 301 64. Chimaphila Umbellata . 311 65. Cantharides . 316 66. Leontodon Taraxacum . 319 67. Digitalis Purpurea . 322 68. Barosma Crenata . 336 69, 70. Cissampelos Pareira . 338 71. Arbutus Uva Ursi . 340 72. Eupatorium Perfoliatum . 353 73. Guaiacum Officinale . 355 74. Daphne Mezereum . 358 75. Xanthoxylum Fraxineum . 361 76. Arum Tryphyllum . 361 77. Carthamus Tinctorius . 362 78. Crocus Sativus . 362 79. Warm-bath . . . . . 366 80. Hip-bath . . 366 81. Foot-bath . . . . . 367 82. Apparatus for smoking opiun l . 390 83. Papaver Somniferum . . 398 84. Hyoscyamus Niger . 399 85. Atropa Belladonna . 400 86. Datura Stramonium . 405 87. Conium Maculatum . 407 88. Aconitum Napellus . 410 XIV LIST OF ILLUSTRATIONS. FIG. PAGE. FIG. PAGE. 89. Humulus Lupulus . . . 414 108. Elettaria Cardamomum 490 90. Dried Lupulinic grain with its hi- 109. Cardamom 491 lum (magnified) . . .417 110. Caryophyllus Aromaticus . 492 91. Cannabis Sativa . 417 111. Foeniculum Vulgare . 493 92. Inhaler . 421 112. Hedeoma pulegioides, 496 93. Ether inhaler . 422 113. Myristica Moschata . 497 94, 95. Chloroform Inhalers . 426 114. Nutmeg in the shell and surround - 96. Strychnos Nux Vomica . 428 ed by the mace 498 97. Narthex Assafoetida . . 441 115. Citrus Limonum 503 98. Castor sacs of Castor fiber . 444 116. Citrus Aurantium 504 99. Musk sac . . 449 117. Camphora Officinarum 505 100. Musk sac, deprived of its hairy 118. Dryabalanops Camphora 506 coat, to show its musculai coat 449 119. Canella Alba .... 510 101. Musk sac deprived of its hairy 120. Drymis Winteri 510 coat and circular muscular fibres 449 121. Acorus Calamus 511 102. Vertical section of the musk sac 122. Piper Nigrum .... 513 in situ.....449 123. Zingiber Officinale 519 103. Helleborus Niger . 457 124. Abies Balsamea 521 104. Ergotsetia Abortifaciens . 465 125. Copaifera Langsdorffii 526 105. Secale Cornutum . 466 126. Melaleuca Cajuputi 530 106. Cinnamomum Zeylanicum . 486 127. Electrical apparatus for medical 107. Coriandrum Sativum . 490 purposes .... 550 LIST OF ILLUSTRATIONS. VOL. II. FIG. PAGE. 128. Cocculus Palmatus . 34 129. Cocculus Palmatus . 35 130. Gentiana Lutea . . 36 131. Quassia Excelsa . 38 132. Simaruba Amara . 40 133. Frasera Walteri . 42 134. Coptis Trifolia . . 43 135. Aristolochia Serpentaria . 46 136. Artemisia Absinthium . 48 137. Dorstenia Contrayerva . 49 138. Anthemis Cotula . 50 139. Magnolia Glauca . 50 140. Magnolia Macrophylla . 51 141. Hepatica Americana . . 53 142. Indigofera Tinctoria . . 54 143. Cinchona Condaminea . 80 144. Cinchona Micrantha . . 82 145. Cornus Florida . 96 146. Liriodendron Tulipifera . 97 147. iEsculus Hippocastanum . 98 148. Acacia Catechu . 125 149. Pterocarpus Marsupium . 127 150. Kramera Triandra . 130 151. Quercus Pedunculata . 132 152. Hsematoxylon Campechianum . 133 153. Geranium Maculatum . 135 154. Artanthe Elongata . 138 155. Diospyros Virginiana . 139 156. Heuchera Acerifolia . . 140 157. Statice Caroliniana . 142 158. Colchicum Autumnale . 199 159. Asagrrea Officinalis . 204 160. Veratrum Album. Linn. var. Al- biflorum . 205 161. Cimicifuga Racemosa . 207 162. Perforated bottom of shower-bath 228 FIG. PAGE. 163. Shower-bath for children 228 164. Abies Excelsa 264 165. Ranunculus Acris 274 166. Jamaica Sarsaparilla 359 167. Honduras Sarsaparilla 359 168. Aralia Nudicaulis 365 169. Vitis Vinifera 409 170. Hordeum . 410 171. Tacca Pinnatifida 412 172. Particles of Tahiti Arrowroot 412 173. Particles of White East [ndia Arrowroot 412 174. Particles of Arrowroot, Potato- starch, and Tous-les-mois as seen through the microscope on a micrometer, whose squares measure one thousandth of an inch ..... 413 175. Particles of West India Arrow- root . . . . . 413 176. Particles of Tous-les-mois . 414 177. Particles of Potato-starch seen by the microscope 414 178. Janipha Manihot 415 179. Particles of Tapioca as seen by the microscope . . . . 415 180. Sagus Rumphii . . . . 415 181. Particles of Sago meal 416 182. Particles of Potato-sago 416 183. Cycas Revoluta, or the Japan Sago-tree . . . . 416 184. Avena Sativa . . . . 417 185. Triticum . . . . . 418 186. Particles of Wheat-starch . 418 187. Zea Mays..... 423 GENERAL THERAPEUTICS CHAPTER I. GENERAL CONSIDERATIONS. Therapeutics defined—Instinctive action of recuperation—Importance of bearing it in mind in the treatment of disease—Cure by sympathy—Expectant medicine—Efforts of nature — Crises — Medical experience — Science of medicine demonstrative — Pre-eminence of therapeutics—Therapeutical indications vary with medical theories—Necessity of dis- covering the pathological lesion — Rational therapeutics founded on rigid physiologico- pathological deduction — Importance of discovering the cause of the lesion — Etiology obscure—Early medical practice—The Asclepiades—Empirics and Dogmatists—French Medical School of Observation — Numerical methods — Necessity for observation and reasoning—Hematology—Importance of principles in medicine. Therapeutics is the branch of Medical Science which comprises the doctrine of the management of disease. Generally, however, the term is restricted to a description of the modus operandi of medicines; and the department is commonly associated, in our Institutions, with Materia Medica; whilst the Practice of Physic is confided to a distinct Profes- sor. Under this division, General Therapeutics is made to embrace the principles of medicinal administration, and the indications, which the different articles of the Materia Medica are capable of fulfilling; whilst the Chair of Practice is appropriated, so far as regards Therapeutics, to the application of those principles to particular morbid conditions, or to what has been called Special Therapeutics. It is the business of the physiologist to investigate the functions of healthy man; the pathologist regards those functions in disease, and the therapeutist endeavours to restore them from the latter to the former condition. There is no branch of medicine with which the therapeutist ought not to be acquainted. To be a good therapeutist requires not only that he shall have had extensive opportunities for witnessing disease, but shall have read extensively the recorded observations of others. It demands, too, the utmost powers of discrimination;—hence, the varied know- VOL. I.—3 34 GENERAL CONSIDERATIONS. ledge, which the physician ought to possess, and the learning and dig- nity of the science. It might be imagined, that lectures on Therapeutics are unnecessary, where the mode of managing individual diseases is given irom tne Chair of Practice; in the latter case, however, the principles are neces- sarily diffused—not sufficiently embodied—and, moreover, the teacher generally presumes, that the student—which rarely happens—is imbued with the" great principles and rules, that apply to the administration and modus operandi of medicines. In the state of health the various functions are executed m a regular and harmonious manner, and are intimately connected by consent or sympathy; but if a morbific cause impresses the organism, this harmo- nious condition is disturbed; a fresh series of actions results, and dis- order supervenes. Physiologists have noticed in every living body an instinctive action —an action of the living principle, whenever manifestly directing its operations to the health, preservation, or reproduction of a living frame, or of any part of it. This applies to the plant as well as to the animal. It is the vis medicalrix naturce, for and against which so much has been said; but which—if restricted to the above mentioned acts—can no more be denied than the existence of life, of which we know nothing except by its results. It is strikingly witnessed in the reparatory power exerted by living bodies after the receipt of an injury. If we tear a branch from a tree, we find, that the injury done to the parent trunk is repaired by an action analogous to that set up by the animal whenever a wound is inflicted upon it. In some vegetables, the reparatory power is so energetically exerted, that lost parts are restored; and it is upon this power that the utility of certain garden vegetables—spinach, pars- ley, cress, &c.—reposes. Such a reparatory power is occasionally— but rarely—met with in the animal kingdom. We see it in the lobster deprived of its claw, and in the serpent that has lost its tail. The nails and hair, too, regain their accustomed length when cut, and the same thing happens to the teeth of the Rodentia or gnawers. Few animals, however, possess, to any extent, the power of restoring lost parts; but all are capable of repairing injuries, and of removing disease when it is within certain limits. In cases of wounds and broken bones, the efforts of the surgeon are chiefly restricted to keeping the parts in apposition, and to preventing the intrusion of extraneous irri- tants, whilst his reliance is placed on those sanative powers that are seated in the wounded part, as in every part of the living frame. It is to this power that we ascribe all the properties assigned "to the cure by sympathy, which, at one time, excited so much attention, was promul- gated by the Rosicrucians, and obtained universal credence in the seventeenth century. This consisted in applying dressings, in the case of wounds, not to the injured parts, but to the weapon °that inflicted them. The sympathetic powder of Sir Kenelm Digby was an applica- tion of this nature, which enjoyed an astonishing reputation. It was first employed at Florence, in the commencement of the seventeenth century, by a Carmelite monk, who had just returned from India The grand duke, hearing of the monk's marvellous cures, asked him for his CURE BY SYMPATHY. 35 secret, which he refused, fearing that the duke might divulge it. Some time afterwards, Sir Kenelm having rendered an important service to the monk, the latter, out of gratitude, communicated to him the com- position of the powder, and Sir Kenelm took the secret with him to England. An opportunity soon occurred for testing its properties. A Mr. Howell, having been wounded in attempting to separate two of his friends who were engaged in a duel, was subjected to its employment. Four days after the infliction of the wound, Sir Kenelm dipped one of Mr. Howell's garters in a solution of the powder; and immediately—it is asserted—the wound, which was previously painful, became easy; but as the garter grew dry, the pains returned, and were relieved by a fresh immersion of the garter in the solution. In five or six days, the wound healed. James the First; his son — afterwards Charles the Second; the Duke of Buckingham, and all the principal personages about the court, were acquainted with the circumstances of the case; and James—whose enthusiasm was not counterbalanced by much judg- ment, and who was, withal, superstitious in the highest degree—obtained the secret from Sir Kenelm, and performed most astonishing cures. In no great length of time the composition transpired, and, as in all like cases, the charm evaporated with the disclosure. The powder, employed by Sir Kenelm, is asserted to have been sul- phate of copper, prepared in a particular manner. Some affirm that it was the ordinary green vitriol of commerce. Dryden alludes to the superstition more than once in his " Tempest or Enchanted Island." Thus, Ariel : "When I was chidden by my mighty lord, For my neglect of young Hippolito, I went to view his body, and soon found His soul was but retired, not sallied out; Then I collected The best of simples underneath the moon, The best of balms, and to the wound applied The healing juice of vulnerary herbs. His only danger was his loss of blood; But now he's waked, my lord, and just this hour He must be dress'd again, as I have done it. Anoint the sword, which pierced him, with this weapon salve, and wrap it close from air, till I have time to visit him again." Act v. scene 2d. And:—Miranda, when she enters with Hippolito's sword wrapped up: "Hip. 0, my wounds pain me! [She unwraps the sword.] " Mir. I am come to ease you. "Hip. Alas! I feel the cold air come to me: My wound shoots worse than ever. [She wipes and anoints the sword."] " Mir. Does it still grieve you ? "Hip. Now methinks there's something Laid just upon it. "Mir. Do you find no ease? "Hip. Yes. Yes: upon the sudden all this pain Is leaving me.—Sweet Heaven, how I am eased!" Act v. scene 2d. It is likewise referred to in the third Canto of the " Lay of the Last Minstrel," of Sir Walter Scott. 36 GENERAL CONSIDERATIONS. The sympathetic ointments, applied to the weapon, or the "armatory unguents/' as they were termed, were of various characters, containing the most absurd, disgusting, and often inert ingredients. The follow- ing extract from the "Sylva Sylvarum" or "Natural History" of Lord Bacon, strikingly exhibits this. The mode of managing the wound sufficiently accounts for the good effects ascribed to the cure by sympa- thy. " It is constantly received and avouched, that the anointing of the weapon that maketh the wound will heal the wound itself. In this ex- periment, upon the relation of men of credit, though myself, as yet, am not fully inclined to believe to it, you shall note the points following: First, the ointment, with which this is done, is made of divers ingredi- ents ; whereof the strangest and hardest to come by are the moss upon the skull of a dead man unburied, and the fats of a boar and a bear killed in the act of generation. These two last I could easily suspect to be prescribed as a starting hole, that if the experiment proved not, it might be pretended, that the beasts were not killed in the due time; for as for the moss, it is certain there is great quantity of it in Ireland upon slain bodies, laid in heaps unburied. The other ingredients are the blood-stone in powder, and some other things, which seem to have a virtue to stanch blood; as also the moss hath. And the description of the whole ointment is to be found in the chymical dispensatory of Crollius. Secondly, the same kind of ointment applied to the part itself worketh not the effect, but only applied to the weapon. Thirdly, which I like well, they do not observe the confecting of the ointment under any certain constellation, which commonly is the excuse of ma- gical medicines when they fail, that they were not made under a fit figure of heaven. Fourthly, it may be applied to the weapon, though the party hurt be at a great distance. Fifthly, it seemeth the imagina- tion of the party to be cured is not needful to concur; for it may be done without the knowledge of the party wounded; and thus much has been tried, that the ointment, for experiment's sake, hath been wiped off the weapon, without the knowledge of the party hurt, and presently the party hurt has been in great rage of pain, till the weapon was re- anointed. Sixthly, it is affirmed, that if you cannot get the weapon, yet if you put an instrument of iron or wood, resembling the weapon, into the wound, whereby it bleedeth, the anointing of that instrument will serve and work the effect. This I doubt should be a device to keep this strange form of cure in request and use, because many times you cannot come by the weapon itself. Seventhly, the ivound must be at first washed clean with white wine, or the party's own water • and then hound up close in fine linen, and no more dressing renewed till 'it be whole Eighthly, the sword itself must be wrapped up close, as far as the ointment goeth, that it taketh no wind. Ninthly, the ointment if Vou wipe it off from the sword and keep it, will serve again, and rather increase m virtue than dimmish. Tenthly, it will cure in far shorter time than ointments of wounds commonly do. Lastlv it will cure a beast as well as a man, which I like best of all the rest, because it subjecteth the matter to an easy trial." ' uecause n The lines in the above quotation, marked in italics, are the kev to the solution of the whole mystery. It is the practice adopted at the instinctive action of recuperation. 37 present day in the treatment of incised wounds, and to this—not to the influence of the sympathetic powder, or armatory unguent, it need hardly be said—must the main curative agency be ascribed, whilst a portion may be assigned to the mental revulsion produced on the suf- ferer, through his faith in the virtues ascribed to the application. The wound was carefully defended from the irritation of extraneous sub- stances, and given up to that instinctive principle, which, we have seen, repairs the injuries to which organized bodies are liable; and it has been suggested, that the results furnished the first hints which led sur- geons to the improved practice of healing wounds by what is technically called the "first intention." The existence, then, of such an instinctive power can neither be denied nor lost sight of in the treatment of disease. The error has been, that undue weight has been attached to it, so that the practitioner was altogether guided by its manifestations—or fancied manifestations —in laying down his indications of cure; and if no such manifestation existed, he waited vainly—and too often unfortunately—until the time had perhaps gone by for the successful administration of efficacious agents. To this system of " waiting or expecting" the term medicina expectans—la medecine expectante—was appropriated. The followers of Stahl—the great apostle of the doctrine—supposed a power to be pre- sent in the system of repelling morbific influences, and of re-establish- ing equilibrium when disturbed. There are but few cases, however, in which trust can be safely placed in this power. It too often happens, that diseased action in a tissue goes on augmenting, until the functions of other tissues become deranged by extension of morbid action, or by sympathy; and disorganization and death follow. Yet the doctrine of Stahl is still maintained by many practitioners—of the old world more especially; and, by some who reject it, terms are frequently employed, which may be regarded as its relics. We often hear, for example, of "efforts of nature," yet the ideas attached to the expression are very unprecise. If diarrhoea should supervene about the favourable termi- nation of a protracted fever, it is looked upon as "critical,"—as a bene- fice de ventre, or a benefice de la nature; but if, on the other hand, diar- rhoea supervenes in phthisis pulmonalis, as an accompaniment of the hectic fever, proves colliquative, and hastens dissolution, we hear no- thing of its being an effort to disembarrass the economy—or of its constituting a crisis. If, again, an individual has suffered under headache, giddiness, and other symptoms of encephalic uneasiness, and epistaxis takes place, after which the symptoms are removed or miti- gated, the hemorrhage is regarded as an effort of nature, although it was doubtless dependent upon the same pathological condition that gave rise to the headache and the other phenomena; but should the hemorrhage occur to such an extent as to excite alarm, or to prove fatal, nothing is said of its being an effort of nature. In the same manner, if hemorrhage occurs in the brain or in the lungs, we rarely or never hear this mode of accounting for it. Yet, although we may discard the notion of efforts of nature, there is no doubt, that good occasionally results from spontaneous discharges, and that, at other times, their supervention indicates a change in func- 38 GENERAL CONSIDERATIONS. tions which may have been long disordered and a restoration to the healthy condition. Thus, where polyaemia or plethora exists in the vessels generally, or in those of some portion of the economy, the super- vention of moderate hemorrhage may diminish the intensity ot the cause; and diarrhoea, or perspiration supervening on a fever ot some duration, in which the secretory function has been disordered, may indicate, that the organs of secretion are assuming a new condition, and that the morbid catenation, previously existing, is beginning to disappear. Although, then, we may not be justified m regarding such discharges as indicating any effort of nature, they may be, and doubt- less frequently are, salutary. An attention to these topics will lead to the combating of irregulari- ties when they occur in the organic actions, provided they are beyond the due point; and, at the same time, teach us not to interfere too much with the instinctive actions, provided they seem to be going on favour- ably. The therapeutist must be guided, however, by observation and reflection as to his rule of conduct in each case. In the very complex operations of the animal frame, the relation between cause and effect is not always readily appreciable; great caution is, therefore, necessary on the part of the observer, lest, in place of facts—properly so called— he should register such as have been termed—not inappropriately— " false." Should he incur this error, owing either to the intrinsic diffi- culty of the subject, or to his incompetency as an observer, a founda- tion may be laid for other erroneous observations; and deductions, and experience may thus be acquired; but such experience may be, in the sequel, most unfortunate. The public are, unhappily, too apt to be led away by this idea of " experience;" erroneously believing that all are capable of profiting by it, and, consequently, that every one who has been sufficiently long engaged in the pursuit of his profession must necessarily be experienced and wise. Were all men equally attentive, and equally gifted with adequate powers of observation and reflection, the deduction would be just; but this is by no means the case. If a man cannot observe and reason on topics of a general nature, he cannot on such as appertain to medicine; and, accordingly, the best rule for estimating the abilities of the physician by the unprofessional is by examining into the character of his mind, his modes of reasoning, his degree of mental application, and his general qualifications. A man of ordinary mind, application, and attainments, may register a few facts; and by comparing them together, may deduce useful inferences so far as these facts may permit, and in this way may prescribe suffi- ciently well in ordinary cases; but such cases are not the touchstone of knowledge. In the multitude of trying cases that present them- selves to every practitioner in the course of his career, what painful anxiety is felt, if he be well informed in his profession, and, withal, a philanthropist! What careful comparison of his own experience with the recorded experience of others! What an amount of physico-moral reflection before he decides! Perhaps in no other profession or calling are the intellectual and moral faculties so much enlisted. But whal consolation awaits the physician, if he can feel satisfied, that the result at which he has arrived, accords with the just demands of the case — IMPORTANCE OF SOUND THEORY. 39 that the decision is adequate to the emergency! These are cases in which ignorance is bliss, but how fearful the responsibility of such ignorance! The curriculum of study, required in the different Medical Colleges, has been suggested by a wise care for the lives and the health of the public, and such a period of attendance upon the lectures that consti- tute it has been prescribed as may enable the industrious—even if not highly gifted—to qualify themselves for entering upon the broad field of observation, and of extended usefulness into which their avocation may carry them. It is within collegiate walls, that the student acquires the prominent facts of his profession, and the great principles apper- taining to its practical administration. He there learns the theory or laws of phenomena, on which all sound and rational practice is based. Too often, amongst the uninformed, the theoretical and the practical pursuit of a calling are placed in unworthy contrast. In no art can sound practice exist without theory. Theory is the mental process which binds observed facts or phenomena together; compares them with each other, and deduces appropriate rules of practice. It is to theory that we are indebted not only for full practical usefulness, but for every science. Facts are, doubtless, the elements of science, but the science itself does not exist, until these facts have oeen brought together, sifted and compared, and great general principles or laws deduced therefrom. In such sifting and comparison a multitude of miscalled facts have to be discarded. In the science of medicine—in every science—those that merit the epithet false are numerous, and many of them rest on the authority of the heedless observer, who arrives at his conclusions with- out due examination. The theoretical investigation of science renders a man cautious even to scepticism. Yery few. therefore, of the mass of recorded facts originate with him: he has little to do in accumulating the chaff that envelopes the grain. The records of the Patent Office of every country tend to elucidate this matter. It has been properly ob- served, that every patent is a speculation. Who, then, are the great speculators ? Not the theoretical men, in the sense in which we have used the term, but what are called practical men,—men, who narrow themselves down to observed facts in their own profession or calling, and who, in consequence of their ignorance of theory, soon find that their inventions are no important additions to existing knowledge. A writer on this subject asserts, that he has made a rough estimate of the number of scientific persons who have published works relative to new inventions in arts, and he finds, that in Europe they did not exceed two hundred during the whole of the last century, whilst there were not fewer than that number of patents taken out in England annually. An ade- quate acquaintance with scientific truths would prevent this waste of time and talent; and hence it is, that a combination of theoretical and practical knowledge is necessary to lead to lofty and enduring re- sults. This is the great improvement in the modern method of teaching the practical sciences. That, which was formerly oracularly delivered from the chair as the result of the experience of the master, is not now promulgated as indisputable. It is placed before the inquirer as a fact, 40 GENERAL CONSIDERATIONS. over and over again examined and scrutinized, and the reasons for any opinion are fairly stated as elements for his decision, lne time has passed away, when the human mind is to credit the mere verba magistn, or to place implicit credence in a scientific assertion, without examina- tion, because it proceeds from this or that individual. The rule of con- duct, implied in the language of the Koman Satirist,—" Marcus dixit, ita est";— "Did Marcus say 'twas fact? then fact it is; No proof so valid as a word of his"— has been too much inculcated in all ages, and no science has suffered so much from it as medicine. It has been properly remarked by Dr. Abercrombie, in his " Inquiries concerning the intellectual powers and the investigation of truth," that in receiving facts on the testimony of others, we require to be satisfied not only of the veracity of the narra- tors, but also of their habits as philosophical observers, and of the op- portunities, which they have had of ascertaining the facts. In receiving affirmed truths, therefore, the inquirer has to exercise caution ; but at the same time to be careful lest by attempting to avoid one error he may incur another, and may pass from credulity to ill-judged scepticism —extremes, which the mind, anxious after truth, will carefully avoid. In the management of disease it is not always necessary, that drugs should be given, unless their use is clearly indicated; or unless, in the case of certain nervous and impressible individuals, whose faith is not reposed in any system of medication that does not include the use of internal medicines. To obtain this faith is an important desideratum, as will be seen hereafter, in the treatment of many diseases, of a nervous character especially. The physician exhibits his skill better by con- trolling disease by appropriate regimen than by administering combina- tions of whose effects he often knows little, and where much of his prac- tice must necessarily be involved in conjecture. The science of medicine is more demonstrative than is usually imagined, and, where the case is not so, the practitioner had better for the time do nothing. Any expe- riment may have one of two opposite results; it may do good or harm; and hence a practitioner is not justified in administering a powerful medicinal agent at random. If he be desirous of instituting experi- ments, he ought to take example from some modern therapeutical in- quirers in Germany, and make them upon himself, rather than upon his patients. It cannot often happen, however, that the physician is at a loss what course to pursue. His physiological and pathological know- ledge will indicate what ought to be the great principles of management; and his acquaintance with the remedial virtues of the different°articles of the materia medica will suggest the proper agents for carryino- those principles into action. To elucidate this, the case of the drug opium may be taken. It is known that it will allay irritation, and produce sleep; a knowledge acquired from observation. It is known also, that in a large dose it is sedative; in a small dose stimulant. When a case of inflammation occurs, the physician is not deterred from its use, because it excites in a small dose; but gives it in a quantity sufficiently large to insure the sedative operation. Accordingly, observation and reflection have led THERAPEUTICAL INDICATIONS. 41 to the employment of this useful drug in cases where the practitioner, a few years ago, would not have ventured upon it. It is by empirical trials, that we become informed of the properties of any medicinal agent, after which sound physiological and pathological knowledge sug- gests its correct application. The great object of the science of medicine is to remove or assuage disease. Hence the pre-eminent importance of Therapeutics. It has been largely modified by prevalent systems or doctrines, yet it bends less to system than any other branch of medicine; and, accordingly, many of the different sects which have existed from time to time have been overthrown by this great test of their validity or weakness. In the closet, a consistent scheme may be formed on paper, but when it comes to be applied clinically, it may be often found to fail. It is ob- vious, that, cozteris paribus, Tlierapeutics should be the touchstone of medical skill. The number of cures ought to decide the qualifications of the practitioner; but it is so extremely difficult—indeed impossible —to estimate all the deranging influences,—so many modifying circum- stances are perpetually occurring, that it cannot be decided that any two cases are precisely identical. Hence, we can never judge of the comparative success of different practitioners, on which so much stress is placed—and placed erroneously—by the public. Owing to these difficulties, also, we have such a diversity of sentiment regarding the treatment of the same affection. Therapeutical indications vary much, however, with medical theo- ries. By indication is meant—the end to be had in view in the admi- nistration of remedies. For example, in a case of polysomia or overful- ness of blood, the indication is obviously to diminish the amount of the circulating fluid. Indications have necessarily been greatly in- fluenced by the views of the dominant medical sect. The humorist or humoral pathologist, who looked to the fluids as the cause of all maladies, directed his attention to the removal of a fancied acridity, acidity, or alkalescency of the humours, or to evacuate them after they had experienced a kind of maturation or preparation, which he called concoction; whilst the mechanical philosopher attended to the permea- bility, or the contrary, of vessels,—the effects of gravity, and the like; and his indications were based upon his ideas on those matters. But those systems, and the Therapeutics founded on them, have passed away; not, however, without having left useful mementoes of their existence; for it is obvious, that the conditions which they invoke cannot be wholly disregarded: the evil with those pathologists was, that they assigned to them too prominent a rank in the causation of disease, and that they attended to them to the exclusion of more im- portant agencies. One of the greatest errors in the investigation of disease, and its mode of management, is the belief which long existed, and still exists with the mere routine practitioner, that it is only necessary to attend to symptoms or phenomena, and to combat the most prominent as they occur. This is obviously insufficient without appreciating the organ that is suffering, and the precise nature of the existing lesion. The same symptom may be present in diseases of very different character; 42 GENERAL CONSIDERATIONS. and before the therapeutist can lay down any satisfactory indications of treatment, inquiry must be made into those circumstances, as well as to detect whether the mischief in the organ be primary or secondary, idiopathic or symptomatic;—in other words, whether the morbid mis- chief commenced in the main seat of the disease, or began in some other organ or tissue, and extended to it by virtue of that correlation, which plays so important a part in every physiological, as well as pathological, condition of the functions. The insufficiency of attending simply to the more prominent symp- toms is readily elucidated by a few cases. A feeling of debility is a distressing symptom in the most inflammatory, as well as in the most enfeebling, disorder; yet how different the. treatment! Itching of the glans penis is symptomatic of stone in the bladder. Itching of the nose, where the mucous membrane commingles with the skin, occurs in irritation of the lining membrane of the intestinal canal: in hepatitis, excruciating pain is occasionally felt at the top of the shoulder: painful retraction of the testis occurs in nephritis; and intolerance of light and sound are distressing symptoms of cephalitis. But it would be ex- tremely unphilosophical to attend solely or mainly to those prominent symptoms. The primary seat of irritation must be inferred from them, and from farther attentive examination; and it is not until the physician has attained a thorough knowledge of the seat and nature of the dis- ease, that a rational basis can exist for his curative indications. The lesion of the affected organ must be appreciated. This is the point of departure for an enlightened practice. To resolve this question demands a careful inquiry into etiology, as well as into physiological pathology, and not until this has been effected can the practitioner properly de- termine on the indications that require fulfilment, and on the mode of fulfilling them. The fundamental object, in every indication, is to put a stop to or mitigate the disorder in the organic actions, and to remove any altera- tion that may have supervened in the tissues consequent on such dis- order. If inflammation, for example, takes place in any organ, the indication is, during the active stage, to remove the particular state of vessels concerned in the morbid condition; and if suppuration, indura- tion, or any other of the terminations of inflammation should ensue, to have recourse to the appropriate remedies for their removal. When once the primary organic lesion is removed, the symptoms occasioned by it will disappear; unless, as in the case of the terminations of inflam- mation, irritations—which have become independent of the primary affection—should persist, and give rise to a special train of symptoms. The attention of the therapeutist has, consequently, to be directed in the first instance, to the primary lesion, and afterwards to the secondary or symptomatic. J The nature of the disease, then, or the precise species of vital modi- fication of tissue, that gives occasion to the morbid phenomena must be the basis of every therapeutical indication; and although the svrno- toms or manifestations may differ in the different ages and sexes and according to the strength, &c, of the patient, the indications will be essentially the same; and the treatment will rest on the same general THERAPEUTICAL INDICATIONS. 43 "principles, requiring modifications according to circumstances; but these constitute secondary considerations. In inflammation, for ex- ample, the general rule must be laid down, that the ordinary antiphlo- gistic remedies are indicated; and this, whatever may be the seat of the inflammation, or the strength, age, habit, &c, of the patient; still, many modifications in the treatment may be demanded according to those various circumstances. The precise morbid condition of tissue in inflammation is, at times, extremely difficult of detection. To explain this, the case of a blood-shot eye may be taken,—a state of the con- junctiva in which several files of red corpuscles are forced into vessels, which, in health, admit perhaps but a single file. A grain of sand, or some extraneous substance, has excited irritation in the conjunctiva, and the consequence has been an afflux of fluids to the irritated part. The smaller arteries have taken upon themselves augmented action; blood has been sent in undue quantity into the extreme vessels, which have become over-distended; so that, in the case assumed, there is an over-distended state of extreme vessel, and an over-excited state of the artery communicating with it. This is a familiar and striking exam- ple : it does not, however, apply only to the blood-shot eye, but to every case of inflammation. In this state of parts, it is manifest, that so long as the extreme vessel remains over-dilated, there will be remora of blood in it to a greater or less extent; the circulation cannot proceed as uninterruptedly through it as through a capillary vessel, whose coats and the tissues surrounding the vessels are in a condition of healthy tone; owing to this circumstance, excitement is kept up in the vessels immediately communicating with the over-distended extreme vessels, which excitement continues so long as the over-distension persists, and, in many cases, the irritation is extended from the parts first affected to the general sanguiferous system, until ultimately the heart and arteries are in a state of excitation and turmoil. Now, a great difficulty in investigating the pathology of inflamma- tion consists in our not always being able to discover whether this atonic condition of the extreme vessel, induced by over-distension, or the over-excited state of the vessel communicating with it, is the con- dition which more especially requires attention: hence the difficulty of saying, in all cases, whether the topical use of astringents or stimu- lants, or the opposite plan of treatment—the soothing—ought to be had recourse to. Every practitioner meets with this difficulty, and accord- ingly, in cases of external inflammation, he is often .compelled to resort empirically to one set of applications; and, if it should not succeed, to another of an opposite character. In certain textures of the body, the predominance of over-distension of extreme vessel appears to exist, when they labour under inflamma- tion, more commonly than in others. This seems to be the case with inflammation of the skin and mucous membranes, which belongs to the variety of erysipelatous inflammation; whilst that of the areolar and serous membranes is of a more active cast, and may be regarded as appertaining to the phlegmonous variety. Accordingly, in erysipelas, and in some of the inflammations of mucous membranes, remedies are occasionally had recourse to, which can rarely be employed in inflam- 44 GENERAL CONSIDERATIONS. mation of the areolar membrane. For example, in some varieties of burn, or erysipelatous inflammation of the skin, stimulating applica- tions are found of service; whilst in others, where the excitement in the communicating vessels is great, antiphlogistic agents are demanded. Cases of inflammation of the conjunctiva have been recorded, in which decided advantage was produced by dropping the essential oil of lemons upon the inflamed surface; and, in most cases of chronic in- flammation, the topical application of gentle excitants is found to be beneficial: accordingly, after gonorrhoea, which is an inflammation of the lining membrane of the urethra, has continued for a long period, we attempt to arrest the discharge by astringent excitants, and if these are insufficient, the bougie is sometimes passed, to excite, by contact, the vessels to their healthy tone; and in this manner the gleet is often got rid of, after it had resisted the continued use of ordinary antiphlo- gistics. In these cases—as in all others—rational treatment is founded on rigid physiologico-pathological deductions. It is important in every morbid condition to inquire into the cause, that may have produced, or is producing, the phenomena. That this must be removed, when practicable, is a self-evident indication. The maxim, " Tolle causam cessat ejfectus," although often true, is not always so. If a thorn be run into the flesh, irritation exists so long as the thorn remains there; and if it be removed, the recuperative powers of the part speedily repair the injury that has been inflicted. In like manner, if a decayed or loose tooth be exciting repeated gum-boils, the obvious remedy is to remove the tooth. But in the large mass of mor- bid conditions, although the cause, which immediately produced the disease, is taken away, the complaint continues. A man, from a night's sojourn in a malarious district, may receive a sufficient dose of the exciting cause to induce intermittent fever, and although he may be removed from the unhealthy locality, the fever will persist after his change of residence. It may be said that, in this case, the malaria may still be present in the system; and this is possible; but it is more probable—more consistent with analogy—that a morbid influence is exerted on the economy from such exposure, and that the effects go on notwithstanding the abstraction of the morbid cause; in the same manner as a disease, produced by local irregularity of action in the capillary system owing to exposure to cold and moisture, may persist, notwithstanding the removal of the cause has been complete. There is probably, at all times, a greater predisposition in the organism to dis- eased action in some particular organ or tissue than in another; so that if irregularity of organic action be induced in any external part of the body, the mischief may not supervene in the part where such, irregu- larity exists, but in the organ especially predisposed to assume a morbid action, through the extensive sympathy which exists between every part of the system of nutrition. Owing to this circumstance, the diffi- culty in discovering the precise cause of a disease is often extreme fortunately, the discovery is not always a matter of moment, inasmuch as the disease usually continues independently of the cause; and it is the disease—the modification in the structure or functions that consti tutes the pathological condition—which we have to combat In all INFLUENCE OF SECTS ON THERAPEUTICS. 45 cases, the patient is anxious to find out, and to suggest, a cause; and the suggestions are frequently of the most unphilosophical character; but although the practitioner may feel this, it is not necessary that he should show it. Allusion has been made to the influence exerted from time to time by dominant medical sects on Therapeutics. Such reminiscences are often well adapted for diminishing our pride in what are regarded modern improvements, and for inducing us to form a more exalted opinion of our brethren in ancient periods. The credit of original conception has, indeed, been often awarded for observations and opinions, which had beea inculcated ages before; escaped notice, and been subsequently re-propounded;—the ancient and the modern being equally entitled, perhaps, to the credit of originators. By such reminiscences we may, moreover, be enabled to trace the course of improvements, and to throw light upon many practices, which, although' frequently the offspring of superstition and credulity, were not without their influence on the pro- gress of the science, and, under some form or other, are in active opera- tion at the present day. A knowledge of the effects of remedial agents must have been ob- tained everywhere in the same manner,—in the infancy of the world as in savage and uncultivated nations at the present day. Individual experience furnished remedies; accident, in almost all cases, leading to a knowledge of their powers over the living economy; and analogy suggesting their application to disease. In no other way than by acci- dent could the knowledge, that jalap acts as a cathartic, or that opium is possessed of anodyne virtues, have been obtained. Even now, when illumined by all the lights which the1 collateral sciences have shed upon that of medicine, our experience with a new article of the materia medica must be wholly tentative; but as soon as we acquire an acquaintance with its effects on the organism, our physiological and pathological knowledge enables us to apply it rationally, with full ad- vantage, to the treatment of disease. Until, however, the properties of any new drug are known, great caution is necessary in making use of it. Camerarius first, and De Candolle afterwards, showed—what is now notorious—that there is considerable analogy in the action on the organ- ism of vegetables which resemble each other in their external charac- ters or botanical relations^; and hence, that the arrangement of plants into natural groups or families is calculated to aid us in estimating the alimentary or medical properties of untried vegetables,—a method of investigation most useful to those who are shipwrecked on foreign and unknown shores, and whose subsistence may have to be derived from the vegetable products; and one also of great value to the scientific naturalist in his appreciation of the •various new plants which he may have occasion to examine, as respects their utility in rural economy or in medicine. Yet this rule of guidance must not be considered abso- lute. The graminece have farinaceous and nutritive seeds; the labiatce are stomachic and cordial; the seeds of the umbelliferoe are tonic and stimulant; those of the euphorbiaceoz acrid and purgative ; the juice of the coniferai is resinous ; and the bark of the amentacece astringent and febrifuge. Such is the general fact; but there are some striking excep- 46 GENERAL CONSIDERATIONS. tions:—the deadly conium, for example, is alongside the nutntive and innoxious carrot; the sweet potato touches the acrid jalap; the bitter colocynth may be mistaken, by the eye, for the melon; the potato is igst the poisonous solanece ; the lolium temulentum, of deleterious amom agency, amongst the cerealia; and the fatal cherrylaurel is in close rela tionship with the plums and the cherries. In the infancy of our art, the number of remedial agents whose vir- tues were learned by experience must necessarily have been few ; yet we have no record of a period when such agents were not known. Experience of particular articles was derived from accidental injuries; and, in the origin of the art, surgery was doubtless greatly in advance of medicine. Sympathy for suffering incited to exertion, with the view of discovering some method of relief; and where sensible agen- cies failed, recourse was had to charms, incantations and amulets, sug- gested by ignorance and superstition, amongst the rude and barbarous nations of the present day, almost as extensively, and confided in as implicitly, as in the cradle of mankind. If the patient died, the event was ascribed to the will of the gods; if he recovered,—by virtue of those instinctive powers which are seated in every organized body— animal and vegetable—and without which the efforts of the physician would be vain,—a case of cure was recorded; but no inquiry was made as to the precise agency exerted. To the charm, the incantation, the amulet, was ascribed the whole result; tradition handed down the knowledge of its presumed efficacy, and led to its employment in similar cases. Would that we were much more philosophical even in the nineteenth century; for we meet with many like cases, that exhibit but a slight remove from'those conditions of ignorance and barbarism, even in people that would start at the idea of being assimilated to the benighted of those remote ages, or the scarcely less elevated members of a barbarous community of the present day! For a long period of history, even amongst the most enlightened nations, there could have been only empirical medicine acquired in this manner; and all medical instruction must have consisted in a transmission, by tradition, of the knowledge of mechanical means, and the properties of remedies, previously employed—as it was conceived with success—for the healing of wounds and other injuries, and for the removal of disease. Art—rude art—existed; phenomena were observed; but no one attempted to fathom the laws of phenomena, and science was therefore not even generated. Herodotus informs us, that the Babylonians, Chaldeans and other nations of antiquity, had no phy- sicians. When any one was attacked with disease, he was carried into the public thoroughfares, and the passers-by were interrogated whether they had suffered under, or witnessed, a similar affection; and if so, they were required to state their experience, and to recommend such measures as might seem to them adapted for the removal of the malady The first individuals, who raised themselves above the vulgar made the treatment of disease an object of study, and obtained success bv practising it, were elevated to the rank of gods. Altars were erected to them ; and the priests, from being the oracles of the god whom the people desired to consult, became themselves physicians. Hence the MEDICAL PRACTICES IN THE ANCIENT TEMPLES. 47 practice of medicine was, for a long period, a part of priestcraft, and was taught by the ministers of the altars with many occult and mys- terious ceremonies, well calculated to impress the vulgar, and to excite a belief in their miraculous powers. Such was the history of Asclepios or ^Esculapius, and the Ascle- piades; and if we advert to the mode in which medicine was practised in the temples erected to him, we can readily comprehend the agencies which were concerned in the relief that was so often experienced. In the first place, it was the universal belief, that all diseases were emana- tions from the anger of the gods. The gods alone could, consequently, cure them; and it was in those sacred places, that iEsculapius mani- fested the evidences of his extraordinary powers. The ceremonies, used to propitiate heaven in favour of the sick, varied at different periods. They were almost all, however, of a nature to act on the imagination, whilst a strict regimen was rigorously inculcated. The entrance to the temple was interdicted to all who had not previously undergone purification,—the processes connected with which neces- sarily tended to excite hope in the future, and to inspire the sick with full confidence in the revelations about to be made to them. When permitted to appear before the idol and present their offerings, they found him surrounded by so many mysterious symbols, and witnessed the performance of so many imposing ceremonies, that their exalted imaginations made them regard as infallible every oracle of the god. Most of the temples, too, were situated in very salubrious places; and within, or around them, mineral and often thermal waters flowed. It is, therefore, easy to conceive, that the purity of the atmosphere, and the change of society and scenery experienced by the invalids during their pilgrimage to consult the oracle, may have had a powerful influence on all those affections that we know to be benefited by similar re- sources. The preliminary ceremonies to which they were subjected, and the sacrifices which were required of them, contributed still more to the same end. In the first instance, the most rigorous abstinence was enjoined. Before they could approach the cave of Charonium they were compelled to fast several days. At Oropus, in Attica, before consulting the oracle of Amphiaraus, they were to abstain from wine for three days, and from every kind of nourishment for twenty- four hours. In leading them through all the avenues of the temple, the priests detailed to them minutely, and mystically, the varied mira- cles which the god had performed on their predecessors, whose votive offerings and inscriptions they had preserved; and dwelt especially on those cases that resembled theirs. After these promenades, carefully adapted, in regard to extent, to the powers of the invalid, sacrifices were offered to the divinity, with fervent prayers to obtain from him the revelation, which was not communicated, however, until the patient had been bathed, rubbed, and subjected to various manipulations well calculated to excite a new action in the nervous system, and, through it, in the whole system of nutrition. They were subjected, too, to fumigations before hearing the answers of the oracle; went through a process of preparation by prayer; slept in the neighbourhood of the temple on the skin of a ram, 48 GENERAL CONSIDERATIONS. which had been offered up as a sacrifice, or by the side of the statue of the god,—expecting, as they were taught to believe, the appearance before them of the God of Health. Can we be surprised, that under such circumstances the excited imaginations, of the nervous more espe- cially, might lead them to fancy, and to credit, that the revelation of future events was actually made to them; or that, in their dreams, they might believe that they saw iEsculapius present himself before them, and instruct them as to the means to be employed for their cure! The remedies advised in their dreams or revealed to them by the priests, who were always the interpreters of the dreams, were usually of a kind calculated to do neither harm nor good,—such, for example, as gentle cathartics prepared of stewed currants, diet easy of digestion, or fasting and bathing, accompanied by various mystic ceremonies. Yet occasionally they were of a more heroic character. Aristides— we are told—was the dupe and victim of the Asclepiades for ten suc- cessive years. He was alternatively purged, vomited and blistered; made to walk barefoot under a burning sun in summer, and in winter doomed to seek for the return of health by bathing his feeble and emaciated body in the river. All this severity of treatment, he was made to believe, was exercised towards him by the express directions of JEsculapius himself, with whom he was persuaded to fancy that he held converse in his dreams, and frequently beheld in nocturnal visions. On one occasion, the god, fatigued by the importunities of Aristides, ordered him to lose one hundred and twenty pounds of blood, which he very judiciously took the liberty of declining! After his recovery the patient rendered thanks to the god, and car- ried him offerings; and, not unfrequently, the parts that had been the seat of the affection were modeled in ivory, gold, silver or other metal, —a species of votive offering, which was termed anathema, and num- bers of which were preserved in the temples. Of one of these votive tablets, discovered in the Isle of the Tiber, and published by Gruter, the following is a translation:— "A blind soldier, named Valerius Aper, having consulted the oracle, received for answer, that he ought to mix the blood of a white cock with honey, and make an ointment to rub the eyes with for three days He recovered his sight, and. returned thanks to the god in the presence of the people." The exclusive exercise of medicine was confirmed to the priests by other regulations. As soon as a valuable remedy or preparation was discovered, its composition and mode of preparation were inscribed on the gates and columns of the temple. The inventors of surgical instru- ments also deposited a specimen; and we can thus understand, that useful isolated facts might be collected by competent individuals into a consistent whole; and there is great reason for the belief that the father of physic was largely indebted to the votive tobl^^vMhS temple at Cos, m the preparation of his immortal works The custom of hanging up votive tablets in the temple of the patron saint, after escape from danger of various kinds, has been known inah ages; and still prevads m certain parts of the world. AccoIdW to Scandinavian mythology, the supreme god Odin or Woden wb g MEDICAL OBSERVATION IN ANCIENT GREECE. 49 our Wednesday, Woden's day—assumes the name of Nicker, when he acts as the destructive or evil principle; hence, perhaps, our term Old Nick, as applied to the evil one. In this character he inhabits the lakes and rivers of Scandinavia, where he raises sudden storms and tempests, and leads men into destruction. In short, he is the northern Neptune, or some subordinate sea-god of noxious disposition. Nicker, with the Scandinavians, being an object of dread, propitiatory worship was offered up to him; and hence it has been imagined, that the Scan- dinavian Nicker became, in the middle ages, St. Nicholas, the patron of sailors, whose aid is still invoked in storms and tempests,—a supposi- tion which receives countenance from the devotion still felt by the Gothic nations towards St. Nicholas. To this saint many churches on the sea-shores are dedicated, and many a prayer to St. Nicholas is still offered up by the seamen passing by. To these churches, in many countries, sailors, who have suffered shipwreck, resort to return thanks for their preservation, and to hang up votive tablets representing the dangers they have escaped, in gratitude to the saint for the protection he vouchsafed them, and in the fulfilment of vows made in the height of the storm. This custom, which is more especially in use in catholic countries, is probably taken immediately from the ancient Eomans, who had it among a number of superstitions from the Greeks; for we are told, that Bion, the philosopher, was shown several of these votive pictures hung up in a temple of Neptune near the seaside; and the custom is referred to by Horace. " Me tabula sacer Votiva paries indicat uvida Suspendisse potenti Vestimenta maris Deo." Carm., 1, 5. "While I, now safe on shore, Will cousecrate the pictur'd storm, And all my grateful vows perform To Neptune's saving power." Francis. Such was the condition of medical observation in the then enlightened G-reece.—confined to the priesthood, and full of mystery to the unini- tiated, but leading to a knowledge of numerous remedial agencies; for there is every reason to believe, that in the earliest periods the ancients had a knowledge of several of our most active remedies,—hellebore, opium, and squill for example. Bloodletting, too—as we have seen— was employed amongst them. We are told,—and it is the earliest record of the operation,—that Podalirius—one of the sons of JEsculapius—on his return from Troy, was cast ashore on the Isle of Scyros, where he landed, however, in safety; and was taken by a shepherd to the court of King Damcethus. Here, he gave proofs of his medical skill, by curing the daughter of Damcethus—Syrna—of the effects of a fall, by bleeding her in both arms, after her life had been despaired of. In those remote periods—as is too much the case even at present—extensive virtues were assigned to agencies, often of the most inert kind, which frequently obtained the credit of cures, that had been effected by the jugglery of VOL. I.—4 50 GENERAL CONSIDERATIONS. the pagan priests, but partly also by the excellent hygienf™l™£ which the patient was subjected. At one time, almost the * hole of the materia medica consisted of the machinery of magic Absurd and un- meaning words scrawled on parchment; figures of idols suspended round the neck, were considered to be capable of curing ague; hemor- rhage was arrested by charms, and even luxations were said to have been reduced by barbarous expressions and magical songs; and we can understand that Cato, -flie^nsor, may—as was affirmed—have suc- ceeded in this manner; or, in Other words, by distracting the attention of the patient by those