1833 1 ;•■.;•: ■v::;,<: ,'..:::'.;.■: '■> ■ ■■:"■.;■,■:■:: /;!.fei'v;;'^i'~^*v8;Kffin5S ';w# 'r: "£ ■ " '& ;-.'v.t';vi" < :'M, «$i if §#:; ■ ■:;^5i»;;;|sij:| .;;.-:-:-;,-nbc«*^;5K. l:-j<; ;l: '-.*:¥(]*., > :Ni.ffV': ^; • ■• ■ ■ :j?-^;-I;«f*:,^'-^:^::"';;:;!;.. '•;■•:! ;!V;p^:!:lSi.5'1S^r::",: :,;r:'X >■>;":% IS' '. <:Z': v ; f'.'l I'-.1'• /....... ' ' PROFESSOR DUNGLISON'S INTRODUCTORY LECTURE ( ------------- Ipublished by the medical class \ -v.,' or THE UNIVERSITY OF MARYLAND »■ . -......- . ... J CORRESPONDENCE. Baltimore, 1th December, 1883. At a meeting of the Medical Students of the University of Maryland, held on Saturday, 7th December, 1883, it was, on motion, 'Resolved, That a committee of five be appointed by the chair to wait upon Professor Dunglison, and request a copy of his introductory Lecture for publication. \V hereupon the following gentlemen were appointed:—JosiahN. Wilton, John H. Brown, Basil Duke, Thos. E. Bond, Jr., Albert G. Welch. Professor Roblet Dunglison: Sir—By a resolution of the Medical Class of the University of Maryland, the undersigned have been deputed to solicit a copy of your Introductory Lecture, for publication. While, in the discharge of the pleasant duty assigned them, the com- mittee convey to you this expression of the high regard of the Medical Class, they'would also beg you to accept the warmest assurance of their individual respect and esteem. Very respectfully, yours, Josiah N. Wilson, John H. Brown, Basil Duke, Thomas E. Bond, Jr. Albert G. Welch. Baltimore, 1th December, 1833. East Fayette street, December 7, 1883. Gentlemen: I have the honor to acknowledge the receipt of your communication of this date, informing me that you had been deputed, by the Medical Class of the University of Maryland, to solicit a copy of my Introductory Lecture for publication; and whilst I cannot but feel that the lecture is unworthy the consideration they bestow upon it,—adapted, as it was necessary that it should be, to a mixed rather than a professional audience,'—I still cannot refuse the complimentary request of so numerous and so respectable a body. Be pleased to express to the class how much I appreciate the "high re- gard" with which they honor me, and to assure them, that I warmly reci- procate their feelings, as I do, gentlemen, those you have been good enough, in addition, to extend towards me. Believe me, with signal respect and esteem, Faithfully, your friend and servant, Robleit Dunglison. Messrs. J. N. Wilson, John H. Brown, Basil Duke, Thomas E. Bond, Jr. and Albert G. Welch, Com. of the Medical Class of the University of Maryland. \ »"~. •• :*, AN INTRODUCTORY LECTURE, DELIVERED TO THE MEDICAL CLASS •OF THE UNIVERSITY OF MARYLAND, On Friday, October 3lst, 1833. By ROBLEY DUNGLISON, M.D. PROFESSOR OF MATERIA MEDICA, THERAPEDTICS, HYGIENE, AND MEDICAL JURISPRU- DENCE IN THE UNIVERSITY OF MARYLAND. £1^___ "v; '.•.-J-Liill^J —- ■ _ ,..:,,J, y PUBLISHED BY THE MEDICAL CLASS. BALTIMORE: JOHN D. TOY, PRINTER. 1833. V 18 33 INTRODUCTORY LECTURE. Gentlemen, On making my appearance for the first time in this hall, and on presenting myself to a new, and a numerous audience, I need hardly, perhaps, affirm, that I labor under emotions, which give occasion to an embarrassment, that might, at first sight, appear affected in one, whose duty it has been to deliver public lectures for so long a period. A short allusion to the circumstances, under which I have recently been, and am about to be placed, will shew, that there is as much foundation for such emotions as there is sincerity in the assertion; and the charge of affectation would rather apply, were I,—from an extension of those feelings of delicacy, that ought to induce us to make all allusions of a personal cha- racter necessarily brief—to avoid referring to them altogether. It is probably known to many of my hearers, that, nine years ago, an agent,*—now no more,—to whose high mental endowments I might add my testimony, were it necessary, after the eloquent sketch of his character from the pen of a distin- guished inhabitant of this city,f and especially after the impor- tant trust reposed in him by the illustrious founder of the Uni- versity of Virginia and his coadjutors in the government of that institution,—was dispatched to Europe, with full powers to select professors for several of the chairs. His choice fell upon me for the Department of Medicine, and it was under feelings of gratification at the selection, and under hopes of future use- fulness, that I first took up my residence amongst Virginians; but under doubts, as I had occasion to observe elsewhere, on a recent occasion, as to the reception, which, as a stranger, I might meet with, and as to the favor that would be extended ot my humble efforts towards the advancement of my profes- sion. That generous people extended towards me, from the mo- ment of my arrival amongst them, the hand of good-fellowship and indulgence, and made me feel, as I have since felt, that the Old Dominion was my second home. To the enlightened Board, to whom the highest offices of * Mr. Francis W. Gilmer. f Mr. Wirt. 4 the University of Virginia are assigned, I owe especial grati- tude for their unvarying kindness, and for the manner in which they have been pleased to appreciate my feeble, but zealous exertions for the establishment and prosperity of that noble institution. Their goodness, as well as that of many of my late col- leagues, and of the people of my second home in general, will ever be regarded as among the elements of the most pleasing portion of my existence; for "I cannot but remember such things were. That were most precious to me." Circumstances, equally gratifying to me, and somewhat anal- ogous to those that occasioned my residence in Virginia, have induced my removal to this commonwealth; and proudly and amply satisfied shall I be, if I experience the same liberal in- dulgence that was vouchsafed me in the state I have just quitted; and if the united exertions of my able colleagues and myself should have the effect of facilitating the acquisition of knowledge, in a science so intrinsically interesting but arduous to the student, and so full of important benefits to humanity. By the changes recently effected in this University, the de- partments, assigned to this chair, are Materia Medica and The- rapeutics, Hygiene, and Medical Jurisprudence. Under the former organization, it embraced Materia Medica or Phar- macology only, or that division of medical science, which treats of the properties of medicines and their mode of admin- istration. To this, Therapeutics has been judiciously added their separation is, indeed, forced and unnatural; and Materi; Medica, without the latter, is reduced to a dry detail of the virtues of medicinal substances, and is as uninteresting as it is arid; but if Therapeutics or the explanation of the modus operandi of different medicinal agents, and their adaptation to disease be conjoined, there are few branches of medical science more interesting, or more practically important. Materia Medica, for example, instructs us, that the class of Epispastics excite vesications: but it is Therapeutics that shows us that such vesications are capable of removing internal disease, that explains how an artificial irritation, thus excited in a 'part, may relieve another part laboring under morbid derangement' and teaches the nice shades of distinction in disease, which may' in one case, demand such counter-irritation, and in another indicate the impropriety of its adoption. The department of Hygtene, or the "art of preserving health," is new to the medical schools of this continent; but wholly, or in part, is taught in different European Univer- sities. It comprises the study of various physical and moral influences on healthy man, and therefore embraces the Materia 5 Alimentaria, or the effects of different kinds of aliment, in re- spect to their nutrient and digestible properties. In many universities, the Materia Alimentaria forms a part of the duties attached to the Chair of Materia Medica. Such is the case in the University of Edinburgh, and it constitutes a pleasing por- tion of the large work of the distinguished Cullen on that subject. Properly, however, Dietetics belongs to Hygiene; along with the consideration of the various influences of the atmosphere, locality, clothing, professions, mental emotions, and occupations, &c. on human health. Under the justly cele- brated Halle this branch of medical science was enthusias- tically cultivated in the Ecole de Medecine of Paris, and they, who attended the valuable instruction of the eminent teachers of that school, when the eloquence of Halle was heard in its halls, will recollect how signally the crowded theatre testified to the accomplishments of the professor, and to the value and interest of the subject;—more especially to the latter, how- ever, for the lectures of the same individual on Natural Phi- losophy were, comparatively, failures. The last department, Medical Jurisprudence, or the appli- cation of medical knowledge to the elucidation of cases that may occur in courts of justice, is also new in this institution: but it has, of late years more especially, been extensively, and successfully cultivated in this country as well as in Europe. It demands some acquaintance with the different departments of the healing art, and cannot, therefore, be fully understood, in its most minute details, by one who has not attended to those departments; but its leading principles can be made sufficiently intelligible to the lawyer without farther study; whilst many of the topics, embraced by it, are of such moment, and com- prise so many interesting subjects of general physiology, that the study is useful to every one desirous of possessing those acquirements which are considered to form the well educated gentleman. Soon, the study of physical, will be regarded as indispensable as that of moral man: the first step has, indeed, been recently taken in this country by the offer of a reward for the best treatise on physiology adapted to common schools. "Know thyself" was an ancient and a wise injunction; and can any study be more calculated to elevate the mind to the most sublime contemplation than the examination of the intri- cate mechanism of the human frame; intricate, inexplicable, but harmonious, ineffably harmonious. A slight retrospection at the state of these departments of medical science in former times, marked, as they were, by ig- norance, credulity, and superstition, will exhibit the immense improvement that has taken place in comparatively modern periods, and will encourage ^ hope, that as the physical and G moral sciences pursue their onward progress, and as the means of observation and experiment are augmented and facilitated, the science may attain a pitch of perfection, of which at the present time we can form no adequate conception, shedding light where all is now obscurity, and tending to dispel doubt and difficulty wherever existent. At one period in the history of medical science, the Materia Medica consisted almost wholly of the machinery of magic. Some, indeed, as Pliny, affirm, that magic was wholly derived from medicine; but, without inquiring into their precise order of precedence, it is certain that there was a close affinity be- tween them. The word Ananazipta, scrawled on parchment, cooled fever: Abracadabra, supposed by Selden to be the name of a Syrian idol, when figured on an amulet and worn round the neck, was supposed to possess the power of curing ague, and of preventing many diseases, especially when uttered in a certain form, and a certain number of times. An hexame- ter from the Iliad allayed the agony of gout, and rheumatism yielded to a verse of the "Lamentations." In all these cases, however, the effects upon the physical ailment might have been produced through the action of the mind on the body, of which we have so many marked examples, and to some of which I shall have occasion to refer presently; but in other cases the incantation was used where such agency could scarcely be presumed. Cato, the Censor, for example, pretended to be able to reduce luxations, after the manner of the Etruscans and Pythagoreans, by barbarous expressions and by magical songs;—such as the following,—"Moras vaeta daries dardaries astatutaries," or "Huat haut huat ista pista sista, domiabo damnaustra et luxato." Homer, too, affirms, that the bleeding of Ulysses was stopped by a charm,* and the notion has even passed down to the present enlightened age, and prevails in certain parts of Great Britain. It is referred to by Sir Walter Scott in "the Lay of the last Minstrel," and is noticed frequently in the popular poetry of the last century but one. In all these cases, however, it is probable that the enchanter employed more direct appliances to the injured part, as in the cure by sympathy to be referred to presently, and that he had not therefore implicit confidence in his charms. Of superstitious cures, effected by charms, there are yet many, and some of them of a sufficiently revolting character. ""With bandage firm Ulysses' knee they bound; Then chanting mystic lays, the closing wound Of sacred melody confessed the force; The tides of life regain'd their azure course." Pope's Homer. Odyss. Book xix. I.in. 457. 7 All, however, that possess any efficacy, exert their primary action on the mind. In Scotland, the Scandinavian and other superstitions largely prevail, and in many of the more seques- tered and less enlightened portions of Great Britain they are still common. For example, it is believed by many,—that a ring made of the hinge of a coffin will prevent cramp;—that a halter, wherewith any one has been hanged, if tied about the head, will cure headache;—and that moss growing on a human skull, if dried, powdered, and taken as snuff, will cure the same affection;—that a dead man's hand, rubbed nine times on a wen or enlarged gland, will dispel it;—that if we steal a piece of beef, rub warts with it, then bury the beef, or throw it over the left shoulder without looking behind us,—as the beef rots the warts will decay;—that a fragment of a gallows on which any one has been executed, if worn next the skin, will prevent or cure the ague;—that a stone with a hole in it, hung at the bed's head, will prevent the night mare,—and that if a tree of any kind be split, and a weakly child be drawn through it, and if afterwards the tree be bound together, so as to make it unite,—as the tree heals, the child will acquire strength. These are but a few of the irrational practices which even yet exist, and which exhibit u-------------what a reasonless machine Can superstition make the reas'ner man."* The only remnant of the notion of charms, yet retained in medical language, is the word Carminative, applied to a class of medicinal substances, employed in cases, which were usually cured or attempted to be cured by Carmina or incan- tations in verse, or to such as operated like a Carmen or verse- charm. It is not much more than one hundred years since the doc- trine of curing the scrophula or king's evil by the royal touch, or what Browne affectedly calls Adenochirapsologia, was im- plicitly credited and not unfrequently practised. The first English Sovereign, who touched for this affection, is said to have been Edward the Confessor, who lived in the middle of the 11th century, and the last that encouraged it was Queen Anne, who died about the commencement of the last century. One of the very last, subjected to this degrading mummery, * The following intelligence is copied into the National Gazette, of the 17th of August last. "The body of Mr. Jas. Cole, blacksmith, was yester- day found in the Delaware, into which he had fallen, from Spruce street Wharf, in a fit. The body was so much mutilated, that it was only recog- nized by a coffin screw, fastened round his neck for a charm:' The reputed prophylactic powers of a child's caul are familiar to every one. 8 was the illustrious Dr. Samuel Johnson, who, by the advice of a celebrated physician, Sir John Floyer, was carried to London in 1712, where he was actually touched by Queen Anne, but without effect. V* Much of the success that often followed this practice has been ascribed to the influence of the mind over the body, but Wise- man, one of the fathers of surgery, who lived in the early part of the 17th century, and who had the best opportunities for observation, asserts, that a part of the duty of the royal phy- sicians and serjeant-surgeons was to select such patients, af- flicted with the evil, as showed a tendency towards recovery, rejecting all others; and as full confidence was placed in the effects of the royal touch, the disease was fortunately left to itself and not officiously interfered with.* Nearly allied to these observances is the uCure by Sym- pathy," which excited so much attention, was promulgated by the Rosicrucians, and obtained such universal creuence in the 17th century. This consisted in applying dressings, in the case of wounds, not to the injured parts, but to the weapon that inflicted them. The celebrated sympathetic S powder of Sir Kenelm Digby, which occupied so much of the public attention, in the time of James the First, is doubt- less known to many of you; and long after that period the for- mularies contained an Armatory unguent, which was applied to the instrument. To this practice my Lord Bacon has referred in his Sylva Sylvarum. In all cases, it would appear, according to that distinguished author, the wound was washed clean, "and then bound up close in fine linen, and no more dressing renewed till it was whole." Under such treat- * Shakespeare alludes to the ceremony, in his Tragedy of "Macbeth." "Mai. Comes the king forth, I pray you? "Doct. Ay, sir; there are a crew of wretched souls That stay his cure: their malady convinces The great assay of art. But at his touch, Such sanctity hath Heaven given his hand, They presently amend. "Mai. I thank you, Doctor. uMacd. What's the disease he means? "Mai. 'Tis called the evil, A most miraculous work in this good king, Which often since my here-remain in England I've seen him do. How he solicits heaven Himself best knows; but strangely-visited people, All swoln and ulcerous, pitiful to the eye, The mere despair of surgery, he cures; Hanging a golden stamp about their necks; Put on with holy prayers: and 'tis spoken, To the succeeding royalty he leaves The healing benediction." X 9 ment, it was of little importance what application was made to the instrument: binding up the wound, bringing the edges into apposition, defending it from extraneous irritants, and leaving it to the restorative power which is seated in almost every part of an organized body, is the approved mode of managing incised wounds at the present day. Dryden alludes to the superstition more than once in his "Tempest or Enchanted Island." Thus;—Ariel "When I was chidden by my mighty lord, For my neglect of young Hippolito, I went to view his body, and soon found His soul was but retired, not sallied out: Then I collected The best of simples underneath the moon, The best of balms, and to the wound applied The healing juice of vulnerary herbs. His only danger was his loss of blood; But now he's waked, my lord, and just this hour He must be dress'd again, as I have done it. Anoint the sword which pierced him with this weapon salve, and wrap it close from air, till I have time to visit him again." Act v. scene 2nd. And:—Miranda, when she enters with Hippolito's sword wrapped up, "Hip. O, my wounds pain me! (She unwraps the sword) "Mir. I am come to ease you. "Hip. Alas! I feel the cold air come to me: My wound shoots worse than ever, (She wipes and anoints the sword) "Mir. Does it still grieve you? "Hip. Now methinks there's something Laid just upon it. "Mir. Do you find no ease? "■Hip. Yes. Yes: upon the sudden all this pain Isleaving me—Sweet Heaven, how I am eased!" Act v. scene 2nd. It is likewise referred to in the third Canto of the "Lay of the Last Minstrel" of Sir Walter Scott. The notion of the influence exerted by the sun, moon, and the various constellations on the body, which prevailed so ex- tensively at one time, has nearly expired with judicial astrol- ogy. Dr. Forster, in his work on aAtmospheric Phenome- na," published within the last ten years, is one of the latest writers, that have dwelt on the effect of the different phases of the moon on human health, and his remarks exhibit the loose kind of evidence on which the belief rests. "There is yet," says he, "another extremely curious cir- cumstance, about the effect of the place of the moon. It is well known to physicians, that there are periods of greater 10 and lesser irritability in the human body; and that, at the irritable periods, many diseases occur, to which the patient may be predisposed: now it seems by the result of long con- tinued observation, that these periods of irritability oftener occur about the new and the full of the moon than about the quarters. Every body, almost, must know from their own experience, that they get up in the morning on particular days less disposed to be pleased, and with more general irritability than usual; these days also happen nearer to the times of the full moon, or of the new moon than to that of either quadrature. To bring this observation into a smaller compass, and to confirm it by future remarks, I have proposed to meteorologists to divide the lunar revolution into four equal parts, or weeks, in the middle of each of which week one of the changes of the moon shall take place. By doing this we shall find the greater proportion of headaches, and nervous diseases of many kinds, to occur in those weeks in the middle of which the opposition and conjunction of the moon shall take place. Moreover, the sudden occurrence of east winds, so obnoxious to nervous persons, seems to me to produce more sudden effects when they occur near to the conjunction or opposition of the moon." I doubt, however, whether there is an affirmation in this ex- tract, that does not require to be confirmed; and I might, with more propriety, appeal to the universal experience of those physicians, who are not wedded to the notion of lunar influence,—in the very cases referred to by Dr. Forster,— to negative the positions he has assumed. Not many years ago, it would have been esteemed culpably sceptical to disbelieve in the effect imagined to be produced by the full moon on the insane, or as they have been termed,— from this very belief in lunar influence,—Lunatics. There is not a poet who, in referring to the subject, does not sanction the superstition. Thus Shakespeare, in a well known passage:— "It is the very error of the moon. She comes more near the earth than she was wont, And makes men mad." And Butler, in his Hudibras, describes the moon as— "The queen of night, whose large command Rules all the sea and half the land, And over moist and crazy brains, In high spring tide, at midnight reigns." The terms "mooncalf," and "moonstruck," have been in- troduced into the language under this popular notion nay it has even been incorporated into the legal definition of insanity "A lunatic," says Sir Wm. Blackstone, "is, indeed pro 11 perly one that hath lucid intervals, sometimes enjoying his senses, and sometimes not, and that frequently depending upon the change of the moon:"—yet it has been most unequivocally established, by careful and accurate observations, in large in- sane establishments, especially in those of La Salpetriere in Paris, and of Bedlam in London, that if the lisijht of the full moon be excluded, the patients are no more liable to exacerbations in their disorder at these, than at other periods. Haslam, a well known writer on insanity, affirms, that he kept an exact register of cases for more than two years, but without finding in any instance, that the aberrations of the intellect corres- ponded with, or were influenced by, the vicissitudes of the moon; and Esquirol, the distinguished physician to La Sal- petriere, states, that he cannot confirm the long prevalent opinion regarding lunar influence. The insane he found to be certainly more agitated about the full of the moon, but so were they at break of day every morning. He, therefore, philosophically infers, that light is the cause of the increased excitement at both those periods; and he states, that the stimu- lus of light frightens some lunatics, pleases others, but agitates all. Equally unfounded is the notion of direct solar influence on the same class of unfortunates at the summer solstice. The whole effect is probably owing to the long continuance of day- light, and the oppressive heat, which prevail at this season. Heat is a well known irritant to the insane; and as light acts in the same manner, when the two are conjoined the effect must be greatly augmented. On these accounts, therefore, the solstice may be connected with maniacal exacerbations; but without the necessity of our presuming that the sun itself exerts any direct influence. The belief in lunar influence has not been restricted to the case of the maniac. Even the simple operations of bleeding, or cutting corns could not, formerly, be ventured upon without attending to the condition of that luminary. The satirist, Butler, has not failed to touch upon this notion in describ- ing the qualifications of the conjurer Sidrophel. "He with the moon was more familiar Than e'er was almanack well-wilier; Her secrets understood so clear, That some believ'd he had been there; Knew when she was in fittest mood For cutting corns or letting blood." It is also referred to, along with some analogous supersti- tions, by Barnaby Googe in his translation of Naogeorgus. "No vaine they pearse, nor enter in the bathes at any day, Nor pare their nayles, nor from their hed do cut the heare away; 12 They also put no childe to nurse, nor mend with doung their ground, Nor medicine do recey ve to make their erased bodies sound, Nor any other thing they do, but earnestly before They marke the muone how she is placde, and standeth evermore." A query, contained in the British Apollo for 1710, exhibits the prevalence of the belief in regard to the cutting of corns, and, strange to say, it is still maintained in many parts of Great Britain, and elsewhere:—the common people consulting the almanack to find when the moon is in the wane, in order that the operation may be performed with full advantage. "Pray tell the querist, if he may Rely on what the-vulgar say, That when the moon's in her increase, If corns be cut they'll grow apace; But if you always do take care After the full your corns to pare, They do insensibly decay, And will, in time, wear quite away. If this be true, pray let me know, And give the reason why 'tis so." The superstitions connected with the increase, full, and wane of the moon were common amongst the ancient Kelts and Goths,—the earliest races that peopled Western Europe. These periods were, with them, emblematic of a rising, flou- rishing, and declining fortune. In the wane, consequently, they carefully avoided entering upon any business of importance. In the Orkneys, they do not marry except in the increase of the moon, and they would consider meat useless, were the cattle to be killed during the wane. In Angusshire, in Scotland, it is believed, that if a child be weaned during the waning of the moon, it will fall off all the time that the moon continues to wane. The superstition with respect to the fatal influence of a waning moon seems to have been general in Scotland, where it was probably derived from the ancient Scandinavians, and hence we account for its prevalence amongst the Germans and other nations of kindred origin. In the Swedish portion of Scandinavia, great influence is, even at the present day, ascribed to the moon, not only as a regulator of the weather but as influencing the affairs of life in general. Many of the popular superstitions regarding the moon, still prevalent among the Germans and Dutch of this continent, acknowledge a Scandinavian origin. For example, both here and m Sweden, the farmer will decline felling a tree, for agricultural purposes, in the wane of the moon, under the fear That it may shrink and not be durable; and a good housewife will not kill for the use of her family during the wane, under the dread that the meat will shrivel and melt away in the pot. All these, and various other phenomena that have been 13 ascribed to lunar influence, are the offspring of superstition, and there does not appear to be the least reason for believing that the moon has any agency whatever on the human body, whether in a state of health or disease. It would be impossible—were it even advisable—in the short space of time necessarily allotted to this lecture, to instance the various shapes, which superstition, applied to medicine, has assumed; and the hold, which it has taken on the minds of many whose station in society, and whose general attainments, it might have been presumed, would have steeled them against the intrusion of such beliefs. The science of medicine has suffered largely from the cre- dulity and ignorance of those who profess it, and nothing can exhibit this more strikingly than the repulsive and ridiculous agents, that have been had recourse to as a part of the Materia Medica; and some of which were introduced or recommended by individuals, distinguished, in their djy, for superior intel- ligence. Thus, the illustrious Bacon believed in the virtue of charms and amulets, and Boyle thought the thigh bone of an executed criminal a powerful remedy in dysentery. Celsus advises the warm blood of a recently slain gladiator, or a certain portion of human, or horse flesh for the cure of epilepsy; and remedies of this description are said to have been actually exhibited with success, for the cure of epileptics, in the poor house at Haerlem, by Abraham Kaauw Boer- haave, a nephew of the celebrated Hermann, and Professor of Medicine at St. Petersburg, who lived so recently as the middle of the last century. Amongst the specifics of Alex- ander of Tralles were the liver of a weasel freed from bile— taken for three successive days fasting; the skull of an ass, and the ashes of clothes stained with the blood of gladiators. Pliny recommends stones, taken from the craws of young swallows, in epilepsy. Democritus mentions that some diseases are best cured by anointing with the blood of strangers and male- factors, and others with the blood of our friends and kinsfolks. Miletus cured affections of the eyes with human bile. Arte- mon treated epilepsy with dead men's skulls, and Antheus convulsions with human brains. But it may be said, that most of these degrading examples of credulous ignorance are taken from a far distant age, when physical science was yet in its first infancy. It would be easy, however, to show, that, at a much later period, the same cre- dulity reigned where it was least to be expected, and even now the Pharmacopeias of certain countries, eminent amongst nationsfor the advanced condition of mind in many of its aspects, exhibit evidences of the like degradation. Sir Theodore Turquet de Mayekne, who was physician to James the first, 14 Charles the first, and Charles the second, of England, and who was the most distinguished character of his day for learn- ing and as a practitioner, mentions among his remedies the balsam of bats for hypochondriasis; remedies taken from cer- tain parts of adders; sucking whelps; earth worms; mummy made of the lungs of a man who died a violent death, and many other articles equally gross, and irrational. Even a century after this period of defective observation and experience, no great advancement had taken place towards a knowledge of the effects of medicines on the animal economy. The doctrines of pathology were experiencing considerable mutation; anatomy and physiology were beginning to be vi- gorously cultivated; many improvements had taken place in the practice of medicine and surgery; and an immense number of fresh articles had been added to the Materia Medica, of which comparatively few, however, have been since retained; yet no great improvement had occurred in the discrimination of-false from true facts, so far, at least, as regards the medi- cinal virtues of those articles that act insensibly on the frame, and which have been commonly denominated alteratives. Of the truth of this the Dispensatory of Quincy, published in 1736, and even the later editions afford ample evidence. The catalogues of the Materia Medica of this country and of Great Britain are free from those offsprings of superstition and credulity, although they may be objectionable for the multi- tude of articles admitted into them. Time, however, and im- proved observation and experiment will rectify this, until,— fortunately for the student, practitioner, and patient,—the list will embrace those agents only whose virtues and applications are understood. Valuable is the time frequently lost in the exhibition of a re- medy of doubtful efficacy: "anceps remedium quam nullum" is indeed, a maxim of by no means universal application; and often is the safety of the patient endangered bv the credulity of a too confiding physician. It is in this way that the use of amu- lets, anodyne necklaces, camphor worn round the neck, &c, is objectionable. Presuming on their prophylactic or remedial powers the wearer rashly passes into infected situations, when he would otherwise have been cautious, and if attacked with disease postpones the employment of efficacious remedies until the time has gone by for their sucessful administration. Different bezoards, or calculi found in the stomachs of ani- mals and at one time generally presumed to have the power of warding off contagious diseases, are still found in the pharma copanas of Amsterdam, Brunswick, Spain, and Wirtemb Z A disti led water of young swallows-officinally called[Aqua Hirundmum cum Castoreo-exists in the Pharmacopeia of 15 Manheim, as an anti-hysteric and anti-epileptic;—the Oniscus or wood-louse is in most of the European Pharmacopeias, as a remedy in dropsy and asthma;—the powder of the dried frog, Bufo exsiccatus, is in the Pharmacopeias of Spain and Wir- temberg, as an anti-hydropic; the powder of the human skull in the same Pharmacopeias, as an anti-epileptic; the dried liver of the mad dog, and that of the wolf in the Pharmacopeia of Wirtemberg, as an anti-hydrophobic; the Egyptian Mum- my in those of Spain and Wirtemberg, with the Hoof of the Stag, formerly regarded as a specific in epilepsy; besides many other articles equally absurd. Their retention is unfavorable to the scientific observation and induction of the people, into whose Pharmacopeias they are received; and it is somewhat surprising, that amidst the various Pharmacopeias of German origin, that of Wirtemberg should be so far behind in reject- ing these relics of ancient ignorance. A useful lesson may, however, be deduced from all these facts. Many of the articles are calculated to produce consider- able effect upon the imagination, and in this way they may re- ally have been productive of advantage in the treatment of dis- ease. Who, for example, could be told that he was about to take a pill made of the powder of the human skull, or of an Egyptian Mummy, without considerable emotion? Accord- ingly, it will be found, that most of these disgusting agents, as well as of the various nauseous remedies yet retained in the Pharmacopeias—Asafaztida, Castor, Skunk-cabbage, &c.—are administered to the nervous and hysterical, as well as in the various affections that occur in paroxysms, to make a power- ful impression on the nervous system, and thus detract from the nervous irritation already existent. In this way, we ac- count for the action of many anti-spasmodics, anti-epileptics, anti-hysterics, febrifuges administered for arresting intermit- tents, &c, and for the efficacy of those methods of acting on the imagination,—animal magnetism, Perkinism, &c.—which have excited the most extravagant enthusiasm, yet most of which have now died away, leaving scarcely a vestige of their having been; but may be resuscitated under some other form, unless the experience of the past—by which, however, mankind are slow to profit—and the rapid diffusion of intellectual and moral light should be sufficient to choak them at their resurrection. Their history ought also to impress us with the importance of having the co-operation of the mind, whenever we are treat- ing disease. Daily experience shows us how satisfactorily the management will proceed, if the faith of the patient be implicitly yielded to the physician, and to the mode of treatment he is pursuing; and how unhappily every thing is apt to go on when the contrary is the case. The mutual / i6 action of the physique and the moral on each other is, indeed, one of the most interesting and useful studies to the physician. When we revert to the state of many departments of Hygiene, a century or more ago, we find the same faulty physics and metaphysics pervading this subject, the same de- fective knowledge of the laws of cause and effect, and the whole subject enveloped in so much uncertainty, that it is difficult to understand, with all their absurd views regarding the dietetic department especially, how any article of food was ever ventured upon. Even yet, many prejudices exist concern- ing the nutrient and digestible properties of particular ali- ments, but there is almost always some ground for the notions that are indulged,—conflicting as they may occasionally be. The views, however, entertained a hundred and fifty years ago, and conveyed in the wordiness, characteristic of the time, appear to us, of the present day, a tissue of impenetrable obscurity. "Thematter of diet," says a distinguished writer of that period, "is neither iron, nor steel, nor silver, nor coral, nor pearl, no nor gold itself, from which worthy simples, albeit most rare and effectual sustenances be drawn (as our countryman (Roger Bacon) of all other most learnedly proveth) to strengthen our body, and to thicken our radical moisture, which is soon consumed (like a fine spirit of wine) when it is too thin and subtile; yet neither have they, neither can they have, a nourishing power, because our natural heat will be tired before it can convert their oyle into our oyle, their substance into our substance, be it never so cunningly and finely exalted. Furthermore, if it be true (which Hip- pocrates and reason telleth us) that as contraries are expelled by contraries, so like is sustained by his like. How should the liquors of gold, pearl, and precious stones (which the chymists have named immortal essences) nourish or augment our mortal substance. Nay doth not that soonest restore decayed flesh (as milk, gellie, strong broaths, and young lamb) which soonest corrupteth, if it be not presently eaten. Is not a young snite more nourishing (yet it keeps not long sweet) than a peacock that will not corrupt nor putrefie in a whole year, no not in thirty years (saith Kiranides) though it be buried in the ground? yet as a candle's end of an inch long, being set in cold water, burneth twice as long as another out of water; not because water nourisheth the flame, which by nature it quencheth, nor because it encreaseth the tallow, which admits no water, but by moistning the circumfluent aire, and thickning the tallow, whereby the.flame is neither so light nor so lively as it would be other-wise; in like sort the substances, powders and liquors of the things aforesaid, may perhaps hinder the speedy spending of natural heat, by outward coolinp- of fierv 17 spirits, inward thickning of too liquid moistures, hardning or condensating of flaggy parts; but their durableness and immor- tality (if they be immortal) are sufficient proofs that they are no nourishments for corruptible men." And he concludes that "neither oriental stones for their clearness, nor pearls for their goodliness, nor coral for his temperating of blood, nor gold for his firmness, nor liquor of gold for his purity, nor the quint- essences of them all for their immortality, are to be counted nourishments, or the matters of diet. Object not the ostrich his consuming of stone and mettals, to prove that therefore they may nourish man: no more than the duck, nightingale or stork, to prove that toads, adders, and spiders are nourishing meats. For our nourishment (properly taken) is that nature or sub- stance, which encreaseth or fostereth our body, by being con- verted into our substance. Now for as much as our bodies (like the bodies of all sensible and living creatures else) consist of a treble substance, namely, aerial spirits, liquid humors, and confirmed parts: it is therefore necessary it should have a treble nourishment answerable to the same: which Hippo- crates truly affirmeth to be air, meat, and liquors." Yet this unintelligible jargon comprises the views of the most eminent writer on Dietetics of the period, a Dr. Muffet, whose work was afterwards "corrected and enlarged by Christopher Bennet, doctor in physic, and fellow of the Colledge of Physitians in London," and bears the imprima- tur of " Francis Prujean, President, and of Balduinus Hamey, George Ent, Edmund Wilson, and Christopher Bennet, Censors." Can we be surprised at the credulity, and ignorance, which prevailed regarding the virtues of medicines, when so much mysticism, and so much defective reasoning were comprised in their theoretical considerations'1 Lastly, the subject of Medical Jurisprudence was equally at a low ebb with our immediate ancestors. Despairing, in many cases, of discovering truth from the confession of the accused, or from the examination of witnesses, they had re- course to measures of the most strange and unsatisfactory character. The trial by battle, the proofs from withstanding the action of fire, of boiling oil and boiling water, were invok- ed, and if the accused could bear these unmoved, he was declared innocent. It was at one time the common belief, amongst the learned and unlearned, a belief also of Scandinavian origin, that the wounds of a murdered person will bleed afresh, if the body be touched ever so lightly, in any part, by the murderer. The belief is noticed by several of the older poets:—thus 3 18 Shakspeare in his Richard III. where the Lady Anne reviles Gloster over the corpse of Henry:— "Foul devil, for God's sake hence, and trouble us not: For thou hast made the happy earth thy hell, Fill'd it with cursing cries, and deep exclaims. If thou delight to view thy heinous deeds, Behold this pattern of thy butcheries; O Gentlemen, see, see! dead Henry's wounds, Open their congeal'd mouths, and bleed afresh; Blush, blush, thou lump of foul deformity, For 'tis thy presence, that exhales this blood From cold and empty veins, where no blood dwells; Thy deed, inhuman and unnatural, Provokes this deluge most unnatural." And Webster, in his Tragedy of "Appius and Virginia," published about the middle of the 17th century: "See Her wounds still bleeding at the horrid presence Of yon stern murderer, till she find revenge."* This superstitious notion gave rise to the trial by Bierright, familiar, probably, to all my auditors by the skill with which it has been worked up by Sir Walter Scott, in his "St. Valentine*s day, or the Fair Maid of Perth." The annals of judicial inquiry shew how strongly the idea had possession of the minds of the members of the sister professions, which have numbered in their ranks, at all periods, the most en- lightened of the community. In the fourth year of Charles I., a female, named Jane Norkott, was found dead in her bed, her throat cut, and the knife sticking in the floor. Two females and a male slept in the next room, and they deposed, that the night be- fore she went to bed with her child, her husband being absent, and that no person after that came into the house. The Coroner's jury gave a verdict of felo de se. A suspi- cion, however, having arisen against these persons, the jury, whose verdict was not yet drawn up in form, desired that she might be exhumed; and accordingly, thirty days after her death, she was taken up, and the jury charged those indivi- duals with the murder. They were tried and acquitted, but so contrary to evidence, that the judge suggested an appeal should be made, rather than that so foul a murder should go unpunished. Accordingly, an appeal was brought by the child against his father, grandmother, aunt, and her husband Okeman. The jury brought in all guilty except Okeman, •Again, in the "Widow's Tears" by Chapman, published in 1612- "The Captain will assay an old conclusion often approved, that'at the murderer s sight the blood revives again and boils afresh, and every wound has a condemning voice to cry out guilty against the murderer " 19 a«d they were executed but without confessing. In the course of the evidence in this case, the following circum- stances are reported by Sir John Maynard, an eminent English lawyer, to have been deposed to. "Because the evidence," says he, "was so strange I took exact and particu- lar notice, and it was as follows. An ancient and grave per- son, minister to the parish where the fact was committed, being sworn to give evidence, according to custom, deposed, "That the body being taken up out of the grave, thirty days after the party's death, and lying on the grass, and the four defendants being present, were required each of them to touch the dead body. Okeman's wife fell upon her knees, and prayed God to shew tokens of her innocency. The ap- pellant did touch the dead body, whereupon the brow of the dead, which before was of a livid and carrion colour, began to have a dew or gentle sweat arise on it, which increased by degrees, till the sweat ran down in drops on the face; the brow turned to a lively and fresh colour, and the deceased opened one of her eyes, and shut it again, and this opening the eye was done three several times. She likewise thrust out the ring or marriage finger three times, and pulled it in again, and the finger dropped blood from it on the grass. "Sir Nicholas Hyde. Chief Justice, seeming to doubt the evidence, asked the witness, who saw this besides you? Witness, I cannot swear what others saw. But my Lord (said he) I do believe the whole company saw it, and if it had been thought a doubt, proof would have been made of it, and many would have attested with me. Then the witness, observing some admiration in the auditors, spake further. "My Lord, I am the minister of the parish, and have long known all the parties, but never had occasion of displeasure against any of them, nor had to do with them or they with me; but as I was minister, the thing was wonderful to me. But I have no interest in the matter, but as called upon to testify the truth, and this I have done." (This witness was a very reverend person, as I guessed of about 70 years of age, this testimony was delivered gravely and temperately, to the great admiration of the auditory.) Whereupon, applying himself to the Chief Justice, he said "My Lord, my brother, here present, is minister of the next parish adjacent, and I am sure saw all done that I have affirmed." Therefore that person was also sworn to give evidence, and did depose in every point__"the sweating of the brow—the change of the colour— thrice opening the eye—the thrice motion of the finger and drawin«- it in again." Only the first witness added, "that he himselfdipped his finger in the blood which came from the dead body, to examine it, and he swore he believed it was blood." 20 In the year 1688, a gentleman of the name of Philip Stansfield was tried, found guilty, and executed at Edin- burgh, for the murder of his father, Sir Philip Stansfield. The indictment, in this case, amongst other things states— "that his nearest relations being required to lift the corpse into the coffin after it had been inspected: upon the said Philip Stansfield touching of it ('according to God s usual method of discovering murder,' says the framer of the indict- ment) it bled afresh upon the said Philip, and that thereupon he let the body fall, and fled from it in the greatest consterna- tion—crying, Lord have mercy upon me!" On this part of the indictment, Mr. Jones—the king's ad- vocate—remarked, "that as to the body bleeding,—although several persons touched it, none of their hands were besmeared with blood but the prisoner's; and that the body having lain two days in the grave, in a cold season, the blood must natur- ally be congealed. That the lifting about the body, and even the incision that was made causing no such effusion before, but only of some water or gore, and should upon the prisoner's first touching it begin to bleed afresh! he must ascribe it to the wonderful providence of God, who in this manner dis- covers murder, especially since no natural reason could be as- signed for it; and that the horrible impressions it made on the prisoner, notwithstanding his resolution to the contrary, might be urged as another argument of his guilt." Eighty years after this a similar case occurred in our own country. It is contained in the attestation of the Coroner of Bergen County, New Jersey.* "On the 22nd day of September, in the year of our Lord, 1767,1, Johannes Demarest, Coroner of the county of Ber- gen and province of New Jersey, was present,—at a view of the body of Nicholas Tuers then lying dead,—(together with the jury which I summoned to enquire of the death of the said Nicholas Tuers.) At that time, a negro man, named Harry, belonging to Hendrick Christians Zabriskie, was suspected of having murdered the said Tuers; but there was no proof of it, and the negro denied it. 1 asked if he was afraid to touch Tuers. He said no, he had not hurt him- and immediately came up to the corpse lying in the coffin* and then Staats Storm, one of the jurors—said "I am not afraid of him," and stroked the dead man's face with his hand which made no alteration in the dead person, and (as I did not put any faith in any of these trials) my back was turned towards the dead body, when the jury ordered the negro to touch the dead man's face with his hand; and then I heard a cry in the room, of the people saying, 'he is the man,' and I was de- * AnnurJ Register, for 1767, p. 144. 21 sired to come to the dead body; and was told that the said negro Harry had put his hand on Tuers's face, and that the blood immediately ran out of the nose of the dead man Tuers. I saw the blood on his face, and ordered the negro to put his hand again on Tuers's face: he did so, and immediately the blood again ran out of the said Tuers's nose at both nostrils, near a common table-spoonful at each nostril, as well as I could judge, whereupon the people all charged him with being the murderer; but he denied it for a few minutes; and then con- fessed that he had murdered the said Nicholas Tuers, by first striking him on the head with an axe, and then driving a wooden pin in his ear; though afterwards he said he struck a second time with his axe, and then held him fast till he had done struggling: when that was done, he awaked some of the family, and said Tuers was dying he believed. Johannes Demarest, Coron." The belief in these cases of monstrous superstition, the cir- cumstances of which are usually explicable, I need hardly say, on purely physical principles, or on the excited imagin- ation of the observer, still exists amongst the benighted in- habitants of many parts of Great Britain, and Ireland, and is the main topic of one of the "Traits and Stories of the Irish Peasantry," of which a second series has been recently pub- lished in Dublin, and reprinted in this country. The public journals of the last week exhibit, indeed, that the superstition has yet its believers here. On the trial of Getter, recently executed in Pennsylvania for the murder of his wife, a female named Juliana Leitz, deposed on oath as follows:—"If my throat was to be cut I could tell before God Almighty, that the deceased smiled when he (Getter the murderer) touched her. I swore this before the justices, and that she bled con- siderably. I was sent for to dress her and lay her out. He touched her twice. He made no hesitation about doing it. I also swore before the justice, that it was observed by other people in the house. This was towards evening, when the doctor and jury (Coroner's) were gone." Such is an imperfect sketch of some of the unphilosophical ideas, generally entertained, in times not very remote, on subjects that fall to this chair, by the professional and unpro- fessional—the learned as well as the ignorant. To compare them with the views at present indulged by the profession demands that knowledge, which it will be my endeavor to communicate during the ensuing course. It is gratifying, however, to learn, that those degrading superstitions which enthralled the mind have been mainly abolished; that a better system of physics and of metaphysics has elucidated the laws that connect effects with their causes—the relative with its 22 antecedent; that an improved acquaintance with anatomy- general, special, pathological and surgical, along with the important and interesting truths and speculations of physiol- ogy ,—sound and morbid,—has dispelled several of those illu- sions that at one time weighed on the science; that mystery, which has been properly designated as but imperfect know- ledge, has been discarded: that the arcana of the science are now thrown open, and that the darkness and complicated dog- mas of the schools have yielded to a better mode of reasoning and experiment, so that what was formerly taught and impli- citly credited, as a dictum of the master, is now exhibited perspicuously and demonstratively, and unless rendered in- trinsically clear and intelligible, is unhesitatingly rejected. If we compare the state of the profession now, with what it was one hundred, nay fifty years ago, and then casl our regards into the future, how cheering is the prospect! Yet we must not form too exaggerated an estimate of the powers of science from its present improved condition. When the gigantic mind of Newton had developed the "new philosophy," the most un- bounded enthusiasm was experienced; and it was presumed that the world would be filled with wonders. "The glorious undertakers," says Glanvil,—who was one of the earliest members and promoters of the Royal Society of London— "wherewith Heaven hath blest our days, will leave the world better provided than they found it. And whereas in former times, such generous free spirited worthies were as the rare newly observed stars, a single one the wonder of an age, and this last century can glory in numerous constellations; I doubt not but that posterity will find many things that now are but rumours verified into practical realities. It may be, some ages hence, a voyage to the southern unknown tracts, yea, possibly, to the moon, will not be more strange than one to America. To those that come after us, it may be as ordinary to buy a pair of wings to fly into the remotest regions, as now a pair of boots to ride a journey. And to confer, at the dis- tance of the Indies, by sympathetic conveyances, may be as usual to future times as to us in a literary correspondence. The restoration of gray hairs to juvenility, and recalling the exhausted marrow, may, at length, be effected without a miracle. And the turning the now comparative desert world into a Paradise may not improbably be expected from late agriculture. Now those that judge by the narrowness of former principles and successes, will smile at these paradoxi- cal expectations. But questionless those first inventions which have, in these latter ages, altered the face of all things' were as ridiculous to former times in their naked proposals' and mere suppositions. To have talked of a new earth to S3 have been discovered, had been a romance to antiquity; and to sail without sight of stars or shores by the guidance of a mineral, a story more absurd than the flight of D^dalus. That men should speak after their tongues were ashes, or communicate with each other in different hemispheres, before the invention of letters, could not but have been thought a fiction. Anti- quity would not have believed the incredible force of our cannons, and would as coldly have entertained the wonders of the telescope. In these we all condemn antique incredu- lity. And it is likely posterity will have as much cause to pity ours. But yet notwithstanding this straightness of shal- low observers, there are a set of enlarged souls that are more judiciously credulous. And those who are acquainted with the diligent and ingenious endeavors of so many true phi- losophers, will despair of nothing." Yet, gentlemen, the new philosophy, valuable—invaluable as it was, could not unfold all the wonders of the universe: there were many subjects, such as the intimate nature of mind and of vitality, to the elucidation of which it was wholly inapplicable, or if applicable inadequate; and even with the light, which a century and a half of experiments and obser- vation have shed upon us, there are numerous points in phy- sics on which we remain in deep obscurity. Condorcet, the strenuous advocate of the "perfectibility of the human race," wildly supposed, that the time may arrive, when death will be the effect only of extraordinary accidents, or of the destruction—which will gradually become more and more tardy—of the vital forces; and that, in effect, the du- ration of the middle period between birth and this destruc- tion has in itself no assignable term. Such a consummation is not to be expected, and indeed passeth all our under- standing. Others have supposed that rapid as the progress of science has been, and with every probability of its continuing to advance with accelerated speed, the universal law of com- pensation will continue to balance the improvement of the human understanding by some equivalent failing. The sub- ject is one of higher metaphysics into which we cannot enter. There are, doubtless, limits beyond which the powers of the human intellect cannot pass, but we are far from having attained those limits. Who, indeed, shall attempt to assign bounds to it? Instead of employing our time in such unprofitable dis- cussions, let us turn assiduously to the discovery and investi- gation of truth, and whether our efforts be directed to every branch of the tree of knowledge, or to one only, science and humanity cannot fail to be enriched by precious fruit. / national library of medicine NLM OIODISAO 3 NLM010015803