m NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service ♦ #'• ■p (DaDURBSffi ®W JLISO^PtSiaiS© ON THE INSTITUTES OF MEDICINE* 4 ByCM By CHARLES CALDWELL, M. D. f the Institutes of Medicine and Clinical Practice* in Transylvania University. c: \ «i'.,$■» 33. wi; ITT LEXINGTON, KT. PRINTED BY WILLIAM TANtfE.3. 1823, \ United States of America,') , District of Kentucky. ) " Be it remembered, That on ;the 1st day of *epu mbcr, in the year of our Lord onetiiousand eight hundred and twenty three, and in the forty seventh year of the Independence ofthe United States of Ame- rica, Charles Caldwell, M D. ofthe said District, hath deposited in this Office, the title of a Bopk, the right whereof he claims as proprietor, in the words'fQllowhig. (lo wit:) , • . "Outlines of a course of lectures on the Institutes of Medicine* by Charles Caldwell, M. //. Professor ofthe Institutes of medicine and Clinical Prac- tice, in Transylvania University " In conformity to the Act oi the Corgress ofthe United States, entit- led "An act for the encouragement of learning, by securing the copies of Maps, Charts, and Books to the authors and proprietors of such copies, during the times therein mentioned," a d also the ad. entitled "An act supplementary to an act for the encouragement of leafj^ng by securing the copies of Maps, Charts and Books totheau'" such copies during the times- therein, mentioned, efit thereof to the arts of Designing and Engi rical and other prints." JOHN H. IIANNi Clerk ofthe Distritf otjflinufck^i roprietors of ingthe ben- tching histo- <4* •y Vi To the Pupils of the Medical Department of Transylvania University,for whose use they are chiefly intended, and to the Physicians generally ofthe western and southern states, these Outlines are respectfully inscribed, by their very f^thful and Obedient Servant, THE AUTHOR. rt it* V ri ~2$\}i^' \ V. ft m \ ^* preface; When invited, in the autumn of the year 1019. io the chair which he occupies in the medical department of Tran- sylvania University, the author ofthe following Outlines hrd the misfortune to find himse/f without a text-boo!', and his pupils without a manual, for a course of lectures on the In- stitutes of medicine. This want, which other teachers of the same branch, more fortunate, perhaps, in resources than himself, do not appear to have considered an evil incompatible with the sat- isfactory discharge of their duties, he had immediate reason to lament. To himself it was a subject of no little embar- rassment,and to his class, a source of well founded complaint. In this state of things, the alternative presented to him was, to rest contented under the existing deficiency, until, after a lapse of years more protracted, perhaps,than his own life, the desideratum might be furnished from some other quar- ter, or, with as little delay as possible, endeavour to supply it by his own labours. The former expedient he deemed inconsistent alike with what he/>wed to himself, to his pro- fession, and to those who expected from him instruction in medicine. To make choice ofthe latter, therefore, he im- mediately resolved, and bound himself to that effect, per- haps injudiciously, by a promise to his pupils. That he did not carry this resolution into effect at an ear- lier period, will not, he trusts, be imputed to him as a fault. jKe delay has been occasioned by thepiessure of duties of ariigher order, devolved on him by arrangements essential to the establishment and permanent interests'of the school of medicine of which he is a member. The transactions ne- cessary to the performance of those duties, which compel- led him, after having visited many distant parts of his o*n country, to make a voyage to Europe, occupied the entire intervals of time between his public lectures, for three years. The present season is the only period of leisure he has en- joyed,since his acceptance ofthe appointment which brought him to the west. A portion of that he has industriously de- voted to the composition and publication of this sviiopsis.- « • *J. PREFACE. Although somewhat tardy, therefore, in fulfilling his en- •^ag-ment, he hopes he is not chargeable with the fault of having ueglected it. , , How^u- the work may meet the expectations of hisipu- piis. for »v hose use it is chiefly intended, it does n^ belong to ti.e author to judge. To time, the great resolver ofprob- lenis, must the decision be referred. That it presents a fuller and more comprehensive com- pendium of the elements of medical philosophy, than any other siijgie volume of the same, or perhaps of any dimensions•, now extant, he ventures to believe. Nor has this belief been adopted, until after a deliberate and faithful inquiry, on the result of which he is privileged to rely. He therefore persuades himself, that the benefit of these Outlines will not be confined to his own pupils. To all students of medicine, and to most physicians who rftay take the trouble to ' consult them, and whose object is to be thoroughly versed in their profession as a science, they may serve as both an index and incentive to further researches, in which, without such a guide and prompter,- the individ- uals concerned might not have engaged. Somewhat confidently, although not, as he flatters him- self, presumptuously, the author ventures further to believe, that in this synopsis will he found emlmiced, either express- ly or by implication sufficiently obvious, every subject of real moment, that justly appertains to the Institutes of med- icine. A course of lectures, then, presenting a competent exposition of it, can hardly fail to be inviting and valuable, to the youthful votaries of medical philosophy. In what degree the lectures delivered by himself com- prize such an exposition, he leaves to his pupils who have heard them to judge. He is permitted only to say, that he faithfully devotes to them the whole force of his talents*, ■whatever it may be; and that they contain a digejjjpf much of what he deems most valuable of the fruits of hiWfe- searches, during twenty eight years of close and laborious professional study. If, in a philosophical point of view, these Outlines and the lectures founded on them, possess any particular merit, it consists, in no small degree, in the unceasing effort which the author makes in them, to guard the subjects to which they relate, fiom the corrupting influence of chemistry mis- applied, and the dregs of humoralism—to expurgate the sci- ence of life from such doctrines, .true or false, as belong ex- clusively to dead matter; and to give a fuller and fairer dev- elopment, than he has elsewhere seen, ofthe principles and JREFAfcE, vii laws by which alone, whether in health or disease, all living matter is governed. The discussions of various unsettled topics which they will tend to perpetuate, and even,perhaps, to invigorate and extend, and the many controverted views which they exhibit, whether correct or otherwise, will not be altogether useless in medicine. Science has its times of awakening and revi- val as well as religion; and, on such occasions, truth is elic- ited by.intellectual conflict. E collisione scintilla, is appli- cable to every department of knowledge. Better for a writ- er or a teacher, whose object is to widen the boundaries of knowledge, to discuss frequently doubtful points, and even to broach occasionally startling errors, than to dole out noth- ing but time-beaten truisms, which,awakening no curiosity, excite no interest. In one case, truth will be roused by the conflict of opposition-, in the other, she will slumber amid the calm of indifference'. Hence the most distinguished and successful teachers in medicine that the world has produced*, have been the most intrepid promulgators of dubious opin- ions and controverted doctrines. Ofthe truth of this, abun- dant evidence m^y be collected from the examples of StahJ and Boerhaave, Cullen and Rush. Although often at war with sectarian tenets, and the dog- mas of the schools, the author of this synopsis makes no pre- tension to the imposing character of a reformer in medi- cine. He will be permitted, however, to observe, that into the customary modes of investigating several medical subjects of great importance, reformation and improvement might be easily introduced. Nor will the case be otherwise, until physicians shall have learnt to apply more generally and rigorously than they have heretofore done, as tests of truth in their profession, those established canons of reason and common sense, without which all science is but conjec- ture, and religion itself the cant of fanaticism. Although, when considered in relation to former times, medkal inqui- ries are conducted, at present, on an improved plan, they are still, or the author is greatly mistaken, marked by tc<* much loose investigation and easy acquiescence, and too lit- tle of severe scrutiny and patient anal) sis. Were he to spe- cify any one subject, which he considers more deeply obscur- ed than others, by prejudice, superstition, and deference to authority, it weuJd be that of contagion. It is not a little surprizing, while it is much to be lamented, that certain schemes of disjointed evidence, and processes of spurious. reasoning, which, as applied to other topics,, would be con temp icon sly rejected., are too often here received as conc^ '■ I4> i'iVEi.'A-C-i:. tive. In relation to this subject, an effort is made in the following pages, and the lectures explanatory of them, to designate more clearly the requisite modes of examination and research. On the comparative merit of the Institutes, as a branch of medicine, it might be deemed unbecoming in the author to dwell. Knowing, however, that efforts have been made to depreciate them, he will observe in their behalf, that they constitutethe true line of demarcation between the empinck and the method ist, the quack and the educated practitioner of medicine. Without them the profession, as a science, would be confusion and darkness, and,in a practical point of view, but little better than a scheme of chances. They have been charged with the fault of containing more speculative than practical truths—doctrines rather to be ad- mired for their ingenuity than esteemed for their usefulness. This accusation is self-contradictory. A truth merely spe- culative as epposed to practical ones, does not exist. When ful- ly understood, every truth is practical, and applicable,dircctty or indirectly, to some useful purpose.. That which is^lot practi- cal is visionary and not true. Truth is the knowledge and interpretation of nature as she is. In every department of nature knowledge is power. Other things, therefore, being alike, he who possesses the greatest amount of truth relat- ing to the human system, in a healthy and a diseased condi- tion, is best qualified to preserve it in the one, rescue it from the other, and alleviate sufferings that cannot be removed. To the intelligent reader it would be superfluous to oh-' serve, that the broken aspect, which, as a literary perfor- mance, these Outlines present, is inseparable from the na- ture of such a publication. Essentially crude and unfinish- ed, as its title denotes it to be, an attempt to clothe it in polished language, or to bestow on it any ofthe ornaments of composition, would have been highly injudicious, if not pre- posterous. The only qualities of style to be aimed at or desired, in a work ofthe kind, are brevity, simplicity, precision, and per- spicuity. If these be attained, the author has been so far successful in all that duty required of him, or judgment and cultivated taste could approve. Unless he find reason to alter his determination, the gen- eral arrangement of this synopsis is the same he will observe in a much larger work, which he meditates on the same branch of his profession. His views, however, in relation to that publication,wiii be materially influenced by the recep- tion ofthe present. CONTENTS Institutes of twedix Hne, definition, extent, and importarlCe ^ Physiology, do. d .a. Dr /ision of, Biology, wb at, Pathology, what. Therapeu lies, xi hat, Charactei ristics 'of dead matter and of livin', beings, Fundame ntal attributes of living- matter, Life, wh< ;rein it -consists, and theories ' ^ Irritabili ty, its laws and application tr , tne philosophy and treat- m ent of diseases, t/, existence, laws andmcy^jflcat;onsof, physiology, f y, generally, ,/ rvatrix et medicatrix ndmurce, or functional physiologyL Sens ibilit Cerebral Sympath Vris const Organic Digestia Hunger* Thirst, atopic of preliminary consideration, do. do. Kindt 'J food most suitable to njian, dj. do. Prehe nsion of food and masfi :,cation, do. do. tition; / do. do. ch,the principal orgar/j of digestion, on of digestion considered in detail. lis, (unctions *nd ph'/jlosophy of, 'aculum chyliand Tl'wacic duct, uses of, lification, lood, history and pi ,i]osophy of, ration, do. do inch xding the history and philosophy of tem- peratures liviiH U matter, generally, n of the blood, /* :tion and Nutritir /n, rption, / ration, , vocal generatioi J( ology, remarks / introductory to, ies of disease, v //hat, Technical < /jivision of, ;iting cause, ximate cause, disposing cau' note causes, Non nai mals as such, , sensible q- aaliUes of, Insensible fiw^*«fnfinen2a,>* read Influenza—23, for ttAn4mafcniffl &Aar;.- aria** AmmalcuUr infiasorisc—32, for "o^".'* t«»es—33, fop "fjoar gartSes?" frogs, turtles—53, for "patati"' ps»-Tati—87, for "Tftowscic** Tba-rasSc— 93^ fop-Mresperatiol\,* zespiratson—97V ibc^pijodssee*' procteees—10^ fet "•Anastomasis^anastaraoai*—103, for Md*fe*ie»tO) wrarra&cv. —118, line ah from the bottom, omit "these**—137, fee St& frOra «fee tofV afle? *fry of. Composition of. Life of. Harmonies and sympathies of, with the living solids,*, Sympathy ofthe blood with itself. General uses and functions of. Functions of the sanguiferous system. Circulation *of the blood* Arterial circulation. Capillary circulation. Remarks on the capillary system generally. Venous circulation. Of JVulrition and grozvth. Functions ofthe absorbent system. Cutaneous absorption considered. Functions ofthe glandular or secreloiy system, OT excretions. Functions of the respiratory system. V italization of the blood. Voice and speech. Laughing and crying. Coughing and sneezing. Animal temperature. tf OUTLINES OF F "irtjons ofthe cutaneous system.. P.r«piration. Complexion, or matter of colour. II.ir. Uses ofthe cuticle. Functions ofthe cellular sy^km. ofadipose substance, uses of F .'•'■ Irons of the muscular system. Fu irtions if the nervous system* S'nsation. Voluntary motion. of i'ie external senses; of internal senses. senses of hunger and thirst. sense of being. of well-being. of ill being. Functions of the cerebral sylem. Of a sensorium commune—remarks on. Of the brain as the organ ofthe mind. Not a simple but a compound organ. Ofthe faculties ofthe mind, as manifested by cerebral organs. The whole being intended as a developement of Phre- nology^ defence of its leading principles, with their applicability to the science and treatment of men- tal diseases, and a vindication of itagaint the charg esof mateiiaiism, fatalism, and immorality. Functions of the generative system. Sexual differences. Effects arising out of these. IVeriLkirilies ofthe male. Testes, the c'lief organs. Powerful effects of, on the general system- *?emen mosculinum considered. A COURSE OF LECTURES* Peculiarities of the ft male. Ovaria—the chief of her genital organs. Etiectsof, v\\ the general spifcrn, Menstruation. Uses of. ^ot confined to the, human race. Of generation. Various modes of, Theories i f. Ovum, where formed. Evolution of. Of superfcetation. Of the nourishment ofthe fcetus in utero. Of hereditary likeness. Of congenital marks. Of equivocal generation. Ofthe periods and prrgrc-ss of human life, with their ef- fects on the system in relation t» the production and the re moval of disease. Infancy. Pueritia, (boyhood.) Youth. Adult age. Decline. Old age. Natural death. Dissolution—a chemical process. PATHOLOGY. Besides expounding the nature of disease in general, this* branch treats ofthe causes, seats, signs, ^mpt( rus,t i isis, di- agnosis, prognosis and termination of diseases; with the mode of operation of their causes in producii.g them. The causes cf disease divided scbolastieally irto remote, predisposing, occasional or exiitmg, aid pi<.xmate. RtniOf nud occasional causes sometimes identified. & OUTLINES OF Remote causes. Of the atmosphere as -i source of disease.-. Its sensible qualities1. Heat. Cold. JDryness. Moisture. Vicissitudes. Pressure or weight. Chemical mixtures. Mechanical mixtures1; Its insensible qualities. Matter of Epidemict. Of Influenza. Of Scarlatina* Of measles. Of Pertussis. Of Varicella, or varioloid disease. This affection may, probably, be propagated eitVr epV demically or by real contagion. It is, therefore plac-^ ed under both heads. Ofthe English sweating sickness*. Of oriental cholera morbus. Of gastric malignant fever. Of pneumonic malignant fever. Matter of Endemics. Of Intermitting and remitting fever. Matter of Endemico-epidemics. Of yellow or malignant bilious fever. Of the oriental plague. Of the Egyptian opthalmia. Matter of Typhus fever as an intercurrent rather than aa endemic or epidemic disease. OF A COURSE «P LECTUKfcS. *S Volatile contagious matter. Of small pox. Of measles. Of Varicella, or varioloid disease. Contagious matter not volatile. Of variola vaccina. Of Lues venerea. Of Psora or Itch. Of Frambcesiaoryaws, } Of Elephantiasis, > * Of Plica polonica. 3 Of the saliva of a rabid animal. Bite of an animal enraged, but not rabio*. Poison of serpents. of other reptiles. of Insects. Noxious matters acting on the stomach and intestines Vegetable poisons. Mineral poisons. Worms. Accidental and anomalous matters. Diet and drink ^s sources of disease. Unwholesome food. An excess of food. Food at improper times. Water unwholesome from temperature or impurities An excessive use of water. Intemperance in the use of other liquors. *Those three are enrolled among contagious diseases rather in conformity to custom, than from a belief of the author in the c«r- rectness ofthe anangement. Although not sufficiently versed in the knowledge of these complaints to decide with posniveness, he has reason to entertain doubts with regard to their being con- Sagtoti0, B * OUTLINES OF Mechanical injuries. Dress. Fatigue. Indolence*., Sleeping. Waking. Exercise ofthe intellectual faculties* Passions and emotions. Retained excretions. Excessive excretions. Peculiar occupations. customs. amusements. Sexual intercourse. Unhealthy ancestor-?. Quackery, or abuse of medicines; Unhealthy situations. Unhealthy dwellings. Light. Sr specific. Whatever weakens the vis vitas, and diminishes the resistance A COURSE OT LECfURSa. 41 Congenital weakness, hereditary or accidental Feriodsof life. Infancy. Childhood. Puberty, Adolescency. Adult age. Decline. Old age. Different temperaments. General. Local. Difference of ses. Menstruation. Pregnancy. Parturition. Lactation. Cessation of menses. Sleep. The foregoing are natural causes. Others are aritf ficial, viz. JDebility from fatigue. from want of exercise. from cold. from debauchery. from inanition. from fear. from want of sleep* from too much sleep. from excessive evacuationfT which living matter makes to the deleterious influence bf morbific causes, creates a common predisposition to disease. Predisposition to ^particular disease results from the influence of a specific; remote «aus«. 1% OUTLINES OF Dabelity from passions ofthe mind. from the influence of remote causes gene? erally—The latter is a specific predis- position. Exciting causes*, Whatever makes a sudden and strong impression on the system already predisposed. A debauch. A paroxysm of terror, or anger—or any other strong passion or emotion. Exposure to extremes and vicissitudes of weather. to sudden and great fatigue, &c. &c. Proximate cause* This being considered by many as nothing but a scholas- tic expression for disease itself, it has been recommend- ed by them that it be stricken from the catalogue of causes. On this topic our opinion is different. The proximate cause is not a synonyme for disease. The proximate cause of fever is that original topical af- fection from which the phenomena that constitute fever arise, without which they cannot take place, and on the extincv tion of which they cease to exist. A correct knowledge of it, is, in a practical point of view, of infinite moment. In etiology, then, the term proximate designates a reality, and ought to be retained. Seats of disease. These are various, according to the nature of the remote cause. Must, of necessity, be in the solids, and are primarily in The skin. The stomach. The schneiderian membrane, or A COURSE 0** LECTURER* 7/3 The Brain. Shift, by sympathy, to other parts, as the Pleura. Peritoneum. Intestines—different coats of. Membranes of muscles and joints, &6V These latter are secondary seats. Signs of disease. Manifested in the state of the 1. Appetite. 2. Muscular strength. 3. Temperature of the skin. 4. Sensation, as to pain. £. Sensation, as to heat and cold, 6. External senses.. 7. Spirits. 8,. Eyes. 9. Countenance* 10. Respiration. 11. Positions of the body. 12. Movements. 13. Faculties of the mi nd,. 14. Sleep—Dreams. 15. Thirst. 16. Pulse? 17. Tongue. 18. Secretions and excretions. 19. Desires and aversions. ,•20. Voice. Prognosis, Prescience ofthe issue'of a disease, derived from existing phenomena. Its elements are, 1. Observations on the issue of similar co-existing die eases. 14 OUTLINES OP 2. Observations on the issue of a previous similar-dj£*. ease in the same person. 3. Vital strength of patient, compared with the strength, of the disease, as estimated by symptoms. 4;. External appearance and manifestations generally, including, 5. Countenance. 6. Position and movements. 7. Condition as to tranquility. 8, Habits and disposition^ compared with the same in- health. 9. State of stomach. 10. State of respiration.. 11. State of intellect. 12. State of abdomen as to distensions-hardness—se%t" sibility. 13. State of the tongue. 14. State ofthe bowels, and appearance of discharges*. 15. Sleep and dreams. 16. Action of medicines, local and general. 17. State of general sensibility. Therapeutics. The science of correct indication and prescription* Includes the science of medicinal substances, their modet. of operating, and the parts ofthe system on which they act. The various topics embraced in this branch, can be pre- sented only in a detailed view. Hygiene. The art of preserving health, and the science which di- ijects it. Treats of the influence of Climate. Situation. Exposure. ■*A COURSE OP LECTURES. 15 Air. Water, or natural drink"" Food. Artificial drinks, Cleanliness. Exercise. Passions and emotions. Intellectual operations. Sleep. Secretions and excretions. Habits. Amusements. Contagious diseases, Sexual intercourse. Medical Police embraces whatever may be calculated to preserve the health of communities. To this brancb belong The situation and arrangement of cities and towns. Their police as to cleanliness and public amusements. public and private burying-grounds. good water and wholesome provisions. The removal or destruction of rabid and dangerous ani- mals. The prevention of contagious diseases. Vaccination. Means of resuscitation from apparent death. Signs of absolute death. Military medical police embraces the situation and ad- ministration of hospitals and encampments, the regulation of marches, clothing, diet, drink, exercfse, enlistment, per- sonal cleanliness, and every thing that can contribute to the health of the soldier. Itf OUTLINES OF Forensic medicine Treafs of such morbid affections and phenomena, corpo- real or mental, as may become subjects ot public judicial investigation. Such are Insanity, and mental incompetency generally: Infanticide. Poisoning. Mortality of woands. Simulated and concealed diseases'* Hereditary diseases. Hermophroditism. Impotency in men. Barrenness in women. Signs of virginity. defloration. recent parturition. Premature and protracted births. False conceptions and monstrous births'. Evidences of hanging and drowning. BIOLOGY. Ofthe characteristic^ of dead matter and of living beings. Things are known by comparision and contrast—light, by darkness—heat, by cold—sweet, by sour—heavy, by light—- white, by black—summer, by winter—virtue, by vice, &c. In like manner, living best known by comparison and con^ trast with dead matter—organic, with inorganic. 1. Large masses of matter around us are amorphous, and 6omparativcly simple in composition and structure. 2. Bounded by straight lines. 3. Have no mutual relationship or similitude, as to acorn- mon mode of origin—each formed, apparently,.in a different way. 4. Nothing definite in their size or duration. A COUfcSE OP LECTURES. ** 5. Have no desires, sentiments, ^ wants; nor any powers of resistance except their hardness or consistency. 6. If protected from accidental violence, might be unlim- ited in the term of their duration. 7.T'ieir species not numerous, yet do they constitute the chief bulk ofthe globe we inhabit. These masses of matter are inorganic and dead. They fuither differ from living matter,in the following par- ticulars. 8. Their individuality depends on identity of original mo- hcu/es, or constituent parts. 9. Have no cellular tissue, as the basis of their struc- ture. 10. Have no faculties, or operative powers—have pro- perties only. 11. Do not perish by any process of action specifically their own: i. e. going on within themselves. 12. Have no powers of assimilation or development within themselves—nor any interior movement produced by excitation. 13. Are subject to no necessary waste, or loss of parts, and have no power of self-restoration. 14. Have no sympathy of parts. 15. Not influenced by habit. 16. Not modified by climate. 17. Are marked by no regular progression through va- rious rtages of existence—infancy—youth—prime—old age. 18. May consist of only one k jnd, or form of matter—solid, fluid, ©r aeriform; ponderable i>i imponderable—not neces- sarily compound. 19. Are n>t so formed, as to serve as organs, or instru- ments of specific action. 20. Are held together by chemical or mechanical attrac- tion only—susceptibly only of chemical or mechauicitj agency. Q 1* ■ OUTLINES OF 21. Their species not cuari[red by change of figure. 22. Interior motion in them i.ot necessary to entire and healthy existence. 23. Growth in them is accidental, unlimited, and by de- position or aggregation/rom without—stratum superstratum* 24. In their growth, there is no fhange or assimilation of augmenting materials* 25. No nourishment necessary fc» maintain their size. 26. Made for the use of living natter. 27. Not begotten and born. 28. Cannot die. I 29. Do not propagate. 7 30. Do rot require atmospheric air for their subsistence- 31. Diminished in size by friction. 32. Not fitted to be recipients of mind. Of living beings. Amount of.living, compared to that of dead matter, very small* Living beings, however dissimilar in some respects, have Strong resemblances in others. The following distinctive characteristics in them, worthy of notice. 1. An insulated totality of phenomena exhibited by them, called vital. 2. They are bounded by curved lines. 3. Repair their individual losses, and propagate theii likeness. 4. Derive nourishment from surrounding dead matter. 5. Form for themselves the substances of which they con- sist, and the matters they secrete. G. Grow or develop themselves from within, and acquire, each species, a definite size. 7. Their individuality consists in identity of the union and condition of the molecules composing them; not in iden'ih' of the mclccvlcs themselves. A COURSE OF-LECTURE*, . [tb ?•. Are heterogeneous in composition and organization-— consist necessarily of ponderable and imponderable matter—Their ponderable portion necessarily solids containing and fluids contained—cellular tissue the basis of their structure. :). Have interior movements, the result of stimulation. 10. Have wants to satisfy. 11. Change and assimilate the substances by which they satisfy these wants, and augment their bulk. 12. Experience losses and effect reparations unequal In amount. 13. Hence perpetual changes in size, from infancy to adult, and from that to old age—and ultimately to dissolution.. L4. Effect, for a time, from .within, developments in all their parts. These developments constitute growth. 15. Aaalogous in their origin and end, springing from living beings like themselves—are born and die*. 16. Are influenced by habit. 17. Are modified by climate. 18. Possess faculties or powers of action. These facul- ties are common or specific. 19. Their term, and amount of growth, and their dura- tion, definite—Die necessarily from their interior ac- tion. 20. Varied ?n figure greatly beyond dead matter. 21. Their form adapted to specific ends. 22. Identity of figure necessary in them to identity of1 species. 13. Parts sympathize with each other, and thus, for health, depend on each other. 24. Held together by vital attraction—at least owe their strength to it—Examples. 25. Resist destruction with a power surpassing that of their mechanical hardness or consistency. Illustra- tion5. 20 OUTLINES OP 6 . Repair their injuries by an interior process. 2.'. Require atmospheric air for their existence. 28. By exercise and friction are augmented in size—Ex- ample s. 29. Interior action necessary to their healthy existence. 30. Not the recipients of chemical action—alone suscep- tible of stimulation, and necessarily so. 31. Made to appropriate dead matter to their wants and uses. Si. The recipients of mind, and sympathize with it. From the foregoing considera'ions it appears, that, in the principles and laws by which they are governed, and on which their phenomena depend, living and dead matter do not mutually interlock—Each stands insulated, and is sepa- rated from the other, by lines of demarcation distinct and bro.id—Th> laws and principles of the one cannot be ap- plied to the solution of the phenomena appertaining to the other. The attempt at such application is a most prolific Source of error. Fundamental attributes of living matter ^on which its operations and functions depend. 1. A power of self-preservation. Examples. 2. A temperature-preserving power. Examples. 3. Excitability, or a capability of being excited by stimulants—Illustration and application. 4. Sensibility, or capability to feel—Illustration unci application. 5. A capability of co-operating in the acts of the mind. Illustration. 6. The attribute of sympathy. Contractility and tonicity, not perhaps in the strict sense ofthe term, vital properties, but rather such as result from organization or structure. \ COURSE OF LECTUIU::?, £? Of Life—Wherein it consists. A legitimate object of physiological research, Theories of. 1. Of a vital principle. Definition of. A belief in the existence of, very ancient, and en- tertained by the most distinguished individuals. Objection. Do not, say some, know the nature of this principle; and should not therefore indulge in speculations respecting it. Answer. True—Nor do we kno'.v any thing of the nature of caloric—of light—of electricity—of magnetism—of gravitation—of mind—of variolous matter—nor even of f.nnmoii matter. The real nature or essence of all things lies beyond the depth of human research. Must not, therefore, decline all inquiry touching their ex- istence, their effects, and their laws. Gravitation and light, illustrated by Newton. Electricity, by Franklin. Mind, by Locke, and other-. Caloric, by Black, &c.—although the uuiure of those agents were unknown (o them. In like manner, may we ascertain the existence and laws of a vital principle, while ignorant of its nature. To shrink from difficult investigations, merely because they are difficult, is the part of intellectual indolence or cowar- dice. Bv such delinquency no progress will ever be made in the science of nature?. To give the subject a fair trial, let us first examine the theories of those who ttttempt to account for life, withoir. %q aid of a vital principle. I. Life, say some, is the result of organization. Objections. Biood, not organized, yet possessed of life. 22- OUTLINES" or Rudiments ofthe embryo, as they escape from the ovar- ium, not organized, yet living—at least we have no- ground to believe them organized. Life is the cause of organization, and cannot, therefore, be its effect. Organization never appears where life has not pre> existed. Death and disorganization not synonymous term3. In many instances, the former occurs without the lat- ter. Organization the mere instrument of vital action, not its source. II. Life, say others, consists in the totality of the living functions—the life of any being in the totality, of such functions of that being, Objection. If one organ cannot give Iife,neither can. a, number. Were life the result of mere organization, then would there be as many kinds of life as there are of organiza- tion, it being a physical axiom, that the operation of a specific cause produces necessarily a specific effect and no other—and were it the result of a totality of functions, then, for a similar reason, would there be as many kinds of life as there are of gradations in the animal and the vegetable kingdoms. Life, the spring and source of all the functions ofthe body—as much so, as the mainspring is ofthe move- ments of a watch—and cannot, therefore, be their effect. An inversion this ofthe order and relations of nature. Might as well say that the steam which moves the en- gine is the effect ofthe movement it produces. Mere organization has no more influence in giving life, than the construction of an engine has in producing the steam which puts it in motion. A COURSE OF LECTURES. QS Steam is the life, the organic structure vitalized and movedby it. III. Life, say the Brunonians, is a forced state—the result of the application of stimuli to organized matter—• Without such application, life cannot exist. 2V lowest grade of life, say they, implies motion. 1 he nicest, 'motion, sensation, and thought. Objection. L;g>> like caloric, exists in two states, active and quiescent. To the former, stimuli are essential; to the latter, not— yet is quiescent, as real life, as active. Instances of active life pv^eent themselves in the sum- mer stato of.vegetables j 32 OUTLINES OF some way, connected with it—Does not itself en ter the system^ Adult animals have a much higher aggregate amount of excitability than infantile one—more organs developed—particularly the generative system— Have also more ample replenishing powers. irritability, its laws and application to the philosophy and treat" ment of diseases. General remarks. Definition of irritability. A fundamental and most important property of In* ing matter. The source of action in automatic or organic life.. The discovery of, and its assignment as the cause oh- muscular motion, erroneously attributed to Haller —Hence called the vis insita of Haller. Both belong to Glysson, who was anterior to Haller. Glysson's work "On the stomach and intestines." The author there discriminates between initabilily and the nervous energy. Ascribes to the former the action ofthe heart and arteries, and the peristaltic motion of the intes- tines. Also the convulsive movement of muscles excited by the applicatipn of irritants, and The acti-on of muscles during sleep, when sensibility- is suspended. Haller extended and confirmed the theory of Glyas son, and gave it currency by the weight of his character. Theory opposed by Why it, and others. Contrary to all evidence, the muscle was said io feel J the stimulus acting on it. * H That whether the stimulus were applied to the mus- \ clc or the nervQs leading to it, contraction alike ^n**;eA A COURSE OF LECTURES. 33 1. Increase the sensibility of a part by inflammation, or sanguineous congestion of any kind, you increase its irritability also. Illustrations-. 2. We are sensible of the impressions which throw into action the, muscles of involuntary motion, such as, the stomach, bladder, diaphragm, intestines, &c. In opposition to this, it was said that we are not sen- sible ofthe impression that moves the heart; and it was asked, whence is it, that, in frost gurtles, newts, &lc. the muscles continue to contract long after decollation, which must necessarily destroy % the nervous influence? To this question it was again replied, that in these cases, the vis nervosa is slowly expended, and that contraction goes on while any of it remains. The controversy touching the vis insila and vis ner* vosa, cannot be determined by examining the struc- ture and economy of perfect animals. Illustrations ofthis. uut by a suitable attention to tliose ofthe lower or- ders of living beings, it may. ft may thus be made to appear, that in beings des- tiuute of brain and nerves, both irritability and & power of motion exist. Vegetable kingdom. • Stamina ofthe Berberis communis, Leaves ofthe Averrhoa carambola Mimosa pudica. Dionea muscipula. Hedysarum gyrans, acted on by sunbeams. Ovalis sensitiva, onoelia sensibilis, drosera ro- tundifolia and long4folia,#c. Explain. In these instances, irritability and a power of motion exist without nervous matter. K Illustrate. OUTLINES OF Animals of a loib order. Animalcule infusoria?, hydatids, polypi, &c. have neither brain nor nerves, yet are irritable, and move. ■Animals more perfect. In these, sensibility, irritability, and the power of motion, not, in every part, in proportion to each other. Were they all dependent on the vis nervo- sa, the case would be otherwise. The heart deficient in sensibility, but possessed of great irritability, and facility of motion. Illustration. The same true ofthe iris—Illustration. Also of muscles generally, which, very irritable, are but moderately sensitive. In paralytic limbs, the vis nervosa is wanting, while the vis insila continues. From the foregoing it appears, that the properties of sensibility and irritability are distinct from, and. independent of each other. < All irritable parts pf living matter supposed to be muscular. Incorrect—Vegetables have no muscles, yet are irri table—Eggs the same—blood the same. In animalculse infusoria? and polypi, no muscles dis- covered—Illustrations. Even in the higher orders of animals, the iris ex- ceedingly irritable, yet not muscular. Laws of irritability. 1. After every action, in irritable matter, a state of rest, or cessation from action, must ensue. Illustrations. 2. Every irritable part has a certain amount of irri- tability which is natural to it, a portion of which it loses during its action A COURSE OF LECTURES.. 35 3. By a process not well understood, it regains, du- ring repose, the portion it has lost. The different states of irritability expressed by the terms, redundance and deficiency. Illuslrations. 4. While the excitability of a part is becoming dimin- ished, there usually occurs an increase in its ex- citement. To this law exceptions exist. Illustrated by the ac- tion of Electricity, . Ardent spirits, Opium, Laurel water, \ The juice of the cerbera ahovai. Illustrations of these. Stimulation supposed to wear out excitability. Incorrect—It is the action ofthe part that exhausts its excitability. A part attempts to act with a force proportioned to the strength ofthe stimulus applied, and the suit- ability of the stimulus to its susceptibility of im- pression. 5. Each irritable part has stimuli peculiarly appro- priated to its susceptibility, calculated to support its natural action. In relation to this topic, animals to be considered in a twofold point ofview. ? First. Each irritable part—heart—stomach—gall— bladder—arteries—absorbents, &c. a distinct irri- table organ, acted on by stimuli salutary to itself, but deleterious if applied to any other part. Il- lustrations. Hence the truth of the.doctrine of specific stimuli, and the absurdity of that of medicating the blood. Illustration and practical application. OUTLINES OF Secondly. All these parts are so connected by sympa- thy, as to form a- system, in. which the action of ^ach stimulus on its own organ, proves salutary to every other organ individually and to the whole. Illustrations. 6. Each irritable part differs from the rest, in the amount ofthe irritability it possesses; and perhaps in its power to retain, and its capacity to receive it. Illustrations drawn from Muscles of voluntary motion. Heart and intestines. Bladder of urine. Uterus* 't. Stimuli produce action in proportion to their irri- tating power—A practical principle of great im- portance—Illustrations. Exceptions drawn from peculiar susceptibility. 8. The action of every stimulus is in an inverse ra- tio to the frequency of its application. . An im- portant practical principle. Illustrations. Law in relation to Cathartics. Ardent Spirits. Opium. Arsenic. Corrosive sublimate. Tobacco. Irritability dormant to one stimulus, awake to anoth- er of the same, or even inferior strength. A prin- ciple in practice highly important. 9. A part is susceptible of being acted on; in pro- portion to the accumulation of its irritability. Another principle impoi tant in practice. Illustra- tions. Famine. A tJOURSE OF LECTURES. 37 Great abstinence. Exposure to cold. Convalescence. 10. Withhold stimuli too long, the process by which irritability is maintained, weakened at first, is ultimately lost. This true of the more perfect animals—not of the less perfect. Cause of irritability. Girtanner's theory of oxygen. Unfounded and futile. That of Beddoes the same. The vital principle, derived from the atmosphere, by the Mood, and lodged in parts suitably organized, appears to be the cause. Sensibility—Existence and laws of. General remarks. The power of intellection, which belongs to the brain as connected with the mind, excepted, sensibility is the highest property of living matter. » That property by which we maintain our chief inter- course with exterior nature, and recognize certain impressions within our bodies. Called by a late writer the faculty of relation. Sensation, a function dependent on sensibility—the ex- ercise of sensibility—or rather the acr of exercising it. Sensation supposed to require a sensorium commune— requires the existence of mind. Sensation, perception, and consciousness must coexist —Illustration. In sensation four things to be considered, the impression made on the nerves, the conveyance of this impres- sion to the brain, or something tantamount toa brain. 38 OUTLINES OF the impression on the brain, and its perception by the mind. Sensation—perception—consciousness— necessarily allied. I, Sensibility improved and rendered more exquisite by exercising it. Illustrations. Touch. Vision. Hearing. Taste. Smelling. In cultivating and improving sensibility, make not the impressions on the nerves too strong. Illustrations. l[. All stimuli which augment vascular action, height- en sensibility. In the process, sensibility and irritability gradually exhausted. Illustrations. III. Diminish nervous stimuli, and continue arterial action, nervous fluid and consequently sensibility, augmented. Illustrations. Theory of sensation. Dependent on vibration or some kind of motion of so£ id matter, or on a nervous fluid. Vibration cannot be the cause. To vibrate, a body must be 1. Elastic—nerves not so. 2. Tense—nerves not. 3. Free from contact with other solid bodies in the part that vibrates—nerves not. Nerves, then, have no quality of vibrating bodies. Existence of a nervous fluid probable. This fluid imponderable. Requires no tubes for its movements, any more than electricity, or other imponderables. Want of tubularity in the nerves, then, no objection to the existence of a nervous fluid. A COURSE OF LECfDRE^. 39 Nervous fluid probably the same with the vital princi- ple, and that of irritability. Modified in its action by the peculiar character of nei' vous matter, and the tissue or structure to which it is attached. Identity ofthe vis insita, and the vis nervosa. Feel with our nerves, and move our muscles, by means ofthe same principle. Remarks. Theory of sensation by Darwin. Sensibility greatly varied—in degree—and in kind—Causes of this—and the importance ofthe knowledge oj it, in the practice of medicine. I. In degree—Varied in this respect by age, sex, temperament, climate, condition of body as to strength, debility, fee- state of society, idiosyncrasy, health and disease, difference of tissue and structure in different parts of the body, This, a most fertile source of differen.ee in sen^i bility. Illustrations. iSomparative sensibility ofthe brain. nerves arising immediately from the brnijr, nerves arising from ganglions. ofthe skin. of mucous tissues. of membranes secreting marrow. re skin generally. Differs in intensity in different places. Divided into tact and touch. The latter, of the highest order—its seat in the end? ofthe fingers. The former diffused over the skin generally. Its sensations may be classed. Illustrations. Touch capable of great cultivation. Importance ofjeehng illustrated. Taste—excited by matters soluble in the saliva. Its sensations maybe classed. Illustrations. Smell—excited by volatile substances coming into contact with the olfactory nerves. Its sensations very various, but cannot be classed. No two of shem precisely alike. Illustrations. Taste and smell the least valuable ofthe senses to man— yet productive of great pleasure, and no inconsidera- ble advantage. To inferior animals they are all important. Hearing—more complex in its nature. Founded, in part, on the elasticity of bodies. Sounding body vibrates. Vibrations ofthe body do not reach the ear. Conveyed to it by the air, to which they are communicated. Hence the presence ofair essential to sound. No body sounds in vacuo. A series of bodies acted on by the vibrations before they reach the auditory nerve. Illustration. All elastic bodies—solid, fluid, and aeriform—convey sound. Practical illustration. A body, when sounding, has two distinct kinds of move- ment. A COURSE OF LECTURES. 43 #ne, common, mechanical, and coarse; the other pecu- liar and more refined—that specific derangement of its particles which produces the figure of impression. The first gives to the air an agitation, which is felt by the common nerves of the skin—its violence may even rup- ture the mcmbrana tympani. The other impresses the auditory nerve alone—gives to the air no propulsive movement—Hence does not agi* tate the lightest matters—smoker-flame—vapour- Propulsive movement disturbs these. Mere mechanical motion cannot produce sound, else would inelastic bodies be sonorous. Movement of air from mechanical propulsion retarded and checked by a currentrof wind—The movement of sound no wind can stay. * ^^y& Intensity of sound proportioned to the intensity with .. which the figure of impression strikes the ear—propor- tioned, therefore, to the force of the oscillatory mo- tion. Theory of sound. Figure of impression specific—distinguish bodies, there- fore, by their sound—Illustration. VISION, To understand this sense, study carefully the structure and character ofthe eye, and the properties of light— These topics belong to anatomy and natural philoso- phy. Rays of light decussate. Image or figure of impression on the retina, inverted. Produced by actual contact of matter, viz. light. Two phenomena considered peculiar to vision. 1. Two organs, yet vision is single. 2. Objects are seen erect, although their images are inverted. Ans. The first of these not peculiar to the sense of vision. 44 OUTLINES OP Two ears—sound single. Several nerves of touch impressed at once—feeling single. Same thing true of taste and smell. Illustrations. Unity of perception—Whence it arises. The doctrine of specific stimulants established by the phi- losophy of sensation. The external senses give a knowledge of external things only—not of what passes within us, in the different parts of our bodies. Yet such a knowledge wc do possess, although somewhat indistinctly, and it is requisite that we should possess it. Illustration. It is derived from-what is considered a sixth sense, de- nominated, m£henesthesie, or self-feeling—called also the sense of beings Bpf well-being, of ill-being. Furnishes no distinct, and well defined ideas, but merely sensations pleasant or unpleasant. This sense—of what nerves composed. Each internal organ might be regarded as a distinct sense, analogous to the organs of external sense. Cerebral Physiology, or the functions and influence of the Brain, in relation to the action ofthe mind generally. Ofthe unity or singleness of the mind. Can any created being, material or spiritual, character- ized by perfect unity of essence, possess a multiplicity of powers or faculties?—Question discussed. This branch of physiology divided into Phrenology and Craniology. The former treats ofthe reciprocal influence of the brain and the mind. The latter ofthe exte-nal manifestations of this, afforded by the cranium. Phrenology affects no exposition of the nature or essence ofthe mind, nor of its mode of action on, or connection with matter, or of being acted on by it. A COURSE OF LECTURES). 45 Assume?, as a postulate, that man is duplex in his nature, consisting of soul and body, i.e. of simple spirit and organized matter. Takes as its basis, and attempts to prove, I. That, in our present compound condition, mind is, in all its operations, connected with matter, and can- not act intellectually without it. II. That the brain is the portion of matter "nth which it is immediately connected— that that portion i" t iere- fore. the organ of intellect--the necessary coadjutor of mind in every intellectual process. Facts and reasonings in proof of this. Phrenology, then, affects to teach something of mind, which, abstractly^ not understood, through the medium of matter, which is. Objections to this doctrine considered. 1st. O'J. Moral sentiments attributed, as their seat, to certain other viscera. Refutation ofthis hypothesis. Certain viscera alleged to be affected by the passions. This objection also considered. 2d. 0'»j. Brain greatly injured—yet intellect unimpaired. Objection answered—brain double. Its duplex character proved. 3d. Obj. In Hydrocephalus, •brain said to be dissolved and removed, yet intellect continues. This objection answered. Ith. Obj. The subject of petrified and ossified brains con- sidered, and the objection deduced from it removed. III. That the brai% is not a single organ, but an aggregation of organs. Illustrations and proofs of this. Unity of consciousness constitutes no objection to the doc- trine of the multiplicity of the brain. Illustration. * 40 outlines of Absolute size of the brain, and its supposed connectVoi. with a proportionate amount of intellect, considered. Intellect alleged to be in proportion to the size of the biain t< thn body—This hypothesis considered. 2b the size ofthe brain to the nerves—This a!s6 considered. Facial angle, as an evidence of the amount of mind con- sidered. Obj. Anatom. answered. The structure of a part sheds no light on its function—We could never have learnt the functions of the stomach, the liver, &c. from an examination of their structure. Nor can we ofthe brain, from an examination ofitsstruc- tu re—111 ustrations. Under a fair and efficient examination ofthe subject, then, anatomy presents no objection to the doctrines of phre- nology. Energy of the functions of the brain—on what do they de- pend? Ans. On the united influence ofthe size and tone of the organ. Illustrations and proof of this. IV. That it is practicable, during the life of man and otktr animals, to ascertain the developments of their brains. Cause of the form and size ofthe head. Whether does the cranium give size and form to the brain. or the brain to the cranium? Ans. The brain to the cranium certainly. Proofs ofthis, at large. In the foetus, the brain formed first, and the cranium after- wards to cover and protect it—must, therefore, be made to fit the brain; else Avould it injure instead of protecting it—else would the thing served be made for (he use of the thing serving—the superior for the use of 'he inferior. A fe'OURSE OF LECTERE*S. *# The two tables of the cranuim run equidistant from each other. Hence the protuberances ofthe brain must be perceptible on the external surface ofthe head. When, in the progress of the growth of the body, hard parts and soft come into conflict, the hard parts give way—Illustrations and proof of this. Brain,in old age, shrinks, and the internal table follows it. receding from the external. Cranium inideots fits the brain. In hydrocephalic patients, the same. Brain possesses a resisting and propulsive power. Hence the form and size of that organ necessarily deter mine the form and size of the head. The head is not, as some have alleged, moulded by muscu- lar action.—Illustration. Fiiculties ofthe mind, divided into Feeling and Intellest. Feeling, divided again intopropensities and sentiments. Intellect, into knowing faculties, and reflecting faculties. The faculties denominated primitive are those 1. Which exist in one kind of animals, and not in another, the mind of all inferior animals being supposed to be the same. 2. Which exist in different degrees in the two sexes in the same species. 3. Which are not proportioned to the other faculties in the same individual. 4. Which do not manifest themselves simultaneously with the other faculties. 5. Which may act or rest singly. 6. Which are distinctly propagated from parent to off- spring. 7. Which may singly preserve their proper state o/health, or alone fall into disease. The functions of faculties, how ascertained. Illustrations on this subject. 43 OUTLINES OF Phrenology not chargeable with materialism. Voluntary motion, a mental operation, but callnot be per- formed without muscles Sensation generally a mental operation, but cannot be per- formed without the various organs < f sense. For thus asserting and thus believing, no one is accused of materialism. Why, then, should he incur the accusation for pronounc- ing the brain to be as necessary to thought, as muscles are to motion, the eye to vision, or the oar to hearing! Every scheme of metaphysics, strictly considered, is as chargeable with materialism as phrenology. The admission ofthe agency of a material organ in every process of intellection, necessary to a rational belief in the immortality ofthe soul. Illustration and proof of this. Phrenology does not favour fatalism. Illustration and proof of this. Does not legitimate crime. IN or does it favour any one species of immorality. Oa the contrary, its moral advantages are great. Illustration. In the science of metaphysics, which it simplifies, and renders tangible, its advantages are also important. -Nor they are less so in the science of mental derangement. To the true an J correct understanding of that affection, phrenology is essential. In denying or opposing it, physicians do injustice and in- jury to that department of their profession, by bringing theory and practice in it, into direct collision. Faculties of the mind. Propensities 4. Adhesiveness, f I. Amativeness, 5. Cnmbativeness, 2. Philoprogenitiveness, 6. D-strrlCt.voness 3= Inhabits eness, 7. Constructiveness, A COURSE OF LECTURES. tJ. Covetiveness, 13. Benevolence, 9. Secretiveness, 14. Veneration, * Sentiments. 15. Hope, 10. Self-esteem, 16. Ideality, V ProPe* 11. Love of approbation, 17. Conscientiousnes, | tonaan' 12. Cautiousness, 18. Firmness. J Knowing faculties. 27. Number, . 1!). Individuality, 28. Tune, 20. Form, 29. Language. 21. Space, Reflecting faculties? 22. Resistance, 30. Comparison, 23. Colour, 31. Causality, 24. Locality, 32. Wit, 25. Order, 33. Imitation. 26. Duration, Illustrations, and arguments in proof ofthe existence and operation of these. Of Sympathy. Sympathy, a fundamental property of living matter, es- sential to its existence and economy, and most impor- tant from its relationship to health and disease. That property or principle, by means of which impres- sion or action in one part of a living body, produces an increase, diminution, or chrnge of impression and ac- tion in another part, or in the whole. The governing principle in physiology, pathology, and therape utics—All general excitement and action grow out of it. All-impo rtant, therefore, to the physician, to have a per- fect knowledge of it. The part sympathizing, sometimes near to, sometimes re. mote from, the part originally impressed, and, in struo ture. sometimes similar, and at other times t\\e revers^. igifr , outlines of In kind, the sympathetic action sometime* similar, some* times dissimilar, to the original; sometimep stronger,' sometimes weaker. Svmoathy varioush divide1. 1. Local and gc.eral. 2. Healthy and diseased. 3. Natural and acquired. 4. Direct and reverse. 5. Physiological, pathological, and therapeuti- cal.—Illustrations. The author's own division. 1. Vlental sympathies, i.e. sympathies of mind with mind. 2. Corporeal sympathies, i. e. sympathies of one part of the body with another, or with the whole. 3. Sympathies ofthe body with the mind, 4. Sympathies ofthe mind with the body. Through the medium of ore, two, or more of these, may be explained all the functions and operations of the body whether healthy or diseased. f. Examples of mental sympathy. Military chiefs Orators. Poets and m-isicians. Dramatical performers. Contagious nature of the passions. Propensity to imitation generally. Certain diseases—Hysteria, epilepsy, &c, Corporeal sympathies. Four organs in which the most powerful are radicated. The stomach. The skin. The brain. The genitals. Stomach, example ofthe sympathies of. Blow on the region oi the stomach, A ©OURSE OF LECTURES, ■Si Draught of very cold water. Exc- ssive draught of ardent spirits,. Cramp of stomach, from any cause. Poisons, emetics, &c. Mania, epilepsy, Chorea St. Viti, &c. from gas- tric irritation. Intoxication. Ga-tric opthalmia, and hnpaired vision. Blindness from visceral irritation. Flatulency, effects of. Strength instantaneouslyrestoreA by cordial drink or savoury food, even before it enters the blood vessels. Tremors from a debauch, how removed. Gastric head-ache.phthisis pulmonalis, hysteria. Dyspepsia, effects of. Inguinal swellings cured by emetics. Rheumatism and effusions into the joints, in the same way. Hemorrhages checked hy drinking cold water. Pulmonary affections removed by emetics. Intermitting fever cured by gastric remedies. Skin. Receives all original impressions from the sensible qualities ofthe atmosphere,and their vicissitudes A most fertile source ofdisease—these impressions pass by sympathy, through the solids to the othe^ parts ofthe system. Illustrated by A high temperature ofthe atmosphere, Burns. A very low temperature, or intense cold.. A humid atmosphere. An arid atmosphere. Sanative agents. Baths, hot, tepid, and cold. 52 outlines or Medicated baths. Sulphureous ditto. Cold applications suppress hemorrhages. Blisters, sinapisms, frictions &c. Change of climate. Appearance and disappearance of cutaneous erup- tions. Metastases from without to within, and the reverse— Cholera. Clothing generally. Cleanliness. The brain, sympathies of, manifested in Mechanical injuries of that organ. Apoplexy. Palsy. Hydrocephalus internus. Mental derangement. Intoxication. Passions ofthe mind. Phrenitis. Voluntary muscular motion. Organs of generation—sympathies of, numerous and pow- erful—begin later and terminate earlier in life, than any others—make the sexes what they are. Illustrations. The hoy before, and the youth after, puberty. The man and the eunuch contrasted—corporeally and intellectually. Males of domestic animals perfect,and castrated, dc> Differences of the occiput and tbe neck. Effects of castration on the stag. Female organs of generation, powerful influence of, on the whole female system. On the throat and the organs pf voice. On the mammae. A 60URSE OF LECTURES. ft The ovaria, effects of their excision, on the body and the mind. Cassation of menstruation, effects of. Pregnancy, effects of. Sympathies ofthe body with the mind. Manifested in the effects ofthe passions and emotions; and of, intense and long continued intellectual la'- bour. Joy. Rage. Terror. Love. Effect of maternal affection on the secretion of milE Morbi studiosorum. Voluntary motions. The mind sympathizes with the body in Delirium from gastritis. Enteritis. Hysteritis, &c. Madness from gastric, hepatic, and muscular irritation. In satyriasis, nymphomania, &c. In hypochondriasis. In every severe corporeal affection. Compound sympathy manifested in the impregnation of the female, connected with the communication of parental likeness. Local or subordinate organic sympathies, and sympa- thies between particular organs or parts. Of the hairy scalp, in wounds or injuries of, with the brain. •,/ Of the brain itself. Wounded, compressed, inflamed or suppurated, ef- fect of on the stomach, muscles connected with the velum pendulum patati, liver, feet, &c. OUTLINES OF Ofthe cerebellum. Seat of the amatory passion. Sympathizes certainly with the sexual organs. Castration, effects of on cerebellum. Wounds behind the ears, effects of—HippocwateSv Wounds on the occiput, effects of, (Diet, des Scr. Med.) Scton in neck, effect of. Temperature of neck, during sexual orgasm. Of the spinal marrow. Alexander struck on the nape with a stone, effect of. Bidloe's experiment on the spinal marrow of a dog,.ef* fects. Vid. Diction, des Sci. Med. Ofthe eyes. Prospects and objects, enlivening, gloomy, beautiful, sublime, fearful, disgusting, &c. Mrs. G. View of unbecoming nudities, and obscene objects. Of a person gaping. One eye sympathizes with the other in disease, viz. inflammation, cataract, &c. A blister, seton, cautery actual or po- tential,in opthalmia,&c. ' Dazzling light produces sneezing. Sight of grateful food, effects of. Contraction of the iris, from light. Dilatation of pupil from gastric or intes.-; final irritation from worms. Sickness at stomach produced by a shattered eye. A wound on the eyebrow produced blindness, ears. Music, effect of. Noise of a file, de. A COURSE OF LECTURES.. m. Whetting of a knife—Boyle. Sound of Bagpipes, effect of. O scene discourse, effects of. Meatus auditorius, tickling of, do. Glass ball in the ear, do. Of the nares. Odours generally, powerful effects of. Sterrutatories, range of sympathies very wide. Smell of cathartics, effect of, ^Boyle.) Odour of males, effect of. Rousseau, experiments of. Matter of influenza. Of touch. Touching velvet, effects of. Tickling, do. Touching between the sexes, do. Of taste. Sympathies and antipathies of,with the slomacb, an<$> digestive apparatus generally. Do. with the salivary glands. Ofthe teeth. Carious tooth, effects of. Irritation from dentition, effects of. Dyspepsia from irritation of dentition. Salivatio dentitionis. Otalgia dentitionis. Extraction of tooth, effects of. Ofthe salivary glands and gums. Sympathies of, under mercurial action, witJJ* the rest ofthe system, wide and powerful. Of the uvula. Elongated, effects of. Of the fauces. Tickling, effects of. Ofthe trachea. irritation of; effects o£ OUTLINES OF Of the lungs. Irritation and wounds of, effects of. Mrs. R*s,- case. Ofthe liver. Biliary caluli in gall ducts, effects of. Hepatitis, symptoms and effects of. Sympathy of the liver with the brain. Men of genius, temperament of. High mental excitement, effects of. Blow received by a French officer, do. An insult to an American youth, do. Jealousy, do. (Horace.) Of the kidneys. Inflamed kidneys, symptoms and effects of. Calculus in pelvis of, do. in meter, do. Sympathize with each other. Gastric diuresis and diabetes. Diabetes from mental causes. Urine altered in almost every complaint. Calculus in one kidney, the other only affected* Bladder and rectum. Frritation of either or both, effects of. Strangury and tenesmus produce each other*. Stone or ulcer in bladder, effects of. Rectum and uterus, sympathy of. and lungs, do.—Fistula in ano. Of the extremities. Tight shoes and cold feet, effects of—cartarrb. Blisters and sinapisms on feet, effects of. Cold water on the extremities, do. Tickling the soles ofthe feet, do. A grain of shot in foot, do. Idiosyncrases. Of two kinds—Peculiar susceptibilities as to thinga not medicinal, and things that are. A COURSE OF LECTURE3*. qf?" Odour of a rose, musk, minionet, effects of. Smell or sight of a cat, or a spider, do. Pressure of a ring, on the ring finger,' do. Mercury, effects of on some. Opium, antimony, &c. do. Sympathy illustrated and proved by metastases. Metastasis hurtful or salutary. Hurtful, when centripetal, i. e. from without to within. Salutary, when centrifugal, i. e. fiomwithintowithout. Of Tinea capitis, produces epilepsy, hydrocephalus internus, opthalmia, defluxion from the mucous membrane ofthe na-is, &c. Of gutta rosacea, produces opthalmia, gastrodynea, sore throat, asthma, apoplexy, &c. Of Erysipelas ofthe head, produces stupor, apoplexy, arixiety, vomiting, dyspnoea, &c. Of Parotidea chronica, produces asthma, phthisis pul- monalis, &c. &c. Of small pox, produces stupor, gastric irritation, con? vulsions, and death. Of J\lcasles, produces asthma, croup diarrhea, &c< Of carbuncles and bubos in plague, produces great an- guish, tremors, extreme debility, convulsions and death. Of Itch, produces dyspnoea, asthma, mania, vomiting, cardialgia, gastritis, diarrhea, &c. Of gout, produces apoplexy, palsy, angina pectoris, gastrodynea, dyspepsia, asthma, vertigo, gutta ser rena, &c. &x.—All these hurtful. Salutary metastasis—The bowels regarded as an external surface. Perspiration and sweating-^—cutaneous eruptions—boils—? diarrhea—hemorrhoids—increase of urine—mucous discharge from the lungs—hemorrhagy from the nares &lc. &lc.—all these are often the effects of metastases from within to without. H 38 OUTLINES OF Metastasis, even among humouralists, presupposes con- sent of action between parts, else why should the mor- bific matter be carried with such uniformity from one part to another? Different kinds of sympathy, referred by writers on physiology to the following causes. 1. Identity of structure. 2. Connection by anastomosing blood vessels- 3. Connection by the distribution of nerves. 4. The continuity of membranes. 5. Connection by cellular tissue. 6. By the sensorium commune. 7. Identity, or great similarity of function. 8. Habit. 9. Association. Remarks and illustrations. Different modes in zohich the sympathies manifest'themselves in- ■ the different organs. 1. Sensation or irritation in one organ, suddenly and strongly manifested in another. 2. A feeble sensation in one organ, followed by an intense one in another* 3. Sensation or irritation in one organ, exciting action chiefly in another, or several others. 1. Av.ion in one organ or part, exciting action immedi- ately in others. 5. An alteration in the elementary functions of one orgaru, followed by a change in the sensations of another. 6. An alteration in the elementary functions of one part, followed by a similar change in the elementary func- tions of another. ?-. A slight aad transient alteration in the elementary functions of one part, followed by deep and serious de-!- van^ement in the elementary functions of another. A COURSE OF LBCTURES. fc $. A sudden change in the elementary functions of one p- rt, restoring to soundness the diseased elementary functions of another part. Laws of sympathy. 1. Sympathies rendered more vivid by debility and indis- position. 2. More vivid in young people than in old. 3. In females than in males—espe- cially the sympathies ofthe body with the mind, and of the mind with the body—and imitative sympathies. 4. Irregular in children; hence their subjec- tion to convulsions, from slight causes. 5. Medicines add to the strength of prevailing sympa* thies, and awaken some that did not before exist. This true of mercury in particular. S. Become stronger by habit. 7. New sympathies awakened by the growth and evolu- tion of the system, /tnd its subsequent changes, and by the changes in life. 8. Different" organs or parts, rarely sympathize recipro- cally. Illustrations. Anomalous sympathies. Pain in knee produced diarrhea. Left arm, pain and partial paralysis of, from diseased bladder. Left hand sympathized with abscess in the brain. ; Wound in the knee produced vomiting, purg- ing and fever. Amputation removed them all. Cause of sympathy considered. Sympathies supposed to arise from, 1, The continuity of membranes. 80 OUTLINES OF 2. The universality of the cellular tissue. 3. The connection of blood vessels. 4. The nerves, alone, or as connected with the brain;, or the blood vessels, or both. 5. A sensoriicrn commune. Objections. Sympathies exist where these reputed causes do not. In the lower orders of animals. Animalculge infusoria;—Polypi, asteriae fee. &c. Vegetables also. Flower of Berbcris Vulgaris. Dio* aa muscipula. The mimosa, and the whole family of sensitive plants. Sympathy is an esscnti d attribute of living matter—as much so as gravity and figure are of dead matter—In living matter, sympathy alone constitutes corporeal unity. Blood vessels, nerves, and a brain, render sympathy more acute,diversified, and extensive; but do not create it. The blood sympathizes with itself as divided into parts,and with the solids. The existence of sympathy denied, and humouralism sub- stituted in its stead. Remarks in proof of its existence. Sympathy the only principle through which to explain the production or the cure of disease. Agents, whether noxious or salutary, must act either through sympathy, or through the blood. Noxious agents. Cold—A very fertile source ofdisease. Acts not on or through the blood. Illustration. Excessive heat, the same. Illustration. A COURSE OF LECTURES*, 61 Passions and emotions, the same. Febrile or other poison* do not contaminate the blood, and cannot, therefore, act through it. Illustration. Poisons swallowed act too rapidly to pass through the blood, Ardent spirits in large quantity. A severe blow on the stomach. Opium. Remedial agents. Of these articles the same is true. Never found in the blood, in a formal state. Act in quantities too small, to medicate that fluid-* So, do noxious agents, in quantities too small to adulterate it. Medicate the whole blood—and you cannot medicate it only in part—you injure many parts to cure ono or two. Illustration. Medicines cure a diseased part, by acting on a dis- tant one, while they could not cure, but would cer- tainly injure, the part diseased, by acting on it- self. Illustrations. Tartar emetic Sulphur. Opium. Blistering plasters. Saline purgatives. Disease consisting in divided excitement and circulation. that state of things can never be changed by a medica- tion ofthe blood. No rational account can be given of the modus operandi of medicines, after they are thrown'into the blood. The specific action of medicines lost by their entrance into the blood vessels. Nature never medicates the blood, in.curing disease. S;2 OUTLINES OF Pis conseroatrix et merbcafrix natures, i- e. the power to present health, and remove disease. Inherent im all living matter, and essential to its exis- tence. Does not depend on, or arise from, organization— Blood possesses it. An elementary attribute of vitality—the great prin-, ciple of self-defence and preservation, in living matter. Something analogous pervades all nature—the whole material universe manifesting a self-preserving power. Illustrations. The harmony of nature preserved, and her economy promoted, by countervailing forces, which seem to oppose each other in a manner similar to the strug- gle between life and death. Centripetal and centrifugal forces. Heat and evaporation. Freezing and evolution of latent heat. The vis conservatrix et medicatrix naturae manifests it- selfin three ways. 1. In a conservative and prophylactic power, in the maintenance of individual existence, and the prevention of disease. 2. In a curative power, in the removal ofdisease. 3. In a regenerative power, in the reproduction of lost parts. For the complete illustration ofthe first and last of these powers, in particular, must descend, in our observations, to the lower orders of living matter. 1. Prophylactic pewer. Living vegetable seeds. Apples, potatoes,turnips, &c. neither frozeo,bruised, nor otherwise injured. A COURSE OF LECTURES. & Living perennial vegetables, viz. trees, shrubs, gras- ses, &c. Fresh eggs. Animalculse and insects in a torpid state. Inhumed animals, and those inclosed in trees, rock% &c. viz. toads, frogs, lizards, serpents, &c. Man, and other warm blooded animals, exposed to in- tense heat, or severe cold. Exposed to other noxious causes, external and internal—and to the common impressions from surrounding nature. Illustrations. Regenerative power. Vegetable kingdom. Lopping of shrubs and trees, to render them bushy- Propagation by section, or cuttings. Inoculation and ingrafting. Annual fall and reproduction ofthe leaf. Illustrations. Animal kingdom. his power strong in the inferior orders of animals, In the polypi. The asteria, or star-fish. The lobster. The crab. The snail. The actenia. The water-newt. Crustaceous animals. Snakes, lizards, &c cast their cuticle, &c» Lizards' mutilated tails grow. Quadrupeds shed their hair, and reproduce it. Birds moult—genitals dwindle—enlarge again) The horns of the stag.. 04 6UTLINES 6t in man himself, this power exists. Healing of wounds, and of fractured bonesV Granulation of ulcers. Reproduction of cuticle, nails and cutis. Of other parts. This power weak in advanced life. Illustrations. 5. Curative power. A knowledge and observance of this, important td the practical physician, in all cases, but especial lyin epidemical diseases, Illustrations. Manifested also in Common catarrh. Paroxysm of intermitting fever* Peripneumony. Poison swallowed—phenomena in case of. Cholera Morbus—phenomena and cause of. Parturition, phenomena of. Change and economy ofthe uterus during gestation. Morbid irritation of schneiderian membrane. Coughing,) Mucus secreted in both for useful Sneezing, $ purposes. Discharge of urine and foeces. Irritating substance in the eye—phenomena of. .'Healingpower most strikingly manifested in surgical process ci--. Illustrations. A common incised wound—process of cure. A leaden bullet lodged in the flesh—effects of. Fracture of a bone. Operation for aneari-m—popliteal, for instance. Pus makes its way toward* the circumference. Adhesive inflammation un:'.es the cellular membrane around an absces-. v. oreventsthe lateral escape ofthe pus—The secretion of pus relieves the suf£ charged vessel?. A COURSE OF LECTURES. $<5 Substitutions of the system. Contraction ofthe aorta—case of, reported by Mons. Paris, Hotel Dieu in Paris. Vena cava obstructed—Its place supplied by Vena Azygos. Thoracic Duct do.—Its place supplied by enlarged lymphatics. "Temperature maintaining power—Shall treat ofthis under the article "respiration and animal heat." Organic or functional physiology. Xfigestion, consisting in the functions of the stomach, and the other chylopoietic organs. These functions all important, not merely to the well be- ing, but to the very existence ofthe system. Constitute the foundation of its being, by preparing the materials out of which it is formed and maintained.. Other functions of the body of man tend to its perpetual waste, diminution, and decay. The functions of the chylopoietic organs, therefore, re- quisite, to afford a sufficient supply of restorative ma- terials. By this circle of waste and restoration, the human sys- tem is kept in a state of constant revolution. Out of this necessity ofthe stomach to the very existence of every other part ofthe body, arises its strong sympa- thetic connections with the whole system. If it be, in its functions,deranged, the system must be ne- cessarily, in like manner, deranged. Several topics connected with digestion requisite to be previously considered. These are, hunger, thirst, the kind of food most suitable to man, and the prehension, and swallowing of food. Of hunger. \n internal sense, sui generis—as real I v so as anv <• I 66 OUTLINES OF the external senses. Called, at times, a sense of inanition. Food its object. The desire of food arising out of it, denominated op* petite. Stomach, the seat of hunger. Proofs of. Cause of hunger. Different theories of. 1. Aaima medica rationalis—Plato and Stahl. 2. Mutual frictions of the coats of the stomach. 3. Weight of the unsupported liver acting on the diaphragm. 4 Acrimony ofthe gastric liquor. b. Pressure of the nerves of the stomach, by the con- traction of its parieles. 6. Salts, ferments, alkalis in the stomach, &c. Discussion. Some of these causes imaginary, and the others in- sufficient. Action ofthe stomach too weak for friction. Were this the true cause, distend* the stomach with air or water, hunger must cease. Dragging ofthe diaphragm by the augmented weight ofthe liver, a mere fancy. Were this the cause, a recumbent posture would pre- vent hunger. Gastric juice not secreted, and, therefore, not pres- ent, when the stomach is empty. Contraction of the stomach too weak to compress its neives painfully, so as to prove the cause of hun- ger. Did hunger depend on the foregoing causes, it would continue until their removal,, by food. This not the case. A COURSE OF LECTURES. wV Removed by the passions, severe study, strong sensations, tying up the nerves, and by the in« fluence of habit. Illustrations. Hunger, what? Views of the author—\n instinctive sensation of want produced by the exigency of the system—by what the late Mr. Hunter would have called the stimulus of necessity—an indication of what the sys- tem requires for its well-being. Thirst. An internal sense, sui generis, like that of hunger. Fauces, its principal seat, though probably sympa- thetically so.* A keen and strong appetency for water constitutes the desire arising from it. Cause. Theories of. i. Anima medica rationales. 2. A preternatural density of the blood, from a defi- ciency of its serous portion. 3. Acrimony of the blood, from a want of wj ter, its proper diluent, passing into it. 4. Stimulus of necessity, or the system's sense of its own wants. The author's own views. Our systems painfully affected by absences or deficien- cies, as well as by present deleterious matter, especial- ly when those deficiencies are, in their effects, inju- rious—e. g. soreness or aching from too much rest, or a want of motion—Hunger, from a zcant of food—Great * Thirst felt in the fauces, to distinguish it from hunger, thaji. the proper application to remove it may be made. 8£ OUTLINES OF uneasiness in tobacco chewers, smokers, &c. from a want of tobacco—to men of great activity from a want of employment. Absence of society painful to the levels and frequenters of it. Impression essential to pleasant sensation—its absence, painful.* Thirst, then, a painful sensation, caused, by the want of the salutary impression of water on the fauces and sto- mach; the sensation rendered more acute by the ne- cessities of the system. • Death from hunger or thirst—cause of. Neither actual inanition, nor a want of fluidity in the blood—but gastric inflammation, giving rise to malignant fever, the inflammation produced by the stimulus of necessity. Hunger and thirst, then, powerful and most acute stimulants. Taste, connected with digestion, because it has an in- fluence on the. process. If pleasant, promotes, if offensive, retards and deranges it. Reason *.yhy? Designates p;\;nei- food. Kind of food most suitable to man. Whether from his nature, is man phyti.orov.s, carnivorous or omnivorous ? Thesciuiion of this question to be derived from inferences drawn from several sources, viz. 1. The structure and character of man's teeth. 2. The mrtion of his jaw.?. 3. The size and structure of his stomach and intes- tines. *Pain and uneasiness given to us in kindness, to warn us of want uuu dtiu^ei". A COURSE OF LECTURES. 69 »{ 4. His appetite for food. 5. The effects produced on him, by different kinds of food. 1. His teeth. Teeth of phytivorous animals, description of. Of carnivorous animals, do. Of man, a mixture ofthe two, or a medium between them. 2. Motion of the jaws. Of the jaws of phytivorous animals, lateral and grinding. Of thejaws of carnivorous animals,up and down, or champing and bruising. Ofthe j; ws of man, a medium between the two, 3. Stomach and intestines. Of phytivorous animals. Of carnivorous animals. Of man, a medium between them. 4. Man's appetite leads him to a mixed diet, i. ..\ a diet consisting of vegetable and animal food. 3. Man subsisting on a mixed diet, attains the highest perfection of his nature. Proofs ofthis. Vegetable food gives health, but not so much strength as a mixed diet. ;.Vhieh preferable, a diet exclusively animal, or exclu- sively vegetable? Ans. What nations live on vegetable food exclusively, and what on animal—Comparison between them. Imputed effects of food on the temper and disposition of man. Prehension of food different in different animals. Some remain stationary, waiting tor their food, and when it arrives, suck it up, somewhat as a vegetable. Illustration. tff OUTLINES OF Others go in quest of food, it remaining stationary, do. Others go in pursuit of food, which flies from th stomach through the Pieces of metal. ) bowels unchanged. They do not however pass rapidly—Not until, by fre- quently advancing to the pylorus, it becomes accustom- ed and reconciled to their touch and impression. Hence they remain in the stomach, perhaps from five to ten times as long as the matter of food does. Chyme enters the Duodenum, to be there converted into chyle. duodenum, structure and character of. Of larger diameter than the other small inter tines. Muscular coat stronger. Not, like them, covered by the peritoneum. More dilateable than they. Denominated, from its character and functions, a second stomach. Internal coat strictly villous. Valvular conniventes numerous. Hence, and from its position and the tortuous course it runs, the passage of the chyme through it is slow. Receives the bile and pancreatic juice, which are secreted in unusual abundance, while the chyme is passing through it. From its internal surface,which is much extend- ed by the valvulae conniventes, arise the lac* teals in great numbers. Duodenum now a centre of fluxion, as the sto- mach was before. Receives the bile and pancreatic liquor. By means of its specific vital powers, uses them much as the stomach did the succus gastric.!* —as an instrument to work with. - Chyle formed here—mass passes on to the Ji'junv.m} outlines or Further matured here by the action of that in- testine—Now very thin—much chyle formed. Lacteals very numerous, and their action vig- orous. "The part a centre of fluxion, but not, perhaps- so strong. Ileum. Lacteals numerous —absorption active—chyle formeel copiously—mass still thin. Part exerts itself like the preceding. Great intestines. Lacteals few—absorption diminished—faecal matter forming—mass thicker. Great intestines inactive, while the others were em- ployed—-the reverse true, now—their turn to labour. Much mucus on internal coat, because the faecal mass is becoming hard. The great intestines,especially the intestinum rectum, constitute the excretory duct of the alimentary or- gan. Intestinum rectum closed by the contraction of the sphincter ani, except during the passage of faeces. Sphincter then relaxes or elongates by its own action, not like a piece of dead matter, nor by mechanical force. Remarks on sphincter muscles. Faeces, fetor of, whence arising. Qu. Is chyle, properly so called, formed in trio intestines? Point discussed,* Bile, reputed uses of in digestion—supposed difference of action and use between cystic and hepatic bile. Points unsettled. Remarks on diseases denominated bilious, showing thc- applica,bility of our doctrines (o practical medicine, Lacteah. A COURSE OF LECTURES, .as Functions, and philosophy of. Not mere conduits—act on, and further matur£- the chyle. Mesenteric glands, functions of. Receptaculum chyli. Uses of. - Thoracic duct. Uses and destination of. Perfect chyle. Appearance and character of. Question respecting the vitality of, discussed. Appears often in arJfce * New-born vegetables not pained, yet they also take in air by a vital process. Why does the infant cry?—What natural or necessa- ry connection exists between pain and crying? Infant cries by instinct—final cause ofthis. May as well, therefore, resolve the first act of inspi, ration into instinct. ?. Schneiderian membrane irritated by the air, (lie. infant pre- . pares to sneeze, to remove this irritation. But cannot sneeze without inspiring. Object. Why, then, not continue to sneeze, instead of regular respiration. But, wherefore sneeze to remove irritation? What natural connection exists between irritation in the nares, and the complicated process of sneezing?—- None—Infant sneezes, then, by instinct. Nostrils closed by mucus—infant struggles to in- spire. Close the mouth and nose of a new-born animal—it struggles to breathe. The young of all inferior animals do not thus pre- pare to sneeze.—\ et they all inspire. 92 OUTLINES OF 3. Change of position, after birth, changes the situation ofthe abdominal viscera—depresses the stomach, liver and in- testines, thus lowering also the diaphragm, and enlarg- ing the thoracic cavity—Mr rushes in to fill the vacu- um, and creating uneasiness, must be again, by expira- tion, expelled. Object. Here, again, expiration presupposes instinct. Wherefore breath a second and a third time, and thus continue? (Kv. r^9\r^m Inspiration is the cause, and not the effect ofthe depres- f>u\^*' ^** *** s*on oi tne diaphragm, and the enlargement of the M vr^ thoracic cavity. Open a pregnant female animal at the proper period— keep the foetus in its uterine position, it will inspire. Birds and amphibia have no diaphragm; neither have fish—No thoracic enlargement, then, here, by mere change of position. Yet do they inspire. 4. A preparatory measure to the change in tlie circulationfrom the fatal to the adult. Blood not now decarbonized by the mother—Uneasiness created by this—Inspiration a struggle to remove it. Object. Infant inspires before the foetal circulation is altered— Respiration, the cause ofthis alteration, rather than the effect. Respiration not unique, as to the cause of its commence: ment. Equally explicable with various other animal proces- ses—Illustration. 1. Sucking. 2. The young aquatic bird, without instruction, has- tens to the water, the first time it sees it. 3. The young lamb recognizes its mother, amidst ©the* animals, even of the same species. A COURSE OF LECTURES. #8 4. Birds migrate at the proper season, without instruc- tion. h. Domestic animals, removed circuitously from the place where they were reared, return by the short- est rout. Instinct, a primitive mental endowment, the cause of all this. So do young animals originally breathe by instinct. Draw in air, as they do milk, or as they take any other kind of food. Necessary, this, to their existence—Would, therefore, be defectively made, if they had not the propensity, as well as the power, to effect their own preserva- tion. Of animal heat, as one ofthe supposed effects of resperation. Importance and interest attached to the subject. Creneral remarks respecting. Theories of Animal heal. 1. The callidum innatum, of the ancients'. 2. Attrition ofthe fluids and solids. 3. Fermentation. 4. Putrefaction. 5. Action of the stomach. 6. Action of the glandular system. 7. Theory of Dr. Black. 8. do. of Lavoisier. 9. do. of Crawford. 10. do. of Lagrange and Hassenfratz. 11. The fluids of the body supposed to give out then heat, in the act of passing into solids. 12. The decarbonation of the venous blood. The first six theories not worthy to be examined. Theory of Dr. Black. Founded on the author's discovery of latent heat Objections to it. OUTLINES ©y Theory of Lavoisier* * Objections Theory of Crawford. Analysis of. Objections to. Theory of Lagrange and Hassenfratz. Analysis of. Objections to. conversion of the fluids ofthe body into the solids, the cause--. of animal heat. Analysis. Latent heat becomes sensible, in The conversion of steam into water. Do. do. of water into ice. In the reverse of these processes,sensible, heat becomes latent. Objections. Even in relation to dead matter, these positions doubt- ful in The freezing of water. The combustion of gun-powder. In relation to living matter, palpably erroneous. Were it true, then ought all living matter to possess «. temperature proportioned to the rapidityof its growth, i. e. proportioned to the rapidity of its conversion of fluids into solids. But this is not the case, as is evinced in the following in- stances, viz. In the growth of vegetables, generally, especially the mushroom, the temperature of which is unusually low—In proportion to .their size, vegetables grow more rapidly than animals—Consequently, convert fluids more rapidly into solids. In that of cold blooded animals—the shark__the alliga- tor—the crocodile, the boa-constrictor, &c. which A «OVRSE OF LECTURES. 65 grow as rapidly, and therefore convert fluids inte solids as rapidly as warm blooded animals. This theory further invalidated by the phenomena of Fever, where the process is liquifying $ yet is heat generated. Famine, do. do. Diarrhea, do. do. Diabetes, do. do. Marasmus, do. do* Phthisis pulmonalis, do. do. &c. Illustrations Also by the phenomena exhibited by The seeds of vegetables. The eggs of animals. Blood newly drawn. Hybernating animals. Illustration. further instances in disproof ot this theory, viz. The uniformity ofthe temperature of the human body in, Cold and hot weather. Cold and hot climates. Individuals becoming fat. Illustrations. In persons who are neither gaining nor losing flesh, the liquifying is a perfect counterpoise to the solidifying process. Explanation and illustration. Becarbonation af the blood, the cause of animal heat. This the obsolete hypothesis of Crawford, substituting carbon for phlogiston. Decarbonation a mere creature of fancy.—Might just as well say, that the secretory process of the kid- neys de urinates the blood,that that of the liver debili- ates it, that that ofthe testes deseminates it, &c. &c. Carbon discharged in respiration, as real a §ecretion OUTLINES Of as urine, bile, saliva, or any other fluid formed by glandular action. Proof of this. ^ Hence that process does not augment the specific tem- perature ofthe blook. Cannot, therefore, on the principles contended for, be the cause of animal heat. No more caloric liberated in the lungs in respiration than is sufficient to raise the temperature of the air that is expired—this air often inspired at zero or be- loW it, and expired at or near the temperature ofthe blood—To produce this effect, much caloric neces- sary. The temperature ofthe systems of animals supposed t@ he in proportion to the extent of their respiratory or- gans, and that of particular parts in proportion to the quantity of blood flowing to them. This hypothesis Untenable. First branch of it not supported by the temperature and respiration of birds, which constitute its strong hold. Invalidated by the comparative temperature and respi- ration of Infants. Adults with lungs unusually large. Pregnant females. Individuals in cold weather and cold climates* Patients affected by, Phthisis pulmonalis. Pulmonary abscess. Asthma. Peripneumony. Typhus f ver. '■The latter branch of the hypothesis invalidated by the phenomena of A limb on which the. operation for aneurism has been performed. A. COURSE OF LECTURES. 97 The temperature ofthe limbs of? dog, whose iliac ar- teries were obstructed by ligatures. Animals resist heat as well as cold— and evenpossess a cold- producing or temperature maintaining power. This proved by, Mr. Hunter's experiments on a dead and a living penis. The immersion of the feet into hot water. The experiments of Fordyce, Blagden, Banks, Tilset, Duhammel, and Delaroche. Explanation and illustration. Anomalous facts. 'Mr. Hunter's experiments on the temperature of the dormouse. Irregular flushings in sundry diseases—hysteria—palsy —apoplexy—epilepsy, &c. Pog's nose always cold. My own views of the production of animal or vital tem- perature. The lungs have no more specific agency in the z'mwie^ diate production of animal or vital temparature, than the stomach, the glands, or any other organ. The heat set at liberty in the lungs, by the formation of carbonic acid gas, is not, in any case, as already stated, more than sufficient to convert into vapour the humidity, and raise the temperature ofthe air, that is expired—None of it, therefore, can enter the blood-r-rlf it did, it would be felt in passing through the parietesof the bronchia,for it must enter, ifatalh, as sensible heat. Nor have the blood vessels any necessary specific agen- cy in the production of vital temperature. Living matter possessing neither lungs, blood vessels, nerves, nor even organization, produce heat—This position established by the phenomena of Seeds. M 98 OUTLINES OF Eggs. Plants, and Blood recently drawn. As already observed, those animals that do breathe, 3b not possess a temperature corresponding in degree to the size of their lungs, and the extent of their respi- ration—Some of them, moreover, produce, heat, when in a state of hybernation,in which they do not breathe at all—Marmot, dormouse, &c. There exists no single specific organ for the production of heat, any more than for the production of nutri- tion and growth. These functions are all performed by the capillaries, under the influence ofthe vital principle—each part producing its own heat, and ef- fecting its own nutrition and growth. Every animal and vegetable has its specific tempera- ture, which is as essential to it, as its specific form. Deprived of this temperature, it perishes—Its pres- ervation of it, is, therefore, only an instance of that resistance of destruction, which belongs essentially to living matter, and without which it could not live^ all dead matter being at war with it. Like digestion, sanguification, and secretion, then, the production of temperature is to be regarded as the result of a fundamental and indispensable function of liv- ing matter, having no dependance on chemical affini. ties, but being governed exclusively by the laws of vitality.—!t is as free from the controul of chemical agency, as thought itself. Motion of the blood. Necessary alike to nutrition and vitalizaiion, that the blood should move throughout the system. Receives the vital principle from the atmosphere, t© communicate it to the solids. TV* .■things, therefore, requisite—that it have access to A BOURSE OF LECTURES. 0S the atmosphere—and afterward visit every point te which it is destined to carry life. Must, therefore, be fluid. Holds intercourse with the atmosphere universally through the medium of respiration, by means of lungs, gills, stigmata, &c. Analogy between respiration and digestion. Circulatory apparatus marked by great variety in dif- ferent classes of animals. Insects. Fish—Explain, as illustrative of circulation in other animals. Frogs, serpents, &c. Mammiferousanimals,ai. the head of which stands man* Circulatory apparatus in the latter class of animals, composed of heart and blood vessels. Heart double— pulmonic and systemic. In this class, circulation two fold—a long and a short one. In the course oftV.c latter, the blood receives the vital principle; in the former, imparts it. Illustrations. For a perfect knowledge of the circulatory system in man, I must refer you to the anatomical department ofthe school. Ofthe heart I shall only observe, that it is muscular and tendinous. Parietes of the ventricles thicker and stronger than those of the auricles. Parietes ofthe left ventricle, stronger than those ofthe right. Final cause ofthis. Valves of the heart, and their uses. Blood vessels divided into arteries, veins, and capilla- ries.* *Th.e capillar? system also is composed of arteries and veins.- 100 OUTLINES OF Arteries two in number, arising from the two ventricle? of the heart—Pulmonary artery, and aorta. Description of. Structure, muscular and tendinous. Irritability belongs to the former coat. Elasticity to the latter. Muscularity of the capillaries. Capillaries collectively much more capacious in diam- eter, than the trunks of which they are ramifications. Arterial system, therefore, resembles a cone. The heart, its apex. The capillaries, its base .Proportion ofthe aorta to the capillaries variously es- timated. Velocity ofthe blood different in different parts of it' course. Veins terminate in two trunks in the two auricles. Resemble the arteries, in general form and distribu- tion. Larger and more numerous than the arteries. Relative capacities of, as two to one or three to two. Structure of, different from that of the arteries. JNo muscular coat—or if any, very inconsiderable. Irritability of, scarcely perceptible. Parietes thinner than those of the arteries, and but slightly elastic. Yet more difficult to rupture. Lose their vigour earlier than the arteries. Valves of the veins, uses of. Most numerous in superficial veins. In deep seated ones, very few. Anastomases of veins, exceedingly abundant. Mode of communication between arteries and veins. By the division here laid down, then, I only mean, that betweea the 1 unctions of the capillaries and the larger bleod vessels, Hhere s a difference as radical and great, as that which exists "between the functions ofthe arteries and veins. A COURSE OF LECTURES. 101 different opinions respecting—Nothing conclusive known on the subject—most probable opinion, what. Many arteries terminate in glands, and secreting sur- faces. The blood vessels thus distributed, divided into five systems—the aortic system, the system of the vena cava ascendens and descendens including what some call the portal system, the system of the pulmonary artery, the system of the pulmonary vein, and the ca- pillary system. Circulation of the blood, description of, beginning at the commencement or capillary portion of the Vena cava. ta this circuit, it twice washes the interior ofthe heart —or once the interioi of each heart—forming in it? course the figure of 3. Thus far of warm blooded animals. In cold blooded animals the heart and circulation single. Ofthe longer or systemic circulation, in warm blooded animals. That being explained, the shorter or pulmonic will be easily Comprehended. The leading organ, the heart, motion of. General movement denominated systole and diastole. in the performance ofthis, the action of the two ven- tricles, synchronous. So is that ofthe two auricles —But in relation to each other, the movements ofthe auricles and ventricles are alternate. Movements particularly described. Is the heart at all times of the same size? Cause ofthe motion of the heart. Heart contracts from stimulation by the blood. But from what c^use does it dilate again? $lere relaxation not sufficient to account for the phe- nomenon, because it implies an absence of action. 102 OUTLINES OF No antagonizing muscle to delate it. Heart, according to Harvey, forced open by the propul- sive movement ofthe blood. Left ventricle, by the force it communicates to the blood, dilates the right auricle—the right auricle, the right ventricle—the right ventricle, the left au- ricle, &c. Aa estimate ofthe force ofthe contraction of the heart attempted by Borelli—180,000lbs. Keil—from 3 to 5 oz. Jurin, Hales, &c—forces intermediate. Objection to the foregoing opinion. 1. Left side of the heart the strongest. Admit-' ting, then, that it could force open the right; the latter being the weakest, could not dilate fhe former. The two sides cannot recipro- cally force open each other. 2. The heart, when out of the body, and when, of course, there is no blood flowing into it to open if, contracts and dilates as before. 3. The heart cannot communicate to the venous blood its circulatory motion, its momentum being equal to that of the arterial blood. Reasons for this opinion. 1. Viscidity ofthe blood. 2. Friction against the vessels. 3. Frequent anastomases of the vessels, by means of which two columns of blood meeting, from different and somewhat opposing directions, almost neutia- lize each other's motion. These causes first weaken, and ultimately destroy all impetus received from the heart. Again. That the blood may move by a vis a tergo, the vessels must be perfectly full. But the veins are not full, in as much as any obstruction A COURSE OF lectures. 103 of the blood in them by mechanical pressure, causes them to swell. Were no other cause but a vis a tergo instrumental in moving the blood, every hemorrhagy of any extent, would check the circulation, by destroying the en- tire fulness of the vessels. Did the blood circulate by the heart alone, that organ would bear, in size, some given proportion to the vol- ume of blood destined to be moved by it—ox—dog— monkey—sheep. After death, arteries empty, veinsfull—This not effect- ed by the heart, which has ceased to act. Prevailing theory of arterial systemic circulation., Contraction of the left ventricle of the heart, aided by; the alternate and successive dilation and contraction of differenfl^portions ofthe aorta and other syste- mic arteries, constituting a kind of peristaltic mo- tion. This supposed action of the arteries effected by the properties of irritability and elasticity, the latter mak- ing amends for the deficiency of the former. Object. In the healthy ana unobstructed circulatory process, no dilatation of the arteries recurs-—certaialy none oc: curs in the larse arteries. This assertion supported by direct and reiterated obser- vat ion. Arterial systemic circulation effected solely by the ac- tion ofthe left ventricle ofthe heart, and the tonicity of the arteries. Explanation and illustration. Capillary circulation effected chiefly by vascular acr tion. That the capillaries act by an inherent and jndepem* dent power, appears from the phenomena of 1. Blushing. 104 outlines or 2. Topical inflammation. 3. Secretion, healthy and morbid. 4. Nutrition. The action and general economy of the capillaries, both in health and disease, exceedingly important. Those vessels constitute, at once, the seat of disease, and the organs by whose sanative action disease is removed. Future improvements in the philosophy and practice of medicine, will arise, in no small degree, from a more correct and thorough knowledge of the susceptibili- ties, sympathies, powers and actual condition,of those vessels. The) are to the larger blood vessels, what the artificer in architecture is to the common labourer, who car-' ries to him the raw materials for building. Thus fur of the circulation of the blood through the ar- teries and capillaries, a process, comparativel}' speak- ing, not difficult to be understood. That fluid now enters the veins, constituting, as al- ready stated, a system of vessels exceedingly differ- ent—-scarcely either irritable or elastic—very dila- table, but having no perceptible reaction. Their" figure or position in relation to the motion ofthe blood, the reverse of that of the arteries, their aggre- gate caliber beccmii'-g narrower instead, of wider, in their progress towards the heart—For the)', like the arteries, constitute a cone, the base ot which is form- ed by their minutest brunches, and its apex by the heart. By this state of things is (he resistance to the motion ofthe venous blood materially augmented. The quantity of the venous blood nearly double that of the arterial. This, another conclusive reason, why the heart, or r>is» trrgo, cannot keep it in motion. A COURSE OF LECTURER I@& Reputed causes of venous circulation. 1. A vibratory motion in the veins. Obj. None such perceptible. Cannot, therefore, be legitimately infered. Besides, such a motiori, did it exist,would tend to throw the blood from the heart, instead of towards it; i. e. from the apex to the base of the cone. VenouB valves could not always prevent this, especially in deep seated vessels, where they do not exist. 2. Muscular compression supposed to be the cause. Object. 1. Muscles press on veins unequally; and must, there- fore, retard the circulation in one part, while they accelerate it in another—must, thus,destroy its equa- bility. This argument Corroborated by the phenomena of spas» modic diseases—Hysteria—Epilepsy—Chorea, &c. Here no acceleration ofthe venous blood; but often an obvious retardation of it, muscular action being great. Illustration. 2* Muscular exertions, even the most powerful, do not, especially if long continued, always accelerate ven- ous circulation. Illustration. 3. M^ny veins situated out ofthe reach of muscular ac= tion, yet does their blood flow freely. 4. In fevers, where, from debility or choice, scarcely a muscle is moved, venous circulation preternaturally rapid. 3. In sleep, when the muscles are at rest, the blood still circulates without impediment. 6. Venous congestion often occurs, previously to any cessation or flagging of muscular action. 7. Blood circulates in catalepsy. Jn paralytic limbs, also,where no mascle moves.. I OS OUTLINES OF Hence, venous circulation has no dependence onmei? muscular action. To have left a process so important, to a cause so pre- carious and inadequate, would have argued signal inattention, and want of wisdom. 3. Pulsation ofthe arteries considered a» a cause ofvenous^ circulation. Object. As already stated, in a healthy and natural condi- tion of action, the arteries do not expand and pulsate laterally. But admit that they do expand, still is the cause in- sufficient. Expansion too inconsiderable to have any material effect—Vein or artery, or both, would recede from the impulse, and no circulatory effect be produced. Two or three veins to one artery, and some at such a distance from arteries, as to be entirely beyond their reach. To have their blood forced onward by arterial im- pulsion, veins must be perfectly full and distended, which is not the case. Were the venous blood moved by arterial action, it would, on the opening of a vein, flow per sal- turn. Instance^ a vein in contact with an artery. Arterial action, like muscular pressure, would des- troy the equability of the blood's movement, by retarding that ofthe hindermost part of the col- umn. Venous circulation, then, by what powers effected? Ans. 1. By the proper action ofthe veins themselves, al- though not visible. A COURSE OF LECTURES. l(ti Analogies confirmatory ofthis. The vessels of vegetables. The lacteals and lymphatics^ The ureters. The bile, pancreatic, and lachrymal ducts. The blood vessels of animals without a heart. Proof that the veins act. Blood circulates in them, in opposition to the power of gravitation, in the lower extremities, and in the jugular veins, when the head is in a depending position. Suction of the heart. Instead of being forced open by the impulse of the re- turning blood, the heart opens by its own action,cre- ating, thus, a tendency to a vacuum, into which the venous blood immediately rushes. n this, the heart is analogous to the sphincter muscles ofthe body. i^hus, by contraction, the left ventricle ofthe heart forces on the arterial circulation, while, by dilata- tion, the right auricle invites it back through the veins. 'roofs that the blood flows towards a vacuum. The process of cupping. Hemorrhages from the lungs, on the tops of lofty mountains. Illustrations and practical inferences. From the foregoing considerations, the circulation of the blood through the arteries and capillaries is com- paratively a plain and simple process. That through the veins more complex and difficult to be under stood. In the latter, perhaps, three powers are concerned.. 1. The proper action of the veins. 2. The suction of the heart. 3. A vis a tergo. ttiiS OUTLINES i>tr Secretion and nutrition. $hall consider these two processes under the same head, because they are closely allied in their nature and character. Of primary interest and importance in physical sci- ence. Two ofthe cardinal results of vital action. Essential to every active form of living matter. A correct understanding of them, beyond most other kinds of knowledge, purifies and liberalizes the mind of the physiologist, and qualifies him to see things as they actually are. A true definition ofthe term secretion compared with the niture of the process designated, demonstrates clearly the erroneous notions that have prevailed on the subject. The term, which means the act of separating, grew out of the corruptions of humoral pathology. Illustration. Shall retain it, from a reluctance to unsettle medical phraseology by an introduction of new terms. Secretion divided into healthy and morbid. Examples,—Bile, urine, saliva, &c.—Pus,the mat* ter of adhesive inflammation, the fluid of arthri- tic concretions, &c. Not a separating, v-ut a generative process—i e. a compounding or decompounding one. Exceedingly extensive in its range, and multiplex in its effects. Fully to understand it, must look through the entire world of living matter; not merely through the high- er orders of it. It is the source of all vegetable odours, tastes, colours. gums, resins, poisoqs, and juices, whether healthy or A COURSE OF LECTURES- 109 -diseased, other than the blood or sap-juice. Illustrations. The source also of all animal odours, of all animal fluids other than the chyle and blood, and indeed of all »e. miliar.productions,whether solid cr fluid—Among the latter are included animal poisons. These are either natural or morbid. To the former belong the poison of the serpent, the scorpion, the asp, the spider, the wasp and other noxious animals. To the latter, the poison of small pox, kine pox, lues venerea, rabies canina, &c. The source of animal secretion is the blood—except in two instances, the arterial blood. Of vegetable secretion, the sap juice, which may be regarded as the blood of vegetables. The science of secretion embraces the following to-" pics, viz. 1. A knowledge ofthe fluid acted on, (the b'ood,) 2. Of the apparatus acting, (i. e. glandu- lar structure.) 3. Ofthe fluids secreted. 4. Ofthe effect of secretion on the bho^ 5. Ofthe destination and u^es of seer' ted fluids. <£. Ofthe modus age Ji of glandular structures, in the formation ot the various fluid- produced. 7. Ofthe sympathetic action and influence ofthe glands on each other,and on the sys' ?m at h-.vr^f The first topic (the nature of the blood) already dis- cussed. Some of the others shall now receive attention. Of secreting organs. "These are widely different from e> b. other, ar*J in structure, more or less complicate- , acrordiu^ iu «.ue change they are to produce in the biocvL no OUTLINES OJP Glands divided into various classes. Conglobate and conglomerate—Definition of. Of these, some are individual, i. e. relate exclusively to the economy ofthe individual possessing them. Others are sexual or specific, i. e. relate to the propaj: gation and preservation of the species. Of individual glands. » Perspiratory and serous glands. Description of, writh illustrations. 2. Cryptae, glandular follicles, and mucus lacunae. Do. Do. 3. Conglomerate glands. Do. Do. 4. Liver, a gland beyond others specific and worthy to be classed by itself.—Illustration. Pre-eminent importance of. 5. Sebacious and ceruminous glands. Description of, and illustration. 6. Lungs—office of—in part glandular,—Illustration. 7. Glands of colour, i. e. which secrete the matter of complexion. 8. Glands which secrete the humours of the eye. 3. The stomach. iO. Glands secreting certain peculiar substances. These belong to animals inferior to man, as the musk animal, the beaver, the pole cat, the torpedo, &c. Of sexual, or specific glands. In the male;. The testes. The prostrate gland. In the female. The ovaria. The uterus. The mammas. Illustrations. A COURSE OF LECTURES. ii* Although the brain possesses many of the characters of a gland, it need not, at present, be so considered, the more especially as its physiology has been already treated of. Of the fluids secreted, their uses and ends. 1*. To facilitate' animal motion generally—of the artf culations—the muscles—the eyes, &c. Illustrations. 2. To moisten and lubricate certain parts, external and internal. Ofthe peculiar aptitude of these moistening and lub- ricating fluids to the situation ofthe parts over which they are spread. Close cavities lubricated with a serous secretion. Those having an external opening with a mucous one. Illustrations and final cause. 3. To aid in the performance of certain important func^ tions.—deglutition—digestion—generation—vision—* hearing—smelling—tasting-^-feeling, excretion, &cV Illustrations. .Secretion of oil and fat. Observation on the uses of. Ofthe menstrual secretion. Proofs that it is a secretion. Berived from the amount of blood the uterus receives— Remarks. From the nature ofthe fluid discharged. Not coagulable—odour peculiar. From its periodical occurrence—all glands acting peri- odically. Uterus then in a state of congestion, like other glandg when secreting. From the fact, that every healthy evacuation from the vascular system, is and must be the result of secrete* ry action* 112 OUTLINES OF Supposed uses ofthe menstrual secretion. To depurate the blood of the female—Remarks. To obviate female plethora—do. To convey to the uterus the part which the female cocf- tributes towards generation—genital particles— semen fcemininum—homunculi, &c. Real uses ofthis secretion. To sustain the vigour of the female organs of genera- tion—prevent the decline of the sexual appetite— and fit the parts for the business of impregnation. Illustration and proofs. Human female alone menstruates regularly and often* and admits at all times the sexual embrace. (Females of the monkey tribe perhaps excepted.) Other female animals menstruate, i. e. have congestion in the organs of generation, only during the season of love. The cowr—the mare—the sow—the bitch, &c. In many small animals, as rats, mice, birds, &c. the sex- ual organs almost imperceptible, except during thef season of love—then become injected and large. Hence a palpabk connection exists in females of eve- ry description, between the sexual appetite, and the injection ofthe generative organs with blood. At the close of each menstrual period, the sexual appe^ tite in woman stronger than at any other time. From the same source arises the fitness ofthe female. organs for com eption. At no other period, but that of their loves, can the fe- males of the inferior animals be impregnated. Women most readily impregnated soon after menstru- ation. Women who do not menstruate, rarely prolific. Cease to be prolific when they cease to men-:, struate. Connection between menstruation and the existence, and condition of the ovaries. A COURSE OF LECTURES. ifa during menstruation, the female organs of generation a centre of fluxion, and seat of augmented energy, and their general sympathies greatly heightened. Illustrations and inference. Further uses of secretion in the inferior orders of liv- ing matter. In vegetables. Odour, taste, colour—To delight, attract, inform, and also to warm and forbid—Illustrations. In animals. Odours—Here also, these give information to enemies, convey to animals warning of their danger, and bring the sexes together, in the season of love—In these respects odour operates even on the human race. Illustrations. Colours and luminous appearances, the result of secre- tion, operate also in the intercourse ofthe sexes. Illustration. As means of defence and annoyance. Examples. In poisonous animals generally—also in the polecat, the cuttle-fish, torpedo, &c. Probable effects of secretion on the blood. Urine—rBile—Matter of perspiration—Remarks on. Ofthe modus agendi ofthe glands in secretion. Various hypotheses have been instituted on the subject —usually tinctured by the prevailing scholastic phi- losophy of the times. Divided into mechanical, chemicaj, and vital—or those of the humoralists, those of the solidists, and, such as partake in part of the opinions of bo|h. 1. The mechanical hypothesis, which stands equally ref- lated to the solidists and the humoralists. Illustration and refutation. 2. The chemical hypothesis, subdivided into t!4 OUTLINES OF That which attributes secretion to a fermenta- tive process. An effervescence between acids and an al- kalis. A certain undefined play of chemical affini- ties independent of either acid or alkali. Illustration and refutation. 3. The-vital hypothesis, or that ofthe solidists, which, regarding secretion as a vital process, attributes it exclusively to the action ofthe solids on the fluids —. f the secreting structures on the blood. Illustration and confirmation ofthis. Ofthe sympathy of the secreting structures or glands, with each other, and with the system at large. This includes the sympathies of membranes of every des- cription. A most important consideration, both in the preser- vation of health, and the removal ofdisease. Its practical application. Glands act not all at once, but periodically, as their ac- tion is requirci In the economy ofthe system. Each glard has an r^sociate circle of parts, which its action, healthy or diseased, influences—This circle, as a sub-system, influences another similar one# and that another, until.the entire system feels the effect. Illustrations, From the foregoing considerations it is not extrava- gant to?ay, that to natural secretion we are indebt- ed for our cci'tence, our growth, the preservation of our health, and its recovery when lost. Morbid se- cietion, on the contrary, is an abundant and power- ful source of disease. Hence the imperious character of the obligation im- posed on us, both as philosophical and practical phy- sicians, to study the process attentively and faithful ly. as well in a sound as on unsound condition. A COURSE OF LECTURES. 11 o Of nutrition. A process of infinite interest to the philosophical inqui- rer—One ofthe most curious within the scope of physiology. Very defectively and unsatisfactorily treated by physi- ological writers. Its close relationship tosecretion. A compound process, consisting of secretion and appos> sition or fixation. Effected by the capillary vessels, which, in all parts, therefore, perform a secretory function—They con- stitute the real mechanicians and architects ofthe body. Like secretion, nutrition is a generative process. Illustrations. Nutrition effected entirely from the arterial blood. Differs however from secretion in this, that it produ- ces from the blood vital matter, while all secret- ed matter is dead. in bestowing substance, then, on the various parts of the body, nutrition communicates to them also the attributes of life. Is there, in different portions ofthe blood, peculiar ap. titudes for nourishing particular parts of the body? Ans. No—Illustrations. Ofthe philosophy of nutrition* This like the philosophy of secretion, tinctured by the reigning philosophy ofthe day. Hence the existence of sundry hypotheses on the sub- ject. 1. Chemical hypothesis, which represents nutrition as a kind of animal chrystallization, arising from the play of chemical affinities—The mere conversion of a fluid into a solid, by chemicalagency. Illustration and refutation. 2. The hypothesis founded on what is denominated Vagina closed by adhesions, tumours, or mem- branes natural or adventitious. 3. Os tincae impervious originally, or by inflam. mation^ cr rendered inaccessible to the semen A COURSE OF LECTURES. 127 masculinum by some deranged position of the uterus. That impregnation can be effected in these unnat- ural conditions of the generative parts, appears from cases reported by Harvey, Morgagni, Hil- danus, Ruysch, Simpson, Haller, and others. It must, then, take place, without the entrance of the semen masculinum into the cavity of the uterus. Experiments by Harvey, De Graaf, Lewenhoek, Haller, and Haighton, on various animals, viz. The cow, the doe, the ass, the ewe, the bitch, and the females of rabbits. All these animals inspected at different periods after coition, and no semen masculinum ever certainly found beyond the vagina. Mr. Hunter reported to have found semen mascu- linum in the uterus of a bitch—Erroneous. Even admitting semen masculinum to gain admis- sion into the uterus, there it must stop. Could not thence find its way to the ovarium. Neither the uterus nor the fallopian tubes calcu- lated to convey the fluid in that direction. Must, from their form and organization, act in the contrary direction. Cannot act both ways—Nothing in the systems of animals aaalogous to such a phenomenon. Fallopian tubes could not convey any thing from the uterus to the ovarium, without experiencing an erection, or orgasm. That nothing such takes place during coition, proved by the experiments of Haighton. These experiments performed immediately after the act, and at every hour from (he first until the ninth. R* orgasm during this period—a turgescency of OUTLINES 6P the vessels just beginning to appear. But impregnation now completed* This event, therefore, had taken place previously to any orgasm in the tubes. 2. Semen masculinum supposed to he carried from the va- gina to the ovarium, by a set of absorbents specifically ap- propriated to that office. Objections. 3. Semen masculinum supposed to be conveyed by absorbent; into the blood, and thence through the sanguiferous sys- tem to the ovarium. Objections. 4. A fecundating aura supposed to arise from the semen masculinum in vagina, and make its way to the ovaria. Objections. 5. Hypothesis of Harvey—Semen masculinum effects impregnation by an influence or power analogous to that of contagion. Objections. In relation to the mode in which the semen masculinum throws its influence on the ovarium, there exist va- rious other hypotheses or conceits too ludicrous in themselves, and too humiliating to the intellect of their advocates, to be recited. In the solution of the process of impregnation, no facil- ity is gained by admitting the semen masculinum into actual contact with the ovarium. Illustration. Further hypotheses. 1. Germs or homunculi pre-exist in semen masculi- num, which, making their way into the uterus. there devebp and growr. 2. Germs pre-exist in the ovarium of the female, which, by the influence of the semen masculinum, in contact or remote, are excited to development and growth. A COURSE OF LECTURES. f^ ^. The male and the female furnish, each, a seminal fluid, which, uniting and commingling in the ute- rus, make a formative effbrt,and produce a foetus-— onjglo it by means of atomical affinities. 4. There exist already formed, in the female ovari- um, certain portions of matter, capable of being, by the influence of the semen masculinum,so quick- ened and endowed, as to assume the formative ac- tion requisite for the production of a foetus. & The hypothesis of Count De Buffon, which al- leges the existence of generative organic parti- cles, which, by uniting in the uterus, produce an embryo. —Illustrations and objections as to the preceeding no- tions. Ofthe theory which attributes to stimulation and sympxthyf the work of impregnation. Ofthis theory,Dr. Haighton, by his experiments, a dis- tinguished supporter. Semen masculinum,deposited in vagina,specifically stim* ulates that organ, which is possessed of specific sus- ceptibilities, and the remainder of the process is per- formed by sympathy. Jfor the better understanding ofthis theory, a few gen- eral observations requisite. impregnation, like every other vital action or process, the result of stimulation. This, a first truth in physiology—immediate, general, irresistible. in vegetables, and many animals of the lower orders, the common stimulants of heat, light, moisture, elec- tricity, &c. sufficient to give rise to a generative ef- fort. c . . In animals marked by sexes, stimulus of a seminal se- cretion alone adequate. Some^art of the system ofthe being, whether yegetf. Q 130 f OUTLINES OF ble or animal, thus stimulated, forms, by a new and specific secretory action, the rudiments of the future offspring. Generation, therefore, as literally the worlMrf secretion, as the formation of bone, or the production of bile. Illustrations. Remote stimulation as powerfully operative asproximate. -Examples, derived from various glands. 1. Salivary glands. 9. Lachrymal do. 3. Liver. 4* Kidneys. 5. Testes. 6. Skin or the cutaneous glandular tissue. Embryo, a secretion from an ovarian gland. If other glands be excited to action by remote stimu- lation of parts not belonging to the same immediate systems with themselves, much more may thi ova- rian glands be thus excited, by such stimulation of a component part of the generative system, to which they belong, and which, as already stated, is connected as a whole by the strongest sympa- thies. Illustration. Place of stimulation, and order of sympathy. Vagina specifically stimulated by semen masculi. num. Course of sympathies. 1. Ovarium. 2. Fallopian tubes. 3. Fundus uteri. 4. Cervex uteri. 5. Mammae. 6. Vagina and external organs of generation. In all these parts semen masculinum cannot be present, yet is it the cause of the chang- es they sustairrC ■ ■ V A COURSE OF LECTURES. r* Through sympathy, then, alone it must operate. Further proof that the whole process of generation is sympathetic. The experiments and reasonings of Dr. Haighton—Re cital cf. Further proofs drawn from generation in fowls, birds, aphides, and vegetables. 1. Fowls and birds. Here the embryo or rather ovulum formed before the sexual embrace—Like the bud of a tree. Embryo or ovulum situated high up the spine, at a great distance from the vulva, in which the semen masculinum is simply deposited by a penis that does not project. Uterus and infundibulum long and tortuous. Many ovula, sometimes upwurds of twenty, impreg- nated by one embrace. These ovula, being in different stages of growth, semen masculinum cannot, through the uterusi come into contact with all of them—does not in- deed, with any. 2. Aphides, several generations of, impregnated by a single embrace—i. e. mother, daughter, grand- daughter, great-grand-daughter, &c. for in this descent, while viviparous, they are all females. Become again oviparous, when males and females are once more produced—Impregnation here, cer- tainly by sympathy. Illustration. 3. Vegetables. In many of these, ovarium very remote from the stig- ma. Style, connecting stigma and ovarium, long and im- pervious. Pollen applied to the stigma, but cannot possibly be conveyed to the ovarium, the style not being tu bular. 1&£ OUTLINES a Must, therefore, extend its influence to the embryx. by sympathy. Pollen not being fluid, but a dry powder, renders its conveyance along the style to the ovarium abso- lutely impossible. Specifically stimulates the stigma, and all that fol- lows is tbe work of sympathy. Impregnation offish and frogs, where the semen mascu- linum comes into actual contact with the ova, supposed to constitute an objection against the sympathetic theory of generation. Not so—Semen comes into contact only with the out- side of the egg—But impregnation implies an inter- nal effect—The seminal fluid of the male, then, not entering the egg, must operate by sympathy. Same thing would be true, in woman, did the semen masculinum gain admission to the ovaria. All animal actions and processes are the result of sus- ceptibility, impression and sympathy. This theory of generation, erected on the suscepti- bility and the sympathy of the solids, much more intelligible and satisfactory, than that arising out of the mixture ofthe fluids. The latter participates ofthe corruptions of humor- alism; the former has the freshness and purity of solidism. In every species of animal, the semen masculinum possesses a power of stimulation sui generis. Supposed to be instrumental, at puberty, in giving form and character to the male. An error—This effect not produced by the stimula- tion of secreted semen, but by the awakened sensi- bility and energy ofthe genital system. The secretion of the seminal fluid a concomitant ef- fect of the same general cause. lilustraiio1?. A COURSE OF LECTURES* 1S3 Of superfatation. -Not twins; but one conception succeeding another, at some distance of time. In woman, correctly organized, can this occur? Feasible, where there are two vaginae and two uteri. A case to this effect recorded in the opuscula pathologica^ of Haller. Similar cases related by Purceli, Lobstein, Pole and others. In any case, superfcetation very rare, and ought to be admitted with great caution. Too much credulity indulged in relation to it. That it can scarcely occur in the case of a single ute- rus and vagina, appears from the following conside- rations. On conception being effected,os tineas and fallopian tubes closed, by a tenacious mucus secreted for the purpose. Membrana caduca also formed, as essential to the foetus. Uterus thus completly occluded, against the entrance of any thing from without. Another foetus must have another membrana caduca, which could not be formed without the removal of tht first. In the progress of gestation, at a later period, uterus en- larged so much, and the general position and rela- tions of the parts so changed, that the fallopian tubes could not reach the ovaria. Conception occuring now, foetus must be extra-uterine. Could a second foetus reach the uterus at this period, great disorder would ensue—most probably disorgan- ization, and destruction of the gravid state. Existing uterine action must be suspended, to admit of another kind, forming a new placenta, Sac. Two kinds of action cannot coexist in the same organ. Thus pregnancy and true menstruation incompatible— The co-existence of any two different kinds of actior 134 OUTLINES OF in the same organ, contrary to the laws of nature— The same thing as to be, and not to be. Sanguineous discharge from the vagina during preg- nancy, not menstruation—not a true secretion—dis- similar in smell, colour, and all other sensible quali- ties. Uterus cannot nourish a foetus, and menstruate, at the same time. Same vessels which menstruate, have formed and now support the membrana decidua. In proof of this, the membrana decidua exists in obsti- nate cases of amenorrhea. In pregnancy, the condition of the uterus too much changed, to admit a second conception. Those subject to amenorrhea seldom prolific. To fit the genitnl system for conception, entire harmo- ny in susceptibility, and concert in action between all its parts must prevail. Attempted defence of Superfetation. 1. Multiparous animals, as the bitch, bring forth, by promiscuous coition, a terrier, a cur, a hound, a bull- dog, a mastiff, &c. each resembling its male parent. Object—Not conclusive—these are instances not of su- perfttetation, but contemporaneous conception. Ovarian vesicles all ripened and their contents convey- ed to the uterus during the same process, not during two or more successive ones. Birth contemporaneous, and all the offspring alike raa- tu re. Besides, the uterus ofthe bitch divided into cells—no membrana decidua—and the foetal rudiments do not* so early attach themselves to the parietes uteri— Each cell a kind of independent uterus. Here, then, analogy gives no evidence of weight, in fa- vour of superfcetation. Human infants born differing much in size, and ap- A COURSE OF LECTLREG. 135 parently also in age—this, either at the same time, or at some interval from each other. Ans. An occurrence exceedingly rare; if, indeed, the event has ever occurred. In former times of great credulity, believed in—at pre- sent, much discredited. Some cases of the kind lately reported. Ans. Foetus had perished prematurely, and was still re- tained in utero. Rendered diminutive by original defect, disease or ac- cident. Foetus, it may be said, if dead, likely to putrefy. Ans. Not if the membranes be entire. Example. Black and white children, both mature, at the. same birth—- from immediate successive connections with a black and a white man. Few cases of this kind reported—know of only three or four, and the evidence in favour of their existence not conclusive. Characterized by inherent marks of fallacy. The offspring of a black person and a white ought to be a yellow—a mulatto. At best, these must be insfences of cotemporaneous conception; not of superfoetation. Such a phenomenon unnatural, and supported by neith- er fact, reasoning, nor sound analogy. Ofthe ovum—Where formed, and how? Observations on. Ofthe nourishment ofthe Foetus in utero. Only two sources of nourishment ever referred to, 1. The liquor amnii. 2. The umbilical cord. Liquor amnii supposed to be taken in, inlvvo ways, By the skin, acting like a spunge, or by means of absorbents- * ■ OUTLINES OF Erroneous—Skin ofthe foetus often so incrusted by thick mucus, as to prevept absolutely any thing from entering in that way. Notion of Democritus. Liquor amnii not the source of nourishment; because; 1. That fluid is not nutricious. Often, towards the close of gestation, exceedingly impure—acrid—putrescent—feculent—bloody. 2. It usually exists in an inverse ratio to the size of the foetus, and its demand for nourishment— sometimes entirely wanting—dry births. 3. Foetus often born without a passage to the ali- mentary canal—sometimes acephalic. 4. Antecedently to the third month, its chylopoietic viscera soft, pulpy, and incapable of the alimen- tary function. Circulation and nutrition the only functions that go on in the foetal system—Brain, lungs, liver, &c. quiescent. *; -^ Condition of foetus perfectly parasitical—Food pre- pared exclusively by the mother, and the mater- nal portion of the placenta. Theory of nourishment by the umbilical cord. JFirst inculcated by the Stoics—Became extinct—Re-. vivedtabout the time of Harvey's discovery—Since thai period, the prevailing doctrine. Ofthis theory, several modifications exist. 1. Direct vascular communication between mother* and foetus. Incorrect. Proofs of this. Injections never pass from the maternal to the foetal system—nor the reverse. Pulsations of the maternal arteries and the umbilical, cofd discrepant. ,FceU'l and maternal blood dissimilar, Difference specified. A COURSE OF LECTURES. 127 Did the maternal blood pass immediately, this could not be the case—There would, then, be transmission, without assimilation or adaptation. Powerful propulsion of maternal blood, the heart and arteries being strongly excited, would injure the ten- der and feeble system of the foetus. Maternal blood supposed to be deposited in placental cells, and thence absorbed, by the foetal veins—foe- tal blood agian deposited by the foetal, and absorbed by the maternal veins.—Erroneous. Placenta composed of two parts, foetal and maternal. These parts made up respectively of vessels from the foetus and the mother. Those vessels intermingle, but never anastomose. Demonstrated, in the early placenta,'by mace- ration. Illustration. Effusion of blood by one set of vessels and assumption by the other, has no existence. Arteries ofthe umbilical cord have no exhalent extrenv- ities—run immediately into veins. Uterine arteries have secretory terminations, which, preparing foetal nourishment, deposite it in placental cells—But the main current of blood returns to the uterus by veins. In the foetal placenta, circulation ofthe blood like that in the lungs. * In the maternal placenta, circulation like that in the corpora caverrosa penis. Between mother and fceUis, then, no direct vascular communication. Proof. Best injections, by umbilical arteries, return by umbili- cal vein. * Injection?, by uterine arteries, return in part, by ut& 138 OUTLINES OF rine veins, and p; ss, in part, into the ccll^ ofthe ma ternal placenta. Fa Hi delivf jei.and umbilical cord c >'. no hemorrhagy from maternal vessels—from the e.id of the divided cord only. Foetus n< t affected by maternal hemorrhagy. Mother dies of hemorrh- ■/', child healthy and vigorous. Converse equally tru —child, in embryotomy, dies with great hemorrhagy; mother, although exceed- ingly weak, not affected by Ihe accident—did the blood flow from her vessels, the case would be other- wise. ,. Child and placenta simultaneously expelled, unless the infant breathe, circulation continues a considerable time—if placed in warm water, from fifteen minutes to half an hour—A remarkable and conclusive case in point. In inferior animals, the monkey tribe excepted,the ma- ternal portion of the placenta not deciduous, but an adherent growth ofthe uterus—Here the foetal por- tion falls off, without hemorrhagy. In some of these animals, the doe, and the female rab- bit, the discrepancy between the foetal and the ma- ternal portions of placenta, still greater. Illustrations. Experiments corroborative. I. Side of a pregnant bitch l«fid open, and umbilical vein divided—hemorrhagy copious, and foetuses- ex- hausted of blood—In another similar experiment, a ligature passed around the umbilical arteries, hem- orrhagy trifling. , - 2. A pregnant bitch killed by hemorrhagy from the di- vided carotid arteries—foetuses alive and vigorous— Foetal portion of placenta full of blood—maternal port o : ■ m-ty and flacci . 3. Feed a pregnant animal with madder—Bones of A COURSE OF-LECTURES. 139 mother coloured—those of fetus not. Congenital small pox and syphilis aff>rd no evidence of any immediate vascular connection between foetus and mother. Perfectly explicable on principles of sympathy. Foetus, then, fabricates its own blood. Analogy from the egg—chick certainly fabricates its own blood from the contents of the egg. Foetus has nn equivalent apparalu---why not, then, do the sam<"?—Vegetable seeds, bean, pea, Sec. the same. What, then, arc the uses ofthe placenta? Ans. Twofold—That organ serves both as lungs and stomach, i. e. vitallizes the blood ofthe foetu*, and secretes a fluid for its nourishment, from the blood of the mother » Maternal portion of placenta, the stomach,foetal portion. the lungs. Analogy ofthe placenta to the lungs. 1. Blood of foetus passes through it, as it afterward? does through the lungs—i. e. a part passes through, as in the case of amphibious, or single heai ted an- imals. 2. Texture cellular, somewhat like that ofthe lungs. 3. Compression of the unfbilical cord strangles, in like manner with compression of the trachea. 4. In passing through the placenta, the blood be- comes arterialized, i. e. exchanges its modena for a scarlet colour—Remarks. Does the foetus in utero produce its own temperature? Question discussed. Whence comes the vital principle or materia vita;, to the blood ofthe foetus? Ans. From the blood of the mother, which derives it from the atmosphere. « Decarbonation ot icetal blood—Remarks on. 140 OUTLINES OF, No conclusive evidence ofthe existence of. Placenta, in us maternal portion, analogous to the sto- mach, in preparing a chyloid fluid for the nourish ment of the foetus. This opinion by no means new—Entertained by various writers of former and remote ages. In relation to certain inferior animals, manifestly true. Evidence to prove its existence in the human race, noi wanting. Seen by Harvey, Haller, Blumenbacji, Burns and others. Harvey denominates it, an "albuminoid fluid." Most easily detected in those animals, the two portions of whose placentas are united on the principle of pa- - pillae and cotyledons, or socket and ball. Here*the secreted fluid has been seen "oozing from the papilloe into the cotyledons. In the human female, secreted by the glandular action of tho uterine arteiies. Sympathy between uterus and mammae exceedingly powerful—Mostly direct; but sometimes reverse. Examples of reverse sympathy. During lactation, catamenia suppressed. Converseiy-—secretion of milk suppressed during a flow of c.tamenia. Further—Uterus and Mammas interchange functions. Illustration. Secretion of milk checked by cold—a similar fluid is sues from the vagina. After parturition, secretion of milk late in appearing— lochial evacuation more copious, and changed in quality, colour, consistence &c. by the admixture of a milk-like fluid. The fluid secreted by the placenta, how conveyed into '^the faotal system? Absorbed by veins, said Harvey. —Not true. Veins do not absorb nutrimental matter. A COURSE OF LECTURES. 141 Fluid taken up bv regular absorbents, and by them conveyed into the fecial circulation. No matter whether these absorbents have been seen or not. Placenta and umbilical cord are nourished a ad" grow, and must, therefore, be supplied with ab- sorbents—No absorbents found in cartilages; yet must be there. These absorbents said, however, to have been seen by \h( kel. VValtherus, Ludwig, Moscngni, and others. Two sets of them—Lacteals and common absorbents— analogous Lo the arrangement of things in the in- tcs'iiiai canal. This theory of foetal nourishment confirmed by the analogy ofthe incubated egg* Third day of incubation, umbilical cord of chick be- giuo to pullulate, and advance towards the folliculus aeris—On the eighth day reaches that chamber—Re- current blood brightened in colour. Observations on folliculus aeris. Vessels concerned in circulation, the only ones issuing from the umbilicus, r*ever enter the vitellus or albu- men. Vitellus, the food for the chick, conveyed to it, not by the umbilical cord, but by a small duct, in the char- acter of a lacteal. This duct, which issuing from the inte tinum Ileuni^ enters the vitellus, called ductus inlcstinalis Sienonis. By this duct is the vitellus absorbed, and carried at food into the intestines of the chick. Albumen, like liquor amnii) not nutricious, and never, in a healthy state, mixes with the vitellus. These two substances inclosed in distinct membranes, which separate them from each other. Albumen serves, perhaps, the purposes of the liquor amnii. A portion of vitellus reserved for tbe uses of the chick after its escape from the shell. This drawn into th-e 142 OUTLINES OF abdomen through the umbilicus—A too sudden Con- traction of the umbilical ring sometimes excludes this residuary portion of vitellus, and the chick dies. The analogy between the mode of nutrition ofthe foe- tus in utero, and the chick during incubation, very striking. Umbilical vessels in both carry venous blood from the embryo, and re! urn arterial. Vitellus, as food for the chick, conveyed by a duct, in the nature of a lacteal. Food for fcetu> secreted in the placenta, and carried to its place ->f destination, by means of lacteals. Contrivance in both, analogous and beautiful. Equivocal generation. The production of a living organized being, vegetable or animal, without the influence of specific parentage. When properly understood, this doctrine, whether true or false, not at war with cither morality or religion. Nor is it, in its nature, as some have very thoughtless- ly and intemperately pronounced it, either unreas- onable or absurd. On the contraiy, it does appear to be the legitimate inference from a fair process of inductive philosophy. Stronger still, a belief in it, is forced on us by observation and the result of expe- riment. This doctrine not favourable to the hypothesis of the self-creative pou er of matter. On the contrary it refers to the Deity both the creation of matter, and the endowment of it with all the pro- perties and powers it possesses. It maintains the Deity to be the original cause of all other causes, and regards matter, whether dead or liv- ing, as well as created spirit, as acting, by derivative powers, a subordinate part in the economy ofthe uni- ■ verse. A COURSE OF LECTURES. 14S If an animal begets its own likeness, it does it by a pow- er derive' fr m its creator—whether directly or indi- rectly, it malf-rs not. If a vegetable begets its likeness, its power to do so must be refered to the same source. This doctrine, then, recognizes the Deity as the fountain of being, power, and action. In this there is noth. ing atheistical, irreligious, immoral, or irreverend. Dea.i matter must have been created before living, the former to serve as the habitation, and for the subsis- tence, ofthe latter. Such also is the declaration of Holy Writ. Dead matter having been created, how was living mat- ter formed out ofit?—by the immediate hand and act of the Deity, or in a secondary way, through the in- strumentality of powers which he had already bes- towed? The latter hypothesis most probable in itself as well as by far most creditable to Deity, and conformable to the views we entertain of his supreme efficiencies. That mechanician who invents and constructs a self- moving and seK regulating system of machinery, man- ifests more genius, and higher capabilities, than he who erects a machine that moves only while he him- self is turning the crank. The calling of matter into existence, and the endow- ment of it with principles and powers for its future government, constituted the only really creative act of Deity. All subsequent arrangements, forms, modifi- cations, and peiformances of matter, were the imme- diate result of those principles and powers. Equivocal generation, oj two sorts. The first derives given kinds of living beings from the combination, according to certain established princi- ples and laws, of elementary matter, capable of unit* ing with the vital principle. OUTLINES OF The second derives such beings from diseased action occurring'in the systems of other living beings of dif- ferent species. Illustrations. Examples of the first found in the production of 1. Conferva fontinalis, 2. Mucor or mould. 3. The rust or smut on wheat, oats, &c. 4. White clover in many places. 5. Timothy do. do. 6. Strawberries, in some places. 7. Certain new species of timber, &c. Illustrations. 3. Mushrooms, do. Such examples found also in the production of, 1. Animalculas infusoria?) Tn , ,. »T., , > Illustrations. Mites in cheese. y Examples ofthe second kind of equivocal generation, found in the production of. 1. Hydatids, in various parts of the body. 2. Intestinal worms. 3. Worms of a nondescript character found in the liver, the brain, the eye, and other parts ofthe bodies of animals. Objects or final causes of the preceeding modes of generation,. interesting and important. 1. The mischief attendant on putrefaction prevented. 2. The fatal result of diseased organic action pre- vented. 3. The earth suitably and usefully peopled with tru- ly native vegetable productions. Illustrations and examples. Death and life nothing but reciprocal mutations of matter—Illustration. General and concluding remarks on the commence- A COURSE OF LECTURES. 145 ment, progress, and changes of vital action, from birth, until natural death. Philosophy of these changes, or their causes and conse- quences. ^Philosophy of growth—of maturity and strength—of decline and old age—and of death from old age. Description of death from old age. Signs of absolute death. PATHOLOGY. Have hitherto contemplated the system of man in a state of general vigour and harmony. By the healthy and natural performance of its own functions, have beheld each organ contributing essentially to the soundness ofthe functions of other organs, and, in this way, to the welfare of the system at large. In this state of things there is a well adjusted balance of power and action—an equilibrium of excitability, excitement, and circulation—Nothing defective, nothing excessive, nothing deranged—the play of every organ eatymatural and pleasant— This is health. In this state of things, the body resembles a well con- structed system of machinery, where each wheel, in moving correctly itself, contributes to the correct- ness and efficiency ofthe whole—or An army so skilfully arranged in order of battle, that each column, in performing its own duties, gives aid to others and strength to all. We have now to reverse the tablet, and take a view of man in an opposite conation, his functions deranged, the harmony and reciprocal good offices of his organs suspended, the general balance of his system, in re- lation to excitability, excitment, and circulation, S OUTLINES OF broken, and the parts, instead of aiding, doing injur) to each other—This is disease. Thus, in a system of machinery, one wheel out of order deranges the whole; and In an army thrown into confusion, that confusion be- comes more disastrous, by the mutual collisions of its disordered columns. Pathology—derivation of the term—definition of—an account, descriptive and philosophical, of the causes, seats, nature, signs, crisis, diagnosis, and prognosis of disease. TJivided into general and particular—or that relating to disease, in the abstract, as contradistinguished from health, and that relating to particular diseases, as dis- tinguished from each other. General pathology appertains exclusively to the Insti- tutes of Medicine. Particular, in part to the Practice of Physic. The teaching of the former in this school, belongs to the chair alone which I occupy. Subject, equally important and difficult. In an al tempt to ticat it correctly and systematically, but little aid to be derived from existing publications. Every treatise corrupted by humoralism, chemical phi- losophy, mechanical philosophy, or all. Arrangement aho exceptionable. Instead, therefore, of depending, for information, on written books, am compelled to look into the book of nature, and endeavour to interpret for myself. This, the richest, purest, and most accessible source of knowledge. »v Cannot he too highly recOinmended to the attention of physicians, especially tho.se who are ambitious to improve f.h^ir profession. A COURSE OF LECTURES. l47 CAUSES OF DISEASE. AH things, material or immaterial, thatcan,by abuse or otherwise, engender disease. Exceedingly numerous. Exist around us--within us—Things most essential to our being—air—aliment—drink—the products of in" dustry—industry itself—-exercise —rest—slecp—r- watching, &c. Intellectual agents—study—passions—emotions., 'Technical division of. 1. Remote—2. Predisposing—3. Occasional or excit- ing—4. Proximate. 1. Remote cause, what? 2. Predisposing, do. 3. Occasional or exciting, do. 4. Proximate, do. Illustration, derived from bilious fever. In relation to this catenation of causes, great inaccuracy prevails in medical writings. Exciting cause not always necessary to produce disease —Instance, in small pox, &c. This cause less specific in character than either of the others—Remarks. Enumeration of exciting causes that are very generally operative. Predisposing cause determines the nature of tiie dis- ease—An individual predisposed to anyone disease, not liable to another. Illustration. Diminution of vital energy, a general predisposing cause of disease. Diminution of Do. in any particular organ, a particular predisposing cause. Proximate cause, defined to be "ipse, morbus..''' Error. My own views of. Remote and exciting causes arc agents j'-, ti *!th>m. 148 OUTLINES OF Predisposing and proximate causes, conditions within. .Although not first in the order of arrangement, nor in- deed in that of nature, shall treat first of the predis- posing causes of disease. Correctly divided into congenital, hereditary, and adven- titious. Distinction between congenital and hereditary, as here- applied. Predisposing cause synonymous with predisposition. Congenital predisposing causes.enumeration of. Hereditary do. Particularly exemplified in predispositions tfl Phthisis pulmonalis. Mania. Scrophula. Gout. Rheumatism. Epilepsy—and a few other diseases. Diseases resulting from hereditaiy predisposition attack ancestors and descendants at about the same period of life—Illustration. Philosophy of hereditary predisposition. Liability of descendants to hereditary diseases, pro- portioned to theirlikeness to ancestors—Illustration; and application. Idiosyncrasy, as a predisposing cause ofdisease. Term explained. Exemplifications. Of temperament, as a predisposing cause ofdisease. Term explained—a deficiency in the balance of the, system. Former opinions on this subject. General and original temperaments, four in number. i. Sanguineous. 2. Bilious. 3. Phlegmatic. 4. Mel- ancholic. A COURSE OF LECTURES. 149 Why so denominated. Can be extinguished by external personal appearances. 1. Sanguineous temperament. Marks of. Philosophy of. Diseases to which it predisposes. This, the temperament more particularly of Youth. High latitudes. Hilly and mountainous regions. The vernal season. Intellect connected with it, character of. 2., Bilious temperament. Marks of. Philosophy of. Diseases to which it predisposes. This, the temperament more particularly of. Adult life. Males rather than females. Warm climates. Low, flat, and marshy regions. Summer and autumn. Intellect connected with it, character of. 3. Phlegmatic temperament. Marks of. Philosophy of. Diseases to which it predisposes. This temperament attaches to every period of life, and every season of the year—strongest, perhaps, in win- ter. Prevails most in low, humid, and cold regions. Intellect connected with it. Subjects of, debilitated. 4. Melancholic temperament—a Higher degree of the bil- ious. Marks of. OUTLINES- OF Philosophy of. Diseases to which it predisposes. Til'-?, the temperament more particularly of. The decline of life. Warm climates. Summer and autumn. High life and opulence, or at least, easy cli cumstances, where leisure and idleness pre- vail. The foregoing are the temperaments most generally recognized and spoken of, because certain external marks render them obvious to common observation. There exist various other conditions of the systenij which may be regarded as temperaments of a subor- dinate character, and as constituting predispositions to diseases. Cephalic temperament, in certain children, until their eighth or tenth year—Illustration and remarks. Pectoral or tracheal temperament in other children, until near the same period. Do. do. Glandular temperament, in others, until the tenth or twelfth year. Do. do. Hemorrhagic temperament, in many individuals about puberty. Do. do. .Yervous temperament, in adults of each sex, more especi- ally the female. Do. do. Pulmonic temperament, in males and females, more espe- cially the former. Do. do. Muscular and membranous temperament. Do. do. Intestinal temperament. Do. do. These minor or subordinate temperaments not to be discovered by external marks. Menstruation as a predisposing cause of disease. Remark;.. *.'' nation of do. do. A COURSE OV LECTURES. 151 Pregnancy, as a predisposing w^ ofdisease. Lactation, do.' Of different periods of life, as predisposing causes ofdis- ease. Term of life divided into six epochs. I. Infancy, extending from birth to the seventh or eighth year. II. Childhood (Pueritia) extending from the close of in- fancy to puberty. III. Adolescence, fiom puberty to manhood, i. e. from the 15th to the 95th-or 30th year. IV. Prime of life, from manhood to the 45th year. V. Decline of life, from the 45th to the 60th year. VI. Old age, from the 60th year to the close of life. First epoch—Divided into three periods. I. From birth to the 7th or 8th month, when the first teeth begin to appear. Predisposition of this period. 2: From the 7th or 8th month, until the close of the second year. Predisposition ofthis period. 3. From the 2d until the 7th or 8th year, when ^the first are exchanged for a second set of teeth. Predisposition. Second epoch. Predisposition. Third epoch. Predisposition. Fourtli epoch. Predisposition. Fifth epo.ch. n Predisposition. Sixth epoch. Predisposition. Practical uses ofthe foregoing remarks* 2 OUTLINES OF The foregoinlt^dispositiong to be considered natu- ral. Adventitious predisposing cause* ofdisease, are produc- ed by the operation of remote causes. They vary, therefore, in their nature with the variation of these causes. Hence, an account of the latter will sinii- ciently designate the former. Of the remote causes ofdisease. These produce their effect by operating from without. They are all stimulants, and operate by impression. Their impressions are sensitive ©r irritative—Definitioa of these terms. Sensitive impressions produce disease most suddenly; but irritative ones not less certainly, and generally of a worse character. Of agents productive ofdisease by sensitive impressions, the principal are heat, cold, mental affections and mechanical violence. Light, sound, and taste rarely engender disease. Smell, more frequently. Causes producing disease by irritative impressions, are variolous matter, matter of typhus fever, the poison that gives rise to bilious fever, in all its variety, and many others to be specified presently—Illustrations. Ofthe non-naturals as remote causes of disease. These are six in number, viz. I. air—2. meat and drink—3. sleep and waking—4. motion and rest— 5. retention anil excretion—6. the passions of the mind. 1. Aii—Not) perse, a cause of disease, but on account of its adventitious qualities, sensible or insensible. Sensible qualities that prove deleterious. Heat, cold, ""moisture, dryness, pressure or weight, and vicissi- tudes. Heat, diseases proceeding from—Remarks. Carried to the extent of burning, do. Cold, do. do. ♦ A COORSE OF LECTURES.. 153 Moisture, do. do. Dryness, do. do.. * Pressure, do. do. Vicissitudes from orie sensible quality to another, dis» eases proceeding fronV—Remarks. Suspension by the neck,and submersion,as causes ofdisease. Remarks. Electricity, do. do. w ititodus operandi of the foregoing sensible qualities ofthe at- mosphere. '' Act exclusively on the skkl—or slightly, perhaps, on the schneiderian membrane. Cannot possibly act otherwise, neither heat, nor cold, nor moisture, nor dryness being able to come into immediate contact with, or act proximately on the interior ofthe body. All parts beneath the cutis vera possess the same tem- perature, whether the atmosphere be hot or cold, and the same degree of succulency, whether it le moist or dry. These causes, then, in the production of disease, act lo- cally, in the first instance, and extend their influence to a general issue, only through the medium of sym- pathy. Illustration. The same thing true of every other febrile cause, pro- ducing a sensitive impression. Hence every fever proceeding from such impression, has a local origin. Touching this point, no difference of opinion can exist. Illustration. That fevers-:resulting from irritative impressions are also necessarily local in their origin, will appear hereafter equally obvious. *#Hence the en or of dividing febrile diseases into idiopa- ^ thic and symptomatic. T 154 OUTLINES OT Correctly speaking, all febrile diseases are symptoma- tic, the phenomena which constitute fever being nothing but symptoms arising from a local affection., Important practical uses ofthis doctrine—Illustration of.. Have, for more than twenty years, been labouring to establish it. While the sensible qualities only of the atmosphere have been hitherto spoken of, as causes of disease, that fluid has been regarded as in a state offpurity. We shall now consider, as sources of disease, certain impurities with which it is occasionally impregnated, « some of which are denominated insensible qualities,* tt because they are discoverable only in their effects, no tests yet devised being adequate to their detection. Of deleterious gases as causes ofdisease. 1. Carbonic acid gas—Remark^. 2. Hydrogen gas, do. Carbonated and sulphurated do. 3. Carbonic oxide—Remarks. 4. Nitrous gas, do. 5. Nitrous oxide, do. 4i 6. Oxygen gas, excess of. The preceding gases not very abundant in the at- mosphere—Hence to dwell on them not impor- tant. Of marsh miasmata, as a cause of disease. Prevalence of, exceedingly extensive. May be generated wherever man can reside. Circumstances necessary to its production, viz; moisture, heat, light, atmospheric air, and dead ^ vegetable and animal substances. Nature and composition of, unknown. Its existence detected only by its effects on living matter. First designated as a cause of disease by Lancisi; an Italian physician of great celebrity. A COURSE OF LECTURES. 155 Creates a predisposition to abdominal diseases, to the alleviation, very often, of diseases of the thorax. Strikes with most certainty in the evening or at night. Probable height ducing an epidemic disease. Seat and character ofthe disease. Subjects whom it attacks. Matter of Varicella. Reasons for believing it also an atmospherical poison Analogies with small pox. Seat and character of. Matter of typhus grdvior, or peripneumonia typhoides. Reasons for believing it an atmospherical and not a se- creted poison, and that it creates an epidemic consti- tution. Seat and pathology ofthe disease. General remarks on. Of diet and drink, as a cause ofdisease. A very extensive and important subject. Must examine it briefly. The abuses of diet and drink only, deleterious. Four reasons why they prove so. 1. The idiosyncrasy of individuals—Illustrations. 2. The use of diet and drink, or either of them, in un- due quantities—i. e. gluttony or drunkenness. Illustrations. 3. The use of both or either, unwholesome in quality. Illustrations. 4. The use of these articles, at unseasonable times. Illustrations. Of sleeping and watching, as causes ofdisease. Abuse of, only, injurious—Illustrations. A COURSE OF LECTURES. 1&3 Of motion and rest, ag causes ofdisease. Abuse of, only, injurious—Illustrations. Peculiar kinds of motion, effects of. Sea-sickness, remarks on. Various trades and occupations, deleterious effect* of. Sedentary habits, injurious effects of. Illustrations and remarks. Of retention and excretion, as causes ofdisease. Exceedingly powerful in the production ofdisease*. Suppressed or diminished evacuations, effects of. Suppression of perspiration, effects of. Do. of menstruation, do.' Do. of urine, do. Do of bile,. do> Do. of saliva, do. Do. of the discharge from old ulcers, do. Do of gleet, hemorrhoidal flux, epistaxis, &c. do-» Retention of foeces^ effects of. Do. of semen masculinum, do. Profuse evacuations, injurious effects of. Illustration and remarks. Of improper clothing as a cause of disease. Unsuitable qualities of the materials, out of which clothes are made. Remarks and illustrations- Unsuitable size and form of certain articles of dress, do. Of the passions ofthe mind, as a cause ofdisease. In the consideration of this subject, the terms, passion, emotion, and affection, will be regarded as synony- mous. Mental affections exceedingly powerful in the produc" tion ofdisease. In some individuals much more powerful than mothers —In females more so than in males. OUTLINES OF Perhaps no other morbific cause operates so unequally on ditferent individuals. Such is the constitution of man, that mental affections are usually most potent in thoge who are least able to sustain their effects. Passions are all stimulants, and like other stimulants, divided into friendly and unfriendly, or salutary and morbific. The former prove noxious only when in excess, the latter are noxious in their nature. Hurtful passions—Fear, grief despair, remorse, avarice, hatred, envy,jealousy and revenge. Like actual pois- ons, these, independently of quantity, are deleterious per se. Friendly or salutary passions, love, joy, ambition, courage and hope. Anger, equivocal in its character—Remarks on. Malignant or deleterious passions, denominated sedatives —Reason ofthis Passions, however opposite in their nature, very similar in their effects, when they prove injurious. Illus- trated by anger and joy—Both excite high vascular action, and determine blood to the head. Fear, as a cause of disease. Description of. Philosophy of. An exciting cause ofdisease, as often as a remote one.-. Effects of, in the actual production of disease—exten- sively and practically considered. Peranges often the organ of intellect. Produces appearances of premature old age. Illustration and examples. Of grief. A more chronic passion than fear. Description and philosophy of. Effects of, in the production of disease. A COURSE OF LECTURES. \£$ Throws disease on particular organs. Illustration and examples. Of despair, remorse, avarice, hatred, envy. Similar in their effects, yet not very highly operative.in producing disease. Act very particularly on the organ of intellect. Remarks. Oj jealousy. Character of. Description and philosophy of. Most formidable to the system of woman. Effects of, in producing disease. Of anger and rage. Description of. Character and philosophy of. Effects of, in the production ofdisease. A powerful exciting cause. Has been known to produce sudden death. Throws its action very strongly on the organ of inteft led. Of the salutary passions, as causes Lead, oxid and acetate of. Dele I erious effects of,manifested in colica pictonum* Seat and pathology of that disease. Aqua toffata, account ofthe effects of. Of worms, in the alimentary canal, as a cause ofdisease. Various kinds of, and their effects, V *** V i'^O . OUTLINES OF Do they ever subserve any useful purpose in thf" human economy? Observations in reply. Of lunar influence as a cause ofdisecrse. Abstract question discussed. If the moon acts on the ocean, a fortiori, must act on the atmosphere. Her influence most powerful at certain periods, viz. at her syziges, or full and change, and her apogee and. perigee. Illustration and proof. Atmosphere the source of many diseases. Whalever therefore, very materially affects it must have an in- fluence on human health. Univeisal belief, which has generally some foundation in nature, favourable to this view of things. Effects of the moon on the weight of the atmosphere, at indicated by the barometer. Experiments on this subject by Luke Howard. Do. much more important and satisfactory, by Dr. Balfour. Particular account of the result of. Dr. Moseley's opinion in relation to lunar influence. Earthquakes and eruptions of volcanoes, occurrences- * of, connected with the same periods of the lunar month. Illustration and proofs of. Lunar influence on vegetables, and the lower orders of animals. Illustration and examples. On the vegetable and the animal kingdom, then, a* well as on the earth, the ocean, and the atmosphere, the moon exerts an obvious influence. It follows, therefore, as a thing of course, that in relation Je diseases, she cannot be impotent. Evidences of lunar influence we must look for, in the systems, not of the vigorous and the strong, but of the plicate and the feeble. In relation to many other % A COURSE OF LECTURES. . 171. morbific causes, the same thing is true. Their effects are confined almost exclusively to the enfeebled. Of diseases subject to lunar influence. I. Hemorrhages.—Illustration and examples. 2. Verminous affections—Do. do. 3. JVephritic affections.—Do. do. 4. Mania—Hence the subjects ofit denominated lunar tics—Illustration and example. 5. Asthma, do. do. 6. Plague—do. do. 3. Yellow fever—r-do. do. Persons already sick injured by a solar eclipse. Instances of. Very old persons usually die, about the full or change, or the quarters, of the moon. Illustration and examples. Most ofthe distinguished dead, respecting the peri- od of whose decease we possess an accurate knowl- edge, have died about the full or change ofthe moon. Illustrations and examples. In the whole range of medical science, there are but few points more satisfactorily established, than that, in the production and modification ofdisease, the moon exerts considerable influence. Such in- fluence,then, is legitimately regarded as a morbific cause. Of the seats ofdisease. This topic may be differently understood, according as reference is made to the part on which the morbific cause originally acts, and makes its first impi essiori, or to that in which the complaint becomes ultimate- ly fixed. There are four surfaces or parts only, which morbific agents can actually reach, and on which, they, there- fore, can primitively act* OUTLINES OF 1. The alimentary canal generally, more especially the- stomach. 1. The tchneiderian membrane. 3. The skin. 4. The brain—This acted on only by intellectual caus- es. These premises afford conclusive evidence of the origi- nal locality of every disease, and subvert the notion of idiopathic fever. Analysis ofthe subject. Diseases become ultimately radicated in one ofthe four principal membranes, of which the body is, in such a great measure, composed. These are t. The mucous membrane. 2. The serous, do. 3. The fibrous, do. 4. The cellular, do. To this but few exceptions exist. The situation of the membrane, and the nature of the topical affection, unite in giving character to the dis- ease. To designate the particular seats of particular diseases, falls within the duties of another chair. Analysis of the rise and progress of disease. 1. Local impression, produced by the morbific cause. 2. This is irritative or sensitive, according to the na- ture of the impression, and of the part impressed. In case of an extremely powerful or malignant impres- sion, paralysis and even death may ensue, without either actual irritation or sensation. 3. Congestion. Meaning ofthe ferm. Difference between it and inflammation. Congestion more an affection of the veins. .Inflammation of the arteries. Three grades of congestion and their effects, specifi- cation of. A COURSE OF LECTURES. 17$ May be deaominated, irritative—inflammatory—pard\ lytic. One of these grades essential to the production of fever, inflammation, pyretic hemorrhagy, dropsical ef- fusion, &c. These latter, so many different forms of sanative ac- tion—indubitable and strong mainfestations of a vis medicatrix naturce.—Illustration. 4. Reaction and inflammation^ Difference between the states of action designated by these two terms. Requisites to the production of inflamation, what? Inflammatory action, character of—wherein it differs from healthy action. Final cause, or uses and intention of—effects of on the- blood. Comparative amount of blooc in the vessels of an in* flamed part, what. Motion of the blood through tbe vessels of an inflam <1 part, whether is it more 01 less rapid than through those of a healthy part? Question discussed. Elements of discussion. Congestion essential to inflaremation. Remora,or diminished impetui essential to congestion. Equability of m#tion must pioduce equability of a- mount of blood in apart, aid the reverse. Illustrated, by the current of a river—the march 6{ an army, &c. Position further proved by exferimen4 and observa- tion. By the nature of'he causes which pro- duce inflammation. These causes and their effects specified.- Inflammation, summary analysisof* 5. Effusion. OUTLINES Of1 G. Suppuration. 7. Induration. 8* Schirrus. 9. Ossification. 10. Gangrene. Such is the course ofthe local impression—Thesymp* thetic effects shov themselves according to circum- stances and laws, on the developement of which, it would be useless to dwell, unless we should descend to a minuteness of analysis, far beyond what our lim- its p'ermit. Of the signs of disease. Definition ofthe te?m. Stands related to sjmptoms, as genera to spe'cies, or as general to speeial pathology. Signs indicate merely the existence ofdisease, symptoms, its kind and cha'acter. Signs of all diseases, nearly the same; symptoms very different. We judge and prognosticate by signs; distinguish and practice by symptoms. The doctrine of synptoms belongs more particularly to another chair. Of the signs of distase, as they appear in I. Debility, par;ial or general—Illustration. II. Pain, do. III. Temperatire of the body, do. IV. The eyes,do. V. The countenance, do. VI. Respiration, do. VII. Decubitis, or mode of lying, do. VIII. States >f the faculties ofthe mind, dp. IX. Thirst, do. X. Appetite, do. XI. Secretions and excretions,. $b> XII. The pulse, do. XIII. The voice, do. 1 A COURSE OF LECTlRtfS. 1>5 XIV. The tongue. Of the crisis ofdisease. Origin and definition of tbe term. Designates an event in the progress ofdisease, by which its issue may be determined. If favourable, usually marked by some evacuation, de- nominated a critical discharge. This manifests the existence of a centrifugal state of ao tion—Meaning of centrifugal, as a term in medicine.* Is the doctrine of crisis true? Question discussed. Favourable crisis indicated by K Sweating. 2. Purging. 3. Increase of urine. 4. Vomiting sometimes, but rarely. 5. Hemorrhagy. 6. Augmented flow of saliva. 7. Augmented discharge of mucus from some portion ofthe schneiderian membrane. Illustration and examples of the foregoing. In case of a favourable critical evacuation, is the bene- fit experienced to be attributed to the mere escape of the matter discharged? Ans. No—but to an equals zation of excitement and circulation, by a transla- tion of action.—Illustration. A proof of the sympathetic theory ofdisease. Crisis more strongly manifested in equable climates, and in cases where but little medicine is given— Where, of course, the march of diseaseis but little interrupted. Critical days—Remarks on. The more acute the disease, the earlier the crisis. The more vigorous the constitution of the patient, the earlier the crisis. Occurs earlier , then, in young persons, than in old., Cff the prognosis ofdisease. Trie knowled ge of, to be derived only from observation 1,7*6 Outlines o*f and experience-r-principle acting as an- auxiliary-*- Influence of climete considerable. Art of prognosis to he practised with great caution, es* pecially by young physicians. Jugulated by the follcwing considerations. 1. The usual issue cf similar diseases; and by the known character ofthe jrevailing disease—Illustration. 2. From the previous issue of a similar disease in the same person. 3 From the existing amount of the patient's vital strength, and its proportion to the violence ofthe dis- ease, as indicated by the strength ofthe mobific cause, the state ofthe symptoms, &c.—Illustration. Vital strength, hovr known. Prognosis drawn sttmewhat from the treatment tbe dis- ease has received, and its perceptible effects—Illus- tration. The more phenomena indicate an event, the more like* ly is that event ;o occur. In acute diseases, prognosis less certain than in chronic ones. Eo-staxis, as a critical evacuation, how foretold. Sweating, do, do. Vomiting, do. do. Purging, do, do. Augmented discharge of urine, do. do. Diseases in which prognosis must be aho;-ys unfavourable. Internal cancer—aneurism of large, and deep seated vessels—Phthisis pulmonalis glandular'and heredit- a>-;—Extensive ossifications and some others—In hereditary diseases, prognosis less favourable than in self contracted ones. Diseases of doubtful prognosis—Peritoneal inflamma- tion generally—croup—hydrothorax—apoplexy—■ palsy—hydrocej; iai ; , &c. Diseases of less doubtlul prognosis- »-Acute pneumonic » COURSE OF LECTURES. m ' Vrtlammation generally—Erysipelas—Scarlatina— common bilious fever, &c. Diseases of favourable prognosis—catarrh—diarrhea— cynanche parotidea—'varicella, &c. Advantages ofdisease. We live in a system, or general and well balanced state, of things, where nothing is ultimate but good and happiness. Every temporary, local, and apparent evil, more than countervails its. own effects, by some lasting, general, and real advantage. Is this true also ofdisease? and if so, what are its com- pensating benefits to man? I answer, they are as fol- lows. J. Disease alone has led us to a knowledge ofthe struc, ture and functions of the human body. 2. It has led us also to the study and attainment ofthe science of nature, generally, especially of chemistry, botany, and certain branches of natural history. 3. It has led us to an acquaintance with the science of intel- lect. 4. It ameliorates our nature, by giving en> ploymcnt to some ofthe best and noblest affections of the heart—charity, benevolence, generosity, firm- ness, &zc. 5. It imparts to us a higher relish for health, and inspires us with gratitude for the enjoy- ment ofit. 6. It moderates, and ultimately extin- guishes, at least to a sufficient extent, our love of life, and our attachment to the world. 7. It reconciles us fro the death of our friends, by converting that event into an escape from suffering. 10. It creates in us habits of resignation and piety. 11. Pain often pre- monishes us ofthe approach ofdisease. OF THERAPEUTICS. Therapeutics, derived from a Greek word signifying to cure,may be defined, '•'•The science of indication and pres- cription, a knowledge of both those points being essen- tial fo the rational and successful treatment ofdisease* i?6 OUTLINES OF This branch of science, then, rests on a twofold basis, u knowledge of the animal economy in health and dis- ease, and a knowledge of the properties of medicinal substances. A tew observations amounting to general rules applicaJ Me to the treatment of every disease, will constitute all that our duty requires of us, or our leisure permits us to attempt, on those two topics. By indication is to be understood, the expression or man- ifestation ofthe change requisite to be produced in the action of the system, or any pari of it, in order to cure or alleviate disease. Or we might mean by it a manifestation of the immediate impression necessary to be made by remediate substances. "By prescription, a designation of the remedies calculat- ed to effect the change required. 1. The science of therapeutics has reference to the body in a living state, possessed ofthe four vital properties of irritability, sensibility, sympathy, and the vis medica- trix natures, or power to attempt the removal of dis- ease. Without these, at least twoofihem, no gene- ral disease can be either produced or cured. 2, The system, unless prostrated below the point of re- action, resists the agency of the mobific cause, and struggles to remove the effect. 3. If it appear to be alone competent to this, the indica- tion is, to do nothing, but enjoin suitable diet, drinkk and general regimen, and allow nature to do the work herself. 4. But if she appear herself insufficient for the task.. mark her progress, and aid her by suitable means. Are her exertions excessive? moderate—feeble? invig- orate—suspended? awaken—altogether wrong?— change or suppress them. But keep them always ia view—Illustrations and examp les To prescribe,with effect, attend faithfully to the fol- lowing considerations, A COURSE tfV LECTURESi l?ft The combined influence of the nature and force ofthe morbific causes,and ofthe susceptibilities, importance and sympathies of the parts affected—the period of the disease, the age, sex, and temperament of the pa- tient—his individual or peculiar susceptibilities, his appetites, antipathies, habits, trade, profession or walk in life—the state of society in which he has moved, his mode of living, &c.—Nor must the cli- mate where he was born and reared, as well as that in which he resides, and the season of the year, be ne* glccted. Observances such as these, distinguish the enlighten- ed physician from the empiric. If the moral and intellectual character ofthe patient, especially the existing state of his passions and emo- tions, be attentively studied, this will more effectu. ally aid the physician in his therapeutical views, and tend still further to the elevation of his profession. Facts and reasonings in illustration and confirmation of the foregoing principles. o. That morbid impression may be cured, let it be di- vided—a principle vitally important, in the practice of medicine.-—Illustration and examples. 7. Impression on one organ reaches another by sympa- thy—another principle altogether indispensable in practical medicine.—Do. do. 3. An attention to the antipathies and appetencies of the sick is peculiarly important, in the science ofthe- ra'peutics—Without this, medicinal substances fail to operate, or opeiate- injuriously—Do. do. 9. An attention to the habits of the patient, corporeal and mental, must never be neglected by him who aims at distinction in therapeutics—Do. do* 10. Before pubeity, the difference of sex is not a point of much moment. But after that period, a vigilant attention to it is emi- nently important—Illustration and proof. OUTLINES (ff Climate, In the full signification ofthe term, is exceed- ingly influential in modifying the susceptibilities and constitution of man. An attention to it, therefore, is not to be dispensed with. Illustration and examples. 11. State ofthe atmosphere in which the patient resides, demands the most serious consideration of the physi- cian.—Illustration. The time ofthe administration of remedies, is a point of no inconsiderable moment in the science of thera- peutics—Illustration and proof. An attention to precedingand co-existing diseases which the patient may have experienced, is of great impor tance—Such diseases influence, not a little, indica- tion and prescription. The foregoing considerations, although highly impor" tant, are only collateral, and therefore, not alone suf- ficient. A point of superior moment remains to be determined.. The immediate seat and nature ofthe disease. But a knowledge of this falls within the compass of par*. ticularpathology, a branch which, as. already observ- ed, it does not belong to my province to teach, but to that of the professor of the practice of physic. Having finished his investigation as to the seat,, the gen- eral nature, and the particular state and character ofthe disease, the practitioner, must next put into- requisition his knowledge of the properties of medi- cinal substances. This conducts him into auother very interesting field of research. Through the whole ofit we are forbidden to accompany him, the greater portion ofit belonging to the depart- ment of Materia Medica. Circumstances prohibit us, at present, to do more than take a general but succinct view of the modus ope- randi of medicines. A COURSE OF LECTURES. IS*. This subject, which must be justly regarded as both curious and important, may be comprehended with- in five distinct questions. 1. Do medicinal substances really act at all, or do they only sustain the actitm ofthe living matter to which they are applied? 2. Whether do they act on the solids or the fluids? 3. Whether do they, in their original impression, act locally or generally? 4. Do they act as stimulants alone, or as stimulants and sedatives? 5. Do all stimulants act alike, differing only in the degrees of their strength; or are all stimulants spe- cifically different from each other1' Question first—Covers an extensive field of subtle and curious investigation. Embraces the scholastic dogma, touching the vis inertia of matter. Can matter, as such, act of itself; or does it move only in obedience to impulse from without, and does that impulse necessarily proceed frtfm spirit? Ans. Yes, matter, even that usually denominated dead, acts as certainly and palpably as spirit itself. Of this we find ample proof in 1. The gravitation of matter—'Illustration. 2. Currents of air, in whatever direction they move. Do. 3. The pointing ofthe needle to the pole—do. 4. Combustion, and its effects—do. a. The reciprocal action of acids and alkalis. G. Clouds of every description, more especially the thunder cloud. These several phenomena are the result of action, yet over neither of them does a spirit immediately pre- side. Nor can we admit the agency of spirit in every depart- ment of living matter., OUTLINES OF In the vegetable kingdom there i:; much actin^ wio> out a presiding spirit to excite it. False impressions in relation to these facts, led the am cients into the errors of polytheism—to a belief in Gods of the air, of fire, of water, of light, of agricul- ture, and innumerable others, If, then, dead matter can act on dead matter, it can act. also on that which is living, But it acts on different principles, and in a different- way. On dead matter it acts mechanically, Viiem'ically,ndarihu for the following reason?. A COUr.SE OF LECTURES. IBS •I. Never found, in a formal state, in the living blood. Illustration. 2. Inject them into the blood vessels, you either pro- duce no effect, do mischief, or kill. Benefit never results from the practice. Remarks. 3. The lacteals and absorbents receive and convey to the blood nothing which is not subdued, and as- similated to the nature of their usual contents. This is certainly the general rule. If exceptions exist, they are but exceptions, the result of some forced or preternatural state of things, and to be bo considered in the discussion of the question. Illustration. 4. Medicinal substances, entering the circulation, in •their crude and formal state, would injure many parts to benefit one.—Illustration and proof. S. Apply a remedy to a part remote from the diseas- ed one, it will cure the affection—apply it to the diseased part itself, it will render it worse. Illustration and examples. Q. Remedies act,in many cases, too suddenly to do so through the medium of the circulation. Do. do. 7, Opium and other vegetable poisons, found in the stomach after death produced by their action, un- diminished in bulk. Examples. §. No difficulty, in relation to their modus operandi, removed by admitting the entrance of medicines into the blood. The operation and effects of dis- tant stimulation, as easily understood, as those of proximate. Illustration. 9. The very idea of a substance being medicinal, precludes the belief that it can be assimilated and received into the blood. Do. 10. Medicate the blood, and you so stimulate every part by its circulation, as to destroy all chance of equalizing excitement. On the contrary, you in- rur a hazard of rendering it still more unequal, by 184 OUTLINES OF exciting most powerfully the diseased organ. Dt,« 11. Introduce medicinal substances into the blood,.. and you destroy entirely their specific action. Illustration and examples. 12. Diseases never cured nor even alleviated by the transfusion of blood. .Could tbe blood be medicat- ed and were this the usual channel for the intro- duction of medicinal influence, the case would be. otherwise. 13. No rational and intelligible accountcan be given of the progress and operation of a remedy, after it has gained admission into the blood,supposing the event practicable. Remarks. 14. Nature, unassisted, cures many diseases. Yet she never medicates the blood. Illustration. }5. The operation of the passions and emotions often cures diseases. But in this way the blood is never medicated. Illustration and examples. 16. The action of all medicinal substances, whose operation is clearly understood, can be fairly trac. ed to the solids. Do. do. Question third. The first impression of medicinal substances is local, and the effect becomes general through the medium of ■sympathy. This is believed to be true for the fol- lowing reasons. 1. Medicines, like all ot^er substances, cannot immedi- ately act where they do not proximately exist—they cannot act immediately on that with which they are not in actual contact. 2. But they can come into immediate contact with but four parts of the system. These are, the skin, the alimentary canal, the schneiderian membrane, and the brain. The latter constitutes the immediate seat of action of all mental agents. Illustration. 3. Of all medicinal substances or agents whose course A COURSE OF LECTURES. 18* of action we can correctly trace, the original impres- sion is local. Illustration anil examples. Question fourth—-Stimulant and sedative, definitions of. 1 am not to be informed that, by some writers, whose opinions arc entitled to every consideration, this is pronounced a question about words,and worthy,there- forc, of but little attention. My own views on the subject are very different. It is not a question about words, but about things, 'of seri- ous concernment to medical science. It involves a knowledge of the tiue relationship between living and dead matter, with which every physician should be intimately acquainted. It is, moreover, essentially connected with an impor- tant principle of the animal economy, to which no member ofthe medical profession should feel indif ferent. It is. indeed, itself a principle, embracing a multitude of facts and phenomena, which, without a correct knowledge of it, can never be either recon- ciled or understood. My duty, then, commanding me to make every effort in my power for the elucidation and defence of correct principles in medicine, I shall, without further pre- face, proceed to the discussion ofit. All medicinal substances act by impression—Impossible for them to act in any other way—action on living matter being synonymous with impression. But every impression is necessarily a stimulus—seda- tive impression, would be an expression self contradic- tory. Whatever acts on living matter, must do it through ir- ritability or sensibility. But these properties can be acted on by stimulants alone. The phrase, sedative agent, is self-contradictory and therefore absurd. X ■1- .*,-.;- t^6 .>.- OUTLINES or • V-V By reverse sympathy ,""t]ie.seconf/rtn/ or remote effects o-f a medicinal substance may be sedative; but nothing ' can render the primary, and immediate one so. But the.nature of a remedy must be determined by its immediate action, rot by its secondary, else can the most potent stimulants be proved to be sedatives— opium, ether, alkohol, heat itself. Illustration and proofs of the foregoing propositions, in which the stimulating powers of cold, and of whataro usually denominated the sedative passions, are dem- onstrated. Question fifth. Are all stimulants alike, differing only in force; or do they all differ from each other specifical- ly in their nature? , Stimulants are such only in relation to living irritable and sensible matter. To reduce the grounds of inq liry, then, to the narrow- est limits, it will be sufficient to ask, Do all substances produce the same kind of impression on irritable and sensible matter? ■In terms still more specific, do all substances, when brought info contact with irritable matter, produce the same action, aud the same sensation, when acting on sensible matter? To this question a negative answer will be returned by every one. In relation to sensibility, the subject is free from all oh- . scurity. Impression on that property produces sensation. But throughout the whole compass of nature, no two dif- ferent substances excite in us the same sensation. If they did, they would cease to be different. For by our senses alone do we recognize difference. Minerals present themselves to us under different figures and colours, and make different impressions on the sense of touch. To our sensibility, therefore thev are stimulants specifically different* A COURSE OF LECTURES. [87 The same thing is true in relation to vegetables. Neith- er in colour, nor taste, noi odour, are any two species of them alike. Even between two individuals ofthe same species a perfect similarity rarely, perhaps nev- er, exists. . To our sensibility, then, they also stand related as so many stimulants specifically different. So do animals. Between different species of them an "essential difference exists, in colour, and figure, and odour, and voice. To our sensibility, therefore, they are stimulants specifically different—Further illus- trations and proofs. Of the relationship of substances to our irritability. Here our evidence, although not perhaps so palpable,i? sufficient to enable us to decide with confidence. Analogy fully authorizes the belief, that substances which, by their diversified properties, produce on our nerves of sense impressions specifically different from each other, must produce impressions equally different on our irritable organs. Corroborative ofthis analogical inference, facts present themselves from every quarter. Purgative medicines act chielly on our irritability, yet no two of them operate alike. They make different impressions because their properties are different. Diaphoretics, diuretics, sialogoques, and expectorants address themselves to our in it.ibility. Yet so dif- ferent are th'j impressions they produce on the sto- mach that one excites perspiration, another urine, a third saliva, and the fourth, a discharge of mucus from the bronchia;. Tonics and astringents act on our irritability; yet the impressions they make, and the effects they produce, are widely different. Calomel and arsenic both acton the stomach; yet 1 need not say how different are their effects. Nor can any one be at a loss as to the cause of this dif- 88 OUTLINES O'F ference. The two substances impress differently the irritable organ to which they are applied. Indeed the most scientific and rational, and, therefore, the best, classification of the articles of materia med- ica now extant, is founded on the difference of effect produced chiefly on the irritable parts of our bodies, by the various families of medicinal substances. In relation, then, both to our sensibility and irritability, it clearly appears, that all different remediate arti- cles are to be regarded as stimulants specifically dif- ferent. Illustration and further proofs of the foregoing opin- ions. Further to pursue the subject of therapeutics, would be an encroachment on the limits of materia medica. Having already transgressed the intended boundaries ofthis outline of my lectures, I here conclude it, re- serving for the enlargement of another edition should one be called for, a synopsis of Hygiene, and Medical Jurisprudence. '# THE END. I I.' .- ^ WZ 2-70 CI Wou. IM * * ARMY * * MEDICAt tIBRARY ijr fluHHnffiM 1*