OUTLINES 
OF THE 
INSTITUTES OF MEDICINE. T. M uore '.s Li thugrriphy Jurton. 
a O SETH A . GALLUT , M . W ., OUTLINES 
OF THE 
INSTITUTES OF MEDICINE: 
FOUNDED ON 
THE PHILOSOPHY 
OF 
THE HUMAN ECONOMY, 
IN 
HEALTH, AND IN DISEASE. 
IN THREE PARTS. 
Should we build facts upon facts until our pile reached the heavens, they would 
tumble to pieces, unless they were cemented by principles.-Rush. 
BY JOSEPH A. GALLUP, M. D. 
Author of Sketches of Epidemic Diseases in the State of Vermont; late Professor of Theory and Practice its 
the Vermont Academy of Medicine, and of the Clinical School of Medicine ; Ex-President of the 
Vermont Medical Society ; Hon. Member of the Medical Society of the State of 
New York. &c. 
VOLUME I. 
BOSTON: 
OTIS, BROADERS, AND COMPANY. 
I R 3 9 . Entered according to Act of Congress, in the year 1838, by the Author, 
in the Clerk's Office of the District Court of Massachusetts. 
TUTTLE, DENNETT AND CHISHOLM, PRINTERS, 
No. 17 School Street. ADDRESS 
As the writer has been chiefly induced to under- 
take the labor of the following design, in conse- 
quence of two very courteous memorials addressed 
to him, from all the students present of two 
classes, at different Medical Institutions, request- 
ing a publication of his Lectures, or the principles 
embraced in them ; he has presumed, with res- 
pectful regards, to present these outlines to the 
Students of Medicine in the United States of North 
America, with a hope of their being in some 
measure useful to the science of medicine, and with 
best wishes of 
THE AUTHOR. PREFATORY REMARKS. 
Considering that some introductory remarks had been made in 
the course of the following pages, it had been concluded to omit 
any formal preface, and to present the work to the candid consider, 
ation of the medical community, without note or comment. How- 
ever, on further reflection, it was deemed proper to offer a few 
brief expositions. 
It can be but of little use to assign motives to such a project as 
the present, which shall have preponderated over the numerous, and 
almost insurmountable obstacles, which stood opposed to its accom- 
plishment. It is hoped, however, that other than mercenary, or am- 
bitious views may be imputed to one, whose feelings, and condi- 
tion in life, incline him to ease and retirement. But, still, the im- 
pression of a duty, which may be due from him to society, by at- 
tempts to reform errors of high import, in a profession to which he 
has been ardently devoted, impels to the enterprise. If he fails 
of accomplishing any portion of the object, the comfort arising 
from a cancelled obligation will remain. 
An author, who suffers himself to be placed on the broad arena 
of public trial, has no right to offer apologies, neither can they be 
accepted, nor even can commiseration be extended to him for fail- 
ures, when the fundamental principles of a science are the stake. 
The honest sentiment of the community of medicine must approve, 
or disapprove. 
It has not been our wish to find fault gratuitously with the opin- 
ions or writings of others; or, surely no further than necessity IV 
PREFATORY REMARKS. 
appears to require." Still it is believed, many volumes might be 
filled with an examination of theoretical and practical errors now 
existing, saying nothing of the past. 
We are well aware of the difficulties, which stand opposed to 
the establishment of cardinal principles in medicine. They ought 
to be framed from a comparative review of a long series of facts, 
and the inductions well supported by the united experience of 
many. Although the studies in relation to the human economy, 
come in near contact with numerous collateral sciences, yet they 
should be pursued independently of these. It is useless for the 
empiric to declaim against principles, or theory in medicine ; for he 
also is wedded to, and practises on such as suit him, as strictly as 
does the severest dogmatist. It is a solecism to contend against 
theory in any art or science, for surely they can have no existence 
without their fundamental principles. 
The science of life is based on principles, different from all 
those pertaining to inorganic substances, and should be studied 
independently of these. The fixed, immutable properties of life- 
less bodies remain unchanged under all circumstances, and their 
motions become obedient to their sovereign affinities. But, not so 
as regards organized bodies. There is a presiding principle, 
which modifies, and even controls their movements; and if all 
other things are compatible, it is always directed to the preservation 
of individual existence, and to its greatest good. If nothing 
incompatible intervened, the movements of the human economy 
would arrive to the same undeviating results, as are observed in 
chemistry, mechanics, hydraulics, &c. In point of precision, it 
might not come behind the exactness of arithmetical figures. 
But this is not the constitution of organized bodies ; their com- 
position is subjected to numerous modifications; and as a sequence 
of this, the presiding principle, which for the present we may call 
vital force, exercises only a conditional control over their move- 
ments, and consequently over their functional results. This force 
exists in so close a relation to the soundness, or integrity of the 
tissues of organization, that it is liable to frequent fluctuations ; 
and the organic movements are prone to perturbations, or an excess 
of accumulation, when they are free to act. PREFATORY REMARKS. 
V 
If these premises are correct, there is no difficulty in apprehend- 
ing the reason why, so great a portion of the labor of former 
coadjutors is lost, or has been worse than useless, in attempting the 
establishment of theorems in medicine too much interwoven with 
physical and mechanical principles. And what system even of 
modern date, is altogether free from the error ? 
Moreover, it is not only mechanical inductions in relation to vital 
movements, which have been thus unfortunate; but most modern 
theorems pretended to be inducted from the laws of living bodies, 
are tinctured with the errors of former times ; and when imagined 
to be safe inductions from established facts, are little else than old 
theories in the liveries of new patch-work. We cannot here parti- 
cularize. In consequence of the misdirected study of the science 
of medicine, if it can now be called such, it has loitered behind the 
mechanic arts, even at a sightless distance. And to add to the 
chagrin, it has been denounced by some of its devotees, as empi- 
rical, dogmatical, conjectural, or charlatanical. 
It has even been declared, that philosophical empiricism has, and 
in future must direct all therapeutical applications in the treatment 
of disease. We are aware, that the empirical practice by random 
trials, as the term implies, has introduced some useful remedies. 
But these trials have been insufferably dangerous, and their bene- 
fits merely accidental. No doubt can be apprehended, but that 
much mischief has been done by them, and will so continue to be, 
unless their use is guided by correct therapeutical principles. Still 
the mischief continues in the use of many supposed remedies, 
merely because they are sanctioned by long usage. A little atten- 
tion to just views of the true character of disease, and properties 
of the intended remedial agents, would exclude many of the in- 
compatible substances now in use, from rational practice. 
What shall we understand by philosophical empiricism ? Ac- 
cording to Dr Dunglison, empiric is synonymous with charlatan and 
quack. We might add, the makers and venders of nostrums, and 
patent medicines, &c. They all plead experience as their magna 
charta of perfection and confidence. But what philosophy do they 
need to employ ? It can be no more needed, nor can it be more VI 
PREFATORY REMARKS. 
just, than the horse-doctor's lecture on the wonderful powers of his 
drench. 
The experience and philosophy of ages may be reduced, com- 
paratively, to a narrow focus, in relation to diseases and their reme- 
dies. When we trace the effects of the causes of disease to the 
primary lesions done the tissues, we find them to be few and sim- 
ple. From a knowledge of these, the more complicated and result- 
ing derangements will be the more easily investigated and under- 
stood. The more perfectly the character of disease is understood, 
the fewer and more simple will become the necessary remedial 
agents which need to be employed for its removal. And again, so 
long as the true character of disease is veiled in doubt and obscu- 
rity, so long will empiricism call to its aid, its burthensome number 
of expedients. Many must be tried; for it will be supposed the 
patient has as many isolated diseases as he has prominent pheno- 
mena. The patient may sink more from the weight of his remedies, 
than that of his disease. 
In the following pages, we have aimed at an investigation of the 
hurtful agents exciting disease ; to expose the simple character of 
the primary changes in the tissues by such agents ; and to demon- 
strate that the remedial agents which are necessary for effecting its 
removal, are likewise few and simple at the onset. Although 
secondary local derangements do occur in the tissues and organs, 
yet the constitutional affection will remain, until the primary cause 
is removed. 
In all our investigations, we have aimed at perspicuity, whilst we 
have studied to be brief. Some suspicions are entertained, that the 
aphoristical style used generally, may have left certain subjects not 
sufficiently explained ; yet it is hoped, when the whole of the sub- 
jects are taken into view, there may exist no great obscurity. 
We will here make a humble request of the reader; which is, 
that he would read in the order the subjects are placed. The 
design cannot be understood by reading a part only, or by reading 
the third, or second part before the first. 
Many appear to have wasted much time in their denunciations of 
every nosographic arrangement of diseases that has been published. 
The fault cannot so much be in relation to the mere catalogue of PREFATORY REMARKS. 
VII 
the modified states of disease, as in esteeming diseases to be inde- 
pendent entities, and altogether isolated in their features and 
essences. When this is the sentiment, it is supposed that it possesses 
a permanency of character, to be treated by a determined round 
of remedies, let the intrinsic nature of the diathesis become ever 
so much modified. If something like this should be the result 
of all nosologies, we agree that they are pernicious in their ten- 
dencies. 
On the thesis, that the local determinations are mere concentra- 
tions of the morbid habit, which give a name to the affection, and 
which are liable to topical changes ; we have designed a noso- 
graphic arrangement, which we humbly conceive will obviate all the 
objections complained of. The local affection is liable to suffer a 
change of place, and visit some other tissue or organ from that it 
did at first In this event it receives a new name, whilst its intrin- 
sic character, perhaps, remains the same. Or, if the character of 
the diathesis should also suffer change, it will take its place wher- 
ever it may belong in the diathetical .gcale. By this scheme, the 
real state of the affection may be investigated, and the medical 
adviser will always be at liberty to use the most appropriate treat- 
ment his judgment may dictate. It, however, becomes necessary 
to have a nomenclature of diseases, if only to be used in our com- 
munications in society ; it at any rate becomes necessary, for indi- 
cating the tissue affected, whilst the physician prescribes for its 
present condition, instead of its name. 
The institutes of medicine imply a broad basis, requiring a spa- 
cious superstructure. Although we have seemed to compress much 
into the stinted space of two ordinary volumes, yet much remains 
to be done. We are aware that the divisions of physiology and 
pathology need to be extended. Another volume at least ought to 
be added, in order to embrace a large part of the nosography we 
were compelled to omit. However, we have attempted some illus- 
trations of the most important orders of diseases, by which we 
have developed many of our peculiar views of their character and 1 
treatment. Surely there is enough to ascertain an approval, or a 
disavowal of the work, by a discerning public. 
The writing and publishing the work, has necessarily been VIII 
PREFATORY REMARKS. 
delayed to a late period, and greatly so by circumstances beyond the 
control of the author. However, he considered this delay might 
give opportunity to some one of American citizenship, more able 
than himself, to furnish something that might deserve the name of 
a natural system of medicine. However, it must now or never, be 
offered to the public with all its imperfections. 
It may be gratifying to some of his quondam pupils, and other 
former friends of the author, to be informed, that the lithograph is a 
fac-simile from a portrait taken about thirteen years since, and at 
the age of fiftyseven. 
Whatever may be the fate of the following design, the author has 
been careful not to form hasty conclusions. More than seven septena- 
ries of his life have been mostly spent, either in practical observa- 
vation, or in the studies in relation to the science of life. He will 
enjoy a rich reward, if his labors can contribute something for the 
relief of suffering humanity. 
Boston, January 1, 1839. CONTENTS OF THE FIRST VOLUME. 
Brief design of the work, ----- 21 
General divisions, - - . . . . 2$ 
DIVISION I . 
PHYSIOLOGY. 
SECTION I . 
1. Definition, - . - - . 29 
2. Synthetical Method, - - - - 29 
3. Ultimate Composition, - - . . 30 
4. Organic Composition, . . . - 31 
5. Gelatin, - - - - 32 
6. Albumen, - - - - - 33 
7. Fibrin, ..... 34 
8 Mucus, - - - - - 35 
9. Atomic Composition, - - - . 36 
10. Auxiliary Constituents, - - - - 36 
• S E C T I O N I I. 
Of the tissues. 
1. Staminal Formation, .... 37 
2. Simple Tonic Property, - - - - 38 
3. Vital Tonic Property, - 39 
4. Gradations of Vital Force, - - - - 40 
SECTION III. 
Organic formations and apparatuses, - - 40 X 
CONTENTS. 
SECTION IV. 
On vitality, in connection with the susceptible tissues. 
1. Dissimilarity of Organic and Inorganic Substances, - 42 
2. Synonyms, ... - 43 
3. Vital Entity, - - - - - 44 
4. Its Origin and Source, ... 47 
5. Illustrations, - - - - - 48 
6. Universal Generant Influence, - - - 49 
SECTION V. 
On the gradations of vitality. 
1. Three Grades of Vitality, - - - - 53 
2. First Thesis; Primitive Tissue or Vegetative Grade, 54 
3. Vis insita, Irritability, or Vegetative Force, - 56 
4. Case of long retained Vegetable Life, - - 58 
5. Vital Gradations, .... 58 
6. Origo Morbida, - - - - - 59 
7. Life and Death, forced states, - . - 60 
8. Reanimation, - - - - - 61 
9. Second Thesis; Vital Systems of Nutrition, - 62 
10. Nervous Ganglia and Plexuses, - - - 63 
11. Their Function persistive, ... 65 
12. Three Orders of Sympathetic Nerves, - - 65 
13. Instinctive Susceptibility, ... 66 
14. Pneumogastric Nerve, - - - - 66 
15. Distribution of Involuntary Nerves to Muscles, - 67 
16. Distribution of Involuntary Nerves to the Surface, * 68 
17. Varied Susceptibilities, - - - 69 
18. Effects of Excitations, - - - - 70 
19. Further Illustrations of the Vital Force, - 71 
SECTION VI. 
Gradations of vitality, continued. 
Third thesis; Nervous System of External Relation. 
1. Plurality of Nervous Functions, - - - 73 
2. Nerves of External Relation, ... 73 
3. Spinal Cord, - - - - - 74 
4. Vital Entity, .... 76 
5. Remarks on a supposed Nervous Fluid, - - 77 
6. Attachment of Vital Essence in different degrees, - 77 
7. Sensations, - - - f - - 78 
8. Touch and Sight, .... 79 CONTENTS. 
XI 
9. Hearing, Smelling, and Tasting, - - - 80 
10. The Cerebral Masses, - 80 
11. Cerebral Masses destitute of Sensibility, - - 81 
12. Cineritious Substance, and Blood, - - 82 
13. Plurality of Function, - - - - 82 
14. Experiments on the Encephalic Nervous Mass, - 83 
15. Internal Cerebral Organization, - - - 86 
16 Relative Proportions of Nervous Matter, - - 86 
17. Internal Senses, or Faculties, - - 8? 
18. Entity, - 89 
19. Prerogative of Intellect, - - - - 91 
20. On the Nerves of Volition, - . - 92 
21. Remarks on Phrenology, - - - 95 
22. On the Inherent Force in Structures endowed with the three 
different Grades of Vitality, - - 96 
23. Synoptical View of the Nervous Systems, - - 99 
SECTION VII. 
Particular tissues. 
1. On the Simple Elementary Tissues, - - 102 
2. Cellular or Reticulated Tissue, - - 103 
3. Fibrous Tissue, .... 105 
4. Serous Tissue, .... 109 
5. Mucous Tissue, - - - - 112 
6. Dermoid Tissue, - - - - 117 
7. Muscular Tissue, .... 124 
8. Parenchymatous Tissue, ... 130 
9. Nutritive Tissue, .... 136 
10. Osseous Tissue, ... 142 
SECTION VIII. 
Of the Blood, .... . 144 
SECTION IX. 
Organic Tissues. 
1. Centrifugal Circulation, ... - 149 
2. The Heart, .... 150 
3. Aortal Circulation, .... 152 
4. Divisions of Circulation, ... 153 
5. Cardiac Quiescence, .... 158 
6. Cardiac Vacuum, - - - - 160 
7. Circulation modified by Age, ... 161 
8. Erectile State of Capillaries, - - - 162 
9. Capillary Arteries, - - - - 163 XII 
CONTENTS. 
10. Relation between Nervous and Capillary Systems, - 166 
11. White Arterial Capillaries, - - - 167 
12. Exhalations, - - - - 168 
13. Gaseous Fluids, - - - - 170 
14. Serous Exhalations, - 172 
15. Function of the Kidneys, > - 173 
SECTION X. 
Organic tissues, continued. 
1. The Pulmonary Circulation, - - - 176 
2. Pulmonary Structure, ... - 176 
3. Exhalations from Aerial Surfaces, - - 178 
4. Respiration, - - - - - 182 
SECTION XI. 
Organic tissues, continued. 
1. On the Centripetal Circulations, - - 187 
2. Two Divisions of Absorbents, - 187 
3. Vital Character of the Converging Vessels, - 189 
4. Equal Balance in Health, ... 190 
5. Process of Absorption, ... 191 
6. External Absorption by the Dermoid Tissue, - 193 
7. Cutaneous Imbibition, or Endosmose, - - 194 
8. Absorption by Nasal, Faucial, and Pulmonary Tissues, - 195 
9. Vital Properties of Oxygen, ... 196 
10. Absorption by the Digestive Mucous Tissue, - 198 
11. History of Digestion, ... 198 
12. Properties of the Chyle, - 201 
13. Different Intestinal Absorptions, - . 203 
14. Internal Absorption, - . . . 
First, by the Veins, ... 205 
Second, by the Lymphatics, . .211 
15. The Lymph, - - . . 212 
16. Lymphatic Absorption, - . . . 212 
SECTION XII. 
Calorification, - - . . . 215 
ADDENDA. 
Sleep, - . . . - 219 
Vital Quietus, - - . . 222 
Dreaming, . . . . - 225 CONTENTS. 
XIII 
DIVISION II. 
PATHOLOGY. 
SECTION XIII. 
1. Preliminary Remarks, ... 229 
2. Expositions, ..... 232 
SECTION XIV. 
1. What is Disease ? - - - 234 
2. Definition, ..... 235 
3. Remarks, ..... 236 
SECTION XV. 
1. Does Disease exist primarily in the Solids, or in the Fluids, 238 
2. Solids most to be regarded in Disease, - - 240 
x 3. The Humoralists and Limitarians, - - 340 
4. Remarks on the Virus of Contagions, - - 241 
5. Remarks on the Scorbutic Habit, - - 242 
6. Phlogistic Diathesis, .... 243 
SECTION XVI. 
1. Which are the Tissues and Organs most essentially affected 
in Disease, .... 244 
2. Morbid Susceptibility of Simple Vegetative Tissues, - 245 
3. Morbid Susceptibility of the Combined Nutritive Tissues, 246 
4. Lesions of the Nervous Tissues of External Relation, 248 
SECTION XVII. 
1; General Disease, or the Morbid habit, - - 252 
2. Phenomena of the Pyrectic Habit, - - 253 
3. Phenomena of the Chronic Morbid Habit, - 255 
4. Local Affections, - - . . 256 
5. Modified Diatheses, - - . . 256 
SECTION XVIII. 
1. The States of the System called Sthenia, and Asthenia, &c. 258 
2. Prefatory Notices, .... 258 
3. Recapitulation of some Modern Doctrines, - 260 
3. Remarks, XIV 
CONTENTS. 
4. On the Nosodynamic State of the Morbid Habit, - 262 
5. Definitions, .... 263 
6. Disease is not Debility, .... 263 
7. Remarks on the Primary Changes in Disease, • 264 
8. Illustrative Cases, .... 265 
9. Summary Remark, - - - . 266 
10. Thesis advanced, - 267 
11. The Causes of Disease are Excitants, - - 268 
12. The Phenomena indicate Tonicity, - - 269 
13. The Treatment declares a Morbid Tonicity, - 270 
14. Illustrations by Collateral Circumstances, - - 272 
SECTION XIX. 
1. On Adynamia, or Subtonic State of the System, - 274 
2. On the Movable Temperament, ... 274 
3. Deficiency of Vital Force, ... 275 
4. Subtonic State in Periodical Affections, - - 279 
5. Adynamia at the Onset and Close of Fever, - 279 
SECTION XX. 
1. Does Disease arise from Constitutional Changes, or from 
some Tissual Irritation ? 280 
2. Preliminary Notices, .... 280 
3. Suggestions from the Causes, ... 281 
4. Proofs from the Phenomena, ... 282 
5. Physiological Thesis, .... 285 
6. Pathological Thesis, .... 287 
7. Local Affections produce Effusions, Reflex Actions, &c. 288 
8. Local Affections, liable to Metastasis, . . - 289 
9. If the Local Affection pre-existed, it would not so readily 
move, . . . - 290 
10. Inquiries on the Second Part of the Interrogatory, - 292 
11. Extensive Wounds do not necessarily produce Disease, 293 
12. Wounds of the Dense Tissues, - - 295 
13. State of Predisposition important, ... 295 
14. Remarks on the Virus of Contagion, - - 296 
15. Resulting Thesis, .... 297 
SECTION XXI. 
1. Physiological Condition of the Centrifugal and Centripetal 
Capillaries, .... 300 
2. Pathological Changes in these Tissues, - - 301 
3. Origin of Congestions, - - - 303 CONTENTS. 
XV 
4. Different Modifications of Diseased Capillary Action, - 305 
5. Therapeutical Remarks, ... 307 
SECTION XXII. 
1. On Ataxia, or the Anomalous State of Disease, - 308 
2. Specifications of certain Anomalies, - - 309 
3. Illustration by Small Pox and Measles, - - 309 
4. In Chronic Affections, ... 310 
5. Anomalies in Pyrectic Diseases, ... 3H 
6. In Typhus Gravior, - . . . 311 
7. In Typhus Mitior, - . . . 312 
8. In Rheumatism and Gout, ... 313 
9. In Cholera, ..... 313 
SECTION XXIII. 
1. Conservative Power of the Nervous System of External Re- 
lation, .... 315 
2. Conservative Power of the Nervous System of Internal Rela- 
tion, . . . . . 315 
ETIOLOGY, OR PATHOGENY. 
SECTION XXIV. 
1. Preliminary Remarks, ... 317 
2. On Remote and Exciting Causes, ... 319 
3. The Causes of Disease act by Incompatible Stimulations, 321 
FIRST DIVISION. 
REMOTE CAUSATIONS. 
SECTION XXV. 
1st. On the General Atmospheric, Pestilent Afflatus, - 322 
1. Its Extensiveness and Effects, ... 323 
2. Ingenerate Origin, - - - - 323 
3. Modifications of Remote Influences, - - 326 
4. Reiteration of Aerial Diseases, - - 328 
5. Remarks on the late Choleric Afflatus, - - 329 XVI 
CONTENTS. 
SECTION XXVI. 
( 
2d. On the Local Atmospheric Contaminations, - - 332 
1. Sensible Effluvia, .... 332 
2. Instances or Proofs, ~ 333 
3. Insensible Effluvia, or Miasm, ... 335 
4. Prefatory Exposition, ... 336 
5. Negative Suggestions, - . - 336 
SECTION XXVII. 
3d. On the Climatic Influences, - . . 354 
SECTION XXVIII. 
4th. On Idiosyncrasies, 358 
SECTION XXIX. 
5th. On Aliment, ..... 363 
SECTION XXX. 
6th. On Exercise, ..... 367 
SECTION XXXI. 
7th. On Clothing, ..... 369 
SECTION XXXII. 
8th. On Alcohol, and other Narcotics, - - - 372 
SECTION XXXIII. 
9th. On Mineral Poisons, - . - - 380 
1. Mercury, ..... 38I 
2. Antimony, - - -' - - 383 
3. Iron, Iodine, and Arsenic, . . . 383 
4 Lead, ..... 383 
SECTION XXXIV. 
10th. On Intense Thought, .... 385 
1. Voluntary Thought, .... 385 
2. Impressive Thought, .... 386 CONTENTS. 
XVII 
SECOND DIVISION. 
EXCITING CAUSES. 
SECTION XXXV. 
Enumeration, ..... 388 
SECTION XXXVI. 
1st. Heat and Cold, with their alternations, and in connection with 
winds. 
1. Both are Active Agents, ... 389 
2. Cold considered Pathologically, - - . 392 
3. Heat considered Pathologically, - - 395 
4. Animal Heat modified by Exhalation, and Evaporation, 396 
5. Winds as modifiers of Sensible'Heat and Cold, - 398 
6. Alternations of Heat and Cold, ... 398 
7. Cold Internally, - - - - 401 
8. Remarks on Climate, .... 402 
9. Heat and Cold as Remedial Agents, - - 403 
SECTION XXXVII . 
2d. Fatigue, Watching, and Surfeiting, ... 405 
SECTION XXXVIII. 
3d. Wounds, Contusions, Burns, and other Lesions, - 407 
SECTION XXXIX. 
4th. Emotions, and Passions, .... 408 
Resulting Remarks, • - - 409 
SECTION XL. 
5th. Contagion and Infection, - - - - 410 
SECTION XLI. 
6th. Diurnal and Sol-lunar Influences, ... 413 CONTENTS OF THE SECOND VOLUME. 
SEMEIOTICE. 
SECTION X L I I. 
1. Preliminary Remarks, ... 5 
2. Harmonies existing in Disease, - 5 
3. Anomalies of the Phenomena, - - 7 
4. Contingent Phenomena, .... 8 
5. Three Series of Phenomena, ... 10 
6. Predisposition, - - - - - 10 
7. Shrivelled Aspect, Paleness and Faintness, - 11 
8. Chills and Rigors, - - - - 11 
9. Paroxysms, and their Periodical Return, - - 14 
10. Cold Sweats, - - - - - 21 
11. Diarrhoea Serosa, .... 22 
12. Diabetes Simplex, - - - - 23 
13. Inordinate Flow of Bile, ... 24 
14. Cardiac and Arterial Action, - - 25 
15. Primary Coma, .... 26 
SECTION XLIII. 
Phenomena attending the acme of the morbid habit. 
1. Preliminary Remarks, - - - - 28 
2. Increased Action of the Heart and Arteries, - 29 
3. Relative Hyperaemia, or Plethora, - . - 30 
4. Increased Heat, - 31 
5. Impaired State of the Exhalations, and Secretions, - 32 
6. Tissual Inflammation, or Phlogotica, - - 32 
7. Elevated Orgasm of the Nervous Tissues of Sense,^Intel- 
lect, and Muscular Power, - - - 37 
8. Changes in the Fluids, ... 39 CONTENTS. 
XIX 
SECTION XLIV. 
Phenomena attending the results of the morbid habit. 
1. Pathological Remarks, - - - - 43 
2. Limitation of Diseased Action, 44 
3. Phenomena Resulting from changes made in the Internal 
Tissues and Organs, - - - 46 
a. In the Encephalon, . . - 47 
b. In the Thorax, - - . 48 
c. In the Abdomen, ... 50 
4. Two Trains of Resulting Phenomena, as Disease may termi- 
nate favorably, or otherwise, - - - 57 
a. Salutary Phenomena, ... 57 
6. The Reverse, - - - -62 
c. Prognosis, - 63 
SECTION XLV. 
1. On the Diatheses; particularly the Synochoid and Typhoid, 64 
2. Diathetical Remarks, - - - - 70 
3. Concluding Remarks relative to the Study of Pathology, 75 
DIVISION III 
THERAPEUTICS. 
Outlines of Nosography, - - - - 81 
ORDER FIRST. 
The fibrous tissues. Diathesisfervidafibrosa. 
SECTION XLVI. 
Preliminary Remarks, . . - 175 
1. Synocha, - 177 
2. Meningitis, .... 193 
3. Sclerotitis, ..... 196 
4. Tonsillitis, .... 197 
5. Linguitis, - . - - 197 
6. Pharyngitis, Laryngitis, and Tracheitis, - . 197 
7. Pleuritis and Pneumonitis, ... 205 
8. Brief Reviews, .... 209 
9. Rheumatism and Gout, - - - - 212 
10. Phlegmatia Dolens, .... 228 
11. Lumbago, and Rheumatalgia, - 234 XX 
CONTENTS. 
ORDER SECOND. 
The mucous tissues. Diathesis fervida mucosa. 
SECTION XLVII. 
1. Synpchus, ..... 237 
2. Catarrh and Influenza, .... 240 
3. 'Peripneumonia notha, or Pneumonitis mucosa, - 241 
4. Phthisis Pulmonalis, - - - . 243 
5. Pertussis, .... 295 
6. Hemorrhage, - ■ - . . - 301 
7. Epistaxis, .... 305 
8. Haemoptysis, - 306 
9. Haematemesis, and Haemorrhagia Intestinalis, - 308 
ORDER THIRD. 
The serous tissues. Diathesis fervida serosa. 
SECTION XLVIII. 
1. Preliminary Notices, .... 30g 
2. Typhus Mitior, or Typhoid Fever, - - 314 
SECOND SERIES. 
3. Serous Effusions into Cavities, or Dropsies, - - 332 
ORDER FOURTH. 
Diathesis fervida complera. Habitus typhoides gravior. Maria, 
et Adynamia. 
SECTION XLIX. 
1. Remarks on the Pathological Character of Severe Typhoid 
Fevers, .... 345 
2. Typhus Gravior; Severe Typhus, or Jail, Camp, Hospital, or 
Putrid Fever, - - - - 372 
3. Plague, and Yellow Fever, ... 382 
4. Cynanche Maligna; Scarlatina, ... 385 
5. Pneumonia Typhoides; Epidemic Lung Fever, - 390 
6. Typhus Petechialis; Spotted Fever, - - 394 
7. Cholera, - - - - ' - 399 
8. Dysenteria Maligna, - - - 411 
9. Enteritis Maligna, and Ileus, - 416 
10. Hysteritis Typhoides; Puerperal Fever, - - 432 
Index, ...... 449 OUTLINES 
OF THE 
INSTITUTES OF MEDICINE. 
BRIEF DESIGN OF THE WORK. 
Man may be viewed as an isolated being, placed in the 
midst of numerous sustaining and pernicious substances, and 
endowed with organs adapted to his own convenience, both 
in relation to external circumstances, and his individual sub- 
sistence. 
He finds himself, on reflection, placed in a medium con- 
genial to his susceptibilities, on ordinary occasions ; he also 
possesses the faculty of forming intimate relations with sub- 
stances composing the material world, through the instru- 
mentality of his perceptive powers, and judging of their 
congeniality to his own necessities.-He contains within 
himself a series of organic apparatuses suited to modify and 
supply the increment as well as the inevitable waste of the 
system, and likewise to insure the perpetuation of his 
species. 
The organic appetencies indicate the necessities of the 
system, and nutrimental substances are assumed ; and these 
pass through various modifications in digestion and assimila- 
tion, and are ultimately applied as constituent vital molecules 
of the system. By this vital process health, comfort and 22 
INSTITUTES OF MEDICINE. 
vigor are dispensed to the animated system, whilst the effete 
molecules are eliminated by the emunctories as useless, if 
not injurious. 
The play of affinities, catenations, and harmonies of action 
in the entire system display very astonishing phenomena of 
the properties of matter under the controlling influences 
of the vital forces. 
To these organic apparatuses is superadded a still more 
refined tissue called nervous ; this is more tardily evolved, of 
more attenuated fabric, which affords to the conservative 
organs a more complete ability of functional exercise. The 
essential property of which, however, is, to transmit to the 
organs of locomotion and of respiration, an ability to perform 
these offices in an efficient manner, in aid of their innate 
irritability ; yet, above this, it is very apparent, although 
confounding to our apprehension, this nervous tissue compo- 
ses the organs which are the seat of intellect. 
By this extraordinary endowment, man not only looks 
within himself, and on the substances around him, but re- 
views the past, contemplates the present, and casts his 
thoughts upon the future ; it, also, enables him to claim 
affinity with kindred essences, as well as corporeal rudi- 
ments ; and in the exercise of organs destined to thought, 
he spontaneously rises in adoration to ken the attributes of 
the great First Cause, who formed him such. 
In an harmonious and easy play of all the organs of nutri- 
tion and intellect, the mind is free and buoyant, the corporeal 
part is capable of activity, and both are engaged in arduous 
enterprises for the attainment of happiness. This is the 
physiological state of man. 
Notwithstanding all these felicitous combinations, the very 
means that minister to the well being of the human species, 
when indiscreetly practised, in excess, or even extreme de- INSTITUTES OF MEDICINE. 
23 
ficiency, as well as the atmospheric circumfusa by which 
they are encircled, serve to modify and disturb the natural 
and agreeable economy of their systems. The connection 
of all the harmonious associations may be broken ; a per- 
turbed state of organic action, with inquietude, distress, and 
wasting, follow at any period of life. The relations of the 
intellect, as well as the organic harmonies, are severed, and 
man may then be viewed as the sport of contending impulses, 
and chemical contingencies ; and under an enervated influ- 
ence of the vital energies, he falters, suffers distress, and 
sinks. This constitutes the pathological state of man. 
In our researches into the diseased condition of the human 
system, we need to have particular reference to the healthy 
state, as it will undoubtedly be discovered, that the morbid 
phenomena are the results of the natural energies of the 
system, when under the influence of excessive stimulations. 
We need, therefore, in our studies in relation to Therapeu- 
tics, whilst estimating the extent of morbid changes, to make 
just comparisons with the physiological economy of the 
system. 
Our conclusions, therefore, in relation to the Therapeutic 
Treatment, will be dictated by a consideration of the force 
of those agents, which modify the system, and cause it to 
depart from the ordinary standard, and having a just regard 
to the character and degree of such divergent action. This 
leads to a review of JEtiology, or the consideration of the 
causes of disease, as well as the changes brought about in 
the economy of the system, producing that catenation of 
preternatural actions which establish the character of disease. 
The following out of these subjects in detail, constitutes 
the science of medicine ; but we must acknowledge that 
these pages comprise merely the outlines of these engrossing 
subjects. OUTLINES 
OF THE 
INSTITUTES OF MEDICINE, 
FOUNDED ON THE PHILOSOPHY OF THE HUMAN ECONOMY, 
IN HEALTH, AND IN DISEASE. 
The Institutes of Medicine may be defined, that science, which 
embraces a knowledge of diseases, and their remedies. As this 
requires the collateral aids of other considerations relating to the 
animal economy, the human system will be contemplated under 
three varying aspects. First, as it appears in a state of health; 
second, as affected by disordered action ; and thirdly, in reference to 
remedial agents for the restoration of normal action. 
For the purpose of obtaining the advantages of proper arrange- 
ment, the subject will be divided into the following distinctive ap- 
pellations :- 
DIVISION I. 
PHYSIOLOGICAL NOTICES, 
OR A CONSIDERATION OF THE NORMAL FUNCTIONS OF THE SYSTEM. 
DIVISION II. 
PATHOLOGICAL NOTICES, 
OR A CONSIDERATION OF THE AETIOLOGY, AND CHARACTER OF 
DISORDERED ACTION GENERALLY. 
DIVISION III. 
THERAPEUTICS. 
UNDER THIS DIVISION MAY BE CONSIDERED THE HISTORY, DIAGNO- 
SIS, AND TREATMENT OF DISEASES, ARRANGED IN A TISSUAL, 
NOSOGRAPHIC ORDER, DIVISION I. 
PHYSIOLOGICAL NOTICES, 
OR A CONSIDERATION OF THE NORMAL FUNCTIONS 
OF THE SYSTEM. PHYSIOLOGY 
SECTION I 
1. Definition. 
What we may have to observe on this subject may be 
considered, only a summary of the phenomena of the vital 
economy which more immediately concern the practical phy- 
sician. The remarks, therefore, will be brief, very much 
to the exclusion of the form, and mechanical action of the 
organs, but having a more especial regard to vital susceptibili- 
ties and movements. 
Physiology may be defined, the science of life; or, an 
exposition of the functional exercise of the organs of the liv- 
ing human subject, in a state of health. 
However, as the normal action of the organs is very prone 
to assume a morbid condition, we may be led to take some 
notice of their pathological liabilities as we pass along. 
The reverse course of anatomical illustration will be pur- 
sued ;-in this, the animal structure, in its entire state, is 
traced to its minute constituent organization ; it is there pur- 
sued analytically. We must begin where anatomy stops ; 
that is, in the ultimate fibres, and molecular compositions, and 
ascend by slow gradations to the formation of tissues, organs, 
2. Synthetical Method. 30 
ULTIMATE COMPOSITION. 
and their united operations in the completion of the animated 
being ;-like Haller, pursue the evolutions of the increasing 
ens, through its rising stages, to the completion of its econo- 
my. We shall, therefore, have to pursue the subject syn- 
thetically ; and from the minutest, through more complicated 
circles of action, attempt to expose the veiled functions of the 
animal system. 
In like manner, the perverted functions of organization may 
be traced, from the simple impression of minute causation on 
the primordial stamina, to the severest conflict of morbid 
action of complicated organs. 
3. Ultimate Composition. 
The process of destructive analysis of animal bodies 
exhibits various substances ; such as phosphorus, the phos- 
phate of lime, soda, magnesia, potash, manganese, sulphur, 
chlorine, iron, carbon, silex, alumine, and several neutral 
salts in small proportion. However, the phosphate of lime is 
very abundant, entering into the composition of the bones and 
giving them their solidity. 
By analysis of the body, either spontaneously or by art, 
are found the following gaseous substances, making parts of 
the constituent elements ; oxygen, hydrogen, and azote, which 
may be confined. There are also, certain evanescent essen- 
ces, in the living state, not confinable ; as caloric, light, 
electric fluids, various gases, and the principle of vitality. 
These have more or less feeble combination with living 
organic bodies, and become evanescent before decomposition 
takes place. The principal elementary ingredients, which 
compose all the soft parts in animal substances, are carbon, 
oxygen, hydrogen, and azote, in different proportions in the 
different organized elements ; phosphorus and lime are the 
basis of the hard parts. Azote exists in the largest propor- 
tion. OUTLINES OF PHYSIOLOGY. 
31 
Chemico-physiological researches indicate many other sub- 
stances in the human body, which some think have been 
constituents ; yet they rather ought to be esteemed products, 
or secondary formations of vital organic influences. Many 
acids are found, as the sulphuric, carbonic, benzoic, uric, 
amniotic, oxalic, formic, acetic, malic, lactic, and rosacic, 
which last is found in lateritious sediment of the urine in 
fevers. 
4. Organic Composition.* 
Upon a cursory inspection of the human body, it is found 
to give a moderate resistance to the touch ; to be composed 
of what may be styled plates, or animal membranes of differ- 
ent degrees of compactness, and pierced in all directions by 
apertures of very different calibres; these constitute the 
solids. Within these openings or tubes, are discovered 
liquids, either red or white, which pass in different directions 
through the solid parts ; these are called the fluids. It would 
appear at first view, that the solids exceed the fluids by weight; 
but, it is found on desiccating the body, that the fluids exceed 
the solids as about nine to one. However, they are quite 
different in different subjects. 
The diffusive, invisible, actuating principle of animal bodies 
has its residence in both these solid and fluid substances, but is 
most eminently appreciable in the former. However, the 
*The author wishes here to advise the reader, that his course in this 
arduous undertaking is intended to be a straight forward one; he cannot 
•top, on ordinary occasions, to give credit to various writers who may have 
richly contributed to improve the science of medicine; and indeed, he 
scarcely feels able, in numerous particulars, to designate, whether the deduc- 
tions he may advance have been formed by himself, or derived from others. 
Neither can he often stop to refute what he may suppose to be the erroneous 
conclusions of others, and thereby interlard the work with contraries; but 
will endeavor to be satisfied, if he can arrange, and express his views in a 
manner to be rightly understood throughout the work. 32 
ORGANIC COMPOSITION. 
fluids sustain an important office in the economy of the sys- 
tem, and bear around in their circuits the rich fluid animal 
matter that becomes attached to the solids to increase their 
growth, or supply their waste. 
It appears to be ascertained at the present time, that there 
are at least four primary animal formations, which by coales- 
cing in varied proportions, constitute the organization of 
animal bodies ;-these are gelatin, albumen, fibrin, and mu- 
cus; and some add ozmazome. These being vitally anima- 
lized molecules themselves, unite by a sort of peculiar for- 
mative affinity in the production of lines, or fibres ; and in 
their turn these lines unite, by various crossings and inter- 
lacings, in the formation of tissues, or membranes. Again, 
these last, by a sort of plastic, formative impetus, generate 
what are called organs. If the process is not so formal as 
first to form lines as suggested, they are found in such a state, 
although the parts may have been formed in tissues by a 
gradual accretion, or elongation. Each of these primary 
animal elements merits some farther consideration. 
5. Gelatin. 
All the four animal constituent molecules before mentioned, 
are composed of carbon, hydrogen, oxygen, and azote, but in 
different proportions. Some physiologists have said, that 
gelatin does not possess any azote in its composition. But it 
seems now proved that it does, but not to the amount con- 
tained in fibrin. It is contended by some also, that gelatin is 
not found in the circulating mass of blood ; however, this is 
shown to be a mistake, but it is found only in a small propor- 
tion.* The muscles, it appears, are first formed in the em- 
bryo, of gelatin, and afterwards receive an addition of azote, 
by which they are converted into fibrin, which renders them 
more capable of contractility. 
* Berzelius. OUTLINES OF PHYSIOLOGY. 
33 
Gelatin, or jelly, is extracted by boiling, from the tendons, 
bones, capsules of the joints, dura mater, cellular tissue, and 
all those membranes called by M. Pinel the fibrous mem- 
branes, of all which it is their principal constituent. They 
are called fibrous on account of their filamentary appearance. 
All these tissues seem to be formed by a condensed and 
modified state of the laminated or cellular tissue, for this is 
almost wholly formed of gelatin. 
It is represented by many experimenters, who have minutely 
investigated the subject, that the molecules of gelatin are not 
so large as those of fibrin. The tissues of which it is a prin- 
cipal constituent, possess a contractile property, but not so 
much so as tissues formed of either albumen, or of fibrin. It 
is probable, however, further observation may be required in 
order to be satisfied, whether gelatin or albumen possesses 
the most contractility. That all the tissues are endowed with 
more or less contractility is very manifest, otherwise they 
could not aid in the organic functions. 
The physical properties of gelatin are ; 1st. It is soluble in 
water, but not in alcohol. 2d. It liquefies by heat, whilst 
albumen hardens by heat. 3d. It can be made solid by cold, 
and drying, but readily putrefies with water. 4th. It may be 
again liquefied by heat, whilst albumen cannot be restored 
when once coagulated. 5th. It has a chemical affinity with 
tannin, and unites with it, by which union it becomes unli- 
quefiable and insoluble. 6th. Uniting with tannin from the 
bark of astringent vegetables, in the skins of animals, 
it converts them into a dense, elastic state called leather. 
6. Jllbumen. 
This constituent of animal matter, receives its name from 
the albumen of the white of eggs, to which it is very similar. 
M. Cloquet says, it always contains sulphur, and subcarbon- 
ate of soda, besides the common elementary constituents. 
When in a fluid state it coagulates at about 165° of Fah. 34 
ORGANIC COMPOSITION. 
Alcohol, the acids, muriate of mercury, astringents, &c., co- 
agulate it. Subjected to the process of drying, after being 
coagulated, it forms a solid semi-transparent substance 
resembling horn, insoluble except sparingly by alkalies. 
This substance is very abundant in nature, as it enters into 
the composition of both animal and vegetable bodies. In the 
human system it is found abounding in the serum of the blood, 
in the humors of the eye, and most of the secretions, parti- 
cularly in the milk ; and, also, in the white tissues. It is 
esteemed to be a principal constituent of the nervous pulp, 
throughout the brain and nerves ; also of the glandular tex- 
tures. It is easily extracted from other substances in combi- 
nation, and its most delicate test is a solution of muriate of 
mercury. 
It exists abundantly in the seeds of vegetables, as well as 
in their roots, stalks, and leaves. It is, likewise, an impor- 
tant constituent of most of the tribes of insects, reptiles, and 
crustaceous animals, as well as the infusoria. As it is readily 
decomposed when subject to warmth and moisture, it affords 
various volatile substances in the form of effluvia, more or 
less disagreeable, if not obnoxious. Old animals have in 
their composition the most albumen, whilst young ones pos- 
sess the most gelatin. Seguin has shown it to be the most 
essential principle in the production of spontaneous fermenta- 
tion of vegetable substances, thereby evolving the saccharine, 
alcoholic, and acetic products. This substance is of much 
use in clarifying liquids ; and, also, by inviscating poisonous 
substances in the stomach, may disarm them of their delete- 
rious influences. 
7. Fibrin. 
This possesses the most vital susceptibility and contrac- 
tility of either of the organic elementary substances. It is, 
therefore, a principal constituent of all the muscles, whether 
voluntary or involuntary. It is found in smaller proportions OUTLINES OF PHYSIOLOGY. 
35 
in the various mobile tissues, as in the vascular tissues, 
especially in those that transmit red blood. However, the 
large arteries and veins have essentially gelatin, but the heart 
and capillary systems are composed mostly of fibrin. The 
molecules of fibrin are said to be larger than those of gelatin 
or albumen. These molecules are of different sizes in dif- 
ferent animals ; they are insoluble in either warm or cold 
water. Fibrin is found in many vegetables, especially in the 
farinaceous seeds. 
It is an important constituent of the blood, and has been 
called gluten, and lymph. It is more prone to take on the 
filamentary form than either of the other constituents ; and as 
soon as the blood is taken from the body, the fibrin assumes 
the filamentary character, and contracts, and carries with it, 
in its healthy state, the red molecules or cruor, and holds 
them in a solid form. If, however, certain states of morbid 
tonicity exist in the vital actions, these filaments contract 
more tardily, but more firmly ; and they firstly allow the 
cruor to subside, and then form a coagulum on its surface of 
a dense white color-; but, again, in certain adynamic states 
of the system, lose their ability of assuming the filamentary 
form, and the blood then remains fluid, and without a coagu- 
lum. The fibrinous portion of the blood may be separated 
from all other matter, by agitating it in water ; it will then 
appear in a white and solid filamentary form. It contains 
more azote than albumen or gelatin. 
8. Mucus. 
This is not admitted by some physiologists as a primary 
element of organic structures, although it is quite plentiful as 
an organic secretion. Yet it is found in some of the more 
dense tissues, as the nails, hair, scales, &c., and it is found 
in small proportion in some of the cellular portions. With 
water it forms a viscid, transparent, soft fluid, rather tasteless. 
In a dry state it is scarcely soluble in water. It appears to 36 
ORGANIC COMPOSITION. 
be rather a sort of cohesive cement in some tissues, than as 
contributing to contractility. 
Ozmazome is found by the destructive processes in some 
of the tissues, especially the muscular. It is thought by 
some to be formed of fibrin in the process of chemical 
decomposition. 
9. Atomic Composition 
It appears that Messrs C. Bell and Richerand recognise 
Copland's elementary constitution of the three animal sub- 
stances, as follows : 
Carbon. 
Oxygen. 
Hydrogen. 
Azote. 
Gelatin, atoms 
15 
6 
14 
2 
Albumen, do. 
17 
6 
13 
2 
Fibrin, do. 
18 
5 
14 
3 
In the process of assimilation and nutrition, there is the 
strongest analogical evidence, that the constituent atoms are 
changed, and modified in such a manner, as that the more 
simple molecules are becoming more complicated, and assume 
more and more the perfect animal character. And, also, that 
these forms of animal matter exist in varied proportions in 
different tissues, temperaments, and ages. 
10. Auxiliary Constituents. 
Analysis discovers, likewise, in the human body, certain 
undefined substances, which have been called amorphous 
masses, or diminutive cementing substances, which fill some 
interstices. Likewise certain products have been discovered, 
which are the results of organization, and seem to complete 
the animal formation ; such as urea ; zoohaematin, or the col- 
oring matter of the blood, containing iron ; osmazome; 
picromel ; cholesterin ; the green matter of the bile ; sugar ; 
resin ; leucin ; stearin ; elain ; caseum ; uric, oxalic, lactic, 
benzoic acids, &c. Some of these are found in the solids, OUTLINES OF PHYSIOLOGY. 
37 
and some in the secretions. It may not be proper to men- 
tion the products of organic secretion, such as milk, bile, 
&c., in this place. 
SECTION II. 
OF THE TISSUES. 
1. Staminal Formation of Tissues. 
Although it is manifest, that the primary elements of 
organization form filaments, or what has been called the 
primordial stamina, or fibres, yet these are found in an aggre- 
gate condition in the tissues; and they can be only partially 
separated, and there is no determining when we may have 
arrived at the single ultimate fibre. Of course we have no 
means of appreciating their properties in an isolated manner. 
We are compelled to study them in an aggregated form, in 
their most simple combinations of webs, or tissues. 
Notwithstanding what has been advanced, it appears that 
Dr. M. Edwards, as well as M. Dutrachet, and others, have 
satisfactorily discovered, by means of a powerful magnifier, 
that the molecules of animal fabrics arrange themselves in 
rows, or in a linear manner, which probably, by the aid of a 
kind of muco-amorphous matter, might be called fibres. They 
estimate the diameter of these globules to be 1-7500th of 
an inch. Even if this statement should be correct, we cannot 
learn any of the vital properties by observations made on such 
attenuated threads. 
The innate cohesive properties of the molecules of animal 
matter, called vital affinity, first display themselves to the eye, 
in the production of lines, stamina, or filaments whilst under 
the influence of the formative process in the generation of 38 
OF THE TISSUES. 
telary expansions, and in the production of a lamellated struc- 
ture called membrane, texture, or tissue. These products 
eventually, in the entire evolutions of structure, exhibit vari- 
ous degrees of thickness, compactness, extensibility, tonic 
and vital contractility. 
Notwithstanding the primary formation of tissues has been 
represented as laminar, yet in the evolutions of organs they 
are of many forms, some round, others extended planes ; 
others again are cylindrical, and indeed of many forms, as 
we see in the complicated organizations ; and yet each tex- 
ture of the organs retains its own peculiarity of properties. 
2. Simple Tonic Property of Tissues. 
All movable tissues possess a property of elasticity, which 
enables the fibres and vessels in their composition, to become 
dilated beyond their ordinary capacity, on occasions of tur- 
gescence, or plethora, which they sustain on ordinary occa- 
sions without injury, and again return to their usual state, and 
even less. However, on extraordinary occasions, the tissue, 
or organ may stiffer immensely from ultra-distention, by the 
loss of elasticity, which occasions a retardation of function, 
and the tissue with difficulty regains its former physiological 
state. The property of elasticity is a physical property of 
texture, and not of vitality. It arises from the arrangement 
of the corpuscular particles of animal composition, and con- 
tinues when the texture has lost all traces of vitality. 
It is this property of elasticity from corpuscular arrange- 
ment, that gives to the more dense textures their exten- 
sibility, as well as elastic contractility, very different, indeed, 
from vital contractility. These are physical properties, and 
being modified by certain intervening amorphous substances 
in combination, are the basis of the temperaments. Thus we 
find the temperaments modified by parental lineage, by age, 
by certain habits of activity, by climate, aliment, and many OUTLINES OF PHYSIOLOGY. 
39 
other extraneous circumstances, which may modify the sta- 
minal fibres. As all the textures are more or less under the 
influence of vital impulses, those modifications which affect 
their extensibility, and contractility, impede their movements, 
and often injure the play of the organism. All the adventi- 
tious states of hypertrophies, hardening and softening of tex- 
tures, affect the physical properties of the tissues, and second- 
arily the vital. 
When any of the soft tissues are divided by the knife in 
the dead state, and especially in the living, they retract, and 
leave a space. This is the tonic contractility of their elastici- 
ty ; and it is more apparent as the subject may be plethoric, 
and as he may possess a more dense compages of structure ; 
whilst the opposite state of inanition, and flaccidity of struc- 
ture will show less contractility. The muscular texture dis- 
covers the most of this kind of contractility, and the nerves 
the least. This property of all the tissues is not affected by 
excitants directly, and does not leave them after all the signs 
of death have appeared, until disorganization takes place. It 
is the vis mortua of Haller. 
3. Vital Tonic Property of Tissues. 
The animal molecules, and the tissues already alluded to 
in a very general manner, are all endowed with a property, 
which gives them their distinctive animal characters. The 
different tissues, and even the organs formed of them, possess 
this property in very different degrees ; by which they possess 
different capacities of excitability, and respond to general 
exciting substances, and even to their own peculiar excitants 
in a varied and modified manner. This is the vis nervea of 
authors, and gives the tissues their vital tonic power. 
It is owing to this property that animals possess an identity 
of character, different from, and even transcending any other 
of the works of creation. By this endowment the united 40 
ORGANIC APPARATUSES. 
organization becomes an isolated automaton, and converts all 
other substances in nature to its own advancement, and well- 
being. 
4. Gradations of Vital Force. 
This vital influence, sometimes so called, admits of three 
cardinal divisions, as will hereafter be illustrated, besides 
many subdivisions. It may now only be remarked, that some 
of the tissues are endowed with the force of one degree of 
vitality, some with two, and others with a third gradation. 
The result then must be, according to the fact, that some of 
them possess a greater, or higher degree of vital susceptibil- 
ity than others ; therefore they respond more readily and 
energetically to the various stimulations ordained to excite 
their movements. 
It is this thesis of the plurality of the vital force that must 
serve as the basis of all our physiological ordpr of functions ; 
and, also, stand as the basis of nosological arrangement, to be 
disposed according as the locations of disease may be more or 
less impressive on individual tissues. However, before dis- 
cussing the subject of vital force, we will notice the combi- 
nations of tissues in the formation of organs, and organic 
apparatuses, in a very general manner. 
SECTION III. 
ORGANIC FORMATIONS, AND APPARATUSES. 
The tissues already alluded to, will merit particular dis- 
cussion in their places ; we need now only to notice, that 
they combine in different organs in different proportions, 
according as the office of the organ may require for the per- OUTLINES OF PHYSIOLOGY 
41 
formance of its individual function. For example, the lungs 
admit in their composition many tissues, such as the mucous, 
the serous, the muscular, the fibro-cartilaginous, the fibrous, 
the nervous, the capillary exhalants and absorbants, many 
sets of red vascular tissue, and finally much of the laminated 
cellular tissue, as a medium of connection, and extensibility. 
And, notwithstanding, the whole amount of fixed animal mat- 
ter of their composition is very small ; this organ has many 
important functions to sustain, and therefore, its composition 
of tissues, and their susceptibilities, are greatly multiplied. 
This is more fully illustrated in the entire respiratory appara- 
tus. 
When several organs become necessary to accomplish 
some important design in the general economy of the system, 
their functions harmonize and act in a kind of subsidiary 
accordance for its accomplishment. This combination of 
organic agency constitutes what has been called an apparatus. 
Thus in the process of aeration of the blood in the lungs, the 
heart becomes an important agent, also the respiratory mus- 
cles, the trachea, &c. And so of digestion, many organs 
unite in its accomplishment, or it requires an apparatus of 
organs. 
As we often have to allude to the vital force, so called, 
and as it is a subject of the highest order, it is necessary the 
student should form as correct views of it as possible, at an 
early period ; we may, therefore, be justified in attempting a 
discussion of it in this place. 42 
ON VITALITY. 
SECTION IV. 
ON VITALITY, IN CONNECTION WITH THE SUSCEPTIBLE 
TISSUES. 
1. Dissimilarity of Organic and Inorganic Substances. 
All the substances in nature are presented to our concep- 
tions under two aspects ; viz. inanimate and animate, or unor- 
ganized and organized ; or, in other words, as possessing life, 
or destitute of it. The first obtain growth from an exterior 
accumulation of molecules, or atoms, upon a nucleus, and are 
united by what is styled chemical affinity, or by atomic 
adhesion. The latter receive accretion and growth by certain 
internal processes ; they are acted on by internal impulsions, 
and are distinguished from the former by a train of pheno- 
mena, which in all ages have been called vital. 
Although this internal agent, or principle, has never been 
demonstrated otherwise than by its effects, yet it has been 
universally accredited as existing in all living bodies, and has 
been considered by all philosophers, either the cause or the 
effect of organization. This question may merit some atten- 
tion as we proceed ; but, in the first place, let us recapitu- 
late some of the phenomena which distinguish animate from 
inanimate substances. A mineral grows, and receives syn- 
thetical accretions of an atomic kind, or of a chemical 
character ; or it may remain stationary for ages. It is com- 
posed of inert matter, yet endowed with certain properties, 
as gravitation, elective affinity ; and perhaps with several 
others casually, as magnetism, caloric, galvanism, &c. Yet 
it does not possess contractility, which implies a pre-existing 
sensibility of some grade. Therefore it feels no adventitious 
impressions, nor has it the ability of repelling them ; it suf- 
fers nothing by a removal ; whereas vegetables are liable to 
suffer when removed, and deprived of constant nutriment, 
except as relates to their seeds ; and they are injured by OUTLINES OF PHYSIOLOGY 
43 
numerous circumstances impinging their peculiar sensibility, 
or marring their organization, and thereby depriving them of 
the powers of absorption and assimilation. 
But the most visible contrast may be noticed in animal 
bodies, which have advanced to some maturity, and then 
deprived of their vivifying agencies. In the more perfect 
orders, in the living state, there is an internal circulation of 
variously modified fluids, especially of red blood, all moved 
by the force of their envelopes ; a definite degree of heat is 
maintained in the interior under a wide range of atmospheric 
vicissitudes, being in man about 98° Fah. The muscular 
system is in play, and the intellect commands its voluntary 
movements. External sensation, and the manifestations of 
mind indicate a force within, urging proofs of a principle 
actuating the complicated machinery, and perceptible at 
every point in those emanations, called the mental expressions. 
This same vivifying agent, also, acts as a preservative, in pre- 
venting the materials composing the corporeal part from 
exerting their physical properties, and destroying its texture ; 
and in fact the force of what may be called vital chemistry 
supersedes the powers of the chemical affinities. 
In the reverse state the contrast is very impressive ; that 
animated being which once walked erect, now lies prostrate 
and motionless, destitute of its former internal functions and 
caloric, as likewise of sensibility, of perception, of all indica- 
tions of intellect and expression. The elements of its com- 
position are left at liberty to exert their affinities, and the 
fabric, once fair and animated, becomes a chaotic mass of 
elementary substances. 
2. Synonyms. 
There appears then to be a notable contrast between ani- 
mate and inanimate bodies, and it becomes an interesting 
pursuit in physiological inquiries, to attempt an investigation 
of this internal causation. It has been often spoken of as an 44 
ON VITALITY. 
agent, yet seldom in modern times acknowledged as an entity. 
It has been called life of man, impetum faciens, archceus, 
thinking principle, vital tonic attraction, nervous energy, 
excitability, sensorial power, vital force, conservative princi- 
ple, spirit, or soul of man. The numerous appellations, 
with their definitions, and many crude notions advanced, 
serve but to expose the veil that has screened it from ordi- 
nary examinations.* 
It appears that philosophers are required to have every 
thesis guarded, and supported by demonstrations drawn from 
tangible experiments, and so conclusive as to compel assent; 
that nothing can be taken on trust, or by analogical induction. 
These lines have of late been drawn so straight as to im- 
pede investigation on subjects, which in their nature cannot 
admit of mathematical or chemical demonstration. How- 
ever, it may be noticed, that undeniable facts may be well 
shown by a series of circumstantial and analogical indications, 
which may compel the assent of the mind as certainly as 
direct testimony, and so it is now held and practised in courts 
of judicature. 
3. Vital Entity, what. 
The question now intrudes itself, what is it that exists in 
animated bodies, both vegetable and animal, which bestows 
on them their peculiar characters, and in its absence leaves 
them to decomposition ? Is it an entity, or is it a nihility ? 
is it the cause, or is it the effect of organization ? Many and 
bold have been the speculations of physiologists on this sub- 
* Since the present subject was put in manuscript, the writer has noticed 
the following remark of one of the greatest ornaments of the profession, Dr 
Rush, and the writer begs leave to insert it as an apology for the length of 
the preSen t thesis: " In beholding the human body, the first thing that 
strikes us is its life. This, of course, should be the first object of our inqui- 
ries. It is a most important subject; for the end of all the studies of a phy- 
sician is to preserve life ; and this cannot be perfectly done, until we know 
in what it consists." (Med. Inq. vol. ii. p. 374.) OUTLINES OF PHYSIOLOGY. 
45 
ject ; the reasonings and conclusions have been so vague, 
that it is necessary severe restraints should be imposed on 
the logic that is used. Some with an apparent view of get- 
ting rid of an entity, an esse, controling and modifying the 
matter of which living bodies are formed and actuated, tell 
us that vitality is merely the effect of organization. They 
hereby acknowledge the existence of an animating something, 
and yet consider it a mere sequence, an evanescent nihility 
as soon as the organism ceases to produce it. There may 
be but little use in this inquiry of naming such physiologists. 
Howeverj this thesis is chiefly supported on the continent of 
Europe ; and even Dr Bostock in England considers it to be 
" the conjoined operations of many actions." Why do these 
philosophers use the term vital force, tonic power; when, 
according to their own views, they acknowledge it to be only 
a physical effect ? M. Broussais is very adroit in styling it 
the " unknown power," although it exhibits more phenomena 
than any other power in the whole range of natural processes. 
In another place he calls it vis creatrix naturce. Even in 
Dr S. Jackson's Principles, we find this trite expression : 
vitality is, consequently, a product of nutrition. And in 
page 100 : " Can it be supposed that the organic force, which 
imparts to organs their capacity for action, exists before the 
organs are formed ?" Many others in seeking for some sort 
of entity have evidently mistook the real one ; so Dr Wilson 
Phillip was satisfied he had discovered an identity of the gal- 
vanic and nervous fluids, as he supposed. 
In reply to these vague suggestions, for they cannot con- 
siderately be esteemed otherwise than visionary, we would 
inquire, what power or influence presided over inert matter 
in the formative processes of organization ? This process 
seems to be as steady as that of gravitation. What then pro- 
duced organization so uniform of construction, so intense in 
function as to usher forth the exquisite phenomena of sensi- 
bility, contractility, and of intellect ? The ordinary physical 46 
ON VITALITY. 
properties of matter never did, nor ever can produce them 
without a peculiar germinating, or adjunctive principle. These 
physical properties may all come in aid, but cannot be effi- 
cient causes of life. There is everywhere a marked distinc- 
tion between the animated world of beings, and the world of 
inanimate matter. It will not do to say these phenomena are 
the effects of chance, for this implies nothing ; even the con- 
stantly determined forms of organization disprove this. It 
will be admitted that life cannot be supported without a free 
play of the organism ; but the question is, what power pre- 
sided over their formation and evolution, by opposing the 
chemical influences, and which still continues them in play ? 
Expecting never to obtain a solution of this question from 
the organists, we shall continue to support the thesis long 
since advanced, and in a degree elucidated by philosophers in 
ages gone by ; and the more so, as what has been since 
offered does not so well accord with facts, and analogy. It 
was advanced by Epicurus and Socrates, and enlarged on by 
Lucretius and others, that life is produced by an exquisitely 
subtle gas, or aura ; or rather, in deviating from those just 
named, it will be maintained, there is a principle pervading 
universal nature, and ready to attach itself to certain molecu- 
lar forms of matter ; and when thus intimately united to such 
corpuscular bodies, affords them a new stimulus, additional 
properties, different capacities, and peculiar appetencies. 
Whatever this essence, aura, or gaseous spirit may be, it is 
different from all other known essences, auras, or gases in 
nature. It is governed by laws peculiar to itself, as we 
see and know all vegetable, and animal organization to be 
directed by their own peculiar, and inherent powers. It 
possesses influences and energies when united to certain 
forms of matter, transcending the force of certain other physi- 
cal powers of natural bodies ; as, in a modified manner, 
gravitation, affinity, magnetism, oxygen, certain degrees of 
caloric, and electricity. It finally, in a limited manner com- OUTLINES OF PHYSIOLOGY. 
47 
patible with organic textures, controls all these, and uses them 
as supports and subsidiaries in the astonishing display of its 
phenomena. 
This power, this property, may hence continue to be 
known by the appellations of vital principle, vital force, vital 
energy, or simply animation, or life. Its peculiar influencies 
in the human system may hereafter receive much amplifica- 
tion. 
4. Its Origin and Source. 
If it should be inquired, from whence originated this prin- 
ciple ?-it might be answered by retorting the inquiry, 
whence originated light, affinity, gravity, and other properties 
and essences in nature ? That Creative Power who said, 
" Let there be light and there was light," said also, " Let us 
make man in our own image,"-"and breathed into his nostrils 
the breath of life, and man became a living soul."* If the 
breath used in the narration should be considered a figurative 
expression, yet an influence must have been diffused into the 
inanimate body ; and not only so, but coeval, and coexten- 
sive with the existence of matter, that all the other tribes of 
creation, both animal and vegetable, assumed portions of it 
necessary for their own individual economy. 
If the pride of modern philosophy will not admit of proofs, 
or direct allusions from the record of inspiration, it is hoped 
it will stoop so low as to admit it in collateral support of a 
thesis partially founded on analogical facts. The pride of 
philosophy must be truly humbled in the view, that no greater 
advances have been made in the science of life since the 
creation of man, and of a subject constantly presented to the 
senses, and to the understanding also. 
* Genesis ii. 7. 48 
ON VITALITY. 
5. Illustrations. 
It has been intimated, that this emanation of vitality is 
coextensive with the other properties of matter fixed on the 
surface of the earth, or floating in the air. It may be expe- 
dient to continue the illustration some farther. In the first 
place, a direct seminal influence, and sexual fecundation can 
scarcely account for all the phenomena of vitality noticed on 
the surface of the earth. Without being obliged to go into 
specifications of much extent at this time, it may be remarked, 
as sufficiently proved by the investigations of geology, that 
various species of vegetables have been found in the transi- 
tion, and after formations of the crust of the earth, which 
have become extinct. Again, others now vegetating are of 
modern origin. So of animals ; natural history furnishes evi- 
dence of species, and genera of animals that have become 
extinct, and others have somehow sprung into existence ; and 
surely, so far as can be discovered, without a direct seminal 
origin. Where are the giants of old ? Here and there a 
petrified skeleton is found deep in the earth ; and also, many 
unknown animals of huge dimensions, besides the mammoths, 
the tapirs, and hippopotami. 
We can form no conception of a seminal origin of the 
myriads of myriads of ephemeral insects that darken the air, 
or of reptiles which separate the foot of man from the surface 
of the earth. All springing into life at the same time, and 
simultaneously giving up the ghost, and becoming extinct. 
They appear again at uncertain intervals, and often hav- 
ing some slight modifications. A volume might be filled with 
facts on this subject; and indeed volumes have been. 
Stagnant waters imbued with some portions of albumen, 
gelatin, or fibrin, and probably other congenial animal sub- 
stances, and when exposed to a high atmospheric tem- 
perature, soon become loaded with innumerable animalcula 
of different genera and species, often visible, and often OUTLINES OF PHYSIOLOGY. 
49 
seen only by the microscope. Neither caloric, nor oxygen, 
nor water combined, can produce organic beings, without a 
vivifying principle besides them, and then they act as auxiliaries. 
6. Universal Generant Influence. 
It is believed, that those who have advocated the thesis 
styled spontaneous generation, have not gone so far as to 
designate very minutely the prolific principle, nor the sub- 
stances it acts on. They commonly illustrate it by a rehearsal 
of facts. It seems expedient, therefore, to follow up the 
subject a little further, without intending to exhaust it. 
In the first place let it be understood, that wherever scrip- 
tural allusions are made, it is not intended they should be 
received as strict philosophical evidence, but as collateral 
facts to aid the illustration of d'fficult subjects. We find 
then, that in the beginning, " the Spirit of God moved upon 
the face of the waters."* Let it only be noticed here, that 
the earth, and air both contain water. At this time, "the 
earth was without form." We will hardly dare to affirm, but 
have reason to presume, that a vital principle was at this time 
diffused in water, earth, and air. For, we are immediately 
informed of the command, " and God said, let the earth 
bring forth grass, the herb yielding seed, and fruit tree yield- 
ing fruit after his kind, whose seed is in itself upon the earth ; 
and it was so."f There is no mention of seed from which 
the herb germinated, but yielding seed, which was in the herb. 
The phraseology, whose seed is in itself, may justly be 
understood as an influence imparted, and of a gene.al kind, 
to the terrestial elements, by the same Spirit which gave all 
the other properties to matter. The same breath which set 
these elements in motion, and determined the circuits of the 
heavenly bodies, also bestowed a principle of Organic vitality, 
* Genesis i. 2. 
t Genesis i. 11, and onward. 50 
ON VITALITY. 
which is coeval with other properties of matter, and will be 
alike, or more enduring. It is as identical in its character as 
any other of the properties of matter, and none so fully 
displays the matchless beneficence of its Author. If the Pen- 
tateuch be admitted as a rule of faith in relation to divine 
subjects, why not in some degree respected in relation to 
subordinated correlative facts ? 
Again, the same Creative Power, said, " Let the waters 
bring forth abundantly the moving creature that hath life, and 
fowl," &c. Also, " Let the earth bring forth the living 
creature after his kind, cattle, and creeping thing," &c., and 
it appears that " God blessed them, saying, be fruitful and 
multiply." There is no intimation of there being either in 
the vegetables or animals any seed from which they took root 
in the beginning, but the vegetables yielding seed for the nu- 
triment of man, and the green herb for the use of animals ; 
and both were apparently brought forth in a spontaneous 
manner. Although the seeds of vegetables were secondary in 
formation, and made for the use of animals, yet they do, for 
the most part, contain germinating points, like cuttings, from 
which other series in succession are propagated. Admitting 
all that can be said in favor of a seminal propagation, it is no 
proof against a spontaneous origin of both vegetables and ani- 
mals, under particular circumstances. 
On the reverse, it will be insisted, and as fact, that innu- 
merable instances are on record of the origin of vegetables, 
and animals in after periods, for which the ingenuity of man 
could not discover a seminal influence, unless it be on the 
thesis of a prolific aura pervading ocean, earth, and air ; and 
together with the agency of other primary animal elements, 
manifesting life and organization to our senses. We speak of 
a spontaneous origin. All that can be meant by the term is, 
an origin without a visible germ or seed, and that it may be 
brought about through the agency of a widely diffused ger- 
minating aura, not cognizable by our senses. It is well known OUTLINES OF PHYSIOLOGY. 
51 
the most latent agents in nature elude the tact of the keenest 
philosophy. Indeed, a mere glance at the subject impresses 
the contemplative mind with the most sublime views of the 
transcendent wisdom, and power of a Creator ; and teaches 
human intelligence its weaknesses, and man to be humble, and 
adore.* 
Much evidence exists of there being a vivifying principle 
pervading w'ater, earth, and air ; and that it has been diffused 
through these bodies ever since the work of creation was 
finished. Although in its diffused state it is not cognizable 
by our senses, yet in a concentrated state it is as manifest as 
other attenuated bodies. Can we discover magnetism, caloric, 
oxygen, or electricity but in a concentrated state, and chiefly 
by their effects ? Can we discover these at all ? Then we 
can as easily apprehend vitality. Are these all light, invisible 
gaseous bodies ? So is this. Are these all indestructible in 
their nature ? So also it is with the spirit that is in man. 
Do these gases delight to dwell with particular modifications 
of visible matter ? So does both vegetable and animal life. 
Do these etherial essences adhere with certain degrees of per- 
tinacity-to particular bodies ? So does the subject of our 
investigation. The parallel might be extended. 
The properties of unorganized atoms, and their composi- 
tions, afford certain evidence of existing predilections and 
antipathies. Similar and more legible phenomena exist in the 
vegetable kingdom ; not only in organized rnolcule uniting 
with rnolcule, but a series of double affinities in motion ; there 
being another influence added, and its effects seen in every 
* Since writing the text, the author has noticed a pertinent opinion in rela- 
tion to this subject, by that ingenious physiologist, Sir C. Bell. " Physiolo- 
gists have, by a late sense of their own weakness, been at last humbled to 
this becoming, but unwilling acknowledgment, that this contractility of the 
muscles is an original endowment of this living matter, derived from the 
Creator, imparted in a way which we cannot know, and so attached to the 
organization of the muscular fibre, that where its organization is destroyed, 
this power is lost." Anatomy and Physiology ; art. Mus. Power. 52 
ON VITALITY. 
feature of the living plant ; and, in a certain process, so 
apparent are the harmonious affinities, that Darwin was excited 
to compose chiming songs on "the loves of the plants." 
Are not all these manifestations more intense in the animal 
creation ; and are there not even emanations of vital aura 
passing in a state of excitement, both of an attracting and 
repelling character ? See the visage of lunacy, and of rage ; 
and on the reverse, the aspect of eloquence, of love, and of 
adoration. If any one is formed of such agelid temperament 
as not to feel these, let him experience the benumbing aura 
of the torpedo-ray, or the more thrilling shocks of the gym- 
note, or electric eel.* These are acknowledged as voluntary 
acts of the animal. Does not the charming of serpents 
and other terrific animals gaping for their prey, consist in an 
invisible emanating aura, which paralyses their victims ? 
The facts already established in the history of animal mag- 
netism, demonstrate the power of mind on mind, and of mind 
over the organism. 
Some have conjectured, that the galvanic aura presides in 
the nervous tissues, and that it produces the phenomena of 
organic life. That this principle exists in animal structures as 
an adjuvant, or may be excited by them, is pretty evident 
from many phenomena shown by experiments, particularly 
some by Beclard and Beraudi. However, the inference is 
no doubt correct as drawn by them, that it is a subordinate 
agent, and controlled by a higher power, or a vital force pecu- 
liar to organic life. So light is a subordinate substance, and 
* The hook'd torpedo, with instinctive force 
Calls all his magic from his secret source; 
And through the hook, the line, the taper pole, 
Throws to th' offending arm his stern control. 
The palsied fisherman, in dumb surprise, 
Feels through his frame the chilling vapors rise, 
Drops the vain rod, and seems, in stiffening pain, 
Tame frost-fix'd wanderer o'er the icy plain. 
Dr. Good's translation from Oppian. OUTLINES OF PHYSIOLOGY. 
53 
frequently given out by animal and vegetable bodies by lumin- 
ous, or phosphorescent phenomena. Caloric, likewise is a 
necessary agent, and under the control of the vital influence ; 
and this, also, opposes the power of gravitation, and the 
chemical affinities. 
Philosophers have spent much time in attempting to estab- 
lish the hypothesis of the infinite divisibility of matter. Com- 
pound bodies are formed of varied proportions of atoms. It 
is probable that many of what we now call atoms in chemistry 
may still be divided, yet there is a ne plus ultra beyond which 
no division can take place ; and these are the primordial 
atoms of nature. The more substances are divided, the more 
difficult they become of further subdivision. Hence the 
most attenuated bodies retain a permanency of character. 
Notwithstanding all that has been said, we do not mean to 
intimate but there may be a radical difference between spirit- 
ual, and atomic entity. Further remarks are deferred until 
we treat of the vital and nervous textures of animality in im- 
mediate connexion. 
SECTION V . 
ON THE GRADATIONS OF VITALITY. 
1. The subject of Vitality continued, by a consideration oj 
its different grades of manifestation, emanating from 
different animated tissues. 
Hitherto vitality has been studied in its general phe- 
nomena : it now becomes necessary, in order more fully to 
develop its peculiar properties, to contemplate it under three 
physiological aspects. 
1st. Vital phenomena, resulting from the action of the 
primitive stamina of animal structures. 54 
GRADATIONS OF VITALITY. 
2d. Vital phenomena, resulting from influences afforded 
by the nutritive, ganglial, or trisplanchnic system of nerves, 
and in co-operation with the respiratory nerves. 
3d. Sensitive, motory, and intellectual phenomena, re- 
sulting from the susceptibility of the different spino-cephalic 
masses of nervous matter, or the nervous system of external 
relation. 
The method to be pursued in all of the physiological 
arrangements, will be, to follow up the nervous tissus from their 
origin, into the several organic tissues they excite, and ac- 
cording to their periods of development. But, we have 
tissues apparently destitute of nervous matter, and yet exhibit- 
ing many of the phenomena of vitality. A consideration of 
these merits previous attention. 
FIRST THESIS. 
2. Primitive Tissue. Vegetative Grade. 
In all the vegetable tribes, no nerves proper have been 
demonstrated ; and yet a kind of organic sensibility does 
exist, which may be called innate, or perhaps vegetative. 
Their tender yielding fibres do contract, and visibly to the 
naked eye, on many occasions, when some impinging sub- 
stance affects their economy. This sensibility must be esti- 
mated as rather intense, when we view it in relation to the 
movements of their fluids, their growth, secretion, flowering, 
and fructification.* 
*The phenomenon is beautifully illustated by Mr Bilsborrow in lines 
addressed to Dr Darwin : 
How the fair flower, by Zephyr woo'd, unfurls 
Its parting leaves, and waves its azure curls; 
Or spreads in gay undress its lucid form 
To meet the sun, and shuts it to the storm ; 
While in green veins impassioned eddies move, 
And beauty kindles into life and love. OUTLINES OF PHYSIOLOGY 
55 
In the first or lower grades of animality, such as the 
zoophytes, fungi, polypi, infusoria and many others, no nerves 
have been satisfactorily discovered in their most perfect state 
of maturity. However, certain physiologists have reported 
their having seen, by glasses, isolated globules of nervous 
matter ; yet it might be required of them, to be sure it was 
not globules of albumen, which they might mistake for nerv- 
ous matter, seeing the former is very abundant in the com- 
position of these kinds of animal bodies. We shall take it, 
therefore, for granted, until better proved, that numerous 
animals of these grades have no nervous substance in their 
composition, or any more provable, than nerves in the hair, 
nails, claws or hoofs of animals of a higher order. 
Notwithstanding this negation, these animals are endowed 
with certain degrees of organic, or rather nutritive action, 
suited to their own internal economy ; such as imbibition or 
absorption, assimilation, and growth. Their apparent sensi- 
bility of external contact is but a short remove from that 
of some vegetables. In all the scale of animal existence up 
to the human species, we find different grades of organs and 
organic sensibility. That this vital force is similar in kind 
to that which pervades the nervous tissues, we infer from its 
performing very similar functions, so far as relates to nutri- 
tion ; that it is expelled by similar agents ; for hydro-cyanic 
acid, and other poisons expel it in vegetables and the lowest 
order of animals, as well as in those having the most perfect 
nervous systems. So the same may be expelled by lightning, 
and even so effectually that there remains no muscular rigidi- 
ty, nor any coagulation of the blood. The vital force exhi- 
bits different phenomena as it exists in different tissues. 
If we view the humble embryotic state of the human kind, 
it has nothing of exaltation above the lower animal tribes, and 
even unconscious vegetables, in point of vital gradation. Its 
economy consists in absorption, assimilation, and the evolu- 
tion of the organism. There are as yet no nerves, nor do 56 
GRADATIONS OF VITALITY. 
they begin to appear, even in points, for many weeks. The 
vital force acts on the primordial particles and fibres, and the 
nascent ens is ushered into form. Like the incarcerated chrys- 
alis, it remains in seclusion a definite period ; and during much 
of this time, the process of accretion is governed by laws 
quite similar to those of the lower grades of animals, and 
this has been often styled the vegetative life of animals. 
3. Vis insita, Irritability, or Vegetative Force. 
The grade of vital susceptibility, which directs and governs 
all these movements, has been distinguished by the trite apel- 
lation of irritability. This term was first used by Glisson, but 
more fully illustrated by Haller under the appellation of vis 
insita, or inherent power. It was first used in the more ap- 
parent contractility of muscles, but has since been applied to 
express the ability of contraction of other tissues, and synon- 
ymously with vis vitalis, inherent power, and in combination 
with the nutrient nerves, instinctive power. This vital powTer 
acts independently of nerves, and often performs functions 
without them; for it existed before their evolution, and 
exists in tissues after the destruction of nerves. It exists in 
the cellular tissue, which may be considered as the common 
generative tissue, even of the nerves. It exists in all tissues 
except the nervous, in the membranes where no nerves are 
discoverable ; in all the centrifugal and centripetal systems of 
capillary vessels ; in tendons and bones, and even in the hair 
and nails ; but in different degrees of force. So also it ani- 
mates the blood, and secreted products, especially the semi- 
nal. The nerves excite, and increase its force in the tissues. 
As it is the first vital force that exists, so it is the last to 
quit the animal tissues, as the sad history of Vesalius shows. 
He was an eminent physician in Spain, and had the misfor- 
tune to lose an illustrious patient. He was permitted, in due 
lime to inspect the body. He was struck with surprise on OUTLINES OF PHYSIOLOGY. 
57 
discovering "the heart still palpitating." The Inquisition 
doomed him to death, but the king commuted the punishment 
to a visit to the holy land, from which he never returned. 
An account is given in Hecker's Journal, by Dr Trustedt, of 
a parturient subject, in which the uterine contractions expel- 
led a full grown child eight hours after the mother was laid 
away as dead. Very similar facts are stated by M. Levert, 
Harvey, and Le Rouse. Abundant evidence is afforded of 
absorption and circulation in minute vessels being continued, 
in ordinary cases, for twentyfour hours or more after death. 
Instances of a similar kind are numerous ; but it is not our 
design so much to particularize, as to generalize. 
We can hardly, however, refrain from some further notice 
of the impressive phenomena attending the death, or loss of 
vitality in the superadded tissues of the entire nervous systems, 
whilst some susceptibility remains. For instance in cholera, 
the morbid impression being most intense on organs supplied 
by the nutritive nerves, these first cease, and surely with 
them the cerebral organs. Yet, the vegetatvie life remains, 
and various sudden movements of muscles follow after several 
hours. The muscular rigidity so constant after death by ordi- 
nary means, is a striking proof also. Yet the cause of death 
may be so violent as to annihilate vitality of every grade at once, 
as by lightning. The primitive tissues partake of this rigidity 
as well as the muscles. It is modified by various circum- 
stances, and commonly continues until the physical state of 
the tissues becomes altered. Some tissues, and even organs 
retain a susceptibility of being moved by excitants after death 
longer than others. As stated by M. Beclard of experiments 
by Nysten, the left ventricle of the heart loses its suscepti- 
bility much sooner than the left auricle, and the stomach 
and intestines retain it longer than the heart itself. 58 
GRADATIONS OF VITALITY. 
4. Case of long-retained Vegetable Life. 
In the American Journal of the Medical Sciences, Vol. XV. 
p. 211, an account is taken from a German Medical Journal, 
of a young man who appeared to be dead, so far as the ab- 
sence of breathing, of any motion of the heart, or of action of 
all the functions of external relation could manifest. Yet, 
some artificial eschars showed signs of suppuration on the 
second, third, and fourth days ; on the fifth one hand was 
found to have been turned round ; and on the sixth and ninth 
days a partial perspiration bedewed the skin. The limbs 
remained pliant. The lips preserved their red color until the 
18th day, a vital aspect. No signs of putrefaction on 21st 
day. By Dr Schmidt. 
5. Vital Gradations. 
The simple animal tissues possess a definite degree of vital 
susceptibility, and sufficient for all the nutritive processes of 
their own peculiar economy ; but, surely not in the perfec- 
tion of animated beings, which possess a superadded ganglial 
system of nerves. Those of a still higher order, and posses- 
sing the exquisite susceptibility of the superadded nerves of 
external relation, are rendered capable of performing far more 
exalted functions, as locomotion, sensation, and conscious- 
ness. To the head of this class is man, possessing the 
greatest proportion of nervous matter, and of the most intense 
sensibility. By this climax we may apprehend what man 
must have been, had he been deprived of these superadded 
structures. Indeed, we see instances in the case of acepha- 
lous foetuses ; and again in idiots of some deficiency of 
particular nervous organs, spoiling their intellectual powers. 
When the functions of these superadded systems of nerves 
cease, we say, on a cursory examination, that life has ceased ; 
and so it is in relation to them and their functions. But, the OUTLINES OF PHYSIOLOGY. 
59 
susceptibility of the primitive vital solids acts as a saving 
principle, for a certain* indefinite period ; for it adheres most 
pertinaciously to these, and peradventure, under certain favor- 
able circumstances, may be restored back to those delicate 
superadded tissues. Therefore, vitality may exist in its first 
grade, after becoming extinct in the nervous systems of inter- 
nal and external relation. 
Some further illustration of the vital aura might be required, 
in relation to its affinity to animal tissues. It is probably the 
most subtle agent in all the works of creation, and pervades 
ocean, earth, and air ; when aided by caloric, vapor, oxygen, 
&c., attaches itself to particular forms of grosser matter, and 
affords them a new, and peculiar stimulus ; it controls the 
other properties of matter in combination, and assimilates 
them to suit its own economy. Thus matter takes on new 
properties, and that which was inert and without form, be- 
comes vivified and organized. 
6. Origo JUorbida. 
It may be suggested, and as agreeable to analogy, that the 
vital aura may concentrate in certain regions and localities, 
where congenial substances may abound, inviting its combi- 
nation. Under such circumstances it manifests itself in the 
luxuriance of vegetation, and great increase of animalculee. 
It being, moreover, an intense stimulus, and in a concen- 
trated state in our atmosphere, may prove an inordinate 
excitant, even on the systems of animals. May not undue 
vital stimulation in the atmosphere produce that general mor- 
bid condition, which has been observed by pathologists from 
time immemorial, called by Hippocrates to thion, or divine 
something ? 
The fact has been noticed by many writers down to the 
present time, and they have designated this morbid state of 
the atmosphere by different appellations. Animal tissues are 60 
GRADATIONS OF VITALITY. 
of such a fabric, as to endure excitations only to a certain 
degree, with impunity. It has been often, and justly re- 
marked, that the highest health borders close on the margin 
of disease. This hint is merely thrown out here, but it may 
merit further attention in our oetiological review.* 
The vital aura requires the support of other excitants for 
the purpose of forming, and maintaining the integrity of the 
organism ; as caloric, oxygen, and certain visible substances, 
as albumen, gelatin, fibrin, together with the elements of their 
composition. Oxygen and caloric are so indispensable for 
the maintenance of life, that animal bodies are provided with 
an apparatus for their constant supply. The organism, 
when once in play, unites the elements of their constitution, 
and applies them in the process of accretion, by a kind of 
plastic vital affinity. 
7. Life and Death forced states. 
Although vitality appears to be intimately attached to ani- 
mal tissues, it loses its attachment, if they are not suitably 
supported, and maintain their integrity by appropriate stimuli. 
So life has been said to be a forced state, and continued by 
constant excitation ; and again, death may be called a 
forced state ; for life adheres to the tissues with considerable 
pertinacity, and may not leave its congenial residence until 
the fibres have become rigid by age, or their texture marred 
by disease, or expelled by violence done the organism. It 
may withstand a long process in a slow conflict, but a sudden 
and violent impress, as by a blow, electricity, or prussic acid 
may expel it in a moment from every tissue. 
* Histories of the plague inform us, that during the rage of this destroyer 
of hundreds of thousands, it is attended with an increase of sexual 
desire. As soon as it had passed by, " They had the courage, (says Dr 
Hodges, of the plague of London, 1665,) to marry again, and betake to the 
means of repairing the past mortality; and even women, before deemed 
barren, were said to be prolific." (Tytler, p. 553.) OUTLINES OF PHYSIOLOGY. 
61 
8. Reanimation. 
It is difficult to avoid the question, whether vitality can be 
reinstated in the organism after being altogether expelled? It 
is difficult in many instances to determine when it has left the 
primary tissues, as in the case of asphyxy. There may be some 
remains of it in these tissues, when all visible organic move- 
ment is absent. Many well authenticated instances show, that 
resuscitation has occurred under the absence of apparent life, 
for some length of time. In the instance of hibernating an- 
imals, the functions of external relations are dormant, those of 
nutrition greatly diminished ; a state of profound and contin- 
ued sleep.-In the case of seeds germinating that have been 
kept twenty, and even more than forty years in a dry state, 
as stated by naturalists ; it is visionary to say they have 
had active life during such length of time. They have not 
the proper adjuvants of vitality ; life has been suspended. 
Still this form of matter again assumes the vital principle un- 
der favorable circumstances. 
The cotyledons of vegetable seeds contain those elements, 
especially albumen, to which the vital force becomes readily 
attached, when the auxiliaries of vitality, moisture, heat, light 
and oxygen are present, in compatible degrees, it takes its 
residence ; the cotyledon expands, the corculum germinates, 
and all the phenomena of vegetable life and organism are de- 
veloped. The same illustration may be applied to the rean- 
imation of the eggs of animals. If in either case any change 
has taken place in the constituents of the seed, or egg, there 
will no animation be discovered. In the Philosophical Trans- 
actions for 1774, there is an account of snails being resuscita- 
ted after being dried, and kept fifteen years. Numerous in- 
stances occur of the resuscitation of insects, as that by Dr 
Franklin of a fly brought from Europe in a bottle of wine. Is 
it not reasonable, and philosophical, to assent to the position 
of a surrounding vital aura combining with congenial matter, 62 
GRADATIONS OF VITALITY. 
and aiding, or even controlling the other agents in the devel- 
opment of life? 
May we not be excused in tracing the springs of life to 
their fountain, even if cold and skeptical philosophy should 
accuse us of feeling after final causes? This is not a meagre 
subject to be reduced to a narrow circle. It embraces a wide 
extent of nature, and points to the immense variety, and num- 
bers of vegetable growth that cover the visible surface of the 
earth, and even that hidden by the deep waters of the ocean. 
The insect, reptile, and finny tribes which encumber ocean, 
earth, and air ; the vast series crowding the zootic catalogue : 
as one species of these, the incalculable millions of human 
beings, which have existed, and which now press the surface 
of the earth, all declare a common vivifying power, which has 
gone forth quickening matter into life and motion, enforcing 
the symmetrical properties of organization, and astonishing the 
collected powers of the intellect of man. Unsophisticated 
philosophy appreciates a cause of organic formation as incom- 
prehensibly extensive, and as apparent as any of the other in- 
explicable principles that bind together, or which agitate the 
elements of inert matter. This universal vivifying principle 
appears to be indispensably necessary, let the germinal influ- 
ence proceed in any manner whatever. 
SECOND THESIS. 
Vital Phenomena resulting from influences afforded by the nu- 
tritive, ganglial, or trisplanchnic system of nerves, and in 
co-operation with the respiratory nerves. 
This tissue of nervous matter is wanting in many of the 
lower order of animals, and in the human foetus for about three 
months from its existence. However, it shows some appear- OUTLINES OF PHYSIOLOGY. 
63 
ance at about the end of the first month, in small points in the 
tissues. It is remarkable that it originates in tissues remote 
from its ganglia, which are afterwards formed and situated 
deep in the visceral cavities. They are first seen originating 
in the intestinal mucous tissue ; but they do originate in such 
tissues, as we say, in their description they are distributed to 
from their ganglia ; they rather terminate in the visceral gan- 
glia. 
This order of nerves grows out of the primitive tissues, 
and therefore may be esteemed as superadded, and posses- 
sing different susceptibilities in different tissues, something sim- 
ilar to the external nerves of sense. In saying this is a su- 
peradded tissue, we do not mean it is an isolated one, but 
harmonizes unconsciously by its peculiar sensibility with all 
other tissues of the vegetative grade. There is a very striking 
consensus existing between every tissue and organ of the sys- 
tem, by which all act as auxiliaries, and establish an exquisite 
harmony of action. As in the oscillations of stringed instru- 
ments, many intonations harmonize to produce melody, so a 
harmony of movement is manifest in the physiological state ; 
but when the train of natural harmony is broken, a new train 
of morbid phenomena arise. 
10. Nervous Ganglia, and Plexuses. 
These nervous filaments concentrate in the form of glands, 
knobs, or ganglia, called, by some, little brains. They are 
found in the head, neck, thorax, abdomen, and pelvis. They 
have considerable firmness as compared with other nervous tex- 
tures. They are of a reddish, or light rose color, and em- 
bedded in cellular substance under membranes, and between 
muscles. They are abundantly supplied with blood vessels. 
These ganglia present two general divisions ; one series of fil- 
aments as already noticed, the other from the vertebral col- 
umn, by filaments sent out from the spinal cord, and directly 64 
GRADATIONS OF VITALITY. 
forming chains of ganglia on each side. These chains of gan- 
glia present an appearance something like an ellipsis, one end 
of which being in the bead, the other in the pelvis. The vis- 
ceral division is situated on each side of the spine, and within 
the ellipses formed by the other chains. 
The lateral ganglia have an intimate communication with all 
the spino-cerebral nerves ; whilst the central ganglia commu- 
nicate in a direct manner only with one pair, the pneumogas- 
tric. However, there is an intimate, but indirect communi- 
cation between the visceral, and spinal ganglia, whilst the 
pneumogastric has but one direct communication with the cen- 
tral ganglia ; viz., the fascia-communicans of Wrisberg, or as 
it is called nervous loop, between the pneumogastric, and 
semi-lunar ganglia. However, the fdamentary distributions of 
this nerve is in the same tissues with those of the abdominal 
ganglia. It is directly distributed to the larynx, lungs, and 
stomach. 
The sympathetic nerve then, or trisplahchnic, or ganglial, 
or intercostal, has obtained the epithet of great, from its extent 
and importance in the economy of the system, together with 
its numerous ganglia and plexuses. These may require some 
short notice. In the head is situated the ophthalmic ganglion, 
the spheno-palatine and submaxillary. In the neck the su- 
perior, middle, and inferior cervical ganglia. There are ten 
or twelve thoracic ganglia. Immediately below the diaphragm, 
near the spine, is situated the semi-lunar ganglia, which by 
some have been called the great abdominal brain, and with the 
solar plexus, has been estimated as the centre of harmonies 
of all the others. Several other ganglia are situated along the 
lumber vertebra, os sacrum, and in the pelvis. 
Numerous branches, or filaments pass off from these gan- 
glia to form plexuses, by which there appears to be an inti- 
mate association instituted, which forms a medium of harmo- 
nies between all the viscera, and in a limited degree with the 
organs of external relation. Filaments arising from ganglia, OUTLINES OF PHYSIOLOGY. 
65 
and other origins, communicate in common envelopes into 
meshes, and come out again to be distributed to different or- 
gans. One important plexus is from the cervical ganglia, and 
uniting with branches of the pneumogastric, go to form the 
great cardiac plexus, placed behind the arch of the aorta. 
There are many other plexuses ; the solar plexus being con- 
sidered very important, by which intercommunications are es- 
tablished extensively. These anatomical notices are acknowl- 
edged as defective. Those who wish for a short view of this 
extensive series of nerves, may consult J. P. Nance's map of 
the great sympathetic nerve, translated by Dr Pancoast. 
11. Their Function Persistive. 
This system of nerves, and the organs they supply of cir- 
culation, secretion, digestion, assimilation, &c., are destined 
to the subsistence and recruit of all the tissues. This demand 
being constant and imperious, this series of nerves is charged 
with a very constant susceptibility ; however, having some 
remissions, it acts at the same time in harmony with the sus- 
ceptibility of the primitive tissues, and their functions seem 
united into one more perfect in design. An action is now 
sustained by the aid of the pneumogastric, in the heart and 
lungs, more steady than the vestal fire, so long as animation 
continues ; yet not constantly of equal intensity. These func- 
tions sustain an independent position, from which they cannot 
be driven by another series of nervous organs of still'higher 
grade, and concerned in the functions of intellect. 
12. Three orders of Sympathetic Nerves. 
As soon as the nervous fibrils and cords emerge from their 
ganglial plexuses, they are marshalled into three divisions. 
The 1st goes to supply the muscles of involuntary motion, 
and forms a union with some cerebral nerves. 66 
GRADATIONS OF VITALITY. 
The 2d passes into the parenchymatous substance of all 
the organic viscera. 
The 3d passes with the arteries, in their outer coat, through- 
out all their minute capillary distributions in the system. The 
peculiarities of vital susceptibilities of these divisions will be 
noticed in their places. 
With a view of being rightly understood, the following no- 
tice of terms, which may be much used, appears necessary. 
The vegetative excitability of the primordeal stamina, in uni- 
son with the susceptibility of the ganglial system of nerves, 
may be styled the organic, or instinctive susceptibility ; or 
aptitude of movements from excitations applied. A prefer- 
ence may be given to the term instinctive, on account of the 
resemblance these organic movements have to mental instincts, 
as respects spontaneity. And more especially as we dis- 
cover a peculiar predilection, or appetency in many of the 
organic movements. For instance, as the chylous absorbents 
refusing to take up any thing but chyle ; also, the wants of 
the system, as indicated by the desire of food, and of respi- 
rable air, &c. Instinctive or organic movements are expres- 
sive of facts ; yet, are always understood implying some pe- 
culiar stimulation, either from the contained fluids, or from 
other associated organs in a state of excitement ; or from 
mental radiations, by the agency of thought, in the excitations 
of what are called the passions. 
13. Instinctive Susceptibility. 
14. Pneumogastric Nerve. 
From the middle rod of the spinal cord, at the medulla ob- 
longata, the pneumogastric nerve arises by single roots, or 
fibrils, and without ganglionic bulgings. It soon divides into 
four important branches ; one goes to the larynx, one to the OUTLINES OF PHYSIOLOGY. 
67 
heart, and one to the lungs and stomach each. These nerves 
unite more or less in the plexuses, and then are distributed 
with the ganglial nerves. They associate the two great sys- 
tems of nerves together, and help to unite the nutrient organs 
in a train of sympathetic harmony, both in health and in dis- 
ease. Besides this nerve several others originate in its vicin- 
ity, and are distributed on the external and internal muscles 
of respiration, the most important of which is the phrenic to 
the diaphragm. Respiration being an important act in the 
process of nutrition, these nerves act in harmony with the gan- 
glial system, neither being under the control of the will; nei- 
ther does the pneumogastric reflect sensation from the viscera 
to the centre of perception, like the nerves of sensation. Vis- 
ceral impressions are reported, but obscurely to the centre of 
perception in health, but more vividly in disease, and proba- 
bly in part through the outer chain of ganglia, which connect 
with the spinal nerves of sense ; and partly by filaments from 
the nerves of sensation. 
Demonstrations are needed to decide positively on the sen- 
sibility of the pneumogastric nerve in reflecting radiations to 
the centre of perception. It very probably furnishes the pul- 
monary sense indicating the want of respirable air. It may, 
like certain other nerves, possess a peculiar sensibility, and 
which is not transmitted to the seat of perception so vividly 
as by the nerves of feeling. In this it resembles the entire 
system of ganglial nerves. When this nerve is destroyed, or 
its function in any manner intercepted, respiration directly 
ceases, and digestion fails. Injuries done to the branch called 
the recurrent affect the speech. 
15. Distribution of Involuntary Nerves to .Muscles. 
The sympathetic nerves going to the heart, lungs, and 
secretory organs may receive attention in treating of those 
organs ; but we can hardly pass some notice of the distribu- 68 
GRADATIONS OF VITALITY. 
tion of those nerves to the voluntary muscles and skin. They 
pass with the arteries, and are distributed in the long, volun- 
tary muscles, and upon the same contractile fibres as receive 
the spinal nerves of voluntary motion, as we are taught by 
anatomists. These muscles are ordinarily under the control 
of the will, by the agency of the spinal nerves. Severe im- 
pressions on this order of nerves, or at their origins in the 
encephalon produce spasms of the clonic kind, or convul- 
sions. But the locomotive muscles are affected with tonic 
spasm, or tetanus, and taken out of the control of the will, 
when certain kinds of morbid impressions are transmitted 
from other tissues supplied with ganglial nerves. This may 
be the basis of an important pathological thesis. 
16. Distribution to the Surface. 
Again, in relation to the distribution of the involuntary, 
or ganglial nerves to the dermoid tissue ; these nerves pass 
plentifully with arteries into the papillae. These communica- 
tions establish a prevailing harmony between the surface and 
interior organs, and membranes ; and this harmony is rarely 
noticed by the spinal nerves of sensation in the physiological 
state. However, in a pathological state it becomes very 
apparent. Hence numerous impressions on the skin, as cold, 
titillation, &c., are instantaneously, oftentimes, transmitted to 
internal tissues ; and the reverse. This sympathetic consen- 
sus has been the theme of every observer of pathological 
phenomena, and yet without the physiological illustration. 
In eruptive diseases, the harmony between the internal and 
external surfaces is clearly manifested, and through the 
agency of these communications. Almost every habit of dis- 
ease injures the healthy balance of action, but it is rendered 
most manifest in malignant, and ataxic diseases. It is also 
manifestly shown in the action of cold either externally or 
internally applied, and in the operation of emetics, &c. OUTLINES OF PHYSIOLOGY. 
69 
17. Varied Susceptibilities. 
We say the nutrient, or ganglial system of nerves possesses 
a peculiar sensibility ; whilst it is confessed this is not defining 
it. The galvanic fluid scarcely excites motions in the invol- 
untary muscles supplied from it, whilst it excites severe con- 
tractions in the external voluntary muscles. So certain ani- 
mal fluids excite particular tissues, and not others. There is 
as great a difference of nervous susceptibility in the secreting 
organs supplied by these nerves, as in the external senses 
supplied by the nervous system of external relation. So 
certain poisons destroy the functions of some of the tissues 
and organs, which have little, or no effect on others. It is 
well established in therapeutics, that certain medicaments 
impress particular tissues more than others. These phenom- 
ena can only be discovered by experience. 
18. Effects of Excitations. 
It seems that certain agents, which we call stimuli, impress 
tissues possessed of the nutritive, or ganglial nerves, through 
a sensibility afforded to them by the incomprehensible vital 
power. This enables those tissues to commence, and reite- 
rate motions. In some tissues these movements are discover- 
able by the naked eye; in others by glasses, and in others 
the effects only clearly indicate antecedent motions of the 
tissue. 
The functions of the tissues are increased on the applica- 
tion of appropriate stimuli, whether as nutriment, or as medi- 
caments, or locally applied in a more mechanical method ; or, 
finally, by the agency of thought, in tissues also having nerves 
of external relation. The effects are an increase of function ; 
fluids concentrate to a part when the excitation is local; in 
this event there is an increase of heat, of turgescence, of 
color, and of expansion of fluids. If the stimulus affects the 70 
GRADATIONS OF VITALITY. 
entire system, and in a tolerable degree only, all the functions 
will be increased. The fluids are seen rushing to the sur- 
face,, and partly forced there by the nervous impetus of the 
interior series of nervous tissues. However, the same sus- 
ceptibility exists in the exterior tissues, and they act in ac- 
cordance ; there follows an expansion of tissue ; a turges- 
sence of fluids ; an increase of caloric ; an additional muscu- 
lar energy, together with a more vivid expression, and force 
of intellect, when not in too great excess. 
It has already been suggested, that the vital tissues endure 
only a compatible degree of stimulation with impunity. If 
applied in,an inordinate degree, their fabrics suffer an amount 
of contraction, which by altering their integrity, impedes the 
free play of the vital force, and a deficiency of function is 
immediately discovered. There is now rather a shrivelling of 
the surface, with paleness, and coldness. The circulations 
all lose in energy ; muscular motion is feeble and tremulous ; 
the features altered, and intellect is wavering. Sudden, 
and impressive thought ; all external and internal high stimu- 
lation, with many agents, are liable to produce this train of 
phenomena. Whilst enduring these severer impressions, the 
instinctive efforts are excited to action, and after an uncertain 
interval usually prevail. When this takes effect, the phe- 
nomena of vitality appear in a high degree, and surpassing 
those already described ; and this arises from the causes 
injuring the composition of the tissues, and leaving more per- 
manent irritations. The condition is now a preternatural one ; 
it is a morbid state. This condition is called reaction, or 
responding or repulsive action. 
In pursuing the climax it becomes apparent, that very 
intense impressions make still greater alterations in the mo- 
bile tissues ; even so that the vital aura ceases to influence 
them, and is expelled. No repulsive actions ensue, nor the 
phenomena of disease ; a state of paresis is induced. OUTLINES OF PHYSIOLOGY. 
71 
19. Further Ilhistrations of the Vital Force. 
If it should be granted that vitality consists of an entity, 
although in the most attenuated form, how does it become 
attached to, and assimilated with the organism ? or, is it rather 
secreted by the nervous tissues, and forms a nervous atmos- 
phere, a halitus, which pervades the fibres of tissues, and 
stimulates them to action, as supposed by Lobstein, and 
many others ? It is difficult to comprehend how permanent, 
and indestructible gaseous bodies can be formed by organic 
secretion. But, what power excites this secretion ? Can 
an effect be a cause also ? Besides, all analogy teaches, that 
secreted products are compounds, and if so, liable to decom- 
position. 
If the nervous influence be a compound it is destructible, 
and must become a nihility, so far as relates to its characteris- 
tic properties. Philosophy can hardly admit such a thesis. 
It must go for hypothesis, and becomes very incongruous in 
its results. No one talks of the secretion of light, of galvan- 
ism, of magnetism, but of their concentration, and in a manner 
to manifest their existence, and clearly show their agencies. 
If it should be conceded, that there is a vivifying essence dif- 
fused throughout the works of nature, and that it has a predi- 
lection to unite with certain forms of matter like other 
ethereal essences, the unprejudiced judgment might favor the 
suggestion of its uniting with the elements of organic mole- 
cules ; and when so combined stimulate to the development 
of new phenomena, and such as may be compatible with their 
compositions and textures. When such excitable tissues are 
put into more intense action, they may draw to their influence 
a further supply, and more vivid phenomena be disclosed. 
The inference to be drawn from these remarks is, that cer- 
tain elements of matter do in the first place combine by 
physical, or natural affinity, and in this state may be acted on 
by a superadded vital force, until the phenomena of vital 72 
GRADATIONS OF VITALITY. 
molecules, of organism, and of animal life be manifested in 
their full perfection. 
We are very sure that the vital force, whatever it may be, 
exists in different degrees in the tissues, sometimes deficient 
and at other times in excess. Or, in other words, it varies 
from the usual standard of mild and agreeable impression. It 
may concentrate in some tissues whilst others are deficient. 
If the organism becomes so modified as not to render it a 
suitable attachment, it leaves it. A severe shock of electri- 
city, a hard blow, or concentrated prussic acid instantly expel 
it by changing the condition of the organism. The same 
happens in a slow change of the tissues by the common 
causes of what is called disease. In this instance the vital 
force may be extinguished by a low train of phenomena as in 
chronic disease, or by an exalted train as in pyrexy, and 
phrenzy. In all these instances the intimate condition of the 
organism suffers a modification ill suited to its residence. 
There is no tissue so congenial to the residence of the 
vital force, or gives it an opportunity for its full manifestation 
as that which we call nervous, to be hereafter treated of. 
We know the fact, and that is sufficient for oui- present pur- 
pose ; yet we know it exists in other tissues, and even in 
vegetables. We know nothing of the manner it acts on the 
congenial nervous masses, or on the primitive tissues ; we 
only know that certain trains of phenomena indicate the exist- 
ence of the vital force in the organism ; and oftentimes the 
state of the organism becomes greatly modified by it. The 
very stimulation^ of this power in excess, may be the means 
of altering the condition of the organism, and induce its 
expulsion, either in the form of protracted disease, or sud- 
denly, as in apoplexy and cholera. The longer disease 
continues with a local concentration, the more the organism 
is liable to suffer changes of a pathological character. OUTLINES OF PHYSIOLOGY. 
73 
SECTION VI. 
THIRD THESIS. 
Sensitive, Motory and Intellectual Phenomena resulting 
from the susceptibility of the different spino-cephalic masses 
of nervous matter, or the nervous system of external relation. 
The nervous tissue being considered as the most manifest 
residence of the vital force, and from which radiations pass to 
other tissues, affording them an increased susceptibility of 
sensation and motility, it seems necessary to give some of 
their structural, or anatomical characters. This will serve 
as a basis for a physiological arrangement of all the subordi- 
nate tissues, and at the same time establishes the order of a 
nosographical arrangement. 
1. Plurality of Nervous Functions. 
The discovery of the plurality of the nervous functions 
introduces the brightest era that ever enlightened physiologi- 
cal science. By its present coruscations, we are enabled to 
classify the nerves, and of course their dependent organs, 
and to follow up their specifications into many genera. By 
following this method, in connexion with their series of 
development, an arrangement of organic function is established 
that never ought to be encroached on. Having made some 
reflections on the vegetative grade of vitality in the primitive 
tissue, and on the nutrient system of nerves within the great 
cavities, we proceed to a consideration of the vital force as 
displayed in the System of external relation. 
2. Nerves of External Relation. 
Nerves are prolongations from nervous masses, or to speak 
more correctly in relation to their origin and extension, they 74 
GRADATIONS OF VITALITY. 
are concentrations of nervous funiculi to the great glandular 
masses of nervous matter located in the encephalon. How- 
ever, as the functions of nerves are diversified, some receiving, 
and others transmitting influences to and from the centres of 
vital movements, we say the nerves go from the centre of 
the great masses. A number of funiculi, or pulpy extensions 
united by telary investments, form fasces, and bundles of 
these form rods, according to Sir C. Bell. A simple nerve 
is where the funiculi of its formation arise in a line from the 
spinal cord ; a compound nerve is where funiculi forming the 
roots "arise in double rows, and each row from a different 
column, or tract of nervous matter. The ninth nerve is 
simple, a spinal nerve is compound." Many fasces of 
nervous fibrils bound together by a common covering called 
neurilema, constitute a nerve. Nerves, then, composed of 
funiculi of different susceptibilities, intercommunicate by 
plexuses, and interchange funiculi, according to the compli- 
cated function of the organ they are destined to ; and when 
arrived there lose their coverings, and each funiculus retains 
its own peculiar properties. 
3. Spinal Cord. 
The spinal cord originates in the primary tissues, and 
passing through various stadia, assumes its characteristic 
appearance before the other great nervous masses. Being 
divided by the mesial line, each half is subdivided into three 
rods ; the anterior giorigin to nerves of voluntary motion, 
the posterior to nerves of the sense of feeling, and the middle to 
the respiratory nerves. At the summit of this column, and 
within the cranium is situated the medulla oblongata. The 
nerves of the organs of sight, hearing, smelling, and tasting 
pass off from the same division at the top of the medulla ob- 
longata, and communicate with the cerebrum. M. Flourins 
seems to have established this fact, as respects the nerves of OUTLINES OF PHYSIOLOGY 
75 
sight and hearing, "for when both lobes of the cerebrum are 
removed, the animal becomes both blind and deaf." We 
may be allowed to infer the same in relation to the nerves of 
taste and smell, if the evidence could have been obtained 
from dumb animals. By continuing the experiment, in ex- 
tirpating one of the tubercula quadrigemina, through which 
the optic filaments pass, the animal lost the power of vision 
of the opposite eye ; and by the removal of the other, vision 
was totally lost. 
Anatomical investigations reveal the fact, that the anterior 
and posterior rods, assigned to motion and sensation, pass up 
from the crown of the spinal cord, by the crura of the cere- 
bellum and cerebrum to those nervous masses, whilst the 
middle "stops short" in the medulla oblongata. However, 
some anatomists allow it a slender connexion with the supe- 
rior nervous masses. As this point is allowed to be the 
centre of all perception, and from which insensible radiations 
pass to the intellect, we may suppose the system of respira- 
tory nerves do not give very thrilling responses to those 
organs ; but rather obey stimulations of the instinctive sensi- 
bility. 
Similar phenomena appear from experiments on the spinal 
cord, that are developed in the nerves. When irritations are 
made at any point of the nerves, or spinal cord, contractions 
of muscles follow below this point ; but if the nerve be tied, 
no motion ensues. But, with respect to the nerves of sensa- 
tion it is the reverse ; no sensation is experienced, if the 
communication is intercepted above the point irritated. Nei- 
ther the nerves nor spinal cord possess sensation, but only 
conduct irritations to the seat of perception, or of motion. 
The fifth pair of nerves, or trigemini, are cranial nerves, 
but have been demonstrated to perform functions similar to 
those of the spinal nerves. They are distributed to the face 
and head, and perform the office of sensation and motion. 
By arranging these with the spinal nerves there will be thirty- 76 
GRADAIlUflS OF VITALITY. 
one pair, and nine cranial. The spinal nerves originate by 
filaments ; those from the anterior rod are destined to mus- 
cular motion, and those of the posterior to feeling. They 
immediately unite in the form of nervous cords in one com- 
mon covering, the posterior having ganglionic bulgings, the 
anterior are destitute. In their direct transit to the tissues 
of terminal expansion they form plexuses, by which each 
kind of neyves associate, and again unite according to the 
complexity of the functions in organs they supply ; yet each 
fasciculus retains its own distinctive character. 
4. Vital Entity. 
These brief anatomical references are introduced, chiefly 
for the purpose of furnishing a plan for the mind to rest on, 
whilst pursuing the study of the vital phenomena of the ner- 
vous forces. It is a proposition so self-evident as not to 
require proof, that organized bodies are endowed with an 
exciting something, which we call life ; as a synonymy we say 
vitality, vital principle, &c. It is equally evident it is of a 
substantive kind, and as well shown as that light, electricity, 
or magnetism are such. Otherwise it must be esteemed 
as the quality, or the mere effects of certain other bodies, and 
becomes an object of annihilation as soon as these certain other 
bodies cease to produce it. But it is expected our pre- 
vious illustrations have established the thesis, that there is 
a kind of entity in this agent, although it exists in a very 
attenuated form. 
As this vital essence in modified states, is the one actua- 
ting all organized beings, whilst united with organic substan- 
ces, it appears to possess a controlling influence over all the 
others, in definite limits ; and over the physical affinities of the 
molecules of matter, and at the same time these affinities do 
exist in a subordinate state in the formation of the organism, 
and composition of fluids, with their fluid animal matter. This OUTLINES OF PHYSIOLOGY. 
77 
vital force may be accumulated, and does more essentially re- 
side in the peculiar textures we call nervous. This is a kind 
of organization designed by nature for this purpose, and is 
produced by the influence of this same entity in the formative 
processes; although the manner in which this is effected we 
cannot investigate. 
5. Remarks on a supposed Nervous Fluid. 
The nervous funiculi are thought by some to form vessels, 
and that these vessels secrete the fluid we call nervous. But 
such vessels have never been demonstrated, nor has the pro- 
duct been shown to be a secretion ; if so, it is a compound 
of elements, and liable to decomposition. The existence of 
these vessels has been inferred from loose hypothetical rea- 
soning ; yet there are serous vessels throughout the entire or- 
ganism. We cannot say such vessels do not exist, yet until 
proved we are not bound to recognise them. We have no 
data to form a conclusion, in what manner vitality is com- 
bined with matter, by which the astonishing results of sen- 
sation, muscular motion, and the intellectual phenomena are 
produced. The extent of our comparative reasoning must 
end in a sort of analogical hypothesis. Electricity is said to 
rest on the surface of bodies suited to its concentration. Mag- 
netism seems more intimately blended with the composition, 
for it will not concentrate in iron in the formation of the mag- 
net, in any considerable degree, without a definite proportion 
of carbon in its composition. 
6. Attachment of Vital Essence in different degrees. 
There is but little difficulty in conceiving of an ethereal gas 
concentrating in the albuminous pulp of the nerves ; and that 
it should combine and harmonize with great mobility remote 
parts ; and having an affinity with a particular kind of animal 78 
GRADATIONS OF VITALITY. 
matter, be retained there with a certain degree of pertinacity. 
It is apparent, that vitality has more freedom of play, and 
manifests more striking phenomena as the tissues to which it 
is attached are of a mobile kind, and in their entire integrity 
of composition. Thus it seems to display in young and mo- 
bile tissues, more intense phenomena than what we discover 
in the rigid and altered tissues of age. It, again, acts in a 
manner to display different phenomena in systems emaciated 
and worn down by exhaustion, from what it does in those well 
nourished and with a suitable distention of vessels. Fi- 
nally, where the excitable organism is disturbed by the causes 
of disease, there arises a very abnormal train of vital pheno- 
mena. 
Vitality pervades all the tissues when in a compatible con- 
ditition for its residence, but in different proportions, and of 
modified susceptibilities. This difference consists essentially 
in the texture of the organization, as destined by nature for 
the exercise of different functions answering the necessities of 
the whole. It casually arises from accidental changes by the 
causes of disease. 
7. Sensations. 
Certain organs are charged with the office of receiving im- 
pressions from externa] objects, and transmitting semblances 
of their existence, form, and certain qualities, to the centre 
of perception ; such are the organs transmitting the sensation 
of feeling, of hearing, of seeing, of smelling, and tasting ; al- 
though these organs are affected by different agents, and in a 
different manner, they all admit of impressions made on the 
tender pulp of nervous matter expanded in the several tissues 
destined to these functions. Although the system is formed 
of dissimilar parts, yet when combined into a whole, it exists 
as an unit, it is now one point of organized matter, and what- 
ever affects one part affects the whole, yet in a modified man- 
ner. OUTLINES OF PHYSIOLOGY. 
79 
If it should be inquired how the tissues came to be pos- 
sessed of the ability of perceiving impressions, we only say 
this is one of the attributes bestowed on them by the vital 
agency. There is no great difficulty in conceiving that a 
body, or light, or sound impinging the mobile nervous pulp 
in an expanded state, should give a consecutive oscillatory 
motion along isolated lines. The difficulty consists in ab- 
stracting the notions we have obtained by our experience of 
rude and gross motions of matter, from the views we ought 
to entertain of the motions of the most subtle agents in nature. 
It is not the vibratory motions of stringed instruments. It is 
rather, undulations given to molecules in contact; but we 
have no simile in nature. 
An impression that we cannot estimate from its minuteness, 
is made on sensitive expansions. Simultaneously an impres- 
sion is given to remote parts of the chain of communication, 
even to the seat of perception, and in a silent manner without 
any proper vibratory motion. If the distance be small or 
great, it alters nothing ; it is perceived as soon in the one case 
as in the other. If there are certain perceptive tissues seated 
deep in the organism at the remote ends of the chain of com- 
munication, the impulse there will be the same as that on the 
surface, for the nervous masses here are merely a continua- 
tion of the same tissue, assigned to the same office. We see 
here an instance of the liability of our understandings to be 
imposed on, by describing tissues and organs in an isolated 
manner, as if they had independent functions. 
3. Touch and Sight. 
In relation to the sense of touch ; if the impressing body 
be of a smooth, obtuse kind, it is so perceived ; if it be of a 
sharp and pointed form, the sensation communicated will be 
so perceived, and no dissimulation can prevail. So with res- 
pect to sight; the impressions in this instance must be through 80 
GRADATIONS OF VITALITY. 
the agency of light; the distances, colors, and other proper- 
ties of bodies are shown by different grades, and intermixtures 
of light and shade. Light, with its deficiencies, or shades, 
or beams of light severed into rays, with their peculiar color- 
ings, being reflected, easily touch the retina. There need 
be no more said to show, that the same contact touches the 
seat of visual perception ; and as the external impression con- 
tains nothing but matter of fact, so the internal conception is 
^fac simile. 
9. Hearing, Smelling, Tasting. 
Undulations of air, either heavy, sharp, or soothing, impress 
the expansion of the portio mollis of the ear. The seat of 
perception is as soon impressed ; and every degree and mod- 
ulation of such undulatory motions are recognised by the in- 
tellectual faculties. The same illustrations will apply to the 
senses of smell and taste. The nerves of external sensation 
transmit to the organs of intellect. The nerves of voluntary mo- 
tion transmit the mandates of intellect to the muscles. It may, 
therefore, be proper to defer any remarks on their functions 
until we have introduced the cerebral masses, although they 
form a part of the spinal cord. 
10. The Cerebral Masses. 
The first threads of nutritive nerves in the primary tissues 
are hardly discoverable until the end of the first month of im- 
pregnation, and the organization of the superadded tissues is 
scarcely completed at the end of gestation. Agreeable to 
Dr Tiedemann's reports of his researches, as well as those 
of others, into the foetal evolution of the nervous system, the 
brain is the last formed ; and the cerebrum later than the ce- 
rebellum. The brain is not distinguishable in less than about 
two months after conception, being very minute, and then not OUTLINES OF PHYSIOLOGY. 
81 
without the fibres being hardened by alcohol ; at this time the 
spinal cord is very large in proportion to the brain. The 
brain can now be seen evidently originating from the two 
principal cords of the medulla oblongata, the pyramidal and 
olivary, whilst the superior part is wanting. 
The cerebellum also, originates by an apparent flattened 
substance from the sides of the medulla oblongata, which soon 
unite in the progress of evolution ; and the crura also ; and 
yet the mass of the cerebellum is not formed until a later pe- 
riod. Strata after strata of cerebral matter enlarge the hem- 
ispheres of both brains, but the exterior convolutions are not 
formed until near the close of pregnancy, and then rather im- 
perfectly. So the cerebellum and cerebrum are considered 
as efflorescenses from the medulla oblongata, or crown of the 
spinal cord. 
The nervous substance appears, when examined by the mi- 
croscope, to be composed of small, semi-transparent globules, 
connected into fibrillae by a viscid substance. According to 
the researches of Dr M. Edwards, their diameter is equal to 
1-7300th part of an inch. These globules are essentially 
formed of albumen. The nervous matter passes through dif- 
ferent grades of density, from a fluid to some firmness. In 
the foetus it is fluid ; in the infant state soft; in the adult con- 
siderably firm. In the pathological state liable to suffer chan- 
ges, sometimes very hard, and also very soft. In a healthy 
state, and after being macerated in alcohol, its fibres may be 
separated, and traced into the cortical substance. 
11. Cerebral Masses destitute of Sensibility. 
The medullary and cortical substance of the brain are des- 
titute of apparent sensibility ; they may be cut and lacerated 
without exciting pain, there being no radiations to the centre 
of perception. At the tubercula quadrigemina, sensibility of 
relation is discovered by the subject experiencing tremblings 82 
GRADATIONS OF VITALITY. 
and convulsions, and these are increased as the medulla ob- 
longata is penetrated. These are the only portions of the 
brain that experience pain, or excite convulsions when in- 
jured, and it indicates that the tubercles form a part of the 
medulla oblongata, and nerves of motion and sensation. 
12. Cineritious Substance, and Blood. 
The cortical, cineritious, or gray substance of the brain is 
situated on its surface, covering the convolutions, or affording 
the matter of their formation. Towards the basis it inter- 
mixes in lines with the medullary white substance, and in the 
spinal cord occupies the central portion. The arteries of the 
brain do not anastomose, although a large proportion of blood 
is sent there. The blood is sent to the brain by the internal 
carotid and vertebral arteries, and these have intimate com- 
munications ; and yet they do not form the minute inoscula- 
tions of other arteries. About one fifth part of all the arte- 
rial blood is sent to the head, whilst the weight of the brain 
is only about one fortieth part of the whole body. The ar- 
teries pass through the pia mater in very delicate capillaries 
into the gray substance, and modify the color of this tissue. 
According to Gall, Bell, and others, the medullary fibres can 
be traced to their origin in the gray substance, and we may 
infer hence, that it acts an important part in the phenomena 
of intellect. 
13. Plurality of Function. 
The texture of the cerebral matter has hitherto bid defiance 
to attempts to separate, and identify its particular organiza- 
tion, so as to indicate individual functions. Notwithstanding 
we have analogy almost equivalent to demonstration, that this 
tissue possesses diversified susceptibilities, and performs dif- 
ferent functions. From hence we infer that it is composed OUTLINES OF PHYSIOLOGY. 
83 
of a diversified organization. Some experiments go far to 
establish the thesis, as well as the analogy, that all other por- 
tions of nervous matter perform separate and diversified func- 
tions. The unison and harmony discoverable in every intel- 
lectual operation, both as respects the encephalic functions, 
and the influence of these in all other functions of the system, 
indicate a union, or concentration of organic prolongations by 
commissure, and this point must be where perception stops, 
at the summit of the medulla oblongata. 
In the first place we will attend to the grand divisions of 
the brain, the cerebellum and cerebrum, and then make some 
reflections on individual functions. 
14. Experiments on the Encephalic Merv o us Mass. 
About the commencement of the present century, M. Or- 
lando instituted a series of experiments in order to ascertain 
the specific function of the brain. M. Flourens, in 1822, 
repeated them before a commission of the French Institute, 
who approved of the conclusions. They have since been 
repeated by M. Fouville, and Pinel Grand-Champ, with but 
little difference in the results. The cerebrum and cerebellum 
were successively penetrated, and indeed sliced off without 
giving pain, or exciting convulsions, as has been already 
stated ; but as soon as the instruments touched the tubercula 
quadrigemina, or medulla oblongata, "trembling and convul- 
sions began." It appears that this is the part where irrita- 
tions produce convulsions " to the exclusion of every other." 
When both the cerebrum and cerebellum were altogether 
removed in a pigeon, it could move, and tumble about, but 
had lost the faculty of regulating its motions ; but when the ce- 
rebellum was half sliced off, its gait resembled that of a drunken 
person. 
When the cerebellum was removed, and the parts above 
and below left entire, the muscular movements were as has 84 
GRADATIONS OF VITALITY. 
been mentioned, that is, altogether accidental ; and yet the 
animal would brace itself when only half of it was cut away ; 
but when entirely destroyed, it moved in all directions when 
threatened or struck. Even in this condition it could see 
and hear quite distinctly : its head was erect, its air lively and 
spirited. The integrity of the cerebellum seems necessary 
to the regularity of locomotion, and if it be removed, the 
animal will never find the balance necessary to such motion. 
The right cerebral lobe of a pigeon was removed, when it 
immediately lost the sight of the left eye. Notwithstanding the 
animal could not see with the left eye, yet the contractility of 
the iris remained. Next the other lobe of the cerebrum was 
removed. The sight of both eyes was lost, but not the con- 
tractility of the iris ; for this depends on the instinctive sus- 
ceptibility of the nutritive system of nerves, furnished from 
the ophthalmic ganglion. The severity of the impression 
from the experiment was such as to induce some general 
debility, but notwithstanding, the animal stood fully upright on 
its feet ; it would not move unless forced or pushed ; it 
would fly when thrown up into the air, but was unable to 
direct its way. When left to itself it remained motionless, 
like one able to move, but destitute of a will to direct, or 
sight to guide its way. As the cerebellum remained, it still 
had the power of balancing muscular motion, but volition 
being abolished, it could not be directed. In all the experi- 
ments on different animals it was shown, when the cerebrum 
alone was removed, they remained listless, but capable of 
moving, whilst memory, vision, hearing, will, and all percep- 
tions by the external senses were extinguished. 
On the other hand, when the cerebellum was removed, 
and the cerebrum left entire, the mental faculties remained, 
but voluntary movements were very feeble, and not directed 
to any object; they resembled the undirected action of mus- 
cles in decapitated animals ; the regulator of motion was gone. 
In the process of voluntary movements it appears, that the OUTLINES OF PHYSIOLOGY. 
85 
determination is the result of the cerebral organs, or faculties ; 
that the direction of these motions is the result of mental 
faculties seated in the cerebellum ; and that the ability of 
motion resides in the spinal cord and nerves. All these phe- 
nomena indicate a plurality of function in the spino-cerebral 
mass, which are subjects of demonstration. 
Further Proofs of Individuality of Function. 
Pressure upon the brain, from above, downwards, produces 
stupor ; whilst lateral pressure does not. It is supposedthe 
vertical pressure in this instance, affects the function of the 
medulla oblongata, the seat of the perceptions. A destruc- 
tion, or severe lesion of one side of the cerebrum, is followed 
by an inability of function of the opposite eye, and of volun- 
tary motion of the opposite side of the body. The commis- 
sures of the brain are numerous from one side to the other. 
It appears further, however, that a section of the fifth pair of 
nerves on one side produces blindness of the same side. So, 
also, a deep wound of the cerebellum occasions paralysis of 
the same side ; or if slighter, a propensity to go backwards. 
And, again, if an incision be made deep from above down- 
wards, the animal rolls over continually even for many days ; 
but on making a similar incision on the opposite side he stops 
rolling, and remains in an even balance. If the incisions are 
not equal the animal may continue rolling, and always towards 
the side most injured. So in some pathological states pa- 
tients show a disposition to roll, and always one way, in 
paralysis to the affected side. Experiments show the cere- 
brum to be the seat of intellect, and the cerebellum the regu- 
lator of voluntary motions. The pons Varolii is considered 
as the point between intellect and instinct. The experiments 
of Magendie, Serres, and Bellingeri may be consulted on 
these interesting subjects. 86 
GRADATIONS OF VITALITY. 
15. Internal Cerebral Organization. 
The functions of the cerebral hemispheres clearly indicate 
a complexity of organization ; for the nerves supplying the 
external senses can be traced into this substance, and proba- 
bly reach the cortical. It is asserted by some physiologists, 
that the most intelligence is connected with the greatest pro- 
portion of cineritious substance ; and it is proved, that in 
man this is far more abundant than in any other animal. With 
respect to the organs giving force to the internal functions, or 
as they are called faculties, we must speak reservedly, 
although analogy warrants their existence. All suggestions 
of identifying their particular location, in the present state of 
science, must be esteemed apocryphal; yet, there is a strong 
presumption of their existence, and that their fibres extend 
into the convolutions also. The cerebrum, although not ad- 
vertising our perceptions of its secret economy, performs the 
most exalted offices of any tissue ; whilst it is a labyrinth, it 
is also the laboratory of intellect. 
16. Relative Proportions of Nervous Matter. 
Certain axioms, or principles in relation to the brain ap- 
pear to be well agreed on by physiologists. Such as that, 
man derives his most perfect intellectual faculties from the 
relative volume of his cerebral hemispheres, when not of a 
pathological kind. And again, the larger the brain and the 
less the nerves, the more comprehensive will be the intelligence. 
Of all animals man has the largest brain, and comparatively 
the smallest nerves. The brain of a horse, and of an ox is 
but half the size of that of a man, whilst their nerves are ten 
times more bulky. OUTLINES OF PHYSIOLOGY. 
87 
17. Of the Internal Senses, or Faculties. 
We assume it as an established principle, that the ence- 
phalic mass, especially the cerebrum, is the seat of intellect, 
and the affective movements ; and further, that these pheno- 
mena indicate the existence of diversified organic tissues ; 
and that by destroying or paralyzing this organization, the 
phenomena of mind cease. The number of the faculties, or 
functions, are differently estimated. Dr Good reckons five, 
being the same as the external senses, viz : perception, mem- 
ory, imagination, reason, and judgment. A mass of evidence 
might be produced to show that some of these faculties, 
or internal senses, may be weakened or obliterated, like the 
external senses, and often admit of restoration. In dreaming 
and delirium, some of them are in a high state of excitation, 
whilst others are dormant. In the natural state, all these 
faculties may be in operation, and in perfect sleep all dor- 
mant. There is a defect of these faculties in the case of 
idiots, and Dr Spurzheim has demonstrated, in a few instances, 
the defection to be in the cortical convolutions. 
Thus far we may go with some assurance, but in relation 
to the mode, or manner of existence of vitality influencing 
the organization, so as to produce the phenomena resulting 
from the intellectual processes, we are in darkness. Indeed 
the same may be remarked of all the vital processes. We 
have no evidence to raise a doubt, but that the same kind of 
vital force which actuates the vegetative, and nutritive tissues, 
incites also the encephalic organs ; for it is one undivided 
property over all the tissues, yet astonishingly modified by 
their dissimilarity of tissue and susceptibility. With respect 
to the organs styled intellectual, we cannot describe how the 
vital aura acts on, or causes them to act in their functional 
capacity, to produce the phenomena constituting mind. 
There is a ne plus ultra to human investigation ; and this is 
necessary to humble the pride of philosophy, and to teach 88 
GRADATIONS OF VITALITY. 
man his weakness, and a view of that Creative Power, who 
spake him into organized existence, and breathed into him 
the breath of life, and, " he became a living soul.':* 
The several internal, mental, organic tissues being endow- 
ed with certain capacities of perception, and susceptibility of 
motion ; perhaps we may be permitted to say, that exterior 
impressions are made on the medullary expansions of those 
organs located in the five external senses. These thrilling 
impressions are simultaneously made, and perceived in the 
internal organization, and their similitudes of impulse impress- 
ed, and retained there. 
We now need the aid of attention, which some properly 
enough have ranked as one of the mental faculties, for the 
purpose of arranging, and fixing those impressions received 
from without. It must be understood there are no innate 
impressions, or ideas, notwithstanding much has been urged 
by very eminent writers ; for the subject knows nothing 
further than as simple impressions are made on what Mr 
Locke calls the tabula rasa of the mind ; and by comparisons 
of the relations of these impressions, in the production of what 
are styled complex ideas. These organs are voluntary, and 
active, and have a striking affinity in this respect, to the mus- 
cles of volition. 
There are two other agencies quite manifest in mental pro- 
cesses, which have been also properly enough by some, rank- 
ed as faculties ; these are thought and association. Thought, 
or its proper excitant, appears to be a very active, voluntary 
agent, calling up, or commanding the service of other facul- 
ties, or organs on every emergency, and marshalling them in 
order. Association seems rather to be a sequent, or a result- 
antprocess, and when excited, instantaneously combines simi- 
lar impressions already received, into a train in succession. 
It may have an affinity to the instinctive motions ; for in- 
stance, an impression of uneasiness made on the pulmonary 
*Gen. ii. 7. OUTLINES OF PHYSIOLOGY. 
89 
sense, excites a series of organs into action, without volition, 
producing complicated motions of the respiratory apparatus 
in the act of coughing, &c. So impressions, called ideas, 
of a similar character, are brought up by the excitement of 
the mementive tissue, or its faculty of association. 
The series of mental processes are trained after the fol- 
lowing manner, as indicated by experience. Attention being 
excited either by a mental, or corporeal stimulus, thought 
commands, or in some manner influences the other tissues, 
already furnished with impressive images, to a state of ex- 
citement, or mobile condition. The tissue of the faculty of 
memory now makes vivid the representations of objects re- 
tained, or ideas already implanted ; and these are defined by 
Mr Locke to be, " whatever a man observes, and is conscious 
to himself he has in his mind." Then the tissue of the fa- 
culty of imagination, being also in an excited state, adds to, 
or dimnishes, or offers new colors to the preconceived im- 
pressions. 
The faculty of reason is excited also, and inquisition is 
made into all the relations appertaining to the agreement or 
disagreement, similarity or dissimilarity of the preconceived 
impressions ; and a harmony of associated motions chiming 
together, the judgment forms the results, indicates the conclu- 
sions, and decides what is most compatible for self-preserva- 
tion, or the well being of ideal consciousness. Another ac- 
tive faculty must here be intioduced, called the will, or the 
determination, which puts the mandates of the judgment into 
execution in controling all the other faculties, and by direct- 
ing the voluntary corporeal movements. 
18. Entity. 
In scanning the mental processes, it should be recollected, 
that they are not the ultimate effect of organization ; this 
only being the medium of visible agencies. All these phe- 90 
GRADATIONS OF VITALITY. 
nomena are dependent on that invisible agency we have long 
been animadverting on, and endeavoring to elucidate as the 
efficient physiological cause of every vital and intellectual 
movement. Unseen, and not heard, all organic nature is set 
in motion by it, and these motions are continued so long as 
the organizations render it a suitable residence. The cerebral 
tissues appear to be the emporium, or concentration, where 
it resides in all the dignity of individual consciousness. We 
will try not to be visionary ; we will keep pretty near the 
limits of physiology, and free from the shackles of the dis- 
cordant metaphysics abroad, yet we can hardly refrain copying 
a few lines of Dr Good's translation of the poem of Lucretius, 
indicative of the residence of the spirit that is in man, but 
not descriptive of its sublime entity. 
Far from all vision this profoundly lurks, 
Through the whole system's utmost depth diffus'd, 
And lives as soul of e'en the soul itself. 
If we might be indulged in speculations aside from organi- 
zation, there might be no great difficulty in showing, that self, 
personal consciousness, or the spirit which is in man, may have 
an independent existence, as well as his gross matter of orga- 
nization. Indeed, we may say far more so, even beyond the 
things of time and sense. The one is composed of many 
primary and secondary elements, and is soon destroyed by 
the affinities of its own composition ; whilst the other may be 
supposed to consist of a more primary elemental character, 
and of far more sublime institution, and if we could express 
it, as emanating from Him who is the effulgence of the divin- 
ity himself. Long before it was recorded in sacred history, 
that the spirit in man shall return to Him who gave it, this 
sentiment became the creed of all the inhabitants of the earth, 
as if it were a universal traditional revelation. And with the 
exception of a few sceptics, is now embraced in every relig- 
ion, even of barbarians. OUTLINES OF PHYSIOLOGY. 
91 
Man, whilst existing in the present tense, is not estimated 
by his symmetrical organization, any more so than a hundred 
dollar bank bill is for its raggy composition. It is a trite re- 
mark that the mind makes the man. It is so indeed, in ev- 
ery view that can be taken. The corporeal part is contin- 
ually changing ; but mind is the same, as memory testifies, 
through every change. Organization cannot extend beyond 
certain limits, but mind can be enlarged by intellectual growth, 
extending throughout "nature up to nature's God." An 
extension of the foregoing views of the human constitution of 
matter and mind, together with their relations to other organ- 
ized beings, might be a pleasant and interesting task, but for- 
eign to this design. 
19. Prerogative of Intellect. 
In conclusion let us notice, that the volitions of mind are 
the functional effects of this last, and superlative endowment; 
meaning the nervous masses of external relation. The or- 
gans of intellect are supreme and independent, in a given 
sphere of action. Not that they control the movements of 
the involuntary organism, for they can only modify their in- 
stinctive appetencies and functions, in an obscure manner. 
But intellect can control all the acts of speaking, locomotion, 
and behavior. It may be provoked by the instinctive incite- 
ments, and by external impulses, but never compelled. It 
may give up its prerogative, and yield to motives, but this is 
not compulsion, it is only voluntarily complying to solicita- 
tion. The acquisition of knowledge relating to one's self, and 
as he is placed in relation to others, and an acquaintance also 
of the physical world, together with the laws established by 
God and man, all teach the moral conduct of human beings; 
and they are hence responsible for acts they perform. No 
instigations can prevail in the doing of good or evil, until in- 
tellect yields assent. Hence arises the accountability of man. 92 
GRADATIONS OF VITALITY. 
20. On the Nerves of Volition. 
A consideration of the functions of these nerves as a part 
of the spinal cord, and as coupled with the nerves of sensa- 
tion, was omitted, on account of their office being to trans- 
mit functional radiations from the cerebral centres, into the 
muscular tissues ; whilst their fellows, the nerves of feeling, 
transmit from the surfaces to this centre. However mysteri- 
ous these phenomena may appear, yet they are supported by 
facts well demonstrated, and serve as examples of the com- 
plexity, and admirable harmony of the organization ; which 
although in descriptive anatomy must be separately noticed, 
yet serve to form a united congeries constituting a unity. 
It was noticed, that these nerves originate in the tissues 
below, already in their formative state in the embryo ; and as 
they increase do concentrate in the spinal cord, and that this 
has a union through the medulla oblongata with the cerebel- 
lum and cerebrum. Their office is to transmit the radiations 
of intellect from the internal senses, or faculties, to the long 
external muscles situated on the outside of the skeleton. 
This function they perform under the direction of the will, 
and by their contractions produce numberless modified mo- 
tions of voice, and locomotion. So far appears to be matter 
of fact, but the rest must be conjecture as to the latent har- 
monious ties of connection between intellect, reason and or- 
ganization. All the relations between the different nerves of 
the spinal cord and cerebral masses, so far as experiments 
show, seem to be intercepted at the summit of the medulla 
oblongata. Hitherto the inquisition may proceed, but here 
it is interdicted, and the " dark chamber of the mind " is her- 
metically sealed against intrusions. Another class of organic 
sensibility exists here, and no doubt of the most exquisite 
kind ; yet we are not permitted to learn its character, except by 
the results of its functional acumen, as experienced in all the 
pleasures and torments of mind. OUTLINES OF PHYSIOLOGY. 
93 
Experience demonstrates, that the internal faculties possess 
a high degree of voluntariness ; they are put in motion by 
thought, and this may be put in action by various external 
stimulations. When in a state of activity, radiations are sent 
along the nervous tissues leading to the locomotive muscles, 
exciting their contractions, and still under the guidance of 
judgment. In a pathological state, severe stimulations from 
internal causes reaching the summit of the spinal cord, induce 
abnormal contractions, or convulsions. We see how readily 
an extensive apparatus in other tissues, may be put in motion 
and continued, when not under the dominion of intellect. An 
excitation once made, an admirable catenation of collateral 
motions succeed. But, in the voluntary muscles, in a physi- 
ological state, the motions are constantly under the guidance 
of intellect ; unless habit establishes a kind of associated har- 
mony of motions, of which the mind may not be conscious, 
in some particular routine of motions. 
The spinal nerves of sensation that are partially bestowed on 
the locomotive muscles, transmit to the centre of perception, 
the condition of the muscles, as whether they are in a suita- 
ble state of mobility to perform the commands of intellect; 
and it is very common for them to receive some preparation 
by stretchings and trials. The nervous impulse affords to the 
muscles the ability of contracting ;-of loosening them into a 
state of relaxation, and of fixing them at any given point. 
Various modified motions of the skeleton follow the contrac- 
tions, as a sequence of their tendinous attachments. 
The locomotive muscles receive four grades or different 
states of vital susceptibility ; 1st, the innate vegetative force, 
(irritability) ; 2d, the muscular branches from the abdominal 
plexuses, by the arteries ; 3d, some filaments of the spinal 
nerves of the sense of feeling ; 4th, the proper spinal motory 
nerves in profusion. All these correspond in harmonious 
subordination in health, but their abnormal motions are sub- 
jects of pathology. 94 
GRADATIONS OF VITALITY. 
Although in the physiological state the encephalic influence 
holds the entire control of the voluntary muscles, yet there 
are many pathological conditions, in which the movements 
are supremely directed by the involuntary, or ganglial nerves 
in their composition. For example ; in the case of severe 
dyspnoea, the subject cannot use the vocal muscles, which 
are associated in the act of respiration ; they are not in the 
control of intellect; for all the muscular energy is directed to 
the dilation of the thorax. Neither can the will stop these 
motions, for they are necessary for the preservation of life. 
So of many other motions which are indispensable ; they are 
conducted by the instinctive impulses. These involuntary 
movements, like many other internal excitements, give origin 
to the vis conservatrix natures ; a kind friend, and though 
often banished by prejudice, has never left her home, or 
been guilty of a dereliction of duty. 
Whilst on the subject of the evolution and functions of the 
nervous tissues of external relation, and the organs under 
their influence, it ought not to be omitted to notice, that 
being the last in successive evolution, although of the most 
intense sensibility, it has the slightest attachment of vital 
force ; that it is the most easily exhausted, and the first to 
fail. In all fatigue or exhaustion, the intellect suffers first 
and most; next the external senses, and voluntary motion. 
Jt is so in high stimulations, in disease, and in old age. 
Common daily exercise demands nightly repose, in which 
there is an obliteration of all the functions of external relation. 
The organic nutritive tissues have far more persistency of 
vital force, and seem scarcely wearied in keeping up a con- 
stant circulation. After these have all failed the susceptibility 
of the primary tissues is apparent for some time, as has 
already been shown. This thesis might admit of much illus- 
tration. 
The subject of vitality, in connexion with the organizations, 
has already been extended beyond what was intended. Its OUTLINES OF PHYSIOLOGY. 
95 
prolixity may shorten other subjects. We do not intend to 
follow out physiology in detail, but chiefly to sketch the 
vital susceptibilities and harmonies, which appear more di- 
rectly connected with the diseased conditions of the system. 
This topic must be abandoned, after making a few notices on 
phrenology. 
21. Remarks on Phrenology. 
In our brief review of the cerebral functions, we have not 
travelled into the domain of modern phrenology . We dare not 
go, at present, beyond a consideration of those organs, the 
functions of which are pretty well accredited, and constantly 
manifesting themselves to our apprehension ; and even here 
some may think we have been too much groping in the mist. 
The specific cerebral organs can only be studied from the 
phenomena they exhibit in health, in disease, and by experi- 
ments ; and even then conclusions must be tardily made by 
much observation and comparison. Some other additional 
sense seems needed to make inquisition into the latent mean- 
derings of matter and mind, so securely invested in an osseous 
casket. It is impossible to designate how many specific por- 
tions of organization exist in the cerebral masses, in the 
present state of physiological advancement. There may be 
many, or they may be few. We are in favor of the thesis of a 
still greater plurality of organs than we have just specified ; and 
that an increase, or deficiency of organic structure in any indi- 
vidual, may so modify his appetencies as to alter his character 
for morality, as well as intelligence. 
It is probable that a strict study of the envelopes of the 
brain, may, in some degree, indicate propensities and. intel- 
lectual character, and in a manner to be read by the scientific ; 
but the scintillations of mind are continually bursting through 
the external senses, and emanating at ten thousand inappre- 
ciable avenues of the countenance, indicative of the qualities 96 
GRADATIONS OF VITALITY. 
of their fountain, and so legible as seldom to be mistaken by 
an unlettered dolt, if not describable by an erudite Lavater. 
The science of phrenology will probably advance with 
more precision, when physiologists shall have fully adopted 
the method of studying it particularly as relates to man, and 
by carefully comparing one part of the brain with another in 
the same individual. 
However, we cannot conceal the sentiment, that physio- 
logy has not arrived to such a point of perfection as to illustrate 
the varied tissues, their locations, and functional relations 
with a precision, to entitle the study of phrenology to assume 
the entire garb of a science. Drs. Gall and Spurzheim, as 
well as many others, are entitled to the thanks of the commu- 
nity of science for the advancement made in anatomy, for the 
spirit of inquiry excited, and the zeal with which investiga- 
tions have been pursued ; and it is yet hoped, that demon- 
strations may elucidate much that is now only accredited on 
apocryphal evidence. 
22. On the Inherent Force in Structures endowed with the 
three different Grades of Vitality. 
It is truly difficult to make very just estimates of the amount 
of vital force bestowed on the varied tissues endowed with 
vitality ; and yet upon a cursory view, it is distinctly discov- 
erable that there is a difference. That there is a difference 
of strength between living, and dead structures, no one ban 
doubt; and this property, or capacity, has been called vital 
tonicity ; a property often modified in intensity, and most 
apparantly so in disease. It is equally manifest that differ- 
ent structures are possessed of different degrees of this vital 
force. This subject will be attempted merely as indicating 
a plan for future investigation. 
1st. Vital force existing in the primitive stamina of animal 
structures. OUTLINES OF PHYSIOLOGY. 
97 
2d. Vital force combined in the tissues of the nutritive 
structures. 
3d. Vital force combined in the spino-encephalic mass of 
nervous matter, and relative organs. 
In relation to the first position, we discover a vital force 
comparatively small, yet steady and persistive. The ger- 
mination of plants, and the growth of the zoophytes appear 
to progress in a simple and easy manner, without manifesting 
very striking phenomena, when having arrived at their great- 
est limits, all their functions are comparatively small; and 
yet the force of the sap of vegetables has been computed 
as considerable, even that of three atmospheres. It is suffi- 
cient for all the purposes of circulation, nutrition, and growth. 
The vital force both in the lower orders of animals, and 
in vegetables is very adherent, for it requires much time, and 
essentia] injury done to their structures to deprive them of 
life. In the simple tissues destitute of nerves in the compli- 
cated animal bodies, there is a steady, and persistive impress 
of vital action, and this continues after the apparent death of 
the more vitalized structures. 
2d position.-In the nervo-nutritive apparatuses there is 
still greater force, but rarely the persistency as in the primi- 
tive tissues. To this grade belong the heart, arteries, and 
exhalants ; and partially the veins, absorbants, with all the or- 
ganism. We see tumors displacing bones, and spasms 
breaking muscles from their attachments. The first by the 
force of a morbid hypertrophy, and the last by the power of 
involuntary muscular contraction. We discover collections 
of matter in the interior of bones breaking them into frag- 
ments ; distentions of cavities from exhalations bursting their 
parietes. The processes of digestion, assimilation, and nu- 
trition going forward with force, and steadiness. The rounds 
of circulation going on against numerous opposing obstacles, 
and maintaining the conflict of disease, often to a great length 
of time. Here might be noticed the throes of the partu- 
rient uterus, and many other involuntary movements. 98 
GRADATIONS OF VITALITY. 
Assuredly herein exists a strong power in these vital actions, 
which indeed harmonize with the vegetative force, and they 
are persistive. With only the slight relaxations, for example, 
between the pulsations of the heart, and the respiratory ac- 
tions, with the remissions of organic movements ; this force 
is continued during the life of the individual, with the modi- 
fications already mentioned. 
3d position.-In this grade of vital structures we discover 
much force, or innervation in the voluntary movements, when 
directed by the most severe commands of intellect. The 
muscles are not possessed of great strength w hen deprived of 
vitality ; but, endowed with it, are capable of astonishing 
exertions. A man under excitement of intellect may carry 
a burthen of twice the weight of his own body ; and in walk- 
ing, bears the weight of the triple burthen on a few muscles 
of the leg. Sir C. Bell remarks, " But such is the depend- 
ence of the muscle on this vital endowment, that the moment 
it dies its power is gone ; and the muscle which would lift a 
hundred pounds while alive, cannot bear the weight of a few 
pounds wThen dead." 
The vital force of this grade is very intense, but not per- 
sistive ; it is soon exhausted, and can only be restored by 
rest and sleep. It may be increased for a short time by 
moderate stimuli, but the exhaustion will be more complete. 
The natural stimulus of voluntary action is that of the intel- 
lect, whilst the organism is in a state of moderate distention. 
Morbid excitations of the organs of intellect may excite it 
beyond the voluntary exertions. The intellectual faculties, 
also, in a state of excitation, manifest an eminent degree of 
brilliancy and vital force. 
Upon a review, then, of the three grades of vital force, 
we discover a climacteric gradation from the first to the last 
evolved, or superadded structures. They might be distin- 
guished as vegetative, nutrient, and nervous forces. OUTLINES OF PHYSIOLOGY. 
99 
23. J1 Synoptical View of the Tissues of Vital Susceptibility, 
and of the Nervous Systems, in the order of Evolution. 
DIVISION I. 
The primitive tissue ; essentially the cellular, with its albu- 
minous fluids ; called the generative tissue, or basis of all 
the others ; together with the resultant, elementary tissues, 
the fibrous, serous, mucous, muscular, glandular, osseous, 
dermoid, cornuous, pilous, &c., are all endowed with the first 
grade of vital susceptibility, the inherent power, vegetative 
force, vis insita, irritability. 
DIVISION II. 
As superadded to the above tissues, the ganglial, sympa- 
thetic, or trisplanehnic nerves ; which, together with the res- 
piratory, constitute the entire system of nutrient force. 
ORDER FIRST. 
The visceral ganglia, with their plexuses. 
a, encephalic. 
b, cervical. 
c, thoracic. 
d, abdominal. 
e, sacral. 
f, spinal filaments, and their ganglia. 
ORDER SECOND. 
Respiratory nerves from the middle rod of the spinal cord ; 
of single origin, and irregular in their course. 
a, the third, fourth, and sixth cranial nerves to the eye. 
b, the portio dura of the seventh to the face. 
c, the ninth to the tongue. 
d, glosso-pharyngeal to the pharynx. 100 
GRADATIONS OF VITALITY. 
e, par vagum, or pneumogastric, to the larynx, heart, 
lungs, and stomachy 
f, phrenic, to the diaphragm. 
g, spinal accessory, to the muscles of the shoulder. 
h, external respiratory, to the outside of the chest. 
ORDER THIRD. 
The, pneumogastric nerve, and the sixth, are the principal of 
the respiratory nerves that unite in the plexuses. After the 
intercommunications, the divergent nerves have three modes 
of distribution. 
a, the muscular branches, transmitted to the internal, invol- 
untary muscles. 
b, vascular branches, to the arteries, and with them dis- 
tributed to the voluntary muscles, the skin, and many 
other tissues. 
c, parenchymatous branches, sent into all the secreting, 
visceral organs, affording them specific, organic sus- 
ceptibilities, like the organs of the external senses. 
The foregoing divisions constitute the entire system of 
vital force, together with the appended tissues and organs, 
devoted to digestion, secretion, assimilation, nutrition, and 
generation. All their functions are constantly progressive 
without volition : and they, also, possess the instinctive 
susceptibility, and give origin to the conservative force. 
These tissues and the nutritive susceptibilities are the seats 
of all the phlegmatiae, and of all the pyrectic diseases to 
which the human system is liable. 
DIVISION in. 
As superadded to the above susceptibilities and tissues, 
the nervous system of external relation, or, as often styled, of 
animal life. By this splendid superstructure, is bestowed a OUTLINES OF PHYSIOLOGY. 
101 
knowledge of external objects, sensation, locomotion, and 
intelligence. 
ORDER FIRST. 
Cranial nerves, destined to the specific susceptibilities of the 
external senses. 
a, olfactory, to the nose, smell. 
6, optic, to the eyes, sight. 
c, portio mollis, to the ears, hearing. 
d, lingual branch of the fifth, taste. 
e, naso-palatine, to tongue and palate, 
/, first and second branch of fifth, to the face, 
feeling. 
ORDER SECOND. 
Spinal nerves, symmetrical; destined to sensation, and lo- 
comotion, or voluntary motion. 
Posterior rod, with ganglia, destined to the sense of feeling. 
(Cranial, see above.) 
a, 7 cervical. , 
b, 12 dorsal. 
c, 5 lumbar. 
d, 6 sacral. Thirty pairs, distributed to the papillae of 
the skin, and more sparingly wherever the sense of 
feeling is perceived. 
ORDER THIRD. 
Anterior trod, without ganglia, destined to voluntary motion. 
Cranial muscular, nerves; third branch of fifth to muscles 
of the jaws. Portio dura of seventh to muscles of the face. 
Spinal, a, 7 cervical. 
b, 12 dorsal. 
c, 5 lumbar. 
d, 6 sacral. Thirty pairs, to all the external mus- 
cles. 102 
PARTICULAR TISSUES. 
These nerves, and their organs the muscles, in their nor- 
mal state, are subservient to the mandates of intellect, or 
function of the cerebrum. 
ORDER FOURTH. 
a, cerebellum, and its appendages. 
i, cerebrum, and its appendages. 
The particular encephalic organs have not been satisfacto- 
rily demonstrated. 
External impulses are transmitted, by the appropriate ner- 
vous tissues, to the internal organs ; impressions, images, or 
ideas are there implanted, called up, and compared. 
For the effecting ^mental processes, certain functions or 
faculties are noticed, as attention, perception, memory, imagi- 
tion, reason, judgment. The exercise of these is attended 
with thought, and a conviction of consciousness. 
These functions prove the individual organs to belong to 
the order of voluntary movements. They act by volition, 
whilst the organs of external sense act from impulsion. 
The encephalic mass of nervous matter. 
SECTION VII. 
PARTICULAR TISSUES. 
1. On the Simple Elementary Tissues entering into the Com- 
position of Organs. 
Many of the tissues called simple, are not strictly so ; as 
it may be difficult to point out one, except the cellular, which 
deserves this qualification. But according to the views of 
Pinel, and Bichat, there are certain tissues entering into the 
composition of organs, or lining them, which possess distinc- 
tive properties. It is necessary these modifications should be OUTLINES OF PHYSIOLOGY. 
103 
studied, as relating to their containing more or less of the 
different molecules of animal matter, particularly albumen, ge- 
latin, and fibrin. Also, as to their cohesibility, density, vital 
susceptibility, and other properties. The physiological char- 
acter of the tissues modifies the organs, and having a knowl- 
edge of these, we anticipate the results of morbid conditions. 
Great discrepancies exist amongst physiologists, as to the 
number of tissues it becomes important to distinguish. Some 
have noticed many, others only a few. It will be in confor- 
mity to our design to notice chiefly those, which from their 
different vital susceptibilities, are liable to manifest diversified 
pathological phenomena. The organs, and their tissues mani- 
fest different degrees of morbid intensity, and its results, under 
similar impressions. All tissues are excitable by stimulations, in 
proportion to their vital susceptibility, or as it is usually termed 
excitability. It becomes necessary, therefore, to investigate 
the properties of the simple tissues, in reference to the for- 
mation of a pathological arrangement of the particular loca- 
tions of diseased action. And especially as disease, at its 
onset at least, most commonly affects a single tissue of an or- 
gan.-See nosographic arrangement. 
The nervous tissues have already been considered. With 
respect to the blood vessels, they must be esteemed as organs 
compounded of elementary tissues as much so as the lungs. 
The tissues then, which claim our present attention are the 
cellular, the fibrous, serous, mucous, dermoid, muscular, pa- 
renchymatous, nutritive and osseous. 
2. Of the Cellular, or Reticulated Tissue. 
This has been called areolar tissue, lamellated structure, 
mucous web, &c. It is formed of minute, whitish filaments, 
chiefly of gelatin. These combined, and by various cros- 
sings, form highly attenuated webs ; hence it often appears 
in a lamellated form. This is the first formed tissue from 104 
PARTICULAR TISSUES. 
fluid animal matter, and has been considered the matrix of all 
the other tissues, and to be the web of the living ens, which 
by certain vital, plastic powers, absorbs nutritious substances, 
or takes them by imbibition, or endosmose. It is very abun- 
dant in the composition of animal bodies, and seems to be the 
common bond of union of its integral parts. It would give 
form to the body, if all other tissues were removed. It unites 
the fibres, and tissues of organs, and some membranes appear 
to be a mere condensation of its substance. 
We are aware of the researches of Professor Fahmann 
and the Meckels, having terminated, in their opinion, in this 
conclusion, that " the greater portion of the umbilical cord, 
the transparent cornea and the conjunctiva, the serous mem- 
branes and the internal tunic of the vessels, consist almost 
exclusively, or rather entirely of a network of lymphatic ves- 
sels." Yet we do verily believe if all this were true, that 
these lymphatics may yet need some little ties to hold them in 
subordination. We are willing anatomists should settle their 
own accounts, and when they are well agreed we will not con- 
tradict them. 
Not only does it unite all the parts of the organs, and cover 
them with condensed membrane, but it invests the whole body 
under the skin, and forms adipose cells containing fat, which 
renders a safer protection from injuries, and supports the en- 
tire organization when distended, and retains caloric. It has 
innumerable cells of the serous kind, communicating through- 
out. They contain an albuminous irrigation for lubricating 
surfaces. The fluid matter exhaled by the arterial capillaries, 
is taken up by the absorbants. Fat, which is composed of 
carbon and hydrogen, is deposited in the close adipose cells, 
and being absorbed, serves useful purposes in nutrition. 
This tissue is very extensible, as shown in great collections 
of fat, or of serum, and in hypertrophies. It is, again, very 
contractile, so much so that Blumenbach speaks of a vis cel- 
lulosa. It may readily take its natural degree of distention af- OUTLINES OF PHYSIOLOGY. 
105 
ter much extension, and even become shrivelled in atro- 
phies. Its sensibility is of the lowest grade of animal tissues, 
partaking of the vegetative kind ; it therefore, in wounds, un- 
less in connection with other excitable tissues, gives slight 
sensation, or pain. As it is the most essential germinating 
tissue, it affords granulations to restore deficiencies of struc- 
ture. It is the common seat of abscesses, and exhaled effu- 
sions of blood, serum, pus, and even gas. 
Although this tissue in its peripheric distribution, as well 
as in connecting fibres and internal tissues, is often the appa- 
rent seat of phlegmatiae, and abscesses, yet the morbid loca- 
tion is in the more sensitive contiguous tissue ; and the 
matter of effusion is thrown into this extensible tissue as a 
reservoir. Erysipelas and rheumatism are examples. This 
tissue resists the processes of decomposition the longest of 
any. In extensive abscesses, after all the others are dissolved 
and removed, this may be drawn forth in masses or shreds. 
M. Andral remarks, " whenever an organ disappears, a greater 
or less quantity of cellular tissue is found in its place." 
In the physiological state, irritations on this tissue afford 
no radiations of sensation to the centre of perception ; no pain 
succeeds. But, in common with all insensible organic tis- 
sues, when in a state of excitation called inflammation, it 
transmits sensation ; yet it does not admit of the degree of 
intensity of pain of many other tissues, especially those of the 
more dense fabrics, it being comparatively mild. 
3. Fibrous Tissue. 
A very firm, dense tissue ; slightly contractile, but rather 
elastic ; of a dull white color ; M. Chausier styled it albugi- 
neous. To this tissue belong the tendons, ligaments, fascia 
of the muscles, capsules of the joints, periosteum, dura ma- 
ter, cornea and scelerotica of the eye ; the chorion of the skin, 
corpora cavernosa of the penis, middle coat of the large arte- 106 
PARTICULAR TISSUES. 
ries, &c. Its composition is essentially gelatin, as analysis 
shows, with a portion of fibrin. Its filamentary composition 
is very cohesive, and endures great resistance. The fibres 
run parallel, most commonly, however, with crossings, and 
all united by cellular filaments. 
Nothwithstanding the compactness and firmness of this 
tissue, in certain states of disease, it loses its density, and 
acquires the softenings common to other tissues, and may 
even become dissolved. It may be suggested, that a soften- 
ing of the middle coat of an artery may give origin to an 
aneurism, or, in the abdominal rings to hernia ; when inflamed 
it is liable to become hypertrophied. 
Although this tissue does not transmit red blood in its nor- 
mal state, yet in a forced circulation blood is injected into it, 
and it becomes the seat of high vascular action, and intense 
pain.-A tissue that may be cut, and torn without the sub- 
ject being at all affected, but after a few hours assumes the 
sensibility of external relation, and the centre of perception 
is notified of the injury. In wounds of the capsule of the 
knee joint, no pain is experienced until some thirty or forty 
hours, when it becomes intolerable, with inability to move, 
and the whole system is affected. During this interval, the 
whole system acquires a morbid sensibility, which is readily 
excited into action by slight exciting causes. In all locations 
of disease in this tissue, the intensity of pain, or of the mor- 
bid sensibility reflects irritations in a manner to increase the 
constitutional phenomena. So in gout, rheumatism, perios- 
titis, &c., the constitutional diathesis is of the dynamic cha- 
racter. The whole system experiences the vibratory echo of 
the exquisite local irritation. 
,We have before stated it as a fact, that this tissue from a 
state of insensibility, acquires perceptible sensibility. How 
this may be produced raises an intricate question. However, 
if we reflect, as has been shown, that every tissue possesses 
a vital susceptibility, yet in very different degrees, we may OUTLINES OF PHYSIOLOGY. 
107 
conceive that some, as this very tissue, may possess so low 
a degree, the vegetative without nerves, as not to be radia- 
ted to the centre of perception, in a normal state. Yet, after' 
a stimulus has been applied for some time, the flow of fluids to 
the part, along with the other stimulations, raises this grade 
of the vital force, so that it assumes a higher, and then radi- 
ates with the other tissues of higher order, to the centre of 
perception. 
And, again, during this lesion of a part, the minute neigh- 
boring nerves of relation receive great stimulations from the 
distention, and other incitives, and their sensibility is increas- 
ed ; so they respond more intensely to the centre of percep- 
tion. M. Bichat states, that ligaments may be cut, torn, and 
stretched in a straight line without exciting pain ; but when 
twisted much pain was excited. All this might be from the 
act of twisting, drawing the neighboring nervous expansions 
of other tissues into the conflict. However, it is a fact well 
recognised, that excitations exalt the sensibility of the simple 
tissues to a high grade. May not all this arise from the in- 
stinctive motions to gain greater force to repel injuries ? 
The degree of vital force is greater in the fibrous tissue, 
as acknowledged by M. Bichat, yet, we can scarcely credit 
him when he says, that, " it hardly ever contributes to the 
formation of pus.v We would rather say, that it is the most 
common tissue that excites the flow of those exudations from 
arterial capillaries, which become converted into pus. So 
we find extensive collections of pus both above and below 
the fascia, and aponeuroses of muscles ; both above and be- 
low the periosteum, and in the internal fibrous membranes of 
bones ; below the skin, or fibrous chorion of the skin ; and 
indeed in the vicinity of the fibrous tissues in every part of 
the system. 
This tissue has two adherent faces, and its connections are 
by the medium of the cellular tissue. The cells, and lamina 
of this tissue every where secrete a sero-albuminous fluid, and 108 
PARTICULAR TISSUES. 
slight excitements cause an abundant flow of it ; and the very 
circumstances which increase its flow, change its character, 
so that a few animo-chemical changes convert it into pus. Now 
we are notified of the seat of the phlegmatise being in the 
contiguous fibrous tissue by the excess of pain, heat, increas- 
ed sensibility, and the general sympathies, rather than in the 
less sensible cellular tissue. Yet the radiations of morbid ac- 
tions excite a flow into its vicinity from the serous exhalants 
of this tissue, rather than from the fibrous, which is not sup- 
plied with similar exhalants to secrete the sero-albuminous 
matter. Its containing some fibrin, and its density, render it 
more excitable than the cellular tissue. 
The reason why pure pus does not form in the instance of 
rheumatism, and wounds in the capsules of joints, is, that 
sero-synovial tissues exist in the vicinity of the fibrous tissue, 
and the secretions are not of the most ready kind to be con- 
verted into what surgeons call laudable pus ; but it is a mix- 
ture, some synovial secretion, some albumen, and some the 
matter exhaled from the cellular cavities. However, when 
the effects of the inflammation extend further, and severely 
along the fibrous fascia of the muscles, it seldom fails to ex- 
crete the matter suitable to be converted into purulency, es- 
pecially when connected with a severe constitutional affection. 
In a mild state it may produce hydropic intumescence. 
Although in following out the sensibilities of this, tissue, we 
have been led too much into the domain of pathology, yet it 
seems necessary to say thus much here, for the purpose of 
this tissue asserting its right in the pathological arrangement, 
which may in due time be offered. This subject might be 
further illustrated.-See note in nosography on the fibrous 
tissue. ' r OUTLINES OF PHYSIOLOGY. 
109 
4. Serous Tissue. 
A thin, diaphanous tissue ; smooth on one side, and ad- 
herent on the other. It is found as a delicate lining over all 
the viscera of the head, thorax, and abdomen. It is, also, 
reflected, and lines all the cavities containing those viscera. 
It is found in its most delicate thinness in the inner coat of its 
own name, the serous cells of the cellular texture in various 
parts of the system, but more particularly by its subcutaneous 
aggregate. It is found lining the inner, or free surface of the 
fibrous capsules of the joints ; and also, on the inner surface 
of all the arteries and veins. The pia mater, and arachnoides 
of the brain claim affinity, and many others. Its extended 
expansions in the thorax and abdomen deserve particular 
attention ; also, the lymphatics and other absorbants. Not 
one of the cavities it lines has any external opening or outlet, 
except by the capillary absorbants and exhalants, otherwise 
than the slight one by the fallopian tubes. 
The serous membrane is very thin and dense ; it will 
endure much stretching, to which it offers considerable 
resistance, which may be seen in the pericardium, which 
consists of two layers connected by a little cellular tissue, 
whereby it offers two free surfaces, one on the thoracic side, 
the other on the cardiac. Its composition does not seem to 
be a compound, but simple, and has been esteemed to be a 
modified condensation of the cellular tissue. Like this it is 
essentially composed of gelatin, and is not readily affected by 
gangrene, nor by maceration in its dead state. 
Blood vessels pass through the subjacent membrane of the 
serous tissues, and in a normal state only white blood, or the 
blood deprived of the red particles, penetrates it. But when 
in an excited state of action, it is penetrated by red blood, 
and in some severe states of inflammation, transudes with the 
serosity into its cavities, or sacs. Anatomists seem not to 
be well agreed in relation to what the serous tissue adheres to. 110 
PARTICULAR TISSUES. 
Some say it is a double membrane ; others that there is a 
condensation of cellular tissue on the outer surface of this, 
and others say it is a proper fibrous fascia everywhere cover- 
ing the organs, and supporting the sacs. We are inclined to 
embrace the latter opinion, and to consider it as related to 
the fibrous tissues, believing this will accord with the morbid 
phenomena in many states of disease. 
There is a constant exhalation from the smooth surfaces of 
this tissue, into the sacs, of a serosity, but without any saline 
particles ; and injections of the finer kinds also pass. The 
exhalation may be wiped off, and soon be again bedewed, in a 
living animal. It possesses merely the organic sensibility, as 
it is sometimes called, like the fibrous tissues. Whilst the 
mucous tissue endures a vast variety of heterogeneous sub- 
stances, this tissue will not bear anything only its own matter 
of secretion ; even the contact of atmospheric air is very 
liable to excite it into a state of morbid incitation. When 
excited in the instance of inflammation, the sensibility seems to 
be of an exquisite kind, and the affection rapidly extends over 
a whole sac ; and not only so, but appears to draw into a 
kind of concatenation or harmony, remote tissues of a similar 
kind. It seems to give to the whole system, when so affected, 
a peculiar morbid tone ; and probably through its harmony 
with the inner coats of the blood vessels, and the serous tis- 
sues investing so intimately the brain. The train of morbid 
phenomena alluded to, are those denominated ataxic, or more 
properly adynamic ; or as more commonly enumerated, as the 
phenomena constituting the low typhoid diathesis. 
As instances in reference to the above allusions, we might 
notice the morbid concentration affecting this tissue in the 
abdomen, called peritonitis ; in the thorax, pneumonia ty- 
phoides, in which this tissue suffers essential lesions. Also, 
in spotted fever the irruption leaves traces, on dissection, 
extending over the whole tissue. The instances of phlebitis 
and arteritis might be noticed ; as also, arachnitis, and many OUTLINES OF PHYSIOLOGY. 
111 
concentrations of diseased action in various pyrectic habits. 
Do the affections of this tissue disturb the economy of the 
nutritive ganglia, and plexuses, immediately outside of it ? 
As these considerations of the elementary tissues are intended 
to have reference to a pathological arrangement of diseases, it 
may be remarked here, in order to be rightly understood, 
that the causes of disease make a general impression on the 
system, that the whole system is disordered, and locations in 
particular tissues are a constant sequence. When so located, 
reflex actions are more or less intense on the general system, 
as the tissues possess different sensibilities, and other modi- 
fying circumstances. These subjects will merit particular 
attention in the department of pathology. 
The serous tissues, like all others, are subject to acute 
and chronic affections. In the former, the process is often 
very rapid, and various modified effusions are the results, 
such as a dense serosity, sometimes uniting the contiguous 
surfaces of the membrane together ; sometimes forming a 
false parasitic tissue ; sometimes a bloody serosity, with 
albuminous coagula. It is justifiable from analogy, to suggest, 
that the subjacent tissue of the serous, is a membrane par- 
taking of the character of the fibrous fascia ; and as the blood 
vessels ramify in it, this tissue is essentially affected in the 
severe states of disease, and is an important agent in affording 
these effusions. The visceral organs all have a similar fascia 
investing them, and affording them strong support, and when 
in an incited state afford effusions more or less dense. At 
other times large portions of serum are poured in, constituting 
dropsies. The serum will coagulate by a low degree of 
heat, by acids, &c. This tissue is subject to hypertrophies, 
tubercles, and many other lesions. 112 
PARTICULAR TISSUES. 
5. Mucous Tissue. 
This is a tissue of very considerable extent, and of high 
importance in the economy of the system. It lines all the 
inner surfaces, which have external openings, as the skin 
lines the exterior. It unites with the skin at all the outlets ; 
or, as some speak, it seems to be a continuation of the skin, 
between which exist many affinities and harmonies. 
Its great divisions are into gastr o-pulmonary, and genito- 
urinary, each having separate oXitlets, and no communication. 
The first division comprises the lining of the eyes, nose, all 
the passages of the internal ear, the fauces, and all of the aerial 
pulmonary passages, as well as all the ducts connecting with 
all the parts named. The other division has its openings at 
the glans penis in the male, and vulva in the female, and lines 
all the organs connected with urination and with generation, 
to their remotest points, through every avenue to the source 
of their organic secretions. It does not belong to the present 
design to follow out the anatomy of this tissue ; however 
interesting it may be, it must be learned from other sources. 
It is called mucous membrane from the numerous mucous 
follicles seated in its subjacent adhering surface, and opening 
upon the free surface, pouring out a soft fluid, wThich constantly 
moistens it, and defends it from various excitations to which 
it is constantly liable. The follicular glands are more abun- 
dant in some places, as the fauces, than in others. That this 
tissue should be defended by such lubrications, it being deli- 
cate and sensitive, is very apparent from the fact of its being an 
essential agent in the processes of vociferation, respiration, 
digestion, secretion, generation and excretion. 
The adherent surface of the mucous tissue, and which con- 
stitutes its body, is of similar composition to the chorion of 
the skin, but much thinner, except in some parts of the mouth ; 
and it is comparatively very tender, being easily torn. On 
the free surface are situated the villi ; it is called the villous OUTLINES OF PHYSIOLOGY. 
113 
coat from its soft downy appearance. These villi are ex- 
tremely numerous, and stand as projecting filaments, as fine 
as.the finest hairs ; they consist of an artery and veins, to- 
gether with lacteals, and nerves. These prominences act a 
conspicuous part in the processes of digestion ; they are tur- 
gid in a state of excitation, and again may be flaccid, and 
this circumstance causes a variation in their color from a deep 
to a pale red. In some diseased states, they become dis- 
tended with carbonized blood, and exhibit a very dark color. 
They vary with the skin in complexion, as the subject may be 
affected with plethora, or inanition. In disease this tissue 
may be turgid, and livid, whilst the skin is very pale, and 
shrunk. This is very common in malignant fevers. 
Besides the vessels of the papillae or villi, there are a vast num- 
ber of exhalants diverging directly in a short course from the ca- 
pillary arteries, which open upon the inner face of this tissue. 
These vessels afford a constant exhalation, and in diarrhoeas 
often pour out immense quantities of serosity. Leaving the 
controverted question, whether the lymphatic absorbants take 
up fluids by this tissue, we are assured that the venous radi- 
cles do, either from the inner surface, or after endosmose. 
Another set of vessels, arising from this tissue in the intes- 
tines are the lacteal absorbants ; these need only to be named 
here. The mucous tissue itself is but slightly contractile, 
whilst its subjacent muscular, and fibrous tissues readily con- 
tract and leave the villous in plaits or folds. 
It every where possesses the instinctive, or organic sensi- 
bility, and in many parts the sensibility of external relation, 
by which impressions, in a normal state, are communicated 
to the centre of perception. In this it has an affinity to the 
dermoid tissue. Its sensibility is therefore more intense than 
any other internal tissue. As the vital impressibility of this 
tissue is variously modified in the different portions of it, con- 
nected with the functions of different organs, it will be ne- 
cessary to bestow some attention to each of them. 114 
PARTICULAR TISSUES. 
The mucous tissue of the external part of the eyes is 
plentifully supplied by the nerves of external relation, and 
is therefore very sensitive ; slight excitants produce pain, 
and an abundant secretion of tears, of the matter of exhala- 
tion and mucus. The tissue lining the nostrils, and sur- 
faces connected with the sense of smell, Js supplied with 
sensitive nerves of relation, besides the ganglial and olfac- 
tory. The mouth, fauces, and pharynx in like manner, with 
the addition of their specific sensitive nerves. In pathologi- 
cal states of these tissues there is an intense reflection of 
morbid harmonies. 
Pursuing this tissue in its pulmonary route, we discover 
again intense sensibility in the uvula, and larynx. In follow- 
ing it into all the aerial arborescences of the lungs there are 
but few nerves of external relation, and but little notice is 
given of injuries, except from the larynx. Disease may 
make important changes in the pulmonary mucous tissue, with- 
out its being felt, unless other tissues become involved, and 
then the sensibility of relation is obtuse. Notwithstanding, 
this tissue, especially at the larynx, possesses a very discrim- 
inating sense in notifying of the necessity of pure respirable 
air. The glottis sometimes suffers contractions from irrita- 
tions, even to suffocation. The functions of the pulmonary 
tissue are extremely important in the process of oxygenation 
and aeration. Irritating substances applied to any of these sur- 
faces, excite a secretion of mucus, and the matter of exhala- 
tion, by which they may be expelled by the aid of coughing. 
Each poriion of the mucous tissue possesses an instinctive 
sense peculiar to itself, and which becomes subservient to the 
economy of the organ it stands in relation to. So with re- 
spect to the digestive portion, we discover in the mouth and 
pharynx, nerves of both taste and feeling, and these are ne- 
cessary and perform indispensable functions ; but the sense of 
hunger, and the particular food or drink required, exists in 
the mucous tissue of the cardia and stomach. It is to this OUTLINES OF PHYSIOLOGY. 
115 
centre that radiations are made from even the nutritive tis- 
sues, indicating the wants of the system ; the gustatory sense 
harmonizes, and the centre of perception recognises it. All 
the nerves of relative sensibility communicate to the spino- 
encephalic mass, with sensation terminating in the medulla 
oblongata. 
Whilst these sensations are in general distinct and con- 
stant, we find the tissue of the stomach and intestines endur- 
ing a vast many heterogeneous substances with impunity. It 
possesses a controlling power in subduing hard, acrid and 
foreign substances, and yet a lively sensibility to others, as 
the various medicaments used to excite its action for particu- 
lar purposes. Some of these affect one portion of this ex- 
tended tissue, and yet scarcely another portion ; when im- 
pressed in any considerable degree, other tissues are drawn 
into harmony of action for their expulsion by either outlet. All 
these motions indicate a modified state of sensibility in the 
organic tissues. Carbonic acid is refreshing to the stomach, 
but suffocating to the lungs. The succus gastricus is a se- 
cretion, the result of a specific sensibility in the organic tis- 
sues of the stomach. No a priori reasoning can have refer- 
ence to these phenomena, they must be learned by experi- 
ence. 
It is said by some anatomists, that there are no nerves of 
external relation distributed in the lower part of the small, and 
upper part of this tissue in the large intestines. Affections 
strictly confined to it there, do not exhibit phenomena indi- 
cating their existence until far advanced. Lesions are dis- 
covered on dissection, which were not suspected. How- 
ever, slow changes may take place in like manner, in almost 
any part. As we approach the anal portion, the sensibility of 
external relation becomes manifest. There is, however, a 
harmony of action throughout this tissue ; tickling the fauces 
excites nausea, and sometimes vomiting ; croton oil proves 
purgative before it can possibly reach the large intestines ; 116 
PARTICULAR TISSUES. 
gamboge and veratrum, in moderate quantities in the stomach, 
excite a flow of saliva, and of serosity into the large intes- 
tines at the same time, and before they can have reached in 
substance into the latter portion. 
The sensibility of this tissue is no less striking in the por- 
tion of it devoted to urination. At the lowermost parts of 
this apparatus there are full supplies of the nerves of exter- 
nal relation, affording intense sensibility in health, but intoler- 
able in a state of morbid excitation. At its superior part, 
the kidneys and ureters, it is regulated by the organic sensi- 
bility, and morbid states are but indistinctly indicated. The 
mucous tissue of the bladder endures the acrid mixture in the 
urine, whilst it becomes impatient under the influence of 
milder fluids. However, in a turgid state of incitation, it 
becomes impatient of even small quantities of urine, and 
voids it often. 
The sensibility and harmony of excited motions in the 
mucous tissue of the genital apparatus, are no less specific, 
and by far transcend any of the other portions. At, and with- 
in the openings in either sex, there is a plentiful distribution 
of the nerves of external relation ; whilst they diminish, and 
become wanting in the parenchyma of the respective secre- 
ting organs. However, congenial excitations produce move- 
ments, which are continued to the remotest points of the tis- 
sue by an instinctive process. In the male these motions 
begin at the secreting tissues, and are progressive ; whilst in 
the female they begin at the outlets, and are retrograde, trans- 
mitting to their tissues of secretion, with no less intensity. In 
the state of excited erethism, radiations are transmitted to the 
centre of perception, from the entire genital apparatus of each 
sex, which under other circumstances might not be intense 
enough to be perceived. 
There exists an intimate harmony of action between this 
internal tissue, and the skin, but they pass unnoticed in 
the normal state ; it is in the pathological condition that OUTLINES OF PHYSIOLOGY. 
117 
they are made the most manifest. These must be sub- 
jects of pathology. In the mean time it may be noticed 
that this tissue, partly from its structure, partly as placed in 
opposition to the dermis, on which many causes of disease 
have a direct influence, and partly from its vital susceptibility, 
becomes the concentration of many forms of disease. Or in 
other words, it forms a place for the local phenomena of the 
diseased habit to become apparent in numerous instances. To 
it may be referred catarrhs, coughs, diarrhoeas, dysenteries, 
gastric fevers, dyspepsy, all the varieties of hemorrhages, 
and many others which may be found in nosographical ar- 
rangements. 
With regard to the character of the diathesis accompany- 
ing locations on this tissue, it commonly holds a middle grade, 
or not of the intensity of morbid action as those phenomena 
resulting from locations of more dense tissues. We can only 
speak generally ; there are exceptions, but usually the affec- 
tions having a concentration of morbid location in mucous 
tissues, are attended with a general habit of diseased action 
often denominated synochus. The yielding state of the tis- 
sue, and readiness to discharges, mitigate the severity of dis- 
tention, and its results. But these subjects require more 
illustrations than can be given here ; the remarks are prema- 
ture. 
6. Dermoid Tissue. 
The skin presents first, the epidermis, or cuticle, an inor- 
ganic, scaly membrane, slightly attached by cellular fibres 
to the subjacent parts ; it may be easily separated by stimu- 
lations exciting a free flow of serosity, producing vesicles, or 
blebs ; it is insensible, penetrated by exhalants, and serves as 
a defence. Secondly, the rete mucosum, or reticulated mem- 
brane, of a delicate, cellular fabric, covering and defending 
the sensible papillae. It contains a black pigment in negroes, 118 
PARTICULAR TISSUES. 
but diaphanous fluids in whites. It is bedewed with aqueous 
fluids, which in a free circulation in warm weather, contributes 
to give plumpness and smoothness to the surface ; but in 
cold weather, and in all instances depriving the skin of a free 
circulation, it shrivels and occasions a contraction of features. 
When over distended in the case of blistering, it is ruptured 
and injured. It is the seat of the cutaneous efflorescences 
and eruptions. 
We next discover the chorion, or true skin ; a dense mem- 
brane, which some divide into various lamina. It is composed 
essentially of gelatin, with a little fibrin, disposed in firm fibres, 
crossing, and interlacing, leaving foramina. It partakes very 
much of the character of the fibrous tissues. It is adherent 
like them, on both its surfaces ; on the outside by the mem- 
branes just mentioned, and on the inside by numerous attach- 
ments of the subjacent cellular tissue ; yet in some places, as 
in the face, by muscular attachments. It is penetrated, first, 
by the hairs, which originate in and below it. Secondly, by 
the mouths, or short outlets of the sebaceous follicles. Third- 
ly, by the arterial exhalants, which convey the fluid of trans- 
piration, with saline, and other principles accompanying it. 
Fourthly, by capillary arteries, and their accompanying nerves 
of internal relation, together with the sensitive nerves of ex- 
ternal relation, all which enter into the formation of the papil- 
lae in the reticular membrane. To these may be added the 
returning veins and lymphatics. The inner surface in partic- 
ular, of the rete mucosum is very vascular, beset with numer- 
ous arteries and veins encircling the papillae, giving floridity to 
the skin, especially in a turgid state. 
The dermoid tissue acts an important part in the economy 
of the system, and scarcely inferior to that of the mucous, as 
will be shown in the processes of exhalation, absorption, ca- 
lorification, &c. Impressions on the surface are readily trans- 
mitted to all the internal tissues, and the vital harmonies are 
reflected from these very promptly in health, and often in OUTLINES OF PHYSIOLOGY. 
119 
disease into the papillae, and reticular expansions. In a healthy- 
subject, the balance of vital movements may be seen broken 
many times in the twentyfour hours, and with but little incon- 
venience ; it is in the diseased state that these phenomena are 
the most important. They are continually liable to variations, 
and especially to internal retrocessions, aggravating every phe- 
nomenon. 
When floridity is present, it affords evidence, that the capil- 
lary absorptions of the internal tissues are free and active, and 
if there should have been much of a congestive state, it is 
now removed by the natural processes ; yet, when the surface 
remains pale, shrivelled, and cold, there is always an excess 
of blood in the internal capillaries, attended with more or less 
distress, faintness, and a liability to pain, and membranous in- 
flammation. It is an essential desideratum at all times, in 
health as well as in disease, that an equilibrity of circulation 
be maintained. 
In health, moderate exercise contributes, and is usually 
sufficient for this object, along with suitable food, and cloth- 
ing, even in a cold atmosphere ; but, in the diseased state, it 
is often necessary to apply rather high degrees of caloric to 
the surface, with frictions, rubefacients, &c., and at the same 
time, caloric internally by means of liquids, together with 
evanescent stimuli. The varying states of the dermoid func- 
tions, therefore, become objects of primary importance in 
health, and also in every diseased state. 
The harmonies of the external and internal tissues are 
evidently sustained by the system of nutritive nerves; the 
nerves of sensation transmit, more or less perfectly, these 
abnormal processes to the centre of perception. Changes 
in the density of the atmosphere, as indicated by the barom- 
eter, as well as heat and cold, alter the functions of this 
tissue. 
The papillae appear to be formed of the two orders of 
nerves, of arteries and veins, connected by the common cel- 120 
PARTICULAR TISSUES. 
lular tissue, and stand slightly elevated on the surface. Their 
vascular structure gives them some erectile force, when ex- 
cited by friction, by the stimulations of caloric, and other 
excitants, and a free circulation follows. They are extreme- 
ly numerous, covering the whole surface, and are the medi- 
um of the sense of feeling ; and are more prominent on the 
extremities where resides the most discriminating sense of 
touch. This sense is very extensive, and seems to harmon- 
ize in an especial manner with all the other external senses. 
It brings together the united harmonies of all the external 
and internal relations, so far as their influence extends into the 
interior. Their immediate function is, to transmit radiations 
of sensations from the surface to the centre of perception. 
Allusion is now made to the sensitive nerves of external re- 
lation. 
But, is there not another order of nerves, likewise, termi- 
nating in close contact in the papillae, the internal nerves of 
instinctive sensibility ? So modern anatomists conclude, if 
they cannot dissect them to their ultimate termination ; neith- 
er can the others be so followed out. But, both are closely 
followed to the papillae, the one in solitary filaments, and the 
other parasitically clinging to the arteries. What is the use 
of all this extensive display of the latter order of nerves in 
the arteries, and in the tissue of the skin ? Can the function 
of this order of nerves be directed solely to the arterial im- 
pressibility, 'or are they also charged with other functions ? 
We find that other vessels perform the office of circulation, 
without this display of nerves, which are destitute of a car- 
diac impulse too. Scarcely any nerves are found in the ve- 
nous circle, which is double that of the arteries. So, also, 
in all the wide range of absorbants, all the white dense tis- 
sues, saying nothing of the pilous, and cornuous textures. 
We are bound to the thesis, that theirs is the instinctive sus- 
ceptibility, and this is a part at least of their functional office. 
May we not infer, that these internal nerves also radiate OUTLINES OF PHYSIOLOGY. 
121 
sensation ; not that of the spinal nerves, not to the centre of 
perception, but of another kind, to the organs of instinctive 
sensibility in the interior ? M. Lobstein insists, that this in- 
ternal system of nerves extends over the whole body, " and 
connects the different parts in close union with itself." Now, 
how is this union effected, unless it is possessed of a sensibi- 
lity by which radiations communicate ? There is then a sen- 
sibility peculiar, and ample for all organic movements and 
harmony, which is essentially independent of the spino-ence- 
phalic nerves, and of which the centre of perception is not 
advertised, except in excess of impulse, and then in an im- 
perfect manner, by the scanty intercommunications of the 
nerves of this order. 
With a full conviction of these physiological references, 
we are prepared to dissent from the views of M. Broussais, 
whose ingenious researches we have read with much satis- 
faction, when he says, " All these facts concur in proving, 
that stimulations exercised on the cutaneous sense, can act on 
the viscera only through the medium of the brain ; - that the 
movements determined in the muscles of locomotion by this 
organ, are invariably the effects of the sensations which it 
perceives secondarily in the viscera ;-finally, that the organic 
movements are in all instances influenced both by the sensa- 
tion, and by the exercise of the muscular contractibility." * 
We are well aware of the extent, and importance of the 
cutaneous sensation of external relation, that it is correct in 
its radiation to its centre, and that a wide range of harmoni- 
ous actions, both muscular and organic, may be set in play 
by it; the first by volition, the second by association. It 
will be granted, that touching the polished surface of " a fe- 
male" excites motions through the agency of thought, and 
radiating thrills involuntarily pass through the organism ; they 
are excited to action, but the will does not control them, nor 
can it scarcely modify them. 
* Phys, applied to Path. p. 64. 2d Edit. Philad. 1828. 122 
PARTICULAR TISSUES. 
Titillation is of similar explanation, except that it excites 
a double sensation, partly of pleasure and partly of pain. 
When slight, volition may silence muscular action, and the 
subject may sit still under it, but when intense it cannot. 
Resistance is made, even if the person tickled determines 
not to make any. The convulsive motion is not controllable ; 
the most violent and involuntary efforts are made to avoid the 
contact, and if unavailable, convulsions may ensue, and the 
violence of these may derange the entire economy, and per- 
adventure may terminate in death. These involuntary move- 
ments confirm an established law in physiology, as expressed 
by M. Lobstein, " that the voluntary muscles perform a 
double, and the involuntary a simple part -because the 
former have two orders of nerves, whilst the latter has but 
one. But we have not yet considered the proposition, that 
the cutaneous sense can act on the viscera only through the 
medium of the brain. a 
There is a sense existing in the skin, which transmits ra- 
diations directly to the viscera. There are numerous impres- 
sions made on the surface affecting the internal tissues and 
viscera, of which the intellect, and cerebral harmonies take 
no cognizance, nor the sensitive nerves any perception. 
Thus a person that sleeps in a cold place is liable to urinate 
often, and if a child, to do so unconsciously. One may sleep 
quietly, and presently be aroused by a tormenting colic, or 
tooth-ache, or, it may be, pleurisy or rheumatism. Most epi- 
demic diseases become excited during sleep ; a state when 
all the functions of external relation are dormant ; it neith- 
er perceives nor does it issue mandates, or take cognizance 
of unusual impressions. 
But, we have evidence of the excitation of the viscera 
without the medium of the brain during waking hours from 
cutaneous impressions. It is very common for people to re- 
ceive an impression of cold damp air, by sitting in a room 
in which the cerebral cutaneous sense does not admonish the OUTLINES OF PHYSIOLOGY. 
123 
intellect of the sensation of coldness. Again, an epispastic 
may produce strangury without advising with intellect. The 
stimulations on the'sensitive surface notify the centre of per- 
ception of uneasiness, and when they have done this they have 
performed their chief office. So the sensitive nerves of the 
trigone plane of the bladder, and of the urethra may perform 
their office too, but still the strangury continues. Indeed, the 
epispastic may have its effect on the surface, and irritations 
be set up in the urinary apparatus in paralysis, and apoplexy, 
whilst all the apparatus of external relation is totally unim- 
pressible, and gives no alarm. Medicaments rubbed on the 
skin produce vomiting and purging, as well as titillation of the 
fauces. Cold, caloric, and the tepid bath, may be noticed as 
modifying internal tissues independent of the nervous system 
of external relation. So also, the iatrileptic applications. 
With respect to impressions made on the internal surfaces, 
they are acknowledged by all to affect, oftentimes, the func- 
tions of the skin. The effects of nauseating medicines are 
visible ; as well as warm aromatic teas. The internal irrita- 
tions in phthisis, and in numerous other states, excite sweats 
and chills. 
These notices have been made for the purpose of arriving 
at the conclusion of there being some other medium, through 
which impressions affect the viscera, besides the nervous sen- 
sibility of external relation. This medium must be the ter- 
minations of the visceral or ganglial system of nerves, accom- 
panying the arteries, and spread on the vascular tissue in the 
reticular structure, and papillae. They have a peculiar sen- 
sibility, or instinctive susceptibility. Impressions on either 
surface radiate to various tissues, and their centre of harmon- 
ies is the semilunar, and other ganglia, with their plexuses. 
It appears the attention of pathologists has been fixed too 
much on the more striking phenomena of the functions of 
external relation, whilst the more abstruse of the internal 
have been neglected, and by many esteemed as unapprecia- 124 
PARTICULAR TISSUES. 
ble. This is the great theatre of the tragedies of all the 
most destructive maladies ; the ataxic, dynamic, and adyna- 
mic fevers, apoplexy, tetanus, with a large proportion of the 
nomenclature of the modified habits of disease, affect the in- 
ternal tissues, and their nervous susceptibilities. 
It is not intended in this place, to notice all the functions 
of the dermoid texture ; they are pretty extensive, and many 
of them will be noticed as separate topics. It may be re- 
marked, that this is rather a compound tissue, and might bear 
the appellation of an organ. However, it has commonly 
been treated of as a tissue. In a nosographic arrangement it 
will be considered as a tissue, and as a totality of function, 
although various simple tissues are in combination. 
This tissue is thickly beset with red capillary vessels, and 
these intermixed with a dense tissue. It is also subject to 
numerous local excitations. It is often the theatre of the con- 
centration of the morbid habit in the form of eruptions, and 
inflammations, and its physiological structure inclines the 
diathesis to be dynamic. It harmonizes extensively with all 
the internal tissues. There is a frequent retrocession of ac- 
tion from the surface, in disease, to the internal tissues, at- 
tended with paleness of the skin, internal turgescence, dis- 
tress, &c. This thesis will merit an extension in pathology. 
7, Muscular Tissue. 
After what has hitherto been noticed, our remarks on this 
tissue will be brief and desultory. The contractile fibres are 
what give to muscles their peculiarity of tissue ; and this 
shortening, by moving the organs attached to their extremi- 
ties, produces the phenomena of their functions. 
Although we call this also, a simple tissue, yet many other 
tissues enter into the composition of muscles, whilst we have 
a principal reference to their contractile fibres. It has been 
seen that two sets of nerves pervade their entire texture, one OUTLINES OF PHYSIOLOGY. 
125 
from the spinal cord, the other by the arteries, like the der- 
moid tissue, from the system of involuntary nerves. Both 
these orders of nerves are superadded to the primitive, in- 
nate susceptibility of the simple tissue. 
Besides these they are plentifully supplied with blood ves- 
sels, which give to most of the muscles a red color, which 
may be all washed off, and leave the muscular fibres white, 
and this is now found to be formed very entirely of fibrin. 
Like other tissues, they have veins, lymphatics, and much 
cellular tissue, which connects the whole together, and by 
their fascia formed of the same in a condensed state, holds 
the whole together in the varied modified forms. We see 
then, that the cellular tissue, composed of gelatin, enters the 
texture of muscles, and even the neurilema of the nerves is 
of the same element. 
Here are organized tissues pervading muscles, and closely 
surrounding the muscular contractile fibrils, and their nerves 
of excitation. So it is also throughout the entire nervous 
tissues, even to the minutest fibrils of the encephalic masses. 
The blood vessels then, so intimately pervading these tissues, 
sustain them' in their physiological functions, but when in a 
morbid excitation, cannot fail to give them undue stimula- 
tions, and essentially alter their functions. It is well known 
to all how readily the vascular system may be excited, and in 
fact in almost every abnormal state, is agitated, and astonish- 
ingly modified in function, attended with various pathological 
results ;-so all these simple, yet susceptible tissues, receive 
impressions from this source, greatly modifying and altering 
their functions. Hence the great influence the circulatory 
system has on the functions of the muscular and nervous 
systems. 
Do the muscles possess the power of dilatation also, as well 
as contraction ? We know of no such power. The intes- 
tines, on a superficial inspection, appear to have this power, 
but it is only on account of another order of fibres coming 126 
PARTICULAR TISSUES. 
into action, after a previous order have been in action, which 
offers the illusive phenomenon. So a worm in motion, shows 
a modification of form, by the action of a different layer of 
muscular fibres. The muscles are released, and fixed at any- 
given point of their circles of movement by the act of voli- 
tion. They are the instruments of intellect, subject to its 
orders and harmonies ; and like this, soon become weary, 
and require repose. 
The strongest argument in favor of the active dilatation of 
muscles is drawn from the active dilatation of the heart, it 
being a fact, that it will contract and dilate when empty. This 
appears to be on account of the peculiar origin and insertion 
of the muscular fibres of this organ. These have no solid 
osseous base for their origin or insertion, not any more than 
in the intestines, and yet their mechanical construction is very 
different. The heart is a dense organ, approaching in some 
parts to cartilaginous, and the muscular plates have their 
origin and insertion in this solid texture. The muscular 
planes run in so many different directions, that perhaps no 
anatomist has ever yet been able to dissect and unravel them. 
Even the investigations of J. F. Vauss have not unfolded the 
meshes of the cardiac fibres in a satisfactory manner ; the 
subject is still overcast with dark shades. A portion, and 
no doubt a large portion, of these muscular planes, have inser- 
tions as well as origins in such a manner, that as they contract, 
they raise the parietes of this organ, whilst the actions of 
others depress them, and so produce the systole and diastole. 
This diastole has an influence on the circulation in the large 
veins, but has been greatly overrated by some. 
The external voluntary muscles are an appendage to the 
nervous system of external relation; they stand in near rela- 
tion to it, and the external organs of sense. Besides these 
there are no organs under the immediate dominion of these 
nerves, except in a limited and partial manner. Yet there 
being some nerves sent in connection with the nutritive sys- OUTLINES OF PHYSIOLOGY. 
127 
tem, there is a harmony of action existing ; however, in 
many tissues very limited. 
The force that the spino-encephalic mass gives the volun- 
tary muscles is very great in the act of volition ; it is still 
greater in certain pathological states when their functional 
exercise is not embarrassed, but free, and yet acting under the 
influence of severe excitations. Thus, in delirium, the 
muscular power may be double to what it could be in any 
voluntary effort. The same circumstances which induce this 
state of tonicity, also excite the energy of the visceral or- 
gans, provided their functional exercise is free. Or, indeed 
the state of tonicity may be so great as to embarrass their 
functional office. So, also, an excess of tonicity delays the 
absorptions in the encephalon, together with an overwhelmed 
state of the nervous function, and coma attends. 
' From whence arise the passions, and what their influence? 
A high toned consciousness of injury done, or of dangers 
threatening the well being of self, or objects dear to it. 
Thought, and the other faculties of intellect arouse all the 
animal, and also the instinctive motions. Intellect is im- 
petuous ; radiations of vital force are sent into all the or- 
gans of external sense, and here the muscles receive a plen- 
itude of energy. Exploits are performed of no ordinary 
kind. The excitation does not stop here, but is extended 
into the viscera, and they perform actions, which afford evi- 
dence of function never seen in the easy state of indifference. 
These functional exercises are mild compared with those of 
external relation, because their nervous source from volition 
is scanty ; yet, in co-operation with the instinctive force, the 
functions of organs become greatly increased, even to the 
pathological state. Hence, anger produces a flow of bile, or 
even blood ; and fear may excite diarrhoea, or diabetes insi- 
pidus. 
As some of the effects of these mental excitations, we may 
mention the contractions of external tissues, causing the hair 128 
PARTICULAR TISSUES. 
to become erect, the skin to be filled directly with blood J 
the respiratory process more enlarged ; the heart acting ve- 
hemently ; the secretions increased, often of saliva, of bile, 
urine, &c. To these we may add involuntary discharges of 
semen, of muco-serous fluids, in sudden diarrhoea ; inordi- 
nate sweats. Here, also, we are often called to witness the 
fact of abortions from the same source, and so synchronous 
as to leave no doubt of the fact. Hence the importance of 
mental tranquillity in all diseases of excitation, whilst men- 
tal excitement may be turned to good account in affections 
requiring excitants. 
We need not stop to inquire by which particular nervous 
filaments these motions are excited, although we know some 
organs are more readily excited than others ; so the heart 
receives most of the nerves of sensation, and it is the most 
frequently affected, and suddenly too. The whole system 
synthetically arranged, and taken from under the knife of the 
anatomist, is an unit. However, each part has its relations 
to every other part; so in all the great functional exercises, 
there are revolving circles within circles of organic motion. 
Notwithstanding this harmony of motion, each organic 
function is limited to its own sphere of action. Although 
mental influences increase organic actions, it cannot control 
them, nor scarcely modify them. When once excited they 
continue by their own instinctive force ; so the influence of 
these excitations may have very permanent effects. And 
again, it must be considered, that an excitation of a highgrade, 
may overwhelm the organism, in a subject not well prepared 
for it, and cause sudden death. Again, on the other hand, 
although excitations may be very impressive, and yet con- 
sciousness is fully apprised that self cannot evade the evil, nor 
the selfish objects be rescued, a state of apathy succeeds ; 
the muscles are relaxed, the circulation is in an irritative state 
of inability, in connection with other trains of phenomena of 
the depressing passions. OUTLINES OF PHYSIOLOGY. 
129 
But this kind of digression has led us from our design. We 
will bestow a little attention to the pathological condition of 
muscles, in reference to their nosographic arrangement. 
The principal we know of diseases of the simple muscular 
fibres, is, in relation to their spasmed and their paralytic 
states. Yet, the muscles are subject to soreness, pains, in- 
flammations, &c., as occurring in the combining tissues. So 
imposthumations are found in them, thickenings, and soften- 
ings as in other tissues. In chronic emaciations the muscles 
become very thin, containing but little fluid matter. They 
lose energy in proportion, and may become adynamic when 
their nerves are free. The voluntary muscles always become 
paralytic when their communication with the brain is inter- 
cepted, whether by ligature, or by a compressing force in the 
cranium ; or, again, when any sudden force of stimulation so 
alters their integrity as no longer to transmit the vital impulses. 
Sudden strokes by weapons, by lightning, by excess of stim 
ulations, have this effect. 
The chief pathological notices we may further make will 
be in relation to their spasmed state. It has been long ob- 
served, that there are two very different states in which mus- 
cles are seen spasmed, and these have had many very singu- 
lar comments by pathologists. They have been distinguished 
by the terms clonic and tonic spasms, and both confined to 
the voluntary muscles. The first is distinguished by sudden 
contractions, and relaxations ; the second by a fixed, spastic 
state. The first is excited by undue stimulations on the 
cerebellum, and medulla oblongata ; and the second, by stim- 
ulations on the abdominal ganglia and plexuses, or some tis- 
sue under the influence of the instinctive susceptibility, which 
includes the two first grades of vital force, the vegetative and 
ganglial. 
As some illustration may be needed in relation to a novel 
thesis, it may be remarked, that the nervous force of exter- 
nal relation, always presides over diseases of periodical types, 130 
PARTICULAR TISSUES. 
and its physiological character is that of action, and relaxa- 
tion ; whilst on the other hand, the physiological charac- 
ter of the nutritive, is a steady persistency of character. 
So we find located in these organs, or this fabric, all the 
phlegmatise and fevers. Dr Mosely says, the fevers in the 
West Indies, and tetanus, often alternate in the same patient; 
and so we have noticed in some cases. In traumatic tetanus, 
the injury is always in tissues under the instinctive sensibility. 
Again, in convulsions it has long been accredited, that stimu- 
lations in the mucous tissue of the first passages, in which there 
are many nerves of sensibility, do excite them. Patients 
affected with a certain variety of epilepsy, speak of a sensa- 
tion, an aura, which they perceive pass gradually from an ex- 
tremity towards the neck and head, and that moment they are 
thrown into a paroxysm. This proves an affection of the 
nerves of external relation. Further illustrations must be 
deferred. 
The character of the morbid diathesis connected with dis- 
eases of the muscles, is diversified according as organs re- 
motely involved, may be under the influence of the one or 
the other nervous centres. We find, however, in a great 
proportion of diseases located in the muscles, that the diathe- 
sis is distinctly of the synochoid character. 
Under this head will be considered the glandular functions, 
embracing the process of secretion. Glands are rounded, or 
conglobate bodies, consisting of an artery, vein, nerves, and 
excretory duct. They are of an agglomerated construction, 
and united by cellular texture. Their composition is gelatin 
and albumen. Their intimate structure is of a filiform kind, 
of late called primitive tissue, or formerly parenchyma, in 
which the process of forming the matter of the new product 
is effected. The convoluted structure of glandular bodies 
8. Parenchymatous Tissue. OUTLINES OF PHYSIOLOGY. 
131 
affords a longer distance, and a larger surface, for the chem- 
ico-vital changes of the secreted products to become per- 
fected. This structural extension presents a striking analo- 
gy to that of the foldings of the digestive tube, for similar 
purposes. 
The glands are simple acini ; or complex, when they are 
called conglomerated, many being included in a common en- 
velope, and united by the common tissue. They chiefly con- 
sist of the lachrymal glands, the meibomian, the ceruminous, 
and salivary. Also, the mammae, the liver, pancreas, kidneys, 
prostrate gland ; the testicles and ovaria ; to which may be 
added the mucous follicles, though not of a glandular struc- 
ture, yet secreting a particular fluid animal matter. To these 
may be added the acini of the lymphatics. So, also, various 
membranous surfaces afford secretions of a peculiar kind, 
particularly the succus gastricus of the stomach ;-they are 
such as do not pre-exist in the blood. Another thesis is, that 
it is of a spongoid character ; and of late the opinion of Leuen- 
hock has been revived by M. Edwards, Dutrochet, and 
others, of a vesicular structure, or a termination of arteries in 
cul-de-sacs ; and that fluids enter by endosmose, or a sort of 
simple imbibition. 
Further, with respect to the intimate structure of these 
organized bodies, in which some of the most important phe- 
nomena of life appear, it has not been satisfactorily revealed. 
This is unlike any other of the tissues ; a gelatinous like mat- 
ter, rather a peculiar substance, is one description. It is 
probably a modification of the primitive tissue. Some mem- 
branous surfaces have been called secreting tissues when they 
are only exhaling tissues. Thus, the pleura, peritonium, 
&c. only appear to transmit fluid substances pre-existing in 
the blood. rIhe sero-albuminous fluids lubricating the cavi- 
ties may be found abundantly in the blood, like the fluids 
exhaled from the lungs and skin. The tissues these fluid 
matters pass make no change on them in health. So accord- 132 
PARTICULAR TISSUES. 
ing to the common received opinion of changes made in 
the fluids by the secreting tissues, others not producing such 
modifications, ought not to be styled secreting tissues. If 
there are morbid changes in the blood, such tissues then ex- 
hale corresponding morbid products ; or they may in this 
event suffer some change in passing the tissue. They are 
exhaling surfaces. Nerves enter the glands in a scanty man- 
ner. It is said some nerves of external relation enter, but 
not sufficient to bestow the sensibility of external relation, 
and they offer no harmonious relations, unless in a pathological 
state ; and then, indeed scarcely perceptible. If, however, 
the investing membranes are involved in disease, the sensi- 
bility becomes very perceptible. So, also, in some high ex- 
citations of the physiological grade, as in the sexual erethism. 
Branches from the plexuses of the nutritive nerves enter 
the parenchyma of glands along with the arteries, and we in- 
fer that these nerves are auxiliary to the secerning processes. 
The term secretion implies a separation of fluid matter from 
the blood ; yet, the process consists in a change of certain 
portions of the blood, which is carried to these organs by the 
arteries. It there receives certain definite changes, by which 
a fluid matter is prepared very different from any of the ele- 
ments of the blood carried to them ; and experiments by injec- 
tion into blood vessels, show it to be more or less obnoxious to 
the economy of the vital movements. These changes in the 
parenchyma of glands, appear to be effected by a process 
pecidiar to this kind of organization, in connection with the 
peculiar vital force there existing, which has been happily 
expressed by M. Broussais, vital chemistry. 
We are compelled to speak of these very secluded pro- 
cesses, in the most intricate tissues, in an indefinite manner ; 
we say peculiar when not able to define a process. Is not 
every vital change and movement peculiar ? We know more 
facts about some, than we do of others, and then speak with 
more confidence, and yet all have a more dense or rarer veil OUTLINES OF PHYSIOLOGY. 
133 
cast over them. The chemist puts vitriolic acid and alco- 
hol into his retort, and distils off vitriolic aether ; and he 
may undertake to explain all about the process ; but can he 
tell why those two articles should possess affinities to unite, 
and form this new substance, altogether different ? 
Blood enters the liver from which all the art of the chemist 
cannot extort a particle of bile. In its egress from this glan- 
dular body, no bile can be detected ; yet in its ducts and 
sacculated depot is found a new substance, daily emptied and 
recruited, the like of which is no where else to be found. 
We may call this process peculiar, or specific, and this may 
be as sufficient for every purpose as if we could approximate 
a little nearer to what we are interdicted. It appears, how- 
ever, that M. Boudet has recently analyzed the serosity of 
the blood very rigorously, and has detected an acid which 
he considers a combination of oleic and margaric acid, and 
that it combined with soda, and " produced a solution resemb- 
ling common soap." The same author thinks he has discov- 
ered cholesterine also, but concludes further experiments 
necessary to determine it. (Am. Jour. No. 28, p. 522.) But 
little reliance can be placed on these forced experiments. 
At any rate these are not hepatic bile. 
Let us proceed then, to say with some confidence, that 
our inference from facts is, that nerves enter these tissues 
from one common source, the abdominal nerves. Let us 
now borrow from analogy, that the nerves of sensation arise 
from one common source, and are distributed to five different 
tissues ; yet how varied are the susceptibilities and functions 
of these different nervous expansions in the organs of exter- 
nal sense ? We may now infer that different branches of 
nerves arising from the abdominal plexuses do possess modi- 
fied susceptibilities, and give a character to the physiological 
powers of the organs they inherit. 
In every stage of life, the chemical affinities of every par- 
ticle composing organization are exerting an influence on each 134 
PARTICULAR TISSUES. 
other, but this effort is restrained, modified, and controlled 
by a higher presiding force. So far they may extend their 
influence and no farther. Just so far as the plastic formative 
force permits, they extend, and it uses them so far as is neces- 
sary to the perfection of the instinctive processes. These 
two forces then, in combination, may with much propriety be 
called vital chemistry. These processes are very extensive 
in the living system. Every glandular secretion is produced 
by the same materials from the common mass of blood, but 
surprisingly modified by a difference of tissue, and nervous 
impressibility. But, compress the nerves leading to a se- 
creting organ, and then the secretion will be suspended, or 
essentially altered. Again, in the instance of disease being 
concentrated in a secreting tissue, the secreted products are 
more or less altered, and sometimes greatly changed. Moral 
influences, which must act through the medium of the intel- 
lectual organs, and secondarily on the nutritive, on frequent 
occasions, modify and alter the secreted products. 
For the purpose of affording opportunity for these pro- 
cesses to have effect, it is necessary the fluid matter should 
be in a state of more repose than whilst circulating in vessels. 
It is the opinion of physiologists, which is supported by mi- 
croscopes, that the blood suffers a partial stasis, after being 
deposited into the filiform tissue, or entered by endosmose. 
Here the changes take place necessary for the production of 
the matter of secretion. But, what next ensues ? Various 
substances in commixture in the central portions of an organ ; 
how are they separated ? We must now have reference to 
the instinctive susceptibility, so everywhere present, and so 
essential in the vital economy. There is clearly a property 
existing in the secerning and nutritive tissues, which may be 
called vital elective appetency. The veins take up the red 
blood, the lymphatics the white, or albumen, and the radicles 
of the excretory duct of the gland, take or absorb the fluid of OUTLINES OF PHYSIOLOGY. 
135 
its secretion. Each tissue is susceptible to its peculiar 
stimulus. 
As we must press into our logic general principles and 
specific properties, so the same parity of reasoning may be 
extended to every secreting organ throughout the entire 
economy. From all these considerations, which will proba- 
bly endure the test of impartial scrutiny, we are forced to the 
conclusion of there being a presiding powTer in animal bodies, 
rather controlling the organization, than dependent on it. If 
any particular tissue is possessed of a sensibility so as to 
refuse all fluids except one, it must then be considered to 
possess a predilection for this one, to the exclusion of all 
others. 
Do the glandular structures afford some specific fluid, 
which is necessary for the perfection of its own products ? 
M. Beclard states, that cutting the pneumogastric nerves sus- 
pends secretion from the coats of the stomach. Digestion is 
then spoiled ; and we must regard the stomach as a gland on 
the large scale, and from which some safe analogy may be 
obtained. These are subjects of inquiry, which the inquisi- 
tive may investigate. We have no doubt of the gastric fluid, 
and mucus of the intestines being necessary to perfect diges- 
tion ; and that other convoluted tissues afford fluids in a similar 
manner. 
The glands suffer remissions, and some intermissions in 
their functions, as the mammae. They all have their appro- 
priate stimuli to set them in motion, or to accelerate their 
secreting motions. Stimulations applied to the mouths of 
their excretory ducts accelerate their function. All the ex- 
cretory ducts open upon the mucous tissues, and they are all 
lined with this tissue to their remotest terminations, or rather 
their origins. 
The glandular functions, like the nutritive, are liable to 
suffer a paresis, or inability of function, at the commence- 
ment of acute diseases. When an irritation of much force 136 
PARTICULAR TISSUES. 
affects the parenchyma, the properties of their secretion are 
liable to change. In some instances it may become acrid, 
and even poisonous, as in the saliva of the dog kind. The 
milk of a woman under the stimulations of pregnancy, is unfit 
for the nourishment of a child. When a glandular tissue is 
suffering excitation, there is an increase of functional exercise, 
and more blood circulates towards it and in it, so as to pro- 
duce a state of erethism. When this prevails, the other 
glands, and indeed other tissues, suffer a diminution of blood 
and vital force. 
All the glandular tissues are subject to various grades of 
morbid excitation ; from slight irritations increasing their 
functions, to the most severe, in which their functions are 
suspended. Phlegmatic affecting their outer coats are 
attended with some pain, but when their inner parenchyma 
is affected, with little or no pain. So abscesses may occur 
in them slowly without being recognised, otherwise than by 
constitutional phenomena. 
They are also subject, from chronic stimulations, to hyper- 
trophy and indurations. Albumen secreted into the cellular 
spaces hardens, as it is liable to, and without softening for a 
long time ; its thinner portions are absorbed, and the struc- 
ture suffers a cancerous or scrofulous degeneration. Again, 
the parenchyma is liable to atrophy, and softenings, when the 
absorbing processes are over active, as has occurred in the 
use of too large quantities of iodine. 
The character of the morbid habit, when the force of dis- 
ease locates on the investing membranes as in the phlegma- 
tiae, is of the high sthenic kind ; when in the parenchyma, it is 
mild sthenia. 
9. Nutritive Tissue. 
As this tissue cannot be distinctly exposed and demon- 
strated by the anatomist, it might be inquired where it is to OUTLINES OF PHYSIOLOGY. 
137 
be found, and what are its properties ? Its existence is in 
part inferred from the necessity of the case, and well demon- 
strated by the magnifying power of glasses. It is one of the 
most intimate structures, not located in a single part, but 
existing in every part, and in the minutest points of the whole 
system. It has some similarity to the isolated tissue last 
treated of, in point of structure, and yet very different in func- 
tion ; for whilst in that, a new modification of movable 
animal matter is formed for foreign uses, this tissue modifies 
and applies the nutritive molecules for its own use, as nutri- 
tive matter for the growth of the body, or repairing the 
waste. 
Whilst the anatomy of the intimate tissues has be^n veiled 
in so much obscurity, we may avail ourselves of the declar- 
ations of Drs. Dutrochet, Edwards, and others, of the vesicular 
cells of the minute structures, or a spongoid tissue, quite dif- 
ferent from the vascular structure. It is alleged, that the 
solid, as well as movable animal matter is formed of organized 
vesicles ; and that the secreting and nutritive processes are 
effected in a tissue situated between the terminations of arte- 
ries and. absorbing veins. This tissue is supposed to favor 
the theory of endosmose, and exosmose. However, these 
subjects require further minute investigation. 
Reference is made to this tissue at the present time, chiefly 
on account of its importance, and its liability to suffer in its 
function, in almost every condition of disease that the human 
economy is subject to. Placed as it is, in every minute point 
between the great exhaling and absorbing processes ; or in 
other words, the capillary terminations of arteries, and absorb- 
ing radicles of veins ; its functions suffer derangement in 
every embarrassment of these by the causes of morbid impres- 
sions. The illustration of these suggestions belongs to pa- 
thology. 
The diverging ramifications of all the arteries have differ- 
ent terminations. There are branches having immediate 138 
PARTICULAR TISSUES. 
inosculations with veins, which serve as protections to keep 
up the circulation, at such times as the capillary termina- 
tions may suffer impediments from sudden changes, interrupt- 
ing their courses. These last then terminate in secreting 
organs, and in the nutritive tissues where the movements are 
slow. In this instance such portions of the circulating mass 
as are adapted for accretion pass by a kind of infiltration, or 
say endosmose, into a tissue called filiform, and areolar ; or it 
is most probable, interstitial spaces of cellular tissue, or prim- 
itive tissue. By M. Dutrochet esteemed vesicular. 
The substances so abstracted, are chiefly fibrin and albu- 
men. Some further impression is no doubt effected by the 
chemico-vital force, when the molecules easily become attach- 
ed to similar matter, the composition of the tissue. It suf- 
fers various movements in the areolae. It was vitalized in 
the blood, and in certain tissues no doubt becomes more in- 
tensely so, at, or soon after its fixation. Every molecule 
adds something in growth. But we know that there is a 
continual waste going on in every part of every tissue, more 
or less according to numerous circumstances. These seem 
to be whatever over-stimulates the minutest tissues, or im- 
pinges their fibres. For instance a forced circulation, either 
by too much food, stimulating drinks, undue exercise, or 
whatever induces a hurried circulation. In these cases there 
is far more waste, but the ordinary movements make some. 
Along with the primary elements of animal matter attach- 
ed to the tissues in the intimate structures, should be men- 
tioned the agency of oxygen. It accompanies the arterial 
blood into them, but the blood is returned deprived of a 
large portion of it. It is changed from red to black blood, 
and evidently contains more carbon. These evidences prove 
essential changes to have taken place in the blood whilst pass- 
ing the nutritive tissues, and these are the chemico-vital 
changes. We must speak generally, for the identical pro- 
cesses have never been revealed ; but, we learn sufficiently OUTLINES OF PHYSIOLOGY. 
139 
of this tissue, and the changes there made, to force a convic- 
tion of its importance in health, and in the derangements of 
perverted action. Nitrogen, and carbonic acid take some 
part in the play of affinities in this chemico-vital laboratory. 
The solids here receive contributions at the expense of the 
fluids. They are returned back to the centre less vitalized, 
and diminished in nutritive properties. 
Those who assume but very little nutriment, and do not 
exercise much, suffer but little waste. It seems that slight 
injury done to the tissues render the molecules of their com- 
position unfit for the influence of the vital force. These 
molecules are soon detached in a gradual manner, they are 
absorbed by the venous radicles, and thrown out by the elimi- 
nating organs in part at least, the principal of which are the 
kidneys, lungs and skin ; and still before this, suffer some 
changes, or decompositions. They lose their vitality, and 
become foreign substances unless re-oxygenated. So man is 
doomed to constant decay and renovation in every part; and 
after some indefinite period, assumes a new body. 
Similar processes of absorption take place in the nutritive 
tissues as those of the secerning. There is but little doubt 
but that, on ordinary occasions, in good health, and full nour- 
ishing, there are more molecules of nutrient matter prepar- 
ed in the tissues than is needed, or used. Nature unpro- 
voked is not prodigal in any thing, and every movement is in 
unison. It may now be suggested, and with earnestness, 
that the lymphatic vessels, so bountifully bestowed every 
where, take up the residue of nutritious molecules, and care- 
fully transmit them back to the centre of circulation ; whilst 
the veins perform the more servile part of taking up the ex- 
crementitious portions. Certainly this is no more mysterious 
than many other instinctive processes that take place. 
The lymphatics always transmit a delicate fluid, of similar 
properties, but small in quantity ; so they are often empty. 
They are as delicate as the lacteals, in their coats, in their 140 
PARTICULAR TISSUES. 
contents, and in their appetencies ; whilst the veins are less 
fastidious ; for in the intestinal mucous coat, they will drink 
up even alcohol, and other poisons. It is true these substan- 
ces unite, and mix at the centre of the circulation ; so does 
the chyle, and gross fluids transmitted by the portal circula- 
tion. Notwithstanding this, the nutritive and secerning ap- 
petencies make their own selections for their individual 
economy, from the so frequently returned blood. 
It has been uniformly taken for granted, that the debris of 
the solids taken back to the circulation, are thrown out of the 
system as excrementitious matter. We have no evidence of 
this being the case, in an exclusive manner ; and it is very 
probable some of the detached particles of the solids, with 
those returned by the lymphatics, are again oxygenated in the 
lungs, and assimilated for further use in the nutritive tissues. 
This is more likely to be the course in health, than in a patho- 
logical state. 
It has already been intimated, that the nutritive and secern- 
ing tissues suffer essential changes in disease. We cannot 
here enter into any considerations relating to aetiology or pa- 
thology. Let it only be remarked, that these tissues feel the 
force of the causes of disease as soon as the dermoid tissue 
does. The associability of the external and internal tissues 
is intimate, as has been noticed in relation to the mucous 
tissues, and it is no less so in these. An inability of 
function takes place, although produced by the most stimu- 
lating and tonic agents, which has always passed current 
under the hypocritical garb of debility, or atony. 
The instinctive harmonies of the tissues is exquisite through- 
out. When the nutritive tissue is incapacitated in its func- 
tion, the stomach refuses food. So again' there is no 
demand for the adjuvants of digestion, the bile, pancreatic 
fluid, &c. These are scantily secreted. If sometimes they 
abound, their presence is obnoxious, and excite nausea, or 
vomiting. Many other unpleasant phenomena attend, and OUTLINES OF PHYSIOLOGY. 
141 
some of them disturbing the sensibility of external relation. 
In perfect health, on the other hand, when the nutritive tissues 
are in free play, these processes add much to the enjoyment 
of life. 
Having proceeded thus far, another train of associations is 
presented, growing out of a fact, which may be offered in 
the following proposition. That is, in ordinary health the 
appetite invites to the taking of more nutrimental substances, 
than is compatible with the best good of the general econo- 
my. The powers of the digestive apparatus are too hard 
pressed, when the appetite is fully gratified ; the nutritive 
tissues, and sanguineous system are liable to be overtask- 
ed. The results are plethora, and polysarca. The high- 
est grade of health approximates closely to the domain of 
disease. Let the voluptuary beware, he had better stop and 
reason, before the inroads of disease demand retribution for 
abused privileges. 
Again, it may be noticed, that without excess of plethora, 
when an organ is moderately excited above the natural range, 
whether by its exercise, or by some local stimulation, it is 
liable to an increase of volume ; and when having increased 
to any considerable degree, it constitutes hypertrophy, or an 
excess of nutrition. The tissue, or organ becomes embar- 
rassed in its function, and may ultimately end in softening, or 
a decomposition. Or, again, it may become indurated, and 
end in cancerous degeneration, or more immediate phlegma- 
tia. 
It is in this concealed tissue, that the most momentous 
physiological processes transpire ; it is the great result of all 
the digestive apparatus terminating in assimilation and accre? 
tion. It is found in progression in the cellular, muscular, 
nervous, and every tissue. So again, its function remote, 
and not having the lively vital susceptibility of many other 
tissues, suffers a stasis of function in the morbid state ; a con- 
gestive state arises attended with all its consequences. Such 
vol. i. 19 142 
PARTICULAR TISSUES. 
a condition in a high degree, may soon be attended with des- 
tructive consequences ; in a moderate degree, may be equal- 
ly destructive, with a long train of phenomena connected 
with the chronic morbid habit. 
10. Osseous Tissue. 
We cannot enter far into the anatomical and mechanical his- 
tory of the bones. Their structure in the embryotic state is 
vascular, yielding, and gelatinous. They have many things 
in common with other tissues and organs, as arteries, veins, 
nerves, lymphatics, and the connecting cellular web. They 
have a fibrous membrane of investment, the periosteum. 
They have, in the hollow bones, a lining membrane, more 
delicate, of similar structure. The interior is filled with an 
oil, inclosed in laminated cells. 
Ossification commences, and is partially perfected in the 
foetal state. A secretion of calcareous neutral salts from the 
membranes takes place in a laminated form, which gives solid- 
ity and firmness to them. According to the analysis of Ber- 
zelius, bones consist of gelatin 32.17 hundredths, insoluble 
animal matter 1.13, carbonate of lime 11.03, phosphate of 
lime 51.04, fluate of lime 00.02, phosphate of magnesia 1.16, 
soda, and phosphate soda 1.20. Gelatin abounds in bones ; 
it predominates in young bones over old ones, and the phos- 
phate of lime predominates in old bones. It has been com- 
monly received, that cartilage differs from bones only in 
containing less phosphate of lime. However, its structure 
is quite different in containing white and small vessels, and 
albumen instead of gelatin, with only a small proportion of 
phosphate of lime. Recent analyses show albumen 45.5 phos- 
phate of lime 00.05, water 54. \ 
The bones have numerous cells, especially in their expand- 
ed ends, in which is oil, and a free circulation of blood. Mer- 
cury poured by a hole into a bone transudes at all points of 
the surface. The same of the oil in the cells of the bones, OUTLINES OF PHYSIOLOGY. 
143 
in drying of them. The centre of long bones is the hardest; 
it is here ossification commences. The ends are large and 
spongy, with numerous cells. There appears to be an order 
of blood vessels destined to the outer layer of bones, one to 
the inner, and one to the internal tissue. 
The bones are endowed with the instinctive sensibility, or 
that of all other tissues not replenished with sensitive nerves 
of external relation. They feel not injuries in the physiolo- 
gical state. Yet their sensibility becomes changed to the 
relative, and is even highly exalted when inflamed. The inter- 
nal medullary tissue is a very delicate membrane, lining the 
interior, and forming cells for the medullary matter. This 
tissue possesses the sensibility of external relation ; the saw 
in amputations gives pain as it touches it. 
This internal membrane is liable to be inflamed and pro- 
duce purulency. One of the most severe phlegmatia we ever 
witnessed, was in the centre of the tibia, in which a large 
abscess appeared in the subcutaneous cellular tissue on the 
sixth day after attack, with extensive redness. On opening 
it, besides much purulency, several fractured pieces of bone 
of its whole thickness, were taken out, as they had only very 
slight attachments. The matter had burst the bone. Puru- 
lency, also, is liable to ensue on the inner surface of the peri- 
osteum, in the more common case of periostitis. It appears 
therefore, that disease affects the hard tissues, as well as the 
soft, and in some instances with much intensity. 
The chronic affections of the osseous texture are numerous 
and complicated. We need only refer to some of them. 
Ossification sometimes proceeds luxuriantly, as it were con- 
stituting a hypertrophy. The periosteum becomes thickened, 
and layers of ossific matter extend nearly over the whole 
body, indicating an ossific diathesis. In some habits fractures, 
and other lesions of bones, are followed with large callosities. 
Ossifications occur in the arterial structure, and elsewhere. 
The saline calcareous substances sometimes predominate over 144 
OF THE BLOOD. 
the gelatin; the bones hence become friable, constituting the 
fragilitas ossium. In these instances the bones lose their 
sensibility, and cohesive firmness ; they can scarcely become 
inflamed, but break very easily, and sometimes by the action 
of muscles. 
On the other hand, there is sometimes a deficiency of 
saline calcareous substance ; it is not excreted and crystallized, 
but the organs remain soft and yielding. The margins of 
bones seem to have nothing as boundaries of their growth, 
and they grow out of the ordinary shape. This constitutes 
the rhachitic diathesis. Again, the phosphate and carbonate 
of lime are sometimes absorbed, leaving the tissue soft and 
flexible, constituting the mollities ossium. Besides, the 
bones are liable to slow irritations and inflammations, injuring 
their textures, as occurs in the instances of spina ventosa, 
and hydarthrus strumatosus. All these arise from consti- 
tutional depravations, having locations in this tissue. 
Aside from the modifying circumstances of the ossific de- 
positions in bones, they manifest very similar phenomena, in the 
pathological state, to those of other tissues. They are subject 
to acute and chronic affections. The diathesis is quite uni- 
formly of the sthenic character ; in the acute, severe sthenia ; 
in the chronic, mild sthenia. 
SECTION VIII. 
Having made as many notices on the simple organic tis- 
sues, as appeared necessary for our design, we next proceed 
to review the blood, esteeming it the essential basis of the 
nutritive fluids, which form the tissues. 
Our attention must be confined to the red blood, circulating 
in arteries and veins ; the absorptions, secretions, and excre- 
OF THE BLOOD. OUTLINES OF PHYSIOLOGY. 
145 
tions require separate attention. On slight inspection, we 
discover a difference in the color of the blood ; in the arte- 
ries df the aortal, or long circulation, it is of a bright, nearly 
scarlet redness ; but after passing the capillary circulation of 
the nutritive and secerning tissues, it is returned to the centre 
of circulation of a dark modena red, and called by some black 
blood. Again, in passing from the right ventricle of the 
heart, through the pulmonary, or short circulation, the arte- 
ries transmit the dark blood ; and having passed the capillaries 
of the pulmonary tissue, the blood again assumes its red, ver- 
milion color, and is now transmitted by the veins to the left 
auricle and ventricle of the heart. It is now replenished 
with a vivifying principle, of which it was robbed in the nutri- 
tive tissues. 
The blood circulates very rapidly in the long circulation of 
arteries, but slow in the returning veins, and if by any means 
it is hurried in the veins it approximates more towards a 
bright redness. The quantity of blood in a middle sized 
person, of common replenishment, may be estimated at 
twelve or fifteen pounds ; but not half'of it can be drawn off, 
as the vessels cannot contract on it, and a large proportion is 
retained in the intimate tissues. Blood drawn from a vein in 
a healthy person, loses its heat, being about 98° Fah., gives 
off a vapor, with some carbonic acid gas, and coagulates. In 
a short time the mass separates into two elements ; the solid 
part is called crassamentum, the fluid serosity. Each of 
these requires some notice. 
The free circulating blood contains nearly all the proxi- 
mate and ultimate principles of the solid tissues ; the gelatin, 
however, in very small proportion. The coagulated crassa- 
mentum contains an essential principle, the fibrin, or gluten, 
or coagulable lymph. It is the property of this to coalesce, 
partake of a filamentary form, when out of the vessels at rest, 
and sometimes within the tissues in some morbid states. Its 
filamentary composition contracts, and it inviscates the cruor, 146 
OF THE BLOOD. 
or red particles of the blood in the coagulum. The red 
portion may be washed out, when the fibrin exhibits its white 
color, and filamentary character. It appears on every exam- 
ination, to be.similar to the fibrin of the muscles, and some 
other solid parts. It is esteemed to be the most essential 
nutrient principle of the blood. Its quantity and quality are 
modified by nutritive substances which have passed the digestive 
processes ; and again, according to the integrity of the assimila- 
tory powers of the vascular tissues. It is again modified in 
disease, always being increased by strong vascular impulsion, 
so abounding in a sthenic diathesis. Messrs Whiting and 
Thackrah, estimated the fibrin to be one thousandth of the 
mass of blood in health, but in rheumatism a seven thousandth. 
Blood drawn in an intense state of vascular impulsibn in dis- 
ease, is longer in forming the coagulum. Dr Mills esti- 
mated in such cases that the coagulum would require seven 
minutes in forming, whilst in a reverse state, or in health, the 
coagulum would form in three or four minutes. 
The cruor is composed of corpuscles of uniform appear- 
ance, all of the same size in the same subject, but of different 
sizes in different animals ; having a colorless, spheroidal 
nucleus, and an envelope of red albuminous matter, as 
shown by the microscope. According to the analysis of Ber- 
zelius, as given by Copland, the coagulum of blood consists 
of coloring matter sixtyfour hundredths, and fibrin, with a 
little albumen thirtysix hundredths. The coloring matter in- 
cinerated, contains one third per cent, of oxide of iron ; 
which is a constituent of the coloring matter, and cause of its 
redness. So Dr Good estimated, that forty men have iron 
enough in their blood to make a good ploughshare. 
The serosity from which the coagulum is formed, consists 
of albumen, with various saline substances, and its water of 
fluidity. According to Marcet, about eightyone parts in a 
thousand of albumen, the rest water, and neutral salts. The 
albumen coagulates at 160° Fah., and if it be pressed, it OUTLINES OF PHYSIOLOGY. 
147 
yields the aqueous fluid more properly called the serosity, 
containing the saline substances ; such as lactate of soda, 
phosphate of soda, muriate of soda, carbonate of lime, and 
perhaps a few others. Chemists have seemed to detect va- 
rious other substances in the blood, some of which may be 
inherent, and perhaps others accidental. 
The morbid states of the blood are subjects of pathology. 
As a whole, circulating in the living healthy subject, it re- 
ceives its impulsion from the heart, and vascular tissues. 
At the same time it is the incitor of these very motions, with- 
out which there could be no cardiac contractions, nor oscil- 
latory movements in the capillary systems. The round of 
circulation is kept up by these two forces, which are in a de- 
gree antagonizing powers. Say the heart gives the first 
impetus, being excited by the stimulus of the blood on its 
vital susceptibility ; its contractions, in accordance with the 
elasticity of the large arteries, impels it into the capillary 
tissues, whether secerning, nutritive, muscular, or exhaling. 
The force of the heart is limited to these tissues ; and the 
blood, with all its products^ is now propelled by the oscillato- 
ry motions of tissues endowed with the instinctive suscepti- 
bility ; except say, some small aid in the large veins without 
valves, by the diastolic action of the heart. We cannot stop 
here to adduce facts and arguments in support of this thesis. 
In the course of the circulation, the blood suffers very 
important, and continued alterations. It is now red blood, 
and suddenly what has been called black blood. It receives 
fluid substances by the thoracic duct of chyle and lymph, and 
by the veins various more crude materials ; as also by the 
lungs gaseous substances. These all circulate together, form- 
ing an intimate commixture in the large arteries, where they 
receive much agitation. It it difficult to determine whether 
some chemico-vital changes take place in the course of arterial 
circulation or not ; but we may be assured it receives some 
preparation here that it cannot have any where else, and 148 
OF THE BLOOD. 
probably becomes more vitalized by agitation of its various 
recruits, as well as in the lungs. 
As to the vitalization of the blood, we have too much 
evidence to be resisted of this being the fact. We will only 
mention,-it goes to the formation of vital tissues ; it coagu- 
lates ; it forms parasitic membranes in morbid exhalations, 
having a circulation, and at a time when the vital phenomena 
are all elevated ; and, lastly, the subtile secretion of the semi- 
nal fluid most certainly is vitalized. But, it must be particu- 
larly noticed, that this is a vitality of the first degree, as 
has already;- been illustrated in Sec. 5. The blood has 
nothing in common with the nervous tissues in respect to its 
vitality, only as it may receive vascular impulsion from 
these, but it is of that grade by some called vegetative ; and 
we use the term on account of the poverty of language. When 
fixed in solid tissues, according as the tissues may be, it 
assumes progressively higher grades of vitality. We know 
this result without being able to describe the process. 
By combining all the facts and circumstances relating to 
the economy of nature, we discover the admirable associa- 
bility existing in the human economy, constituting a unity of 
design in the completion of a whole. The vital force 
impressing both fixed and movable animal matter. The 
same matter now movable, then fixed ; now again mova- 
ble, and traversing never ending circles. All these motions, 
and changes, tend to eflbct the great design of existence, 
and intellect, and consciousness, and spiritualized immortality. OUTLINES OF PHYSIOLOGY. 
149 
SECTION IX. 
ORGANIC TISSUES. 
1. Of the Heart and Arteries; or of the Centrifugal Cir- 
culations. 
We have been making some remarks on what we have 
thought proper to denominate the simple tissues. But, the 
critic might say they are not simple tissues. If they aie not so 
in fact, we have considered them as such technically. It be- 
comes necessary now to consider the heart, arteries, and 
veins as organs. 
It comes convenient after speaking of the blood, to make 
some brief remarks a little more particular, on the forces 
which move it. In doing this we shall have to treat of the 
entire centrifugal circulations ; together with the oxygenation 
of the blood, or its decarbonization. After these, the centri- 
petal circulations. 
There is no necessity of entering upon the anatomy of the 
heart and arteries, as it may be found in all the books, and sup- 
posed to be known to every one. The heart performs 
important functions, and it is a strong muscular organ ; 
some species of animals have a circulation without a heart, and 
an instance is mentioned by Hewson, in which " the circula- 
tion had been carried on merely by an artery and vein." 
However, in the human species it is an important organ, and 
considered as the centre of the circulations ; it gives an im- 
petus to the blood which is not lost until it has reached the 
capillary vessels. The large arteries have but little or no 
muscular contractility, they have more of it as they ap- 
proach the capillary tissue, and here they are chiefly muscular, 
and contractile. 150 
CENTRIFUGAL CIRCULATIONS. 
2. The Heart. 
It may here be remarked, that the heart is bountifully sup- 
plied with vital force. 1st, its inherent vital force ; 2d, its 
ganglial supply, in co-operation with the pneumo-gastric 
nerve ; 3d, many spinal filaments. Yet, in health, it does 
not possess the sensibility of external relation, or the centre 
of perception does not recognise its injury or movements. 
When disturbed by diseased action, however, it transmits 
imperfect sensations of uneasiness, called precordial distress, 
anxiety. The adjacent dense tissues sometimes transmit a 
sensation of pain. Notwithstanding, thought, and the affec- 
tions of intellect have a manifest influence on the movements 
of the heart, and on the entire circulations, even into the nu- 
tritive and secerning tissues. Instances are numerous, and 
daily presented, of the influence of mind upon the cardiac 
movements. It did not escape the attention of Shakspeare, 
in the instance of the cruelty of King Lear's daughter to- 
wards her father ; he says, 
She struck me with her tongue, 
Most serpent-like, upon the very heart. 
1 have full cause of weeping; 
But this heart shall break into a thousand flaws, 
Or ere I'll weep. 
Although intellect cannot directly control the instinctive 
movements, yet it has a severe impressive influence on all 
the tissues. Let us for a moment particularize in the case of 
Mrs Seaver of Maryland. On beholding the mangled corpse 
of her husband, she became fixed in thought ; she did not 
weep, and her sorrow was dumb ; 
She stood, 
Pierc'd by severe amazement, hating life, 
Speechless, and fix'd in all the death of wo. 
She had an infant; but its fountain of nourishment dried up ; OUTLINES OF PHYSIOLOGY. 
151 
it pined and died ; whilst the mother sunk beneath the bur- 
then of her calamities. 
The heart being a susceptible, active, and energetic organ, 
soon feels the hurtful impressions of the causes of disease. 
A feeble person stepping into a cold atmosphere for a few 
minutes, is liable to spasmodic palpitations. In all those 
affections, or derangements of functions called fevers, the 
heart is one of the organs first disturbed ; and the amount of 
its disturbance, by one train of phenomena or another, will 
be in accordance with the general impression made on the 
system, and the injury manifested throughout. So the pulse 
may be called the nosometer of the system, and its indica- 
tions have been noticed in the diseased state, from time im- 
memorial, however subject to numerous illusory modifications. 
The direct course of the circulation from the heart as the 
centre, to every remote tissue internally, and to the peri- 
phery of the system, all serve to unite this organ in close 
harmony of function with all other tissues. If the larger ar- 
teries have less immediate influence from their structure and 
use, yet they carry in their outer coats numerous visceral 
nerves, which establish a permanent harmony between the 
heart and remote excitable tissues. Although the capillaries 
of veins as well as arteries are beyond the systolic action of 
the heart, yet, whatever excites the heart affects these also 
more or less, and even stimulations on the surface affect the 
heart also. The stomach likewise is bound by nervous cords 
to act and react in harmonious concert. Furthermore, the 
capillary red vessels enter, and make a part of the nervous 
tissues of external relation, embracing the entire spino-ence- 
phalic masses, and are intimately distributed there. So 
whatever disturbs the cardiac, and capillary circulations, 
cannot fail to affect the functions of this system of nerves. 
Hence in all morbid excitations of the heart, these tissues, 
and also intellect, sensation, and voluntary motion, are liable 
to suffer injury. 152 
CENTRIFUGAL CIRCULATIONS. 
3. Of the Mortal Circulation. 
The principal use of the larger arteries seems to be, to 
serve as conduits to transmit to remote parts. So the long 
nerves connect remote parts. We do not know why the 
blood that enters the coronary arteries of the heart, is not as 
perfect for the stimulation and invigoration of that organ, as 
it is distributed to the plantar muscles of the foot. Is not 
the portio mollis of the ear as perfect in its function as the 
remotest nervous tissues ? In the case of the circulation, we 
may merely suppose there is an opportunity for a more 
intimate mixture of different substances, but these have 
been very intimately blended in the pulmonary circulation. The 
heart and large arteries direct the blood to the minute cir- 
culation in the tissues, and here is the great theatre of 
changes, of calorification, of nutrition, and of secretion. 
The heart has only a limited control over the circulation, 
beyond the large arteries, their capillaries and inosculations with 
veins ; it is then confided to other powers of movement. Yet, 
it is necessary the heart should offer a constant supply of fluid, 
as it may be removed from the capillary tissues. In health, this 
balance is well adjusted, but in disease may be broken. 
Suppose the heart to act suddenly in an impetuous manner ; 
the tissues may be inundated ; they cannot transmit fast 
enough for the heart to be supplied. The blood is now ac- 
cumulated in the tissues, and the effect will be an embarrassed 
and tumultuary circulation. 
The more frequent course may be, that numerous circum- 
stances may conspire to retard the capillary circulation. 
The first impressions of the causes of disease, often have this 
effect. The sequence must be an accumulation of blood in 
tissues : in the dense tissues it may assume a darkened 
color ; in loose tissues a manifest congestive state. The 
heart acts feebly because it has not a supply of blood to ex- OUTLINES OF PHYSIOLOGY. 
153 
pand and stimulate it, and partly from the embarrassment of 
the vital force. 
4. Divisions of Circulation. 
However, before attempting an illustration of the abnormal 
conditions of the capillary circulations, we may notice that 
there are four great divisions of circulation, besides the 
minor ones. It is common to make use of the form of a tree 
as a diagram, to illustrate the divergence of the vascular 
branches. There are then four trees : 1st, the aortal tree ; 
2d, the carotid tree ; 3d, the pulmonary tree ; 4th, the por- 
tal tree. Two of these trees have many communicant 
branches, viz. : the aortal and pulmonary ; it is more doubt- 
ful with respect to the communicant branches of the circula- 
tion in the head and liver. In this case, all the blood must 
pass by the capillaries ; it must be left at certain points by 
the force of the heart and arteries, and taken up by the ve- 
nous radicles, and transmitted back by the converging circu- 
lation. 
The blood moves slowly in the intimate tissues, to what 
it does in the arterial branches ; but, it has a broader surface 
to move in. It moves tardily in the veins compared to that 
in the arteries ; so the number and capacity of calibre of the 
veins is more than twice that of the arteries. The heart and 
arteries have a great preponderance of nervous susceptibility 
compared with that of the veins ; their outer coat being filled 
with the nutritive nerves, they receive into their tissue a full 
proportion of nervous susceptibility in their capillary subdi- 
visions ; and all analogy, as well as experiments, demonstrate 
their greater vascular activity. This is plainly shown in 
wounds by the force of the hemorrhage. This establishes an 
important point in physiology, and the phenomenon assumes 
even more importance in pathology. It must be kept in 
mind, that the radicles of the portal tree have no influence 154 
CENTRIFUGAL CIRCULATIONS. 
of the heart and arteries, to expedite the movements of the 
blood. Their impetus is all lost in the arterial circuit of the 
coeliac and mesenteric arteries in passing through the several 
abdominal organs of their distribution. A centripetal circula- 
tion forms in the short vena portae to be again distributed in 
the liver ; and then again converging before it reaches the 
cava, and thence the heart. 
In this long round of double circulation, the three last 
divisions, being all venous trees, are performed with only a 
little direct nervous influence, and that arises from the distri- 
bution of the hepatic artery, which goes to nourish the liver ; 
and more scantily upon the vena portae. Modern anatomists 
have discovered some nerves in the portal vein, which had 
been denied by those before them. However, the activity 
of this order of vessels must be greatly inferior to that of the 
heart and aortal capillaries ; and yet they will obey their nat- 
ural stimulus, the blood, in their physiological state ; but, are 
liable to suffer from all the causes producing a retardation of 
circulation. The circulation in the vena portae has been 
computed by some, as twenty five times slower than in other 
veins of the same diameter. 
So again, with respect to the cephalic tree ; although there 
are many communications of arterial branches between the 
carotids and vertebral arteries, there are none between the 
arterial capillary branches and the sinuses of the brain ; so all 
the disproportional mass of blood sent to the brain, has to 
pass by capillary arteries the cortical portion of the brain, and 
its membranes, and again be concentrated by the absorbent 
veins. We know that slight causes produce some, more or 
less, disturbance in the cerebral circulation, in the physiologi- 
cal state ; and every medical attendant, and observer must 
appreciate the importance of every delay, or derangement of 
these circulations in the diseased conditions. 
Let us now revert back to the aortal and pulmonary trees, 
which may be reviewed in connection. The blood has a OUTLINES OF PHYSIOLOGY. 
155 
more free transit here than in the former instances ; for the 
communicant branches in the aortal tree serve, to a certain de- 
gree, as safety valves. In the pulmonary tree there is a more 
ready transit from all the arterial capillaries into the venous 
absorbants, on account of their short course, and the yielding 
texture of the lungs. Very coarse injections readily pass 
this tissue. Notwithstanding these provisions, the balance of 
circulation may be easily broken, and the organs suffer injury, 
even in the physiological state, and by circumstances discon- 
nected with disease. 
Let us suppose a person in a state of quietude, having a 
good temperament, with an equal balance of blood, with the 
heart and larger arteries and veins suitably distended, to be 
surprised by an enemy. He either enters into combat, or 
gives ground and is pursued. He now suddenly enters into 
severe exercise, which is continued. Exercise implies ac- 
tion of the locomotive muscles. It is well agreed that these 
organs are fully supplied with blood ; their red color indi- 
cates this, and all experiments prove it. It is again, a fact 
that the alternate contractions and relaxations of muscles 
increase the capillary circulation. The contractions expedite 
the blood into the veins, and the relaxations invite arterial 
blood ; so these motions, rapidly performed, are liable to fill 
the cavse, even faster than the cardiac actions can dispose of 
it ; so for a time these vessels suffer a surcharge. 
It should be noticed, however, that muscular contractions 
expedite the blood more in the veins than in the arteries ; and 
at the same time the capillary tissue can scarcely supply the 
veins for a length of time. The effect will be an accumula- 
tion of blood in the capillary arteries, so long as the large 
arteries supply them. These derangements embarrass the 
nervous energy, and muscular power diminishes. At the 
same time it should be noticed, the capillary circulation in the 
secreting organs, and nutritive tissues, cannot dispose of the 
blood so fast as it is forced there by the heart. The organs 156 
CENTRIFUGAL CIRCULATIONS. 
are inundated, and the blood is forced into tissues it is not 
accustomed to traverse, such as the white tissues, and even 
the nutritive tissues become engorged. Notwithstanding all 
these retardations the right side of the heart obtains a good 
supply of blood on account of the more rapid circulation from 
those sources which are free. 
During the excited circulation, the mucous and dermoid 
tissues are distended, they suffer a capillary turgescence, and 
blood is liable to escape from the former at all the unprotect- 
ed surfaces, as the nostrils, fauces, and internal pulmonary 
tissue. The external surface of the body becomes not only 
turgid, but red and heated ; at the same time the cutaneous 
exhalations are increased to a large amount, so that sweat 
runs from the surface, notwithstanding there is much evapo- 
rated by the heat externally. Animal caloric is always de- 
veloped in proportion to the state of innervation, and rapidity 
of circulation, either generally, or partially. The fluids be- 
come rarified, and actually require a larger space than before, 
or in the state of rest ; and at the same time, the state of 
innervation implies a contractile condition in every vessel 
and movable tissue in the system. The result is, a tempo- 
rary plethora ; and this might prove suddenly fatal, were it 
not that the mucous and dermoid tissues, together with the 
spleen, and dilatable cavse serve as reservoirs. 
Still more striking phenomena occur in the heart, and in 
the pulmonary tree. The blood urged into the cava?, and 
thence into the auricle and ventricle, stimulates the heart, 
already in a state of innervation, into inordinate action. The 
first impidse will be to nearly overwhelm it; we then discov- 
er a tremulous, irregular, and tumultuary motion. It may 
soon recover its ordinary rythm, and act with force ; its 
systoles may then be an hundred and twenty or sixty, whereas 
in health they may have been about seventy in a minute. 
The prsecordial region suffers a sensation of distress. 
The dark carbonized blood is thrown impetuously into the OUTLINES OF PHYSIOLOGY. 
157 
pulmonary arteries, and indeed in larger quantities than can 
pass the capillary tissue ; is becomes largely distended in its 
distributions in the pulmonary tissue, and the effect will be to 
compress the branches of what might be called the bronchia] 
tree, or aerial cells. A sensation of suffocation is now exci- 
ted ; vitality cannot be preserved without oxygenated air. 
The respiratory muscles are called into action to elevate and 
expand the thorax, in order that the lungs may expand and 
admit more air into the vesicular structure. An obstacle now 
immediately presents, if the subject continues in severe exer- 
tion ; for in this instance it is necessary, in order to sustain 
exertion, that the thorax be fixed at a given point by the res- 
piratory muscles. These muscles are now held in requisition 
for both these functions. Their contractions must now be 
divided between the fixation of the thorax, and its dilatation. 
Their task is now severe, and each function is imperfectly 
performed, and dn an interrupted manner ; and during this 
time vociferation is scarcely practicable. So much blood is 
now retained in remote tissues, and in the capillary tissue of 
the lungs, that the left ventricle suffers a deficiency ; it is not 
distended as usual, so the pulsations are small, frequent, and 
tremulous. 
In consequence of the imperfect expansion of the thorax, 
and the vascular distension, the aerial cells admit of little 
separation, and a sufficiency of air is not admitted to supply 
the necessary oxygen, nor to eliminate caloric, carbonic acid 
gas, and other substances by expiration. A congestive state 
of the blood vessels takes place of dark carbonized blood ; 
there is liable to be exhalations of bloody serum into the 
bronchia, and into the cavity, or sac of the serous membranes ; 
the aerial cells are liable to ruptures, and engorgements of air 
producing permanent compression on other cells, or emphy- 
sema. Indeed fatal suffocation is liable to ensue ; but the 
respiratory muscles commonly become greatly fatigued, and 158 
CENTRIFUGAL CIRCULATIONS. 
relax their exertions in fixing the thorax, and are rather 
instinctively directed to the expansion of it ; and now 
respiration is performed in quick succession with severe pant- 
ing. During all these processes the blood suffers alterations; 
it is deprived of too much of its water of fluidity, and there 
is an increase of fibrin ; much of it is forced into tissues 
where it suffers a stasis. 
It may readily be inferred, that the foregoing illustrations 
represent a state of the system bordering, at least, upon the 
pathological ; so indeed, if it were continued, it must amount 
strictly to the pathological. However, the recuperative 
powers of the system will restore the lesions of moderate ex- 
tent ; but, if any incidental cause of disease should co-operate 
with this state of things, and fix the accidental derangements 
in their .perverted state, the consequence would be severe 
disease. 
5. Cardiac Quiescence 
Upon a cursory inspection it might appear, that all the 
involuntary muscles were subjected to perpetual action, and 
untiringly perform their destinies. Yet, this is not the case ; 
they have short periods of repose, whilst the voluntary muscles 
require long periods. No muscle, therefore, either voluntary 
or involuntary, can be excited beyond certain limits, without 
danger of such a degree of exhaustion as to incapacitate them 
from performing their functions. , There is a short period of 
rest in the heart between the contraction of the auricles and 
ventricles, and some longer between the systole of the ventri- 
cles and that of the auricles; It appears that Laennec esti- 
mated the res.t of the heart too large when he says " that in 
twentyfour hours the ventricles have twelve, and the auricles 
eighteen hours quiescence." It is difficult to make accurate 
estimates on this subject ; yet, We must concede that the 
heart has rest ; and the slower the systolic action the more 
rest it has, and the reverse. OUTLINES OF PHYSIOLOGY. 
159 
Severe excitation of the heart, from whatever cause, is 
liable to exhaust its vital susceptibility, producing a paresis, 
and consequently a cessation of circulation. Laennec men- 
tions a case of palpitation in a subject of hypertrophied heart, 
in which the pulsations were between 160 and 180 in a 
minute, continuing eight days ; we are confident of never 
knowing an instance of such frequency in acute disease in 
the adult, but that terminated in death within thirtysix hours, 
and often in six. Do not many pyrectec affections have a 
sudden and fatal termination at their commencement, from 
exhaustion of the nervous energy of the heart ? At the 
onset, the pulsations are sometimes very frequent, with a 
general embarrassed circulation. 
The circulations in different organs may admit of very 
considerable deviations within the range of health, when no 
morbid cause exists to fix them there. A tissue under the 
influence of excitants, invites the rush of fluids to that part. 
Even the agreeable stimulus of food increases a flow of mucus 
and saliva in the mouth ; the same of the blood and secre- 
tions into the stomach in digestion. Every hour perhaps, on 
exposures to cold weather and exercise, the balance between 
the surface of the body and the internal tissues is broken. 
In summer, the circulations on the surface are permanently 
increased ; in winter the internal tissues have hyperaemia. 
So we have sweatings in hot seasons, and increased urination 
in cold. In the instance of venereal orgasm, those organs 
suffer turgescence. Large suggillations are soon absorbed in 
health. Whilst one apparatus of organs suffers turgescence, 
some others have anaemia. However, an unequal circulation 
in the diseased habit is to be greatly deprecated. If the fore- 
going derangements of circulation should be fixed in their per- 
verted conditions by cold, or any other cause of disease, a 
pathological state might soon be the result. 160 
CENTRIFUGAL CIRCULATIONS. 
6. Cardiac Vacuum. 
Some notices have already been made in relation to the 
suction power of the heart, and on capillary attraction. By 
way of recapitulation, we may remark, that they imply too 
much of mechanical principles to be in accordance with all 
other vital movements. The cavae serve as reservoirs of 
blood in a limited manner, and suffer an undulatory motion as 
the right auricle contracts and dilates ; the blood rushes into 
the auricle and ventricle as they dilate ; and we freely admit 
that the heart is endowed with an expansive power. By this 
mechanisin a suction force does exist, and is extended so far 
as the large veins extend without valves. But, it is contrary 
to all analogy, and all the laws of physics and of vitality, to 
infer, that any suction power of the heart, assisted by atmos- 
pheric pressure, can cause fluids to be absorbed by the 
mucous tissue of the internal viscera, or by the serous tissues. 
These circulations, and in the capillary systems, continue for 
more than twentyfour hours after a cessation of the heart, 
and respiration. So the sap in vegetables ascends only so 
long as they retain any portion of vitality. The veins fill, 
and become largely distended when ligatures are applied to 
them. Furthermore, capillary circulation can be expedited 
in numerous ways, without any agency of the heart. The 
absorbants take up congenial fluids, whilst mechanical suction 
might take up all fluid substances indiscriminately. Finally, 
there is as much evidence of a vital capillary action, as there 
is of such an agency in the heart itself. 
Admitting, then, a limited degree of suction force by the 
active diastole of the heart, as influencing the circulation in 
the large veins without valves, and which are surrounded by 
an osseous encasement, we may admit another mechanical 
force, which has some influence on the same extent of circu- 
lation. This has reference to the process of the expansion 
of the thorax in the act of inspiration. The air rushes to fill OUTLINES OF PHYSIOLOGY. 
161 
the vacuum in the lungs, and a suction point is established in 
the whole thoracic cavity, and more space is given for the 
circulation generally. The jugular veins are seen to dis- 
charge their blood in the act of inspiration, and become turgid 
in expiration. The circulation through the lungs, also, is 
promoted by the dilatation of the chest, with the expansion of 
the vesicular tissues ;-hence the panting exertions in forced 
respiration. Surely, in the foetal life, the blood circulates 
without this force of thoracic dilatation, or any suction power, 
for there is a circulation before the heart is formed. 
7. The Circulation modified by Age. 
There is a larger proportion of fluids in relation to the 
solids, in youth, than in old age. So-again in youth, the arte- 
rial system contains a larger proportion of blood than in old 
age. This circumstance favors growth whilst the organism 
is developing. At length the activity of the arteries insures a 
state of condensation, with less mobility and distension of 
structure ; their capacity is diminished at a period when nu- 
trition is less needed. The veins not being subjected to such 
severe action as the arteries, and having thinner and more 
-yielding tunics, receive and retain a larger proportion of blood 
in old age than the arteries. The superficial veins, by not 
being compressed as the internal by a more rigid state, show 
a greater distention and become liable to varices. In age, 
both the capillaries, and the common mass of blood, acquire 
an undue degree of condensation, and deficiency of mobility. 
In consequence, not only is capillary circulation retarded, 
but so likewise are all the absorptions. Hence the liability 
of aged people to palsies, apoplexies, dropsies, dyspnoea, 
&c. 162 
CENTRIFUGAL CIRCULATIONS. 
8. Erectile State af Capillaries. 
All the capillary systems are subject to assume a turgid, or 
erectile state, in certain conditions of fulness and innerva- 
tion, Some tissues, as the spleen, corpora cavernosa, and 
corpus spongiosum of the penis, the female nipple, clitoris, &c., 
have been emphatically called erectile. However, erection 
is common to all the tissues, only differing in degree ; it ap- 
pears in the skin in disease, and in fright. A state of vital 
tonicity or innervation is necessary to its existence, and it 
cannot be maintained in any tissue without this. The struc- 
ture of some tissues of a yielding distensible fabric, and at 
the same time fully supplied with blood and nerves, affords the 
fullest view of it. A contractile movement gives occasion to 
a turgescence of the arterial extremities as well as veins. It 
appears that Professor Muller of Berlin, has discovered a 
kind of sacculated appendage to the penal arteries ; a differ- 
ent termination from the nutritive arteries of the spongy 
bodies. The principal arteries furnish the blood of the 
venous caverns, also the nutrient arteries, and at the extremi- 
ties of these is a sacculated termination of a contorted appear- 
ance, which he calls helicine arteries. These horned sacs 
are very small and numerous, projecting into the venous 
spaces, and are believed to act an important part in the 
erections. , 
The phenomena of the more visible erections reveal those 
of minuter tissues. An excitation, either by thought, or 
some physical impulse, is made on the vital susceptibility of 
a tissue. A tonic or dynamic state ensues, and the blood is 
not only invited to such part by the vital movement, but re- 
tained there by the same force for a certain period^ and suf- 
fering vascular action. It is a physiological action, and as 
soon as the vital tonicity becomes exhausted the tissue returns 
to its former condition. Had the erection been connected 
with a morbid impress in any tissue, it might not subside, but OUTLINES OF PHYSIOLOGY. 
163 
give origin to inflammation. So we find similar circum- 
stances of a morbid character continuing in the penal tissue, 
give origin to priapism. The uterus, also, affords similar 
examples. 
The turgescence of the spleen, liver, cavse, and the thy- 
roid gland is rather of a passive kind. 
If we were to take into view the whole capillary system of 
vessels, it might be nearly equivalent to a consideration of 
the whole of the organs, as they are chiefly formed of arteries, 
veins, exhalants, lymphatics, and the parenchyma of organs. 
There are large vessels traversing, the organs, and these are 
embraced on every side by capillaries of some kind. It is 
the capillary arteries we now consider, which are direct con- 
tinuations of the larger arteries, and carrying red decarbonized 
blood directly from the heart to the several tissues of their 
destination. As soon as they enter tissues, they assume a 
soft, contractile fabric, and at the same time an increased vital 
force from what obtains in the larger arteries. They now 
deliver over their red blood, in all the aortal circuit, to the 
secerning and nutritive processes, to be there deprived of its 
most vitalized parts ; whilst the capillary arteries of the 
lungs receive back the blood, in a deteriorated state, to be- 
come there again revivified. 
The red capillary arteries are very numerous throughout 
all the tissues, but abound vastly more in some tissues than in 
others. Whenever there is an organ destined to perform an 
important function, it is fully supplied with capillary arteries 
and red blood. Thus the cerebral organs, the great extended 
plane of the mucous tissues, the parenchyma of organs, the 
muscles, and the outer surface of the skin are bountifully 
supplied. These same tissues also, are proportionally en- 
dowed with nerves, either cerebral or nutritive, or both, ac- 
9. Capillary Arteries. 164 
CENTRIFUGAL CIRCULATIONS. 
cording as their functions may require. The red capillaries 
give off series of white arteries, into the white tissues, trans- 
mitting blood deprived of the coloring principle ; which 
tissues perform secondary functions, for which the red por- 
tions of the blood are not so much needed. The principal 
functions performed here seem to be nutrition and exhalation. 
These tissues are only scantily supplied with nerves of any 
description ; some have none, and have a near approxi- 
mation to the vegetative susceptibility. The capillary arteries 
again, give off the capillary exhalants, terminating in the in- 
ternal cavities, and on the surface of the body. 
In health, there is a certain balance observable between 
the containing vessels generally, and the contained fluids. 
In order that health be preserved, this balance in each indivi- 
dual should be maintained, although there may be a great 
disparity between different individuals, and which may be 
considered as depending on numerous circumstances estab- 
lishing the different temperaments of men. So with respect 
to the common mass of circulating fluids in any particular in- 
dividual, in a state of quietude, there is an equal balance con- 
tinued between the heart and large arteries on the one hand, 
and the capillaries on the other ;■ saying nothing of those 
discrepancies in the capillary circulation, which usually and 
habitually occur in the ordinary economy of digestion, 
nutrition, &c. If there is a plenary state of the larger 
arteries, the same will be manifest in the capillaries ; and 
again, whatever diminishes the plenitude of the large arteries 
or veins, proportionally lessens the amount in the capillaries. 
The solids contract on the fluids in every tissue equally, 
whether the inanition is produced by withholding nutriment, 
or blood be taken from arteries, veins or capillaries. If sud- 
denly abstracted, before the solids have time to contract e- 
qually, syncope will be likely to occur. 
Sudden abstractions of blood from the general mass, are 
soon restored from the various capillary tissues ; so a loss of OUTLINES OF PHYSIOLOGY. 
165 
blood from the large vessels excites a movement, or rather 
expedites the circulation in all the capillaries. If the abstrac- 
tions are large, there will be less fluids pass by exhalation, 
and there may be an imbibition, or endosmose take place 
from outer surfaces, until a congenial balance is restored. 
These movements all arise from the instinctive appetencies 
existing in the system, regulating its best economy, when not 
perverted by incidental contingencies. Yet, although it may 
be said, that nature is sedulous in guarding the well-being of the 
human economy, numerous circumstances do conspire to thwart 
it ; and it is the object of the art of hygieine to avoid them. 
The arterial capillary circulation, like that of the heart and 
large arteries, is chiefly governed by the vital influence of the 
nutritive system of nerves, and the external superadded system 
has merely a modifying influence over it. Thought and 
painful sensations may prove excitants, under certain circum- 
stances, but the motions of the capillaries depend mainly on 
this system of nervous force. 
It is nevertheless true, that injuries inflicted on the spino- 
encephalic system of nerves, by which their functions are im- 
paired, or even paralysed, produce an impaired condition of 
the capillary function. The cutaneous nerves lose their share 
of invigorating influence ; the skin is not so florid, nor is ca- 
lorification so perfect ; transpiration is diminished. 
It is not those causes on the surface of the body merely 
producing pain, which affect the capillary circulation of the 
skin, but rather such as excite the nerves of the capillary ar- 
teries which accompany them from the visceral plexuses. So, 
the sensation of cold does not destroy the balance of capillary 
circulation between the external and internal tissues, but its 
tonic influence. However, this balance is injured more or 
less, in almost every morbid condition. It is chiefly an ex- 
citation of the nutritive nerves which capacitates the capillary 
arteries and veins, to assume an altered and a morbid action. 
An altered action on the surface produces a harmony of 166 
CENTRIFUGAL CIRCULATIONS. 
altered action internally, and even simultaneously, yet in a 
modified degree. As cold, and atmospheric pressure, affect 
the surface more than the internal tissues, so their tonic 
influence diminishes the turgidity of the cutaneous capillaries, 
and increase that of the internal tissues. Hence at the attack 
of disease we commonly discover anaemia of the surface, and 
hyperaemia, or congestion, internally. 
It has already been stated, that much inequality of capillary 
circulation, and organic force may obtain in a physiological 
state, and their functions become accelerated. The same con- 
dition occurs in the cerebral functions. Mental excitations 
occurring in a healthy condition of the system, invite a tur- 
gescence of the capillary tissues of the cerebral organs ; and 
it appears that the use of the fluids here, aside from nutrition, 
is, to sustain the functions of the cerebral tissues. When 
this takes place in a compatible degree, the force of intellect 
will be increased, and even sustained, beyond the ordinary 
period of repose. The circulations in such a state must be 
free or unembarrassed. However, this condition cannot be 
sustained beyond a certain point ; for either coma or delirium 
will be the result of incompatible excitation, or too long con- 
tinued exertion of intellect. Such a state of the cerebral 
organs is very similar to that of other organs, sustaining excess 
of action. The capillary tissue, winding around the nervous 
fibrils, and entering into their intimate fabric, modifies the 
cerebral functions. From this may be deduced many patho- 
logical inferences. 
10. Relation between Nervous Sensibility and Capillary 
Action. 
There seems to be a mutual relation between the capillary 
and nervous systems. It has been mentioned, that an exci- 
tation of the nervous sensibility invites an afflux of fluids ; so, 
again, an afflux of fluids to a part always raises the sensibility OUTLINES OF PHYSIOLOGY. 
167 
of that tissue. Both these conditions exist constitutionally, in 
a particular manner in youth ; and they are always attended 
with a proportional disengagement of caloric. So the bodies 
of youth are better warmed than those of age, having less 
sensibility and capillary fulness. In febrile diseases both 
these conditions exist in an eminent degree, occasioning a 
disengagement of caloric. No adequate conception can be 
obtained of the capillary circulation in health by inspecting 
dead subjects ; it can only be learned, as relates to intensity, 
by observations, comparative experiments, and vivisections. 
11. White Arterial Capillaries. 
The cartilages, tendons, ligaments, fibrous and serous mem- 
branes, do not receive red blood, but they are traversed by 
white capillary arteries, transmitting albumen and gelatin. To 
these might be added the capillaries of the hair and nails, trans- 
mitting chiefly gelatin. No nerves exist in these tissues ; yet 
when excited sufficiently long, either by experiments or in dis- 
ease, they admit red blood, and their sensibility becomes exalted, 
so that the sensation of pain is transmitted to the centre of per- 
ception. In the trichosis plica, or Polish mat, the hair enlarges 
to several times its natural size, admits red blood, and when cut 
bleeds, and gives exquisite pain. The hair and nails some- 
times become equally sensible from wounds. The same of 
the internal membranes ; they admit red blood, become ex- 
alted in sensation, and afford morbid secretions. These 
notices are made to illustrate the obscure physiological state 
of these tissues. As soon as the preternatural susceptibility, 
or as it might be called, morbid tonicity becomes changed, the 
fluids are absorbed from the capillary tissues, and no more 
are admitted than in the physiological condition. 
The tissues traversed by red blood, resemble a vascular 
network everywhere anastomosing. Injections thrown in by 
an artery, find their way into veins, excretories, and even on 168 
CENTRIFUGAL CIRCULATIONS. 
the serous tissues. So there seems to be a communication 
by capillaries with all the tissues of the system. In all these 
instances it passes by continuous vessels, by the exhalants 
into other tissues, and by continuous arteries into continuous 
veins ; but we cannot conceive of any injections in the living 
subject, even if they do in a dead one, passing from a nutri- 
tive, or from a secerning tissue into veins, for this must 
require the vital acts necessary for the process of absorption. 
By way of illustration, we might say, that injections may pass 
into serous cavities by the exhalants, but that they cannot be 
made to pass from those cavities by absorption, for this 
requires a specific vital action, the other being merely a con- 
tinuous circulation. 
In the dead subject, fluids pass readily by capillary vessels 
into other tissues, and on to the skin, and mucous surfaces, 
which could not occur during life, unless some peculiar pa- 
thological state were present. Vitality gives to all the solids, 
and even fluids, a dynamic state, which might be called vital 
tonicity ; it is apparent in all the organism, in the muscles, 
and the same in the capillaries ; and it is this force which 
retains the fluids in their proper vessels. When this force 
is abstracted, the capillaries yield very readily, and even the 
blood has a weaker crasis, and more readily conforms to ordi- 
nary impulses. Therefore blood permeates the mucous 
tissue of the lungs when life has ceased, that could not during 
the living state. 
12. Exhalations. 
In following up the centrifugal circulations, we must notice 
a broad surface, from which arise an infinity of capillary ves- 
sels, transmitting thin fluids from the red and white capillary 
tissues. These exhalants transmit at least two kinds of fluids ; 
one of which is a thin, sero-albuminous fluid, and deposited 
in all the serous sacs, as the ventricles of the brain, and arach- OUTLINES OF PHYSIOLOGY. 
169 
noides, the pleura, pericardium, peritoneum, tunica vaginalis, 
and all the cells of the subcutaneous cellular tissue. The 
other is an aqueous fluid, having in solution many saline sub- 
stances, and excrementitious matter, with a small portion of 
albumen. This is deposited on the entire surface of the 
body, in the form of transpiration, or sweat; also, on the 
mucous tissues of the lungs and of the digestive apparatus. 
Materials that are not only useless, but obnoxious, are thrown 
out by these tissues, and hence they have been called depu- 
rating organs. To these ought to be added the urinary ap- 
paratus, for it conveys in like manner, substances already 
existing in the circulating mass, which by accumulating there 
would prove obnoxious, if not eliminated. 
The exhalent vessels arise from the extremities of the 
capillary arteries, and by short courses deposit their fluids on 
the surfaces of membranes. Besides the saline substances 
exhaled, more or less, on all these surfaces, there is, also, 
acetic acid, ozmazome, carbonic acid, azote, caloric, and 
probably other gaseous bodies. The cutaneous and pulmo- 
nary exhalations have been proved by Dr M. Edwards as 
very similar ; and we have many facts demonstrating gaseous 
exhalations, or exosmose, from the capillary circulation into 
the digestive canal. In the most perfect state of health these 
excreta are not very abundant ; but, in the pathological state 
are often profuse. The aqueous matter sometimes is pro- 
fuse, at other times greatly deficient; and so of all the others. 
Acetic acid is thrown out largely in some fevers, so that a 
sour smell is readily perceived. 
Berzelius insists, that the fluids exhaled and eliminated 
from the system all contain an acid, w'hilst those secreted and 
employed for internal uses are all alkaline, or contain some 
alkaline principle. The milk, a secreted fluid of utility, 
contains lactic acid. Tiedemann observes, that the products 
of the secreting organs for future use, contain organized glo- 
bules, whilst the depurations never contain any. 170 
CENTRIFUGAL CIRCULATIONS. 
In the physiological state, these four depuratory surfaces, 
the skin, lungs, digestive surface, and kidneys, have a just 
balance, are in constant exercise of function, with only a little 
variation, and continually eliminating from the common mass, 
in the round of circulations, such substances as would be in- 
jurious if retained. But, exposed as the bodies of men are 
to the circumfusa, especially atmospheric vicissitudes, the 
vital actions suffer impressions, and changes of functions fol- 
low, in a manner to produce essential modifications. The 
skin, or expanded dermoid tissue, commonly first suffers 
change, and diminution of function ; and in consequence of 
this the instinctive movements are directed towards some 
other tissue of the kindred functions, and discharges from 
such tissue may be very large. 
In consequence of the vicarious discharges last spoken of, 
the general system is often relieved from a greater conflict of 
morbid action. Hence it is, that the cutaneous exhalation 
being suppressed, it is immediately followed by copious urina- 
tion on many occasions ; or, it may be a diarrhoea, instead of 
diabetes simplex. Again, it may be, especially in cold sea- 
sons, that the internal impetus is directed to the mucous 
tissue of the lungs, producing catarrh, or in a more aggravated 
degree, pneumonia. At any rate, when any of these depura- 
tory exhalations are suppressed, and without any vicarious sub- 
stitute, grave disease is very liable to succeed. 
The analysis of the fluids demonstrates, that the foregoing 
substances, together with uric acid, exist in the blood ; and 
all pathological observation proves, if retained there, they 
become injurious stimulants upon the vital susceptibilities. 
13. Gaseous Fluids. 
The gases have not been so much noticed in the circulating 
fluids, but they are proved to have an existence there, and 
probably act a more important part in disease than has been OUTLINES OF PHYSIOLOGY. 
171 
supposed. They go the rounds of circulation in a combined 
state, and the circumstances of their evolution and exhalation 
are not well understood. The poison of certain reptiles and 
insects appears to set them free. The attention of experi- 
menting physiologists might well be further directed to this 
subject. 
An extraordinary case of extrication of gas is related in 
the 18th Volume of the American Journal of the Medical Sci- 
ences, by Mr Raleigh, of India ; of the extrication of gas " in 
the inferior venous system." The veins supplying the ascend- 
ing cava were distended greatly, and especially the veins of the 
liver, kidneys, &c. On cutting into them gas rushed out 
with " a hissing noise." The heart also was greatly dis- 
tended, and on opening the right auricle, gas rushed out and it 
suddenly collapsed. No gas appeared in the descending 
cava or its branches, neither in the arteries. 
Gases are sometimes exhaled into the alimentary canal in 
large quantities, at the commencement of disease, exciting 
flatulent colic, especially after exposure to cold ; at other 
times not until disease has continued some time, then pro- 
ducing meteorism, or tympanitis. M. Andral mentions 
gaseous exhalations, or as he calls them secretions, from the 
skin, the lungs, and the alimentary canal as a physiological 
process ; and also into the cellular tissue, the serous sacs, 
and uterine cavity, and even into the blood vessels in cer- 
tain pathological conditions. (Sect. xiii. 7.) 
An aeriform fluid has been discovered on opening large im- 
posthumations externally. Also, in cases of empyema. In 
one case in particular, it found passage by the canula of the 
trocar when there was no pneumo-thorax, or communication 
with the bronchia. Dr Forbes, in his notes on Laennec, 
mentions effusions of air. (Page 310.) 
In our observations upon the phenomena connected with 
an exalted state of action, and in different habits of disease, 
we had long ago noticed, that the expansion of vital fluids 172 
CENTRIFUGAL CIRCULATIONS. 
was greater than might be supposed of other fluids, under 
similar circumstances of heat ; whilst the thermometer indi- 
cated only two or three degrees above the natural standard, 
the volume of the mass of blood would appear to be greatly 
increased, and even when large evacuations of blood had 
been made. Do the gaseous expansions, even in a combined 
state, contribute to this phenomenon ? Some physicians have 
undertaken to describe the gaseous pulse, as they call it; 
and indeed, it seems difficult to account for it altogether 
from the state of the solids, and without taking into the ac- 
count a modification of the fluids. M. Lobstein noticed this 
great expansion of fluids, but referred it to a " nervous ple- 
thora." However, this must be a very untenable position, 
for he ought in the first place to prove that a specific nervous 
fluid exists at all. We may rather refer the phenomenon to 
an excitation of vital force, giving occasion to a greater evo- 
lution of caloric, and gaseous expansion. 
14. Serous Exhalations. 
As it is the design of the present work to bestow more 
regard to general principles than to the minutiae of physiology, 
we pass over numerous facts and circumstances, which may 
be very essential, but are to be found in many modern works. 
So with regard to the exhalations; and yet we cannot avoid 
bestowing a moment's attention on the exhalations of the serous 
tissue of the brain, the arachnoides. M. Magendie has par- 
ticularly called attention to it, though much neglected. 
This tissue covers the whole of the brain, cerebellum, and 
spinal cord, besides lining the ventricles. An albuminous ex- 
halation constantly bedews it. and whenever atrophy of the 
cerebral mass occurs, the. vacancy is filled by this fluid. 
This function acts a conspicuous part in all vascular exci- 
tations of the cerebral organs. This fluid is liable to be 
exhaled in excess, and that on slight irritations, and sud- OUTLINES OF PHYSIOLOGY. 
173 
denly. In the normal state, absorption takes up the fluid ; 
but, if the absorbants cannot act in the diseased state, or the 
exhalation should be too viscid for imbibition, its accumula- 
tion occasions a fearful train of phenomena in all the organs of 
external relation. The tissue becomes thickened, and some 
effusions attend, producing an inability of cerebral function. 
It becomes necessary briefly to notice the kidneys, as a 
part of the centrifugal circulation, and eliminating surfaces. 
The anatomy of these organs can be learned from the proper 
sources ; and we shall only make such physiological references, 
as may be applicable to the present design. Although these 
organs have the glandular, parenchymatous structure, and ac- 
tually secrete fluids, they are not of a peculiar character, for 
they merely contain substances that pre-existed in the com- 
mon mass of blood, or with only slight modifications. In the 
circuits of the fluids, and their passing the secreting and nu- 
tritive tissues, and taking with them effete materials, the 
results of the vital chemistry continually going forward, the 
blood becomes charged with substances of a noxious charac- 
ter, which if retained would prove hurtful. The most char- 
acteristic substance eliminated by the kidneys is the uric 
acid and urea. This is destructive to animal tissues ; and 
when not thrown out always injures the cerebral organs and 
functions. It is a combination of uric acid, carbon, and am- 
monia. It affords the peculiar urinous smell when urine is 
thrown on burning coals. It is a recrementitious product, 
and not necessary in the process of nutrition. 
In the perfect economy of nature, it seems necessary that 
certain materials should be eliminated by organs adapted to 
the purpose of transmitting substances that might injure the 
sensibility of more delicate tissues ; and they even might be 
highly offensive to the organs of sensation in passing off in 
15. Function of the Kidneys. 174 
CENTRIFUGAL CIRCULATIONS. 
the form of vapor. Besides the urea, the substances which 
pass by the kidneys are, a gelatinous animal matter, muriate 
of soda, either separate or combined in triple salts, phosphates 
of lime, and magnesia; also, phosphoric and benzoic acids. 
At certain times are found sulphate of soda, and of lime, the 
oxalate of lime, besides other saline bodies. In health about 
certain definite quantities of these bodies pass by the kidneys, 
although the amount of aqueous matter may be greatly diver- 
sified. 
In disease, the urine is liable to suffer important changes 
from the natural condition, and merits particular considera- 
tion in pathology. The chemical changes then going for- 
ward, whilst the vital actions are scarcely able to restrain 
their heterogeneous affinities, give origin to various noxious 
compounds, which require to be eliminated before health can 
be restored. So we find copious sediments in the urine to 
be good pledges that a relaxation or perviousness of emunc- 
tories has taken place, by which the capillary tissues will be 
relieved of plethora ; and also, of the stimulations of injurious 
combinations, which may have taken place during the conflict 
of disease ; or, peradventure, have been instrumental in the 
production of it. Albumen passes with the urine in certain 
diseased conditions, especially in dropsies connected with a 
dynamic diathesis ; it will coagulate by heat and acids. 
The kidneys are furnished with nutritive or ganglial nerves 
from the renal plexus, accompanying the emulgent arteries 
into their parenchyma. They do not possess the sensibility 
of external relation in their interior, but do on their exterior 
after moderate excitation. The vessels of their parenchyma 
are large and free. Injections by the arteries pass freely in 
these organs, not only into the ureters, but into the vein^ al- 
so, in the dead state, but it is doubted whether a vital tonic 
power would admit them. If the ureters are tied, the urea 
will be absorbed back into the circulation, and prove injuri- 
ous, unless eliminated by some vicarious outlet, as has been OUTLINES OF PHYSIOLOGY. 
175 
known to take place by the skin, mouth, umbilicus, or even 
the ear, constituting the paruria erratica. If the kidneys be 
extirpated, urea will still be found in the blood. 
The quantity of exhalations from the skin is modified by 
many circumstances ; the ordinary quantity of insensible per- 
spiration may be about thirty ounces in twentyfour hours ; in 
the case of sweating, cutaneous exhalation may be very con- 
siderably increased. It is about twice as much in summer, 
and in hot latitudes, as it is in winter and in cold latitudes. 
Diseases of the skin are most prevalent in hot latitudes, 
whilst urinary calculi, and diseases of the urinary apparatus, 
afflict the inhabitants of the cold and variable latitudes. Tis- 
sues subjected to an excess of function, are liable to assume 
an increase of sensibility, by which they become impatient 
under ordinary stimulation ; and when the saline and stimu- 
lating substances of one of these tissues is thrown upon the 
other in excess, morbid excitation is liable to follow. 
The urine of children contains but a small proportion of 
urea, and very little phosphate of lime, as the latter is em- 
ployed in the formation of bones. In old people it is pretty 
abundant, and if not discharged by the kidneys, might pro- 
duce deposits on other tissues. Urinary calculi are of great 
varieties of composition. M. Berard considers urea as the 
most azotized of all animal substances, and its excess requires 
elimination from the blood by the kidneys, as the excess of 
carbon is by the lungs. Animal food increases the relative 
proportion of azote in the blood, as vegetable food does that 
of carbon. / 
Having reviewed as many circumstances in relation to the 
aortal, or long circulation, wit'll the eliminating surfaces of 
the centrifugal circulations, as our limits admit, we now ad- 
vert to the pulmonary, or short circulation ; and this may re- 
quire some notice of the lungs as an organ. Afterwards the 
centripetal circulations will merit attention. 176 
PULMONARY TISSUES. 
SECTION X. 
PULMONARY TISSUES. 
1. Of the Pulmonary Circulation. 
The respiratory apparatus performs very important func- 
tions in the human economy ; it has reference to many 
movements of external relation, and also to the internal econ- 
omy of many organs. In the former, the lungs stand related 
to all the modulations of voice, as in common language, 
speech, singing, hallooing, and various exclamations. To 
these may be added coughing and sneezing, excited by irri- 
tating substances on the mucous tissues. Laughing, crying, 
sighing, and sobbing, are expressions of the passions. The 
former are motions of volition, the latter of necessity. The 
lungs also stand in intimate relation to other organs as sus- 
taining the entire force of the circulation through their tissue, 
equal to that of the aortal circulation. It is an imbibing and 
exhaling organ, as will appear in the sequel. 
2. Pulmonary Structure. 
This is so peculiar, it merits some notice.-1st, a fibrous 
tissue uniting the cartilages of the bronchia, and traversing the 
whole of each lobe, and affording some degree of elasticity. 
When the lungs are separated from the body, they retain 
their form by the force of this tissue.-2d, the internal mu- 
cous tissue, possessing something of the sensibility of exter- 
nal relation, and which has already been spoken of.-3d, the 
external, or serous tissue, possessing the instinctive or or- 
ganic sensibility.-All these are connected, 4thly, by the 
cellular tissue, and liable to admit fluids and air by extravasa- 
tion and effusion into its interstitial spaces.-In this tissue are 
imbedded, 5thly, the pulmonary arteries carrying black blood, OUTLINES OF PHYSIOLOGY. 
177 
and the pulmonary veins transmitting red blood.-6th, the 
bronchial arteries, one from the aorta, the other from the 
intercostal, transmitting oxygenated blood for the nourishment 
of the tissues.-7th, the lymphatic absorbants, and bronchial 
veins, together with innumerable absorbants and exhalants, 
besides the mucous follicles.-Sth, the nervous tissues, to 
wit, the recurrent to the mucous tissue, and the nerves fur- 
nished from the cardiac and pulmonary plexuses to the blood 
vessels carrying both dark and red blood. 
Such is the complexity of the tissues of this organ, of little 
specific gravity, and containing within its bronchial cells, or 
aerial superficies, a surface exceeding that of the whole peri- 
phery of the body. Here is expanded a large surface for the 
contact of atmospheric air, for the convenience of absorption 
and exhalation. Dr Horner has very well demonstrated, 
that these aerial cells are of a globular form, and that they all 
communicate together by lateral apertures of about one 
twelfth of a line in diameter. 
All the vascular tissue, and the minute capillary exhalants 
and absorbants, are of a yielding and distensible fabric. Gross 
injections easily pass from the pulmonary arteries, into the 
pulmonary veins ; and also from the pulmonary veins back 
into the arteries, as there are no valves in the veins. Injections 
readily pass from the arteries into the aerial cells ; in disease, 
red blood often passes into these cells by the exhalants, and 
without any rupture of textures. In dead subjects, this ap- 
pearance is very common. Again, fluids injected into the 
bronchial cells, have been absorbed in living animals, and 
found in the left chambers of the heart, in three or four 
minutes after being injected, as proved by unerring tests. 
The loss of the vital tonicity in the dead subject, affords 
opportunity for tne blood to be transmitted into the aerial 
cells, which does not take place in the living. However, 
certain pathological states do allow it to pass. 178 
PULMONARY TISSUES. 
3. Exhalations from the Aerial Surfaces. 
In pursuance of our order of following out the centrifugal 
circulations, and exhalations, it becomes necessary, firstly, to 
bestow a little attention to these as appertaining to the short 
circulation. 
The dark carbonized blood, thrown from the right ventri- 
cle of the heart, passes rapidly along the short pulmonary 
arteries, and by infinite subdivisions, is distributed on the 
delicate mucous tissue of the aerial cells. Many important 
functions are effected in this tissue ; its surface being large, 
the exhalations of fluid matter are very considerable, and yet 
no exact estimate can be put on it. Richerand estimated it 
at about four pounds in twentyfour hours ; and it has been 
estimated very differently by different experimenters. In 
warm latitudes, and in warm seasons it is less than in cold 
latitudes and seasons. It is called the pulmonary transpira- 
tion, and is quite similar to the cutaneous transpiration, but 
does not contain the neutral salts so manifest on the skin, and 
on the intestinal mucous surface. 
The gaseous substances are eliminated from the capillary 
exhalants of the lungs, such as carbonic acid gas, azote, hy- 
drogen, carbon, the aroma of ingested substances, as of the 
essential oils, of garlic, of onion, asparagus, cheese, &c., 
whilst the more gross saline bodies pass by the kidneys and 
skin. However, the volatile substances do pass, also, by 
these emunctories. This pulmonary surface is also the outlet 
of many adventitious substances, especially occurring in dis- 
ease. The smell of mercury is discovered in the breath, and 
certain fevers called putrid, are attended with offensive efflu- 
via. Alcohol also passes freely. 
It is scarcely necessary to mention the former hypothesis 
of water being formed in the lungs by the synthetical union 
of oxygen and hydrogen ; it is demonstrated as passing by 
very short courses merely through the mucous tissue, direct- OUTLINES OF PHYSIOLOGY. 
179 
ly from the arterial capillaries, and probably by continuous 
pellucid vessels; or, may it pass by exosmose without con- 
tinuous vessels ? 
This fluid is of essential service before it leaves the aerial 
cells, by diluting the mucus of the follicles, which other- 
wise would be too viscid to pass off in the air of respiration. 
By being thus diluted, the mucus becomes suspended, and is 
eliminated with the air of respiration, after it has lubrica- 
ted the membrane. When the pulmonary exhalation is defi- 
cient, as often occurs in disease, the mucus becomes viscid, 
and tenacious, and then excites coughing for its expulsion. 
In warm weather the pulmonary vapor becomes suspended in 
the atmospheric air, and is invisible, but in cold and especially 
damp air, it is not so united, but appears in the form of vapor. 
It is very manifest that caloric, instead of being absorbed 
by the lungs, is actually eliminated from the system by these 
organs. Like other exhaled bodies it is passing off from all 
point and a due portion passes by the air of expiration. It 
is believed that Brodie's experiment of fanning the lungs with 
a bellows has been confirmed, by which the body cools faster 
after death than when it is not practised. Animal heat is no 
more evolved in the lungs than in other parts of the system. 
It is prone to accumulate above the wants of the system, and 
if not eliminated would become destructive ; it is therefore 
necessary for the human species to exist in an atmosphere 
below the ordinary heat of the blood. This degree of tem- 
perature is found to be between 60° and 65® Fah., to relieve 
the excess of caloric, whilst that of the blood is about 98°. 
When atmospheric temperature is equal to that of the blood, 
it is necessary it should be accompanied with free sweats, the 
evaporation of which combines large portions of the caloric, 
and relieves the excess of heat. 
It has been stated that oxygen is exhaled from the lungs ; 
but this is in small proportion to what is absorbed by the mu- 
cous tissue of the lungs. Absorption will hereafter be con- 180 
PULMONARY TISSUES. 
sidered ; but it seems necessary now to notice, that large por- 
tions of oxygen are absorbed. Atmospheric air may be esti- 
mated as composed of about 19 parts of oxygen, 80 of nitro- 
gen, and 1 of carbonic acid gas. Say about half of the oxy- 
gen of the common air is absorbed in respiration, and it is 
found the respired air is returned loaded with carbonic acid 
gas, and nearly in proportion to what is required of oxygen 
to convert carbon into carbonic acid gas. A small portion of 
oxygen in a free state either passes by exhalation, or is com- 
bined in the vital processes. 
There is then a large proportion of carbonic acid gas ex- 
haled from the lungs, and which, according to M. Edwards, 
Collard de Montigny and others, is formed in the capillary 
system in the processes of nutrition, secretion, &c., and by 
uniting with the excess of oxygen. Large portions of carbon 
are taken in with vegetable food, and when combined with 
oxygen are readily expelled. But, before this takes place, no 
doubt the oxygen has served very valuable purposes by stim- 
ulating the vital solids, and increasing the vital force through- 
out every organ. We see the blood in the capillaries of the 
lungs immediately affected by it at its absorption, by which 
it is changed from a dark modena, to a bright scarlet color. 
The blood is now returned to the left auricle and ventricle of 
the heart enriched by a compatible stimulus, by which it ex- 
cites the nervous tissues, and their organs to vigorous actions. 
Oxygen is not only a compatible, but an indispensable stimu- 
lus ; for the constitution of animal fabrics is such, that vital 
movements cannot be continued without it. But this topic 
will be descanted on when speaking of calorification. 
The chemical physiologists have bestowed much attention 
to ascertain the amount of gases, and other excretions exhaled 
from the body in a given time. But there has been great 
discrepancy in their results, and no two can be found to agree 
in them with much precision. There are numerous circum- 
stances which modify the imbibitions and exhalations ; some of OUTLINES OF PHYSIOLOGY. 
181 
these are the deviations of health of the slighter kinds in 
the individuals practised on ; a difference in food assumed ; 
the deviations of atmospheric heat, weight, and moisture ; 
they are also modified by age, season of the year, by time of 
day, by exercise, and even affections of the mind. It may 
be noticed, that absorptions, and exhalations of gases and 
fluids take place by the skin, and intestinal surfaces also. 
In the physiological state, the instinctive susceptibility pos- 
sesses a tendency, or appetency to regulate and modify the 
economy of the vital movements, so as to preserve itself in a 
just and easy balance. This is not the direction of conscious- 
ness, but results from a harmony, or consensus of structural 
sensibility existing throughout the whole organization, by 
which the complicated machinery is reduced to a unity. It 
is by this property of the vital solids, that they assume more 
or less of extraneous, compatible substances, to suit tl.e i e- 
cessities of the system. And again, it is by the same in- 
stinctive economy, that useless and unwelcome substances are 
thrown out of the circulation by the exhalants, when they are 
not needed, or become oppressive ; and the quantities of such 
substances so eliminated, will be varied by numerous concur- 
rent circumstances in relation to the wants of the organism. 
It is agreeable to this thesis, that animals existing in an at- 
mosphere containing a plus, or minus proportion of oxygen of 
some considerable variation, suffer little or no inconvenience, 
only they make use of a more or less volume of air. The ab- 
sorption is in proportion to the wants of the system, and this 
can be supplied in either event in the healthy state. How- 
ever, when the tissues of the lungs have lost the absorbing 
powers, as in asthmatics, and dying people, the most conge- 
nial composition of air cannot satisfy their wants ; they pant 
for more when a plus exists all around them. 
The causes of disease are all such contingent circumstan- 
ces, as interrupt this delicate harmony of moveme ts in the 
vital tissues, by impressions made on the nervous susceptibil- 182 
PULMONARY FUNCTIONS. 
ity, and thereby altering their movements from their normal 
condition. Many contingencies almost daily occur to nu- 
merous individuals, which produce deviations from the most 
perfect economy; but they soon become restored by the re- 
cuperative powers, and no further notice is taken of them, 
whilst some of the exhalations, and absorptions have been al- 
tered. However, let the morbid impression be of a more 
grave kind, by which the vital movements have been more 
permanently altered, and there arise more manifest phenome- 
na in reference to the exhalations, absorptions, secretions, 
&c. In such instances the exhalations may be almost uni- 
versally suppressed ; they may be constrained in one tissue, 
whilst they are profuse in another ; and the absorptions may 
suffer similar derangements. A continuance of this abnormal 
state gives origin to the diseased habit. 
The process of endosmose, and even exosmose is very ex- 
tensive in both animate and inanimate bodies. It seems to 
be a law of nature, that any substances placed in opposition 
have more or less a tendency to be diffused into each other, 
according to their degree of mobility. So gases and fluids 
pass through the tissues of the human system, and obtain just 
balances. Notwithstanding, if there should be a great excess 
of any one, as an accumulation of carbonic acid gas in a con- 
fined room, the excess might not only be prejudicial, but fa- 
tal. 
4. On Respiration. 
The mechanism of respiration has been well explained by 
some modern physiologists ; it will require only some casual 
remarks in addition to what has heretofore been said. The 
lungs of the new-born infant are collapsed, and as solid as 
muscle, and sink in water. They have been compressed in 
a dense medium, and in the firm parietes of the uterus, so 
that the elasticity of the foetal thorax has never had an oppor- OUTLINES OF PHYSIOLOGY. 
183 
tunity to assume its destined position. On arriving in its 
new, and specifically lighter element, the thorax of the foetus 
has a tendency to expand by its own elasticity, and to an ex- 
tent far above the volume of air respired in ordinary respira- 
tion. This force, together with the necessities created by 
the new change of circulation, and want of oxygen, excite 
the muscles of respiration into contraction. By this process 
the capacity of the thorax is very considerably increased, and 
as the vacuum is made, the bronchial cells are filled with at- 
mospheric air ; at the same time the blood rushes through 
the pulmonary arteries, which before passed direct into the 
left chambers of the heart, and aorta, by the ductus arterio- 
sus and foramen ovale. 
The respiratory motions are continued by necessity, as 
long as life continues ; and indeed, the vital forces cannot be 
kept in play any longer than absorptions, and exhalations of 
the aerial surfaces are perpetuated. Respiration cannot long 
be restrained by any voluntary exertion ; a man may starve 
himself to death, but cannot voluntarily suffocate himself ; 
for the respiratory sense is so intense and commanding, that 
it excites a train of involuntary movements, by which the 
thorax becomes enlarged, and the atmospheric air will, of 
course, supply the vacuum, and the wants of the system are 
satisfied. These respiratory motions are kept up during 
sleep, and in the condition of apoplexy, and even when the 
cerebrum and cerebellum are cut away, by the force of the 
superadded respiratory nerves. However, when the pneu- 
mogastric nerve is cut, the respiratory sense is lost, and 
although the thorax may be dilated, no absorptions take 
place. 
On ordinary occasions, the voluntary muscles act by the 
determination of the intellect, through the medium of the 
symmetrical nerves, from the spine to the diaphragm and 
external muscles. The intercostal muscles approximate the 
ribs ; their curved position downwards, now by moving up- 184 
RESPIRATORY FUNCTIONS. 
wards enlarges the capacity of the thorax, with the aid of the 
two wings of'the-diaphragm, which simultaneously contract, 
and bring its superior convex surface towards a plane, and 
inspiration follows. During this time, the abdominal muscles 
are at rest; but during expiration, the abdominal muscles 
contract, and by pressing the viscera against the lower surface 
of the diaphragm, together with the elasticity of the thoracic 
parietes, this process is effected. 
These movements of the diaphragm, and abdominal mus- 
cles are not alone necessary for the circulations through the 
lungs, but serve an essential purpose, also, by promoting the 
circulations in the abdominal viscera. Perhaps the tardy cir- 
culation of the branches of the vena portae could not well be 
sustained, without this oscillatory aid. The influence of these 
motions extends still further, and affect the circulations in the 
cavae, and many other portions of the venous, and absorbent 
systems ; whilst the oxygen inspired, excites the arterial 
actions in the lungs and in every remote tissue in the circula- 
tory system. 
The outer surfaces of the lungs are in close contact with the 
pleura costalis, and of course they expand by the atmospheric 
pressure in proportion as the thorax is enlarged, for they 
have no active extensibility or contractility of their own. 
They never contract to their former foetal state, not even 
when removed from the body. There is always a large por- 
tion of air filling the aerial cells even in expiration ; so the 
absorptions are going on equally the same during inspir t on 
and expiration. About sixteen or eighteen respirations ordi- 
narily occur in a healthy adult in a minute, and the heart may 
be said to contract nearly four times during each respiration. 
There is a very constant relation between the number of 
pulsations of the heart, and that of respirations. When 
the circulation becomes increased by exercise, by a pyrectic 
habit, or indeed any cause, the respirations are increased 
pretty constantly in a similar ratio. It appears there is a ne- OUTLINES OF PHYSIOLOGY. 
185 
cessity of aeration of the blood in its passage through the 
lungs, and the more freely it is forced through these organs, a 
more frequent respiration becomes necessary. If there exists 
any mechanical impediment to a full dilatation of the parietes of 
the chest, or of the lungs, the number of respirations is 
increased in order to give the whole of the blood an oppor- 
tunity for aeration. And further, as dilatation of the thorax 
expedites the circulation through the pulmonary vessels, so a 
necessity of increased respiration is produced. 
Perhaps the amount of air, in a common sized man, con- 
tained in the lungs, may be estimated at 210 cubic inches in 
forced inspiration ; in mild, say 110 inches. In healthy, 
placid respiration only about one fifth part of this is expired, 
and again replaced in one respiration. But, respiration may 
be so forced as that half of the whole quantity may be thrown 
out from the lungs. This reservation of air in the lungs is 
very important, in the expulsion of any substances acciden- 
tally passing the glottis, for the purpose of expelling them 
without an inspiration ; and also, in some irresist ble coughs. 
And, again, in the event of compressions of the lungs exter- 
nally, or effusions internally , life could not long be sustained 
but by the displacement of the surplus air. 
The necessity for free atmospheric air, and amount of 
oxygen required, may be appreciated by taking the lowest 
estimated quantity of air used at each respiration, say, 25 
cubic inches, at a common temperature, at each respiration, 
allowing 20 in a minute, although we consider this large. In 
an hour 30,000 cubic inches would be required ; or 360,000 
in 24 hours, equal to 46 hogsheads. Suppose only 8 per 
cent, of oxygen absorbed, the amount would be very great, 
which is required for the use of the human economy. The 
absorption of this gas has been abundantly demonstrated, for 
air without it is either useless or deleterious ; it changes the 
color of the blood instantly, and increases its quantity of 
fibrin ; some have insisted that it raises the temperature of the 186 
CENTRIPETAL CIRCULATIONS. 
blood one or two degrees ; but this may be doubted. De- 
prived of oxygen, the whole mass of blood assumes a dark 
color, and ceases to afford the necessary stimulations ; the 
subject then falls into asphyxia. 
Besides the instantaneous change of the color of the blood, 
in passing the capillaries of the lungs, its capacity for caloric 
is increased, according to Davy, as 913 to 903 ; it coagu- 
lates more quickly ; its serum is less abundant, and the pro- 
portion of fibrin increased. Hematization is begun, and no 
doubt greatly perfected in the lungs ; and this must essentially 
be effected by a vital process ; for, on a division of the 
pneumogastric, it is impaired, and ultimately destroyed, 
although the vital force of the lungs is not wholly dependent 
on this nerve. The impoverished venous blood meets with 
the chyle and lymph, just before entering the lungs, and the 
mass of fluids soon becomes thoroughly mixed, and with the 
oxygen forms chemico-vital changes, which enrich it for 
nutrition, and the disengagement of caloric. The oxygen, 
with a small amount of azote and hydrogen, enter the thin 
coats of the aerial parietes by endosmose, being attracted by 
a dense fluid. The gases pass into the blood and return, 
according as the necessities of the system, in health, may 
require. 
The lungs of the foetus being useless, the blood transmitted 
by the aorta and iliac arteries, to the placenta, is of the dark, 
venous character ; but it returns by the umbilical vein to the 
foetus enriched with decarbonized blood, by the influence of 
the maternal blood in the placenta. OUTLINES OF PHYSIOLOGY. 
187 
SECTION XI. 
organic; tissues-continued. 
1. On the Centripetal Circulations. 
Having bestowed as much time on the centrifugal or di- 
verging circulations as our limits allow, together with remarks 
on particular organs in direct relation, we will now review 
the functions of the tissues which supply the common mass of 
fluids, by absorption, and their concentration to the common 
centre, dr the converging circulations. It is expected the 
allusions already made will shorten this division of our sub- 
ject. It will be difficult to avoid some remarks on organic 
structures, and certain functions not directly absorbing. 
From the first moment of embryotic existence, to the last 
hour of life, all the substances required for accretion, and for 
the supply of waste, enter the great circulations by extended 
surfaces, and through tissues by certain passages, so minute 
as to elude the ken of anatomists. No vessels have been de- 
monstrated as passing the epithelia of these tissues, but are 
found immediately below. By some the existence of vessels 
is inferred, but denied by others, who insist that substances 
pass by imbibition or endosmose. The process is usually 
called absorption. 
2. Two divisions of Msorbants. 
This process requires to be divided into two kinds ; 1st, 
as it occurs in the surfaces of external tissues ; 
a, the dermoid tissue. 
6, the pulmonary, faucial, and nasal tissues. 
c, the digestive mucous tissue, by venous radicles and lac- 
teal absorbants. 188 
CENTRIPETAL CIRCULATIONS 
2d, as it occurs in the internal tissues, being supplied from 
extravasated fluids and capillary vessels ; 
a, by the venous radicles. 
6, by the lymphatics. 
Each of these may require some passing remarks. How- 
ever, it seems necessary, in the first place, to attempt some 
further elucidation of a subject still greatly controverted, and 
which is veiled in some obscurity. It appears that the pro- 
gression of every branch of science has preceded the science 
of life ; that the laws of inert matter in the department of 
physics, have made gigantic strides, whilst those of life and 
organization have remained at a sightless distance. Even the 
application of those laws in the department of therapeutics, 
upon the broad scale of usage, has but little to boast over the 
by-gone years of two centuries. This is not from want of ex- 
ertion, for no science has employed greater talent, and more 
industry than that of physiology. So Lord Bacon had occa- 
sion to remark, that medicine had been greatly labored but 
not improved ; that its advancement had been circular rather 
than progressive ; or in other terms,' a repetition of experi- 
ments for the purpose of bringing the laws f vitality in sub- 
ordination to those of physics, or explaining the movements 
of life by those of inorganic matter. 
It will, nevertheless, be frankly conceded, that very many 
physiologists, since the middle of the last century, have made 
brilliant advances by explaining the phenomena of life on the 
principles of vitality as displayed in the organism. Yet, as 
the effects of mechanical views, we find some advocating 
still, that life itself is an effect of organic movements ; that 
the circulation is sustained by suction, and absorption by 
capillary attraction. It is acknowle Iged that the laws which 
govern the vital phenomena are abstruse ; yet enough are 
made manifest to force the conviction, that organized beings 
are governed by laws peculiar to themselves, or to life ; so OUTLINES OF PHYSIOLOGY. 
189 
long as this ruling principle abides in the organism. When it 
ceases they become the sport of physical influences. 
In the physiological state, the instinctive susceptibilities 
control the organic movements, and commonly for the great- 
est well-being of the united organism. When the sensibilities 
of the tissues are changed by hurtful impressions, a perver- 
sion of organic action is liable to occur ; incompatible sub- 
stances may be taken in by absorption, which otherwise 
might not have gained admittance. Such heterogeneous 
substances may produce commotion, when meeting with 
more excitable tissues, by their undue stimulations, and a train 
of perturbed phenomena ensue. 
3. Vital Character of the Converging Vessels. 
Some portions of the human tissues approximate the pri- 
mitive of the lower orders of animals. It is worthy of 
special notice, that in all the absorbing vessels, and converg- 
ing circulations, no nerves are discoverable ; whilst in the 
diverging circulations they are everywhere found, even in the 
capillary tissues. We find nerves in the diverging portion of 
the vena portae, answering to the hepatic artery of the same 
organ, but scarcely any in the converging portions of the 
portal circle ; neither do they exist in the venous, lymphatic, 
or chylous absorbents. The vital susceptibility of the con- 
verging systems seems to be more, if not altogether of the 
character of the primitive or vegetative kind ; whilst that of 
the diverging is under the domain of the nutritive nervous 
force in addition to it. How far the electro-magnetic force 
may render aid in these movements we cannot at present 
decide. 
This anatomical state of the two different tissues modifies 
their physiological character. The vital susceptibility of the 
converging tissues, appears amply sufficient for all their func- 
tions. Indeed, it is a wise provision in design, that they 190 
CENTRIPETAL CIRCULATIONS. 
should not be over susceptible to excitants increasing their 
action, whereby the vascular system might be inundated. 
We observe in them, therefore, a far more steady function 
than in the diverging ; and although it may be capable of oc- 
casional and partial excitation, yet it is a steady and enduring 
action, not subject to the commotions of the highly nervous 
tissues. It is so far independent of nervous force that their 
functions are commonly continued, although less perfectly, 
after the paralysis of nerves, and a cessation of all the func- 
tions of organs dependent on nervous force. 
On the other hand, the diverging circulations are all easily 
accelerated in function, and again more readily exhausted. 
If accelerated, the immediate rush of fluids to the periphery 
of tissues is not so much connected with fatal results ; for 
their contents may be thrown out of the circulations on the 
exhaling surfaces. However, if the impetus should be spe- 
cially directed to some internal organ, such tissue might 
suffer severely. These different physiological conditions of 
the tissues admit of extensive application in pathology. We 
need here make only a single allusion, and that is in respect 
to the internal absorptions, as the veins, lymphatics, &c. 
The altered state of function of the diverging capillaries com- 
monly embarrasses that of the absorbing venous radicles ; a 
state of hyperaemia may exist, and internal absorption is com- 
monly impeded by it. This condition occurs in a great many 
instances in the morbid habit, and it becomes an important 
indication to adjust the balance between the diverging and 
converging capillary tissues. The even tenure of their func- 
tion is interrupted in perhaps every state of disease. 
For the purpose of perpetuating an easy physiological, or 
healthy condition, it is necessary the ingesta, or absorptions, 
should bear a just balance with the egesta, or matter thrown 
4. Equal Balance in Health. OUTLINES OF PHYSIOLOGY. 
191 
out. If the former gain the ascendancy, the vessels will be 
subject to plethora, or a hypersemia, with its concomitant 
evils. If the latter prevails, the vessels will suffer inanition, 
and the whole organism a state of atrophy. It is hardly ne- 
cessary to notice, that this last condition may arise from 
withholding the proper nutrimental substances, or, from an 
inability of function in the absorbing tissues. With respect 
to the former, or state of hypersemia, it is liable to 
arise under favorable circumstances for it, such as a 
full supply of compatible substances of nutriment, and an 
active state of the vital tissues. In every instance of com- 
patible fulness of the vascular system, there is a certain 
degree of tonic force in the tissues and organs throughout the 
system, constituting health with adequate strength. 
Suppose this tonic state to be increased, the exhaling tis- 
sues might obtain so much dynamic force as to retard the 
exhalations, and so much as they are retained they afford too 
great fulness of vessels. This order of vessels is more liable 
to respond to the stimulations, and acquire tonicity, than the 
absorbents, on account of their superior vital susceptibility 
over that of the latter. Whilst the absorbents, there- 
fore, continue a more equal movement, the exhalants are 
impeded ; for, it is a well known fact, that tissues too highly 
stimulated become turgid, and transmit with difficulty by ab- 
jorbing vessels. 
5. Process of .Absorption. 
It is manifest that all the external increments, as well as 
the internal decrements of animal bodies, enter by the exter- 
nal or internal absorbing tissues ; meaning the dermoid, 
digestive, and pulmonary surfaces. The fact is indisputable, 
whilst the quo modo is problematical. The difficulty is 
increased on account of anatomy not being able to demon- 
strate the presence of absorbing pores in the tunics, 192 
CENTRIPETAL CIRCULATIONS. 
and the inlets of the vascular tissues, if any such ex- 
ist. We cannot therefore say any do exist. These are 
some of the intimate tissues, whose structure may never be 
revealed otherwise than by analogy. However, we have 
good demonstration that fluids and gases do pass through 
tissues, without direct porosity, when impelled by galvanic 
currents. 
We have repeated some of the experiments of Dr Dutro- 
chet, and are fully convinced, that rarer fluids and gases will 
permeate dead animal tissues, and displace denser fluids and 
gases. The blood and lymph are more dense fluids than ever 
enter as increments. There can be nothing unphilosophical 
in assenting to the proposition of fluids entering, and passing 
by endosmose, through the living tissues, or the thin epi- 
thelia of the organic tissues. Indeed, oxygen and other 
gases entering by the lungs are examples. 
With respect to the manner of these incrementitious fluids 
entering the radicles of the absorbing vessels, we know 
nothing again only by inference. However, there may be no 
greater difficulty of their entering these by endosmose, than in 
entering and passing the interstitial spaces of the membranes. 
Or, if the ultimate tissues are vesicular, they may pass by the 
same impulses. Notwithstanding the embarrassments con- 
nected with these subjects, we may make many practical 
and useful inferences, even in the present state of our know- 
ledge, when supported by observation and collateral facts. 
Every day's experience indicates the utility of the tepid bath 
of water, by immersion, in all those affections connected with 
an internal congestive state of the venous radicles. It cannot 
be doubted, that an inability of venous absorption exists in 
such instances. The removal of this is indispensable ; and 
it is found to be greatly expedited by the tepid bath, which of 
itself possesses great density, compared with atmospheric 
air. Yet, when the bath is impregnated with saline sub- 
stances, or starch, or, what is similar, an infusion of wheat OUTLINES OF PHYSIOLOGY. 
193 
bran, it is found to be more efficient. It is understood that 
other benefits attend the use of the bath, such as increasing 
exhalation, or exosmose, exciting the surface by caloric, &c., 
but all we now insist on, is, that one cardinal benefit of its 
use consists in promoting internal absorption. 
6. External Absorption ; 1st, by the Dermoid Tissue. 
The skin imbibes both liquids and gases ; and indeed 
solid bodies sometimes when transformed into the liquid state. 
Yet, it does not act so much as an absorbing tissue, as an ex- 
haling one. It has been supposed that the scaly texture of 
the epidermis embarrasses its inhaling powers. But, why 
not one as well as the other ? Perhaps atmospheric pressure 
may make a difference. But, as the digestive mucous tissue 
may be considered a counterpart to the dermoid, it may be 
noticed they act inversely ;-the former absorbs bountifully, 
and exhales less ; the latter exhales much, and absorbs less ; 
so the necessities of the system are supplied. Remove the 
epidermis, and the skin readily absorbs ; irritate the mucous 
tissue of the digestive tube, and it exhales liberally. 
Experiments demonstrate that persons, who have lain for 
some time in a tepid bath, are heavier than when they enter- 
ed it. The sick have been supported for some length of 
time by a bath of nutrimental substances. The lives of sail- 
ors have been preserved by bathing in the sea instead of 
drinking water. The embryotic rudiments of the foetus in- 
crease by absorption before there is any placental attachment. 
Whole ships' crews have been salivated by the vapor of mer- 
cury, in hot latitudes, when some jars were broken in the 
hold of the ship. If it should be said this might enter by the 
pulmonary tissue, we might add, that mercury, in its metallic 
state, has been found in the bones of persons, who had used 
it only by external friction. Blisters produce strangury, and 
odors of garlic, and numerous other substances, applied to 
the body, are detected in the blood, and the exhalations. 194 
CENTRIPETAL CIRCULATIONS. 
7. Cutaneous Imbibition of Gases, or Endosmose. 
Whether gaseous substances are absorbed by the skin, and 
pass the circulations into the intestinal canal, producing mete- 
orism, may be difficult to demonstrate. However, it seems 
to be a fact, that an impression from external cold, or in 
common parlance, on the taking of a cold, there is liable to 
be a flatulence of the intestines, and in movable habits very 
suddenly. Dr. Edwards considers the dermoid and pulmo- 
nary tissues as performing very similar functions ; and Aber- 
nethy has performed many experiments indicating the respira- 
tory action of the skin. (Sec. X. 13.) 
It is stated by Count Chaptai, that limbs plunged into car- 
bonic acid gas become benumbed throughout their whole 
extent. P. C. Collard has demonstrated this gas to be 
activehj deleterious. In order to try its effects on the der- 
moid surface, he placed himself in a tub of fermenting grapes, 
with his nostrils closed, and a tube reaching from his mouth 
into pure atmospheric air. At the end of only five minutes, 
he felt a sensation of weight in his head, with indistinct vision 
In eight minutes, pain in the temples, tinnitus of the ears, 
with vertigo ; in ten minutes, languor of the limbs, and in- 
creased action of the heart ; in twelve minutes, slow respira- 
tion ; in nineteen minutes, the tube fell from his mouth, and 
he escaped with much difficulty. Sparrows inclosed in car- 
bonic acid gas, with their heads at liberty, on an average died 
in an hour and a half. 
If it should be suggested, that carbonic acid gas acts di- 
rectly on the cutaneous nervous tissues, in these instances, 
without entering the circulation ; it might be answered, that 
we do not know of any experiments to support it ; for all of 
them show it as existing in the circulation, and its surplus to 
be readily exhaled. This gas is not deleterious, except in 
excess. It is habitually assumed along with liquids, and lia- 
ble to intoxicate. It has been injected into the jugular vein 
of animals, and if in excess and rapidly, according to the ex- OUTLINES OF PHYSIOLOGY. 
195 
periments of Nysten, it may kill by distention of the ventri- 
cles of the heart, or as a poison ; but, if slowly, according to 
Collard, its excess is found to be exhaled from the lungs. If 
it were not soon eliminated, it would be destructive. These 
experiments establish some important principles ; 1st, that 
gases may exist in combination with the blood ; 2d, that an 
excess of gas, above the wrants of the system, is soon elimi- 
nated ; 3d, that carbonic acid gas is a narcotic stimulus, and 
not a sedative. 
8. 2nd, The Nasal, Faucial, and Pulmonary Tissues. 
These must be ranked with the external tissues, for they 
are in constant contact with the air of respiration. The 
mucous tissues are of the most active kind in relation to imbi- 
bition. Many volatile substances pass the olfactory mem- 
branes, and manifest stimulating, and even intoxicating effects. 
From the travels of Baron Humboldt we learn, that the rude 
inhabitants of the Orinoco intoxicate themselves, by inhaling 
at the nose the powder obtained from the pods of the acacia 
niopo; it lasts for several days, with a ferociousness border- 
ing on madness. So payment was demanded of the traveller, 
who said he was much refreshed by going into the cooking 
room, although he ate nothing. The membranes of the 
mouth and fauces absorb fluids, and even nutritious substan- 
ces. Thirst may be suppressed by holding water in the 
mouth. A hungry person perceives the refreshing influence 
of the first mouthful of food, as soon as taken into the mouth ; 
and it is probable that some portion of it reaches the heart, 
through the medium of the absorbing veins, as soon as the 
solid morsel arrives in the stomach. 
Many allusions have already been made in relation to pul- 
monary absorption. There seems to be no impropriety in 
using the word endosmose, to denote this process, without 
being strictly wedded to the theory which gave origin to it. 
The substances that pass this tissue must be of the gaseous 196 
CENTRIPETAL CIRCULATIONS. 
kind ; and these pass and repass with great facility, as the 
tissues are well adapted to the process. As the primary ele- 
ments of the tissues are formed of gaseous substances, so the 
aeriform substances pass, in part, by the lungs, and go to 
form the solid tissues, and the blood. 
Oxygen united with metallic bodies increases their weight, 
and it no doubt adds to the weight of animal bodies. Azote 
also, is a principal elementary constituent of animal tissues, 
and enters by the digestive membrane, and also by the pul- 
monary. When not a sufficiency enters by the digestive tis- 
sue, more enters by the lungs ; when too much enters by the 
digestive tissue, the excess is thrown out by the lungs. The 
instinctive susceptibilities possess a great aptitude in rendering 
accommodations for the well-being of the general economy. 
9. Vital Properties of Oxygen. 
The fluids returned to the heart and lungs, by the centripe- 
tal circulations, are of three kinds ; the dark venous blood, 
which has returned from the tissues deprived of an essential 
portion of its nutrient and vivifying principles ; and again 
loaded with many substances it has obtained in its route by ab- 
sorption, and convertible again into nutrient principles ; 2d, 
the chyle, which has already undergone one digestion in the 
alimentary tissues ; 3d. the lymph, returning as a surplusage 
from all the nutritive tissues. These all meet together at a 
little distance from the right chamber of the heart, on their 
way to the lungs, where they all in combination, receive the 
vivifying influences of the gaseous inhalations. This union 
appears to be indispensable ; for without it, all the combina- 
tions of the other nutrient fluids, in the character of venous 
blood, would be vapid, and not capable of sustaining vitality. 
The aspect, and radical character of the blood becomes in- 
stantly changed in the capillaries of the lungs, otherwise, ac- 
cording to Collard, life could not be sustained more than four 
or five minutes. OUTLINES OF PHYSIOLOGY. 
197 
In the process of respiration, the noxious and useless gases 
are exhaled by the pulmonary tissues, the chief of which is 
carbonic acid gas. It is supposed the loss of this improves 
the color of the blood, as well as its qualities. However, 
the great privilege of respiration consists in the imbibition of 
oxygen into the circulation, which was denominated by the 
ancients pabulum vitce, as they knew nothing of oxygen. 
This, as an elementary principle of air, of water, and of arte- 
rial blood, appears to be a congenial and active agent in aU 
the animal tissues, stimulating them, and co-operating, in an 
inexplicable manner, with the vital principle. By its union 
and immediate influence on the crude and vitiated venous 
blood, it becomes suddenly transformed into rich and pure 
arterial blood, without having to pass eighty thousand times 
the rounds of circulation, as Boerhaave supposed. It is now 
prepared to excite the action of all the diverging circulations, 
to effect nutrition, and the disengagement of caloric in all the 
capillary tissues. 
It should be borne in mind, that oxygen is absorbed by 
other tissues than the lungs, but in less degree ; yet, suffi- 
cient under certain circumstances, to form carbonic acid gas 
in the capillaries ; and this may account for the phenomenon 
noticed by Nyston, Edwards, and others, of carbonic acid 
being formed by some animals confined in hydrogen gas. 
Oxygen is acknowledged to be the great acidifying agent, and 
the instinctive powers of the system appear to be very sedu- 
lous in finding expedients for sustaining its own economy. 
Some inferior animals might exist in this manner, and carbon 
be eliminated by its union with oxygen, for a limited time ; 
but, it is not likely the human economy could long be sup- 
ported in this manner, if at all. 
The functions of the lungs, therefore, bear an important re- 
lation with the entire economy of the system. They are im- 
portant in the function of haematosis. They free the circula- 
tions of even noxious principles, whilst they imbibe the indis- 198 
CENTRIPETAL CIRCULATIONS. 
pensable agent oxygen, which combines the heterogeneous 
mixture of the nutritive fluids into congenial and exciting 
agents ; and at the same time provide for the calorification of 
the whole of the tissues. However, in their impaired condi- 
tion, other absorbing and eliminating surfaces act as imperfect 
substitutes to a certain extent. 
10. 3d, Absorption by the Digestive Mucous Tissue. 
The organs, and the process of digestion might be consid- 
ered at length in this place ; but this embraces many organs, 
and diversified functions, which must be passed with only a 
few cursory remarks. It would be aside from our design, to 
treat of all the circumstances in relation to organs contribu- 
tory to digestion, or to the process itself. This subject has 
been fully developed in many recent works on physiology ; 
and as a particular thesis by Dr. Beaumont, who has done 
much justice to it. We shall, therefore, be restricted to 
casual remarks, and chiefly to the absorbing processes of the 
digestive tissues. 
The digestive surface may be associated with the external 
surfaces ; for, although it has an internal folding, it is con- 
stantly in contact with foreign substances, and even more so 
than the lungs, or skin. Solid substances suffer disintegra- 
tion, and receive chemical changes in the digestive tube pre- 
paratory to entering the circulation by absorption, and becom- 
ing vitalized. 
11. History of Digestion. 
The peculiar sensation of the want of nutriment is seated 
in the stomach, and communicated to the centre of perception 
through the medium of the pneumogastric nerves. But this 
sensation is greatly modified by the necessities of the entire 
organic tissues. The instinctive susceptibilities are often so OUTLINES OF PHYSIOLOGY. 
199 
acute as to indicate the kind of nutriment most needed. This 
sensation instinctively directs to the prehension of such sub- 
stances as are convertible into nutriment, and it rarely mistakes 
the object. 
Nutritious substances may be assumed both in the liquid 
and solid form. The latter are approximated to the liquid 
form by manducation, and the commixture of saliva, and the 
mucus of the mouth and fauces. By voluntary movements 
they are thrown into, and through the pharynx, where they 
are no longer in the charge of volition, but subject to the or- 
ganico-instinctive movements, directed by the nutritive sys- 
tem of nerves. The esophagus, therefore, by its contractile 
motions, impels the nutritive bolus into the stomach. It here 
remains three or four hours, according to the compactness of 
texture, or the state of the stomach, suffering a disintegration 
of its particles of composition, until reduced to a pulp ; and 
this is effected partly by the agency of moisture, of caloric, 
by the undulatory motion of the stomach, and the influence of 
the secretion called gastric fluid. 
That this fluid is accessory to the disintegration of nutri- 
mental substances cannot be doubted from the evidence of 
Dr Beaumont's experiments, and his is a mere confirmation 
of those antecedent by many experimenters. It appears that 
this fluid possesses an avidity, if not an affinity for such sub- 
stances as are radically nutrimental, in whatever form present- 
ed, and whether animal, or vegetable ; such as starch, albu- 
men, fibrin, gelatin, oil, sugar, &c. The stimulations of food, 
and of other substances, as the thermometer in the case of 
St. Martin, increases the flow of the gastric fluid into the 
stomach, where it is ready for the contingencies of digestion. 
There remains scarcely a doubt, butthat this fluid, or some 
parts of its constituents, combine with the nutrimental sub- 
stances in the formation of chyle ; or, it might be said, be- 
come accessory to the first stages of its formation. It is not 
complete until uniting with the other secreted fluids in the 200 
centripetal circulations. 
duodenum, or second stomach ; viz. the bile, pancreatic fluid, 
and intestinal mucus. All these are accessory to the forma- 
tion of the most perfect chyle, whilst the remaining portions 
of them, together with the residual matter of the alimentary 
substances are propelled onward, by the peristaltic force, to 
their anal exit. 
In respect to order of time, it may be remarked, that 
whilst the disintegration of the nutrient substances is taking 
place in the stomach, the venous radicles of the mucous tis- 
sue of the stomach, and upper intestines, are absorbing the 
aqueous, odoriferous, saline and other portions of the nutri- 
mental mass ; together with a portion of certain substances in 
a fluid form already animalized, as well as certain portions 
suffering decomposition, called putrid. These are all seized 
by the interposing, absorbing veins, and carried directly to, 
and through the liver, and into the great highway of venous 
blood. 
These substances suffer little or no change in the stomach, 
but immediately come under the dominion of the vascular in- 
fluence in the branches of the vena portae, in the abdomen, 
and also in the liver itself. Experiments demonstrate, that 
alcohol and many other substances pass from the stomach to 
the liver within six or eight minutes after being taken in. 
Although no experiments have fully demonstrated the in- 
ternal economy of the liver ; yet by analogy we are assured, 
that this great viscus performs other functions than merely 
the secretion of a little bile ; and this, perhaps, by the he- 
patic artery, instead of the branches of the vena portse. All 
those substances that can be subdued by the vital force of the 
liver, become changed towards nutriments, and pass into the 
venous circulation, a little after the chyle by the thoracic 
duct, to be ready to receive the impressions in the lungs be- 
stowed also on other nutrimental substances ;-whilst those 
which cannot be changed, such as the alkaline substances of 
vegetables, tartarized antimony, mercury, arsenic, with many OUTLINES OF PHYSIOLOGY. 
201 
others called medicines, and poisons, pass into the common 
mass of blood also, and exert their peculiar influences on the 
different tissues. 
Again, whilst the intestinal venous absorptions are pro- 
gressing, the gastric fluid, by forming intimate unions with 
the more fixed nutrient substances, is forming the basis of the 
chyle. This pultaceous compound, called chyme, soon pass- 
es the pylorus to be perfected into chyle. The venous 
absorptions are still continued, whilst the chyle is perfect- 
ing, and passing onward to be absorbed by its own pecu- 
liar vessels, the lacteal absorbents; as if in contempt of its 
other, or former company. Some experimenters have thought 
they had seen chyle straying in the mesenteric veins, but no 
other nutrimental substances but chyle in the lacteals. Mad- 
der will color the bones, but not the chyle. We may con- 
clude that some portion of chyle may pass the radicles of the 
omnivorous veins. 
From the moment the ingested substances have passed the 
pharynx, they are subject to the vital force and vital affini- 
ties ; and they are no further under physical power, than per- 
mitted by this force. Or, in other words, the chyle is per- 
fected, by the chemico-vital force of the digestive tissues. It 
is even not made perfect in the intestines, whilst in commix- 
ture with its residuary matter; it is not found there, and not 
until after it has entered its own peculiar vessels. It here re- 
ceives impressions, which establish its character, but that 
character is not completed until it has passed many glands, 
and arrived through a long route to its destination, or union 
with venous blood. 
12. Properties of the Chyle. 
It appears to be convenient in this place to make some 
further notices in reference to the chyle. 
Before it has passed the lacteal glands it is in its simplest 202 
CENTRIPETAL CIRCULATIONS. 
form, a white homogeneous fluid. As soon as it has passed 
these glands, it has become albuminous, resembling milk, and 
coagulable. Before it enters the left subclavian vein it has 
assumed a light reddish tint, and possesses much the proper- 
ties of the blood, except its color. It contains some fibrin ; 
and may we not expect the fibrin of the blood is essentially 
formed from the chyle ? 
The chyle is modified by the kind of food made use of. 
Dr Marcet in his analysis, found that chyle from vegetable 
food, yielded about three times as much carbon as that from 
animal food ; that the chyle from animal food began to putre- 
fy in three, or four days, whilst that from vegetable food 
could be kept for weeks, or even months without putrefying ; 
that the chyle from animal food is much like milk, and on 
standing a creamy substance rises ; its coagulum is opaque, 
and has a pink hue. On the contrary, the chyle from vege- 
table food is commonly nearly transparent, like the serum of 
of the blood ; its coagulum is colorless like an oyster, and no 
creamy substance rises to the surface. So the ingesta modi- 
fy the chyle, and of course the blood also, and a knowledge 
of these facts lead to practical inferences. 
Furthermore, soon after chyle is taken from the thoracic 
duct it spontaneously forms a coagulum. It separates into a 
solid, a serosity, and an oily pellicle, and its reddish tint in- 
creases on exposure to the atmosphere. It is difficult to es- 
timate the amount of chyle produced in a given time ; per- 
haps a pound or two in twentyfour hours ; yet it is greatly 
modified by the ingesta, and integrity of the digestive powers. 
The lacteals are sometimes found empty, but commonly 
turgid in three or four hours after a full meal, and sometimes 
sooner. 
For the anatomy of the lacteals, reference may be had to 
Leiberkuhn's description, by C. Bell, in his anatomy and 
physiology of the human body. OUTLINES OF PHYSIOLOGY. 
203 
13. Different Intestinal Absorptions. 
Our digressions have led us aside from the immediate sub- 
ject of absortion ; but this could not well be avoided, as our 
course is to descant on the organs, and functions in connec- 
tion. We might stop here and spend time on the subject of 
the liver, pancreas, mucous, follicles, and other subjects in 
connection with digestion and absorption, but conclude most 
proper to omit them. 
There are at least two important absorbing tissues con- 
nected with the digestive surface, viz. the venous and lacteal. 
We have already been obliged to anticipate much in relation 
to these, especially the lacteal. With respect to this last, 
we have nothing to udd further, or to the process itself, differ- 
ent from that of other tissues. Whether the absorbing 
mouths open on the mucous tissue of the intestines, or 
whether chyle enters by imbibition, or endosmose, may be 
decided by future experiments. 
It will be noticed, that venous absorption is placed amongst 
the internal absorptions ; and there it acts the most impor- 
tant part; but still it performs an essential process in the in- 
testinal absorptions, which have been styled external. In 
this instance the fluids are taken from membranous sur- 
faces. 
For a long period after the discovery of the circulation of 
the blood by Harvey, it was the commonly received opin- 
ion amongst physiologists, that intestinal absorption, and all 
absorptions were performed by the veins. However, after the 
discovery of the lymphatic system, and the investigations of 
Moscagni and Cruikshank, it became the common belief, that 
these delicate vessels had to perform all the burthens of ab- 
sorption. The writings of the Monroes, Hunters, and Bells, 
are full of this theory, even down to about the year 1820. 
The lacteal system was esteemed a part of the lymphatic, 
and it was supposed, that all materials passing from the di- 204 
CENTRIPETAL CIRCULATIONS. 
gestive tube into the mass of circulation, must pass this slen- 
der tissue, be they never so severe and disgusting. 
At about the time last mentioned, the suggestion arose in 
France and Germany, that there must of necessity be some 
other route by which substances pass into the mass of blood, 
since various, as coloring, saline, odoriferous, and certain 
medicinal substances were detected in the portal blood, but 
never in the lacteal vessels. Besides, it appeared to be the 
honest conclusion, that these minute vessels could not very 
easily transmit the enormous quantity of fluids assumed by 
some, and which were found streaming from the kidneys and 
surface of the body. Therefore, a series of experiments 
were instituted to find some other course by which the blood 
vessels were replenished ; at the head of these we find M. 
Magendie, Dupuytren, Tiedeman, Gmelin, Ribes, Adelon, 
Segalas, Fodera, with others ; and in America, Lawrence 
and Coates, with some others. 
The results of these experiments afforded the most con- 
clusive evidence, that the lacteals essentially transmit only 
chyle, with its water of fluidity ; whilst in the vena portae 
and liver were found many heterogeneous substances, some of 
nutritious matter, others saline, others poisonous, as alcohol, 
etc. In consequence of this, the lacteals were freed from 
their cruel burthens, and a rightful dignity conferred on the 
vena portae and liver. But, the investigations did not end 
here. 
The internal interstitial absorptions were also examined ; 
and we may in this place be permitted to remark, that the 
delicate lymphatics were relieved of a great task, that had for 
a long period been imposed on them. The results are, that 
the internal absorbing system admits of two divisions ; one of 
red veins, the other of white veins, called lymphatics. These, 
with the lacteals, compose the entire internal centripetal cir- 
culation. They all perform similar, though not identical 
functions. They all have valves ; all absorb fluids at their OUTLINES OF PHYSIOLOGY. 
205 
capillary origins ; all transmit slowly and steadily to the cen- 
tre, by their innate vital susceptibility. They originate in 
diff erent tissues, and transmit different fluids of nutrition ; viz.: 
the lacteals from the mucous tissue of the digestive surface ; 
the lymphatics from the internal white albuminous, and the 
nutrient tissues ; the red veins from the red sanguineous tis- 
sues and surfaces of membranes. These divisions will admit 
of some further remarks in their proper places. 
More particularly we may notice, with respect to absorp- 
tions from the digestive surface, that chyle alone, in a normal 
state, passes the lacteal absorbents and thoracic duct into the 
blood ; that the radicles of the mesenteric veins absorb nu- 
merous heterogeneous substances as well as nutrimental, 
which pass the portal circuit ; and, as insisted on by some, 
that a certain set of absorbents take up nutritious particles, 
sometimes a little chyle, which they transmit to veins in the 
mesenteric glands. The experiments have been numerous 
and often repeated, which go to establish these positions. 
14. Second Division of the Centripetal Circulation, as sup- 
plied by the Internal Tissues; 1st, by the Veins. 
It has already been shown that the arteries have different 
terminations, and as this should take place in the different 
tissues, so the process of venous absorption may be modified. 
Some capillary arteries transmit to veins by inosculation ; so 
this blood has a direct course, and these veins can hardly be 
said to absorb. This is a wise provision to sustain the cir- 
culation in the contingency of certain states of disease, when 
the absorbing processes may be impaired. Arteries termi- 
nate for the most part, in the nutritive, secerning, serous, and 
erectile tissues, in which event the blood suffers a temporary 
stasis, and aside from the vascular circulation. It is one of the 
most imposing phenomena incident to the vital economy, that 
fluids are so uniformly, and steadily taken up by the capillary 206 
CENTRIPETAL CIRCULATIONS. 
veins, as we are assured they are, and transmitted back to the 
centre of the circulations. 
We may, again, include all the morbid accumulations, 
which take place in different tissues, as imposing burthens on 
the absorbing veins. False theory has hitherto, for the most 
part, assigned this office to the lymphatics, which is not sup- 
ported by any direct evidence. The veins, then, take up all 
abnormal extravasations of fluids that are absorbed ; whether 
in the interstitial spaces, on surfaces of membranes, in tu- 
mors either accute or chronic, in excavated ulcerations,* or in 
hypertrophied enlargements of parts wherever situated when 
removed. This thesis is now assumed ; it will receive some 
illustration when on the subject of lymphatic absorption. 
With respect to the physiological process by which the 
internal absorptions take place, we are mostly ignorant, ex- 
cept what may be obtained from analogy. It is most proba- 
ble the incipient radicles of absorbing vessels suffer a degree 
of turgescence, of dilatation and contraction ; and these mo- 
tions may be alternated by momentaiy repose. This is a 
state common to many organs and tissues, as the puncta 
lachrymalia, even the heart itself, and almost every organ. 
The same process, whatever it may be, is common to the 
veins and lymphatics of the internal interstitial tissues. These 
two are the only internal absorbent systems we know of ; 
although the lacteals are very identical, only originating upon 
what we have seen proper to call an external tissue. 
Venous absorption is one of the most momentous functions 
in the human economy ; it is sustained by the first grade of 
vital force, yet steady, and indispensable to ease and health. 
Although it has a tendency to a steady and determinate ac- 
tion, it may be interrupted by the numerous causes of de- 
rangement to which the system is exposed. Let this process 
be suspended, and the routine of movements necessary to 
* Andral, Vol. I. p. 301. OUTLINES OF PHYSIOLOGY 
207 
health are suddenly interrupted. The blood may be thrown 
into the capillary, and interstitial tissues for a time, by the 
more excitable arteries, with their nervous impressibility ; 
but this centrifugal force must soon be diminished also, or 
suspended. The heart and arteries are no longer duly sup- 
plied by the returning veins in such an event. 
If we pursue the train of phenomena a little further, on the 
surface will be seen dark discolorations, from the accumula- 
tion of blood in the interstitial tissue ; coldness from a defi- 
ciency of calorification, and some degree of insensibility from 
compression of the nervous expansions ; or, the same circum- 
stances and phenomena may be mostly concentrated in the 
internal surfaces, attended with venous accumulations, called 
congestions. Whatever increases an undue vascular fulness, 
or plethora, and undue tonicity, is liable to induce an inability 
of the absorbing processes. The causes of disease all con- 
spire to produce this abnormal state, and hence the frequency 
of congestions. 
The heart absorbs from the veins, and discharges its con- 
tents into the arteries ; the capillary veins, or radicles, absorb 
from the arterial terminations, and restore it to the grasp of 
the heart. This circle cannot be broken with impunity ; and 
how numerous the chances of disturbance in the expanded 
capillary and nutritive tissues. An equal balance is neces- 
sary to the continuance of health. 
A preponderance of evidence seems to be in favor of the 
veins absorbing from all the serous surfaces, an office usually 
assigned to the lymphatics. As an evidence of this may be 
adduced the fact that ligatures on the large lymphatic trunks 
are not followed by serous collections ; whilst ligatures on 
the veins are subsequently followed by such accumulations. 
Some, who have long been persuaded of the exclusive sove- 
reignty of lymphatic absorption, have appeared very unwilling 
to abandon the hypothesis, and allow to the veins their legiti- 
mate functions. They have insisted that there are a series of 208 
CENTRIPETAL CIRCULATIONS 
lymphatics, very short indeed, which empty their absorbed 
fluids immediately into the small red veins. They are not 
proved to be lymphatics, any more than the radicles of veins, 
and why call them by that name ? 
It has been advanced by Professor Lippi, that he has suc- 
ceeded in detecting direct lateral communications between 
the lymphatics and veins. Fahman insists this to be an error, 
and that veins have been mistaken for lymphatics. Dr Rossi 
of Bologni, sustains the opinion of Professor Fahman, and has 
demonstrated the supposed lymphatics to be venous radicles. 
The conclusion must inevitably be, that veins absorb from 
the serous cavities the fluids thrown out there by the arterial 
exhalations, and transmit them back ; and that they take up 
crude and gross substances besides blood and serum ; such 
as pus, camphor, assafoetida, mercury, antimony, alcohol, and 
numerous other substances. All these have been detected in 
the veins, but never in the delicate, transparent, and half dis- 
tended lymphatics. These perform a more chaste and en- 
viable office, as may soon be shown. It is very probable the 
pus supposed to be found in the lymphatics by Andral, was 
in the venous radicles.* 
We have reason to be persuaded, that experimenters have 
been deceived in many of their processes for the purpose of 
proving the normal causes of absorbed fluids. It can hardly 
be supposed, that many of the tests used for this purpose can 
obtain admittance by the absorbing vessels ; certainly not by 
the fastidious lacteals and lymphatics, if by the more vora- 
cious veins. For illustration, let us notice an experiment by 
Fodera, and repeated in this country by Lawrence and Coates, 
on similar principles ; in which he injected into the thorax of 
a rabbit, a solution of hydrocyanate of potass, and then a solu- 
tion of sulphate of iron into the peritoneal cavity. At the end 
of three quarters of an hour, the parts w ere uniformly blue ; 
the coloration was not confined to any series of vessels, but 
•Vol. I, p. 304 OUTLINES OF PHYSIOLOGY. 
209 
the whole of the tendinous part of the diaphragm had imbibed 
the blue matter. So of all the other experiments performed 
with these severe, attenuated, diffusible substances. 
Substances of this character do not pass the vascular tis- 
sues in their natural courses ; they penetrate animal tissues by 
infiltration, or transudation along the cellular connecting me- 
dium, rather than the vascular conduits. They sometimes 
tinge the fluids in vessels, but always the cellular tissue first, 
when the vessels have size enough to admit a discrimination. 
"At first a slight discoloration only, is observable in the parts, 
which gradually becomes deeper ; afterwards the liquids of 
the lymphatics, and of the blood-vessels become colored in 
its (their ?) turn."* 
In all these cases the coloration primarily affects the simple 
solids, and secondarily the contained fluids ; whereas if they 
entered what is called the mouths of the radicles of the ab- 
sorbents with the fluids, these must be first colored. Some 
of these readily soluble, and diffusive agents may have found 
their way into the chylous and lymphatic vessels, but that they 
passed the same legitimate route of the chyle and lymph, re- 
mains to be proved. Besides, this process of coloration re- 
quires about an hour to show itself; and yet it will take place 
instantly by the aid of galvanism. It is apparent that no vas- 
cular absorption could be so accomplished. So dead animal 
substances are turned of a reddish color in a solution of ni- 
trate of potash. No safe inferences can be drawn, therefore, 
from this kind of experiments ; the substances are incompat- 
ible writh the vital susceptibility. The tender vital solids de- 
mand association with fluids of kindred composition ; yet, the 
sensibility of some tissues may admit of imposition, or suffer 
deception. Severe and forced experiments do show nume- 
rous communications between the different vascular tissues, 
of which we have no evidence of a normal circulation ; but, 
in a morbid state, fluids may pass them, as in the instance of 
* Appendix to Rioherand's Physiology, art. Absorption. 210 
CENTRIPETAL CIRCULATIONS. 
forced experiments with acrid, soluble substances. So fluids 
impregnated with acrid substances, pass dead tissues, which 
would be repelled by living tissues. 
However physiologists may differ as to the manner in which 
absorption is effected, and the intercommunications of the sev- 
eral tissues, yet venous absorption is a very important and ex- 
tensive process. Much of the supposed labor imposed on 
the lymphatics, by former physiologists, is now ascertained 
to be performed by the veins. Indeed, all absorption from 
the exterior surfaces, except the chyle, is performed by the 
venous radicles ; and all the internal, except the lymph. We 
are now alluding to the normal action, being well aware that 
foreign fluids have many times been found in both the lacteals 
and lymphatics, in certain forced or morbid states. 
We may refer then to the veins, all the absorptions from 
the dermoid, pulmonary, and digestive surfaces, whether of 
fluids, of gases, or of solid substances, except chyle. Again, 
with respect to the internal absorptions, the veins likewise ab- 
sorb plentifully from the capillary tissues of red blood ; from 
the parenchymatous and nutritive tissues ; from the serous 
tissues they take up serum, and from the mucous tissues mu- 
cus, and aqueous bodies, and occasionally accidental bodies. 
These two last surfaces afford a broad extent for venous ab- 
sorption, especially by including the numerous subcuticular 
cellular cavities. The veins perform the office of what has 
been called accidental absorption, that is, the taking up of 
foreign substances, such as extravasated blood and gases ; of 
the decomposed substances from the nutritive tissues ; of pus 
in any part of the system ; of animal substances, as ligatures 
of silk, leather, catgut, &c. Even calculi deposited in the 
cellular tissue have been removed by venous absorption, and 
also emphysematous swellings. Hypertrophies of tissues, 
and the tumors of acute and chronic phlegmatice, are taken up 
by the veins, when removed. 
It appears then, without'at present taking into the account OUTLINES OF PHYSIOLOGY. 
211 
the lymphatic system, that absorption, whilst it is one of the 
most inexplicable, is one of the most exalted and indispensa- 
ble functions of the animal economy. It gives support from 
the first moment of embryotic existence throughout life, and 
whenever interrupted is sure to be followed by disease : and 
such diseased state will be continued until the absorbing pro- 
cesses are fully established. It is not a function confided to 
the fickle sensibility of any nervous tissue, but to the persis- 
tive grade of primitive vitality. 
2d, On Internal Absorption by the Lymphatics. 
The lymphatics are a series of converging, absorbent ves- 
sels, very minute, of a delicate structure, transparent, and so 
contractile that when empty they resemble fine threads, and 
are difficult to be detected. They are distensible to a certain 
degree, beyond which they cannot be forced without ruptur- 
ing ; and although their coats are very thin, they will bear a 
greater weight of mercury than the veins. They have valves 
about every quarter of an inch. They originate in every 
part of the system, unless we except the medullary part of 
the brain, and from the most intimate tissues, and yet the ex- 
act point of their origin has not been demonstrated. They 
are extremely numerous, and run in two planes, like the 
veins!, one deep seated, the other superficial, resembling the 
veins. They run through many acini, or glandular bodies ; 
except this they resemble the veins in their courses, and of- 
fice. They concentrate, and unite in the thorax with the 
lacteal absorbents, and both enter the blood vessels together. 
Their anatomical structure is identical with the lacteals, and 
of the same grade of vital force. 212 
CENTRIPETAL CIRCULATIONS. 
15. The Lymph. 
Although the lymphatics are very numerous, all that Ma- 
gendie could obtain of their fluids from a large dog, was one 
and a half ounce ; it is thinner than chyle, having some red- 
dish, or yellow tint ; it spontaneously coagulates into a mass 
of albumen, and a serosity separates. 
According to Shevreul, 1000 parts contain 926.4 of 
water ; albumen 61, fibrin 4.2, muriate of soda 6.1, carbon- 
ate of soda 1.8, a fraction of phosphate of lime, magnesia, 
and carbonate of lime. 
16. Remarks on Lymphatic Absorption. 
It does appear quite incredible, that physiologists should 
ever have- suffered themselves to have been so deceived as 
they seem to have been, in ascribing functions to the lym- 
phatics, which it is impossible they ever could have sustained. 
In order to perform every task imposed on them, they need 
not only to possess intelligence to be the " modellers of the 
form of the body while growing," of Mr. Hunter, but the 
maxillary strength of the ship-worm. They have been said 
to carry back from all the extreme points of the system the 
excrementitious substances ; also the matter of tumors, ex- 
travasated blood, bile, substances of an acrid kind from the 
intestines, and skin, such as mercury and cantharides ; also, 
exhalations into serous cavities, pus from every part of the 
body, and even to " nibble " away calculi and bones. These 
must be very imposing burthens for such delicate vessels, 
especially to transmit such gross substances through their 
fine wrought ganglia. Neither of these substances have been 
detected in the lymphatics, nor any other foreign substances, 
which had passed by their mouths ; and indeed it has never 
been shown that they have mouths suited to such voracious- 
ness. OUTLINES OF PHYSIOLOGY. 
213 
The same mistaken views which led to these absurd refer- 
ences, left the liver almost useless, except the secretion of a 
little bile, which might have been performed by an organ not 
larger than the pancreas. It might have been supposed that 
nature had mistook her purpose in forming the liver, and that 
it served only as a deposit of malignant humors, and the 
focus of almost all diseases. This organ has been much 
abused by such views ; for post-mortem examinations show 
it to be comparatively but rarely diseased ; and it has been 
robbed of its rightful office as an important assimilatory or- 
gan, one that modifies all the absorptions passing the portal 
circulation for nutrition. 
The origin of the lymphatics, so far as they have been de- 
tected, is not on the surface of the body, nor from the inter- 
nal membranes, but in the most intimate tissues, especially 
the white or albuminous textures. Mercury injected into the 
cellular tissue, in the dead subject, often finds its way into 
the lymphatics ;-and when the trunks of these fine vessels 
are tied, there is no accumulation of serum in the serous sacs. 
We have some right to infer they originate, not only from the 
intervening cellular tissues, but from the nutritive, and filiform 
tissues also. They absorb and bring back to the common 
centre of circulation, certain albuminous substances, again to 
pass the process of aeration in the lungs, to commingle with 
the common mass, and to serve the purposes of nutrition. 
So the red veins and the lymphatics each, should be consid- 
ered as independent series of veins ; the lymphatics to trans- 
mit small quantities of white blood, whilst the red veins con- 
vey barge quantities of colored blood, with certain other gross 
materials in suspension. 
Whilst it has been insisted by some, that the absorbent 
systems, especially the lymphatics, are extremely active and 
devour much, others have supposed they keep a slow and 
steady motion, that they can scarcely be interrupted, neither 
retarded nor accelerated. Both these views are erroneous. 214 
CENTRIPETAL CIRCULATIONS. 
When not disturbed their function is very steady, and they 
never can be accelerated like the arteries. The lymphatics 
are probably less easily disturbed in their function than the 
veins. Yet their functions are often interrupted by the 
causes of disease ; we see the external veins do not fill, but 
remain flaccid and pale. This deficiency of absorption may 
be more or less injurious, on account of the large mass of 
centra] circulation not being supplied. 
We say then the functions of the lymphatics are not very 
easily disturbed ; they continue action to a very considerable 
extent, oftentimes, when the functions of other tissues are in- 
jured by disease, or as we might say in fevers. So it often 
happens that in such cases the digestion is spoiled, the lac- 
teals transmit no chyle, and yet the lymphatics may be free 
and transmit to the centre of circulation considerable of nu- 
tritious substances from the nutritive, and albuminous tissues. 
By their agency, then, the blood is partially replenished with 
nutrimental substances, although pbtained from the resources 
of the system, instead of from external absorption. 
Causes which produce a state of incompatible tonicity, 
and contraction of absorbing surfaces, embarrass the free ac- 
tion of the absorbents of every kind. And, again, whatever 
excites a turgescence, or plethora, has the effect of com- 
pressing the absorbing radicles, and impeding their action. 
It surely is an important indication to excite the absorbent 
actions. Tumors are seen to disappear in the dead body 
that could not be removed by any series of absorbents during 
life, when morbid tonicity existed. Intumescences can never 
be removed until the absorbing processes gain the ascendancy. OUTLINES OF PHYSIOLOGY. 
215 
SECTION XII. 
CALORIFICATION. 
The subject of animal heat has purposely been delayed, 
until having gone through with what seemed necessary to be 
noticed on all the exhaling and absorbing tissues ; supposing 
it might then be shorter explained, and better understood. 
But considering what has already been intimated, our remarks 
will be brief. 
The organic movements could not be sustained without a 
certain amount of caloric, to render the solids pliable and mo- 
bile, and keep up the fluidity of the blood ; neither could the 
play of the vital aura be sustained without it. This could not 
well be effected by external warmth, even in an atmosphere 
of higher temperature, for animal bodies are bad Conductors 
of caloric ; therefore, their economy is wisely such, that it is 
evolved by the several processes going forward in the internal 
tissues. 
Although different species of animals possess different de- 
grees of temperature, yet each species has a strong tendency 
to retain their own particular amount of internal warmth. The 
degree of internal heat seldom varies, notwithstanding the ex- 
ternal may be very different, except in certain conditions of 
disease. The human economy requires about 98° Fah., but 
it would accumulate to a morbid point to be constantly in an 
atmosphere of that degree, were there not some provisions to 
conduct it off. In ordinary health it is found that an atmos- 
phere of about from 60° to 65° Fah., keeps up an equilib- 
rity ; so that, as the system tends to a surplusage of caloric, 
this lower temperature about balances the excess. 
Suppose a person to remain in an atmosphere of 98°, and 
to have sweats ; the evaporation of the humidity, by being 
turned into a gaseous form, absorbs caloric from the surface ; 
so the body is cooled. But, this may not be the only cause 216 
CALORIFICATION. 
that intervenes to counteract an intolerable increase of caloric. 
Such a state enfeebles the nervous force, and the organic ac- 
tions are diminished, by which circumstance there is not so 
much caloric set at liberty in the tissues, from a latent state. 
Some subjects are cold in the hot season of the year. So 
certain states of disease impairing nervous force, are attended 
with coldness. Again, there is not so large a proportion of 
oxygen in a warm, as in a cold atmosphere ; and further, the 
pulmonary tissue partakes of the common inability, and may 
not take in so large a proportion of this active stimulus of or- 
ganic tissues. These, and perhaps other circumstances are 
constantly present to counteract an intolerable excess of ca- 
loric. In the reverse, suppose a person in an atmosphere 
several degrees below 65°, without much evaporation, yet 
receiving the tonic influence of cold, he would retain the com- 
mon temperature of body, especially when in exercise. 
It is doubtful whether there is a larger proportion of caloric 
evolved in the lungs than in the other internal tissues ; unless 
their great vascularity, and activity of function give occasion 
to it. Many cases are presented like one of Graves and 
Stoke, by the Dublin Reports, of extensive tubercular dis- 
ease of the lungs, with only 14 respirations in a minute, and 
pulse 126, yet having much heat. The vascular action of the 
tissues generally, and of the lungs in particular, were intense 
without the usual supply of oxygen by the lungs ; yet it might 
be supplied by other tissues ; notwithstanding, the tissue may 
suffer great' stimulations in the absence of the usual supply of 
oxygen. So it is with all other organs beside the lungs ; for 
caloric is most abundant in such tissues as possess most blood, 
and have most functional exercise ; and by increasing such 
actions, there will be a proportional increase of free caloric. 
Although the lungs admit oxygen, the most powerful excita- 
tions for the evolution of caloric are in the tissues ; and the 
lungs act as ventilators, and eliminate its excess. 
If these positions are just, we may conceive that caloric is OUTLINES OF PHYSIOLOGY. 
217 
evolved in every tissue in the system, but in some more than 
in others ; and that it may be increased or diminished by nu- 
merous contingencies. But, these are secondary circumstan- 
ces, and in a physiological view, it might be inquired, what 
agency organized beings possess over all other bodies in na- 
ture, to conduct all these processes with such astonishing ex- 
actness, whilst being counteracted by numerous obstacles? - 
We must answer by again making reference to the inexpli- 
cable properties of the vital force ; a power ordained to con- 
trol, within definite limits, all organic functions. Its quo 
modo may be said to be inexplicable ; yet we may mark many 
of its phenomena. In the most intimate tissues there are con- 
tinual mutations going on, combinations and decompositions, 
which may be said to be of a physical character. There are 
not only visible and tangible elements in circulation, but many 
kinds of gaseous bodies freely passing and repassing, without 
knocking for admittance, or taking a formal leave. But, it 
must be noticed, that whilst within the precincts of the living 
tissues, they have to act a subordinate part to what they might 
in the alembic of the chemist. In the tissues, whether com- 
bined with fluids or otherwise, they give stimulations, and the 
responding movements are by vital solids, not as from inert 
physical bodies. Motion in physical bodies extricates calor- 
ic, but far more freely, and in an inexplicable manner from 
vital tissues. In disease attended with free action, tissues are 
in an exalted state, and impressed by more than ordinary stim- 
ulations ; so more caloric is set free, and heat abounds. 
Caloric is unequally distributed in the system in health ;• 
whilst the internal heat may be 98° Fah., the surface and extre- 
mities may not be more than 50°, or even less in a cold atmos- 
phere. In many pyrectic diseases of the dynamic character, 
the internal heat may be 102° or more, whilst the surface and 
extremities may be about 60°. Such organs as the disease 
impresses more emphatically may havex an ardent heat, whilst 
other organs are diminished below the standard of health. 218 
CALORIFICATION. 
All these modifications arise from an excess or diminution of 
vital action in the capillary tissues. 
We may conceive, according to the laws of chemistry, 
that every act of nutrition, by which fluid bodies pass to the 
solid, and especially in which gaseous bodies take the solid 
form, that caloric is given off in a free state to warm the tis- 
sues. In living systems these changes are constant and 
impressive, though not always of the same amount. Finally, 
we may sum up all that appears necessary to be said ^t pre- 
sent, or the chief we are able to say on this profound subject, 
by suggesting; that, the physical chemistry of organized 
bodies is subordinate to the vital chemistry ; and that, the 
unperverted instinctive sensibilities direct the organic move- 
ments, in relation to caloric also, in the best manner to sus- 
tain the well-being of the united organism. Notwithstanding, 
all these salutary processes may be intercepted and perverted 
by overwhelming circumstances, and the very conservative 
principles of life and health, may administer to its destruction 
in the condition of grave disease. 
However, when injurious contingencies are not in excess, 
we discover the same conservative principle in activity, in 
avoiding an excess of heat from external circumstances, that 
exists in avoiding an excess of fluids and gases by absorption. 
So a subject exposed to an overheated atmosphere sutlers 
but little alteration of* internal heat. The dermoid and pul- 
monary exhalations eliminate much of it. It should also be 
had in mind, that the human body is a bad conductor of calo-, 
ric. The surface may be much heated, without suddenly 
affecting the internal temperature. The excess of stimu- 
lations, also, diminish the energy of vital actions which are 
necessary for the evolution of caloric. ADDENDA. 
In studying to be concise, we are aware that our physio- 
logical notices have been too brief. If we had intended to 
have exhibited a full view of physiology, many topics would 
have engaged attention that are now omitted, and indeed 
more extensive illustrations given on subjects now merely 
descanted on. From many omitted subjects we select the 
article of sleep, which seems to require a little attention by 
way of addenda. 
On Sleep.. 
The phenomena of sleep are familiar to every one. It 
consists in a cessation of the functions of the superadded, or 
spino-encephalic organs. The external sensitive organs are 
dormant ; muscular motion is quiescent ; there is no per- 
ception of ideas, and the intellectual faculties are at rest. 
This is the .condition of easy and natural sleep, when there is 
no corporeal incitation nor inquietude of mind. 
All those organs which have relation to external objects, 
and internal reflections, depend on the nervous susceptibility 
for their ability of action, and these are the organs which be- 
come fatigued, insensible and quiescent in sleep. It is a law 
of the cerebral masses and their prolongations, the nerves, 
that their susceptibility becomes exhausted by thought, exer- 
cise, and various other incitations. The infant sleeps half 
its time, and the adult one third, or perhaps one fourth of his 
time. This, however, depends much on temperaments and 
habit. 1 220 
ON SLEEP. 
The efficient and proximate causes of sleep have been 
exciting questions amongst metaphysicians, and Professor 
Stuart expressly says, " the investigation is beyond the reach 
of the human faculties." We approach this subject with the 
humble belief, that the mystery is capable of being revealed, 
and even so by the suggestions already made. We need 
have reference to one law of the animal economy which 
seems well agreed on ; which is, that the energy of the nerves 
of external relation is rather quickly exhausted when the 
organs they are distributed to have been exercised for 
some length of time, or severely exercised for only a short 
time, or if stimulations of thought have been severe and pro- 
tracted. Grief disposes to sleep; and criminals usually 
sleep the,night before execution. The same phenomena ap- 
pear from high internal stimulations by which the functions of 
these organs have been forced. Cullen styled it a state of 
collapse ; Brown considered it an exhaustion of excitability, 
Darwin called it a state of diminution of sensorial power. 
The late anatomical discriminations of the nervous functions 
explain more fully the phenomena of sleep. 
The functions above alluded to may all be quiescent, whilst 
the nutritive, nerves and their functions continue their office. 
Nutrition continues during sleep and perhaps more perfectly 
than during the hours of wakefulness, whilst there is not 
so intense a state of perturbed excitation in the nutritive 
tissues. This placid train of vascular circulation is most con- 
genial to the delicate process of nutrition, and the subject 
arises from sleep not only invigorated in intellect, but with 
increased strength and appetite. The ordinary exhaustion of 
nervous force gives occasion to a mild congestive state in the 
brain, which renders sleep the tnore profound. The con- 
gestive state may be rendered more complete by the use of 
narcotics, but every increase in this manner induces, more or 
less of a morbid state of sleep, approaching to coma. Such 
sleep is not refreshing, and when the subject awakes he is OUTLINES OF PHYSIOLOGY. 
221 
dull of intellect, and sluggish in motion, because the conges- 
tive state in part remains, being increased by the medi- 
cament. 
We have assumed the thesis, that, in natural and easy 
sleep, all the intellectual faculties and operations are at rest 
as well as sensation and locomotion. This is in strict anal- 
ogy with all other phenomena of the nervous system of ex- 
ternal relation. The internal faculties are computed by some 
to be five, perception, reason, judgment, imagination and 
memory. If any wish to put down five others we will con- 
tend they are all dormant in the article of natural and easy 
sleep. 
If these faculties or internal senses are dormant, there can 
be no intellectual operations, no exercise of them in the act of 
thinking. The negative of this is gratuitously assumed by 
some, who contend that the mind never ceases thinking, al- 
though they have no evidence that they do think. Mr 
Locke seems to have argued fairly and unanswerably, as well 
as quaintly, when he says, " If I think when I know it not, 
no body else can know it." So we conclude there is no ev- 
idence of the intellectual operations being in play during easy 
sleep. 
It is a physiological fact of the highest interest, that all the 
nutritive functions may proceed in a great degree of perfec- 
tion when deprived of the brain, and its most important ap- 
pendages, as in acephalous infants, and indeed in the embryo 
in the first months of gestation. In apoplexy the whole of 
the organs of external relation are paralyzed. The diseases 
affecting the organs supplied by the two systems are of differ- 
ent characters, attended with diversified phenomena as may 
hereafter be more fully illustrated, and which are partly indi- 
cated in the nosography. 
There are different degrees of soundness of sleep in differ- 
ent subjects, and at different times. Some may be roused 
from their slumberings much easier than others. In all con" 222 
VITAL QUIETUS. 
ditions of predisposition to disease of the congestive kind, 
and especially when preceded by fatigue and cold, the sleep 
will be very profound, and may approach towards coma. 
But, when the vascular system approaches a state of irrita- 
tion, and yet free from congestion, there may be a protracted 
watchfulness, and sleep will be foreign from the subject. So 
slight stimuli produce watchfulness, as tea, small quantities 
of alcohol and opium. But if taken in such quantities as to 
exhaust the vital force and produce a congestive state, they 
induce sleep, which, however, is liable to be of a morbid 
kind. For the purpose of keeping up a state of wakefulness 
in cases of necessity, the stimuli should be in very small quan- 
tities, and not very often repeated. Moderate emotions and 
passions excite to watchfulness, but when severe they pro- 
duce exhaustion, followed by a congestive state, with sleep. 
Thus the loss of a small purse of money may keep a person 
awake, whilst a great calamity is usually followed by sleep. 
For the purpose of enjoying refreshing sleep on ordinary 
occasions, the body should repose in an easy position, the 
health should be perfect, and the conscience not burthened 
with crime, nor the mind with inquietude ; for it is said of 
sleep, 
Swift on his downy pinions flies from wo, 
And lights on lids unsullied with a tear. 
The exercises of thought and motion, in the mass of man- 
kind, exhaust the vital force of the nerves of external relation 
in twelve or eighteen hours, so that sleep spontaneously oc- 
curs, and often irresistibly. The night conduces to repose 
from the absence of light, noise, and many other excitations. 
The periods of sleep become more fixed by habit. 
Although this topic may partake more of the pathological 
than physiological aspect, yet it is here introduced a» a con- 
Vital Quietus; or, Entasia Jlcrotismus, of Good. OUTLINES OF PHYSIOLOGY 
223 
trast to the quietus of the organs of external relation in sleep ; 
and thereby demonstrating, that there may be a quietus of the 
nervous energy of internal relation, whilst the organs of ex- 
ternal relation are active. Sleep makes a near approach to 
the pathological state, yet it appears periodically, whilst 
acrotismus arises accidentally. 
'I his state cannot be considered as asphyxia, for common 
usage has applied this to failures in both the nervous systems. 
Acrotismus implies an absence of pulsatory action, with 
collateral inability of vital actions, whilst the nervous energy 
of external relation remains free. 
This state has some resemblance to the incubus, or ephi- 
altes nocturnus et diurnus ; still it is different, for this is 
connected with a spastic sternalgia, the internal involuntary 
muscles are affected, and it suddenly disappears. In acro- 
tismus there seems to be an impress on the semilunar, and 
indeed on all the internal ganglia and plexuses. Their func- 
tions are diminished, suspended, and often fatally extinguished. 
It may be styled a ganglial apoplexy. 
A temporary suspension of these functions occurs in syn- 
copy ; it is often more persistive in a condition called trance ; 
and there are too many well attested cases of apparent death, 
and actual interments, to be denied or made light of. In these 
cases consciousness often remains, but the individual is dis- 
enabled in locomotion and vocal expression. In another 
grade of it, speech is measurably free, together with the 
intellectual faculties. In the noted case of acrotismus of 
John Hunter, as related by Sir E. Home, which continued 
nearly an hour ; he could, by a voluntary effort, speak, and was 
all the time conscious of what passed, whilst there was an 
entire cessation of cardiac action. " There was a suspension 
of the most material involuntary actions ; even involuntary 
breathing was stopped ; whilst sensation, with its conse- 
quences, as thinking and acting, with the will, were perfect, 
and all the voluntary actions were as strong as before." From 224 
VITAL QUIETUS. 
the history of this case we may infer its connexion with 
sternalgia, affecting the muscles more than the ganglia. Many 
other cases are on record. 
We will now refer more particularly to those conditions 
connected with impressions on the ganglial system. We 
have witnessed many similar states of the system, and espe- 
cially at the attack of what have been styled malignant fevers, 
particularly of that form vulgarly called spotted fever, and in 
dysentery, in which some recovered, but far more proved 
fatal. There comes on a gradual diminution of the force of 
the cardiac action ; and in an hour or two, perhaps all pulsa- 
tory and cardiac action cease. For an hour or two after their 
apparently entire cessation, the subjects sometimes converse 
rationally in a low and hesitating manner, often closing their 
eyes in gentle slumbers, and apparently without pain, except 
a slight precordial distress, with occasional sighing. In some 
instances, however, there is more distress. The counte- 
nance is only slightly pale, and the general aspect resembling a 
person falling into a placid sleep, whilst even in the article of 
death. After eternal rest has seized the subject, for many 
hours, the body more resembles a state of quiet sleep, than an 
ordinary cadaver. 
We have seen cases of simple fever terminate, especially 
in cold seasons, in a very similar manner in enervated sub- 
jects, and after several days continuance, apparently from a 
concentration of morbid force on the origins of the tris- 
planchnic system of nerves. Do not many of the sudden 
deaths, called cerebral apoplexy, occurring in aged and en- 
feebled people, arise in a similar manner ? 
Surely these may be styled morbid contingencies, yet they 
show the independence as well as the mutual relations of the 
two great systems of nervous force. 
There are many attested cases of revivification from trances, 
as we have witnessed in acrotismus. The rigid state of the 
internal tissues, which generally exist at the attack of OUTLINES OF PHYSIOLOGY. 
225 
disease, (Sect, xviii. 4,) may at length become relaxed ; at 
least so far that the vegetative, or first grade of vitality, 
may effect absorption sufficient to remove the congestive state 
oppressing the ganglia and plexuses, so that their lost func- 
tions may be restored. 
Dreaming. 
This too might be called a pathological state, for it stands 
opposed to easy and natural sleep ; it is an imperfect sleep. 
Whilst in the former all the functions of external relation re- 
pose in an easy quietus, in the latter condition, only a part 
are dormant, whilst the rest are awake, and perform incon- 
gruous motions and disjointed associations. 
The phenomena of dreaming go far to establish a plurali- 
ty and independence of functions in the internal senses, as 
we know exist in the external. It has been demonstrated 
that some of these may be obscured, whilst others are active, 
so we infer the same of the internal under particular circum- 
stances. Again, as some of the external senses are less pro- 
found in sleep than others, as hearing and sight, so of the in- 
ternal. Imagination is less liable to profound slumbering than 
reason or judgment.* 
Dreaming is excited by some uneasy sensations of mind 
or body. Ideas are awakened but not arranged in just order ; 
for although associations follow, it is in a disjointed and bro- 
ken manner ; they are not determined by the will, nor mar- 
* It is an interesting pursuit for the philosopher, to observe the various 
operations of the intellectual faculties, brought into play by various incita- 
tions, giving occasion to numerous volitions and associations. Thus Darwin: 
How thoughts to thoughts are linked with viewless chains, 
Tribes leading tribes, and trains pursuing trains ; 
With shadowy trident how volition guides, 
Surge after surge, his intellectual tides; 
Or queen of sleep, imagination roves 
With frantic sorrows, or delirious loves. 226 
DREAMING. 
shalled by the judging faculties ; ideas are accidentally asso- 
ciated in an incoherent manner, forming caricatures, monsters, 
and nondescripts ; yet on a nearer approach to wakefulness 
become more symmetrical, and the factitious images may be 
brought to remembrance when awake. 
The trains of excited ideas commonly have some relation 
to the circumstances that excite them, and such as press hard 
on the mind. Thus, the lover dreams of his mistress ; the 
miser of cash, or of thieves breaking in to steal; the recol- 
lections of the warrior are of battle and blood, whilst the 
sad mourner apprehends his departed friend in review before 
him, 
The muscles in dreaming often suffer some agitations, but 
they are not directed to any object, because the faculty of 
volition is not in exercise nor under the direction of the will. 
Much anxiety is experienced on some occasions, when the 
imagination suspects an enemy close at hand, and yet unable 
to defend against him, or make an escape ; the subject 
suddenly awakes with much agitation. In these perturbed con- 
ditions of dreaming, there exists a pathological state of the 
respiratory muscles ; they dd not act freely, but become fixed, 
and allow of an accumulation of blood in the heart and lungs, 
until the intolerable distress excites wakefulness. DIVISION II. 
PATHOLOGICAL NOTICES, 
OR A 
> > . . 
CONSIDERATION OF THE ETIOLOGY, AND CHARACTER 
OF DISORDERED ACTION GENERALLY. PATHOLOGY 
SECTION XIII 
1. Preliminary Remarks. 
Our illustrations will be conducted on the broad basis of 
investigations of the causes of disease, Etiology ; the pheno- 
mena, Semeiotice ; and the character of the morbid habit gen- 
erally ; or more strictly Pathology. 
The philosophy of medicine in all its relations, is of a 
peculiar character, and identical in its kind. It is in subor- 
dination to a force never found in purely physical matter ; but 
amenable to a power which presides over organized substan- 
ces, and influences their movements ; alike persistive in the 
disturbed conditions of disease, as in the placid trains of the 
phenomena of health. This controlling influence is subject 
to various modifications from changes made in the organism 
by exterior circumstances, and the transition is often too easy 
from the normal to the disturbed state. 
The phenomena of disease are so far more intense than 
those of health, that the sufferer, and peradventure the medi- 
cal attendant, when ignorant of the structure and functions of 
the organism, may be led to suppose that some additional 
entity is thrust in, and that he has new forms and sensibilities 
within the body, which never before existed there. The 
natural conclusion will be that these must be removed ; and 
nearly the whole materia medica may be tried empirically for 230 
PRELIMINARIES. 
this purpose, and yet the suffering may still continue. This 
is only one of the many false views of the character of 
disease. i 
Neither does a certain assemblage of symptoms constitute 
disease. These are only tjie indicators of perturbed action 
going on in the tissues. They speak in legible terms to those 
who can read, and understand the language of physical im- 
pulses on vital tissues, and organs; and the responding 
motions excited, and displayed by an union of apparatuses, 
now show a discordance, which at other times were progress- 
ing in harmony. We cannot accord with the purblind views 
of those who say, " all physiology as far as it is hitherto 
known, is totally or nearly useless in explaining any thing 
which happens in fever." " In short, fever is a disease, the 
whole of the appearances of which have been in no ways ac- 
counted for." * Discouraging indeed for the long labors of 
the amphitheatre, and the tortures of vivisections. 
Numerous have been the false views of disease, and often 
so entertained by whole communities, as well as individuals. 
Opinion has been marshalled against opinion, and of course 
the treatment has been as opposite as the antipodes. Public 
confidence has been impaired, and even personal opinion dis- 
trusted after tedious rounds of practical experience. Medical 
sentiments have been often neutralized, and of course made 
inert ; or all theorizing has been abandoned, and the mutable 
symptoms of disease followed up as disease itself, with a blind 
zeal, when they are but the mere indices of their prototypes, 
or the injury inflicted on the organization. 
In consequence of these jarring sentiments, a well grounded 
assurance in the treatment of disease has been weakened; the 
way opened for the entrance of impostures, and the science 
of medicine stigmatized as uncertain, visionary, and conjec- 
tural. Poor recompense indeed, for the labor and zeal of 
ages bestowed on that art, which Hippocrates esteemed di- 
* Fordyce on Fever, pp. 18 and 20. OUTLINES OF PATHOLOGY. 
231 
vine, and which was designed to relieve the distress of man, 
and prolong his existence. 
Such views ought no longer to be tolerated by men of en- 
larged information, and who are in possession of the immense 
store of facts elicited by modern improvements, in all the col- 
lateral branches of medicine. There are materials for form- 
ing a new generalization of the principles of medical science ; 
and there is the more need of this, since nothing efficient has 
been attempted for a long time past, and the labor and res- 
ponsibility is so imposing, that it has been rather evaded by 
many most capable of undertaking the task. 
In the outset, we indignantly repel the trite, sarcastic in- 
uendos, which have so often uncourteously been cast by 
many ; by direct allusions to theorems advanced, having been 
formed from lamp-light cogitations in the closet; and the 
bending of facts and analogies to support a favorite hypothe- 
sis. We have been inducted by another, and more hardy 
routine of study. And, from the full conviction of the insuf- 
ficiency of every generalization hitherto attempted, have re- 
explored the chartless empire of medicine ; and wishing to 
save it from the quicksands of empiricism, have made many 
comparisons in the open air, in the dissecting room, and at 
" the bed-side of the sick." Having a few incontrovertible 
data, as polar stars in view, we have endeavored to form in- 
ductions, which will not readily be dissipated by the fire of 
experiment. If the arrangement is new, it is supported by 
facts not altogether novel. 
If we are not able on all occasions to offer a satisfactory 
explanation of every phenomenon of disease ; yet, it is possi- 
ble the outlines of a system may be designated, which, if it 
be not perfect, still may not be false. 232 
PRELIMINARIES. 
2. Expositions. 
The excellency of Sir I. Newton's improvements in phy- 
sics, does not consist in having discovered the principle of 
attraction inherent in inert matter, but in having shown that 
attraction acts directly in proportion to the mass of matter, and 
inversely as the distances. Is it not possible to offer a clew, 
which may lead to an unfolding of the laws of organic life 
upon an axiom almost equally simple in character and con- 
struction, and which may serve as a guide to the pathologist, 
through the intricacies of his researches in relation to dis- 
ease ? 
The vital force responds directly in proportion to the integ- 
rity of the organization, and is equivalent to the compatible 
or incompatible range of stimulations applied. The integrity 
of the organization is supposed complete in the physiological 
state. In this condition compatible stimulations produce nor- 
mal actions. Suppose the integrity of the organization to be 
injured by excess of sensibility, and at the same time exposed 
to excessive, or incompatible excitations ; there will then be 
abnormal movements, productive of pathological phenomena. 
And, even compatible stimulations will show similar pheno- 
mena, but perhaps of a lower grade. 
An embarrassment arises from the fact, that the vital force 
is not fixed in the tissues of a constant amount, as attraction 
is to physical bodies ; it is diminished or increased, as the 
organization may be impaired. It may be injured in a man- 
ner to produce very exalted, or elevated phenomena; or, in 
a manner to show enfeebled phenomena, below the normal 
grade. Its intensity of attachment to organization, is there- 
fore, always conditional. 
In all our investigations, therefore, into the laws of the vi- 
tal movements in disease, regard should be had to the amount 
of vital force existing at the time, and the ability of the orga- 
nization to maintain it. The degrees of divergence from the OUTLINES OF PATHOLOGY. 
233 
normal state should be carefully noted, and the facility and 
correctness of doing this will be learned by diligent observa- 
tion and experience. The degrees of divergence may be suf- 
ficiently ascertained for all practical purposes, but never with 
geometrical exactness. 
Very important inquiries may follow, for the purpose of 
ascertaining what intervening circumstances may have altered 
the state of the tissues, and modified the vital susceptibilities ; 
and, also, in relation to the most suitable method of restoring 
the natural exercise of the functions. If it should after all, 
be suggested, that medicine is not one of the exact sciences, 
it might be replied, that the rule is as exact as any in Euclid, 
even if we are not able to estimate or measure the pathologi- 
cal aberrations, which may be present, except in a comparative 
manner by the judgment. 
Ouninvestigations will be directed by an attempt to develop 
the entire character of the diseased habit, and to expose the 
several relations which combine together the different tissues, 
organs, and fluids in a unity of perverted impulses ; believing 
as we do, that mere pathological results of diseases, as dis- 
covered by autopsical inspections, and as lately practised by 
many, are of but little utility, when disconnected with the ac- 
companying pathological phenomena, and antecedent causes, 
which excited the perturbed movements, producing such re- 
sults. 234 
DISEASE GENERALLY. 
SECTION XIV. 
1. What is Disease 7 
A question easily asked ; and without much reflection, it 
might be supposed to admit of a ready and laconic answer. 
Yet, there is scarcely an interrogatory in the whole round of 
science more difficult to answer in a lucid and satisfactory 
manner. If, in all our researches and illustrations, we can 
expose the character of the diseased habit, and make it fami- 
liar by its simplicity, and, also, disrobe it of its numerous 
false garbs, we shall have attained the full extent of our 
endeavors. 
All that we have hitherto advanced, has been intended to 
form a basis, and point the way for a review of the numerous 
contingencies, which excite a new train of phenomena, mani- 
festing lesions' done to the vital susceptibilities, and to the 
tissues under their influence. 
We speak of disease, in the singular number ; and yet every 
nomenclature affixed to medical systems, is loaded with 
terms and definitions of many hundred diseases ; and, indeed, 
it is necessary so to be. Although the morbid habit has 
many things in common, and sufficiently so, that we can con- 
template the perturbed condition of disease in gross, yet it 
admits of various modifications in the different diatheses 
attending it, and the numerous locations of particular diseases 
in different tissues, and organs. All these are varied mani- 
festations of the diseased habit, and require specifications ; 
otherwise medical language would be altogether unintelligible. 
A location of disease in the head requires some symbolic 
term to distinguish it from a location in the thorax. The 
misfortune attending nosographic catalogues, is, an attempt to 
isolate disease, and define the character of the diathesis by an 
assemblage of symptoms in connection, and affix it to the 
nominal distinction of the disease, as having a local origion, OUTLINES OF PATHOLOGY. 
235 
and isolated state. This is incompatible with just pathology, 
and on this account all nosographies have received merited 
censure, but ought not to be expunged. The short exposi- 
tions ought not to be received as illustrating the entire char- 
acter of the disease, but only the peculiar characteristics, 
and as emanations or phenomena of a common diseased habit. 
Perhaps our language, when speaking of the common mor- 
bid habit, and the different locations emanating from it, may 
be unintelligible to some, and especially to those, who sup- 
pose disease very uniformly to originate at some particular 
point of irritation, and to radiate over the tissues. This sub- 
ject will receive ample discussion in a separate section, in 
due time, and it is hoped, in a manner to convince and satisfy. 
2. Definition. 
With respect to a short definition of disease generally, or 
the morbid habit, we might say, that it consists in a manifes- 
tation of a series of phenomena, indicative of the repulsive 
powers of the instinctive energies of the living system. The 
phenomena are correct indicators of the existence of an ab- 
normal state, and that the internal organs are suffering chan- 
ges, which tend to alter their functions, and destroy their 
structural integrity. The history of the phenomena of dis- 
ease in general will be attended to in due time. 
These phenomena are not always identically the same in 
kind, or in degree, nor do they always appear of the same 
number at the beginning, in different cases ; yet enough are 
always present to convince the subject afflicted, of experi- 
encing bad ease, as the word disease strictly implies.• If not 
directly attended with pain, yet there will be an uneasiness ; 
and various phenomena are more or less present, indicating 
a general excited, perverted, and perturbed action in the 
system, with an altered state of function of some organs or 
tissues, in some or many parts of the system. Or, on some 
occasions, there will be an inability of functional exercise of 236 
DISEASE GENERALLY. 
organs at the commencement ; but, most commonly after ex- 
isting only a short time, the phenomena all indicate a state of 
elevated movement, above the ordinary physiological grade. 
3. Remarks. 
The common morbid habit may exist for a short time be- 
fore it manifests any very severe disturbance of any particular 
organ. When this does take place, however, many other 
phenomena are developed, and with greater intensity and pre- 
cision, and the affection now receives its cognominal appella- 
tion. However, this assemblage of symptoms furnishing a 
particular name is not the whole of the disease, for this pre- 
viously existed in the entire habit, and still exists after a loca- 
tion may be formed ; although a superficial inspection might 
incline an unwary observer to think the whole of the disease 
to be in the part, because he discovers not only pain and red- 
ness, but perhaps, a tumefaction of the part, with other occa- 
sional local phenomena. The same observations apply to 
internal affections. 
There being many phenomena constantly present of a sim- 
ilar aspect or affinity, in almost every habit of disease, and 
certain physiological changes so uniformly connected with 
them, that some pathologists have contended for a unity of 
disease ; by this, meaning that all diseases consist of similar 
physiological changes at their commencement, although of 
very different degrees of intensity, by whatever cause exci- 
ted ; and that the mode of treatment admits of much uniform- 
ity at the onset. It is also suggested, that the various aspects 
of diseased action at the beginning, are mere modifications, 
varied by the intensity of the causes, by the different condi- 
tions of predisposition, of temperaments, season, climate, and 
the sensibility of the different tissues locally affected, &c. 
And further, that as disease may have progressed, and new 
changes or morbid alterations taken place in the tissues, with OUTLINES OF PATHOLOGY. 
237 
other phenomena, so the treatment may need to be modified 
also. 
Many pathologists', besides Dr Rush, have noticed a close 
affinity in diseases, or a strong relationship existing, and run- 
ning through the whole of the morbid nomenclature, but have 
not been able to form a system of generalization on account 
of certain false dogmas, which in their minds demand prece- 
dence. Even so late a writer as Dr Southwood Smith 
seems to have unconsciously espoused the sentiment as re- 
lates t(> fevers, and comes very near admitting it in all inflam- 
mations, upon observing so " close," and " constant con- 
nexion between them." " Supposing the proofs hereafter to 
be adduced to be conclusive, that the events in fever and 
their order really are what has now been stated, how clearly 
and beautifully does this view of the disease enable us to rec- 
ognize one and the same malady through all the modifications 
it undergoes, and therefore throygh the countless aspects it 
assumes." * 
This thesis appears to be supported by too striking facts 
and analogy, to be hastily rejected, and yet it admits only of 
conditional assent. We do not implicitly admit, or reject it 
at present, but defer any further notices, until we have more 
thoroughly explored the mysteries of the morbid habit, and 
the circumstances inducing it. 
It would be desirable to investigate the morbid habit, ac- 
cording to the succession of cause and sequence ; and this 
course will be pursued as far as appears practicable. Yet, 
there are so many contravening circumstances, and mutual 
dependencies, that it is difficult to decide where to begin, 
and how to follow up the impulsive and repulsive movements 
to the best advantage. However, we will in the first place, 
notice some things very much in common. 
* Treatise on Fever, p. 65, Am. Ed. 238 
SOLIDS AND FLUIDS. 
SECTION XV. 
SOLIDS AND FLUIDS. 
1. Does Disease primarily exist in the Solids, or in the 
Fluids ? 
Although the human system consists of dissimilar parts, 
yet it is a composition of apparatuses operating in unison, to 
effect ultimate designs of congenial character. All its parts 
therefore act in harmony, and with a unity of design both in 
its physiological and pathological conditions. Every compo- 
nent part is endowed with a vital impressibility of a certain 
grade, and every part may suffer injury by hurtful impres- 
sions ; and again every part may become excited to repel 
them, ft has been shown that the blood, and even other 
animal fluids possess a certain grade of vitality, and of course, 
are liable to suffer as well by the causes, as in the conflict of 
disease. 
The contentions of the solidists and humoralists have 
served only as obstacles to the improvement of medical sci- 
ence. A great waste of time and labor has been made. It 
is quite immaterial in a practical point of view, whether nox- 
ious impressions directly affect the susceptible tissues, or 
whether they are admitted by absorption into the circulation, 
and affect the blood and the same tissues by their interna 
stimulations. Very similar phenomena will arise indicating 
the most suitable treatment in the one instance as in the other, 
and all manifesting lesions done to the vital economy. Neither 
can the phenomena be very dissimilar ; for an injury is expe- 
rienced in both solids and fluids very soon alike. The mor- 
bid condition of the fluids is in an exact ratio to that of the 
solids, for they suffer changes directly, if not primarily. On the 
other hand, suppose the fluids first to suffer change, then their OUTLINES OF PATHOLOGY. 
239 
unnatural stimulations immediately change the condition of 
the solids, and in either event there arises a perverted state 
of functional exercise, constituting the morbid habit. Not- 
withstanding, it is quite evident, that the noxious impressions 
are commonly first made on the vital tissues. 
Let us suppose the ordinary means of replenishing the 
vascular system to be too abundant, by which a state of hyper- 
semia, or plethora, may be produced ; and as a consequence, 
the freedom of vascular action, and circulation, becomes im- 
paired. This condition when once formed, will strongly re- 
semble that disparity which is often produced by the contrac- 
tion and condensation of the vascular tissues, by the stimula- 
tions of the external causes of disease. The diminution of the 
calibres of vessels produces a relative hyperaemia ; and the 
phenomena in either event are very similar, except in the one 
case it may be produced slowly, and in the other suddenly. 
The solids make an impression on the fluids, yet not as 
inert bodies mechanically impress physical bodies ; but, by 
all the inexplicable attributes of vital force ; and this force is 
exerted on vital fluids also. The impulse and reaction are 
mutual, and in health harmonious. But, let either become 
altered, the vital impulsions will become changed, and the 
secretions, nutritions, and indeed every vital process, must 
suffer alterations also. We have much evidence which might 
command our credence, that morbid alterations in the tissues 
are more permanent, and not so readily restored as alterations 
in the fluids. The latter are more changeable than the for- 
mer ; they can be evacuated, and the vessels replenished with 
other fluids in a short time, whilst changes in the solids must 
be more slowly produced. This remark applies more espe- 
cially to confirmed habits of disease ; for, in the incipient 
stages the morbid movements of the solids can be more 
readily regulated, before there are any structural changes. 240 
SOLIDS AND FLUIDS. 
2. Solids most to be regarded in Disease. 
That the movements of the solids are more to be regarded 
than the condition of the fluids, in the treatment of disease, 
can hardly be doubted ; since the motory powers reside in them, 
and these powers claim attention in proportion as they pos- 
sess higher conditions of motivity than ever can appertain to 
the'fluids. This circumstance being constantly apparent in 
the phenomena, has led to the so common reception of the 
views in relation to modern solidism, to the almost entire ex- 
clusion of the participation of the fluids in the phenomena 
and treatment of disease. With respect to the inquiry, whe- 
ther the causes of disease act primarily on the solids, or on 
the fluids, it might be briefly answered, that disordered action 
may be excited both ways. Yet it may be noticed, that as 
the solids possess a higher degree of vital susceptibility, so 
they are more exposed to hurtful agents, and are far sooner, 
and much oftener excited to perturbed movements, than the 
fluids are to lesions. It is in the tissues, then, that we 
chiefly notice disordered action, and to which the treatment 
must essentially be directed. 
3. The Humoralists and Limitarians. 
The opinions that very generally occupied the attention of 
the faculty before the time of Hoffman and Cullen, of disease 
being caused by a peccant state of the fluids, and the means 
used for its correction, have had an unfavorable influence 
on the improvement of therapeutics. They considered that the 
disease, or febrile state, was necessary to alter or concoct the 
condition of the fluids, and prepare them for expulsion. So 
the physician had little to do, but chiefly to look on, and 
watch the hoped for crisis. The modern views of the solid- 
ists, who adhere to the notions of self-limited diseases, are 
alike unfortunate for letting pass the precious opportunity of OUTLINES OF PATHOLOGY. 
241 
rendering timely and efficient aid. The expectant treatment 
is alike reprehensible in both instances ; whilst a correct 
knowledge of the morbid economy cannot fail to excite the 
energies of the intelligent and conscientious practitioner to 
use means to modify, or to intercept the perturbed actions of 
the vital tissues, before organic lesions take place, and 
thereby render the morbid state both shorter and safer. 
4. Remarks on the Virus of Contagions. 
How does the virus of contagion, diffused in the atmos- 
phere, find access into the system and excite disease ? It is 
highly probable by being absorbed and producing an internal 
excitation. Let us suppose the variolus virus emanating 
from one subject to another. It does not come in immediate 
contact with nervous expansions, when absorbed, for they 
are everywhere covered with an epithelium. It is probably 
absorbed, and especially by the pulmonary tissue, or perhaps 
the intestinal. It now comes in contact with the absorbent 
veins, possessing only the first grade of vital force, as has 
been already illustrated. Now we find this manner of receiv- 
ing the virus, is attended with much delay in showing its 
effects, from what occurs when the virus is applied directly to 
tissues with nervous expansions, as happens by inoculation, 
or placing the virus in contact with the dermoid nerves and 
capillaries. In the former case, two quarter lunations are re- 
quired for the incubation of the virus, before the phenomena 
of disease occur ; whereas in the latter they appear at about 
the end of one quarter lunation. We do ilot say the process 
proceeds exactly in this manner ; it is suggested as an hypo- 
thesis, and merits further investigation. 
However, if the suggestion should prove to be correct, 
the principle might be extended, and by it we might explain 
the fact of the virus of the viper proving so suddenly fatal 
when received by a wound ; and also why it may often be 242 
SOLIDS AND FLUIDS. 
taken into the mouth with impunity. The absorbents do 
not admit some deleterious substances ; and, if it be true 
that the tissues of vegetative sensibility are not easily excited 
by them, we may conceive why the numerous kinds of sensi- 
ble and noxious effluvia, with which the atmosphere is often 
loaded, so seldom produce disease. The nauseous air of the 
dissecting room does not produce disease, neither the touch 
of the putrid cadaver, unless in contact with a wound. So 
sedulous are the powers of the absorbent instinctive sen- 
sibility in avoiding hurtful agent's, that we may infer the 
causes of disease most commonly to act on the nervous suscep- 
tibility; rather than through the medium of the fluids. Heat 
and cold as causes of disease, particularly affect the susceptible 
tissues ; so, also, fatigue, surfeiting, mental affections, &c. 
5. Remarks on the Scorbutic Habit. 
The scurvy is a form of disease rather aside from the or- 
dinary conditions. The most striking phenomena first ap- 
pear in the fluids, or apparently so. Yet, a serious question 
may be raised, whether the solids have not primarily lost a 
large share of vital tonic .power, and along with this much of 
sensibility also. But, as opposed to this, the disease usually 
rises from a fault, or deviation in the regimen. Too large a 
proportion of the muriate of soda may have been assumed, 
and without being eliminated from the blood, by the kidneys 
and skin, from cold, and a concurrence of other incidental 
causes. One proof of the scorbutic diathesis being produced 
by primary changes in the blood, is, that the too long use 
of mercury produces a very similar state, and if used in the 
treatment, almost certainly destroys life. Again, an altera- 
tion of the regimen, or use of vegetables, does much to re- 
move the diathesis, or loose crasis of the blood. On the 
other hand, the excitation of the energies of the mind by in- 
vigorating the solids, has often Cured the disease. Finally, OUTLINES OF PATHOLOGY. 
243 
on a comparative review, we may safely infer, that both the 
solids and fluids are alike in fault. The latter give unnatu- 
ral stimulations, whilst the former return enfeebled oscillations. 
6. Phlogistic Diathesis. 
Opposed to the preceding crasis of the blood is that con- 
dition, which the pathologists of the proceeding century called 
a lentor, or siziness of the blood. It consists of a conden- 
sation, or increased tonic force in the tissues, as well as in the 
fluids, and constitutes the diathesis usually called phlogistic. 
It was supposed by the humoral pathologists, that this crasis 
of the blood existed antecedently to the manifestation of the 
disease, and that the lenior must have produced it; just as 
some modern pathologists say that tubercles are antecedently, 
somehow or another, formed accidentally, and produce phthi- 
sis. However, with respect to the siziness, or tonic crasis 
of the blood, from all the observations we have been able to 
make, the dynamic state of the fluids and solids progress 
nearly together. The changes in the blood seem to be mod- 
ified, by the morbid impulse of the vascular tissues. Yet, 
when this state of the fluids exists, it offers serious impedi- 
ments in the secerning and capillary tissues ; it passes with 
difficulty, and is attended with many of the pernicious re- 
sults in the circulation insisted on by the former pathologists. 
It is very uniformly conceded, that a retention of custom- 
ary secretions, for elimination, such as bile, urine, milk, 
menstrual purgation, &c., predispose to, and actually give 
origin to disease. No doubt they produce abnormal stimula- 
tions on the capillary tissues ; yet it might be inquired, whether 
the tissues might not primarily be in fault, and occasion such 
retentions of the secretions ? However, as soon as disease 
becomes manifest, the entire composition is involved Jin per- 
turbed action, and morbid changes. 244 
SEATS OF DISEASE. 
SECTION XVI. 
SEATS OF DISEASE. 
1. Which are the Tissues and Organs most essentially affec- 
ted in Disease ? 
Whatever may be the causes of disordered action in the 
human economy, and whatever physiological circumstances 
may contribute to produce and modify the existing phenome- 
na, we discover some traits in common to them all. One of 
these is, that every form of disease has a seat of concentra- 
tion in some tissue, where its most essential character is dis- 
covered ; in other words, every form of disease is chiefly 
manifested by some kind of local affection. We cannot in 
this section make any inquiry what the effects may be on the 
general habit, by the local condition affecting tissues of differ- 
ent grades of sensibility ; nor, whether the local affection may 
be esteemed the cause or sequence of the morbid habit. We 
shall then be confined to the fact of the existence of local af- 
fections, and to an inquiry which those tissups are, and what 
pathological divisions they may admit of. 
The phenomena and intrinsic character of disease appear to 
be essentially varied by the sensibility, and difference of struc- 
tures of the tissues affected ; and as the sensibility depends on 
the amount of nervous matter, and vital vegetative force be- 
stowed on them, we may make some references to the physi- 
ological divisions already detailed, as the rule of the divisions 
of their morbid states. The tissues, then may admit of three 
primary divisions of liability to morbid excitation. 
1st. The primitive tissues endowed with irritability, or 
vegetative sensibility. 
2d. The tissues and organs endowed also with the gangli- 
onic visceral, or nutritive sensibility. 
3d. The nervous tissues of external relation. 
Each of these grades requires some particular notices. OUTLINES OF PATHOLOGY. 
245 
2. ls^, Morbid Susceptibility of Simple Vegetative Tissues. 
As respects an isolated state of disease exclusively in the 
simple primitive tissues, we have only to say, that so far as 
evidence extends, we may suppose it to be quite simple, and 
as presenting only a few phenomena, and these rather mild. 
We have but little evidence of the embryotic state, before 
the development of nerves, being attended with disease. The 
accidents it may meet with are rathe^ of a mechanical kind. 
However, we are well persuaded, that in the more advanced 
state, and after the full development of the nervous tissues, 
those parts possessing the least vital susceptibility, are the 
least subject to disease, and often suffer extensive lesions 
without being attended with high morbid excitations. The 
cellular tissue, veins, and parenchyma of organs mjght be men- 
tioned as examples. But, the nervous systems of both ex- 
ternal and internal relation are so generally diffused, and inter- 
woven in human tissues, it is difficult to make precise dis- 
criminations. 
We might make reference to animals of the lowest order, 
without nervous tissues, as proofs of a low grade of sensibil- 
ity, and suffering but little from injuries done to their textures. 
They may be mutilated and the limbs restored ; some when 
cut into pieces, vegetate, and become perfect animals ; others 
even live a long time when decapitated. Indeed they scarce- 
ly suffer disease in a manifest manner. Yet we may suppose 
the human tissues of simple irritability possess a higher sen- 
sibility than that of the lowest order of animals, or of vegeta- 
bles, when it may be of a similar kind. Even the hair and 
nails may assume a high grade of sensibility, and admit of 
vivid radiations to the centre of perception. 
It is in association with the nerves of the nutritive or in- 
stinctive sensibility, that the simple solids endowed with the 
first grade of vital force, show their co-operating influence ; 
and these next claim some attention. 246 
SEATS OF DISEASE. 
3. 2tZ, The Morbid, Condition of Tissues, and Organs, en- 
dowed with the Ganglionic, Visceral, or Nutritive Sensi- 
bility. 
These tissues and organs possess a sensibility peculiar in 
itself, and suited to the apparatuses of its endowment. By 
this property the organs become associated in a harmony of 
function, and their movements are steadily performed, and 
essentially independent of other modifying influences, both in 
health and in disease. 
These tissues and organs, in connection with the vegetative 
tissues, compose the principal part of the human system. It 
will be the shortest to say, they compose the entire corporeal 
system, except the spino-encephalic masses and their prolon- 
gations, the nerves. It is, however, to be kept in mind, that 
the respiratory nerves form a part of the nutritive system. 
Although the nerves of sensation are distributed in most of 
the tissues, more or less, they have but little agency in the 
processes of nutrition, or the repulsive processes in disease. 
Their office is to transmit sensations, and excite muscular 
contractions. They often notify the intellect of injuries in- 
flicted, when they have taken no part in the annoyance. It 
should be remembered, that the vascular tissues of the nutri- 
ent system penetrate, and entwine the nervous system of ex- 
ternal relation, not only in the minutest nervous prolongations, 
but throughout the entire encephalic masses, and thereby af- 
ford many modifying impulses to these nerves of external 
relation. 
It may now be remarked, that most of the physical agents 
and impulses, that act on the system, altering the organic 
movements, and producing disease, do so by impressions on 
the instinctive susceptibility of the organs of nutrition, and in 
co-operation with the vegetative vital force. It is conceded 
that mental influences affect or modify the organic movements 
in a more or less permanent manner. But, these influences OUTLINES OF PATHOLOGY. 
247 
all act as causes, and if accessory to the production of per- 
manent disease, always effect some change in the functions of 
the nutritive structures. Neither does pain excite permanent 
disease, although it may excite present commotion. In the 
instance of wounds, the pain arising from the lesion of the 
nerves of sensation soon subsides ; but, it may return, if the 
phenomena of disease afterwards arise in the organic tissues, 
from their own susceptibility. These subjects can only be 
intimated in this place. 
Impressions then on the involuntary organs and tissues, 
excite the commotions in their functions, which produce the 
phenomena of disease. These are of two kinds ; the one 
having reference to the constitutional state of disease, the 
other to the amount of injury done locally to the organs ; and 
these phenomena assist, and unite in showing the whole 
amount of the morbid condition that exists. The organic 
tissues in their high state of excitation, assume an elevated 
state of sensibility, which transmits to the centre of percep- 
tion some tokens of the degree of injury done them. 
And, again, the high state of sensibility of the nervous tis- 
sues of external relation, radiates a sort of reflex action over 
the entire system, by a kind of consentaneous harmony, usu- 
ally called sympathy, which is often productive of many an- 
omalous, or fugitive symptoms, termed nervous, and yet 
forming no part of the idiopathic affection. On many occa- 
sions, and especially at the commencement of acute disease, 
both these series of nervous tissues suffer a diminution of sen- 
sibility, from changes produced in the simple tissues. 
All the varied modifications of pyrectic diseases ; all the 
phlegmasiae internally, or externally, acute or chronic ; and 
finally, all affections producing cardiac, or capillary excita- 
tions have their seats in these nutritive tissues and organs. 
Nor need we except what has been styled mental diseases, or 
affections perverting the functions of the organs of intellect. 
For, the vascular tissues traversing, and entwining the nervous 248 
SEATS OF DISEASE. 
expansions, and cerebral organs, derange their functions, when 
in a state of excitation. Again, all comatose, paralytic, and 
spasmodic affections have their seats in the morbid conditions 
of the capillary vessels traversing the nervous tissues of ex- 
ternal relation ; and these capillary tissues are a part of the 
involuntary nutrient system of organs. 
We see by these expositions, that the abnormal move- 
ments of disease are independent of any acts of volition ; that 
they rise, progress, and terminate by a series of impulses and 
vital actions depending chiefly on foreign exciting agents, the 
lesions produced, and the movements continued by the in- 
stinctive, repulsive sensibility of the organization. In these 
conflicts the organs are liable to suffer immensely, and traces 
of their spoliation may be discovered by post mortem inspec- 
tions ; or oftentimes by a train of sequences in the living 
subjects. 
A knowledge of the seats of morbid impressions in differ- 
ent tissues, and organs, forms a basis for arranging by affinity, 
the various modifications of disease ; and this is the only 
method to form a useful, and physiological nosography. 
These local affections then of the involuntary tissues, either 
external or internal, admit of various subdivisions into orders, 
and genera, so as to embrace all necessary distinctive appel- 
lations, and yet without being encumbered with an overwhelm- 
ing mass of detailed specifications. 
4. 3d, Lesions affecting the Nervous Tissues of External 
Relation. 
The illustrations already given, may lessen what we might 
have to express on the subject of disease being primarily 
seated in this tissue. So far as we can discover, there are 
but few affections having primary seats in the cerebral masses, 
or their prolongations : and indeed, whatever lesions are found 
here, appear almost inseparable from influences produced by OUTLINES OF PATHOLOGY. 
249 
morbid states of the system of the nutritive tissues. Let us 
review some of these. 
In the instance of apoplexy, we have no evidence of a 
primary change in the nervous tissue of external relation, 
although it manifests very imposing phenomena ; there exists 
merely a change of function. The inability of the exercise 
of intellect, and of motion is sudden, and manifestly a 
sequence of primary lesions, in the capillary tissue of the 
brain, attended with congestion, or effusion. Nothing differ- 
ent can be shown in relation to the various paralytic affec- 
tions, unless they arise from local contingencies. 
The agitations in convulsions appear to be produced by 
impressions made at the origins of the motory nerves by the 
capillary arteries. In a large number of cases inspected by 
Dr Sanders, he found the blood vessels of the neurelema, at 
the origins of the motory nerves, highly injected, and mani- 
festing appearances of an active state of vascular incitation. 
The same has been demonstrated by others, whilst no lesion 
of the nerves could otherwise be found. 
It might be supposed that neuralgia would present strong 
claims to some lesions of structure, for little or no vascular 
alterations can be detected in the tissues of the nervous ex- 
pansions, the seat of pain ; except a temporary turgescence 
during the paroxysm. However, even in these cases, some 
pathological changes have been found at the origins of such 
nerves as had been affected with pain, such as vascular tur- 
gescence, and sometimes hypertrophy, or thickening of the 
tunics of nerves. The neuropathic state seems to consist in 
an increased sensibility of the nerves of feeling ; and it is fully 
probable, that this is produced by an active state of incitation 
of the capillary tissue of the neurelema, at the origin of the 
affected nerves. The remedial agents applied in the site of 
their origins go far to prove this ; being such as relieve 
vascular turgescence. 
We frequently discover a morbid sensibility of the nervous 250 
SEATS OF DISEASE. 
tissues of externa] relation, of the nutritive system of nerves, 
and even in tissues destitute of nerves ; and if their sensi- 
bility can be excited to a morbid condition, without any 
capillary turgescence, it seems difficult to discover what those 
causes may be. There is scarcely any pyrectic state that 
can continue but a short time, without an increase of capil- 
lary turgescence, and of course increase of sensibility in all 
the nervous tissues, yet in some parts more than in others. 
The very circumstance of morbid sensibility becomes a cause 
of aggravation of all the phenomena. 
Most of the instances of dysaesthesia, or depravations of 
the functions of the external senses, and the hallucinations 
thence arising, depend on a state of hyperaemia of the vascu- 
lar tissues of the affected organs. The circumstances render- 
ing this state of the capillary tissues so permanent, will here- 
after be attended to. 
In a state of general capillary turgescence, the muscles of 
voluntary motion, very frequently suffer an inability of 
function. This condition has too frequently been esteemed 
a state of debility, and treated as such. The turgid state of 
the vascular tissues of the muscles, where the nerves of mus- 
cular motion are distributed, goes far to occasion this condi- 
tion of inability, by impeding the free exercise of the nervous 
force. But, again, the same state of the capillary tissues in 
the brain, produces the same effect of inducing muscular 
inability ; and also a state of coma, or inability of the intel- 
lectual functions. In these instances, also, we must refer the 
primary changes to exist in the capillary tissue, rather than in 
the nerves of external relation. 
This condition of the morbid economy most commonly ex- 
ists at the commencement of pyrectic diseases ; and along with 
the impaired function of the nerves of volition, the nerves of 
the sense of feeling lose a portion of their function, or have 
it perverted. But, as the capillary turgescence abates, and 
sensibility increases, muscular motion may become very ener- OUTLINES OF PATHOLOGY. 
251 
getic, and the sense of feeling more acute ; so, an exalted 
state of intellect may follow, amounting to delirium. In 
pursuing our illustrations, we have been led into this 
digression. 
The nervous tissues become hypertrophied on some occa- 
sions ; and again, they are affected with atrophy, and ramol- 
issement. All these states prove, that the nutritive capil- 
lary tissue plays an important part, and that the seats of 
disease exist in them rather than in the nervous fibrils. If we 
advert to the instances of insanity, with all the modifications 
of alienation of mind, there is a mass of evidence obtained 
from autopsical inspections to show more derangement of 
organic structure, than of primary changes of the nervous 
tissues. Nevertheless, as these changes of organic structure 
are not to be sufficiently discriminated in the cerebral organs, 
it becomes necessary in a nosographic arrangement, to have 
reference to the phenomena of the deranged functions of the 
intellectual organs, instead of their particular morbid states in 
the tissues. 
Furthermore, there may be states of morbid innervation 
in the cerebral organs, by mere capillary turgescenpe, which 
soon subsides, without leaving traces of structural changes in 
the nervous tissues. And, again, it is an acknowledged fact, 
that severe mental incitations produce a high state of morbid 
innervation, perverting the economy of the intellect as 
severely, as that by diseased capillary turgescence. These 
mental incitations, producing an excess of innervation, seem 
to be merely a stronger impulse of the faculty of thought ; 
and when this happens, by any accident, to affect cerebral 
tissues already in a more than ordinary state of susceptibility, 
all the phenomena of mental alienation may be excited. This 
very condition, again, gives occasion to a capillary turges- 
cence, which, by continuance, may produce structural 
changes. 
We say then laconically, the principal seats of continued 252 
THE MORBID HABIT. 
disease, exist in the involuntary nutritive tissues and organs. 
Not forgetting, however, the intimate connection, and de- 
pendencies of each and every part of the system, by means 
of united nervous tissues, which in health chime together in 
the production of pleasurable sensations ; yet, when pervert- 
ed by disease, these harmonies become dissevered, the body 
and mind experience distress and anguish, and the entire sys- 
tem is involved in universal perturbed action. 
SECTION XVII. 
THE MORBID HABIT. 
1. What is to be understood concerning Universal, or Con- 
stitutional, or General Disease, or the .Morbid Habit ? 
In every scientific investigation, it is necessary to form as 
distinct a conception of the object of inquiry as is possible 
to be obtained. In our present pursuit, we have to examine 
one subject at a time, and each one stands in a certain rela- 
tion to other topics in connection ; and many of these 
we have not yet arrived at. Something, therefore, is neces- 
sary to be taken for granted, until made plain by future illustra- 
tions. 
Disease may be said to be a succession of causes and 
sequences, occurring in the economy of the human system, 
and manifested by a train of phenomena different from 
those Of health. To describe all the phenomena which 
occur, or which may occur, would be going through the whole 
nomenclature of particular diseases. This is not our inten- 
tion in the present section, but only to allude to those which 
indicate a general diseased state, and without reference to OUTLINES OF PATHOLOGY. 
253 
local tendencies, or the peculiar symptoms of individual dis- 
eased states of the system. That such a state may exist is 
very manifest to every observer, especially at the commence- 
ment of disease. 
In order then not to be misunderstood, we may attempt an 
analysis of the common pyrectic habit ; for it has been a 
common received opinion, that fever, in its most extensive 
meaning, consists in an universal affection of the entire sys- 
tem, whether there exists any local affection or not. Cullen, 
in his definition of fever, expressly adds, negatively, " with- 
out any primary local affection." Yet Broussais, on the 
contrary, maintains that all fevers are symptomatic, and ori- 
ginate from lesions done the digestive mucous tissue ; whilst 
Clutterbuck refers the seat of irritations to the membranes of 
the brain. Although we have much in reserve to notice on 
these discrepancies, yet all we contend for now, is, that all 
pathologists agree in the fact of a common constitutional affec- 
tion, let the causes or the precedence of phenomena be what 
they may. 
2. Phenomena of the Pyrectic Habit. 
Almost every disease to which the human system is liable, 
is attended by a train of phenomena, which, by common con- 
sent, is called fever, notwithstanding the phenomena admit of 
numerous modifications. Some prominent symptom may 
give a specific name to the disease, when it is essentially the 
state of fever that ought to be regarded. Yet when disease 
is very manifest in the absence of such prominent symptom, 
the disease is, by common consent, styled fever. Our con- 
stant experience confirms an important sentiment advanced by 
Dr. Southwood Smith ; viz : " Perhaps there is no disease 
so little understood as the ordinary fever of this country, and 
none by the mismanagement of which so much life is 16st."* 
Treatise on Fever, p. 18. 254 
THE MORBID HABIT. 
In most febrile affections, then, we discover an alteration 
of the general aspect, and oftentimes before the subject is 
aware of being diseased. This occurs most emphatically 
in the graver affections, called malignant, as cholera, spotted 
fever, plague, &c. Soon a lassitude is perceived, an inabil- 
ity of muscular motion and of intellect, always most erro- 
neously called debility. Perhaps next in the order of 
succession, a sensation of chilliness in ordinary cases, where 
responding action takes place ; but when not, then perma- 
nent coldness on the surface. There are most commonly 
muscular tremors and rigors, with an internal sensation of 
distress. The pulse becomes more frequent; or, sometimes 
less frequent at the commencement, or tremulous, yet always 
altered. Most commonly there is an increase of heat, yet 
sometimes a diminution ; or heat in some part, with coldness 
in other parts. There may be thirst, or there may be no 
thirst ; an increase or diminution of sweat and urine ; there 
may be vomiting, coma, watchfulness, delirium, or not. 
These phenomena are intended chiefly to designate the first 
stage of the pyrectic habit. They become modified after 
some continuance, more stable, and manifest. 
By this time it will be discovered, that we speak indefi- 
nitely concerning the phenomena, and quite conditionally. 
This will be acknowledged ; and so long as we speak truth 
it must be so. There is not a symptom attending that dis- 
eased condition called fever, in its extensive meaning, but 
what may singly be absent ; and yet this does not disprove 
the fact of its existence. So inconstant are the phenomena 
of fever from different causes, and as affecting different tem- 
peraments,, that no invariable definition could ever be made 
out ; and yet the disease exists, and enough of the pheno- 
mena are always present to convince every physician of the 
reality of the disease, and that it is fever, in the common ac- 
ceptation of the term, however prone they may be to differ 
in other matters. OUTLINES OF PATHOLOGY. 
255 
Most of the phenomena alluded to, fully indicate an uni- 
versal and primary affection of the organs and tissues of the 
entire system ; and the causes are commonly as equally 
extensive. In the instance of coldness in some parts, whilst 
there is heat in other parts of the system, it'should be noticed, 
that the state of coldness is as much indicative of disease, as 
the state of increased heat. But, we cannot at this time 
dwell upon the analysis of symptoms. It must be further 
noted, that in every fever there is a change in the blood ; the 
secretions and excretions are also in correspondence with the 
change in the vital tissues. The blood may be changed in the 
proportion of its constituents ; it may suffer change in its fluid- 
ity ; it may suffer important changes in its crassis ; this may 
be too dense, or too louse. 
3. Phenomena of the Chronic .Morbid, Habit. 
Passing for the present what may be called the acute state 
of disease, we may notice, that every slow or chronic state 
of disease, has a train of phenomena very similar to those of 
the acute or pyrectic kind. All the difference consists in a 
slower accession, and a more obscure state of the phenomena; 
and attended with slower functional and structural changes. 
The phenomena denoting a common morbid habit, are legible 
in every feature of the diseased condition, by those who are 
accurate in discerning, and know how to read them. How 
often do we find chronic disease to be nothing more than a 
modified and protracted state of acute disease ; a mere sequel 
of disease, only half cured by a doubting, temporizing treat- 
ment ; although tardy in its progress, yet sure of its victim ? 
In all the round of chronic diseases there exists a radical mor- 
bid habit, and without reference to their local affections ; and 
these are liable to migrate from tissue to tissue as long as the 
common morbid habit continues ; unless the structure be- 
comes too excessively injured. 256 
THE MORBID HABIT. 
4. Local Affections. 
If there is a single phenomena connected with the morbid 
habit that is always present, sooner or later, it is the exist- 
ence of a local affection of some kind, and in some tissue. 
Whether the local affection is an antecedent, and has a share 
in the production of the morbid habit, or whether it be a se- 
quence, will be considered in the following section, (18.) 
For the present we only say it always exists, and commonly 
very early. The particular disease never assumes a definite 
character, nor a specific name until it is manifested. So if 
fevers, or other diseases of a pyrectic character do not have 
primary local affections, they soon form. However, in some 
chronic cases, and in certain tissues they afford only slight 
indications of their existence. Here it may be remarked, 
that when a general state of disease continues without pain, 
and no essential disturbance of any organ, yet if emaciation 
attends, with an altered pulse, there is great cause of suspi- 
cion of some tissue suffering irreparable injury. So the 
lungs may suffer ; ulcerations may exist in the coats of the 
intestines,; or imposthumations may destroy, unheeded, the 
parenchyma of organs. This arises from the slow progress 
of the disease, the insensibility of the tissues, and the absence 
of pain in not indicating the state of the organ. The decep- 
tive condition, however, may be learned from a vigilant in- 
spection of the constitutional symptoms. 
5. Modified Diatheses. 
The character of the general morbid habit is of vastly more 
importance, in a therapeutical point of view, than that of the 
local affection. This, however, gives indications of the state 
of the morbid habit, and its severity assists in directing the 
amount of remedies. Furthermore, as the location may be 
on different tissues, and of different organic sensibility, so the OUTLINES OF PATHOLOGY. 
257 
reflex action of these tissues, disturbing the united harmonies, 
of the natural economy still further, may, and do modify the 
common morbid habit. This, in connection with the speci- 
fic impulses of the antecedent causes, lays the foundation for 
establishing the different diatheses, so called, and which are 
very manifest. 
So we discover a particular state, condition, or diathesis, 
called the sthenic or asthenic, phlogistic or typhoid, &c. 
So again, in protracted, or chronic diseases, there are dis- 
tinctive shades. We appreciate the scrofulous, the cancer- 
ous, the phthisical, the hydropic diathesis, &c. These are 
pathological distinctions arising from physiological conditions, 
and cannot be gainsayed by sophistical inuendos. They can 
only be considered as mere modifications of the morbid habit. 
In all these instances there is a primary constitutional, diseas- 
ed condition ; modified, however, by the cause of the partic- 
ular disease, by the temperament of the patient, and the sus- 
ceptibility of the tissue locally affected. 
Although it is very difficult to form a definition of the com- 
mon morbid habit, or of fever generally ; yet, as wb descend 
to specifications, we find more stability of character, and 
more permanent series of phenomena to discriminate, as in 
the instance of the diatheses. By proceeding further, and 
viewing diseases of particular locations, they assume more of 
a defined character, and admit of very constant definitions. 
Thus, a quotidian ague, pleurisy, and dysentery can be dis- 
tinctively defined, notwithstanding the diathesis in each of 
them admits of important modifications in different instances. 258 
STHENIA AND ASTHENIA. 
SECTION XVIII. 
STHENIA AND ASTHENIA 
1. How ought we to appreciate the different States of the Sys- 
tem in Disease, often styled Sthenia and Asthenia, Dyna- 
mia and Adynamia, Tonicity and Atony, or Strength and 
Debility ? 
So much labor in medical science has been for ages lost ; 
and being well aware if our own investigations are not rightly 
conducted, they will be entombed in the common vault of 
oblivion, we are determined to step with a mother's caution, 
and weave every thread with feelings of high responsibility. 
The conclusions of a medical attendant bear a close resem- 
blance to an award on life and death. As a man thinketh so 
is he ; and indeed, whether right or wrong, as an honest 
man's creed is, so will his conduct be. 0 ! Thou Good 
Supreme, teach us aright! 
2. Prefatory Notices. 
The terms in the interrogatory appear to be synonyms, 
with their opposites ; and they have been used to express 
opposite diseased states, when they express nothing but dif- 
ferent physiological states of the system, and cannot, but 
very arbitrarily, apply to the pathological state. However, 
we may at present review them after the manner they have 
been used. It might here be remarked, that the phenomena 
of disease are often quite imposing, and liable to deceive, and 
many have been deceived. An excess of tonicity in animal 
tissues becomes a pathological condition, and Very often di- 
minishes vital energy, producing an inability of function. 
Although the terms may be considered as sufficiently ex- 
pressive of two opposite states of the diseased economy, yet OUTLINES OF PATHOLOGY. 
259 
what, or how far has the former, denoting strength, been ap- 
preciated, used, or applied in the ordinary states of disease, 
so as to insure practical utility? It appears, that these terms 
have been brought into use by the ingenuity of that class of 
pathologists, who have been called solidists, and who have, 
for about half a century or more past, been the expositors of 
the laws of the morbid habit. This in itself would have been 
justifiable, had they amplified and extended the boundaries of 
correct pathology. But, what has been the result ? Although 
they set out on a more favored thesis, all mankind are pre- 
sented with overwhelming evidence of a deterioration of prac- 
tical results. 
The former physicians, or the humoralists, were intent on 
the expulsion of peccant humors, and with this view they bled, 
vomited, purged, sweat, &c., when they did anything. By 
such treatment they relieved the condition of hypereemia, so 
often apparent in disease ; and at the same time did much to 
relieve the rigid state of tissues, which is commonly so appa- 
rent also, that it seems incredible it should escape detection 
by any tyro of the profession. 
Although a superficial view, as well as a close inspection, 
shows a state of morbid tonicity to exist in by far the greatest 
proportion of diseases, especially those of the graver kinds ; 
yet, so it has fallen out, that the weaker has overpowered the 
stronger, and meagre debility been transformed.to a giant, in 
imagination. Every enthralment of organs, by a state of mor- 
bid rigidity, and congestion, or infarction of blood, producing 
an inability of function, has been construed, in theory, as some 
condition of potent debility ; and remedies consistent with the 
error, applied, however injurious. The causes debilitating, 
the effect debility, the treatment adequate stimulation ! 
Notwithstanding a large proportion of practitioners have re- 
volted at the results of the tonic, and incendiary treatment, in 
accordance with such sentiments, and in a great measure 
abandoned it; yet the creed remains, and most of the medi- 260 
STHENIA AND ASTHENIA. 
cal journals abound, more or less, in expositions on the prin- 
ciples of atony, and medical halls yet reverberate the echo. 
Is it not time a redeeming spirit was infused into the minds of 
honest students, to guide them in the courses of truth, and 
rescue them from errors as fatal as the pestilence itself? 
3. Recapitulation of some Modern Pathological Doctrines. 
Setting aside certain notions which a few still advocate, that 
all diseases have their primary seats in the fluids ; it may be 
said, that the prevailing sentiments or theories in relation to 
the causes, seats, and character of disease, especially fever, 
may be reduced to two ; and even these consist of direct con- 
traries, and it might be said inconsistencies, in part at least. 
One of these was introduced by Dr Cullen, and followed 
up by Brown and Rush, with some modifications. This the- 
sis avers, that the causes of disease (fever) are of a sedative 
nature; that they firstly impress the brain, and quickly the 
whole system, and that they diminish the vital energies, leav- 
ing a universal state of debility. Also, at the same time a 
spasm is somehow formed on the surface ; that this provokes 
the recuperative powers of nature, and a conflict arises, and 
in this strife the elevated phenomena of fever are developed. 
Local affections are soon formed, but none existed at the on- 
set. 
We might accord in the view of a general impression af- 
fecting the vital susceptibility ; but, not that the causes are 
sedative, nor that a state of debility is induced. Again, a 
state of spasm incontrovertibly implies a state of rigidity, or 
tonicity, or fixity. A state of debility, or the reverse,, must 
have reference to a state of weakness, of languor, and of lax- 
ity. How these different states can exist at the same time, 
in the same tissues, from the same cause ; or, indeed, how 
one can produce the other, is quite paradoxical, and becomes 
a solecism that needs no reply. Dr Cullen's views of the OUTLINES OF PATHOLOGY. 
261 
causes of disease were very loose and undecided ; but, his 
treatment was less exceptionable than his theory ; for, in 
adapting it to the contingencies of particular cases, the phe- 
nomena and stages of disease, he was compelled to go adverse 
to his theory, and use debilitating remedies. He was so far 
inconsistent, but honest. 
Dr Brown adopted the same views of the debilitating na- 
ture of the causes ; of disease consisting of a state of debility, 
and without primary local affection. He amplified the theory, 
and his treatment was in accordance with it; and so far as he 
was consistent with himself, just so far was his treatment the 
more pernicious. He found a few exceptions ; but, nineteen 
cases in twenty must be stimulated until the process of de- 
bility was subdued ; and if the excitability of the nervous sys- 
tem should become almost worn out, the doses must be quad- 
rupled or so, instead of giving it time to recruit by rest. 
It is rather derogatory to the character of medical science, 
and its guardians, that this deceptive, yet enticing theory 
should so easily fascinate the minds of more than half the civ- 
ilized world, at the close of the last century. However, the 
mental excitability is so far now exhausted in this country, 
that it will take more than the double proof spirit of Yates 
and Maclean to restore it.* 
The sentiments of the yet lamented Dr Rush, were in ac- 
cordance with the others, respecting the sedative nature of the 
causes, that disease was general in the system at the onset, 
and that the whole system suffered a state of debility. So 
far his practice would have been altogether inconsistent with 
his theory, had he not been convinced, by a kind of reason- 
ing satisfactory to himself, no doubt, that this very condition 
of debility produced eventually a state of energy in the entire 
economy, as was abundantly shown to exist by the phenome- 
na, and surely well proved by his treatment. As the pheno- 
* Authors of a book called " The Science of Life, and Ultra-Exciters." 262 
STHENIA AND ASTHENIA. 
mena indicated a state of sthenia, so he met them with effi- 
cient asthenic remedies. We might say, his treatment was 
correct, whilst his theory, in part, was hypothetical.* 
The other theory alluded to maintains, that all fevers, and 
indeed all diseases originate from local irritations, primarily 
excited in some tissues, or organs, by local causes ; and that 
the nervous system is the medium of radiating similar influen- 
ces over the entire system, and thence producing the pheno- 
mena of fever, which they call symptomatic. Whilst one 
insists that the primary seat of local irritation is in the head 
very uniformly, another as often refers it to the entero-gastric 
mucous tissue ; and again, another to the heart and arteries, 
&c. Considering our present thesis is confined to the condi- 
tions of tonicity and debility, as constituting an essential fea- 
ture in the character of the morbid habit, we shall defer any 
strictures on this theory at this time, and notice it in a future 
section, whilst on the subject of general and local affections. 
4. On the Mosodynamic State of the Morbid Habit. 
There is a poverty of medical language to suit the present 
state of improvement, although it is overloaded with a bur- 
thensome technology. The medical nomenclatures will ere 
long require revision, as has already been done in chemistry. 
We shall, however studiously avoid much of this ; yet, when 
we can find no term to convey an idea intelligibly, we must 
try to make out one. There has been no way, but by cir- 
cumlocution, to express the intrinsic condition of the morbid 
state ; nor has it ever been very successfully attempted in any 
manner. Sthenia, dynamia, tonicity, innervation, strength, 
as well as their opposites, are all mere expressions of physi- 
* Whilst being well protected by the mantle of charity, we freely say, if 
these remarks possess any shades of severity, the necessity of the case has 
elicited them. At the same time, we award a large share of merit, for the 
good these laborers in the field of science have done the profession. Whilst 
we respect characters, we must be free with principles. OUTLINES OF PATHOLOGY. 
263 
ological conditions ; the former do not even express an in- 
crease of strength ; yet, perhaps it has commonly been im- 
plied. 
5. Definitions. 
The term nosodynamia might be used to express diseased 
or morbid strength, from nosos and dunamis. For this pur- 
pose it will be employed at present, and synonymous with 
morbid tonicity. The word debility ought to be stricken out 
of medical language. It has been too loosely, and too exten- 
sively used ; it is not sufficiently definite, and its use has been 
insufferably abused. The term is as loose as that of liver com- 
plaint ; a sort of catch-all. In the instance of apoplexy, for 
example, it would be very improper to say, the muscles are 
in a state of debility. This is not expressive of the fact, they 
rather suffer an inability of function. So of every tissue, and 
organ whilst suffering a state of paresis. To express a soft, 
loose, flabby condition, the word laxity might be used. For 
emptiness, or draining off, exhaustion might be employed ; and 
when applied to the vital force, enervation is quite appropriate. 
6. Disease is not Debility ; neither is Debility Disease. 
The word debility has been used to express a mere ima- 
ginary state of disease, and which can be shown to exist 
only by erroneous notions of the morbid habit. In all the 
instances of prostration of strength in acute, and even chronic 
disease, unconnected with extreme vascular exhaustion, there 
will be high or elevated phenomena, as soon as the enthral- 
ments are removed, which embarrass the vital energy and 
play of the organism. There is latent strength enough, and 
too much ; this is manifested as soon as the embarrassments 
are removed. Perhaps ten minutes before the most extreme 
prostration, the subject was in his full vigor of strength. The 
phenomena of disease evince energy as soon as the tissual em- 
barrassments are removed. 264 
STHENIA AND ASTHENIA. 
7. Remarks on the Primary Changes in Disease. 
Many of the common causes of disease may impress the 
system, excite some momentary commotion, and yet not pro- 
duce disease. So fatigue, although carried to excess, does 
not always excite disease : neither does debauchery, nor 
watching, nor the most racking tortures of the inquisition, nor 
even extreme exposures to heat and cold. We can dwell on 
etiology, only for illustration. But, suppose three persons to 
be exposed to great fatigue, cold and moisture ; yet only one 
of them may be made sick, attended with chills, inability of 
functions, followed by throbbings and fever, along with deter- 
minations to the joints, or to the throat, for instance. The 
inquiry is, what circumstances stand in relation with this case, 
which do not exist in the others ? There is an evident change 
producing now what may be called the morbid habit. 
The answer must be very obvious, as elicited by all the 
phenomena ; that an extensive change has occurred in all the 
intimate tissues ; not only on the surface, but in the tissues of 
the internal cavities, and even in the tegumentary tissues, of- 
tentimes. The character of this change will be explained as 
we proceed. It is this change, whatever may be its charac- 
ter, which constitutes disease, and there will be no disease 
without it. It is of a persistive nosodynamic character in it- 
self ; or, it might be said, it is the property of the vital tis- 
sues to remain in this morbid condition an indefinite length of 
time, until some active exciting impulses remove it; or until 
the physiological derangements destroy the integrity of the 
organization, and expel the vital influences. So most dis- 
eases have some continuance. They may be prolonged by 
bad treatment, shortened by correct treatment; the notions 
about self-limited disease to the contrary notwithstanding. A 
favorable state of predisposition, and various collateral cir- 
cumstances protected the others from contracting similar mor- 
bid changes. OUTLINES OF PATHOLOGY. 
265 
This change in some of the vital tissues may continue a 
long time, and not destroy life. Notice the whole catalogue 
of protracted diseases ; and yet recoverable, if the sequences 
have not, by long continuance, too greatly injured the tissues. 
Sometimes this morbid condition of tissues is suddenly re- 
moved. Notice the instances of the reports of authors, of the 
sudden cure of fever, of gout, and even of phthisis pulmona- 
lis, by terror, excited by some violent mental or corporeal im- 
pression, or both together, as of falling into cold water, ship- 
wreck, earthquakes, &c. In all these instances, the thrilling 
excitations which pass to the most intimate tissues, agitate the 
capillaries of the returning or centripetal circulation to a more 
perfect exercise of their function. They now act more en- 
ergetically, being roused from their state of paresis. . The 
impetus given to the vital susceptibility, serves to continue 
the now excited circulation ; the natural absorptions become 
restored, and the congestive condition soon removed ; the 
physiological processes now proceed as in health, the primary 
derangements being removed. 
8. Illustrative Cases. 
Let us notice a few short cases in illustration. A man, 
frequently subject to epilepsy, was riding in a single wagon 
with his wife, and as they were descending a hill, he was at- 
tacked with a paroxysm, and at the same moment lost the 
reins. His horse ran violently more than half a mile ; the 
agitation was great over a rough road, besides that of the fit ; 
the result was, he was free from injury, and he was ever after 
free from the disease. 
A woman had been insane fifteen years. One night she 
secretly left her bed and husband, and travelled about fifty 
rods to a small pond, and plunged in with a view to commit 
suicide, as she afterwards confessed. She was no sooner un- 
der water, than she wished herself out, and by a great effort, 266 
STHENIA AND ASTHENIA. 
did get out, and go home highly drenched, and perfectly sane. 
She had some febrile excitement for about two weeks, yet was 
sane, and has so remained for twelve years. 
Another woman was made insane by the terror of her house 
being in flames, and it was burned down. So she remained 
ten years ; during which time her husband and family removed 
to another state; and after a while this house burned down 
also ; and from that time she has remained sane. In the 12th 
volume of the New England Journal, is a case of dropsy sud- 
denly removed by fear ; reported by Dr S. W. Williams- 
Many are the instances of the severest forms of acute dis- 
eases, being entirely or essentially removed in twentyfour 
hours, by a co-operation of well adapted remedies, at an early 
stage especially. That particular, or preternatural-state of 
the intimate tissues, or basis of the morbid habit, must be al- 
tered or removed, before there can be a return of physiologi- 
cal actions. Disease will continue until this is effected. 
In disease the functions of the most intimate tissues are 
embarrassed more or less, and so continue until a change by 
some universal influence relieves them. In mild cases the 
physiological efforts often restore themselves; yet, in others 
certain universal excitations become necessary to be brought 
about, either by strong agitations of mind impressing the or- 
ganism, or by certain remedial agents, which restore the ca- 
pillary circulation of the nutritive tissues. See Sec. xlix. 2. f. 
9. Summary Remark. 
We freely accord in the sentiment of the causes of dis- 
ease making an impression extensively on the vital tissues, 
and that the whole system is primarily affected, as we shall 
probably show in the next section ; and also, that the local 
affections are of a secondary, and dependent kind, or receive 
their chief importance from the morbid habit. But, that the 
causes are of a sedative kind, and that they leave what has OUTLINES OF PATHOLOGY. 
267 
been styled a state of debility in the tissues, must be denied. 
That the reverse condition does actually exist, we shall now 
attempt to prove. 
THESIS ADVANCED. 
10. In every preternatural condition of diseased action, of an 
active and permanent kind, there exists a state of nosody- 
namia throughout all the tissues, and even whilst there 
may accompany it, a very considerable degree of exhaus- 
tion, and occasional inability of organic function. 
If this thesis should appear to some as untenable, it is ex- 
pected a little reflection will make it familiar. We shall illus- 
trate it- 
1st. By the causes of disease. 
2d. By the phenomena. 
3d. By the most useful treatment. 
4th. By the collateral circumstances in connection with 
the nosodynamic state. 
We have not much time to waste in bestowing strictures 
on proffered dogmas, advanced by many ; such as, " the ex- 
istence of a law, by virtue of which the power presiding 
over life reacts against debilitating causes.* Or as follows, 
" Debility, as often constituting what is, in the common lan- 
guage of medicine, disease itself. "f Neither the following, 
as well as many others ;-" That debility is in general the 
first link of febrile action is undoubted, but the connection 
it has with the subsequent phenomena is yet unexplained."^: 
These notions will be left as they are, to be supported by 
their own advocates. 
* M. Broussais' Phys, and Path. p. 45. 
f Dr J. Copland's Diet. Pract. Med. as referred to in Amer. Jour, of 
Med. Science, Vol. xv. p. 212. 
t Barton's Cullen, p. 257, notes. 268 
STHENIA AND ASTHENIA. 
11. 1st, The Causes of Disease afford inordinate excitations 
to Vital Tissues. 
It may be said, and with some correctness, that every sub- 
stance in nature coming in contact with vital tissues, are ex- 
citants, or stimulants. Some of these may be compatible 
with the healthy condition of living tissues, and actually sup- 
port and nourish them ; others may be too insipid to afford 
sufficient excitation ; and, again, others are too severe, afford 
too much stimulation, and disturb the harmonious economy 
of the system, and in excess, or combination, may even 
paralyze the functions of organs. These last are the agents 
which may be called the causes of disordered action, and lay 
the basis of the morbid habit. 
We cannot as yet enter upon the department of etiology, 
but only make some assumptions to be hereafter illus- 
trated. It appears that some pathologists agree in the sen- 
timent, that the imputed causes of disease are of an ex- 
citing and tonic character. We shall assert them to be in- 
compatible excitants ; and, that they impress the vital tissues 
in a manner so as to alter their functions, and together with 
an increase of organic sensibility and energy, induce a new 
train of phenomena, as the tokens of suffering organs. 
The principal part of the reputed causes of disease are, 
the various kinds of contagions, and the virus of the infec- 
tious diseases ; the supposed miasmatic gases, or malaria ; 
opium, stramonium, and the whole tribe of narcotics ; arse- 
nic, mercury, the oxides of lead, and many other mineral 
poisons ; incompatible degrees of heat and cold, especially 
sudden alternations ; large proportions of nutriment, especially 
of much flesh meats and condiments ; alcoholic drinks of 
every kind ; whatever greatly excites thought, as mani- 
fested by the emotions ; wounds and contusions in combina- 
tion with other causes, &c. In any considerable degree, and 
especially in certain combinations, these all become incom- 
patible excitants. OUTLINES OF PATHOLOGY. 
269 
The above either increase the volume of fluids, or produce a 
tonic oscillatory motion of tissues. In a moderate degree, and 
applied singly they may produce a mild state of excitation, 
called predisposition to disease. Largely applied, and often 
in combination, they suddenly exhaust the vital force, and 
induce an alarming assemblage of phenomena. Opium and 
alcohol may produce coma, and death ;-a man has been 
known to be instantly killed by drinking a pint of rum ; 
another by swallowing a wine glass of oil of spearmint. So, 
the causes of disease produce the alarming phenomena, which 
never fail to be manifested with equal severity in all severe 
epidemic diseases, and without losing their specific, exciting 
characters. In small quantities they excite the tissues ; in 
large quantities they exhaust the vital susceptibility, and in- 
duce a morbidly tonic state of the tissues, with exhaustion 
of vital force. When the recuperative powers of the sys- 
tem become rallied, there arises an elevated train of morbid 
phenomena. 
12. Qdly, The Phenomena of Disease indicate an Increase of 
Tonicity in the Tissues ; or the State of Nosodynamia. 
The very incipient signs of disease often show this ; such 
as shrivelling of the skin, the papillae anserinse ; also, paleness, 
from a condensed state of the dermoid tissue. The same 
condition exists in the internal tissues, and the capillary ves- 
sels every where compress their fluids, producing a relative 
plethora. The nosodynamic state may constringe the capil- 
lary exhalants and absorbents, so that they do not act, and 
blood accumulates in the venous radicles and nutrient tissues, 
producing a congestive state. This pathological fact is only 
announced here; it will be illustrated in its place. Sometimes 
the exhalants are not so far constringed, and the internal vas- 
cular force drives out a large proportion of the matter of ex- 
halation ; as takes place in excessive sweatings, and on the 270 
PROOFS OF NOSODYNAMIA. 
mucous tissue of the digestive tube in diarrhoe, cholera, &c. 
All these embarrassments provoke the instinctive suscepti- 
bility in a manner to produce inordinate action ; or, the im- 
press may be so severe as to paralyze, and produce a paresis 
of organs, or inability of function ; and even death. 
If the recuperative powers prevail, as is most commonly 
the fact, there is manifested an exalted train of phenomena ; 
such as an increased force of cardiac and capillary action, 
heat, pain, &c. In these perturbed movements, there must 
be more or less of an exhaustion of vital force, and there may 
be an exhaustion of fluids ; yet, still the labor of the heart, 
arteries, and other organs will continue more or less forcible, 
so long as the nosodynamic state continues, or the vital sus- 
ceptibility of tissues becomes exhausted, and a fatal termina- 
tion ultimately follows. 
We discover in the functions of the organs of external re- 
lation, an elevated state of intellect, and increased energy of 
muscular power, provided the organs are free to act, and not 
held in rigid durance by a contraction of tissue, with a con- 
gestion of fluids, as often exists in the first stage. The 
whole range of semiotice might be canvassed, and it would 
only serve to multiply the proofs. 
13. 3dly, " The successful method of treatment, shows the 
nature of the disease." (Hippocrates, and all antiquity.) 
The mystery of debility will dissipate like a fog before 
sunshine, as soon as a distinction is made between it, and a 
state of inability of function from a nosodynamic state. We 
may now recapitulate some of the leading remedies adapted 
to the alteration, and removal of the diseased state, and com- 
pare whether they do not indicate a state of increased ton- 
icity. 
a. Warm Bathings.-These relax the tissues, and pro- 
mote both exhalation and absorption. Water is an agreeable OUTLINES OF PATHOLOGY. 
271 
emollient, and caloric the most natural excitant to promote 
capillary action, and secretion. 
b. Cathartics.-These not only diminish the contents of 
the first passages, but the whole of the vascular tissues. 
They always enervate a well person. 
c. Emetics.-Vomiting is often a part of the responding 
and recuperative processes, and well adapted to elicit uniform 
action in the system, and restore absorption, secretion, &c., 
and yet it enervates, and thereby relieves pains and spasms. 
It always exhausts a well person, although the sick will en- 
dure it. Its use in relaxing the tissues in luxations, and par- 
turition, is proof that it relieves the state of nosodynamia in 
fevers. Although often used to promote sweats, it must first 
relax the rigid state of the tissues. The beneficial effects of 
tartarized antimony, in diminishing the vibratory action of the 
heart and arteries, and promoting action in capillary tissues, 
have continued it in extensive use for about two centuries. 
d. Blood-letting.-This in a well subject is always ener- 
vating, or weakening, when used to any considerable amount. 
Yet, in disease it is often invigorating, by removing the con- 
ditions of the nosodynamia. All will accord in the sentiment 
ol its beneficial use in a high, free and expanded state of arte- 
rial action ; and yet, there is not so great a weight of disease 
in such a state, as there is in some other conditions of dis- 
ease, where the powers of the vital movements are constrain- 
ed and smothered, and existing merely in an enthralled, and 
latent state. The testimony of a great many practitioners 
might be adduced to show the utility of blood-letting in such 
conditions ; and its utility arises from relaxing the nosody- 
namic state. There are some, however, frail enough to 
argue, that the causes of disease are debilitating, that the 
tissues are debilitated, and that debility itself is the disease, 
and insist toughly, that blood-letting in its direct influence is 
invigorating, and therefore bleed to remove debility ! 
In some conditions of disease of the less severe grades, 272 
PROOFS OF NOSODYNAMIA. 
the recuperative powers of the system quickly arise in energy 
on the abstraction of blood, and quickly exhibit a distinct 
dynamic force. The absorption of congestions soon becomes 
active in such cases. Yet, again, in cases of greater severity 
of morbid impression, the absorptions are more tardy, and dif- 
ficult to be excited. Taking of blood in such cases is liable 
to further prostrate the recuperative energy, if done hastily, 
or in excess, and the whole system suffers a still greater di- 
minution of energy. In such cases detractions of blood 
should be slowly and carefully made, together with other ad- 
juvants to excite absorption in the intimate tissues, or other- 
wise it may be injurious. It ought not to be practised very 
early, nor profusely, until the responding forces have time to 
become excited, or begin to make efforts. 
e. Sudoresis.-The leading object in the treatment of dis- 
ease in general, is, to restore the absorptions, exhalations, 
and secretions ; or, in other words, the natural activity of the 
capillary tissues. So, as an adjuvant, commonly after blood- 
letting, recourse is had to the process of sweating. Although 
of itself it may remove tnany mild conditions of disease, yet 
not severe cases. This is a relaxing process, and whilst it 
has the effect of restoring the inability of functions in organs, 
and tissues, it increases calorification, and natural strength in 
the whole system, if rightly conducted. 
14. ithly, Illustration by collateral circumstances in connec- 
tion with the Nosodynamic State. 
Probably enough has been advanced to show, that morbid 
strength exists in most conditions of disease ; if not, we 
might add the appearances discovered in the traces of disease ; 
such as, the effusions on the surfaces of tissues, and in the 
substance of organs. These are of various kinds, as fibrin, 
serum, blood, albumen, and various mixtures compounded of 
them. They demonstrate a state of inordinate vascular ac- OUTLINES OF PATHOLOGY 
273 
tion, without a single proof that they ever occur as a sequence 
of enfeebled vascular propulsion, during life. 
Let this morbid condition of the system be produced by 
whatever cause it may be, yet it preserves a very similar 
character, admitting however certain modifications, which we 
cannot notice here any further than to say, that it is some- 
times attended with serous exhalations of tissues, but most 
commonly with a dry, rigid state of them. Cullen discerned 
it through a fog, when he thought he discovered a spasm on 
the surface ; but it exists in all the capillary tissues. It has 
not precisely the character of the tonic spasm. There must 
always be an antecedent morbid state to produce spasm, and 
as soon as this is removed spasm ceases, and often before. 
Spasm may be accompanied by, or transformed into fever ; 
it is only a phenomenon of the morbid habit, like convulsion. 
This morbid state accumulates slowly in many forms of dis- 
ease, especially the chronic. 
The continuance of the nosodynamic state, is one charac- 
teristic to distinguish it from spasm. Indeed traces of it 
may be found after apparent death. The constrained, rigid, 
and contracted state of the surface before death, and the con- 
tractions of the intestines, and of the common biliary duct, 
after death in cholera, may be considered as the effect of this 
condition, as well as the muscular rigidity so common in oth- 
er diseases ; all which phenomena continue as long as there 
may be any remains of vegetable life. Intussusceptions, also, 
in many states of disease, as well as priapism after apparent 
death, might be mentioned. 
We cannot bring analogies from any bodies in nature be- 
sides, to illustrate the phenomena of organization, either in 
health or disease. We say then, the nosodynamic state is 
peculiar to animal tissues, that it is produced by noxious 
agents, that it remains until removed by the recuperative pow- 
ers of the system, or by certain appropriate remedies, or until 
the sequences have destroyed the integrity of the organism. 274 
ADYNAMIA. 
SECTION XIX. 
ADYNAMIA. 
1. On the Mynamic, or Subtonic State of the System in 
Disease, and on Enervation. 
It appears necessary to bestow some attention to the ad- 
verse conditions of the system in this place.. 
The above terms seem to have been used oftentimes syn- 
onymously, although, strictly speaking, they are of different 
import. Whilst adynamia implies want of strength generally, 
enervation has reference to a deficiency of nervous force. 
Subtonic has reference rather to the laxity of the tissues, 
and appertains to the phlegmatic temperament. However, 
in relation to the present subject, these, as well as atony, may 
be reviewed in connection. 
2. On the Movable Temperament. 
That these conditions do actually exist, and on many occa- 
sions become very manifest and perplexing, will readily be 
granted ; but how far they have an agency in the formation of 
primary disease, will be the subject of inquiry. An habitual, 
relaxed, enervated, and movable temperament may give 
occasion, or liability, to become more easily impressed, by 
many of the common causes of disease, than other more sta- 
ble habits ; but, of itself can hardly be said to constitute dis- 
ease. We notice many of these temperaments enjoying 
quite easy health,-although as it were in a small circle. When 
they become affected by any cause, and have their natural 
economy disturbed, they are liable to exhibit a modified, and 
eccentric train of the phenomena of disease. But, notwith- 
standing this, the general character of the morbid condition is 
very much the same, but yet modified. Thus, when pneu- OUTLINES OF PATHOLOGY. 
275 
monia, typhus fever, or measles prevail epidemically, these 
subjects are impressed with a morbid habit similar to others, 
but are yet liable to many anomalous or nervous symptoms. 
A less amount of morbid tonicity exists. 
3. Deficiency of Vital Force. 
Again, in all subjects, especially the movable, who become 
affected in the time of the spreading of epidemic diseases', 
we discover oftentimes, extreme variations of the vital ener- 
gy. At certain times they may be affected with syncope ; 
at the onset of disease there may occasionally be a low train 
of phenomena, evincing a state of enervation, or adynamia. 
Still there is a general morbid habit, and it will show itself in 
the phenomena of responding action of less severity, as soon as 
the energies of the system become elicited. These sinkings 
as they are often called, or fugitive, anomalous symptoms, are 
not the disease ; they only manifest different states of the ner- 
vous force, in the process of responding action, and as labor- 
ing under derangements connected with the common morbid 
habit. These anomalies sometimes appear in the most robust, 
sanguine temperaments. 
During the progress of fevers, especially those of a low 
grade of action, the phenomena of enervation are liable to 
occur on rising, and sitting up ; or when there has been a lit- 
tle exposure to cool air, or want of some suitable refresh- 
ment. The whole of the vital force may be lost at such 
times, and death suddenly follow. If cordials, or stimuli are 
freely given at such times of depression, although often 
necessary, the phenomena of the morbid habit will be far 
more elevated on the return of vital energy, and a free circu- 
lation. The same at the onset of disease with a feeble pulse, 
and low train of symptoms ; if much stimuli are exhibited, 
the subsequent phenomena will be more intense, unless so 
much is used as to exhaust the impressibility of the system, 276 
ADYNAMIA. 
and death follows. In all these instances there exists a noso- 
dynamic state. 
The term sedation has been used by some to express the 
deficiency of both muscular power, and the diminution of or- 
ganic force in syncope, as well as lighter faintness. It can 
scarcely mean anything different from enervation. These 
are common phenomena in disease, often arising from unequal 
excitation. These phenomena are not peculiar to feeble sub- 
tonic habits, but are often present in the robust. They 
are most frequent in malignant diseases. Excess of stim- 
ulation may suddenly be followed by sedation, whilst gen- 
eral disease is present; it may be viewed as an accidental 
symptom. Yet, there are states of disease both acute and 
chronic, which require some mild tonics and stimulants, espe- 
cially when directed to promote capillary circulation. Not- 
withstanding, so long as there remains a frequent pulse, with 
distress and general weakness, the primary cause of the dis- 
ease has not been removed, and such treatment should be 
used with great reserve. 
In the instance of a deficiency of red blood from hemor- 
rhage, or very poor diet, as also from constitutional inability, 
the subjects are liable to contract a morbid habit, and the 
phenomena indicate a slate of irritative excitation, rather than 
a definite phlogistic diathesis. These cases may be very 
severe, and terminate in death, as Dr M. Hall has shown of 
the order of diseases he calls mimoses ; and also, as M. An- 
dral has illustrated of the state of anaemia ; and yet in the post 
mortem examinations, little or no organic lesions are found. 
In all these cases, it is not the deficiency in the quantity of 
blood that excites disease, nor indeed the defect of red blood, 
and gluten, nor the state of debility so called. However, 
these subjects are more exposed to the ordinary causes of 
disease, and a morbid habit is liable to be formed. The phe- 
nomena of this morbid habit are considerably different from 
those manifested in full, sanguine temperaments. There OUTLINES OF PATHOLOGY. 
277 
constantly arises a state of increased organic sensibility, and 
again the sensibility of external relation is augmented. As 
the morbid habit forms, there will be local determinations to 
some organ, or apparatus of organs, simulating inflammation : 
at the same time a train of fugitive, nervous phenomena, 
which are very distressing, and serve to engross the whole 
attention of the patient, if not delirous, and liable to mislead 
the medical attendant. The low grade of organic movements 
seems to indicate a state that requires the exhibition of tonics, 
and stimulants ; but, whilst a general morbid habit exists, 
they only aggravate the disease, however useful they might 
have been before the accession of the diseased state. 
On the inspection of the organs of those who are destroyed 
by such affections, the usual traits of inflammation are not 
found. An organ which had manifested severe phenomena 
during life, may show but little derangement; no infiltrations, 
no exudations on the surface, or even vascular congestions. 
The crasis of the blood had not been sufficient in density, from 
the deficiency of red blood and lymph, to produce these ef- 
fects, although the organ may have been surcharged and dis- 
tended. Yet, as no infiltrations had taken place, the vascular 
distention is directly absorbed as soon as life ceases, and the 
vital tonicity has subsided. There may be some serous ac- 
cumulations in cavities, and something more, in certain grades, 
but nothing to verify the existence of a real phlogistic diathe 
sis. 
Notwithstanding all this, there had existed a nosodynamic 
state of disease, with very unequal distribution of circulating 
fluids, with a constant tendency to anaemia of the surface, and 
hyperaemia of the internal tissues ; coldness of the skin, and 
internal heat. In all these instances, the system may be suf- 
fering ravages both in the form of acute and chronic disease ; 
and whilst laboring under disease in the chronic form, is lia- 
ble to more severe attacks in the acute form, and suddenly 
to prove fatal. A severe local determination may concentrate 278 
ADYNAMIA. 
in the head, the thorax, the abdomen, or even the muscular 
tissues, deranging, or destroying their functions. 
As we are treating on an order of diseases, rather than any 
particular habit of disease, so our remarks must be very gen- 
eral. In the way of further illustration, it may be noticed ; 
that, although a marked nosodynamic state of tissues exists, 
there is but little opportunity to meet and remove it by the 
common debilitating remedies ; and again, it can but rarely 
be removed by direct stimulants and tonics. 
The indications are, to establish an equal circulation through- 
out the entire system, by restoring the exhaling and absorbing 
processes, thereby removing the internal hypersemia to the 
surface, and relieving the nutritive ganglia. This may be ef- 
fected by caloric in the form of the tepid bath, by mild steam, 
rubefacients, frictions, &c. At the same time such internal 
stimuli should be exhibited, as are of a fugitive kind, and 
directed to promote exhalation on the surface, and internal 
secretion ; carefully avoiding the whole tribe of narcotics. 
As such subjects often have some desire for food, panadas, 
warm broths, or beef tea, &c., are often beneficial. Perspi- 
ration with mild laxatives, commonly remove the morbid habit. 
When this is effected, as may be known by the subsidence of 
the pulse, return of sleep, and equal circulation, recourse may 
be had to carbonate of iron, and other tonics to some advan- 
tage ; as they might have been used to insure some stability 
of organic action before the access of the morbid habit. 
Subjects who have lost large quantities of blood, and show 
an appearance of extreme anaemia and exhaustion, are never- 
theless free from disease, and may soon recruit. So, also, 
at the close of severe fever, attended by great exhaustion, the 
restoration will be sudden and complete, provided the morbid 
habit be radically removed. Common nutriments are usually 
3. Mere loss of Fluids does not excite Disease. OUTLINES OF PATHOLOGY. 
279 
sufficient for this purpose, without the aid of tonic and stimu- 
lant medicines. So the state of debility, as it has been called, 
does not produce disease, but only gives occasion to its more 
ready access. 
4. Subtonic State in Periodical Affections. 
However, there are certain states of the system having a 
mild, yet sometimes a severe morbid habit, in which there is 
a periodical return of paroxysms. Examples of this may be 
cited in the instance of intermitting fever, and periodical epi- 
lepsy. These paroxysms cannot be intercepted by stimu- 
lants, so long as the general morbid habit continues of much 
force. If exhibited for this purpose in this condition, the 
disease assumes a continued form, with elevated phenomena. 
Yet as soon as the morbid habit is removed, and if the pa- 
roxysms continue, then tonics and stimulants ^afford a certain 
stability of functional exercise, and readily intercept their re- 
turn. 
In the forming state of disease, especially fever, there often 
exists considerable irregularity in the phenomena, with feeble 
responding action. In such cases, stimulants directed to pro- 
mote circulation in the capillary systems, accompanied with 
caloric externally, are of essential utility. Still the irregu- 
larity of functions, and the enervation are not the disease, nor 
the cause of it, but only casual and anomalous phenomena. 
Again, at the close of fatal cases of acute disease, we dis- 
cover a train of phenomena indicative of adynamia and ener- 
vation. These are natural occurrencies, and always to be 
expected whilst there is an insupportable morbid habit exist- 
ing. Although tonics and stimulants appear superficially to 
be indicated in such instances, yet all the remedia sunt vehc- 
mentes stimuli of Brown, only hasten the fatal event. 
5. Adynamia at the onset, and close of Fever. 280 
MORBID LOCATIONS. 
By way of recapitulation- then, it might be said, there are 
few or no diseases caused by adynamia, enervation, or debil- 
ity ; that these are rather accidental phenomena in connection 
with the morbid habit; and although they occasionally need 
to be alleviated, do not demand primary attention ; nor can 
we find a place for a class for them in a nosographic arrange- 
ment. 
SECTION XX. 
MORBID LOCATIONS. 
1. Is Disease produced by extensive constitutional changes, 
and thence forming local concentrations; or, does it origi- 
nate at some tissual point, and from thence radiate over 
the entire organization ? 
2. Preliminary Notices. 
Perhaps there is no inquiry in all the rounds of pathologi- 
cal research, of more importance than this, both as respects 
the correct science of diseases, and their therapeutical treat- 
ment; and, at the present time, there is none on which the 
guardians of the health of the community are more divided. 
Those who are vacillating in opinion will always be the agents 
of mutable and inefficient treatment; whilst those who em- 
brace wrong theorems will use improper remedies. We 
humbly hope so to offer the facts in connection, as to con- 
vince all of candid minds. 
If we were to give laconic answers to the interrogatories, 
we might answer both in the affirmative ; but conditionally as OUTLINES OF PATHOLOGY. 
281 
respects one of them at least. They require some amplifica- 
tion, and separate consideration. 
Suggestions relating to general disease being antecedent to 
local affections ; in reference, 
1st, to the causes of disease. 
2d, to the phenomena of disease. 
3d, to the fact of absence, and mutability of local affection, 
whilst disease exists. 
3. First- The Causes. 
Reference may be had to Sec. xviii. 7, for a slight allusion 
to the causes, which induce a morbid habit. Most of these 
will be found to be such as make an uniform, and universal 
impression on extended tissues. Thus cold, heat, conta- 
gions of most kinds, hyperaemia internally, passions and emo- 
tions, fatigue, watching, debauchery, together with various 
atmospheric circumfusa. These are very extensive, and 
affect the entire surface of the body externally, or the whole 
of the tissues internally. They all do, in some considerable 
degree, impress the vital susceptibility in a manner incom- 
patible with health, and universally. Can it be supposed, 
that such wide impressions shall only affect primarily, some 
single tissual point, and in the most interior structures ? 
Their effects are, and must be, a state of general impres- 
sion, and an excitation given to vital tissues widely extended ; 
often, however, at first mild, producing a state of increased 
susceptibility, called predisposition ; and next, by repetition, 
a distinctly morbid condition ; and this is directly manifested 
by strong and elevated action in the corporeal, and in the 
mental functions. The causes acting in combination, how- 
ever, may, by excess of stimulation, exhaust, or considerably 
impair the vital force ; and even this shows an extensive ap- 
plication to vital tissues. The wide extended recuperative 
powers of the system do, however, most commonly gain an 282 
MORBID LOCATIONS. 
ascendency, in which event high action will be perceived uni- 
versally, and in a more permanent manner than ever arises 
from any simple local irritation, without constitutional 
disease. 
4. Second-Proofs of Primary Morbid Habit, by the 
. Phenomena. 
As relates to the phenomena of general disease, they were 
in part alluded to in Sec. xvii. 2. We may now only notice, 
that the altered aspect, the universal chills and heats, univer- 
sal diminution of strength, and alteration of many, if not of 
all the functions, do indicate a general derangement through- 
out the entire economy. An inequality in the action of 
organs is quite characteristic of general disease. The cen- 
trifugal circulations are often very unequal, and the centripetal 
imperfect, so the blood partially circulates through the cold, 
and almost anaemic tissue of the surface, giving a sensation 
of heat and cold. The extremities are cold and nearly 
bloodless. This condition is as much indicative of general 
disease, as if the same parts were hot by a forced circulation. 
Directly, then, the whole surface becomes morbidly hot, 
the heart and arteries throb, and numerous phenomena are pre- 
sented, showing an universal affection. But, it may be said, 
during this time there has been some point of irritation, some 
local stimulation set up, which has produced all these general 
phenomena; or, certainly some excitation in the gastro- 
intestinal mucous tissue. 
It might be answered, the subject was well a few hours 
before ; he ate and drank as usual, and had no premonition of 
local injury, or point of irritation. Although now, or very 
soon he may be disturbed by a pain somewhere, as in the 
head, side, abdomen, or joints. At any rate, numerous 
instances do occur, in which no pain, nor any local disturbance 
can be discovered, until the disease has made some manifest OUTLINES OF PATHOLOGY 
283 
progress, and this is a fact demonstrated by every day's 
experience. 
We need not be compelled to bring much authority to 
show this fact; however, one may be taken from Dr J. John- 
son, a man of extensive experience, to show we are not 
mistaken. In his treatise on Abdominal Affections, p. 33, 
he says, "I have known the fever run high for several 
hours ; nay, for a whole day, before there is any local demon- 
stration of dysentery, clearly showing that, in such cases, the 
whole system is first affected." A vast collection of facts 
might be gathered from writers perfectly similar. These are 
not speculative opinions, but a rehearsal of demonstrated facts. 
The case related by Dr Southwood Smith of his friend Dr 
Dill, is full of proof and interest.* 
The paleness, and indescribable altered aspect that attends 
some subjects, laboring under' an unheeded predisposition, 
just before an attack of some severe malignant fever, is most 
certainly proof of an universal diseased state. These cases 
are often noticed by the bystanders, before the subject is 
aware of illness, and thinks himself well. This state may 
continue several hours ; the disease is now uniform through- 
out the whole system. No local determination has as yet 
taken place ; the disease is, as it were, incubating, and in a 
well balanced constitution the local determination is not so 
quickly formed. But, in a moment not heeded, the local de- 
termination is hard pressed, by the accumulated weight of 
disease, to some important organ, and the consternation is 
great. So some may die very suddenly in severe epidemic 
• I 
seasons. 
In such cases, if the determination should be to the brain, 
the death would resemble apoplexy ; and Dr Rush speaks of 
the apoplectic state of fever ; and every practitioner of much 
experience must have witnessed it. How often in malignant 
typhus, in yellow fever, in spotted fever, &c., this may 
happen. It is common for the local determination to form 
* Treat, on Fever, p. 221. 284 
MORBID LOCATIONS. 
early, but the longer it is delayed, the more severe it will be 
when it does take place. ( 
In a mild state of predisposition, the first notice the subject 
may have of ailment may be a local pain in some part, or a 
hemorrhage from some mucous tissue, or a local spasm. 
Yet, as the local determination progresses, the phenomena of 
general disease become more developed. So, the patient 
will insist, oftentimes, that the pain was the first thing that 
ailed him, and he wishes to get rid of it, and supposes he 
would then be well. An unwary observer would take his 
word for it, that he was perfectly well until the pain began, 
as he did not see him at the time, nor investigate the subject. 
Yet, he very probably had the premonitory signs of disease, 
and one of these are unusual alacrity of mind, and energy of 
body. This is a fruitful source of error ; the secret stimula- 
tions often accelerate the physiological functions. 
To illustrate the fact of general impressions affecting the 
entire sensible tissues on the surface, and concentrating to a 
point internally, and very suddenly, we might mention cer- 
tain tissues internally, possessing a state of morbidly increas- 
ed sensibility, such as a carious tooth ; an exposure to cool 
air will be felt in a few minutes ; the same of those disposed 
to neuralgia, to rheumatism, and an irritable bladder ; or 
again in the instance of puerperal women. These influences 
are transmitted to the internal part by the nervous tissues, 
and in all these tissues by a concentration of force directed 
through the medium of the arterial ramifications of the nutri- 
tive, or ganglial nerves ; and then the nerves of external rela- 
tion notify the centre of perception of the injury done to the 
part locally affected. 
As it appears to be a subject of great importance, to estab- 
lish the fact of primary general impressions being made, and 
an universal state of excitation following, as arguments that 
diseases do not arise from mere local irritations, the privilege 
is taken of transcribing part of a letter from Dr James San- OUTLINES OF PATHOLOGY. 
285 
ders of Edinburgh, to Sir H. Halford, Nov. 1831. Med. 
Chir. Rev. v. 20. " We now come to the point of vital 
importance, I mean the state of the patient sometime previ- 
ous to the overwhelming assault. I am convinced from am- 
ple experience, that such prostration of the vital powers 
never occurred unpreceded by a certain portentous state of 
the ichole body, which was sketched by Hippocrates, and 
elegantly portrayed by Celsus. The signs of this state are 
concealed from the unwary, under the alluring mask of felici- 
tous health ; so that when there are unusual vigor, alacrity, 
and activity of mind and body ; when the eyes sparkle with 
unwonted brilliancy, and the whole complexion is conspicu- 
ously improved ; when every faculty and every function is 
exercised with facility, and a power that the person has sel- 
dom or never experienced, let him beware ; he is on the 
brink of a precipice ; and if an epidemic prevails, it has al- 
ready seized him ; his fall will be sudden and tremendous, 
in proportion to the exaltation which he enjoyed. This is 
the first stage of the epidemic fever, inadvertently called the 
cholera." 
5. Physiology of Local Concentration. 
Having advanced far enough in showing that a state of 
predisposition, and even incipient disease may exist for a time 
without any local affection, and that it does soon form, it 
might now be inquired by what known process, or law of the 
human economy they do form. We need to make some 
physiological allusions. 
PHYSIOLOGICAL THESIS. 
The, intellectual processes when most active, can contem- 
plate but a single object at the same time ; voluntary mo- 
tion is capable of but one direction at the same moment ; 286 
PHYSIOLOGICAL NOTICES. 
and some one of the internal apparatus of organs is in 
greater excitation, for the time being, than the others are. 
A man may have a complexity of business, and seem to 
attend to several topics at the same time, yet he does not. 
He has a place of concentration, or deposit in his mind, 
where every fact in relation to each topic is deposited. He 
may converse with three persons in one interview, and he 
turns his attention to each with the rapidity of electricity, and 
has a focal point of deposit for each, where all relating to one 
topic is placed ; or otherwise he would get confounded. His 
attention is concentrated on only a single item at the same 
instant. When the mind is absorbed intensely on one sub- 
je.ct, it is with difficulty broken off.* 
It is difficult to perform two opposite motions, destitute of 
an harmonious rythm, at the same instant. It requires much 
practice, until it shall become mechanical, to move one hand 
perpendicularly, and the other horizontally at the same time. 
The motions on musical instruments are a series of succes- 
sions, and all in harmony. 
The same law seems to prevail in the internal economy of 
the organs ; each organ, or apparatus of organs, has it turns 
of greater intensity of function than ordinary, serving as a 
focal point of organic force. This may be observed in mas- 
tication, digestion, lactation, procreation, &c. The nervous 
force, and capillary turgescence, are more concentrated on 
some one of these apparatuses, for a time, than on other 
organs, and during this time there is some deficiency of force 
in all the other organs. 
In the morbid economy, it has been accorded, for a long 
time, but especially noticed by the Hunters, that the economy 
could not endure more than one series of diseased action at 
the same time, for both must have local points. The mea- 
sles will interrupt the progress of the inoculated small-pox, and 
* See Richerand's Phys. p. 21. OUTLINES OF PATHOLOGY. 
287 
it is said the vaccine virus will interrupt the chin-cough. No 
two pains can exist of equal severity at the same time, for the 
major will absorb the minor, by drawing to its circle an 
excess of vital force. When counter irritations are severely 
inflicted, they often transfer the diseased location. A case 
of phthisis pulmonalis has been cured, by a severe scald 
on the thorax, followed by extensive soreness and much pur- 
ulency. 
The foregoing reflections have been made for the better 
comprehension of the following : 
PATHALOGICAL THESIS. 
6. JI general morbid habit, with increased excitation, can con- 
tinue but a short time, without its principal force being 
directed to some focal point ; and it is this concentration 
which establishes the local affections for the time being, in 
accordance with the physiological impulses. 
This focal point possesses more of the nosodynamic force 
than exists in any other part; and indeed, so much the less ex- 
ists at the time in the entire system ; hence paleness, chills, &c. 
However, disease is constantly accumulating, until arrested ; 
so there may be a sudden increase in both. The focal point 
is most liable to form in a part either constitutionally, or acci- 
dentally the most sensible, or irritable. Notwithstanding, 
there is something in the remote causes of epidemic diseases, 
which inclines the subsequent disease to concentrate, very 
uniformly, on some particular tissue. It is as difficult to tell 
wherefore, as it is why certain medicines act on particular 
organs. So cholera embraces in its local affection, one 
tissue, small-pox another, pneumonia, a third, and dysentery, 
a fourth, &c. 
Disease is often produced by sudden exciting causes in 
combination, without any perceptible state of predisposition ; 
and in such an event, the morbid habit may concentrate on 288 
PATHOLOGICAL THESIS. 
different tissues, according to the idiosyncrasy of each indi- 
vidual, and as many forms of particular diseases be produced. 
This may be noticed when many are made sick in company, 
by exposure to cold, heat, moisture, fatigue, &c. A fact is 
stated by Dr J. Johnson, in his treatise on the Influence of 
Tropical Climates on European Constitutions, which is in 
point, viz. : Twentyeight soldiers were employed at work in 
the neighborhood of an extensive marsh in America. Every 
one of them was made sick, but of different habits of 
disease. Three died of cholera, five of dysentery, four of 
what they called adynamic fever, with yellowness of the skin, 
and all the others had malignant intermittent fevers. These 
facts are full of instruction, and require no further illustration 
than has already been made. 
7. Local Affections produce Effusions, Hypertrophies, and 
Reflex Actions on the General System. 
The concentration of the nosodynamic force acts as an 
excitant of the part, and there is suddenly an accumulation 
of blood, with distention of the capillary tissues, turgescence, 
pain, heat, and effusions according to the severity of the 
morbid habit, the character of the diathesis, and the anatomi- 
cal character of the structure affected. These effusions are 
usually from the surfaces of the organs, especially in epi- 
demic diseases ; but, they often occur in the substance, and 
parenchyma of organs, and in this event, constitute an order 
of affections which have been styled local inflammations, as 
hepatitis, &c., although erroneously ; for these also depend 
on a general state of disease. 
These local affections always attend chronic diseases in 
one shape or another, but in a mild manner. They are often 
so mild as merely to increase the nutritive economy of the 
part, and in this instance produce the condition of hyper- 
trophy, so much noticed of late. However, they com- OUTLINES OF PATHOLOGY. 
289 
monly produce indurations, which in time become soften- 
ed, insuring a destruction, or important injury of the part. 
Every tissue is liable to be the seat of some local affection, 
and as they possess different degrees of sensibility, or rather 
susceptibility, so the reflex, or sympathetic action over the 
general system will be of different degrees of intensity, and 
the morbid economy will become modified by it. When 
concentrating on dense tissues more pain is excited, from the 
difficult distention. This pain of a part excites the reactive 
energies of the system, serves to restore the general depres- 
sion at the commencement of disease, and goes far to pro- 
duce that state of the system, which has been styled phlo- 
gistic. When falling on more lax, and less sensible tissues, 
the reflex action will be mild, and the general economy not 
much affected by it. Yet, if it concentrates on some of the 
nervous tissues, it reverberates with great intensity over the 
system, unless it be so severe as to paralyze their function. 
8. Local Affections are liable to change of place, or Me- 
tastasis. 
These mutations are most common at the commencement 
of disease, or at its decline ; but when the diathesis is strong 
as at the zenith of fever, they do not change ; and again, when 
the effusion has been thrown into the substance of an organ, 
it cannot easily be moved, but its effects ought to be obviated 
by efficient treatment. 
These mutations of local affections furnish an argument, 
that they are not primary, or antecedent to the morbid habit, 
as suggested in proposition 3d, at the beginning of this sec- 
ti on ; which we will now consider. 290 
METASTASIS. 
9. Third-If the Local Affection pre-existed, and was suffi- 
ciently powerful to produce the Morbid Habit, it could 
not So readily move to and fro. 
The fact has already been alluded to ; and the instances of 
a change of topical affection are so common, that it is hardly 
necessary to specify. As the local determinations may affect 
different tissues or organs, so the disease assumes a new 
name, although the character of the morbid habit may remain 
very nearly the same. So Darwin says, he twice saw an 
elderly woman relieved from ascites, by insanity supervening. 
When the insanity abated, the dropsy returned. A man 
having the appearance of hydrothorax, with swelled legs, be- 
came free of those complaints on the approach of insanity. 
Volumes might be filled with similar proofs ; one case only of 
our own experience may be noticed. 
In 1824, a woman about twentyfive years of age was at- 
tacked with the common phenomena of severe disease, and 
directly an intense pain in the left side, a little above the 
margin of the diaphragm ; full and frequent pulse ; dyspnoea, 
cough, &c. The affection might be called pleurisy. Six 
full bleedings were practised in seven days, together with 
other treatment ; at length a blister to the part. In four days 
after, another epispastic to the part. The next day the pain 
was totally absent, and yet considerable fever remained. 
The day following the head was attacked ; pain, throbbing, 
&c. Another bleeding from the arm also, relieved the head. 
In a few hours, however, the local affection had migrated to 
the blistered surface of the side ; severe pain, heat, throbbing, 
tumefaction, dryness. An emolient poultice applied to the 
now inflamed surface, was soon followed by a copious, puru- 
lent discharge. Every appearance of disease now immedi- 
ately subsided, and health was restored. 
If diseases are excited by primary local irritations, as they 
are called, and intense enough to produce the imposing phe- OUTLINES OF PATHOLOGY. 
291 
nomena of severe universal morbid action, it appears incom- 
prehensible how the local cause can quit its hold so easily 
and travel to some other part. Consider the gout and rheu- 
matism, with local affections, very constantly moving about, 
not only from one joint to another, but from the external to 
the internal tissues, and vice versa. Whereas, the pheno- 
menon admits of easy solution on the thesis of a primary 
morbid habit giving origin to local concentrations. 
Even M. Broussais, the exulting champion, at the present 
time, of exclusive local causation, appears to be in perplexity 
on this subject, as is shown in his Pathology, p. 37. "We 
see indeed that the viscera are super-irritated by the blood, 
and that they are too sensible to the action of external agents, 
which may equally happen without plethora ; this is irritation. 
But, we do not know why it abandons its first seat to fix itself 
where the abscess is about to form." It is wonderful, that a 
man so full of expedients could not propose some solution of 
the problem. Yet, only let him return to true physiological 
principles, and he might readily give a just answer ; for the 
local affections are constantly under the control of the modi- 
fying influences of the general morbid economy. 
Dr Southwood Smith appears to have committed an error 
from too little reflection, in considering the internal phlegma- 
tiae to have primary origins in the affected organs ; and from 
thence exciting sympathetic fever ; whilst he accords in the 
opinion of fever being antecedent to, and giving origin to the 
local affections connected with it. Fevers are usually con- 
nected in their origin with some extended remote causes, and 
yet both fevers and inflammations may arise from ordinary spo- 
radic causes. In epidemic fevers, the local affection most 
commonly embraces the investing tissual surfaces of organs ; 
in the instance of what has been styled phlogistic inflammation, 
the substance of the organs are affected, and with an intersti- 
tial effusion, liable to terminate in purulency. After all, he 
thinks they have a close connexion. "But though in the 292 
LOCAL INJURIES. 
present state of our knowledge we are not justified in consid- 
ering fever and inflammation to be the same,yet the close, per- 
haps constant connexion between them, is a fact of the utmost 
importance to be known, and requires to be incessantly be- 
fore the view of the practitioner. " (Treatise on Fever, p. 65.) 
When he said of pneumonia, enteritis, hepatitis, " The 
earliest indications of disease that can be discovered have 
their seat in the affected organ itself," p. 63, he only com- 
mitted the common error of not noticing the premonitory 
phenomena. And again, he seems not to have regarded 
the opinion of his countryman, Dr Jenner, who says, 
that " every pimple has an errand to do from the constitu- 
tion." In the phlegmatise the diathesis is strong, the gen- 
eral depressions of malignant fevers are absent, and the 
locations are early formed ; the early ravages of the organ 
excite severe pain, which is liable to arrest the whole atten- 
tion of both patient and physician ; and, again, the location is 
so strongly fixed that it cannot very readily migrate, yet it 
may at the beginning, or on a mitigation of the diseased 
habit. ' 
Having progressed thus far, in answer to the first interro- 
rogatory at the head of this section, we will now attempt an 
answer to the second, viz : 
10. Does Disease originate at some Tissual Point, and from 
thence radiate over the entire Organization 2 
We are free to concur with the localists in every physio- 
logical fact, or thesis that is just, having reference to local 
irritations, or lesions affecting the entire economy. We 
accord very harmoniously with M. Broussais, that " Impres- 
sions made by external bodies, agitate instantly the entire 
extent of the nervous system, and in this way reverberate 
into the viscera." We will even go farther, and say, we 
have seen a person laid prostrate in syncope by a bruise on OUTLINES OF PATHOLOGY. 
293 
the little toe ; another by some offensive effluvia; another 
affected with hysteria, on hearing of distressing news. These, 
and similar instances are numerous. The nervous thrills may 
often be distinctly felt, diverging sometimes to the whole 
viscera, sometimes to one organ ; but, still these nervous 
commotions are not disease, neither do they excite a perma- 
nent morbid habit, unless in co-operation with some conjunct 
cause, which impresses the nutritive tissues. Such commo- 
tions are transient, and the subject soon recovers his strength. 
However, if they should be constantly reiterated, they would 
contribute to the formation of a morbid habit, and this would 
have some local tendency when formed. 
Pain of a part, let it be ever so severe, does not of itself 
excite disease. The centre of perception is merely notified 
of some divellication of the sensitive nerves, but disease is 
the prerogative of the entire nutritive system. A man may 
be flagellated until he faints, or indeed until the vital force is 
totally expelled, and until he is dead, yet he does not die of 
disease. So the tortures of the Inquisition do not produce 
disease, unless in combination with the very circumstances, 
which might excite it without the tortures. 
12. Extensive Wounds do not necessarily produce Disease. 
We may be justified in following up this subject some fur- 
ther. It may be asserted that extensive wounds, and even 
compound fractures are not necessarily followed by fever. It 
is true, that it very commonly falls out so, that the subject is 
affected with severe disease, and this greatly aggravates the 
local injury. The circumstances in connection with acci- 
dents, are usually such as may expose the subject to cold, 
and various other familiar causes, which contribute to form a 
morbid habit ; and he may often have bad treatment. Still 
we do insist, if suitable precautions are taken in a subject free 
from predisposition, general disease may commonly be avoid- 294 
LOCAL INJURIES. 
ed, and of course the chief discomforting sequences of severe 
inflammation of the injured part. 
We will assert from our own observation, that sundry- 
cases of compound fracture, in some of which the bones of 
the leg have been thrust through the integuments, and cloth- 
ing, and even into the ground, have healed by the first inten- 
tion, and without fever, or abscesses. For this purpose rest, 
and the entire quieting regimen must be observed ; a tight 
roller ; elevated position of the limb ; and above all a strict 
regard to the avoiding the. formation of a morbid habit ; by 
blood-letting ; laxatives ; perspiration ; spare diet, &c. as 
well as avoiding all exciting causes, with a freedom from pre- 
disposition. 
This position will scarcely be credited by many ; for, it is 
the common belief, that severe wounds, and compound frac- 
tures must necessarily be followed by fever, from the irrita- 
tion they give, with high inflamjnation, and all its results. 
Now, those who esteem the local irritation the cause of all 
that follows, will rest contented in the use of certain local 
remedies, which cannot effect any beneficial influence on the 
general habit, and of course are of but little avail. They are 
incautiously led to supply the patient with opiates to relieve 
local irritation, whilst by their high stimulating properties, 
they invariably aggravate the common morbid habit, and the 
case is ultimately made worse for their use. 
There are, however, certain cases of severe injuries, es- 
pecially of the joints, which have continued long, until 
the system has become much reduced by discharges, and 
the morbid habit may have been removed ; yet there is liable 
to be a train of distressing, fugitive symptoms, called nervous. 
These cases are more troublesome than dangerous, and they 
may be greatly relieved by anodynes, for the purpose of 
inducing insensibility. If the injured part cannot be restor- 
ed, amputation is a sure and proper remedy. OUTLINES OF PATHOLOGY. 
295 
Wounds of the Dense Tissues. 
Simple wounds are often followed by the most alarming 
consequences. How often is a small cut in the capsulary 
ligament of the knee joint followed by the most disastrous 
circurrfStances ; and again, how often the subject escapes 
with impunity. What makes the difference ? Surely, noth- 
ing besides this, that in the one case, he might have been la- 
boring under some degree of predisposition, and now became 
exposed to the causes inducing a morbid habit; and in the 
other case he was protected from these circumstances, and of 
course the wound gave no trouble. In the unfortunate case, 
the subject experiences no trouble until about the third day 
after the accident. During this time the morbid habit forms, 
and its concentration of local impulse is sudden, and distress- 
ing from happening in a dense tissue, and its reflex action is 
severe. 
It has been always noticed, that vyounds touching the liga- 
mentary, or fibrous tissues, in hot seasons and climates, are 
liable to be followed by trismus, or by general tetanus. Yet 
a large proportion of wounds of this description are free from 
this symptom. This result is precisely according as the sys- 
tem shall have been protected from a general state of disease, 
or not. It may occur at very different periods, as the sub- 
ject may have been exposed. 
13. State of Predisposition important. 
Sir Astly Cooper remarks, that students, on first coming 
to London and attending to dissections, experience but little 
inconvenience from the wounds they receive in that business. 
But, after being there a few weeks, experiencing the excita- 
tions of the place, the labors imposed on them, with the new 
mode of regimen, then every trifling wound gave much trou- 
ble, and often became alarming. A state of predisposition 296 
LOCAL INJURIES. 
has now been formed, and admits of similar explanation as 
before. And it goes to show that the fault is not so much 
in a supposed virus, as jn the acquired habit. The success 
of all important surgical operations essentially depends on 
the general state of the system ; hence arises the necessity of 
preparing a patient for such an operation, and scrupulous at- 
tention after it, as is now practised by all discreet surgeons. 
Dr Lind, in speaking of a sickly season at Bengal, remarks, 
11 at this time a slight cut of the skin, the least scratch of a 
nail, or the most inconsiderable wound, turned quickly into a 
putrid, spreading ulcer, which, in twentyfour hours, con- 
sumed the flesh, even to the bone." 
14. Remarks on the Virus of Contagion. 
In every contagious disease, the virus seems to be making 
secret changes in the system, until the entire economy be- 
comes affected ; and the very first phenomena that do appear 
are such as declare an universal affection. There can be no 
point of local irritation ; for their specific locations do not 
show themselves until certain periods after a morbid habit has 
existed. All the difference there ever exists between the 
most malignant, or confluent small pox, the milder distinct 
kind, and that by inoculation, depends on the different inten- 
sities of the morbid habit. 
The difference between a mechanical injury of a part, and 
a similar alteration of the same part as a sequence of a morbid 
habit, may be very great. Had M. Broussais considered this, 
he might not have been surprised that extravasated blood from 
local injury should be so harmless, when he had seen it so 
troublesome in disease. In Physiology applied to Pathology, 
p. 415, he says, " we learn from what has been said, that 
when blood is accumulated in a part of the body by any me- 
chanical force whatever, it may be eliminated by extravasa- 
tion ; (absorption ?) but it is very remarkable that inflamma- OUTLINES OF PATHOLOGY. 
297 
tion does not take place in consequence." Now this appears 
to be no more remarkable, than that a wound by a sword pas- 
sing the lungs, with blood effused, should heal kindly, by 
avoiding the supervention of a morbid habit; whilst a com- 
mon haemoptysis is a signal of alarm ; because there always 
is an antecedent morbid habit. However, in such cases there 
often exists an antecedent local change of structure in the 
lungs, and this will make the case doubly alarming. 
Our illustrations might be extended to a great length, but 
we have not time. Perhaps enough has been advanced to 
establish the following as an answer to the second part of the 
interrogatory. 
RESULTING THESIS. 
15. Local injuries, or other irritations often radiate, more 
or less, over the system, and with different degrees of inten- 
sity ; but, their influence is transient, unless a general 
morbid habit exists at the time, or directly supervenes; and 
in this event, they become the foci of the general diseased 
state. 
As brevity must be our constant director, it may be suffi- 
cient to say in this place, that a more absurd and misleading 
dogma never was published, than we find in the commentary 
to the 72d proposition irt M. Broussais' Pathology ; viz., 
" Thus one of the principal axioms of the physiological doc- 
trine, that all diseases are primarily local, may be rigorously 
demonstrated. It is now understood why this demonstration 
was necessary to enable us to prove that the physiological 
doctrine had borrowed nothing from the modern Italian." 
And all this exultation, when he had proved nothing, only an 
attempt to pervert the just principles of physiology ! 
It becomes a subject of curious reflection, that the inge- 
nuity of M. Broussais should have enabled him to detect so 298 
LOCAL INJURIES. 
many lesions of the gastro-intestinal mucous tissue, which had 
for ages escaped the attention of numerous observers.* This 
is surely a subject of observation, and not of induction. For 
a great length of time the autoptical examinations had been 
conducted in the same place, and no doubt with precision, 
and the lesions of this tissue had been noticed, but not mag- 
nified above their real pathological importance, as they now 
seem to be. In almost every condition of the morbid habit, 
there is an undue proportion of blood concentrating to the in- 
ternal tissues, with a proportional destitution of the surface. 
The mucous tissue is very vascular, liable to become turgid, 
and assume a state of hypersemia above that of any other tis- 
sue. This state of turgescence might easily be mistaken for 
what some call sub-inflammation. The blood concentrates 
into this tissue after the death of the subject, and assumes a 
darkened appearance oftentimes. It is, however, nothing 
unusual for this tissue to suffer some degree of irritation, and 
even inflammation, along with other tissues in general con- 
tinued disease. 
However, it is often in a more important pathological state. 
Yet, a great proportion of these states ought to be considered 
as the sequences of a morbid habit, rather than as primary le-' 
sions provoking disease. Although this is a delicate vascular 
tissue, and possessing some sensibility of relation ; yet, it en- 
dures with great submission the burthens imposed on it. In 
the instance of excess in eating, and the use of alcoholic 
drinks, the hurtful influences are commonly greater in the 
common circulatory system, and remote organs, than in the 
digestive mucous tissue. The effects of alcohol are more 
striking in the muscular and nervous apparatuses, and even in 
the brain and liver, than in the alimentary canal. 
Furthermore, most.of the lesions detected in this tissue are 
* Agreeable to M. Rayer's statement, 28,299 patients were admitted into 
the several hospitals of Paris, in 1807 ; of these 6,143 were treated for con- 
tinued remittent fever, whilst six only were considered to be affected with 
gastritis. OUTLINES OF PATHOLOGY. 
299 
undoubtedly the sequences of a determination to it, by the 
agency of the morbid habit. Many fevers are attended with 
large hemorrhagic discharges from this tissue, after some 
continuance ; they might be esteemed critical, and ought not 
to be hastily suppressed. Or in other words, a change of 
local effort is made to this vascular tissue, establishing what 
Dr Cullen styled a hemorrhagic effort. 
Again, turgescence, and even ulcerous lesions are often 
discovered in this tissue, in many cases of protracted disease, 
as in phthisis, typhous fever, &c. Perhaps no one will 
assert, in the case of phthisis, that the intestinal mucous tis- 
sue, follicles, and glands were primarily affected ; and it 
never has been proved that these parts are primarily affected 
in typhus. M. Chomel expressly declares to the contrary : 
" Now if all the symptoms of the disease and its severity de- 
pended on the lesions of the follicles, there wrould certainly 
exist a relation between the phenomena during life, and the 
extent of the lesions after death." But, he says there is no 
such relation ; and he sets them down as effects merely of 
the general morbid condition under which the patient labors.* 
There is a mass of evidence showing, that the membranes 
of the head, lungs, and abdomen are also affected in typhus, 
and the phenomena indicate, that the affection in the head is 
oftentimes antecedent to that of the mucous follicles of the 
intestines. The vascular, erectile, and yielding state of this 
mucous tissue inclines it to manifest more prominent appear- 
ances, on inspection, than any other of the internal tissues ; 
nor is it surprising that it should often be found softened 
sooner than other tissues ; and it may even suffer some slight 
changes before death. 
Injustice to M. Broussais, we feel disposed to award to 
him due praise for having done so much in exposing the inju- 
ries resulting from the " incendiary treatment." Yet, if he 
* American Journal of the Medical Sciences, No. 29, p. 139. 300 
CAPILLARY TISSUES. 
had entertained more enlarged views of the character of dis- 
ease, he would have extended the treatment, and used more 
decided remedies, without losing so much time as seems re- 
quired to extinguish local irritations. And all this might have 
been done with less prolixity, and without having several 
times exhausted the whole of his native language. 
SECTION XXI. 
CAPILLARY TISSUES. 
What are the particular, and the relative conditions of 
the Centrifugal and the Centripetal Capillary Tissues, 
especially in the three great visceral cavities, in the state 
of disease 7 
1. Physiological Recapitulation. 
The heart is the centre of all the circulations. The blood 
is projected from the ventricles, in its diverging course, and 
permeates every organ and tissue by extremely minute ves. 
seis called capillaries. This kind of tissue is found in the 
short or pulmonary circulation ; in all the organs and mem- 
branes where blood is transmitted by the aorta, both in the 
interior and exterior tissues of the system, as in the head, 
thorax, abdomen, muscles, &c. A double circulation is ob- 
served in the portal circle, the second of which is effected 
without the direct agency of the heart. The terminations of 
this series of capillaries is partly in the organs, and extended 
tissues, to be thence returned ; and partly on the surfaces 
of tissues, and from thence eliminated from the body. 
From the extremities of the diverging capillaries and inter- 
stitial spaces, arise a series of capillary vessels, or absorbent OUTLINES OF PATHOLOGY 
301 
veins and lymphatics. And, also, another series from the 
free surfaces of tissues internally and externally, called pul- 
monary, serous, intestinal, and dermoid absorbents. These 
all transmit the different substances of their particular ab- 
sorptions back to the heart, along with the venous blood, by 
the converging or centripetal circulation. The amount of 
extraneous materials taken by the external surfaces ought to 
be equivalent to what is eliminated. A continued, and quite 
equal circulation in all these tissues, is necessary to insure 
ease and health. 
2. Pathological Changes in these Tissues. 
It is in these intimate tissues that the inexplicable processes 
of the vital economy are effected ; and in disease they are the 
theatre of morbid perturbations. The causes of disease, 
whether of slow or sudden impress, are of a stimulating and 
tonic character ; yet of different degrees of activity. They 
impress the vital susceptibility of the tissues destined to nu- 
trition throughout the system, and this implies the combined 
vital force of the ganglial nerves, and the innate vegetative 
susceptibility. 
An impression then of an inordinate kind on those tissues, 
increases their force and contractility. By an increase of 
contractility the functional powers of the tissues are increased ; 
and there will immediately be perceived an increased force in 
the heart, together with a rigid, condensed state of the tissues, 
mostly discovered on the surface of the body, where there is 
a large share of capillary vessels. This manifests a morbid 
tonicity, and contractility of capillaries, which is always inore 
or less of a persistive character. 
The capillary vessels, however, of the internal tissues, are 
still more extensive, and suffer a similar change. It may be 
noticed, that on account of the minute calibres of the capil- 
lary vessels, every modification diminishing them still more, 302 
CONGESTIONS. 
even if it be small, must have an injurious effect on their 
ability of transmitting their contents. This often appears 
plainly on the surface, attended with paleness and a sup- 
presssion of sweat; and the same circumstances do clearly 
exist in the internal tissues, although a congestive state be 
present. • 
We may now make reference to the physiological fact, that 
the heart, and all the large and capillary vessels of the diverg- 
ing circulation are supplied with visceral nerves, whilst nearly 
all of the converging series are destitute, and possess only 
the vegetative susceptibility. 
In consequence of this disparity of vital impressibility, when 
a common stimulation ip applied, the diverging circulations 
will be disproportionally accelerated, and there must be an 
inequality of function between these great and asssociated 
tissues. 
This disparity of function is liable to increase ; and direct- 
ly in the graver aspects of disease, the ganglia and abdominal 
plexuses suffer embarrassments very similar to the capillary 
tissues. Their physiology declares them to be freely supplied 
with capillary blood vessels. Now, the same circumstances 
that cause the other internal capillary tissues to become 
turgid, also occasion an accumulation in and around the vis- 
ceral nervous tissues. Their function is now embarrassed, 
very similar to what occurs in the encephalon, producing 
coma. These ganglia, then, suffer an inability of function, 
and on this account, all the tissues under their influence, 
suffer, also, a diminution of function, which has so long, and 
so preposterously been called debility. 
Whether this venous distentiop, called congestive, exists 
in the head, thorax, or abdomen, the accumulations soon 
diminish, on an effusion, or an exhalation taking place from 
the tissues into the serous cavities. If, in the head, or 
spine, they disappear, on an effusion of serum taking place 
into the ventricles, or theca of the spinal cord, and so of other OUTLINES OF PATHOLOGY. 
303 
tissues. If an inflammation concentrates on a tissue, they 
also disappear, yet arterial turgescence supervenes. They 
are most often found in suddenly fatal cases, and on an early 
inspection ; for, as soon as the vital, or rather the nosodyna- 
mic force leaves the tissues, they become absorbed and 
disappear, in part at least. 
3. Origin of Congestions. 
There is now existing a nosodynamic state in all the 
tissues, yet having some different effects on the nerveless 
veins from what is has on the nervous capillary arteries. 
The heart and arteries very surely propel their fluids into the 
capillary tissues faster than the radicles of veins can dispose 
of them. The blood, then, is lodged in the incipient veins, 
whose coats are more distensible than those of the arteries, 
being destitute of circular fibres ; and also, into the nutrient 
interstitial spaces, giving origin to congestions, petechias, 
maculae, vibices, &c. These frequently appear on the der? 
moid tissue, but more frequently in the internal tissues ; yet, 
often unequally in different sections of the system. 
It now becomes necessary to attend more particularly, to 
some of the circumstances connected with the origin and 
formation of these venous accumulations. They always ap- 
pear in the greatest abundance in those cases attended with 
the greatest prostration of vital force, and irregularity of 
function. This is equivalent to saying, they exist most in 
cases where there is the greatest weight of disease, although 
not the strongest state of vascular action. Those fevers, in 
which they most frequently appear, have been called by the 
former physicians, severe typhoid, malignant, ataxic, adyna- 
mic, or putrid. 
We do not know of a single agent of a directly enervating 
kind that conspires to produce the congestive state, but have 
a knowledge of many which act as excitants on vital tissues 304 
CONGESTIONS 
producing it. With a view of assisting the illustration of an 
intricate subject, we might make some reference, to certain 
experiments performed on living tissues by the vivisectors. 
Particularly to some which have been made by Dr Georg of 
Liepzig, with a primary view to ascertain the properties 
of many articles of the materia medica, and in these he seems 
to have outdone all others. 
There has always appeared a strong analogy between the 
phenomena attending fevers of the graver kinds, and those 
attending the use of narcotics in some considerable degree, 
or so as to produce a state approaching that of narcotism. 
In the experiments we now refer to of Dr Georg, the prussic 
acid was used. He gave it to every member of a society of 
twentyseven persons, formed for the express purpose of 
ascertaining its properties in healthy subjects; It first pro- 
duced a state of excitation of mind and body ; but, it was 
sooner or later, according to the quantity, followed by ener- 
vation, or a state of exhaustion. On the animals he gave it 
to, it produced distress, stupor, death, with congestions. 
So, likewise, congestions of the brain are found in subjects 
destroyed by alcohol or opium, and other excitants. 
Experiments on frogs, fixed under a microscope, afforded 
an opportunity to see plainly, the motions of the arterial and 
venous blood in the mesentery. "After the first dose, the 
blood continued to circulate regularly for several minutes ; it 
passed more quickly through the arteries, and more slowly 
through the veins. At the end of about ten minutes, the 
course of the blood in the veins became still slower, in the 
arteries it continued the same, and did not alter for eight or 
ten minutes subsequently. There then occured from time 
to time, a stasis in both sets of vessels, but this happened 
more frequently and continued much longer in the veins than 
in the arteries." 
"On the approach of death, retrograde movements of the 
blood took place, but of short duration. About fifteen min- OUTLINES OF PATHOLOGY. 
305 
utes after death, the blood in the veins had assumed a violet 
hue, while at the commencement of the experiment, it was of 
a bright red. In the artery, on the contrary, the blood, 
which had been also of a bright red, became pale, almost 
white. The artery itself became more contracted, while the 
size of the veins was unchanged. In large doses the acid 
suddenly destroyed sensibility, and few or no morbid pheno- 
mena occurred. 
These experiments are similar to those made by 
others, and go to prove, that excitants affect the mo- 
tions of arteries more than those of the veins ; that the 
former contract the strongest, and hold out the longest ; 
that the blood ceases to move first in the veins. With 
these facts, and considering the veins more distensible than 
the arteries, the venous dilatations may be explained. The 
blood sometimes suffers a stasis in the interstitial spaces ; al- 
so, there may be extravasations, forming petechiae, maculae, 
&c. In some of the severer grades of fever, the capillaries 
take on a high state of excitation, and exhibit an erysipelatous 
inflammation ; on other occasions various kinds of effusions, 
but these subjects will come under consideration elsewhere. 
4. Different modifications of diseased Capillary diction. 
A difference in the combinations, and force of the causes ; 
also, of the susceptibility of individuals exposed, modify the 
subsequent disease. 
1st. They may make only a moderate impression compar- 
atively, and the disparity produced between the diverging 
and converging capillaries will not be so great. The stimu- 
lations may be capable of awakening the repulsive energies 
of the tissues, and in a manner to enable the absorbent veins 
to take up the blood nearly as fast as it is furnished by the 
arteries. The excitations become uniform throughout. The 
blood is fast thrown into the capillaries, and quickly taken 
up ; the veins are filled, heat is evolved, and the heart 306 
RESOLUTION. 
stimulated to forcible action. This state, only partially 
sketched, will manifest the sthenic diathesis. 
2d. The causes may act in combination, and on a subject 
predisposed. The diverging circulations- may be carried on 
for a time as above stated ; but the absorbent veins are less 
capable of performing their office ; the congestions increase 
their embarrassment. A great proportion of blood is retained 
in the capillary tissues of the interior ; coldness prevails on 
the surface ; the large veins are not filled, neither the ven- 
tricles of the heart supplied. The systolic action of the 
heart is often repeated, with a scantiness of blood, and the 
pulsatory vibrations are frequent, small, chorded, and retir- 
ing. The fortunate period of relieving such cases is before 
the vital force becomes too far exhausted. 
This state of the system is very imposing ; the inability of 
functions, and diminution of vital energy in the system of ex- 
ternal relation, may be very considerable, whilst there may be 
a great weight of nosodynamic force existing in the entire 
nutritive tissues, although in a hidden, latent state. This 
condition is liable to continue, and make further derange- 
ments until all the capillaries are greatly embarrassed, and 
their functions cease. However, the recuperative powers 
oftenest prevail, and the circulations become established in 
their physiological courses sooner or later ; yet only a few 
days, and sometimes as many hours, will decide this. This 
state of the system will be attended with what has been styled 
the typhoid diathesis, which will require further illustra- 
tion. 
3d. In a subject under circumstances quite similar to those 
mentioned in the first article, and who after exposure to partic- 
ular causes, may have a concentration of the nosodynamic force 
to some internal organ,as the tissues of the brain, lungs, liver, 
&c., the vascular tissue soon becomes engorged; and a vi- 
bratory action becomes established in the part, rather inde- 
pendent of the heart. Directly, effusions take place into the OUTLINES OF PATHOLOGY. 
307 
interstitial spaces, and often on the external investing mem- 
brane ; tumefaction, pain, heat and throbbing attend. This 
is the phlegmatiae of Broussais, or the empresma of Good. 
In such a condition, the absorbing veins are incapable of 
acting, and the local capillary excitation is liable to destroy 
the organ. The balance of circulation is mostly on the side 
of the diverging capillaries, and the intention should be to di- 
minish this arterial force, and excite the converging, or ve- 
nous circulation. When the latter obtains, a resolution will 
take place, yet never without it. 
So, likewise, is the condition of every fever, of every dia- 
thesis, and of every grade of severity, let them be called by 
whatever names they may, and whether attended with local 
phlegmatiae, or a tissual excitation and engorgement. So again, 
this is the condition of all the chronic phlegmatiae, both inter- 
nally and externally ; they will persist until the absorbing 
processes obtain an ascendancy over the diverging capillary 
circulations. As soon as this force subsides into a state of 
moderation, and the capillary veins have obtained an ascen- 
dancy, with a little time, there will be a mitigation of pain, 
of soreness, of tumefaction, and finally of e^ery morbid phe- 
nomenon. The nosodynamic force is removed in all these 
instances; the cardiac and arterial severity of action abates ; 
the secretions and exhalations become established, and now 
the fever admits of what has been called a crisis, and the in- 
flammation of resolution. 
The foregoing illustrations have been made to bring the 
morbid habit into view, and show the importance of the cap- 
illary tissues in the process of disease, in its most extended 
sense. Byitwejearn the necessity of restraining the over 
balanced power of the centrifugal circulations, whilst suitable 
5. Therapeutical Remarks. 308 
ATAXIA. 
measures ought to be early taken to excite the absorbents of 
the centripetal circulations. 
And furthermore, we learn the importance of seasonably 
reducing the nosodynamic force in the heart, and capillary ar- 
teries in disease ; and, indeed, in all the absorbing tissues, 
before they can take on their accustomed functions. M. 
Magendie found by experiment, that, in hypersemia, absorp- 
tion takes place more certainly, and in one fourth part of the 
time after venesection that it did without it ; by this, proving 
the existence of morbid strength, and that venesection dimin- 
ishes it, and gives freedom of action. The particular man- 
agement of this process belongs to therapeutics. 
SECTION XXII. 
ATAXIA. 
1. On Ataxia ; or the anomalous state of disease. 
This term appears to have been used by Selle and Pinel 
to designate an order of fevers of the severe typhoid aspect, 
which were accompanied with formidable, yet anomalous 
symptoms ; continually liable to vary, and especially affecting 
the functions of external relation, yet having their principal 
seats in the nutritive organs. 
Viewing all diseases as manifestations of disturbed physio- 
logical movements, so they have a tendency to maintain a reg- 
ularity of character ; yet many intervening circumstances are 
liable to exist, producing a discrepancy of phenomena, and 
variation from their most fixed procedure. This is so much 
the case, that scarcely two diseases of the same species are 
exactly alike in every particular, in different individuals. 
We wish, therefore, to extend our remarks on the ataxic 
state of disease, in a manner to embrace many of the eccen- OUTLINES OF PATHOLOGY. 
309 
tricities we meet, in different habits of disease ; otherwise we 
may never expect to discover or appreciate "the invariable 
concurrence of a particular number of events," so much in- 
sisted on by Dr Southwood Smith. It will, also, be discov- 
ered, that the anomalous forms of disease essentially modify 
the results of it; and this circumstance cannot fail to derange 
the numerical method of investigating its character. 
2. Specifications of certain Anomalies. 
In the commencenpent of disease, or the formation of the 
morbid habit, the natural catenations of physiological move- 
ments are often interrupted from the common order of the 
pathological movements, and unusual anomalies may occur in 
many functions ; as in the circulation in the capillaries, and 
in the rythm and force of the cardiac actions. Neither is it 
confined to the circulatory system ; it often appears in the 
cerebral and other organs ; whilst one apparatus acts vehe- 
mently, another may be torpid, or altogether suspended. One 
part may be cold, whilst another is very hot. 
So again, in the functions of external relation ; some of the 
organs of sense may be greatly increased in sensibility, whilst 
another is diminished. There may be coma and vigilance in 
succession ; in muscles, lassitude or convulsions. Disease 
has been said by some, to consist of a constant series of ir- 
regularities ; yet this is not true ; although it consists, in its 
disenthralled state, of an elevated state of action, it may have 
many anomalous, or accidental phenomena, not essential to its 
regular character. 
3. Illustration by Small Pox, and Measles. 
Let us view the disease of small pox, which we may sup- 
pose to possess an identity of character, and progressing with 
a train of definite phenomena. Yet, it is very common, es- 310 
ANOMALOUS STATE. 
pecially in children, to see a paroxysm of convulsions before 
the eruption shows itself. This is an accidental or ataxic 
symptom ; not a necessary one of the disease, but arose from 
a part of the precordial distress emanating to the origins of 
the motory nerves, exciting the voluntary muscles into incon- 
trollable actions. The disease still progresses in its essential 
course, and the accidental phenomenon by the convulsive per- 
cussions, may have been of use in furthering the eruption, 
which is a necessary sequence of the disease. The convul- 
sion may be esteemed as a part of the reactive process. 
A similar condition is often discovered in measles ; there 
is liable to supervene an intolerable oppression at the precor- 
dial region, with shortness of breath. This is often followed 
with vomiting ; and w7hen it does occur, the eruption soon 
appears, and the disease pursues its destined round of regular 
phenomena ; whilst the precordial distress and vomiting were 
accidental phenomena in reference to the disease, although 
they never appear without cause. 
So, also, the access of many pyrectic diseases is attended, 
oftentimes, with convulsion, or vomiting, purging, hemor- 
rhage, coma, syncope, &c., from existing peculiarities of the 
individual, when they make no necessary part of the train of 
symptoms identical to the disease ; and these accidental phe- 
nomena may sometimes be of use, and at other times disad- 
vantageous to the progress of the disease. Whilst we 
maintain, therefore, that every particular location of disease 
possesses a stability of general character, with regular cause 
and sequence, yet they are subject to many anomalies from 
individual physiological circumstances. 
4. In Chronic Affections. 
In chronic diseases of slow access, we often discover a 
train of anomalies before the disease becomes sufficiently de- 
veloped to admit of a specification. Indeed, after it becomes OUTLINES OF PATHOLOGY. 
311 
established, and its location fully fixed in some tissue, still 
there may occasionally be many accidental phenomena, 
affecting some function of body or mind ; they are often 
called nervous, yet the steady course of the disease may not 
be much affected by them, although the medical attendant 
may be liable to be led into error. These anomalies ought 
always to be distinguished, and if they merit some particular 
treatment, it ought not to interfere with that most appropriate 
to the essential disease. 
5. Anomalies in Pyrectic Diseases. 
It is in the comparatively mild grade of fevers called sthe- 
nic or inflammatory, in which we discover the greatest stabil- 
ity and succession of phenomena, and the maintenance of a 
definite character ; yet these may have some anomalies. 
The circulation at the access soon becomes more equally es- 
tablished, and it is now maintained by a force that saves the 
depressions, and retrocessions of action from the circumfer- 
ence to the central tissues ; which event when occurring, 
is liable to produce, not only a new, but a dangerous train 
of phenomena. 
6. In Typhus Gravior. 
If we turn our attention to the fevers called adynamic, ty- 
phoid, or malignant, we may discover far more irregularity 
than in any other aspect of the diseased habit. It is in these 
higher grades that the eccentric phenomena gave origin to the 
term ataxia. They are represented as presenting a continual 
aberration of character, both as respects the phenomena of 
mind, and of the organism. In some, the sensibility is 
highly exalted, and in the same individual in a short time as 
greatly diminished. Indeed, all the phenomena proceed in a 
manner very incoherent. At one time great coldness, and 312 
ANOMALOUS STATES. 
again intense heat on the surface generally. Soon, again, 
great heat in one section of the body, whilst there is a torpor 
of function and coldness in some other. Sometimes pain in 
the extreme, and soon followed by insupportable faintness ; 
pulse variable, often small and frequent, as in spotted fever, 
and liable to a complete acrotismus. We need not repeat all 
the phenomena ; we refer only to a few, as illustrations of the 
anomalies ; whilst the particular disease is progressing with a 
fixed location in some part, often in the encephalon, with a 
destructive tendency. 
The epithets, asthenia, adynamia, often bestowed on 
this order of fevers, ought not to influence the treatment. 
The high state of sensibility, and excessive vascular stimula- 
tions, must soon be moderated by a sedative treatment, or 
the case is lost, and perhaps immediately. Diffusible, and 
evanescent stimuli, with the aid of caloric externally to excite 
the absorptions, are indispensable. Correct treatment may 
soon harmonize the dissevered catenations of action, and the 
disease may then proceed with a regular train of events. It 
was these aberrations, and mutations, which led Van Del- 
mont to the suggestion of an Ar chews traversing the internal 
organs in disease. 
7. By Typhus Mitior. 
In the instance of low typhus, there exists, also, a nosody- 
namic force, which impedes the capillary circulations. A 
very constant tendency to coldness on the surface with plen- 
tiful congestions in the internal tissues of the head, abdomen, 
or thorax ; mostly in one or other of the two former cavities ; 
yet, always predominating in one of them. There may occa- 
sionally be heat on some parts of the surface, but there will 
be at the onset a prevailing disparity between the external 
and internal surfaces ; with many fugitive phenomena liable to 
deceive, and yet not essentially connected with the identical OUTLINES OF PATHOLOGY. 
313 
character of the disease, and succession of cause and 
sequence going forward. 
In this, and many other modified habits of disease, the 
most important desideratum is, to obtain a more equal capil- 
lary circulation, with an especial effort to excite the venous 
absorptions. No essential impression can be made to mod- 
erate, or arrest the force of the disease until this is effected, 
nor will it assume its own proper train of phenomena. From 
want of attention to this circumstance at the onset, the dis- 
ease will continue intractable, and opportunity often afforded 
for the interference of empirics ; who, by even an unad- 
visable method of sweating, have often rendered essential 
relief. 
8. By Rheumatism and Gout. 
These often afford illutrations of our thesis. The former 
possess something of an identity of character, like sthenic 
fever ; whilst the latter, in a habit of more exalted sensibility, 
presents a protean aspect, representing many of the most for- 
midable affections. Whilst the local concentration is steadily 
fixed in the arthritic tissues, it exhibits a regular series of 
sequences. No sooner has it migrated to some of the indis- 
pensable internal organs, than we discover a terrific train of 
anomalies which, if not suppressed, may directly prove fatal. 
9. By Cholera. 
In epidemic cholera we perceive an emphatic specimen of 
the ataxic state of disease. Whilst an universal nosodynamic 
condition confines the capillary circulation, there exists an 
aberration of organic sensibility, and the phenomena proceed 
with great incoherency. This is the only dangerous state of 
the disease ; when disrobed of these spasmodic perturba- 
tions, it pursues a regular course of cause and sequence, and 314 
ANOMALIES. 
not of the most dangerous character. It might, perhaps, be 
insisted on, that these intense phenomena -so constantly oc- 
curring at the onset, do actually constitute a part of the char- 
acter of this intractable disease ; yet, they do not constantly 
occur. 
It appears, that instead of the chief force of the strong 
morbid habit concentrating on the encephalic organs, as in 
typhus gravior, it accumulates on the system of the nutritive 
nerves, and of course their subordinate organs. Whilst some 
are fixed in spastic rigidity, others act impetuously, yet very 
incoherently. The capillary circulation stops at the origins 
of the venous radicles, and a great part of the force of local 
tendencies appears to concentrate on the exhalants both of 
the digestive mucous tissue, and the dermoid, by which they 
pour out a torrent of serosity; whilst the nervous system of 
external relation, with its organs, is but little disturbed. Sup- 
pose the morbid concentrations to have been to the head, it 
would have been a case of ataxic fever. 
As the sanguineous capillaries act but little in the intimate 
tissues, there will of course be a deficiency of vital heat, with 
an altered aspect. However, we cannot, in mere illustrations 
of a particular thesis, enter into the pathological minutiae of 
isolated diseases ; they will be noticed in their places. We 
only contend for the existence of a general morbid habit, at- 
tended with anomalous phenomena, not always essential to 
the disease, nor do they develop its true character. OUTLINES OF PATHOLOGY. 
315 
SECTION XXIII. 
REACTION. 
What should be understood by the Conservative, and Recupu- 
rative Powers of the System 9 
Every animated being possesses properties, and certain 
abilities of self-preservation, of seeking good and avoiding 
evil, or threatened injuries, and of resisting them when 
present. This property is confided to the nervous appara- 
tuses. It will therefore be considered under the two divi- 
sions of the nervous systems of external and internal relation. 
1. Conservative Power of External Relation. 
The organs of sensation act as sentinels to advertise the ap- 
proach of evil, and guard the subject from injury. Every article 
of food and condiment is examined before use ; and so of other 
circumstances. If any tangible substance is unpleasant, or 
hurtful, it is removed or avoided as far as ability permits. 
Personal assaults are indignantly repelled. These facts are 
mentioned merely to show the existence of such a property. 
2. Conservative Power of Internal Relation. 
It ought not to be denied, that the internal sensations often 
recognise injurious impressions, and that resistance is made 
to avoid them ; and when admitted into the system, to expel 
them. We have noticed this property in Sect. v. -11, under 
the appellation of instinctive susceptibility. It is a property 
always present and active in different degrees. If any iritat- 
ing substances affect the glottis, a train of involuntary asso- 
ciate motions is excited for their removal, by coughing. So 
of offensive substances in the stomach, by vomiting, di- 
arrhoea, &c. 316 
REACTION. 
But, it may be said, all these irritations affect the nerves of 
external relation distributed on internal surfaces. Notwith- 
standing the nutritive tissues have their appetencies and aver- 
sions, they refuse many substances of an offensive character 
by absorption. If deceived, and irritating materials become 
absorbed, an excitation, either general or local, in the organs 
is raised to expel them. So all medicines that enter by ab- 
sorption, and excite particular organs specifically, do act. 
So also of the causes of disease which may enter by absorp- 
tion. 
It may be said that certain morbid agents alter the internal 
tissues, and without any extraneous substances being added. 
Nevertheless, there is an embarrassment of function in such 
instances, or obstacles to a free circulation ; and even these 
act as stimuli. So stimulations are applied to the most inti- 
mate tissues in an indirect manner, and these affecting the 
instinctive susceptibility of such tissues, excite inordinate 
action for their removal ; and this may be shown by experi- 
ments, as clearly as that muscles contract when irritated. It 
is this kind of derangement in circulatory tissues which ex- 
cites morbid action, or the restorative processes, or respond- 
ing action. 
We discover, hence, a resisting and repelling force in vital 
tissues, and this was long since properly enough called the 
vis conservatrix, et medicatrix natures. The term is signifi- 
cant, and synonymous with recuperative power, the efforts of 
nature, and sometimes simply nature. This very repulsive 
effort constitutes the reaction of medical writers, and is man- 
ifest in all the phenomena of disease. No removal of disease 
can ever take place without it, and the chief object of the 
practitioner ought to be, to guide and assist it. 
Having progressed thus far, it appears expedient to bestow 
some attention to the causes of disease, and this will engage 
our attention for a time. OUTLINES OF PATHOLOGY. 
317 
SECTION XXIV. 
ETIOLOGY, OR PATHOGENY. 
1. Preliminary Remarks. 
However difficult this subject may be, yet it must be 
approached ; for none other in the round of medical inquiries 
is more interesting to the community, as well as to medical 
men. Here, again, the labors of the profession have been so 
ill directed, that but small advancement has been compara- 
tively made in etiological researches. However, notwith- 
standing the immense expense and loss of time in establishing 
quarantines, in the founding cordons to fence against aerial 
afflatus, and the exploring ideal miasmata ; yet we are not 
fully prepared to. accord with an elegant writer in saying, 
" the laborers in this fertile field of inquiry have reaped little 
more, than if they had been tilling the sands of Africa, or 
ploughing the watery ocean." * 
Hypothetical notions have too much engrossed attention, 
whilst common sense and plain matter of fact have been seated 
in the back ground. We do believe that some precision 
may be attained in relation to many topics of the causation of 
disease, and some advances may be made in the investiga- 
tion of the more secret sources of the pestilence that stalks 
in silence through the broad atmosphere, and inflicts unseen 
lesions in the hidden tissues, as well as the more manifest 
ledantia. But, still, we must accord with Dr Abercrombie, 
that u it is one of the most difficult topics that can engage the 
attention of the medical inquirer." Dr Sydenham remark- 
ed, " were the attention of medical men directed as much to 
the prevention as the cure of diseases, many of those devia- 
tions from the healthy condition, now considered as the 
opprobria of our art, would be prevented." 
* Dr J. Johnson. 318 
ETIOLOGY. 
However, the subject of causation is of more importance 
antecedently, and the being enabled to avoid the ledantia, 
than in the treatment of the diseases arising therefrom. The 
diagnosis of each particular case must indicate the treatment, 
let the agents be what they may which produced it. We 
find similar states of the system existing when induced by 
very different causes, and the treatment must be in accord- 
ance with the intensity of these, and as developed by the 
phenomena. For instance, when called to treat a case of 
narcotism, it would be about the same whether produced by 
alcohol or opium, notwithstanding one case might be inclined 
to be more persistive than the other. A phlogistic diathesis 
inquires a certain amount of remedies, by whatever cause 
produced. 
So, also, from the same variolous virus, one case may be 
distinct small pox, and the other confluent. Remedies ought 
to be employed to suit each individual state. Again, epi- 
demics are often ushered forth suddenly when no one can 
demonstrate the cause ; yet, the phenomena immediately 
reveal the character of the affection, and indicate the treat- 
ment. So, correct views of the pathology of disease gener- 
ally, may, in a great measure obviate the defects of precision 
in relation to their remote causes. Yet the primary physio- 
logical changes, which we call the primary cause, require the 
utmost vigilance, as well as the secondary ; for when disease 
stands in close relation with a structural lesion, it demands 
severe investigation. It is, however, at all times, especially 
as relates to chronic diseases, desirable to know the causes, 
and to ascertain the physical changes wrought in the tissues 
by them. 
DIVISION OF CAUSES. 
The subject of pathogeny will be divided into three orders 
of causation. OUTLINES OF PATHOLOGY. 
319 
a. Remote causes. 
I 
b. Exciting causes. 
c. Primary cause. 
a. The remote causes have often been styled predisponent, 
and on the belief that they effect certain changes in the fluids 
and in the vital tissues, rendering them more than ordinarily 
susceptible of morbid excitations ; and when disease is ex- 
cited, and actually exists, they afford a specific tendency to 
affect particular tissues, and in a peculiar manner. There 
are, also, many personal circumstances, or idiosyncrasies, 
which act as remote, or predisponent causes. 
b. The exciting causes are such as produce some pertur- 
bation, or sudden change in the system generally, or in some 
particular part harmonizing with ' the whole ; by which a 
change of vital force and of function is produced. This ex- 
citation of disease is more readily brought about in a subject 
already predisposed, than in one free from such a state. A 
change more or less persistive is produced in the intimate 
tissues, and a morbid habit established. 
c. The primary cause, as already intimated, is the first 
change made in the tissues by the preceding causes, altering 
their susceptibility, and the harmony of their functions. It 
constitutes the first link in the catenation of changes establish- 
ing the morbid habit. It becomes, therefore, the exclusive 
subject of pathology, and will not require any further atten- 
tion in the present subject of causation. 
2. Remarks on Remote, and Exciting Causes. 
Our review then will be confined to the simple divisions of 
remote and exciting causes. However, these subjects can- 
not be viewed in a strictly isolated manner ; for in many in- 
stances it will be difficult to make the distinction. It might 
be contended, that in many instances, the remote cause may 
produce disease without any direct exciting circumstances, as 320 
ETIOLOGY. 
in the instance of the acknowledged contagions and infections. 
It may be immaterial whether the virus be considered a re- 
mote, or an exciting cause ; yet, it is certain that it acts most 
energetically on a predisposed habit. It is further argued 
by some, that influenza, dysentery, pneumonia, spotted fever, 
typhus, cholera, &c., seize their objects without any inter- 
vening circumstances to light up disease, as exciting causes. 
On the other hand, it is contended, that all the wide 
spreading diseases do require an exciting cause to bring them 
into action, by the formation of a morbid habit; that the 
state of predisposition may be so intense as for disease to be 
produced by an intervening exciting cause not very appre- 
ciable, or not heeded, from inattention ;-and as confirma- 
tory of this position, reference is made to the fact, that many 
have escaped the prevailing disease by a strict regard to pre- 
cision in avoiding all the extraneous circumstances, which 
may affect the economy of the system, or such as may be 
esteemed exciting causes. 
It may further be noticed, that many of the exciting 
causes, by being slowly applied, but repeated, may produce 
a state of predisposition, like other remote causes, and in 
their turn become.exciting causes also. So watching, fatigue, 
surfeiting, alcohol, cold, heat, &c., by being repeated, create 
an increase of sensibility in the tissues, with an almost im- 
perceptible alteration of function. On a further exposure, 
these same agents might excite severe disease, without any 
remote atmospheric afflatus, but more certainly when this ex- 
ists. So heat and cold, by frequent alternations, often pro- 
duce disease, and sometimes oh a first exposure. The limits 
between remote and exciting causes are. therefore, difficult 
to be defined, although there is a manifest distinction, in many 
instances. 
Finally, it appears quite certain, that all epidemic diseases, 
and many chronic, are lighted up, and assume their peculiar 
livery, by some exciting cause, by which the nosodynamic OUTLINES OF PATHOLOGY. 
321 
state becomes fixed ; and yet, the excitation may be slight, 
as in the instance of cholera instantly seizing a subject on 
rising from bed, and stepping on to a cold floor. 
3. The Causes of Disease act by Incompatible Stimulations. 
In some former sections, allusions have been made to the 
thesis, that all the causes of disease, strictly speaking, are ex- 
citants ; or, that they consist of agents producing an incom- 
patible stimulation. It is the same both with remote and ex- 
citing causes. Although there be many circumstances which 
may produce an abstraction of vital force by withholding its 
supply ; or by sudden excess of stimulation, deprive the tis- 
sues of their ability of rendering it a suitable residence ; yet, 
these cases can hardly be styled disease, although they may 
have a place in nosographic descriptions. 
There are many instances which occur in devastating epi- 
demics, in which there are primary morbid changes in the 
tissues quite intense ; these are sometimes so severe, that the 
usual exciting causes extinguish life before the phenomena of 
disease become developed. The subjects appear to die from 
want of stimuli, whereas death occurs from excess of stimula- 
tion ; and indeed the effect is not very dissimilar on the tis- 
sues from that which occurs on taking a pint of rum at once ; 
or, the tonicity induced on drinking cold water when the sys- 
tem is excited by heat. If it should be granted that one 
ounce of alcohol is an excitant, it must be very perverse logic 
to infer that half a pint is a debilitant. Further proofs will 
be advanced when treating of the exciting causes. 322 
ETIOLOGY. 
SECTION XXV. 
FIRST DIVISION. 
ETIOLOGY. 
L Remote Causations. 
In this division we shall make some reflections, 
1st. On the general atmospheric Pestilent Afflatus. 
2d. On the local atmospheric contaminations. 
a, Sensible, 
by Insensible. 
3d. On the influences of climate. 
4th. On Idiosyncrasies. 
5th. On Aliment. 
6th. On Exercise. 
7th. On Clothing. 
8th. On Alcohol, and other Narcotics. 
9th. On Mineral Poisons. 
10th. On Intense Thought. 
These are copious topics, and require much in detail ; we 
can do but little more than point out the method, as is hoped, 
in which they ought to be studied. 
1st. On the general Atmospheric, Pestilent Afflatus. 
1. Remarks. 
The history of diseases from the remotest period, even 
down to the present time, affords sufficient evidence of the 
prevalence of severe diseases at particular seasons, and far 
exceeding the ordinary amount. These periods continue 
sometimes several years, involving different countries and lat- 
itudes, or their inhabitants, more or less, in severe calamities. 
In some cities nearly half the population has been swept off 
in a short time, by one form of disease, whilst another modi- 
fication, under some other name, rages in another district with OUTLINES OF PATHOLOGY. 
323 
nearly equal severity; the loss may be one in ten, or one in 
three of the inhabitants. Man knows not where to flee for 
safety ; nor can he escape its presence ; for as the poet has 
expressed it, " a secret venom oft corrupts the air, the wrater, 
and the land." 
2. Its Extensiveness and Effects. 
There have been seasons when the vegetable productions 
were blighted with mildews by some secret taint; and al- 
though luxuriant, yielded but little fruit for the sustenance of 
man ; when likewise, the beasts of the earth, and fishes of the 
sea sickened and died. At the same time, or in quick suc- 
cession, an invisible something seizes on the bodies of men ; 
they also sicken and are laid prostrate, and whole communi- 
ties are filled with dismay. The picture is well portrayed by 
our medical poet Dr J. Armstrong, and ought to be pre- 
served. 
' Of every hope, deprived, 
Fatigued with vain resources, and subdued 
With woes resistless, and enfeebling fear ; 
Passive they sunk beneath the mighty blow. 
Nothing but lamentable sounds were heard, 
Nor aught was seen but ghastly views of death. 
3. Ingenerate Origin. 
The question has arisen amongst philosophers, what is the 
medium that sustains this noxious agent, and from whence did 
it arise? There are some facts, and much analogy in favor of 
its aerial existence ; and this was the sentiment of the most 
ancient, as well as the modern pathogenists. But from whence 
it came, and what its entity consisted of, has been a subject 
of speculation and hypothesis ; it has escaped every scrutiny, 
and every test. It received different appellations as the wri- 
ter's modified views of its character dictated. Hippocrates 
called it to thion, or divine essence. Diemerbroeck styled it 324 
ETIOLOGY. 
pestilential germ. Sydenham referred it to certain occult 
qualities in the atmosphere ; whilst Rush and others, denom- 
inated it an inflammatory constitution of the air; The Arabs 
in allusion to the same thing as producing the cholera, call it 
El Haiva, the wind, or blast that passes. Or it may be styled 
a pestilent afflatus. 
We will chiefly contend for the fact, that certain periods, 
embracing from three to ten years, or more, occasionally 
occur, in which destructive diseases prevail, and that there 
exists the strongest presumption of a wide spread contami- 
nating influence in the common air, affecting the fluids, and 
vital susceptibility of all organized compositions, more or 
less ; but, from what physical influences it arises, is yet a 
matter of conjecture. We know not much more, or differ- 
ent from the allusion of the Psalmist, when he spoke of " the 
pestilence that walketh in darkness, and the destruction that 
wasteth at noon day." Dr N. Webster has compiled a very 
useful epitome of medical history, in which he endeavors to 
establish a coincidence, and dependence of pestilent diseases 
on planetary influences, in connection with the agency of 
electricity. On a former occasion,* we were inclined to 
advocate the thesis ; but on further reflection have grown 
more sceptical. From whatever source it may have an origin, 
it must be very extensive, as it embraces a wide range of 
aerial surface. 
In Section vi. 5, a suggestion was made, with a view of 
exciting further inquiry, that an excess of vegetative life per- 
vading the atmosphere might, by undue stimulation, affect 
organized beings. On the thesis of an all pervading vital 
aura, Sect. vi. 6, this suggestion is raised ; and on the facts, 
that during the pestilent periods, and in districts suffering 
most, there is an excess of vegetative and animal life ; that 
myriads of insects and reptiles appear ; that the intellects of 
men are elevated, even to a degree of impassioned ardor. 
* Sketches of Epidemic Diseases in the State of Vermont. OUTLINES OF-.PATHOLOGY. 
325 
and too often attended with broils and wars ; that the procrea- 
tive powers are increased ; and finally, that the entire organ- 
ism shows signs of a more than ordinary state of excitation.* 
The effect has commonly been assigned as the cause, in the 
hypothesis of decaying vegetables, and putrefying animals 
contaminating the air ; whereas it is far more probable, that 
the same cause, which affords an undue increase of vegetable 
and animal life, may stimulate the living system to excess of 
action, and excite disease in some form. However, there is 
a great weight of testimony to show, that the decomposition 
of vegetables or animals does not excite disease, notwith- 
standing so much has been advanced on the hypothesis. 
Sickness- often follows great scarcity of vegetation ; and 
again, a luxuriance accompanies, and follows severe epidemic 
diseases. 
A considerable number of facts are put together by Pro- 
fesssor Chapman, in an essay on the causes, &c. of epidem- 
ics ; Phil. Jour. Med. Sciences, Mo. 18 ; which go to show 
very satisfactorily, that the effluvia of decomposing animal 
bodies do not produce disease, and nothing more than some- 
times a temporary commotion. In the same work also, many 
facts are stated, showing an increase, and decay of numerous 
animals, of the lower classes, in seasons of devastating sick- 
ness. We may remark, that shallow waters have much albu- 
men, and are filled with various kinds of vermin He also 
makes this pertinent remark, in a casual manner ; " It seems to 
me a much more rational conclusion ; that this unusual fecun- 
dity is owing to the state of things of which epidemics are 
the effect." And further mentions the fact as occurring in 
yellow fever, of " the black vomit being found, during the 
life of the patient, so filled with animalcula as essentially to 
constitute that fluid." For a still more extensive collection 
of facts on these interesting topics, Dr Webster's valuable 
*See Tytler on the Plague. 326 
ETIOLOGY. 
work on pestilence, may be consulted with great advan- 
tage. 
We shall not urge this subject at present ; but, if it be 
true, that there is an all pervading vital aura, which sustains 
the immensity of organized beings, (Sect. iv. 6,) we may by 
analogy assent to the suggestion of conditions of excess, or 
certain concentrations like galvanism, and the manegtic aura ; 
and in such an event, it may no doubt spur to excess the 
living tissues, producing disease ; and, also, cause the ocean, 
earth, and air to teem with life prolific, bringing into existence 
myriads of ephemera to flutter in the sunbeams, and stay just 
long enough to declare their Maker's power. 
4. Modifications of Remote Influences. 
Whatever may be the ingenerate cause which gives origin to 
the pestilent afflatus, it is very extensively diffused; and 
also, in different periods, seems to possess some new modi- 
fications. It will not be contended but that local causes may 
produce some variations in its character and severity, yet we 
perceive it is quite persistive in its character for a time. For 
example, influenza and cholera retain their character in every 
clime through the habitable world, whether on high or low 
situations ; although there may be some difference in their 
severity at the access, height, or decline of the morbid 
period. Whilst the pestilent afflatus is very intense, the par- 
ticular habit of the prevailing disease will sternly maintain its 
influence, to the exclusion of almost every other form of epi- 
demic disease ; and it is an ancient remark, that even chronic 
diseases assume something of its peculiar livery. 
However, this persistency of character does not usually last 
for a great length of time before certain mutations take place ; 
although it seems the late cholera afflatus might be a singular 
exception. It is far more common for one habit of disease 
to follow some other in succession during the pestilent period. OUTLINES OF PATHOLOGY. 
327 
For instance, the spotted fever in the winter of 1810-11, in 
the Northern States, was changed in the winter of 1811-12 
to wide spreading, and destructive pneumonia. The change 
was not uniform, however ; for as the diseases spread from 
north to south, there was occasionally one disease in one 
section, and the other in another, in a very irregular manner. 
In the course of a year or two after, they visited the South- 
ern States, producing diseases of a modified character. This 
pestilent period continued about five years, and during this 
time, various other habits of disease prevailed, more or less 
uncommonly, in different parts of the civilized world. 
The pestilent afflatus by altering the organic sensibility of 
the tissues, predisposes them to be more easily wrought upon 
by adventitious exciting causes. And furthermore, it always 
affects some one tissue more than the rest of the tissues ; 
and such affected tissue becomes the focal concentration of 
the particular disease, as soon as the morbid habit is formed. 
So almost every affection in epidemic periods possesses a 
similarity of character and phenomena. But, an inexplicable 
change may take place, and some other tissue may suffer a 
similar change, and in this event another form of disease may 
appear with o'ther phenomena, and receive some other name. 
History informs us that malignant typhus often precedes the 
plague ; that pneumonia occasionally follows influenza, scarla- 
tina, and spotted fever in quick succession ; and yellow fever 
again stands in close relation with bilious remittent fever. 
Many other facts might be brought to show, that all epidemic 
diseases possess a kind of affinity, however modified by 
circumstances. 
There are noticed, again, other modifications, which also 
admit of no explanation ; only from the sequence we infer 
some change of properties suited to idiosyncrasies. Although 
in certain seasons no class of people are exempted from the 
morbid impression ; yet there are other times in which par- 
ticular classes are affected, whilst others escape. The spot- 328 
ETIOLOGY. 
ted fever in New England in 1811, chiefly affected children 
under twelve years of age, and young women ; whilst in 1812, 
the pneumonia principally seized on the most robust, middle- 
aged males. In some epidemics the blacks are exempted, 
and on other occasions they have been affected, to the exclu- 
sion of all others. Sometimes different families in relation- 
ship, although remotely situated. And again, particular nations 
are sometimes affected, to the exclusion of all others ; as 
described by our medical poet, in relation to the destructive 
sudor Anglicus of England, at about the end of the fifteenth 
century. | 
It seemed the general air, 
From pole to pole, from atlas to the east, 
Was then at enmity with English blood; 
For, but the race of England, all were safe 
In foreign climes ; nor did this fury taste 
The foreign blood which England then contained. 
5. Reiteration of Aerial Diseases. 
Diseases of aerial origin may be repeated in the same indi- 
vidual as many times as he may be under similar circumstan- 
ces to receive an impression. The disease is never.commu- 
nicated from one subject to another. Thus, the influenza, 
plague, yellow fever, spotted fever, pneumonia, cholera, 
typhus, dysentery, scarlatina, intermittents, with all the dis- 
eases which have received names from the places they seem 
to originate in, ate liable to afiect the same subject at other 
periods, and even during the same period of sickness ; being 
liable also to relapses. Notwithstanding, a subject who has 
passed entirely through any of this class of diseases, is not so 
liable to them again as another, because he does not so 
readily again obtain a predisposition to light them up. These 
facts distinguish all epidemic diseases, or those of aerial origin, 
from those dependent on a specific virus. In these instances OUTLINES OF PATHOLOGY. 
329 
the disease is communicable, and the subject can have it but 
once, and he is not liable to relapses, although he may be to 
aggravations. These last, as the small pox, measles, whoop- 
ing-cough, kine pox, &c., are the only self-limited diseases ; 
and they are subject to so many modifications, that they are 
scarcely deserving the appellation. When the general atmos- 
pheric afflatus is present, the diseases of this order prevail 
more readily, and with greater severity. 
6. Remarks on the late Cholera Afflatus. 
A brief review of the late epidemic may afford some 
instruction on aerial influences, as it seems to be the most ex- 
tensive, persistive, and destructive of any on record. It first 
appeared in Asia, and extensively in the region of the Gan- 
getic Delta, in 1817 ; a country where it had for ages been 
known to be endemic. It appears now to have arisen with 
some new modifications of severity, and as if its source was 
inexhaustible. Our geographical allusions are intended more' 
for atmospheric than for terrestrial boundaries. Reference 
may be had to various official reports from India of its extent 
and ravages. We can only remark, that it passed in all direc- 
tions, but its principal line of march was from east to west. 
Its devastations have reached from 20 degrees south latitude 
from the equator, to 65 degrees of north latitude, and more 
than 100 degrees of longitude, before making its transit over 
the Atlantic ocean. 
The particular routes of this destroyer of life have been 
quite irregular, but it progressed on an average about three 
or four miles a day westwardly. It has stopped and retro- 
graded in its course ; escaping some villages, whilst it revisited 
other cities, and at an unexpected time suddenly seizing on 
the favored ones ; this is common to other epidemics. Its 
stay at different places was quite various, sometimes a few 
months, at others only a few weeks ; yet hovering about, and 330 
ETIOLOGY. 
occasionally becoming more aggravated. It loitered several 
years near the confines of Europe, and at length, as if it had 
gathered strength, in 1829 entered, visiting even the cold re- 
gions of Russia in summer and winter. In 1830 it reached 
England, Scotland, and made solemn progress in the south 
of all Europe. Before it bestrode the Atlantic, the most 
careful estimates of its victims amounted to fifty millions. 
The people of this western continent rested securely in the 
protection of the waters of the wide Atlantic. But, to us it 
appeared a frail barrier. In March, 1832, in an introductory 
lecture, the following sentiment was announced : " Even 
England, with her high oxygenated atmosphere, is not pro- 
tected from pestiferous blasts. The cholera at this very 
moment proves, that science has not purged the atmosphere 
of malignant taints ; it stalks triumphantly through every 
clime, and bends its proud steps towards the setting sun ; 
decides the fate of battles, and too often defies the tardy use 
of medicine. Shall we claim protection from its embrace, 
either from our physical condition or our moral graces ? 
Nothing short of Almighty clemency can shield us. This 
region has already experienced desolating sickness ; a new 
combustion of atmospheric gases might again light up the 
torch of pestilence ; in which event we might become the 
actors of other scenes and other times, as depicted by an 
elegant historian : 
Dire was the tossing, deep the groans; despair 
Tended the sick, busied from couch to couch; 
And over all death shook his cruel dart " 
On the 8th and 9th of June following, (1832,) the Asiatic 
Cholera, as it has been called, showed its frightful aspect at 
Quebec ; fifteen sickened, and seven died on the ninth ; 
some of these were emigrants just arrived, and some were 
citizens. The belief of its communication from one person 
to another, by those who knew not its character, excited OUTLINES OF PATHOLOGY. 
331 
great alarm, as it had done wherever it had appeared. Its 
rapid spread to Montreal, New York, Detroit, the great 
West, and South, and even South America, cannot be de- 
tailed here, but may be learned from many excellent treatises 
written by American physicians. Finally, the cholera 
afflatus in a period of about seventeen years, had nearly em- 
braced every section of the earth, destroying people of 
different temperaments and habits. lit 1835 it still loitered 
in many places, but was not so severe. 
One fact in connexion with the first appearance of the 
cholera on the American shore ought not to be omitted ; 
which is, that there was an easterly or north-easterly wind, 
which prevailed very constantly for four weeks previous to 
the 11th of June, 1832, when it ceased. There was an 
almost continued dripping, and it might be called a rainy sea- 
son, together with a degree of coldness which threatened to 
blight the prospects of agriculture. Surely the coincidence 
of so long continued wind, and the immediate appearance of 
the cholera, are worthy of notice. 
There appear to be numerous circumstances which fa- 
vored the progress of the disease in particular places, and 
amongst particular classes of people, which cannot be noticed 
now. Notwithstanding it followed the low courses of fresh 
water, and seized on the profligate and enervated, yet after- 
wards it did visit high and dry regions, and affect the most 
healthy and circumspect part of society. The local and 
exciting circumstances will be considered in their places ; 
but none of these can produce the disease without the pre- 
disponent pestilent afflatus. 332 
ETIOLOGY. 
SECTION XXVI. 
ETIOLOGY- CONTINUED. 
2d. On the Local Atmospheric Contaminations. 
Our reflections on this subject will lead to some inquiries 
directed to ascertain,how far vegetable and animal decompo- 
sitions, separate or combined, affect the bodies of mankind, 
and produce disease. It will be necessary to consider, 
a, Sensible effluvia, 
6, Insensible effluvia, or miasm. 
With regard to the first, the prima facie evidence gives 
forcible impressions of a noxious agency, which, by coming 
in contact with the living system, might produce disease ; 
and therefore the stench of putrefying vegetable and animal 
substances has been viewed with horror, and avoided as far 
as possible ; and the belief of its contaminating power has 
been formerly sanctioned by the faculty very generally. But, 
of late the subject has undergone a severe investigation, and 
the result is, that however offensive the floating gases of de- 
compositions may be to the olfactory sensation, and although 
they may occasionally be attended with syncope, vomiting, 
and even fatal asphyxia, yet they are in no appreciable man- 
ner productive of disease, or the formation of the morbid 
habit. Their influence is chiefly on the nerves of external 
relation, and evanescent. 
Nothing is more common than to read of the corruption of 
the bodies of the slain in battle producing, as was supposed, 
the plague, dysenteries, and other malignant diseases, when 
they depended on other coincidental circumstances. The 
most destructive diseases have prevailed, when their origin 
could not be imputed to the decomposition of organized sub- 
stances ; and again, where these processes have been going 
on in great profusion, there is no evidence of their occasioning OUTLINES OF PATHOLOGF. 
333 
the prevalence of disease in any form. They may exist in 
abundance without being accompanied by disease. 
2. Instances as Proofs. 
In support of this last proposition, we will briefly advert to 
a few out of many facts which might be presented. 
a. In all parts of our own country, as well as in others, 
there are numerous slaughter-houses ; and at every such 
place there arises a stench very offensive to those not accus- 
tomed to it ; and yet, the people engaged in the work, or 
visitors, are not made sick by it ; and it is even confidently 
asserted, that those people are not so likely to be affected as 
others when sickness prevails.* 
h. In the anatomical dissecting rooms, now numerous even 
in this country, and greatly multiplied in Europe, no disease 
has ever been assigned as originating from them, although it 
had ever been supposed, that decompositions of human organi- 
zation afforded the most noxious effluvia. 
c. In every farmer's barn-yard, in the country, in every 
house-yard, also, in villages and cities, there is usually going 
on decomposition in the warm seasons of the year, and often 
the effluvia are very offensive, and yet no disease prevails, 
perhaps, in six years out of seven ; but, if there should be 
disease, how familiar it is to refer it to these disgusting gases ? 
Thes6 offensive gaseous productions are chiefly hydrogen, 
sulphureted and carbureted hydrogen, ammonia, and carbonic 
acid gas ; none of which, separate or combined, ever pro 
duce a pyrectic habit, even where greatly evolved in chemi- 
cal processes. 
* Dr W. F. Edwards, "On the Influence of physical agents on Life, p. 
186, Phil. Edit, states, that at Montfaucon, in one of the greatest slaughter- 
ing establishments of horses, dogs, cats, &c. in the environs of Paris, " that 
the cholera affected scarcely any of the workmen." Also, by the advice of 
M. Diwhatelet, that the workmen and their families, " are in general re^ 
markably healthy." 334 
ETIOLOGY. 
d. During the impulse of national fervor that afflicted 
revolutionary France, the existing powers authorized the 
breaking up of the graves of the ancient sovereigns in St. 
Dennis, as a kind of revengeful insult. It is represented by 
Mr Howard, that there arose from the tombs a thick dark 
vapor, extremely offensive, which produced sudden depres- 
sion, and even fatal asphyxia in some of the wretches engaged 
in it, but no defined pyrectic disease ensued. All these 
kinds of gases impress the nervous system of external rela- 
tion, without very essentially affecting the great system of 
nutrition, the seat of disease. (Sect. xvi. 3.) 
e. Another instance has often been alluded to by etiologists, 
as occurring at Paris, and published by M. Thoset, in the 
Journ. de Physique, 1791.* It consisted in the removal of 
the cemetery of St. Innocens, which covered about two acres 
of ground in the centre of the city, estimated to contain six 
hundred thousand bodies, which had been accumulating for 
six centuries ; it occupied two years in removing it. The 
stench was quite insupportable, and often the mephitic vapors 
affected some of the laborers with dizziness, syncope, tre- 
mors, and even asphyxia, yet no fever occurred, nor any 
endemic prevailed. 
f. Other instances of the removal of cemeteries might be 
mentioned, and with similar results ; and also, we might take 
into the account the manufactories of animal substances as 
the making of adipocire, candles, soap, &c. The extensive 
fisheries also ; foul wharves, giving out complicated and dis- 
gusting effluvia, might be adverted to, and every reference 
would only confirm the fact, that neither endemic nor epide- 
mic disease, has ever been shown to be generated by them, 
and that these gases exist in full profusion during the most 
healthy periods. Professor Chapman has done a service to 
medicine, in collecting many facts to support the thesis in 
his Thoughts on the Causes, Phenomena, and Laws of Epi- 
demics, &c. 
* Phil. Jour, of Med. and Phys. Science, No. 17, p. 376. OUTLINES OF PATHOLOGY. 
335 
Having a presentiment that the enlightened community of 
medicine will readily assent to the foregoing positions, this 
part of our subject may be relinquished, whilst we enter upon 
the other, and by far more laborious part. 
3. Insensible Effluvia, or Miasm. 
Within about the last half century, much time and labor 
have been spent in the investigation of the marsh miasmata, 
or malaria, as they have been called ; and so many ingenious 
writers have favored their existence, and their efficiency as a 
potent cause of numerous diseases, that it has become almost 
an established creed. The coincidence of solar heat, the 
sensible effluvia, and disease often occurring at the same 
time, were very imposing circumstances, and it is not sur- 
prising that investigations should have taken the turn they did. 
Yet, after it had been well proved that sensible effluvia 
never produce disease, still the tenaciousness of opinion has 
led very many to adhere to an inappreciable cause, a something 
still called by its. former name, which never has been demon- 
strated, or in any manner brought into a cognizable form, 
either by the efforts of chemistry, or the power of magnifiers, 
nor by legitimate effects. Every analysis of the air at the 
surface of the most suspected marshes differs not from 
that which is brought from the higher strata of the atmosphere. 
The extensive experience of Dr Ferguson seems to have 
taught him only to discard one half of the errors of common 
opinion ; for, whilst he disclaims the noxious influence of all 
sensible effluvia, he still favors the existence of an insensible 
malaria. He says, "I shall not multiply facts, and illustrations 
of the same kind to prove, that putrefaction, and the matter 
of disease are altogether distinct and independent elements."* 
However,we are not able to discover a single fact or illustration 
he has given to show a disease-producing cause, but what 
may fairly be explained by an appeal to other, and more man- 
* Phil. Jour. Med. & Phys. Sciences, No. 13, p. 9. 336 
ETIOLOGY. 
ifest circumstances. Had etiologists pursued the line of in- 
vestigation indicated by Hippocrates, Sydenham, Huxham, 
Mosely, and many other former coadjutors, they would 
have been better rewarded than tilling the sands of Africa, or 
even of Holland, Spain, or the West Indies ; as Dr Fergu- 
son, and many others seem to have done. 
4. Prefatory Exposition. 
It is true we have favored the existence of inappreciable, 
remote causes in the instance of the atmospheric afflatus ; 
but, here is no room for any other assignable cause, and the 
evidence of its existence nearly amounts to demonstration ; 
and the hypothesis has been sanctioned from the earliest to 
the latest records of medicine, and even without controversy. 
The hypothesis of an existing terrestrial miasm is of recent 
date ; it is altogether gratuitous, and not needed to explain 
any phenomenon in the history of causation. Whilst its ad- 
vocates have been driven from their first assumption of its 
manner of existence, they have advanced another mode less 
tenable than the first. 
Our instruction was in the school of the miasmatists, and 
we did not closely question the principle, until we had suffer- 
ed a committal both in public,* and private. Yet, on a thor- 
ough review, and a conviction of error, feel ready to abandon 
it, and take a pleasure in advocating what we consider as truth. 
5. Negative Suggestions. 
1. It will be difficult to expose our views of the causation 
of disease, until we have an opportunity to discuss many sub- 
jects before us ; we can now offer merely some negative 
suggestions to the existence of malaria. 
We make more particular reference to Dr Ferguson, be- 
cause, so far as we are instructed, he was the first that ap- 
* In Sketches of Epidemic Diseases, &c. OUTLINES OF PATHOLOGY. 
337 
peared in public, and before the Royal Society at Edin- 
burgh, in the early part of 1820, to advance the following 
sentiment of " vegetable and aqueous putrefaction -he 
says, " it is my intention in this paper to show from a narra- 
tive of facts, that they are unfounded, and that putrefaction, 
under any sensible or discoverable form is not essential to the 
production of pestiferous miasmata." " The marsh poison, 
is notwithstanding by far the most frequent and destructive 
source of fever to the human race."* It is not then any 
discoverable entity that produces disease, nothing that can in 
any manner be appreciated before hand ; but something that 
eludes the watchfulness of the nervous tissues of external re- 
lation, and not disturbing their functions, until secretly fasten- 
ing on the great system of the nutritive tissues, and like a 
poison paralyzing their functions. It may now merely be 
stated, that all the phenomena of the differently modified fe- 
vers may be accounted for without it. 
2. It is not a little curious to observe the discrepancies of 
opinion amongst the miasmatists of the properties of their 
supposed agent. Dr Ferguson represents it as possessing 
" an uncommon, and singular attraction for the earth's sur- 
face " it creeps along the ground and " the inhabit- 
ants of ground floors," are oftenest affected ; " that it is cer- 
tainly lost, and absorbed by passing over a small surface of 
water." In the same journalf Dr Chapman says, " the ex- 
periments of De Lisle show, independently of other evi- 
dence, their comparative levity."^ 
On the other hand many contend, that it can be wafted to 
a considerable distance ; and others to a great distance by 
winds, and still retain its noxious potency. In the 59th No. 
of the Edinburgh Review it is supposed to be transported in 
the air from Holland over the German ocean. " But the 
* Phil. Jour, of Med. & Phys. Sciences, No. 13, p. 2. 
1 Idem, No. 16, p. 374. 
t What experiments can show the character of inappreciable substances ? 338 
ETIOLOGY. 
east wind has the power of transporting it to a considerable 
distance, and we have but little doubt that whenever it occurs 
in this city, (Edinburgh,) where it now is rare, the poison is 
transported from Holland."* In 1811, a certain writer on 
the spotted fever then prevailing in the valley of the Connec- 
ticut river, gravely insisted, that the cause was a miasm, 
wafted by the north-west wind from the northern section of 
the state of New York, and in the month of February, whilst 
the earth was sealed in frost, and covered with snow. Oth- 
ers, again, state that its influence extends only to a few feet. 
c. But little less amusing are the sentiments of men of 
sober science on this grave subject. Dr Ferguson states his 
experience in South Holland, with the army, in 1794, on 
" a level plain of sand, with a perfectly dry surface, where 
no vegetation existed or could exist, but stunted heath plants. 
In digging, it was universally found to be percolated with 
water to within a few inches of the surface, which so far from 
being at all putrid, was perfectly potable in all the wells of 
the camp." This year there was severe sickness, because 
there had been "a very hot and dry summer." But, when 
he returned there in 1799, "with the army under the com- 
mand of the Duke of York, which remained the whole 
autumnal season in the most pestiferous portion of that un- 
healthy country, without suffering in any remarkable degree," 
the assigned reason is, it had been a rainy season, and cold. 
Now in this case the surface was kept wet, and not scorched 
by the sun reflecting intense heat. 
And further, "in 1810, a British army at Walcheren, on 
a soil as similar as possible, and certainly not more pestifer- 
ous, but under the different circumstances of a hot and dry 
preceding summer, instead of a wet and cold one, suffered 
from the endemic fever of the country to a degree that was 
nearly unprecedented in the annals of warfare." 
We do not doubt a single fact here stated, but the reasoning 
and inferences are insufferable. It seems the miasmatists to 
• Phil. Jour, of Med. & Phys. Sciences, No. 16, p. 374. OUTLINES OF PATHOLOGY. 
339 
make out their case, overlook the most obvious circumstances 
which are presented, as altogether insufficient to excite dis- 
ease, whilst they enlist such as never can be shown to exist. 
Is it possible for so powerful, and noxious an agent to be 
generated in a clean, dry, sandy soil, with pure water be- 
neath, and where no vegetation exists ? It is not even 
attempted to be explained in the present instance ; only the 
troops were sick, and died in multitudes, and nothing could 
be capable of doing so much, except an invisible, untangible, 
ghostly something ! This will be the fate of all armies, and 
even citizens until their attention shall be turned to look after 
the more obvious causes, and take precautions to avoid them. 
After being driven from the thesis of animal and vegetable 
putrefaction, they still do reverence to their imaginary idol, 
though not germinating from hay, wood, or stubble, or any 
thing else they have assigned as its origin. 
d. We can only here remark briefly, that the heat of a 
scorching sun on a plain surface of dry sand in a low level, 
must be very intense, although no notice is taken of it in 
the history. It could not be less than 80 or 100° Fah. 
Such a heat in any climate, alters every physiological func- 
tion of the system, and increases its sensibility to a high state 
of predisposition. Again, the contrast must be great between 
day and night on a soil filled with water just below the surface, 
and covered with sand, after some radiations have taken place. 
It is very common for the thermometer of Fah. to fall from 
90 to 60° at night. Add to this the great evaporations of 
moisture by day, and heavy dews by night, and we have 
cause enough, without due precautions, to destroy both the 
armies of Spain and Walcheren ; and without taking into the 
account the numerous irregularities of soldiers ; provided 
they are exposed to the dews and night air. And, farther, 
every medical observer must be aware, that these circum- 
stances have a sudden, as well as powerful, effect on predis- 
posed systems. 
e. Again, it is nothing remarkable, that the steady wet 340 
ETIOLOGY. 
weather in such a climate as Holland, in 1799, should be 
called healthy. The sun is obscured a part of the time, and 
when clear the earth is not heated, but moist and cool. The 
contrast between day and night is not great; the inhabitants 
have not suffered extremes, nor sudden alternations of heat 
and cold. But, it has always been noticed, that the setting 
in of a cold, rainy season, after a hot and dry summer, was 
liable to be attended with severe sickness in some form. 
Yet, if the malaria causes the sickness, why did it not appear 
before ? So, also, many are made sick by dysentery, or 
some other disease after a shower. And, in a similar man- 
ner, sailors lodging on shore only for a single night may all be 
made sick. There is no necessity of dragging in imaginary 
agents to excite disease. What ? all seized by malaria in one 
night! Were they not rather affected by the extreme atmos- 
pheric vicissitudes ? 
Furthermore, it is very well agreed amongst the miasma- 
tists, that the inappreciable noxious agent is most concen- 
trated, and does the most mischief at nightfall, whilst through 
the day, when it is ascending, it is said to be perfectly 
harmless ! 
e. Every one knows that the precipitation of the dew, to- 
gether with the increasing cold of evening, is liable to excite 
disease, and in all countries and places where dews exist ; 
and the danger is the greatest in hot seasons, whilst there is 
the greatest contrast between night and noon, and this is in 
July, August and September. It has repeatedly been dem- 
onstrated by the thermometer, that the variations of tempera- 
ture are greater in.low situations, than in those considerably 
elevated. But let us inquire, why this potent agent should 
not fasten on the bodies of men whilst ascending so profusely, 
as they say ; and especially, why it should be more virulent 
after being diluted in the atmosphere, and tossed by winds ? 
Is it of so incorrigible a nature that it does not become dissi- 
pated, or neutralized, or subdued like all other gases in the 
great aerial laboratory ? The same column of air that receives OUTLINES OF PATHOLOGY. 
341 
the gas at noon, cannot precipitate it, or the same vapor, as 
it is constantly moving onward. 
f. Dr Ferguson says, "that form of fever to which it 
(malaria) gives rise, rages throughout the world wherever a 
marshy surface has been exposed for a sufficient length o^ 
time to the action of a powerful sun." We grant that fevers 
of different aspects are liable to prevail under these circum- 
stances, whether the marsh be of salt or fresh water, even if 
on the top of a mountain; and there is nothing paradoxical 
about it; and the disease may prevail without malaria. It is 
enjoined that, "the marsh must cease to be a marsh," or 
dried up before it gives out its venom. Now this requires 
not only a " powerful " but continued sun ; and when the 
moisture is mostly evaporated, the sun acts on a broad sur- 
face without a leaf to intercept its rays. Notwithstanding 
there is no water on the surface, still the aqueous exhalations 
are abundant, and at nightfall there are always very heavy and 
cold dews. Experiments have repeatedly shown, that mod- 
erately dry surfaces of the earth exposed to the sun's rays, 
afford more vapor of exhalation than moist ground, because 
the heat of the ground is so much greater, evaporation is more 
copious. All surfaces not shielded by vegetation or water, 
become very hot at 80° or 90° of Fah., and emit much of 
the vapor of water, affording dense dews ; and Dr Ferguson 
says these are the only places which generate the poison. 
So also, the natives in Spain could have no idea of the real 
causes, nor could they appreciate the supposed poison, and 
said the troops had poisoned themselves by " eating mush- 
rooms." 
Surfaces covered with vegetation are not so greatly heated 
by the sun, neither is the contrast so great between noon and 
night, nor is there so much dew. The dews in Egypt are 
dense during their seasons of plague ; and whilst the heat of 
the day is intolerable, the nights are so cold as to require sev- 
eral blankets to sustain warmth during the time of sleep. In 342 
ETIOLOGY. 
Spain, according to the statement, the sickly places were low 
soils of dried sand on a rocky substratum ; and in the West 
Indies, the same with coral bottom, and all of them destitute 
of vegetation, having been covered with water. Most cer- 
tainly these are the proper conditions to develop the true cau- 
ses of disease, without the aid of any direct poison. The 
contrast of heat and cold is great, and the dews are heavy. 
g. It appears to be a well proven fact, that those who 
sleep on ground floors are more liable to contract disease than 
those who lodge in the higher apartments. So long ago as 
1742, Sir J. Pringle says, "it was then observed that such 
as lay in the upper stories, were much more healthy than those 
who were below on the ground floors, which were all very 
damp." It appears he was able to divine the true reason at 
the time, and without the aid of malaraic poison. The ground 
floors are always more moist than the upper stories. Mois- 
ture, or damp air always conducts off more caloric from the 
body than dry air. Damp rooms are always cool; and this 
is what increases the disparity between the temperatures of 
noon and night, and these circumstances are always sufficient 
to create even yellow fever, after the subject has been ex- 
posed to a temperature of about 80° or 90° of Fah., for some 
length of time. The ordinary amount of sickness on high 
grounds, is nearly in proportion to those of the low in hot 
seasons, and in a ratio as the latter is hotter through the day, 
and colder with heavy dews in the night. 
h. After due homage to malaria, Dr Ferguson remarks, 
"I am far from presuming to deny that there are fevers from 
pure excitement; for soldiers and others have been attacked 
and died of yellow fever before they landed in the West In- 
dies, or could be exposed to the influence of land miasmata 
in any shape." Notice, without land miasmata. This ad- 
mitted fact might seem to settle the question even against him- 
self, since it might be considered, that the disparity of tem- 
perature between night and noon is never so great on the wa- wx- tAiHULOGT. 
343 
ter as on the land ; for the coolness of the water keeps up a 
greater equilibrity ; and in vessels the people are better pro- 
tected against chills and dews, nor are these so dense. And 
many instances might be adduced to prove, that sickness has 
been avoided by strict attentions in avoiding the heat of the 
sun, and the coolness of the evenings on land, as well as on 
shipboard. 
i. Dr Combe remarks* in relation to the mortal sickness 
on board the squadron of Lord Anson, " the causes of dis- 
ease lay entirely within themselves." In page 274, he con- 
trasts the prudence of attending to his men, by the circum- 
navigator Cook; he says, "the Resolution performed a voy- 
age of three years and eighteen days, through all climates, 
from 52° north, to 71° south, with the loss of only one man 
by disease, out of 112. And in his last voyage, so effica- 
ciously were the same means put in practice, that his ship 
was brought home, after an absence of four years, without 
the loss of a single man by disease." It might wound the 
pride of the miasmatists, for any one to say, that the health of 
both citizens and soldiers on land, might be as well protected 
from disease of all kinds, by a judicious attention in avoiding 
the real causes, instead of succumbing to an imaginary one. 
If miasm is such a potent agent as represented, then hygienic 
attentions could no more evade it, than the small pox can be. 
If it be true then, as Dr Ferguson suggests, that yellow 
fever may be produced on the water, without the supposed 
poison, and by mere excitement, why not on the land, where 
the predisposing and exciting causes are more intense ? And 
if these causes are sufficient on a small scale, why not on a 
larger one, where the concurrent circumstances are increased ? 
It is stated by Dr O'Hallaran, on yellow fever, that what 
were called miasmal fevers, were far more severe on the hill 
Monjui, in Spain, 700 feet high, than on the marshy grounds 
* Principles of Physiology applied to health, p. 271. 344 
ETIOLOGY. 
below. Dr Bancroft mentions similar facts at St Lucie, and 
Grenada. So also, Dr Blanc mentions facts of a like kind. 
Let severe disease prevail wherever it may, yet the cause 
must be miasm, in the opinion of all the miasmatists, and some 
explanation given, however frivolous. 
The experiments and observations of Dr Potter of Balti- 
more, are ingenious and useful, in proving a state of predis- 
position to exist in most people during an epidemic season, 
and that the blood suffers changes anterior to the attack of 
disease; but prove nothing as respects these changes being 
produced by a miasmatic poison. 
We have heard much of the malaria of the Pontine marsh- 
es ; but are there not causes enough to modify the normal 
actions of health, and excite disease, without the aid of any 
malaria ? Dr Johnson remarks,-" Italy, indeed, is very sin- 
gularly situated in respect to climate. With its feet resting 
against the snow-clad alps, and its head stretching towards the 
burning shore of Africa, it is alternately exposed to the suffo- 
cation of the Siroces from the arid sands of Lybia,and the icy 
chills of the tramontane (winds) from the Alps, or the Apen- 
nines." Dr Clark states, that the mean temperature of the 
Mediterranean generally in the month of August, is at 80° 
Fah., and of course it is sometimes higher. Here are all the 
essential causes, with their different bearings, to produce dis- 
ease of the severest kind, by exposure to them. The inhab- 
itants often keep their houses until after the dew-fall in the 
fore part of the evening, and then go out without so much 
danger ; but, who can say there is an invisible poison to be 
shunned ; or, is it not rather the physical effects of the pre- 
cipitating dew ? Dr Mosely states,* that he has experienced 
" shivering and coldness, as in an ague," in passing the swamps 
near Kingston, Jamaica, and also the Pontine fens between 
Rome and Naples, early in the morning before sunrise ; and 
* Tropical Diseases, p. 39. OUTLINES OF PATHOLOGY. 
345 
advises, that sailors never be permitted to sleep on shore, in 
low, damp soils. 
j. We can scarcely avoid making some reference to the 
facts stated by Dr Chapman, in his Thoughts, &c., on Epi- 
demics.* Speaking particularly of yellow fever, he says,- 
" The fever has, moreover, invariably appeared along the 
wharves, and rarely extended itself far into the city, or be- 
yond the influence of this position." In p. 121 : " Exactly 
the same thing happens with regard to the whole of the West 
India Islands." In p. 122 : " It appears not to be limited 
to the foulest spots in the city he adds, " the nature of the 
cause which modifies exhalations in this position, so as to gen- 
erate pestilential fever, is wrapt in obscurity !" Indeed, any ex- 
planation upon the miasmatic hypothesis must forever be wrapt 
in obscurity. Our author intimates there are greater sources 
of filth in the upper than in the lower part of the city. This 
accords with a sentiment of Dr. P. Donaldson, though not pe- 
culiar to him. "We observe the prevalence of the disease 
(yellow fever) in the most salubrious parts of cities, and the 
absence of it in the most noxious hovels and streets."! 
The above quoted facts show a close connection with the 
history of cholera, except in the one case the condition of 
predisposition may be supposed to be. chiefly obtained from 
an aerial influence, and in the other from many circumstances 
in connection with certain degrees of atmospheric heat. All 
the histories agree, that it makes its first appearance, and 
greatest severity in low and humid situations, along rivers, 
lakes, and savannas. So also, most commonly appear ady- 
namic fevers, dysenteries, remittents, and intermittents ; to 
these might be added the typhoid fevers of humid jails. 
The solution of these phenomena become quite familiar, as 
soon as our minds are relieved of the delusive spell of conta- 
gion and infection. Whilst these have any place in the etio 
•Phil. Jour. Med., &c., No. 17, p. 120. 
t Syst. of Med. and Chirurg. p. 189. 346 
ETIOLOGY. 
logical creed, every explanation will be shaded with doubt 
and mysticism. The phenomena of the extraneous circum- 
stances acting on the human system, must be subjects of oth- 
er sections. We may now merely say, that low and flat lo- 
cations in warm seasons are hotter than more elevated situa- 
tions ; and at night the low situations, on account of the dews 
and water in the earth, are colder than high situations. Not 
that dew or water have any thing particularly deleterious in 
them, but that they are conductors of heat, and suddenly re- 
duce the amount of personal caloric, as soon as the heat of 
the day is past. Alternations of heat and cold excite disease, 
and fix the morbid habit. These will admit of illustrations 
in their places ; but, in tl^e mean time let us remember, that 
the older physicians were well aware of the annual and diur- 
nal vicissitudes producing disease, as is well sung by the poet 
of health ; 
For while the effluence of the skin maintains 
Its native measure, the pleuritic spring 
Glides harmless by ; and autumn, sick to death 
With sallow quartans, no contagion breathes. 
k. It is clearly shown by many writers of undoubted au- 
thority, that in the interior of the southern and middle states 
of America, yellow fever has prevailed an hundred miles and 
more from the Atlantic coast and cities ; and in a strikingly 
characteristic manner. In addition, and confirmatory of these, 
we may add the testimony of the late Dr Coventry, Presi- 
dent of the New York Medical Society, in an annual address 
before the society in 1825. He had been conversant with 
diseases in Europe, and in the interior of the state of New 
York. And after his removal to the new and flat country of 
that state, he met with fevers attended with black vomit, and 
the intense yellowness as described in the phenomena of yel- 
low fever. After a visit to the city, and making strict inquiry 
into the phenomena of the fever there in 1805, especially in 
Pearl street, he says, " I was as fully convinced of the iden- OUTLINES OF PATHOLOGY. 
347 
tity of this disease, with the epidemic that had raged along 
the margins of the western lakes, as I was of my own exis- 
tence." Dr Merrill, in his account of yellow fever at Natchez, 
in 1823,* states, that in the month of October, as the weath- 
er grew cooler, it began to decline in severity, " and not un- 
frequently assumed the type of an intermittent." The ther- 
mometer ranged, from 80° to 93°, from the 1st of July, to 
25th August; dry weather. Also, from Dr Cartwright's ex- 
cellent essay, in the Medical Recorder, 1826, wre learn that 
remittent and other forms of severe disease preceded, and 
followed the yellow fever at Natchez ; and we infer that the 
latter was nothing more than an aggravated, or more malig- 
nant state of disease. The diseases were all modified by the 
different seasons of the year, and called by other names. This 
is a proof they could not arise from a specific miasm. 
I. The character, and of course the phenomena of the 
family of fevers, suffer many modifications under different 
circumstances, both as relates to the intensity of the causes, 
and the personal susceptibilities of individuals exposed. So 
we see some epidemics of greater, others of less severity, 
although similar in kind. Some individuals in the same epi- 
demic will experience more, others less severity. Some- 
times the general acting causes are not so intense as suddenly 
to excite disease, but make certain impressions on the vital 
sensibilities, which imperceptibly alter the economy of the 
solids and fluids, and after an uncertain time induce disease, 
when the subjects are exposed to some, even slight, exciting 
cause. Thus, quotidian and tertian intermittents may be 
excited long after the formation of an incipient state of pre- 
disposition. It does not require so great severity of heat, 
and collateral circumstances, to induce these habits of fever, 
as those of the severe typhoid aspect. Neither can we dis- 
cover why intermittent fever may not be induced without a 
* Phil. Jour. Med. & Phys. Scien. No. 18, p. 255. 348 
ETIOLOGY. 
specific malaraic poison, as well as hectic fever ; they both 
have periodical paroxysms, coldness, heat, sweats, &c. And 
indeed, intermittents have sometimes been the precursors of 
phthisis. All pyrectic diseases are more readily excited in 
such localities as experience the earliest autumnal frosts ; 
these being low wet flats. Not that frost produces the dis- 
ease, but only that it proves a greater degree of comparative 
coldness in such locations. 
It seems to be a trait in the character of the human mind, 
in the investigation of philosophical topics, to overlook obvi- 
ous and familiar circumstances, and seek for some remote, 
undefined, and inexplicable cause. Diseases of manifest do- 
mestic origin, and proved such on investigation, have been 
insisted on as brought from other countries. When the fire 
of investigation exposes these errors, they appear as sportive 
as the aerial flight of malaria from Holland to Edinburgh. 
The causes of disease are simple in their nature ; and the 
principles of diseased action will be found to be equally as 
simple, and depending on only a few elements, when cor- 
rectly analyzed and exposed to view ; yet, there is more 
labor in removing the rubbish, than in erecting the edifice. 
m. Our respect for the author just now referred to, Pro- 
fessor Chapman, induces us to notice one other thesis in 
No. 16, p. 383: " In their operation, marsh effluvia are 
very wide and pervading. No section of the body escapes ; 
hence the number and diversity of epidemical and other 
diseases of which they are the source. Every variety and 
gradation of bilious fever, whether intermittent, or remittent, 
or continued-inflammatory, or typhoid, or malignant-as 
well as the several forms of intestinal disorder, cholera, dys- 
entery, and diarrhoea, are, for the most part, distinctly to be 
traced to such influence." This sentiment may be common 
to all the miasmatists ; but, it reminds us of the rashness of 
Epimetheus in opening the Pandorean box, and scattering 
the many plagues upon earth. It is said that inspiring hope OUTLINES OF PATHOLOGY. 
349 
should ever remain at the bottom. Let us therefore take 
courage, that with perseverance, some of these evils may be 
mitigated. 
It seems by the propositions, there are many specific ma- 
laria, engendering as many specific diseases, and as M. Brous- 
sais would say, they specifically affect some point in the 
different tissues, some way or another, and induce sympa- 
thetic fever ! So we seriously understand, whether right or 
not ; yet we hardly know, nor are instructed, whether rheu- 
matism and phthisis thus originate ; or indeed influenza. 
But, we must consider, we suppose, the cholera to be pro- 
duced by it; and we may believe that the disease was pro- 
duced by it at St. Petersburg in the winter of 1831-2, and 
at near the same time at Archangel, by the borders of the 
White Sea, in latitude 65° north ; places it never appeared 
in before ; although it requires 79° Fab. of heat to evolve 
the malaria ! We may, also, refer the winter epidemics of 
New England to the same agents, the spotted fever, pneumo- 
nia ; and why not croup, pleurisy, puerperal fever, and iatro- 
insanity 7 
We feel bound to review this subject in a respectful man- 
ner, and with feelings of deep solemnity. Let us then be 
allowed to inquire, if each epidemic has a specific marsh virus, 
or infection for its origin, how can one epidemic, and individ- 
ual cases in such epidemic, be transformed into other habits 
of disease ? The fact seems to be admitted by the Professor 
himself; it is known by every observing physician. But, 
small pox, excited by a specific infection, never changes into 
measles or any other disease, neither does whooping-cough 
change to kine pox. In the instance alluded to in Sect, 
xx. 7, of the twentyeight made sick in a swamp, of four dif- 
ferent diseases, must there have been as many species of 
malaria ? 
n. Our design is not to admit of much extension of argu- 
ment ; the present subject demands some attention, and it 350 
ETIOLOGY. 
may briefly be remarked, that dysentery sometimes changes 
into typhus in the same individual, and remittents into con- 
tinued fever, &c. In an epidemic season, the remittent 
fevers, with a little change of atmospherical phenomena, may 
be directly changed to yellow fever. These facts are well 
shown by Dr Francis Boot, in his Memoir of the Life and 
Medical Opinions of J. Armstrong, M. D. It is noticed in 
various places, especially Vol. I. p. 490. Also, he has 
brought together many interesting facts in the history of. en- 
demic and epidemic diseases, to prove, that they are modified 
by seasons, latitudes, and personal circumstances ; he op- 
poses the doctrine of the contagionists, but is an advocate of 
the. existence of marsh malaria ; an opinion not to be won- 
dered at considering the school in which he was educated, 
and probably not having turned his attention so intensely to 
the subject as it merits. 
In a comparative review of the fevers in the southern, 
middle, and northern sections of the United States, Dr 
Boot has collected many facts which go to show, that the 
fevers in the southern states, in warm weather, assume the 
intermittent or remittent forms ; and as cool weather ap- 
proaches, and in winter, fevers of a continued type prevail. 
In the middle states, continued fevers and intermittents pre- 
vail in summer, and the former in winter. Whilst in the 
northern states, especially in New England, intermittents are 
rarely found, even in the hottest season ; but typhus, and 
fevers of a continued form. Numerous meteorological cir- 
cumstances may exist in different locations, and take a part 
in modifying the vital susceptibilities, and in exciting those 
physiological commotions, which usher in the morbid habit. 
It will be taken for granted, that no discreet pathologist 
will insist on the existence of terrestrial miasm in the winter 
season in the latitude of the New England States, and espe- 
cially when the surface is frozen and covered with snow, 
which it often is for five months in the year. And yet we OUTLINES OF PATHOLOGY. 
351 
seem well warranted in stating, that there is nearly an equal 
amount of sickness and deaths in the six cold months, as 
there is in the six warm and temperate months, beginning on 
the first days of October and April. Indeed, in some winter 
epidemics the sickness exceeds that of the summer. Heat 
and cold, with their alternations, acting as remote and exciting 
causes also, along with an epidemic constitution of the air, 
may be considered adequate to the production of the most 
formidable diseases, without the aid of miasm, either in win- 
ter or summer. 
o. Whilst contending against the existence of an inappre- 
ciable malaraic poison, and of as many grades and qualities as 
there are shades of difference in disease, we feel not disposed 
to deny, but that the gaseous exhalations of decomposing ve- 
getable and animal substances, in close unventilated places, 
and excluded from the sun and air, as the holds of vessels 
and crowded prisons, may act as excitants on the nervous tis- 
sues, and co-operate with other agents in the establishing a 
predisposition to disease. Their influence may be feeble 
and transient, for very filthy places are only occasionally vis- 
ited with sickness ; yet, they may claim some share in the 
multiplied range of causations. The facts we have adduced 
rather militate against the suggestion, but we are willing to 
grant to them, in such conditions, all the potency they have 
not been shorn of. In the instances mentioned by Dr Fergu- 
son, where disease prevailed on a dry sandy soil, without any 
vegetable or animal productions, and sweet water underneath, 
there could not be any gaseous extrications, and we find dis- 
ease excited without them. And further, we have repeatedly 
seen dysentery, typhus, and malignant fevers prevail in very 
neat country places, where no filth could be detected, and 
on high ground. 
p. Yet, again, there are other situations, in which the gas- 
eous emanations disturb the sensibilities more poignantly 
than sleeping in an apothecary's shop, a distillery of ammo- 352 
ETIOLOGY. 
nia, or a grog-shop. In either case the atmosphere is satu- 
rated with floating stimuli ; perhaps commonly harmless ; 
nevertheless, they may add to the weight of stimulations, 
when various other circumstances have increased the tissual 
sensibilities, and without possessing anything like the charac- 
ter of poisons. We can only say, if these gaseous substances 
ever become injurious, it must be in this manner ; and yet 
the inducements to cleanliness are so numerous, they ought 
to excite to first attentions for their removal. 
We would willingly have ended this article long before 
now, had the subject been of any less importance ; and sure- 
ly no satisfaction can be obtained in opposing the very res- 
pectable weight of opinion arrayed against us. Yet, so long 
as the notions of malaria are prevalent, etiology must remain 
stationary. 
However, it seems necessary further to notice, that the 
miasmatic etiologists have proceeded from one hypothesis to 
another, until the subject has become systematized, and airy 
nothings made as palpable as Macbeth's ghosts. Two im- 
portant divisions have been made, one called kaino-miasmata, 
or that which is common in the open atmosphere, and pre- 
vails in filthy, marshy districts, as Ferguson says " from per- 
fectly dry surfaces but as fable tells us, from too much 
water in marshes, and " Hercules, accordingly drained the 
Lernean marshes, and thus dried up this abundant source of 
pestiferous emanations."* • 
The other is denominated idio-miasmata ; and is said to 
arise from chemical changes in the personal excretions, re- 
tained in confined and unventilated apartments, as prisons, 
the holds of vessels, etc. A virus is supposed to be genera- 
ted, which becomes contagious, or communicable from one 
person to another. Besides these, various other subordinate 
divisions have been made. 
* Dr Eberle, Prac. Med. Vol. II. p. 35. OUTLINES OF PATHOLOGY 
353 
q. We only need to remark, that more evidence is re- 
quired before these sentiments ought to obtain undoubted 
credence. That people confined in what is called an idio- 
miasmatic atmosphere, suffer a severe state of predisposition, 
we do not doubt, their whole exterior aspect proves it. So, 
also, with those, who reside near marshes. So the Cretins 
of the Alps are greatly modified by the extraneous circum- 
stances, in which their bodies are enveloped. So, again, 
with every tribe, and nation on the earth. 
Even the inmates of colleges and factories all have their 
peculiar aspects, which are indicative of internal changes 
of tissual susceptibility. Let the ordinary exciting causes of 
disease be applied, and we find the phenomena as different, 
as the predisposing circumstances have been. The highlan- 
der wilVhave a different type of disease from one who has 
been steeped in the chilly damps, and fogs of marshes. 
So, also, he, who has been long confined in badly ventila- 
ted and damp rooms, without much light, or exercise, 
and constantly steeped in his own, and his comrades' acrid ex- 
halations, will no doubt have a different train of phenomena 
from either of the others, and they usually are of that pecu- 
liar group called typhoid. And yet, again, this group is not 
precisely similar to that which occurs amongst citizens at 
large, although they may both be called typhus. 
The inmates of these filthy abodes are not sure to become 
sick, and scarcely more so than people at large, yet, in an 
epidemic season, with an atmospheric afflatus, they are liable 
to suffer much, and may be some of the first to become sick. 
Yet it is reported that the secluded in prisons, nunneries, &c. 
are not so often affected with the plague as those abroad, and 
more exposed to exciting causes. They often retain an or- 
dinary state of health in such conditions for months 
and years, without having typhus ; notwithstanding, the efflu- 
via of their rooms may be so great, that a visitor perceives it 354 
ETIOLOGY. 
to be oppressive even at the outer door of the building, and 
quite insupportable within. 
Again, when such inmates are affected with typhus, it is 
common for the same disease to prevail in high, dry, and 
clean habitations. We have known well characterized ty- 
phus prevail in a neighborhood, and especially go through a 
neat family of eleven persons, in four months, a few miles in 
the country from a filthy jail, the inmates of which escaped 
the disease through the whole year, and still longer. The 
etiology of typhus requires further, and more rigid investiga- 
tion, and with reference to other causes than direct conta- 
gion, or idio-miasmata. 
We cannot stop to follow out the subject of the doubtful 
existence of the miasmata in the minute details that it merits ; 
but, will refer to a lucid article " On miasm as an alleged 
Cause of Fevers" by John Bell, M. D.* 
SECTION XXVII. 
ETIOLOGY-CONTINUED. 
3d. On the Climatic Influences. 
It is manifest that the human economy possesses a pliancy 
by which it becomes in a measure accommodated to the va- 
rious external circumstances of different latitudes and cli- 
mates. This adaptation, however, is more or less incom- 
plete, and the physiology of man is liable to be distorted from 
the most happy standard, and receive numerous modifica- 
tions ; and yet not so great, but that different subjects, in dif- 
ferent latitudes, attain to nearly the same term of longevity. 
* Phil. Jour, of Med. Sciences, Vol. XI, p. 274. OUTLINES OF PATHOLOGY. 
355 
The stature, form, proportion, features, and complexion may 
all be changed by the different impressive circumstances of 
climate and regimen. Not only the body, but the mind also, 
receives modifications in like manner from climatic circum- 
stances. The slow, deliberate movements of northern intel- 
lects acquire expansion and celerity of movement after hav- 
ing been, as it were, sublimed in tropical regions. 
Notwithstanding these modifications, the inhabitants of dif- 
ferent regions possess nearly the same amount of general 
health, their diseases however, being different. Those of 
the torrid zone, are most liable to be of the acute, typhoid 
character ; those of the frigid zone are of a more slow, or 
chronic kind, with feeble, but continued morbid action ; 
whilst in the temperate latitudes, the diseases are of a mixed 
character, some seasons and locations admitting of the severe 
hypersthenic character, others of the mild typhoid aspect, 
with a host of chronic affections. The diseases are in ac- 
cordance with the physiological conditions of the inhabitants ; 
for in hot regions the organic developments are sooner effect- 
ed, and the susceptibilities are more acute than in the tem- 
perate zone ; the residents in this last circle possess a pre- 
cedence in these respects, as is shown in the fact of females 
menstruating in hot climates at about twelve years of age, in 
the middle latitudes at about fourteen, and in the frigid about 
sixteen years. 
The reason why the system bears the heats of the Indies, 
and the colds of Nova Zembla with impunity, is on account 
of the gradual manner that these, and all other of the peculiar 
extraneous circumstances are applied. The infant is nurtur- 
ed and grows to maturity amongst them, and the whole or- 
ganism, and their sensibilities become moulded, and modified 
to their peculiar stimulations ; and life possesses more con- 
genialities in their particular locations, than on any other spot 
of earth. This is so much the case that removals from a 356 
ETIOLOGY. 
round of congenialities, and particular grades of stimulations 
are liable to be attended with dangerous results. 
When a change of climatic circumstances is suddenly made, 
the consequences are liable to be destructive to the healthy 
economy of individuals. It is therefore the suddenness of the 
change that is most to be dreaded. The southerner might go 
to the frigid regions to reside there, with but little risk of in- 
jury, provided he would pass gradually from one latitude to 
another, and stay long enough to become acclimated in each. 
His system must acquire the habit of dispensing with the 
intense stimulations of solar heat, and acquire that of evolv- 
ing more vital warmth within himself; for it is observed, the 
internal maximum in both conditions is about 98° Fah. His 
sensibilities must suffer until habit slowly introduced, dimin- 
ishes their acuteness. Until these changes are established, 
he will be liable to suffer from a new range of stimulations. 
A sojourner in the southern from the northern regions, will 
be liable to suffer still more, on account of the stimulations 
being more intense, and acting on a system of density, of 
hyperemia, and inusitation of solar heat. He also, needs to 
pass slowly from one grade to another. The air he breathes, 
as well as that which envelopes the surface, is more rare and 
expanded with caloric ; heat accumulates in the system; the 
blood becomes expanded ; and adds to the general state of 
fulness, and irritation. The whole system suffers a sort of 
erethism ; his body indicates,.by the thermometer, three or 
four degrees of increase of heat. Essera appear on the sur- 
face, and this is only an index to point out what is taking 
place in the alimentary canal, liver, and indeed in all the in- 
ternal viscera. The appetite becomes capricious, and the 
digestion difficult, with indescribable uneasiness ; occasional 
diarrhoea of a bilious appearance ; lassitude, thirst, slightly 
furred tongue, scantiness of urine, and unrefreshing sleep. 
This merely constitutes the state of predisposition, and it 
will be the more severe as restrictions on regimen, and other OUTLINES OF PATHOLOGY. 
357 
prophylactic measures have been neglected. The organism 
acquires a morbid predisposition, readily transformed into 
disease. 
Let such a subject now arrived in the torrid zone, be plac- 
ed at night as a sentry in the open atmosphere, either on ship- 
board or on land, 15° or 30° colder than the day, we may 
then easily estimate his liabilities. In an hour's time, he 
may feel the effects of cold in every , section of his system, 
although he may not perceive a great sensation of cold. But, 
there is wrought in the most intimate tissues a change, a state 
of contractility in the involuntary, instinctive tissues, and 
impeding the nervous force, and capillary circulations ; or 
finally, a state of nosodynamia. According to the severity of 
this condition, so will the subsequent phenomena appear ; 
either terminating in immediate death, or showing more or 
less of the phenomena of disease of one variety or another, as 
numerous incidental circumstances may direct. However, 
we are anticipating our subject in order to give a short illus- 
tration. . 
Our remarks have been very general, and chiefly in refer- 
ence to the common level of low lands in southern latitudes. 
But, it should be remembered, that even within the tropics 
the high lands afford every climate of the north ; they present 
the perpetual snow-capt mountains, and every latitude thence 
to the vallies. Some mountainous passages have the cold- 
ness of northern Russia, and " in the conquest of Chili, many 
of the Spaniards were frozen to death sitting on their mules, 
in crossing the mountains that divide Chili and Peru."* It 
is the suddenness of the changes that breaks the harmonies of 
health, and excites the morbid commotions ; it is, therefore, 
the design of hygieine to direct the conduct so as to avoid 
disastrous sequences. 
* Moseley, p. 6. 358 
ETIOLOGY. 
SECTION XXVIII. 
ETIOLOGY. 
4. On Idiosyncrasies. 
There are certain peculiarities, which seem to have their 
seat in the nervous tissues of external relation ; such as faint- 
ness produced hy the smell of a rose ; aversions raised by 
the smell or taste of cheese ; epilepsy excited by the pres- 
ence of a cat in the room, although not seen or heard, &c. 
Our present inquiry in tracing remote causes, will be direct- 
ed to those relating to the functions of the organism, in which 
they are assigned to be attended in particular cases, with a 
greater liability to disease, than exists in the ordinary habits 
of mankind. They may be divided into, 
a, Constitutional. 
b, Adventitious. 
The constitutional peculiarities consist either, first, in mal- 
formations ; or, secondly, in an increased sensibility in some, 
or all the tissues, whereby slight excitations are attended with 
disproportionate organic movements. 
Malformations act mechanically to impede the regularity 
and perfection of organic movements, or to increase in an in- 
ordinate manner certain functions. Thus, in the case of a 
distorted, and contracted thorax, impediments are offered to 
the free exercise of the heart, and lungs. In this event, the 
lungs probably suffer most, there not being sufficient capacity 
for the blood brought by the long aortal circulation, to pass 
freely the short circulation. The lungs cannot expand suffi- 
ciently to admit both the circulation of blood, and the aerial 
fluid. Both these circulations are straightened, and there is 
not so much room for a surplus of air to remain in the lungs 
as is necessary for ease and safety, in the event of accidents, 
or even hurried exercise. The subject is liable to dyspnoea OUTLINES OF PATHOLOGY. 
359 
on slight movements, and a very constant state of tissual ex- 
citation is apt to be present. This state of disparity may 
favor the progress of chronic diseases of the lungs. 
A disproportion of blood sent to an organ by a malforma- 
tion, is liable to keep such organ in a state of increased ex- 
citement. Suppose the carotid arteries should be only a lit- 
tle larger than ordinary, and the descending aorta a little smal- 
ler ; there might be an unfortunate disproportion of blood sent 
to the head, whilst the rest of the body would suffer from a 
scantiness. The consequence of cerebral turgescence is 
readily apprehended ; in other parts there is a deficiency of 
nutrition. Although the instinctive processes seem quite 
sedulous in producing a harmony in all the formative pro- 
cesses, yet the physiological symmetry is sometimes infringed 
on, and the most healthy economy may be interrupted. A 
slight modification may, in process of time, make essential 
changes, and these effects become causes of other alterations, 
and in some uncertain time, the general economy becomes af- 
fected, so that on the approach of any adventitious cause, ve- 
ry formidable disease is liable to ensue, and possibly with- 
out it. 
Perhaps, there has never been a human system of perfect 
symmetry, since the days of mother Eve. We may conclude 
there was corporeal perfection direct from the hand of her 
Maker, and before extraneous circumstances had produced 
any disturbing passions ; if Milton's fancy was just respect- 
ing her moral mein : 
" Grace was in all her steps, heaven in her eye, 
"In every gesture dignity and Ijve." 
Some disproportion is liable to obtain in some of the ner- 
vous, or the nutritive organs. Some local injury early done 
an organ ; some manner of nutrition, or education, or cer- 
tain excitement of particular passions may mould individual 
organs into a state of too great, or too little development ; 360 
ETIOLOGY. 
according as these circumstances may happen, so the organ- 
ism will be modified in their evolutions and future functions. 
These peculiarities are liable to be transmitted to offspring, 
and increase with increasing circumstances, favoring a further 
disparity of formation and function. So we find some habits 
far removed from the security of a healthy proportion of or- 
ganic symmetry. The same thesis may be extended to the 
organs of intellect, and lays the basis of all phrenological 
distinctions and propensities. These malformations are lia- 
ble to produce distorted intellects, insanity. 
c. Increased Susceptibility. 
Under the second division, we may notice the fact, of 
there being an increased sensibility of tissues, by which they 
become more than ordinarily susceptible of impressions. 
Some people, from childhood to their acme, and in their 
best conditions, are liable to cardiac perturbations upon the 
most trivial excitations of body or mind, connected with a 
constant increased pulsatory action. They are always suf- 
fering, and these commotions constantly sustain a state of ir- 
ritation in the heart, lungs, and indeed, in the entire system. 
The functions, and sometimes the structures become im- 
paired, and in the event of other accidental causes, such 
habits suffer particular injury. 
The above may help to explain another circumstance in 
relation to the tissues, either specially or generally. There 
appears to be a sort of idiosyncrasy predominant in some 
habits, by which they take on a morbid action upon very tri- 
vial excitations. Thus, the lungs are easily affected, and a 
cough becomes excited up oh very slight circumstances. 
Not only so, but they take on a peculiar morbid action, which 
imperceptibly ends in effusions that form into tubercles. OUTLINES OF PATHOLOGY. 
361 
When this is once effected, these serve as conjunct causes 
for producing other derangements. 
A state somewhat similar in the tissues, especially the aci- 
ni, constitutes the state of predisposition to scrofula. When 
this exists, the unfortunate subjects are hurried into the de- 
velopment of that disease from slight exciting circumstances. 
The same may be said of many other constitutional liabilities 
to disease. The hereditary diseases all have their origin in 
a congenital, increased sensibility of some particular tissue of 
organic susceptibility. 
There is an hereditary hemorrhagic disposition, which 
shows itself in the most trifling lesions, and the bleeding is 
scarcely capable of being stanched. There is also an ac- 
quired condition of hemorrhagic susceptibility. Some 
portion of the vascular tissue of the mucous membrane as- 
sumes an increased state of organic sensibility. Upon the 
event of slight circumstances it becomes turgid ; something 
like what has been called an hemorrhagic effort takes place 
by capillary action, and blood continues to be poured out un- 
til the system is greatly drained. 
Often have we noticed, that certain habits of thin, and 
rather slender fabric, are liable to form purulency whilst at- 
tended with only a moderate state of general excitement. 
Pus will be largely deposited beneath, or between the layers 
of membranes in a few days after the part shows only slight 
signs of local inflammation, and almost without its common 
phenomena. We have seen thirteen abscesses form below 
the periosteum, in different parts of the body, in a boy ten 
years of age, and in the course of five weeks. They all re- 
sembled the collections in periostitis, but with less pain. 
They would form in about two or three days so as to require 
an incision; they discharge freely, and readily heal. In 
chronic diseases, and especially phthisis, purulency in some 
idiosyncrasies forms very early, and copiously. 
This diathesis purulenta is not of very infrequent occur- 362 
ETIOLOGY. 
rence. It has been noticed by many observers to occur un- 
der apparently different circumstances ; and recently by Dr 
Watson of New York.* It often occurs in connection with 
wounds, but these are not necessary to its existence. It ap- 
pears to consist in an altered state of the albuminous, and 
fibrinous portions of the blood, whilst this stands in close re- 
lation to an erythematic, irritative state of the serous linings 
of the arteries and veins. This affords an increased suscep- 
tibility, which is more concentrated in some parts than in 
others. The exhalant arteries pour out their fluids in such 
parts, which become more of the character of pus by passing 
the diseased tissues, whether through the coats of veins, 
or into the cellular tissue in any part of the body ; a wound 
existing at the time is not so liable to afford purulency as the 
excited serous tissues in any internal part. A purulent effu- 
sion in this diathesis has often been discovered under the 
arachnoid tunic of the brain when little suspected ; in many 
of the other viscera also. This condition is always attended 
with a frequent pulse, and other phenomena of an irritative 
pyrectic habit, very liable to a fatal termination. Until this 
state shall have become better understood, it may be esteem- 
ed as an adventitious idiosyncrasy. It requires for its correc- 
tion a mild, bland, antipyrectic treatment, adapted to the cir- 
cumstances of the case. Tonics and stimulants are perni- 
cious. It partakes of the character of phlebitis, and ar- 
teritis. 
Various conditions of disease from ordinary causes, may 
have a general morbid susceptibility, and in particular tissues 
also ; so they may become the seats of future disease on the 
accession of a morbid habit by new excitations. These ad- 
ventitious states of the tissues, now suffer the same liabilities 
as the hereditary. 
Thus in numerous instances in different temperaments, we 
* See American Journal of Medical Sciences, Vol. XXI, p. 37, 1837. OUTLINES OF PATHOLOGY. 
363 
find the tubercular deposits not only in the lungs, but in other 
thin tissues in various parts of the body. We must refer 
their origin to a peculiar state of the diseased system and tis- 
sual susceptibility, which for want of more knowledge of the 
subject, we are induced to call a state of tubercular idio- 
syncrasy. 
SECTION XXIX. 
ETIOLOGY. 
5th. On Aliment 
It is rare for disease to have its origin from a single cause 
alone ; more commonly several circumstances concur simul- 
taneously, or in succession, which co-operating together have 
a share in disturbing the most perfect physiological harmonies. 
Suppose a subject to assume more aliment than is suited to 
his well-being ; its influence on the system may be greatly 
modified by his exercise, or his indolence ; and if he should 
not assume a sufficiency to supply the ordinary nutrition 
required, the same circumstances might concur in altering the 
effects on the system. And more especially would the 
results, in either case, be modified as he might be exposed 
to extremes of heat or cold. However, we must study the 
agents that are liable to injure the economy of the system, in 
a separate manner. 
Circumstances which might essentially injure one person, 
might not be perceived as detrimental to another ; and yet 
every cause impinging the body may be supposed to act with 
the same amount of physical force, whilst the effects are very 
different. The various susceptibilities of different habits 
should always be taken into the estimate, when judging of 
the liabilities to injury from the use of food. Every tern- 364 
ETIOLOGY. 
perament possesses a determinate degree of staminal, and 
vital force suited to its own economy, and it is capable of 
greater or less resistance to all assailing circumstances. 
Whilst one might endure severe fatigues, and vicissitudes of 
weather, another might be easily destroyed by them. 
Similar disparities may be noticed in the assumption of 
food. Some of a like size and age require more than others ; 
the internal assimilatory processes may be more or less 
perfect, and one may have greater excretions than the other. 
So one may obtain twice as much recruit from the same 
amount of ingesta as another. For a general proposition it 
may be stated, that in health, the appetite is prone to indicate 
the want of more food, than is compatible with the well-being 
of most individuals ; and it is often indulged merely for the 
pleasure of eating. In such an event, the organs of digestion 
are too much burthened, and dispepsy is a natural result. 
Also, the assimilatory powers are too greatly forced, and hy- 
pereemia is liable to be the consequence. The whole vascu- 
lar tissue becomes inordinately distended, and too severely 
irritated by the hyperaemia. 
In the case of too great alimentation, the physiological 
actions are liable to be spurred beyond the range of medioc- 
rity, and a state of increased sensibility induced. These 
circumstances attend the commencement of a state of predis- 
position to disease, so that the exciting causes more easily 
affect the tissues. It is a common remark, that children who 
are restrained by necessity, or by rigid discipline in their diet, 
are not very liable to take cold, nor be made sick. For a 
person to pass through an epidemic season of almost any dis- 
ease, strict regard should be had to regimen, that it be light, 
simple, and regular. 
Notwithstanding, there are proper limits to be observed in 
respect to the amount of nutriment. Too great a state of 
inanition, and want of vital force, may render the system less 
able to resist the vicissitudes of weather, and various other OUTLINES OF PATHOLOGY. 
365 
circumstances, which are liable to disturb the harmony of the 
physiological actions. With regard to the amount of nutri- 
ment, and the choice of food, every person of intelligence 
ought to observe and be his own adviser. Nothing is more 
difficult than to advise another in health, further than general 
principles. Animal food is more nutritious and stimulating, 
than vegetable, whilst in moderate quantities, it is of easier 
digestion. It ought to be but moderately indulged in, in epi- 
demic seasons. Milk is a very congenial nutriment after it 
has passed the first digestion, and but rarely makes disturb- 
ance in that instance. 
With respect to the question, whether it may not be for 
the best good of all people to refrain from the use of every 
kind of animal flesh, as articles of diet ? It may merely be 
remarked, that it is inexpedient to urge it, as the fashion, 
and wants of society never will admit it in practice. It is 
unphilosophical, also, to insist on it, as some habits would 
suffer from total abstinence from it. It becomes a necessary 
kind of aliment in cold latitudes., That too great a quantity is 
used in New England for health of body and serenity of mind, 
cannot be doubted. It is devoutly to be wished, that a 
restrictive system might be adopted, and made fashionable. 
In the mean time, we have no hesitation in enjoining on cer- 
tain habits, nearly a total abstinence from meats ; and such 
are, persons of a sanguine temperament; those disposed to 
hemorrhage, to phthisis, to mania, to gout and inveterate 
rheumatism, and to other habits of disease of the phlogistic 
character. A diet restricted to vegetables disposes to an 
excess of carbon in the blood, whilst a pretty strictly animal 
diet inclines to an excess of azote and ammonia ; and excess 
of either will prove injurious. 
Temperance in the use of animal food contributes to 
serenity of mind, and clearness of intellect. It ought, there- 
fore, to be urged for the happiness of society in a moral as 
well as physical point of view ; and, also, ought it especially 366 
ETIOLOGY. 
to become general and approved by a nation engaged in men- 
tal improvements, by common literature ; also, in all the arts 
and sciences ; and especially, according to the fact, of our 
rising republic being pledged for the promotion of peace, and 
universal benevolence. 
The blood is the recipient of nutrimental substances, and 
it must suffer alterations by the quantity, and quality of the 
food. It suffers changes as the digestive processes may be 
more or less complete ; and also, as the nutriment may be 
more or less saturated with muriate of soda, and other con- 
diments. These are all stimulants without adding anything 
as real nourishment. Their excess is very pernicious, and it 
is always safest to use them in small quantities. In the 
instance of all pyrectic excitations, they ought to be omitted. 
Nevertheless, we cannot, with M. Broussais, so much 
refer the injury done to the mucous tissue of the digestive 
apparatus, as to the stimulations received into the circulating 
mass. Excitations are awakened in all the tissues by excess 
of alimentation ; the gastro-intestinal mucous tissue receives 
only a part, and harmonizes in a limited manner with the 
centre of perception. The nutrimental stimulations are 
quickly absorbed, and we discover the heart and arteries ex- 
cited, together with the capillary tissues every where dis- 
turbed, internally and externally, and extending into the 
nervous masses. In hypersemia the organs suffer a turges- 
cence, and are subject to all the sequences of distention, 
hypertrophy, and phlegmatiae. 
A proper regulation of regimen may, and will have great 
influence in the prevention of disease ; and when it super- 
venes, in its removal. But, reference must be had to ap- 
proved treatises on hygieine for particulars.-It may be 
remarked, that although we have cursorily noticed aliment as a 
remote cause of disease, it may, nevertheless become an ex- 
citing cause also, when improperly used. This subject may 
meet with some attention under the head of exciting causes. OUTLINES OF PATHOLOGY. 
367 
SECTION XXX. 
ETIOLOGY. 
6th. On Exercise. 
"Toil and be strong," is an excellent adage ; yet, it must 
be remembered, that each one must toil in a manner suitable 
to his individual abilities for exercise. An amount of labor 
that would be borne with pleasantness by one, might destroy 
another. So different is the compactness of the stamina of 
different textures, and ability for toil, even under circumstan- 
ces very similar in other respects. Exercise for the purpose 
of being useful, and giving firmness to the constitution, should 
be steadily and regularly performed. Severe efforts at pro- 
tracted intervals may be very injurious. 
The entire centripetal and centrifugal circulations always 
languish, and move slowly without a very constant, daily 
exercise of the locomotive muscles. And of course the 
blood is not being perfected in the rounds of circulation, nor 
sufficiently applied to the tissues ; these become flaccid, ex- 
sanguious and feeble in their functions. The countenance be- 
comes pale, and indicates the state of internal tissues. The 
mind, also, bears the impress of the enfeebled organization. 
In a state of indolence of body, and apathy of mind, the 
nutrimental substances are not perfected by digestion, for the 
supply of the system, nor applied to the tissues in a sufficient 
quantity to nourish, and afford fulness and strength to the 
muscles. In such a condition the appetite fails, and a suita- 
ble supply of nutriment may not be taken in. Besides these 
deficiences, the secretions are tardy and not duly performed ; 
the saline substances are retained in the circulation, as well 
as other excrementitious matter, and all serving to afford mor- 
bid accumulations with their stimulations, which become most 
obnoxious on the approach of disease, which is usually of a 
comparatively low grade in such instances. 368 
ETIOLOGY. 
The laborer in the field, or in the open atmosphere upon 
the ocean, enjoys a keen appetite, has brawny muscles, and 
ample strength, provided exercise be not extended beyond 
the range of constitutional ability. 
His habit pure with plain and temperate meals, 
Robust with labor, and by custom steel'd 
To every casualty of varied life ; 
Serene he bears the peevish eastern blast, 
And uninfected breathes the mortal south. 
When exercise is severe, and protracted to fatigue, and 
especially if then continued, the blood is forced into the cap- 
illary system faster than it is absorbed by the radicles of the 
veins. The organs suffer a turgescence, and become excited 
in function, with an exaltation of tissual sensibility. The cir- 
culatory force becomes at length partially exhausted in the 
tissues, and they are now easily affected by exciting causes, 
the principal of which is cold. In such a state, small varia- 
tions of atmospheric temperature have a powerful influence 
on highly excitable tissues, and a state of nosodynamia is 
readily formed. A foundation is now laid for the perturba- 
tions of diseased action, and this is manifested by many dis- 
cordant phenomena peculiar to the organs and tissues affec- 
ted, by the local concentrations of the morbid habit. 
We cannot stop here to trace the sequences of such a state 
of things, nor touch the remedial course to be pursued. The 
proximate cause of the diseased habit now becomes fixed, 
and the results will be modified by numerous circumstances ; 
and the event may be disastrous, unless the secretions and 
absorptions are immediately restored to the normal state. 
This may usually be readily accomplished, before the organs 
react on themselves, producing secondary results. 
Severe exertion of muscular force breaks the equilibrium 
of the circulation, retains the blood in the vital organs, en- 
dangers their integrity, and affords a liability to aneurisms, 
visceral hyperemia, hemorrhages, and phlegmatiae. When- OUTLINES OF PATHOLOGY. 
369 
ever a person is thus exposed, he should make use of some 
prophylactic measures of a very simple kind ; such as repos- 
ing on a couch with a blanket laid over according to the tem- 
perature of the atmosphere. A mild cutaneous transpiration 
should be kept up by the use of pleasant aromatic drinks ; 
pediluvy. 
SECTION XXXI. 
ETIOLOGY. 
7th. On Clothing. 
We are creatures of habit to a certain degree, with respect 
to the amount of clothing required for each individual. Not- 
withstanding, no force of habit can counteract the inclemen- 
cies of the higher latitudes, or the vicissitudes of the temper- 
ate ones. Aside from the moral purposes of clothing, its 
utility consists in retaining the caloric of the body in cold 
seasons, and defending the body in hot seasons from the 
scorching rays of the sun. In the former instance, the mate- 
rials should be slow conductors of caloric, and of a dark col- 
or, thereby absorbing the solar heat ; and in the latter, they 
should be ready conductors of caloric from the body, but of 
a light color, thereby reflecting the sun's rays. The fric- 
tion of clothing on the surface in exercise, adds something 
by extricating caloric, as well as by exciting the dermoid tis- 
sue. 
The great object of clothing is to maintain a temperate, 
but equable amount of caloric on the surface of the body. 
Although the internal organs possess peculiar aptitudes in 
maintaining a definite degree of heat, yet the surface and ex- 
tremities are liable to great variations, so that there are se- 370 
ETIOLOGY. 
vere disparities existing on some occasions, either from ex- 
ternal cold, or an internal inability to evolve caloric. The 
important desideratum is, to maintain an equal distribution of 
heat in the system ; for without this, the physiological pro- 
cesses will be interrupted more or less. Every impression 
of cold admitted to the surface below the point of tempera- 
ture that the subject has been accustomed to, instantly with- 
draws from the body a just proportion of its caloric, and as 
this is taken away, so in proportion there is an assault made 
on the regularity of the functional exercise ; although it may 
not amount to disease, yet the system is more exposed 'to 
other hurtful agents. 
The effect of incompatible degrees of cold is, to condense, 
and contract the dermoid tissue, to embarrass the exhalations 
on the surface, and propagate a state quite similar, to the in- 
ternal tissues. If heat is soon restored, and especially if the 
exhalations resume their course on the surface, but little inju- 
ry may be done. However the subject often runs some risk 
in this, and a state of equilibrity ought to be maintained, and 
restored when broken. When incompatible degrees of cold 
are often reapplied, and followed suddenly by heat, the tis- 
sues acquire an increase of sensibility, by which they are 
more exposed to be acted on by a subsequent exposure, and 
indeed to other exciting causes. Hence arises a state of 
predisposition, and cold in this instance becomes merely a 
remote cause of disease. But, remote causes rarely produce 
active disease without some exciting cause, and on a repeti- 
tion of exposure to cold, it may become the exciting cause. 
Persons long exposed to cold and damp air, with little ex- 
ercise, and scanty clothing, are especially liable to obtain a 
predisposition, and are readily excited to disease of various 
habits and phenomena. The importance of a sufficiency of 
clothing to keep up an equilibrity of circulation, and exhala- 
tion from the surface, is readily apprehended. Diseases thus 
induced are usually of the chronic character, as scrofula, OUTLINES OF PATHOLOGY. 
371 
scurvy, phthisis, &c. Those confined to studies should be- 
ware of such exposures. 
On the other hand, an excess of clothing, by retaining too 
much caloric on the surface, especially in warm seasons, 
keeps up too great excitation, and affords a liability to cuta- 
neous eruptions. The internal tissues, also, suffer a morbid 
susceptibility, by which the exciting causes again act with 
greater force. And furthermore, a habit is produced of much 
inconvenience, requiring more clothing than otherwise might 
be necessary for health and comfort. Yet there is no as- 
signing rules for the amount of clothing for each individual ; 
for much depends on the quantity of caloric evolved in the 
system, each one having a sort of idiosyncrasy in this res- 
pect, which needs to be modified by clothing to suit particu- 
lar cases. A morbid sensibility affects some people ; in 
which case they require more than ordinary clothing, but an 
excess of heat exhausts the vital force too much, and leaves 
a state of enervation. Changes of the quantity of clothing 
ought always to be made in a gradual manner. 
Clothing should be modified to obviate the injuries result- 
ing from sudden, often hourly changes of atmospheric tem- 
perature. Some are so exquisitely susceptible of changes, 
that an intervening cloud of a few minutes continuance, in a 
warm sunshiny day, will excite chills, and perhaps pain in 
some morbidly sensible organ. In such, great circumspec- 
tion becomes necessary. Even the most robust should in- 
crease their clothing at nightfall, and not suffer the damp air 
of the evening to effect a morbid impression. There is 
much danger in such exposures, as the sensation of cold is 
but rarely perceived in proportion to its amount, and the 
changes it makes in the tissues. 372 
ETIOLOGY. 
SECTION XXXII. 
ETIOLOGY. 
8th. On Jllcohol, and other Narcotics. 
" Ah! sly deceiver ! branded o'er and o'er, 
" Yet still believ'd ! exulting o'er the wreck 
" Of human vows." 
It is the physiological influences, chiefly, of those articles 
called narcotics, which must arrest our attention at the pre- 
sent time. These have been known by other terms, as 
hypnotics, anodynes, cordials, &c. . Writers on materia me- 
dica have grouped together certain articles possessing some- 
what similar properties when applied to the system ; yet, 
their influences are not precisely alike ; for some have a 
greater action on certain portions of the nervous systems than 
on others. They all agree, however, in adequate quantities, 
in producing a peculiar state of the system called narco- 
tism. This is known by the following phenomena : at first, 
ease of body, a placid state of mind, and an increase of 
strength ; then muscular weakness, heaviness of the head, 
imperfect vision, a diminution of sensibility, hallucination. 
This is soon followed by an entire loss of sensation and mo- 
tion, and the subject lies prostrate as in apoplexy ; there 
being a temporary paralysis of all the nervous systems of 
external relation, whilst the functions of internal relation still 
continue and are often increased. However, if the quantity 
taken should be considerably larger, the entire vital force will 
be expelled, and death ensue. 
When the quantity is very large, some of the articles called 
narcotics may destroy life instantaneously, without a single 
physiological phenomenon accompanying the process. How- 
ever, they are usually applied in small quantities to relieve 
ennui, and a morbid appetite for them ; to diminish pain, or OUTLINES OF PATHOLOGY. 
373 
other perturbating phenomena attending disease. They have 
been called, and still may most emphatically bear the appella- 
tion of poisons. 
Passing by all former speculations in relation to the modus 
operandi of these substances, they may be called ultra^stim- 
ulants; or such as impress the vital susceptibility of the 
system in an inordinate manner, and in an incompatible degree. 
In small quantities they are acknowledged to be stimulants ; 
if so in small doses, why not in large ? The diminution of 
energy which follows their use in excess, is a demonstration 
that the vital force has been exhausted by the inordinate 
stimulation ; similar to an excess of exercise in the effect, or 
as any other stimulation leaves a state of prostration of 
strength and vital susceptibility. Essential oils applied to 
the stomach, and electricity to the whole body have the same 
effect; so, also, contusions, extensive burns on the surface, 
and excess of passion, &c>. 
Narcotics may be admitted as medicines in small doses, or 
as stimulants and cordials, in cases of exhaustion, but in a 
very limited manner, and seldom ought to be repeated. On 
account of their sudden operation, and their evanescent ef- 
fects on the organs of external relation, they have obtained 
the appellation of diffusible stimulants by some, mean ng st ch 
as soon pass away. Notwithstanding, they show, on careful 
observation, very permanent stimulant effects on the organs 
of nutrition throughout the system, for fortyeight hours or 
more. The impression on this system of nerves is not so 
sudden, nor manifest, but continues much the longest. This 
may be observed in subjects in health, bi t more decidedly in 
those suffering with a pyrectic morbid habit; provided the 
observer will discriminate between the phenomena of the 
disease, and those cf the narcotic. 
All narcotics show their most visible effects on the organs 
of external relation, although both systems of nerves receive 
stimulations. There is nothing extraordinary in this, for the 374 
ETIOLOGY. 
same order of phenomena occur m the case of all other 
stimuli. The effects of exercise and of food are first disco- 
vered in the functions of the nerves of external relation. 
The intellect and the muscular systems collapse into a state 
of inactivity from exhaustion, whilst the internal organs are 
still acting under the influence of severe stimulations. The 
physiological functions of these two orders of nerves have 
been illustrated ; it may only further be suggested, that the 
intention of administering narcotics for the purpcse of allaying 
irritation, is a very dangerous practice in all pyrectic habits. 
Intellect and muscular motion cease from excess of excita- 
tion, and the organic system is spurred on in a manner, also, 
to be exhausted, and terminate in death, in co-operation with 
the stimulations'exciting the disease. 
Our further remarks may be confined to alcohol and opium, 
as being the articles in most common use as (Cordials or me- 
dicines. 
a. Alcohol. 
This is a chemical substance, the result of fermentation, 
and never found as the product of nature. It had long been 
known to exist in wine and cider, but never as a separate 
substance until the discovery of the art of distillation. It 
was first used as a medicine, in small quantities ; 'since, how- 
ever, as a drink for well people, and by its deceptive 
influences, has been the remote or immediate agent of de- 
stroying more lives than pestilence or wars. 
The first taste of alcohol is disgusting, but a little use 
makes it pleasant, and it is chiefly sought after on account of 
its 'effects in producing hilarity of mind, and temporary en- 
ergy of the muscles. The mind becomes relieved from care 
and anxiety, and indulges in pleasant revery, but disposed to 
anger upon slight, or even supposed provocation. - The 
muscular system endures exercise on its use but a little time, 
before a kind of lassitude supervenes, and this demands a OUTLINES OF PATHOLOGY. 
375 
repetition of the dose. It is too often repeated, until there 
supervenes a state of imbecility of mind and muscles, called in- 
toxication. The mind being weakened, it misjudgesin relation to 
the sequences of the repetitions, and so the organic appetencies 
triumph over reason. There is danger of self-destruction, 
unles's in some lucid interval total- abstinence is religiously 
determined on. and adhered to ; for a slight .indulgence very 
commonly sacrifices intellect on the altar of organic appe- 
tency. ' . • 
However, this article has been very extensively used in 
less quantities than to produce intoxication, but not without 
injury to the integrity, of the physiological condition of the 
tissues, especially to the nervous tissues of external relation. 
Possessing no nutrimental matter in itself, it only excites and 
spurs onward the functions of organs, beyond the point of 
endurance ; their ability of action becomes exhausted after 
over stimulation, so they become languid, and but imperfectly 
perform their round of duty. In such a state, cold and 
other exciting causes have a greater effect in lighting up dis- 
ease, as the morbid sensibility gives them a predisposition. 
This need not be a matter of surprise, since alcohol easily 
combines with water, and is readily absorbed .by the venous 
radicles of the digestive mucous tissue, although denied by 
the more chaste lacteals ; it passes the portal system to the 
common mass, and to the brain as well as every other organ. 
It has been distilled from the blood of the liver, and discov- 
ered in the cerebral tissues ; thus it injures every tissue in 
the system. However, it does the greatest violence to the 
nervous system of external relation, for this soonest suffers 
from every kind of excessive impulse, and demands a long 
repose to be restored to its pristine energy. The weakness 
of judgment, liability to delirium vigilans, and wavering 
gait of the tippler prove the injury done this order of nerves. 
The whole system suffers ; a protean train of nervous 
phenomena appear. Of the collatitious viscera, the liver, 376 
ETIOLOGY. 
and stomach bear la greater weight of injury than the others. 
If the practice is persisted in, the appetite becon es spoiled 
for food, and incontrollable as relates to alcohol. The un- 
happy victims cry aloud for it, and assume it with avidity, 
when < ven mixed with gall and aloes. The repetitions be- 
come exciting causes, and disease, in some form, progresses 
with terrific aspect; not admitting of cure, and scarcely of 
relief. Darwin has grouped some of these maladies, in per- 
sonifying Vitis >in the character of a nymph seducing the 
swains. ' A • 
" Drink deep," she carols, as she waves in air 
The mantling goblet, " and forget your care." 
O'er the dread feast malignant chemia scowls, 
And mingles poison in the nectar'd bowls. 
Fell gout peeps, grinning, through the.slimy scene, 
And bloated dropsy pants behind unseen ; , 
Wrapped in robe, white lepra hides his stains, 
And silent phrensy', wreathing, bites his chains. 
b. Libidinous Excesses. 
Considering we have not allotted a section to the subject 
of debauchery, or excess of libidinous practices, as a re- 
mote, or predisponent cause of. disease, a few remarks 
might be admitted here, as it may claim some famil . - 
quaintance with the preceding article, and perhaps some mor- 
al affinity also. It cannot, however, be under deep obliga- 
tions, since alcohol only provokes desires, without adding 
ability to gratify them. • However, let the provocation to the 
excess of venereal iridujgencies originate from whatever 
source it may, the effects are dismal, and calamitous to ih 
unfortunate debauchee, who eventually becomes a mere cari- 
cature of human dignity. Having lavished the most subtil- 
ized of the vital aura, and the first fruits of virile energy, 
the depreciated residue of corporeal being becomes an easy 
prey to the ten thousand awaiting agents of destruction that OUTLINES OF PATHOLOGY. 
377 
surround him. A certain amount of indulgence leaves an ir- 
resistible, irritative propensity, and the organism assumes 
control in defiance of voluntarily. After all this, there are 
instances, in which a morbid irritation locates in the genera- 
tive tissues, without Any previous men al depravity, or ex- 
cessive indulgence of alcohol, and is a ter.ded with conse- 
quences equally disastrous. These unfortunate cases, hap- 
pening oftentimes in the most virtuous youth, ought to be 
discriminated, as they require the most sympathising, as well 
as soothing treatment. ; 
c. Opium. 
We have already spoken of narcotics being peculiar stim- 
ulants of the nervous tissues, of which opium is one of the 
principal. The term stimulus is very general, and every 
substance in nature may come under its auspices, from cold 
water to the flames of burning alcohol. When it is applied 
to the living system in a state of health, it ought to denote 
such substances as impress, and excite action above the or- 
dinary standard, or beyond the common substances of nutri- 
ment. There are various substances of this character, and 
yet we find they act very differently ; some act mechanically, 
others chemically, whilst there are others, which make im- 
pressions on) certain tissues in a manner we cannot compre- 
hend, and we can only discover by their effects that peculiar 
impressions have been made. The vital force is the medium 
of transmission of impressions in the living system, so we 
infer that narcotics affect the whole system through the me- 
dium of the nerves, when applied to a part. 
Narcotics give stimulations rather peculiar, and yet 'post 
mortem inspections reveal very similar states of the capillary 
tissues, to those which appear in fevers called congestive. 
Whether we can fully explain the modus operand! of narcot- 
ics, or of the causes of malignant fever, or not, there seems 378 
ETIOLOGY. 
to be a strict parallel in the phenomena of each, both 
in the living, and in the lifeless state of the body. It is 
probable that certain excitations of the nervous susceptibility,, 
although different in kind, are attended with similar results in 
their morbid effects on the nutritive tissues. 
Small quantities of opium repeated in a well person, ex- 
cite at first the milder phenomena of a febrile habit. There 
is a similar alacrity of mind, and activity of body that often 
precedes' the more severe fevers ; then paleness, thirst, scan- 
tiness of excretions, furred tongue, heaviness or pain of the 
head, lassitude, increased frequency and force of the pulse. 
Let the quantity be'increased, and oftener repeated, and 
the more intense phenomena of fever will appear, and pro- 
ceed to delirium, coma, and death.' 
This being the result, we might by analogy infer,'that less 
quantities of this article produce more or less excitation of 
the functions of the system, and this is the'fact'very mani- 
festly. Those who habitually use this article constantly ex- 
perience an excitation in the circulatory system ; they exist 
under a preternatural stimulation, and if this is withheld at the 
usual periods, they suffer ennui, and severe depressions. 
The whole order of the digestive, and assimilatory functions 
are depraved ; they are imperfectly nourished, and the secre- 
tions suffer a deterioration. A sallow complexion shows the 
state of the internal tissues. There is-leanness, feverish 
heat, thirst, costiv.eness^ and diminished excretions every- 
where, unless perhaps, morbid sweats occasionally. This 
condition might aptly enough be called a state of poisoning. 
The subject experiences a constant morbid sensibility in the 
entire organism of internal, and external relation. Such may 
easily be affected by the common exciting causes of disease, 
and an intense morbid habit be the result. 
The habitual use of opium is as obnoxious, and equally 
predisposes to disease as alcohol, and ought as sedulously to 
be avoided. It is, however, admissible in certain states of OUTLINES OF PATHOLOGY. 
379 
depression, and even here the quantity ought to be very limit- 
ed ; for, as soon as the repulsive powers of the system take 
effect, the morbid action will be the more intense, and an 
over-dose always combines with the cause 6f depression, and 
aggravates the disease in the event. It may be admissible in 
some of the subtonic states of the system, as in periodical 
diseases unconnected with a constant morbid habit. It is ad- 
missible in painful affections of the nerves of external rela- 
tion, but should be no longer continued than until the neural- 
gic cause can be removed ; for,- it assuredly will induce a 
morbid habit, and render the case worse. It is, however, 
much less injurious in diseases locating on organs of external 
relation,.than on the. nutritive organs. 
The practice of using opium in the treatment of low, con- 
tinued and typhus fevers ought to be deprecated. It is rare 
that a single moderate dose can be given without ulterior 
injury, although the present composure may seem to justify it. 
No article is so liable to pass an imposition on the empirical 
attendant, the patient and friends, as this. The severity of 
the disease is smothered by the tranquillity it produces ; but 
it will resume its authority as soon as the sedation ceases, 
and with more violence. The temptation is urgent for its 
repetition, and if done, the patient progresses into a still 
worse condition. The pretence held out by some is untena- 
ble, that any combination of other articles, as in Dover's 
powder, can neutralize and render innocuous the effects of the 
Opium in its composition. Neither can the pure acetate of 
morphia be trusted in such cases with impunity, nor bella- 
donna, stramonium, &c. There is a morbid habit existing in 
these instances, and a state of nosodynamia, which is aggra- 
vated by the stimulations of the narcotics. 
Although Sydenham, and many others since his time, and 
even to the present period, have used narcotics in the treat- 
ment of febrile affections, it has been on the account of false 
notions entertained of the character of the morbid habit, and 380 
ETIOLOGY. 
not from their ulterior beneficial effects. We find many, 
however, who have discovered their pernicious effects, and 
amongst these, Dr. J. Johnson in his treatise oh derange- 
ments of the internal organs. " The narcotics, as opium, 
hyoscyamus, poppy, hop, and laurel water or prussic acid, 
are dangerous sedatives, since they too generally leave an 
increased morbid irritability, after their soothing effects have 
passed away, besides deranging the functions of the digestive 
organs, and confining the secretions." 
In order to ascertain with some precision the effects of 
opium in such cases, let the trial be made in a patient that 
has passed several days with fever, and when he seems to be 
about as sick one day as another. Then use one common 
dose on'y, and note well the effects ; faking as accurate dis- 
crimination as possible between the phenomena of the dis- 
ease and those ofJthe narcotic, for fortyei^ht hours at least. 
But, this digression may have run to an unjustifiable length. 
By way of recapitulation, we may notice, that the whole 
tribe of narcotics present allurements to the unwary, with all 
the suavity and meekness of the serpent of Eden, and the 
deception is too often equally as fatal. Behold the end, and 
avoid the consequences. 
SECTION XXXIII. 
ETIOLOGY. 
9th. On Mineral Poisons. 
Poisons and medicines are relative terms only ; for, there 
is scarcely an article of the materia medica of much efficien- 
cy, but that by an abuse of its use, may become injurious to 
the economy of the system. Certain mineral substances, OUTLINES OF PATHOLOGY. 
381 
with their different preparations, called poisons, under dis- 
creet management, are found useful in changing the morbid 
action of tissues. But, they may be very injurious when 
used in too large qualities, and too long persisted in. Those 
in common use are mercury, antimony, iron, arsenic, lead, 
copper, &c., to which might be added, iodine, which is rather 
a vegetable acid. 
Not being able to discriminate, we can only speak in gen- 
eral terms, that these are all excitants of the vital tissues 
through the agency of the vital susceptibility ; but each one 
has a peculiar impress on some tissues rather than on others. 
It is common with these, as all other excitants, that when 
used to an undue extent, they exhaust the vital force of 
organs, and leave them paralytic, after having increased their 
functional power. And besides, they leave in the tissues a 
permanent state of chronic excitation, but of an abnormal 
kind. The tissues have sometimes an increase of suscepti- 
bility. It is these conditions which render poisons liable to 
become remote causes of disease. A few remarks on each 
of the above articles may be sufficient for our present 
purpose. 
a. Mercury. 
Every preparation of this article acts as a severe excitant 
of the circulatory system, for it is readily absorbed. Its spe- 
cific tendency is to the salivary glands ; but it produces a 
common sthenic diathesis, as is shown by the blood, and ev- 
ery other phenomena. It ultimately weakens the crasis of 
the blood. This is liable to be followed by a frequent pulse, 
emaciation, and a morbid sensibility of all the tissues, but es- 
pecially of the salivary apparatus ; so that a repetition of the 
article easily re-excites salivation. So also disease in various 
forms is more readily produced by the common exciting cau- 
ses, after this article has been used to the point of salivation, 382 
ETIOLOGY. 
than before. Indeed it never ought to be used to this extent. 
The subjects are liable to pains in the fibrous tissues, and 
mercury has been found in its metallic form in many different 
tissues. It injures most the scrofulous, phthisical and scor- 
butic habits. Andral says, mercury acts on the blood similar 
to animal and mineral poisons.* 
The vapor of mercury affects also the nervous system of 
external relation very injuriously; it produces in some tremu- 
lous palsy, called by Marat, tremblement metallique, which 
lasts for life ; in others, symptoms not very dissimilar to the 
effects of lead, especially in the muscles of the arms and 
wrists. Convicts in the quicksilver mines where heat is em- 
ployed, occasioning a distillation, nearly all die hectic or be- 
come paralytic, although their stay underground is only six 
hours in twentyfour. These subjects become so saturated 
with mercury, that a piece of brass plate put into their mouths, 
or rubbed on the surface immediately becomes white like sil- 
ver. Mercury placed on a shelf in a warm room, in a bowl, 
will salivate the inmates of the room in a few weeks, even at 
moderate temperature. In addition to all this, clinical prac- 
tice shows too much lasting proof of its improper employ- 
ment. 
The use of this article, and all its preparations, might be 
dispensed with as internal remedies, and others less objec- 
tionable, and equally efficacious, substituted. If gonorrhoea 
and syphilis can be cured without it, why not other diseases? 
It is because many have been so wedded to its use, that they 
have not so much as tried other measures. Judging from our 
best knowledge of its general use, we are disposed to believe 
that it has been of less utility than injury for more than forty 
years past, throughout the entire w'estern continent. Drs 
Charmichael, Blackall, B. Bell, Broussais ; also, Messrs 
Pearson, Mathias, and many others may be consulted on this 
subject. 
* Path. Anat. Vol. I., p. 401. OUTLINES OF PATHOLOGY. 
383 
b. Antimony. 
It is only the excess, or too long continued use of this ar- 
ticle, or its different preparations, especially in gastric irrita- 
tions, which renders it injurious. It is one of the most useful, 
in the form of tartrate of antimony, of any which crowds the 
materia medica, by relaxing the rigid state of the tissues in 
disease, and promoting capillary circulation ; and yet it is lia- 
ble to exhaust too much when very freely exhibited. When 
continued too long it adds irritation to the tissues, especially 
of the stomach, in a similar manner as when applied to the 
dermoid tissue for some time. The injury done by this arti- 
cle is, however, small, compared with mercury ; whilst its 
beneficial influences are far superior. It is only injurious in 
excess. 
c. Iron, Iodine and Arsenic. 
A long continued use of these articles in any considerable 
quantity leaves a state of increased susceptibility in all the tis- 
sues, after they have manifested their tonic effects. Iron is the 
most harmless, and seems to exert its principal influence on 
the digestive and assimilatory tissues ; iodine on the absorb- 
ing, and arsenic on the nervous tissues. The excess of ar- 
senic especially, as well as the others is succeeded by a 
chronic irritation, or mild pyrectic habit, emaciation and lia- 
bility to be converted into more severe disease by some ex- 
citing cause. With suitable attention, however, they are all 
useful articles of the materia medica, and the two first can 
hardly be dispensed with. 
d. Lead. 
We have to speak generally of stimulations on the tissues, 
not being able to discriminate the peculiar impressions of each 384 
ETIOLOGY. 
noxious substance. They, however, impress vital solids 
quite differently, and metallic substances leave rather durable 
impressions. The stimulations of spices, of animal poisons, 
iron and lead are quite different. This latter article, or its 
oxides appear to possess an astringent stimulation. It enters 
the system in the form of gas, by the lungs, or of protoxide 
by the stomach, and often only in very minute quantities. It 
most ostensibly affects the spinal order of muscular nerves, 
and the abdominal plexuses, producing spasm, or rhachialgia, 
painter's colic. It is attended with severe pain, costiveness, 
emaciation, &c. The acetate of lead has been used exten- 
sively, both internally and externally, without injury. Not- 
withstanding, it does prove poisonous when it becomes 
changed to a carbonate, as is known by its crystals changing 
into a white powder. It has in this state proved poisonous, 
when used in lotions and poultices. It ought to be used with 
good vinegar in every mode, and it may then be considered 
harmless. The injury done by lead is by affecting chiefly 
the nerves of muscular motion instead of sensation ; yet it 
does affect the ganglial nerves and abdominal organs. 
We consider the articles just mentioned, as being but an 
inconsiderable part of those used sometimes as medicines 
with their various preparations, which are liable to injure the 
economy of the system, and render it more liable to disease. 
Look at the long catalogue of charlatanical nostrums ' OUTLINES OF PATHOLOGY. 
385 
SECTION XXXIV. 
ETIOLOGY. 
lOi/i. On Intense Thought. 
The function of the cerebral organs, called thought, is 
either voluntary, or impressive. The first includes the inter- 
nal processes of intellect ; the second is excited by external 
sensations. 
a. Voluntary Thought. 
The brain constitutes an apparatus of organs of volition. 
It determines the direction, and force of the locomotive 
muscles, and controls the process of thought ; it may be 
directed by the will to the clouds, or to the earth. Like the 
muscles, the organs of thought become fatigued, and repose 
is indispensable for a restoration of innervation. The mind 
engaged in severe thought whilst the muscles are at rest, oc- 
casions a turgescence of the capillary tissues of the brain, 
and similar to what occurs in the muscles when exercise is 
used without much intellectual operation. In consequence 
of the cerebral turgescence, which occurs in study with little 
exercise, the other portions of the system suffer a deficiency 
of stimulations ; they are not suitably nourished in severe and 
protracted thought. Digestion is liable to be imperfect; 
hematization may be deficient, and the muscles enfeebled on 
account of too large a portion of vital energy being expend- 
ed on the encephalic organs. Intense thought produces fatigue 
of body as well as of mind. 
A subject applying himself severely to literature, to the 
study of the abstruse arts and sciences is quite sure to suffer 
physiological changes ; he becomes pale and emaciated, 
attended with weakness of muscles, deficient secretions and 
excretions, whilst the turgescence in the brain has created a 386 
ETIOLOGY. 
state of abnormal excitation ; he is liable to watchfulness, 
with occasional pressure, inviting an apoplectic state. How- 
ever, it more commonly induces a train of phenomena called 
nervous, with a disposition to hallucinations. Every form of 
narcotic, and tonic medicines increases the predisposition. 
In such a state, the exciting causes may readily take effect, 
and establish a morbid habit. 
Impressive Thought. 
Numerous contingencies from without, are liable to make 
severe impressions on the mind, through the medium of the 
external senses, which affect the well-being of the individual, 
and become objects of intense thought. They excite atten- 
tion and thought in a ratio as they may be esteemed more or 
less conducive to one's prosperity, or adversity. Hence they 
become either pleasurable, or painful sensations ; the mind 
dwells upon them with intensity, in proportion to their 
importance, and often to that grade as to produce strong 
emotions and passions. Every severe mental excitation pro- 
vokes the cerebral organs into vehement exercise, and radi- 
ates through the whole entire organism, and their functions 
are liable to suffer much perturbation. 
Affections of the mind have often been known to cure dis- 
eases, both acute and chronic ; they also may cause disease. 
"Under uneasy circumstances of mind, gout will arise in 
persons strictly temperate and virtuous, active, free from 
hereditary predisposition, and in every respect qualified to 
claim an exemption from this great scourge of anxious refine- 
ment, and artificial society."* Perhaps there is scarcely any 
one, who has not perceived as the effects of surprise, a thril- 
ling sensation pass over the system, and reaching the inmost 
tissues. Even sometimes the visceral organs are excited into 
vigorous actions. (Sect, xxxix. 4.) 
• Ferriar's Med. Histories and Reflections, Vol. II. p. 54. OUTLINES OF PATHOLOGY. 
387 
The passions may be divided into the impetuous and the 
submissive. The origin of the former consists in the senti- 
ment of an ability to maintain one's rights, or regain them 
when lost. The sentiment cherished by hope, gives addi- 
tional energy. The subject rushes onward in anger, rage, 
and revenge, quite regardless of consequences, for the intel- 
lect has entered the domain of the hallucinations. 
The submissive passions are those where the sentiment of 
inability prevailed, without hope of avoiding evil, or obtaining 
good. Despondency, fear, and despair make up the train, 
and the subject becomes an easy victim to his adversary. 
All the emotions and passions are attended with intense 
thought, and the physiological movements often become 
greatly modified, even so as to produce various and profuse 
excretions, hemorrhages, sudden jaundice, whitening of the 
hair, rupture of the cavities of the heart, &c. The cele- 
brated author of the Zoonomia died in a paroxysm of anger, 
from a slight provocation. A matron had been informed her 
son was slain in battle ; yet, this was not true, for he sudden- 
ly came into her presence, and she died in his arms of joy. 
Cases might be multiplied. The severity of grief is well 
depicted by Shakspeare in relation to Richard II. on find- 
ing his friends had all gone over to Bolingbroke. 
Of comfort no man speak ; 
Let's talk of graves, of worms, and epitaphs ; 
Make dust our paper, and with rainy eyes 
Write sorrow on the bosom of the earth. 
The passions, like poisons, might be turned to good ac- 
count in the cure of disease ; but, they would require more 
skill and discretion, than to guide the lightning from the 
clouds in a stormy night. In the tardy chronic state of or- 
ganic action, the thrill of surprise, and the impulse of anger 
have often been instantaneously successful in exciting the 
absorbing tissues, and eradicating a long delayed morbid 
habit. (Sect, xviii. 7, 8.) 388 
ETIOLOGY. 
SECTION XXXV. 
ETIOLOGY. 
SECOND DIVISION OF CAUSATION. 
b. Exciting Causes. 
Some allusions have already been made in relation to 
these ; they may be esteemed to be, all such circumstances 
as excite abnormal motions, and in a manner to affect the 
intimate economy of the organism, either through corporeal 
or mental excitations. 
The exciting causes are numerous, and to recapitulate 
them all would not only be attended with great difficulty, but, 
perhaps, might be impossible. When we turn our attention 
to the varied pursuits of life, and the unstable habits of many, 
we see mankind exposed to numerous contingencies, and agi- 
tations of mind and body. These commotions are extended 
through the tissues by the vital harmonies, and disturb the 
economy ; and although they may not always be followed by 
disease, yet when a state of predisposition exists from any of 
the remote causes, or a coincidence of some other disturbing 
circumstances, there is liable to take place a morbidly fixed 
condition, which may not spontaneously be restored. When 
this occurs, it may be esteemed as the primary cause of dis- 
ease, and acts as the basis of the morbid habit. 
Many of the remote causes already alluded to, by being 
often repeated, or again applied with severity, may also be 
considered as exciting causes ; such as surfeiting, intoxica- 
tion, exercise extended to fatigue, &c. Our attention will 
be turned, at the present, to some of the most common. 
1st. Heat and cold, with their alternations, and in con- 
nection with winds. 
2d. Fatigue, watching, and surfeiting. OUTLINES OF PATHOLOGY. 
389 
3d. Wounds, contusions, burns, and other lesions. 
4th. Emotions and passions. 
5th. Contagions and infections. 
6th. Diurnal, and sol-lunar influences. 
SECTION XXXVI. 
ETIOLOGY. 
1 st. Heat and Cold, with their alternations, and in connection 
with Winds. 
1. Both are Active Agents or Excitants. 
We have constantly insisted, that the laws of organic life 
are peculiar in their kind, and although affected by physical 
force, are not governed by the same influences, nor do they 
exhibit similar phenomena. The expositors of the physical 
laws of nature insist, that all they know of cold is, that it is a 
negation of heat, and the attending phenomena are the results 
of a deficiency of caloric. The inference is, that cold is 
merely a negative property. 
Notwithstanding, an expositor of the laws of organic life 
has a right to insist, that cold is a positive and active agent 
in relation to the vital movements of all organized beings. 
Each organized system possesses power within itself of main- 
taining a definite degree of caloric, when placed in a compat- 
ible temperature. If, however, the medium be far below in 
temperature, the radiations of caloric will deprive the body of 
its necessary supply, and cold makes a direct assault on its 
vitality. 
The human system is found to maintain about 98° Fah. of 
heat, and as the vital actions are continually evolving it, there 
would be an oppressive accumulation, were it not eliminated 390 
ETIOLOGY. 
from the body as fast as it is extricated. For this purpose 
it is found that a temperature between 60° and 70° Fab. is 
necessary to accommodate the sensibility of different habits. 
Very young children, invalids, and old people, not having the 
power of extricating so much caloric, and often possessing an 
acute sensibility to cold, do not require so low a temperature 
as the more robust habits. The above range of ten degrees 
is taken to accommodate the different habits. 
Let us suppose there be added to the 70° Fah. of caloric 
in the atmosphere, 28° more, making 98°, or equal to the 
internal heat of the body. In this case certainly a positive 
agent is applied, the force of which would be intolerable, if 
there were no means by which the caloric could be conducted 
off. On the reverse, let the atmospheric caloric be reduced 
from 60° Fah., by taking 28° from it, and we arrive at 32°, 
the point of congelation of water. The human body, placed 
in such an atmosphere, also experiences a positive agent 
altering its susceptibility, and impressing its economy as an 
active agent. Increase the amount of cold, and it will de- 
stroy all vital movement, and fix the tissues in frost. We 
insist, then, that cold is an impressive agent in relation to the 
physiology of man. 
Heat is the expanding and volatilizing agent of all bodies ; 
it renders the tissues more pliable, active, and extensible ; it 
accelerates all the vascular oscillatory movements, increases 
secretions and excretions ; it causes the fluids to expand, and 
the florid countenance indicates a turgescence of the capil- 
lary tissues everywhere. Yet, it must not be urged beyond 
a compatible degree. It is now shown to be an excitant. 
On the contrary, cold is the condensing and solidifying 
principle of all bodies ; it produces a contraction and corru- 
gation of the skin, with the papillae elevated ; muscular en- 
ergy is diminished if applied in an incompatible degree; it is 
attended with a shrivelling of the entire surface, and a with- 
ered or sunken aspect. The fluids are lessened in volume, OUTLINES OF PATHOLOGY. 
391 
and circulated with difficulty, especially by the venous ab- 
sorbents ; paleness appears, with diminished secretions and 
excretions ; sensation becomes blunted with numbness, and a 
torpidity of intellect attends. Cold acts on vital tissues 
rather as an astringent or tonic, than a direct stimulant. It 
relieves sudden faintings and loss of vital force. 
The barometrical weight of the atmosphere has a co-ope- 
rating influence along with heat and cold. In warm seasons, 
and hot latitudes, the air is more rarified, and does not com- 
press the surface as in a cold atmosphere ; as a sequence of 
this the blood becomes expanded, the cutaneous capillaries 
are filled, and made active in their functions, whilst exhalation 
and the vital susceptibility are increased. On the other 
hand, in a cold dense atmosphere, the surface is compressed, 
the blood diminished in volume, and diverted in an undue 
proportion to the internal tissues; The economy is therefore 
modified by the barometrical changes in the atmosphere, and 
these changes are modified by heat and cold. 
The two circumstances of innervation and circulation, are 
necessary to the extrication of animal heat. The circulations 
cannot be continued without the nervous force, and this can- 
not be kept up without the aid of oxygen, and a certain 
amount of external caloric. Whatever alters these conditions 
modifies the amount of ingenerate animal heat, although much 
depends on the susceptibility of different subjects. 
Our remarks are chiefly intended for the inhabitants of va- 
riable climates, exposed to sudden vicissitudes of tempera- 
ture, which are not met with in more northern latitudes ; 
yet, cold is there a tonic also. The fact that females do not 
so early menstruate, and that the venereal propensity is less 
urgent, is no argument in favor of cold being a debilitating 
agent. Although the flame of love is less intense from the 
absence of high heat, and the spiced diet of hot regions, yet 
the procreative powers are more steady and effective in the 
latitudes of Russia and Sweden, than in the torrid zone. 392 
ETIOLOGY. 
Beaupre states, that it is common in these places for a virtuous 
wife to present her husband with a family of twenty or more 
children for his maintenance. No doubt the intensity of cold 
may be so severe near the polar regions, as to greatly di- 
minish all the vital functions, but still there exists a strong 
state of tissual tonicity. 
2. Cold considered Pathologically. 
One of the most unfortunate of all errors that has ever 
crept into pathology, is the hypothesis, that cold acts as a 
sedative on living animal tissues. ; or, that it debilitates 
them. It will on the contrary be contended, that cold 
is a positive agent, and acts on vital tissues as an astrin- 
gent, or tonic. It is then quite easy to conceive, that 
an inability of function may be the immediate effect 
of its application, in any considerable degree. Yet, 
when high heat has been applied, the admission of cold be- 
comes indirectly invigorating. Cold in an incompatible de- 
gree impedes the nervous energy, also the circulations and 
functions of organs generally. The condensation of tissues 
affects the minute nervous fibrillae producing enervation, and 
insensibility to ordinary stimulations ; it produces an inability 
of nervous energy, whilst the simple tissues are condensed. 
Cold applied to the surface, simultaneously affects the in- 
ternal tissues. A state of enervation more or less is every 
where produced, yet often unequal. Innervation and circu- 
lation are impaired. Some tissues for a time may act in ex- 
cess ; but, when the effects of cold are in any considerable 
degree, the deficiency of function may be so great, that the 
instinctive energies cannot prevail, and life may be extin- 
guished, even whilst the inmost tissues are held in rigid du- 
rance. 
The physiological distinction must here be kept up, be- 
tween the nervous system of external relation, and that of OUTLINES OF PATHOLOGY. 
393 
the interna], or nutritive system. It is in these last that cold 
exerts its principal pathological influences, whilst the former 
merely feels the changes, and notifies the centre of percep- 
tion of their extent, so long as they remain active. But, it 
perceives rather imperfectly the changes in the internal tis- 
sues. Many instances of sudden death occur, as in spotted 
fever, cholera, and other severe affections, attended with 
coldness, whilst the intellectual perceptions are but little 
disturbed ; and yet the external nerves of sense do not 
transmit the sensation of coldness. 
There being then, a tonic force added to the circulatory 
tissues ; so, wThen the repulsive powers prevail, and capillary 
circulation becomes established, it will be in excess, and 
produce the exalted phenomena of severe disease, or ardent 
fever. If, however, the internal changes produced by cold 
be immediately relaxed, the secretions and excretions may 
be restored, and health soon follow ; or, otherwise, the phe- 
nomena of disease will continue so long as the primary cause 
of the morbid habit may remain. It is always understood, 
that cold, like all other exciting causes, will more certainly 
affect the predisposed, and more probably establish a morbid 
habit in such. 
A subject will bear severe cold with less injury, if the cir- 
culation in the capillary tissues is active when he approaches 
it, and especially writh exercise. After exposure, he will en- 
dure another with ease, if he becomes effectually warmed. 
Hence, those who are much exposed by day to cold, should 
sleep in a warm place. The circulation in the capillaries is 
then sustained ; something as it is in those who have been in 
a high heated bath, as in Russia, and by the aboriginal Amer- 
icans ; they will endure plunging into cold water, or snow, 
without injury, if not too long continued. The activity of cir- 
culation, and presence of caloric, do not admit the rigid state 
that often takes place under other circumstances, fixing the 
first link of morbid catenations ; or in other words, the tern- 394 
ETIOLOGY. 
perature is not yet reduced below the normal standard ; if 
this should take place, disease might follow. 
In any other point of view the effects of cold appear con- 
tradictory ; and indeed it has been used as a very accommo- 
dating agent to suit different theories ; but, too many incon- 
sistences often attend their expositions. Dr Cullen in his 
First Lines, remarks, "cold is manifestly an astringent." 
Also, " in certain circumstances cold becomes a stimulus to 
the living system." And again, "cold in certain circum- 
stances has manifestly a sedative power." He also, consid- 
ers it one of the occasional causes of gout, "which induce 
debility." Dr Brown, also, in his Elements of Medicine 
says : " cold equally as excessive heat, produces atony, and 
laxity of the vessels." And again, "cold as well as heat 
relaxes. " Moreover, it appears, that all those writers, who 
esteem debility to be the chief element of disease, and that 
" there must be a weakening of the system before either fe- 
ver, or inflammation can be excited in it," do necessarily in- 
fer, that cold must be a debilitating agent, since they make 
no distinction between structural tonicity, and functional ina- 
ability. 
Instances are very familiar in delicate, movable habits, in 
which on a moderate exposure to cold air, they suddenly 
grow pale, and experience lassitude, faintness, with a sensa- 
tion of sinking at the stomach, and often immediate vomiting. 
A superficial observer would say, this is a case of debility 
produced by cold. The real explanation is, the tonic influ- 
ence of the cold on the surface retards the capillary circula- 
tions ; hypersemia exists in the internal tissues ; a tonic and 
turgid state of vital tissues impedes the nervous force. An 
inability of function exists, and the vomiting is one of the in- 
stinctive, recuperative processes which help to restore the 
lost balance of circulation. These sudden depressions are 
usually quickly restored ; if not, the derangement may lay 
the basis of a morbid habit. Indeed, a large proportion of OUTLINES OF PATHOLOGY. 
395 
deaths which occur suddenly, and without the characteristic 
phenomena of any definite disease, are from this source, 
both in winter and summer. Death by drinking cold water 
in summer, when the body is heated, admits of similar ex- 
planation. 
3. Heat considered Pathologically. 
Although it is an intrinsic property of the human economy 
to resist the undue impressions of cold and heat externally, 
and to keep up an equilibrity internally, yet it is not able on 
all occasions so to effect it, and especially as relates to the 
surface. When innervation is deficient from any cause, 
there will be a deficiency of caloric extricated. On the 
contrary, when the vital forces are unduly excited with a free 
circulation, by internal stimulations, by exercise, and also by 
an atmospheric temperature from 80° to 98° Fah., caloric 
will exist in excess, unless it be dissipated in part by evapo- 
ration of the surface. 
Solar heat operates intensely at the above temperature, on 
the surface, and also in the lungs ; and it accumulates univer- 
sally in the system, the ingenerate heat cannot be suffi- 
ciently eliminated. The capillary tissues become distended, 
and their excitations radiate to all the tissues. The skin 
suffers much, it assumes a morbid sensibility, and after it has 
transmitted large and continued discharges, becomes dry, 
red, chapped, and subject to eruptions of different kinds. 
The aqueous portions of the blood have been largely ex- 
pended, and the residue has become too dense and stimu- 
lating. 
A continuance of this state of things cannot fail to exhaust, 
more or less, a portion of the vital force ; in consequence of 
this, the centrifugal circulations are not so well sustained, 
and there is an undue concentration to the internal viscera ; 
they assume a state of morbid hypersemia and excitation. 
The organs, being surcharged with blood, have their func- 396 
ETIOLOGY. 
tions increased, and are liable to pour out their excretions, 
and internal exhalations ; hence the liabilities to diarrhoea, 
and bilious discharges in hot seasons. Again, if a few de- 
grees of cold have been applied to the surface, dysentery, 
hemorrhage, cholera, gastric, bilious and yellow fever, may 
readily be excited. At the same time, a liability is induced 
to fevers with concentrations to the head. A little more se- 
vere exposure is liable to produce great excitations in the 
cerebral organs, called coup de soleil, or sun-stroke. 
4. Animal Heat modified by Exhalation, and Evaporation. 
Were there no counteracting force, heat would accumulate 
to a destructive amount in the human system, when placed in 
an atmosphere of its own temperature. But, the external 
heat increases the action of the exhalants, and a large portion 
of fluid is usually thrown out. The body will be cooled in 
proportion as this is eliminated in the form of gas, by uniting 
with caloric. With this protecting process, many have en- 
dured high degrees of heat without injury. 
If, however, the state of the skin and lungs be such as not 
to admit of much exhalation, as in ardent fevers especially, 
the heat may accumulate to a distressing amount; perhaps 
106° or 108° Fah. In such an event, the evaporation of wa- 
ter applied to the surface acts as a substitute. 
There are four states of the air which modify the cooling 
process of evaporation in health. 1st, a moist and warm air ; 
2d, a moist and cold air ; 3d, a dry and hot air ; 4th, a dry 
and cold air. 
a. JI moist and warm air.-This is always oppressive, 
and enervating. The air being already saturated with moist- 
ure, does not imbibe the vapor of sweat ; it accumulates on 
the surface, whilst the internal heat is retained. The blood 
is expanded in volume, and oppresses the muscular and cir- 
culatory powers. Neither are the caloric nor the exhalations 
from the lungs any better disposed of. The enervation is OUTLINES OF PATHOLOGY. 
397 
such that the skin is often cold, and the exhalation stands in 
drops, or runs off. There is now a high state of predispo- 
sition, and disease is easily excited by an exposure to dry 
and cold air, especially if in motion by wind. 
b. Cold and moist air rapidly conducts caloric from the 
body, without evaporation of the moisture, and induces chills. 
A person passing suddenly into this from a heated atmos- 
phere, is very sure to contract a severe morbid habit. 
Hence, sailors, who by some accident are obliged to tarry 
over night on cold damp land, and amidst heavy dews, are 
made sick immediately, and all the fault may be charged to 
malaria, unless a plea of alibi be entered. Those who dwell 
steadily in such an atmosphere, without changes of much 
heat, become disposed to diabetes, diarrhcea, dropsy, inter- 
mittents, cholera infantum, scurvy, scrofula, &c. 
a. Jl dry and hot air is injurious, by dissipating the exha- 
lations, and fluids of the body too freely, and leaving perma- 
nent irritation in all the tissues, with increased sensibility. 
There is liable to be a deficiency of oxygen, whilst the air is 
loaded with dust. The absorbents are excited, thirst at- 
tends, and aqueous fluids are greedily taken up. Diseases 
of the severest kind are easily excited by the common agents, 
after an exposure of some time to such an atmosphere. 
d. Dry and cold air, also, dissipates the exhalations sud- 
denly. The body is deprived of its caloric, suffers the sen- 
sation of cold, with a rigid state of the tissues. This state 
of air is very prevalent in the eastern part of North America, 
and is often attended with wind from the north-west. It is 
considered agreeable in the summer months, but rather intol- 
erable in the winter. In spring and autumn it is too cold for 
comfort. This state of air disposes to catarrhs,'rheumatism, 
pneumonia, and phthisis pulmonalis. Almost all the thunder 
storms in summer are from a westerly direction, and often 
followed by a cold, and dry atmosphere. This state of the 
atmosphere prevails in the winters of New England, and 
VOL I. 51 398 
ETIOLOGY. 
proves injurious to invalids, to old pedple, and to infants. 
Many statistical accounts prove the fact, of there being many 
more deaths of old people, and of infants in the cold season 
of the year, than in the warm. This ought to excite atten- 
tion to the proper measures for such subjects avoiding the 
inclemency of the winter season. 
5. Winds as modifiers of sensible Heat and Cold. 
These are shifting currents of air, and come from every 
point of the compass ; and not only so, but the upper strata 
of the atmosphere are often precipitated, and mix with the 
terrestrial. There are often transverse currents in the upper 
strata. The air precipitated is often quite cold, after the 
lower strata are removed. An seronaut, Mr Lauriat, set off 
in a temperature of 76° Fah. ascended 1250 feet, and found 
the temperature 28° Fah., or four degrees below freezing. 
This was above the clouds. These are carried upwards 
sometimes, in thunder storms, suffer congelation, and precip- 
itate hail, as well as cold air. Currents from the south, in 
this region, are warm and moist ; from the east chilly and 
moist. Air in motion removes the personal atmosphere, 
which is ordinarily warmer than the common atmosphere, 
and it is replaced successively by cold air, and greatly redu- 
ces the heat of the body. Yet the thermometer indicates no 
greater coldness in a current, than in a calm, unless it be of- 
ten moistened. 
6. Alternations of Heat and Cold. 
The human system by a slow exposure, will endure great 
extremes of heat and cold ; but, suffers severely in respect 
to these, as in other instances, by sudden changes of habits 
of every kind. It appears to be the sudden application of 
cold, after heat, which most commonly fixes the tissues in OUTLINES OF PATHOLOGY. 
399 
their state of morbid rigidity. The sudden application of 
heat, after exposure to cold, is not so very injurious, al- 
though it is liable to induce a temporary exalted state of vas- 
cular action, which might have been avoided by a more slow 
application. The warmth promotes absorptions, and sus- 
tains the other circulations, and thereby rigidity and chills 
are precluded, and any temporary injury is removed by the 
sweats that usually follow. 
We have hitherto spoken of heat and cold in a very gen- 
eral manner, without specifying the amount of either neces- 
sary to excite disease. With regard to this, it is altogether 
conditional. We find disease excited by cold in summer as 
well as in winter, although there is a vast difference of atmos- 
pheric temperature between the two seasons. Not so much 
depends on the actual amount of cold, as on the suddeness 
of its application after heat, and the state of the subject ex- 
posed. Besides any other predisposing circumstances, the 
heat of summer increases the tissual sensibility universally, so 
that the system is more readily acted on by many agents, than 
it is in winter. Hence the frequency of acute disease in hot 
seasons, and at such periods as manifest the greatest disparity 
of temperature between day and night. 
Let us suppose a person having been for some time in an 
atmosphere of 90° Fah., to be transfered to an atmosphere 
in summer of 80° Fah., he will be as likely to gain a morbid 
impression of cold, as in winter to pass from 40° to 20° 
Fah., under circumstances otherwise equal. So we find dis- 
ease excited in summer by a few degrees of difference in 
temperature. The variations of what might be called a tem- 
perate day, or going from sunshine and resting in shade, being 
often sufficient to excite severe disease. The medical poet 
has told it very well ; 
Hot from the field, indulge not yet your limbs 
In wish'd repose ; nor court the fanning gale, 400 
ETIOLOGY. 
Nor taste the spring. O ! by the sacred tears 
Of widows, orphans, mothers, sisters, wives, 
Forbear. No other pestilence has driven 
Such myriads o'er the irremeable deep. 
The difference of temperature between noon and night, in 
New England, is often more than 15° or 20° Fah. It was 
even sometimes 37° in August; 45° in January, and 61° in 
February, in 16 hours in 1813.* And besides, the dews of 
summer have a controlling influence on the principles already 
mentioned. It is in accordance with all history of diseases, 
that the greatest number, and severest kind occur at those pe- 
riods in which there is the greatest difference of temperature 
between noon and night, and during the presence of the heav- 
iest dews. From about the middle of July, to the middle of 
September usually responds to these circumstances. Here 
are agents sufficient to excite disease, without miasm. The 
same circumstances continued, with a little modification, may 
excite disease at all seasons of the year; having, however, 
certain modifications also, of character and phenomena. 
Rains in the West Indies, according to Moseley, greatly 
increase the disparity of temperature, and may excite dysen- 
tery in a regiment of soldiers in one night; he says, "cold 
is the cause of almost all the diseases in hot climates, to which 
climate alone is accessory." So thought Tissot, Cleghorn, 
Huxham, and many other observing physicians. But it may 
be said by some, there is another and better method of ac- 
counting for the origin of disease; that is, by malaraic exci- 
tation. 
The inducements to intemperance in exercise, diet, and 
drink are so urgent amongst soldiers, and men of business and 
enterprise, that exposures will constantly take place ; and es- 
pecially as but few know, or will stop to learn the dangers 
that surround them, or the means of avoiding them. It may 
not be far from the truth to assert, that almost every person 
* Dr Job Wilson on Spotted Fever, pp. 86, 88 and 90. OUTLINES OF PATHOLOGY. 
401 
might remain free from disease, even in the severest epidem- 
ic seasons, if they thought and practised the means of safety 
with as much assiduity as they pursue the courses of pleasure, 
fame and profit. 
We acknowledge there are numerous sources of exposure ; 
but with diligence they may be shunned. We pass through 
many local atmospheres every day ; from room to room, and 
sometimes underground rooms ; from sunshine to shade ; from 
exercise to a cool resting ; from the heat of the sun, to shade 
of clouds and showers ; from heated rooms in winter, to zero 
weather ; from labor in a scorching sun, to the dews and 
breezes of evening, and perhaps, whilst much exposed in 
sleep ; besides other contingencies innumerable. So a very 
constant attention is necessary to avoid impressions at sickly 
periods. 
7. Cold internally 
As the circumstances just alluded to, primarily affect the 
external surface, and in quick succession the whole of the tis- 
sues ; we might now make reference to impressions on the 
internal surfaces, suddenly reverberating over the entire sys- 
tem, in the instance of drinking cold water, when the body is 
in a high state of temperature. The hurtful effects usually 
occur in the predisposed, and that most commonly an alco- 
holic predisposition. The tonic action of cold water is pri- 
marily in the neighborhood of the visceral ganglia and plex- 
uses ; a state of nosodynamia is instantly induced, affecting 
these, and the entire tissues also ; and of such severity, often- 
times, as to intercept all vital movements in the space of a 
few minutes. If not quite so severe, it is sure to implant the 
radicles of a morbid habit in the inmost tissues, which soon 
vegetate into either acute, or chronic disease. 402 
ETIOLOGY. 
8. Remarks on Climate. 
In the torrid regions there is a preponderance of nervous 
susceptibility over the tonic state of the tissues ; every thing 
relating to life and sensibility is on an elevated scale. The 
diseases are, therefore, of sudden access, of exalted action, 
and rapid termination. In the temperate regions many of the 
diseases of summer and winter are of a similar aspect; yet, 
a large portion are of a dilatory character, and range in the 
scale of chronic diseases. The aptitude to excitations is not 
so intense, and the hurtful changes in the tissues not so se- 
vere in such conditions. Although the temperature is almost 
constantly fluctuating in the middle latitudes, yet slight im- 
pressions only are often made in the tissues, but they are lia- 
ble to be permanent. For instance, the primary changes 
made by alternations from heat to Cold, and which terminate 
in phthisis pulmonalis, are often very slight, but unrelentingly 
persistive. It is the bane of temperate and changeable cli- 
mates, and scarcely known in any other. 
It appears that Dr Brigham, of Connecticut, has lately 
made some obituary expositions, showing the austerity of the 
disease, and its comparative clemency in the milder and more 
southern districts. In Portland, Maine, the deaths by phthi- 
sis pulmonalis were as 1 in 3.53 ; in Portsmouth, as 1 in 
5.39 ; in Boston, as 1 in 5.79 ; in New York, as 1 in 5.89 ; 
in Philadelphia, as 1 in 7.17 ; in Baltimore, as 1 in 6.18 ; 
in Washington, as 1 in 8.51 ; in Charleston, S. C., as 1 in 
7.08. It is rarely found beyond the Gulf of Mexico, whilst 
it has been for ages the scourge of Great Britain, and North 
America, as well as other places of cold and fluctuating tem- 
peratures. Hence, the means of avoiding it are very obvious, 
although difficult sometimes, and greatly neglected. OUTLINES OF PATHOLOGY. 
403 
9. Heat and Cold as Remedial Agents. 
The physiological influences of heat and cold being duly 
appreciated, we are led to many important practical results ; 
which, however, cannot be dwelt upon here. It may be 
briefly noticed, notwithstanding, that as there is a coldness on 
the surface, and unequal circulation existing in a very large 
proportion of diseases of northern latitudes, the application of 
heat in some form, is a necessary and pleasant adjuvant in the 
treatment, particularly at their commencement. In many 
cases it is indispensable for the removal of the morbid condi- 
tions. It ought, however, always to be used with discretion, 
and not urged to excess. It may be applied by the air bath, 
by dry heat, by mild vapor bath, or the water bath. Each 
of these methods may have a preference in particular cases. 
In acute diseases, if necessary at all, it ought to be one of 
the first applications. In a large proportion of chronic dis- 
eases, its repeated application to the surface, in some of the 
above forms, will be found of singular utility, especially the 
tepid bath universally. 
The application of cold to the surface by means of the air 
bath, or sponging with cold water, or by the shower bath, 
may be so managed as to have a tonic effect in many chronic 
cases, attended with enervation, and mobility of habit, pro- 
vided it be rightly conducted. It should not be continued a 
very long time, but should b6 followed by frictions on the skin 
and bodily exercise, in a manner to insure a free and direct 
circulation in the capillaries. But, it will be injudicious if 
there exists any internal local inflammation of an organ. It is 
also of doubtful use in persons so far enfeebled, that re-action 
may not suddenly take place, and such are in danger of per- 
ishing in the attempt, or contracting more severe disease. 
Cold, by means of water or ice, has been a common appli- 
cation to the head, and sometimes over the whole body, in 
fevers attended with pain in the head, or delirium. If used 404 
ETIOLOGY. 
indiscriminately, it is not only a doubtful, but a dangerous 
application. It should not be admitted in the early stage of 
fever, or pyrectic affections, whilst there is any congestive 
state present; neither in local inflammation internally in the 
head, for'they are quite similar in pathological character. In 
such cases it should be deferred, and be made, perhaps, one 
of the ulterior remedies. After the necessary evacuations 
have been made, and to the point of relief, in the early stage 
of such cases as indicate a strong determination to the head, 
and the engorgements, both venous and arterial, are essentially 
removed, and there exists a free and equal circulation exter- 
nally, with high heat, and probably delirium ; in such cases, 
cold applications to the head are of essential service, and 
often relieve pain or delirium, very quickly. But, applied 
without these precautions, it is almost certain to aggravate the 
disease, and render it more dangerous, by adding strength to 
the primary cause, and fixing it in an aggravated state of in- 
flammation. (See further expositions, Sect. xlix. 2 f.) 
The same restrictions ought to be observed in the use of 
the cold dash, as it is called, to the head, or pouring water 
slowly from some height. As this is a more powerful agent, 
it ought to be used with more circumspection, and it some- 
times may be very useful, after all the relaxing remedies of 
inflammation have been carried to a full extent. 
After the capillary vessels have been relieved of their most 
turgid state, and admit a free circulation, with high heat, they 
then bear the tonic influence of cold, or cold water. The 
cold, also, by abstracting the heat, relieves directly of a large 
portion of stimulus ; and in the absence of this stimulus, the 
turgescence of capillaries is permitted to subside still more. 
So, when the surface is hot, and raises the thermometer of 
Fahrenheit perhaps to 106°, as occurs in some states of scar- 
latina and ardent fever, cold water may be applied freely on 
the surface, to great advantage ; provided, however, the pre- OUTLINES OF PATHOLOGY. 
405 
parations mentioned in the foregoing paragraphs have been 
made. 
As the turgid tissues lose their excess of blood and 
caloric, they afford better opportunity for the exhalations and 
absorptions to take effect. This remedy should not be con- 
tinued any longer than it manifestly affords relief. However, 
in ordinary practice, where we meet with one case of disease 
that will be benefited by cold, we probably find, in this cli- 
mate, twenty that require warmth, especially at the onset. 
Much more might be added on heat and cold, both as causes 
and remedies. Many allusions to them will casually be made 
in the division of therapeutics. (Sect. xlix. 2, f.) 
SECTION XXXVII. 
ETIOLOGY. 
2d. Fatigue, Watching and Surfeiting. 
Some allusions have been made to these as remote causes 
of disease ; and so of many other contingencies ; they some- 
times act as predisposing, and under different circumstances, 
as exciting causes. When moderately applied beyond the 
ordinary usage, they act as predisponent, and when vehement- 
ly applied as exciting causes of morbid actions ; or in other 
circumstances, co-operate in producing a morbid habit of 
greater or less severity. 
Fatigue implies a forced circulation, with an expenditure 
of muscular energy, and vital force generally. The blood is 
lodged in the capillaries, and the depreciated state of the 
system disenables the absorbents to take up readily, and 406 
ETIOLOGY. 
slight degress of cold retard, and fix if there ; so disease 
may readily be excited. (See Sect. ix. 4.) Again, a per- 
son laboring under a state of predisposition, may be excited 
into disease by over-exertion, from the sudden agitation given 
to the general system. The state of perturbation continues, 
and becomes fixed, especially when associated with even 
slight degrees of cold. The Roman athlete used the tepid 
bath, and aromatic ointments to secure themselves from sub- 
sequent disease after their severe exertions. Shall it be sup- 
posed the present age possesses less knowledge of prophylac- 
tics ? They seem not to be so circumspect, or vigilant in 
preserving health. 
Watching is also attended with an expenditure of vital 
force, and leaves more or less excitation throughout the tis- 
sues. In severe epidemic seasons many contract disease by 
aiding the sick, especially when their intellect is not elevated 
by ardent affections. All the other extraneous circumstances 
impinge with greater effect in such conditions. A person 
deprived of sleep for one night, acquires an increased sensi- 
bility to cold. 
Surfeiting adds oppressive stimulations to the digestive or- 
gans, and the whole system also. An agitation is every 
where produced, and so we find frequent instances of disease 
excited by it, on ordinary occasions ; but, at sickly periods, 
and in the predisposed, it is very sure to excite severe disease, 
or the prevailing epidemic. Many instances in the late epide- 
mic cholera verify these remarks. OUTLINES OF PATHOLOGY. 
407 
SECTION XXXVIII. 
ETIOLOGY. 
3d. Wounds, Contusions, Burns, and other Lesions. 
In Section xix. 12, some observations were made on the 
influence of wounds, and contusions, occurring under various 
circumstances, and in connection with a morbid' habit. 
Whenever a subject labors under a predisposition, wounds 
and contusions are far more likely to excite general disease, 
and become far more aggravated thereby. They excite per- 
turbation, and the local affection usually concentrates to the 
injured part. This is liable to inflame, suppurate, or be- 
come gangrenous according to the prevailing diathesis. 
Burns, and scalds on the surface, produce excessive stim- 
ulations, and an expenditure of vital force generally. Sub- 
jects become comatose from the loss of vital force, and are 
liable to sink by excess of stimulations. The more internal 
stimulants are given, the worse the case is made. If they 
surmount the first impressions, the stimulations reach the nu- 
tritive system and continue, and immediately establish a mor- 
bid, or pyrectic habit, especially in co-operation with an ex- 
posure to cold. Narcotics aggravate the case. Whatever 
destroys the sensibility of the surface, as a strong solution of 
nitrate of silver, does most service. 408 
ETIOLOGY. 
SECTION XXXIX. 
ETIOLOGY. 
4th. Emotions and Passions. 
So many allusions have already been made to this subject, 
that it needs not to be dwelt upon. These may act both as 
exciting, and predisposing causes, according to their severity, 
and the present condition of the subject. They may excite 
a train of phenomena indicative of melancholic insanity, or 
of furious rage. In the former instance the circulations, se- 
cretions, and excretions become torpid ; in the latter they 
are agitated, and the direct expenditure of vital force may be 
so great as to induce sudden death ; or the perturbations may 
provoke general disease, attended with convulsions, he- 
morrhage, apoplexy, or fever. 
Moderate excitations of mind enable the body to perform 
unusual labors, and sometimes to a great extent without inju- 
ry > yet, they are liable in the end to produce exhaustion, 
followed by disease, perhaps insanity. A victorious army 
will endure great fatigue with an exemption from sickness, 
whilst a retreating one is liable to be overtaken by disease, 
if not by the enemy. The agreeable excitations of intellect 
impart vigor, and a repelling force to impinging extraneous 
circumstances. The reverse occurs in despondency. 
The primary impulse of the passions is on the nervous sys- 
tem of external relation ; soon, however, the nutritive tissues 
feel the impulse, and the capillaries distributed in all the ner- 
vous tissues are immediately disturbed, and their functions 
soon altered. An excess of fear, grief, anger, revenge, and 
even of love and joy, may suddenly destroy life, or light up 
the flame of disease. (Sect, xxxiv. 10, 6.) OUTLINES OF PATHOLOGY. 
409 
5. Resulting Remarks. 
The review we have made is not expected to embrace all 
the remote, or exciting causes of disease. They may be 
very numerous, and many of them obscure in their nature. 
The foregoing will serve as a basis to which others may be 
added. After disease has been established, and made some 
progress, there follow a succession of effects ; so that the 
primary effects in the tissues from changes made by the ex- 
citing, and remote causes may be lost, or not easily distin- 
guished, yet the secondary effects are commonly very prom- 
inent, as the sequences of disease. 
The causes of disease have usually been treated in a lax 
and undefined manner, and without much of a systematic ar- 
rangement and much uncertainty seems to have prevailed in 
relation to various diseases, whether they have an origin from 
contagion, or from extraneous circumstances, or as they may 
be styled, the circumfusa. We allege, that all the diseases 
usually styled epidemic, have their origin in the manner last 
mentioned ; and, also, the sporadic, and chronic diseases, 
having regard to constitutional liabilities ; excepting such as 
are known to be contagious, or infectious, and which belong 
to the next section. 
To be more explicit, some may be mentioned ; such as all 
the grades of typhus, mitior and gravior ; the oriental plague ; 
yellow fever ; spotted fever ; scarlatina pneumonia ; chol- 
era ; dysentery ; influenza ; intermittents ; erysipelas ; rheu- 
matism ; gout; phthisis ; with all the phlegmatiae, and 
chronic diseases, with the exceptions, however, mentioned 
above. 410 
ETIOLOGY. 
SECTION XL. 
ETIOLOGY, 
5th. Contagion and Infection. 
These terms have nearly similar lexicographic definitions ; 
and they have been used synonymously, in a manner to per- 
plexTthe student. The late attempt to prove the kaino, and 
iciio-miasmata to be contagious, has served to confound their 
use still more. We will attempt to designate the proper, and 
necessary use of these terms by the following definitions, and 
applications of them. 
a. Contagion may be defined, a principle, or subtile virus, 
which excites a specific morbid action in animal bodies, of 
an acute pyrectic character, and limited duration ; affecting 
the same subject but once ; attended with internal visceral 
excitations, and for the most part eruptions ; producing a 
similar virus by diseased organic secretion, which is commu- 
nicable to other systems by effluvia, or by contact; whereby 
a disease of similar character is excited. To this division 
belong, variola ; varicella ; rubeola ; pertussis ; parotidea ; 
the hybrid affection vaccinia, and perhaps some others. 
b. Infection ought to be restricted to those affections 
communicable by contact alone, by a specific virus ; of un- 
limited duration ; liable to affect the same person more than 
once ; for the most part of a chronic character, and without 
visceral excitations ; producing a morbid secretion of a similar 
kind. To this division belong, syphilis ; gonorrhoea ; ele- 
phantiasis ; lepra; psora ; herpes ; tinea capitis ; trichosis ; 
the virus of horse glanders ; framboesia ; and perhaps some 
others. Under this division, also, may be placed, hydro- 
phobia ; the virus communicated by the bites of venomous 
animals ; the acrid, poisonous properties of certain vegeta- OUTLINES OF PATHOLOGY. 
411 
bles, producing affections of a more acute character, yet not 
agreeing in all the particulars. 
We know but little of the origin, or entity of these con- 
taminating principles ; neither are we allowed to discern their 
modus operandi; nor what secret changes are made in the 
hidden tissues by the contagions, whereby the system be- 
comes insusceptible of a reiteration. However, the practi- 
cal laws of the contagions and infections, have become toler- 
ably well established by slow experience. 
The contagions have a precision of access not observed 
by the infections. The former when communicated by efflu- 
via, require about two quarter lunations from the time of ap- 
plication, before a morbid action is excited ; whilst those ad- 
mitted by insertion, require only one quarter lunation. The 
different varieties of the infections are extremely variable re- 
specting their period of incubation, and accession. 
It appears that the exciting virus must reach the suscepti- 
ble tissues, either by absorption or insertion, and accumulate, 
before an excitation is produced. (Sect. xv. 4.) When it 
takes effect, in all the contagions, and some of the infections, 
we discover a train of phenomena not very dissimilar to that 
of the common morbid habit of the acute character. This 
seems to prove the simplicity, and congruity of morbid ac- 
tion, and that disease has many things in common. Not- 
withstanding this, each of the affections has its own peculiar- 
ities, which go to establish its nosographic character, and 
these distinguishing traits are very constant by means of their 
local tendencies, and peculiarities of eruptions. 
Notwithstanding the contagious affections are excited by a 
specific virus, and require a limited period to pass through 
the system ; yet, the duration of the pyrectic state may be 
greatly modified by internal changes and extraneous circum- 
stances. The morbid habit may be prolonged in them to an 
indefinite period, by certain combinations of the common 412 
ETIOLOGY 
causes and sequences of disease, especially with cold ; and 
they may even terminate in severe chronic affections. 
The distance that the contagious effluvia may take effect 
on the unprotected, depends on many circumstances. Vari- 
ous experiments show, that the effective virus extends only a 
few feet from the person affected, in an atmosphere free from 
currents. The atmosphere dilutes, and no doubt neutralizes 
it. The distance then depends, 1st, on the quantity of the 
virus in a given place ; 2d, on the course of any atmospheric 
currents ; 3d, on heat or cold ; for contagions remain the 
longest active, and spread with most facility, in cold seasons. 
On the contrary, warmth appears to be more favorable for the 
propagation of infectious diseases. 4th, on the general pes- 
tilential afflatus in the atmosphere ; for such seasons are far 
more favorable for the spread of contagious, as well as epidemic 
diseases. 5th, on the personal condition of the subject at 
the time of exposure ; as whether his system is in an absorb- 
ing condition at the time, or in a state of increased sensibility ; 
whether he has been exhausted by hunger, fatigue, watching, 
&c., or is exercised with fear, or any other depressing pas- 
sion ; all these circumstances favor the absorption of the 
virus. Prudence might, therefore, dictate the keeping the 
more safe distance of several rods. 
There appears to be considerable evidence to create a be- 
lief, that contagions may originate in certain seasons favoring 
their virulency, without a positive pre-existing virus. No 
doubt many circumstances must conspire to produce them. 
When the diseases appear under these circumstances, they 
spread with nearly the celerity of epidemic diseases, and often 
possess unusual malignancy. So, also, the infections more 
manifestly have a spontaneous origin sometimes. 
The virus seems to act as a chemical ferment, changing 
the fluid matter, and exciting the fixed matter of animal bodies 
into inordinate action. It multiplies in a ratio of the conge- 
nial substances existing in the individual affected ; and there- OUTLINES OF PATHOLOGY. 
413 
lore some receive far more severe impressions than others, 
and produce more of the peculiar virus. 
The contagions maintain their definite characters, although 
their diatheses suffer essential changes, by which they mani- 
fest some new phenomena ; whilst the class of sporadic and 
epidemic diseases are subject to important modifications from 
the circumfusa, assume new liveries, and require other dis- 
tinctive appellations. 
SECTION XLI. 
ETIOLOGY. 
Ou Diurnal and Sol-lunar Influences, as Exciting 
Causes. 
Had not reminiscence rather casually recalled this subject, 
it would have remained at rest, like many others so little 
thought of since the engrossing topic of malaria has become 
the almost exclusive causation of disease. We cannot fol- 
low this subject out in the details it merits, but merely excite 
attention to it as a prolific source of excitations offered to the 
vital susceptibility of animal tissues. 
However superciliously the influence of the bodies com- 
posing the solar system may have been regarded by some, as 
affecting the human economy, and exciting disease, yet it may 
be demonstrated they possess some controlling power in many 
of the other processes in nature. 
Solar heat and light, with the reflected rays from the moon, 
and the diurnal motions of the earth, produce astonishing 
changes in the atmosphere every day and night, which also 
impress the entire animal and vegetable productions, modify- 
ing their economy. So, also, the annual revolutions of the 414 
ETIOLOGY. 
causes and sequences of disease, especially with cold ; and 
they may even terminate in severe chronic affections. 
The distance that the contagious effluvia may take effect 
on the unprotected, depends on many circumstances. Vari- 
ous experiments show, that the effective virus extends only a 
few feet from the person affected, in an atmosphere free from 
currents. The atmosphere dilutes, and no doubt neutralizes 
it. The distance then depends, 1st, on the quantity of the 
virus in a given place ; 2d, on the course of any atmospheric 
currents ; 3d, on heat or cold ; for contagions remain the 
longest active, and spread with most facility, in cold seasons. 
On the contrary, warmth appears to be more favorable for the 
propagation of infectious diseases. 4th, on the general pes- 
tilential afflatus in the atmosphere ; for such seasons are far 
more favorable for the spread of contagious, as well as epidemic 
diseases. 5th, on the personal condition of the subject at 
the time of exposure ; as whether his system is in an absorb- 
ing condition at the time, or in a state of increased sensibility ; 
whether he has been exhausted by hunger, fatigue, watching, 
&c., or is exercised with fear, or any other depressing pas- 
sion ; all these circumstances favor the absorption of the 
virus. Prudence might, therefore, dictate the keeping the 
more safe distance of several rods. 
There appears to be considerable evidence to create a be- 
lief, that contagions may originate in certain seasons favoring 
their virulency, without a positive pre-existing virus. No 
doubt many circumstances must conspire to produce them. 
When the diseases appear under these circumstances, they 
spread with nearly the celerity of epidemic diseases, and often 
possess unusual malignancy. So, also, the infections more 
manifestly have a spontaneous origin sometimes. 
The virus seems to act as a chemical ferment, changing 
the fluid matter, and exciting the fixed matter of animal bodies 
into inordinate action. It multiplies in a ratio of the conge- 
nial substances existing in the individual affected ; and there- OUTLINES OF PATHOLOGY 
415 
fore some receive far more severe impressions than others, 
and produce more of the peculiar virus. 
The contagions maintain their definite characters, although 
their diatheses suffer essential changes, by which they mani- 
fest some new phenomena ; whilst the class of sporadic and 
epidemic diseases are subject to important modifications from 
the circumfusa, assume new liveries, and require other dis- 
tinctive appellations. 
SECTION XLI 
ETIOLOGY. 
6th. On Diurnal and Sol-lunar Influences, as Exciting 
Causes. 
Had not reminiscence rather casually recalled this subject, 
it would have remained at rest, like many others so little 
thought of since the engrossing topic of malaria has become 
the almost exclusive causation of disease. We cannot fol- 
low this subject out in the details it merits, but merely excite 
attention to it as a prolific source of excitations offered to the 
vital susceptibility of animal tissues. 
However superciliously the influence of the bodies com- 
posing the solar system may have been regarded by some, as 
affecting the human economy, and exciting disease, yet it may 
be demonstrated they possess some controlling power in many 
of the other processes in nature. 
Solar heat and light, with the reflected rays from the moon, 
and the diurnal motions of the earth, produce astonishing 
changes in the atmosphere every day and night, which also 
impress the entire animal and vegetable productions, modify- 
ing their economy. So, also, the annual revolutions of the 416 
ETIOLOGY. 
earth in her circuit round the sun, change the aspect of every- 
thing about us. These are phenomena presented to the 
senses of every one ; but still, there are many of the hidden 
processes, which depend on concealed influences, meriting 
our attention. The attractions which bind the spheres in 
their circuits, must influence every substance, more or less, 
within the circle of their embrace. 
The constant coincidence of the flowing and ebbing of the 
great movable waters, by the single and combined influence 
of the sun and moon, has become an universal fact. It is 
more than probable, if sufficient attention had been bestowed 
on the subject, that before this, similar and greater flowings 
and ebbings of our atmosphere would have been established. 
Many observations have been made showing regular currents, 
and stated changes of some of the imponderable elements 
existing in the atmosphere. 
The barometer proves a variation in the pressure of the at- 
mosphere, which must affect living bodies in some degree. 
These variations are the most conspicuous in the intertropical 
regions, where it is stated, the mercury has regular diurnal 
ascents and descents, which must depend, not on accidental, 
but permanent influences. 
It is asserted by M. Saussure, that there is a regular minus 
of electricity at the latter part of the night, and that it increa- 
ses to its plus with the sun at its height. 
Mr Haustein has shown, that the magnetic fluid has regular 
semi-diurnal changes from the minimum to the maximum 
points. The magnetic needle vacillates towards the west as 
the sun rises towards its zenith, and towards the east as it de- 
clines. 
Dr M. Edwards has shown that more oxygen is absorbed at 
certain periods of the twentyfour hours, than at other times. 
Can it be supposed these influences are chiefly confined to 
inanimate substances, and that the susceptible tissues of living 
bodies should not, also, be affected by them ? The daily, OUTLINES OF PATHOLOGY. 
417 
and often periodical hilarity, and depressions of the most ath- 
letic show the contrary ; and far more so the hypochondriac, 
or movable habits. 
The whole vegetable and animal tribes are intensely affec- 
ted by the circumfusa of the atmosphere ; and are excited, 
depressed, moulded and modified by its varying impulses, 
both visible and insensible. Many of the aerial influences 
arise from the sun and subordinate planets ; but the moon, 
although a secondary one, is enabled by its proximity to pos- 
sess considerable influence. 
That these influences affect the physiological economy 
ought not to be doubted. The minor influence of the moon 
has not of late years received the attention it deserves. The 
ancients bestowed much attention to the subject, and no doubt 
they undertook to establish principles before an uniformity of 
facts warranted them. Yet some have been sustained, be- 
sides the regular movements of the ocean. In the female pe- 
riods of depuration, certain classes have a very constant coin- 
cidence with the quadratures of the moon; and, again, the 
periodical accessions of many diseases present striking coin- 
cidences. 
If the study had been continued, and with more precision, 
there ought not to be a rational doubt, but manyhnore patho- 
logical phenomena could have been found to have a corres- 
pondence with, and dependence on, the lunar attractions, in 
her different phases ; also, by her light in the night, and mod- 
ifications in accordance with the sun by day, in the great play 
of affinities of the imponderable elements of our atmosphere. 
We cannnot attempt to repeat the numerous facts which 
are in reserve, of the coincidence of the attack of disease 
with the conjunction of the sun and moon, or the change ; nor 
of the exacerbations, nor crises of disease either favorable, or 
otherwise ; nor the accessions of periodical diseases. The 
attacks of insanity, and its exacerbations were found to be 
so coincident with the quadratures of the moon, that the affect- 418 
ETIOLOGY. 
ed were called lunatics. It has been particularly observed 
that hemorrhages are essentially influenced by the phases of 
the moon. 
It is not unphilosophical to infer, that modifications of the 
intensity of the elements composing the medium in which 
man exists, should affect his nervous susceptibility, increase 
and expand the circulation, and the concentrations be directed 
to irritable tissues, establishing a local erethism in them, and 
thence exhibit the phenomena of disease. 
As the advocates of sol-lunar influence from their own ob- 
servations, we may mention, Aristotle, Galen, Avicenna, 
Hoffman, Diemberbrock, Van Helmont, Baglivi, Muschen- 
brock, Mead, Bacon, Pitcairne, Moseley, Balfour,' Blane, 
Hunter, Gall, Spurzheim, and J. Johnson. Many others 
might be added. 
Such a weight of testimony surely demands respect suffi- 
cient to excite inquiry ; and it seems that by neglect the 
present generation must be incompetent judges, and desti- 
tute of negative facts to oppose the thesis. 
As observations on this subject ought to proceed on a 
large scale, may it not be suggested, that every Medical So- 
ciety might do properly by enjoining it as a duty, for each 
member to make accurate observations on the subject, to 
record, and report them annually ? 
Dr Spurzheim well remarked in his observations on insani- 
ty, that, " A philosophical treatise on the periodicity of the 
phenomena of nature in general, and of man in particular, in 
his state of health and disease, would be at the same time 
very interesting for anthropology, and very useful for practi- 
cal medicine." But such a treatise cannot be made out with- 
out the elements.