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THE OATH OF HIPPOCRATES 
 
 1 SWEAR BT APOLLO THE PHYSI- 
 CIAN AND AESCULAPIUS AND 
 HEALTH AND ALL-HEAL AND 
 ALL THE CODS AND CODDESSES 
 THAT ACCORDING TO MY ABIL- 
 ITY AND JUDCMENT I WILL 
 KEEP THIS OATH AND THIS 
 STIPULATION ■*, + a A 
 
 GIVE NO DEADLY MEDICINE 
 TO ANYONE If ASKED -NOR SUC- 
 CEST ANY SUCH COUNSEL- AND 
 IN LIKE MANNER I WILL NOT 
 GIVE TO A WOMAN A PESSARY 
 TO PRODUCE ABORTION 4pWITH 
 PURITY AND WITH HOUNESS I 
 WILL PASS MY LIFE AND PRAC- 
 TICE MY ART<p WILL NOT CAS- 
 TRATE ANYONE - NOT EVEN 
 THOSE LABORINC UNDER THE 
 STONE.- AND WILL SHUN MEN 
 WHO ARE PRACTITIONERS OF 
 THIS WORK < INTO WHATEVER 
 HOUSES I ENTER I WILL CO INTO 
 THEM FOR THE BENEFIT OF THE 
 SICK • AND WILL ABSTAIN FROM 
 EVERY VOLUNTARY ACT OF MIS- 
 CHIEF AND CORRUPTION - AND 
 FURTHER -FROM THE SEDUC- 
 TION OF FEMALES OR MALES OF 
 FREEMEN AND SLAVES ^WHAT- 
 EVER DM CONNECTION WITH MY 
 PROFESSIONAL PRACTICE OR 
 NOT IN CONNECTION WITH IT 
 I SEE OR HEAR IN THE LIFE OF 
 MEN WHICH OUGHT NOT TO 
 BE SPOKEN OF ABROAD - 1 WILL 
 NOT DIVULGE AS RECKONING 
 THAT ALL SUCH SHOULD BE 
 KEPT SECRET <WHIL£ I CON- 
 TINUE TO KEEP THIS OATH UN- 
 VIOLATED MAY IT BE GRANTED 
 TO ME TO ENJOY LIFE AND 
 THE PRACTICE OF THE ART RE- 
 SPECTED BY ALL MEN - IN ALL 
 TIMES - BUT SHOULD I TRESPASS 
 AND VIOLATE THIS OATH • MAY 
 THE REVERSE BE MY LOT 
 
 O RECKON HIM WHO 
 TAUCHT ME THIS ART 
 l^rChr. E Qy ALLY DEAR TO 
 ME AS MY PARENTS • 
 TO SHARE MY SUB- 
 STANCE WITH HIM AND RELIEVE 
 HIS NECESSITIES IF REQUIRED 
 TO LOOK UPON HIS OFFSPRING 
 IN THE SAME FOOTINC AS MY 
 OWN BROTHERS AND TO TEACH 
 THEM THIS ART IF THEY SHALL 
 WISH TO LEARN IT -WITHOUT 
 FEE OR STIPULATION AND 
 THAT BY PRECEPT LECTURE 
 AND EVERT OTHER MODE OF 
 INSTRUCTION I WILL IMPART 
 A KNOWLEDGE OF THE ART TO 
 MY OWN SONS AND THOSE OF 
 MY TEACHERS AND TO DISCI- 
 PLES BOUND BY A STIPULATION 
 AND OATH ACCORDING TO 
 THE LAW OF MEDICINE • BUT TO 
 NONE OTHERS <fl WILL FOL- 
 LOW THAT SYSTEM OF REGIMEN 
 WHICH ACCORDING TO MY 
 ABILITY AND JUDCMENT I CON- 
 SIDER FOR THE BENEFIT OF MY 
 PATIENTS AND ABSTAIN FROM 
 WHATEVER IS DELETERIOUS 
 AND MISCHIEVOUS <"l WILL 
 
 Medical Center Lit] 
 it Collection 
 
 niversi’ 
 
Digitized by the Internet Archive 
 in 2016 
 
 https://archive.org/details/lecturesobservat01bail 
 

 
 
 
 
 
 
 
LECTURES AND OBSERVATIONS 
 
 MEDICINE. 
 
LECTURES 
 
 AND 
 
 OBSERVATIONS 
 
 ON 
 
 MEDICINE. 
 
 BY THE LATE 
 
 MATTHEW BAILLIE, M.D. 
 
 LONDON : 
 
 PRINTED BY RICHARD TAYLOR. 
 
 1825 . 
 

 
 
 
 
 
 
 
 
 • 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The following Papers are printed for pri- 
 vate distribution among the friends of the 
 late Dr. Baillie, by his Executors, in obe- 
 dience to directions left in the following 
 Codicil to his Will : dated Cavendish Square, 
 Dec. 27, 1821. 
 
 “ I wish my two Introductory Lectures 
 “ to the course of Anatomy which I gave in 
 “ Great Windmill street, my Lectures upon 
 “ the Nervous System read before the Col- 
 “ lege of Physicians, and a short account of 
 “ my experience in the Practice of Medicine, 
 “ to be printed , but not published. One hun- 
 “ dred and fifty copies may be printed, of 
 “ which one copy may be given to each of 
 “ my more intimate medical friends, and the 
 “ remainder to the Royal College of Phy- 
 
 a 3 
 
VI 
 
 “ sicians in London. They are hardly of 
 “ sufficient importance to be published, and 
 “ yet I am unwilling that they should be 
 “ completely lost, as something useful may 
 “ be extracted from them. They will form 
 “ together a small octavo volume.” 
 
CONTENTS. 
 
 Page. 
 
 Introductory Lecture to the Course of Ana- 
 tomy given in Great Windmill street. 
 
 In two Parts : Part 1 1 
 
 Part II. . . •* 43 
 
 The Gulstonian Lectures, read before the 
 Royal College of Physicians, May 1794 . 93 
 
 Lecture I. Anatomy of the Nervous System 96 
 Lecture II. Physiology of the Nervous 
 
 System 122 
 
 Lecture III. The same continued . . 140 
 
 Some Brief Observations drawn from the Au- 
 thor’s own Experience upon a considerable 
 
 Number of Diseases 161 
 
 Complaints of the Head 165 
 
 Of some Diseases of the Neck . . . 172 
 
 Of some Diseases of the Chest . . . 176 
 
V 111 
 
 Page. 
 
 Of Palpitation of the Heart . . . . 182 
 
 Of Diseases in the Cavity of the Ab- 
 domen 186 
 
 Of Inflammation of the Bowels . . . 195 
 
 Of some Affections of the Liver . . . 197 
 
 Of some Diseases of the Pancreas . . 207 
 
 Of some Diseases of the Spleen . . 209 
 
 Of some Affections of the Kidneys . . 212 
 
 Of some Diseased Affections of the Uri- 
 nary Bladder 222 
 
 Of some Diseased Affections of the 
 
 Womb 228 
 
 Of some Diseased Affections of the Ova- 
 rium 234 
 
 Of Fevers 237 
 
INTRODUCTORY LECTURE 
 
 TO 
 
 THE COURSE OF ANATOMY 
 
 GIVEN IN 
 
 GREAT WINDMILL STREET. 
 
 IN TWO PARTS. 
 
 [First Delivered in the Year 1785.] 
 

INTRODUCTORY LECTURE. 
 
 PART I. 
 
 It is not necessary for the understanding of 
 any science that we should be acquainted 
 with its history. A science consists of an 
 accumulation of facts depending on certain 
 principles, and is more or less perfect accord- 
 ing as the facts are more or less numerous, and 
 the principles have been investigated with 
 greater or less accuracy. It arises from small 
 beginnings, and advances more rapidly or 
 slowly, according to the circumstances which 
 may have affected the curiosity and the in- 
 dustry of men. These circumstances have 
 been commonly accidental, and are at all 
 times to be considered as foreign to the sci- 
 ence itself ; for there can only be a necessary 
 
 B 
 
connexion between the facts and principles of 
 which it consists, and none at all with any 
 particular age, or country, or persons. There 
 must always have been the same effects and 
 the safne causes existing, whether they had 
 been known or not, — whether they had been 
 discovered at a later or more early period, in 
 one country or in another, or by this or that 
 particular set of men. 
 
 There is, however, a strong curiosity 
 prompting us to inquire into the history of dis- 
 coveries in any branch of science : nor is this 
 void of utility. It points out the activity, the 
 strength, and weakness of the human mind ; 
 holds out the most powerful motives to exer- 
 tion ; shows much to admire and to emulate, 
 and exhibits enough to check pride and teach 
 humility. 
 
 When we observe that by the industry and 
 ingenuity of one man discoveries have been 
 made which are of universal and permanent 
 benefit to mankind, can we desire a stronger 
 motive to call forth the exertion of our own 
 talents ? But when, on the other hand, we 
 observe that discoveries shall be obvious for 
 ages, and yet escape a whole world of indi- 
 
3 
 
 viduals, there will be no reason for us to be 
 elevated with pride. 
 
 If such be the advantages arising from this 
 inquiry, it would be improper not to gratify 
 a very natural and laudable curiosity, or to 
 withhold from you the strongest motives to 
 industry which can affect an honourable 
 mind. It is proposed, however, to trace at 
 present only the grand outlines of the pro- 
 gress of anatomy ; as the detail of the smaller 
 individual discoveries will be better under- 
 stood when those subjects are, explained to 
 which the discoveries relate. 
 
 By anatomy is to be understood the inves- 
 tigation of the structure of any animal body. 
 This is very intimately connected with reason- 
 ing upon its functions, which has been called 
 physiology. Indeed they are so closely allied 
 together as to be inseparable ; the one being 
 the materials, and the other the principles of 
 the same branch of knowledge ; and they ought 
 therefore to accompany each other in their 
 history. It is impossible for men to examine 
 the structure of an animal body, without 
 reasoning about the use of the several parts ; 
 and it would be a very unprofitable pursuit 
 
 b 2 
 
4 
 
 to attend to the one, except as being subser- 
 vient to the other. 
 
 An animal body is obviously so curious in 
 its construction, that it could not escape the 
 attention of men possessed of any powers of 
 observation. The human body, as being most 
 familiar, and the more common animals, 
 would necessarily claim some attention even 
 in the rudest age, long before the annals of 
 any history. It is in vain, therefore, to at- 
 tempt fixing any precise- beginning to ana- 
 tomy : it arose, like other arts, insensibly ; men 
 being always possessed of considerable know- 
 ledge without being conscious of it, and with- 
 out any foresight of its being separated into 
 a particular branch of science. Much of 
 anatomy was known before any attempt to 
 arrange and separate this knowledge, and 
 every thing was left to the impressions of me- 
 mory, without order or distinction. 
 
 The external form of the human body must 
 always have been well known, and a variety 
 of circumstances would occasionally discover 
 something: of its internal structure. A consi- 
 derable wound would point out the difference 
 between the skin, the muscles, and the bones, 
 
by exposing all of them together ; and a wound 
 that penetrated into the brain, or into the chest 
 or belly, would give some general knowledge 
 of internal parts. 
 
 A more extensive source, however, of ana- 
 tomical knowledge, would be derived from 
 the more common and domestic animals. 
 When animals were killed for food, they would 
 afford a considerable opportunity of anato- 
 mical observation ; and men would naturally 
 transfer the anatomy of such animals to the 
 human subject, being led by .a strong ana- 
 logy from circumstances of general resem- 
 blance. 
 
 The custom of sacrificing to the gods, and 
 particularly that of examining the viscera of 
 animals in order to form a presage of future 
 events, would add considerably to the stock of 
 anatomical knowledge. By this time men 
 had emerged from the rudest state of barba- 
 rism, had acquired some degree of civiliza- 
 tion, and had become more curious, as well 
 as better fitted, to observe what might come 
 before them. The custom itself obliged them 
 to attend more closely to appearances, and to 
 observe varieties, which would give a consi- 
 
6 
 
 derable opportunity of increasing the know- 
 ledge of the vital parts in an animal body. 
 
 The custom of managing the dead among 
 some nations might also contribute a little 
 to this sort of knowledge. Among the Egyp- 
 tians the practice of embalming is well known 
 to have existed ; and among this nation, so 
 remarkable for its many superstitions and 
 its extraordinary veneration of the dead, we 
 are told that a particular class of men was 
 employed for this purpose. In this operation 
 they took out a portion of the viscera, washed 
 them with antiseptic fluids, and filled the ca- 
 vities with aromatic substances. Such a prac- 
 tice was exposing many parts of the body to 
 observation, which would assist in increasing 
 the knowledge of anatomy : but it was con- 
 fined to a few, and those not the most respect- 
 able of the community. 
 
 By such accidental channels of information 
 only could the knowledge of anatomy be ad- 
 vanced in the very early ages ; the means being 
 very imperfect, and the men employed being 
 little fitted for observation. To later and 
 more enlightened periods we are to look for 
 more considerable improvements, when men 
 
7 
 
 had been more excited to inquiry, and were 
 better able to investigate. 
 
 Among the ancient philosophers we find 
 that the knowledge of anatomy and physio- 
 logy was not neglected. Before any researches 
 into the human mind, when mankind were 
 beginning to emerge from ignorance into 
 knowledge, the properties of matter first so- 
 licited attention. These were objects of sense, 
 and had made the strongest impression ; and 
 under such circumstances of advancement, 
 nothing could more strongly excite the cu- 
 riosity than the wonderful machine of an ani- 
 mal body. They were, however, not aware 
 of the difficulty, of the length of time, of the 
 patience, of the frequency of examination, 
 which are necessary in the prosecution of 
 such a study ; for they have been much more 
 ready to form opinions than to inquire by 
 dissections into animal structure. Of this 
 class were Pythagoras, Alcmaeon, and Empe- 
 docles ; some of whose opinions have been 
 handed down to us. They are generally ill- 
 founded, because their knowledge of anatomy 
 was very imperfect ; yet they are sufficient to 
 show that their curiosity had been properly 
 
8 
 
 roused, although the true road to inquiry was 
 still unknown. Men had not then learned that 
 it required a full investigation of facts before 
 opinions could be justly formed, and princi- 
 ples established ; a circumstance too often 
 overlooked even in modern times. 
 
 Under such circumstances, it was impos- 
 sible that the knowledge of anatomy should 
 rapidly advance. It made a part only of na- 
 tural history, claiming the attention of philo- 
 sophers generally amidst other objects, but 
 had not yet been detached, becoming a sepa- 
 rate branch of inquiry. This is an improve- 
 ment which cannot be made till knowledge 
 has considerably advanced. The little that 
 is known at first of the different branches of 
 science does not require division and ar- 
 rangement ; and it is only the accumulation 
 of facts that can point out their utility. 
 
 This improvement in physic happened in 
 the time of Hippocrates ; and anatomy there- 
 fore began naturally about this period to be 
 cultivated by a particular class of men. We 
 are then to consider this era as remarkable in 
 the history of anatomy and physic ; for it laid 
 the foundation of their more rapid progress 
 
9 
 
 in succeeding times. Hippocrates was bora 
 in the first year of the 80th Olympiad, and 
 460 years before Christ, in Cos, an island of 
 the iEgean sea. He is said to have been de- 
 scended on his father’s side from Esculapius, 
 and on his mother’s to have been allied to 
 Hercules. He had been educated in all the 
 learning of those times, but he was particu- 
 larly attached to medicine. His desire of 
 knowledge was so ardent, that he could not 
 be satisfied with what might be acquired at 
 his native place ; but he travelled for a number 
 of years through different parts of Greece and 
 Asia Minor. During his travels he visited 
 the temple of Diana at Ephesus, and took 
 the trouble of arranging and transcribing the 
 tables of cure which had been deposited there. 
 It was a custom among the ancients, that all 
 who recovered from any dangerous illness 
 should, for the benefit of others, leave an ac- 
 count at the public temples, of the disease 
 under which thej^ laboured, and the remedies 
 which cured them. A practice of this sort 
 was likely very much to promote the know- 
 ledge of medicine ; and attention to cures 
 which were accumulated in such places was 
 
10 
 
 probably the best education for a physician 
 which the times afforded. Hippocrates, after 
 having collected all the knowledge which the 
 most ardent curiosity and excellent talents 
 could acquire by travelling through the most 
 enlightened countries, retired to his native 
 island, there to exercise the profession of a 
 physician, and to distribute the benefits of his 
 former industry. Such merit as his could not 
 remain long hid ; and accordingly we are told 
 that princes, excited by his reputation, were 
 solicitous to allure him to their courts : but 
 his attachment to his native country was so 
 strong, as to make him resist the temptation of 
 splendour and the favour of monarchs ; — an 
 instance of want of ambition perhaps more 
 rare than his perseverance or his talents. 
 
 His works are very numerous, and are to 
 be considered as medical rather than anato- 
 mical. The anatomy is interspersed through 
 his works irregularly, except one or two par- 
 ticular treatises, which however lie under 
 suspicion of being spurious. His works dis- 
 cover a most ardent curiosity, uncommon 
 industry, and a singular sagacity of observa- 
 tion. It is not to be expected that at so early 
 
11 
 
 a period his anatomy should be very perfect; 
 for dissection of human bodies was not in use, 
 and much could not be learnt from the occa- 
 sional dissection of brutes. He still, however, 
 deserves the most honourable mention in the 
 history of anatomy, because by his means 
 medicine rose at once to the dignity of a sci- 
 ence, and anatomy became united to it, as 
 necessary to its cultivation. After the time 
 of Hippocrates anatomy still continued to 
 advance, though slowly, being an object of 
 curiosity both to the physician and to the 
 philosopher. Aristotle, the celebrated tutor 
 of Alexander the Great, pursued with un- 
 common ardour his researches into the animal 
 structure, in which he was assisted by the li- 
 berality of Alexander himself. He has written 
 a large work upon animals, in which he has 
 introduced the human anatomy. This is very 
 inaccurate ; and indeed in one place he 
 frankly confesses that the interior parts of a 
 human body are very uncertain, and little 
 known ; and he recommends the examination 
 of those animals which have the nearest re- 
 semblance to the human species. 
 
 Although little advancement had hitherto 
 
12 
 
 been made in the knowledge of anatomy, yet 
 it was increasing as an object of curiosity, 
 and it afterwards laid the foundation of re- 
 searches which were more judiciously under- 
 taken, and more successful in their result. 
 
 Not Ion o- after the time of Aristotle lived 
 © 
 
 Erasistratus, the first person we hear of who 
 employed himself in the dissection of human 
 bodies. He enjoyed the patronage of Nica- 
 nor king of Sicily, who encouraged him in 
 the ardour of his researches by allowing all 
 the criminals to be dissected who were put to 
 death. This was a large field of observation; 
 and yet, if report be true, it was not suffi- 
 cient to satisfy the curiosity of Erasistratus ; 
 for he is said to have procured leave to dis- 
 sect criminals alive, that he might have an 
 opportunity of examining operations which 
 take place only in a living body. This, how- 
 ever, must be considered as a popular tale, 
 invented and propagated through idle credu- 
 lity, and the natural gratification arising from 
 impressions of wonder. It is to be regretted 
 that his works are lost ; not from any real 
 knowledge that they would communicate to 
 the present times, but that they might show 
 
how far the mind is able to advance of itself, 
 at a very early period, in a new field of know- 
 ledge, which had been involved by many con- 
 jectures, and many false comparisons of ana- 
 logy. His great thirst after knowledge, and 
 his extraordinary opportunities, could not fail 
 of procuring him a most distinguished repu- 
 tation ; so that he became a guide and autho- 
 rity to future anatomists, as may be gathered 
 from what remains of his observations in the 
 works of Galen. 
 
 It would appear that he had seen on the 
 mesentery of kids some lacteal 'vessels filled 
 with chyle, which he has described with great 
 exactness, although shortly, and without form- 
 ing any conjecture about their real use. He 
 had examined the valves of the heart, and 
 knew its alternate contraction and dilatation. 
 He thought that respiration was intended 
 only for the purpose of supplying the arteries 
 with air, and that digestion was carried on by 
 the muscular powers of the stomach bruising 
 the food. Such are a few of the observations 
 of this celebrated anatomist, which show a 
 general attention to the structure and the 
 operations of the body, though some of them 
 
14 
 
 are ill-founded, from want of collateral know- 
 ledge, and from ignorance of the method of 
 experiments to ascertain facts. 
 
 About the same period flourished Hero- 
 philus, an anatomist of much celebrity in an- 
 cient times, who has been also said to have 
 employed a great deal of time in the dissec- 
 tion of human bodies. His school was at 
 Alexandria, where he enjoyed the patronage 
 of the Ptolemies, princes well known for their 
 liberal encouragement of science. Under 
 such circumstances he had much opportunity 
 of observation, which he was not disposed to 
 neglect ; for he has raised to himself a name 
 admired by some succeeding anatomists even 
 to a degree of servility. Fallopius has not he- 
 sitated to consider him as incapable of error. 
 
 Herophilus appears to have emplo} T ed a 
 good deal of time on the nervous system. 
 One of the sinuses of the brain he has called 
 torcular , and it is known at present by the 
 name of the Torcular of Herophilus. The 
 nerves he has clearly distinguished from ten- 
 dons and ligaments, with which they had been 
 formerly confounded. He had examined the 
 structure of the heart, and he gave to the 
 
15 
 
 large vessels names expressive of their struc- 
 ture and his conjectures of their use, which 
 they retained till the celebrated discovery of 
 the circulation, and even some time after- 
 wards. His works, however, have been lost, 
 like those of Erasistratus ; so that we can have 
 only a very partial view from what has been 
 quoted of him by succeeding authors. 
 
 The last of the ancient anatomists is Galen, 
 than whom few have deserved more praise, 
 or been transmitted to posterity with more 
 respect. He was born at Pergamus, a city 
 of Asia Minor, about 131 years after the 
 Christian era. His father had himself a turn 
 for letters, and resolved to spare no pains nor 
 expense in the education of his son, in whom 
 even at a very early period he could observe 
 extraordinary talents. He therefore put him 
 under the tuition of the best philosophers ; 
 but died very soon, and long before he could 
 form any certain prospect of his son’s future 
 reputation. About two years after his father’s 
 death, wdien he was about nineteen years of 
 age, Galen betook himself to the study of 
 physic ; and to give himself every advan- 
 tage, he employed several years in travelling 
 
16 
 
 through different parts of Asia Minor, and 
 some islands in the Mediterranean. At the 
 age of twenty-eight he returned to Pergamus, 
 his native city, where he was charged with the 
 care of the gladiators ; but he remained there 
 only a few years, and then went to Rome. 
 
 His works show him to have been a man 
 of uncommon industry, as well as extraordi- 
 nary talents. He cultivated anatomy with 
 ardour, and employed much of his time in 
 dissection. Upon this subject he has written 
 largely ; but it is to be regretted that he was 
 obliged to gather the human anatomy from 
 analogy with those brutes which bear the 
 greatest resemblance to man. Some modern 
 anatomists have asserted that he never dis- 
 sected a human body : and indeed this is 
 probable from what he has said himself ; for 
 he mentions the having seen the skeleton of 
 a robber as a very remarkable occurrence. 
 But it will appear from his descriptions and 
 comparisons that he had occasionally ex- 
 amined parts of the human body. 
 
 He was perfectly aware of the importance 
 of anatomy to physic and surgery, and has 
 spoken upon this subject with most uncom- 
 
17 
 
 mon force and energy. “ What,’' says he, 
 in his second book of Anatomical Adminis- 
 trations, “ can be more useful in wounds 
 which are received in battle, in the extraction 
 of darts, in the excision of bones, the reduc- 
 tion of luxations, the opening of fistulae, than 
 to be well acquainted with the anatomy of the 
 extremities ? It is of more use to be acquainted 
 with the exterior than the interior parts of 
 the body, as the shoulders, back, breast, the 
 ribs, the belly, and the outward covering of 
 the neck and head; for we are often required 
 to cut into abscesses and sinuses. In the ex- 
 cision of bones it is necessary to cut and dis- 
 sect ; and if we do not know where the ar- 
 tery, vein, or nerve may lie, we are much 
 more likely to be the cause of death than of 
 health to the patient.” 
 
 He was not only highly sensible of the im- 
 portance of anatomy, but has been most 
 judicious in his advice about the mode of 
 studying it. He strongly advises the frequent 
 dissection and examination of bodies, and 
 that we should not trust to the accounts of 
 others. Apes were dissected in his time ; 
 and he recommends such animals as approach 
 
 c 
 
18 
 
 nearest to man in their resemblance. Still 
 he is sensible of the deficiency, and advises 
 the going to Alexandria to have an oppor- 
 tunity of examining the human skeleton itself. 
 His descriptions are clear and well arranged, 
 there being no mixture of one part with an- 
 other, which is often to be found in ancient 
 writers ; and those who are conversant in the 
 dissection of apes bear testimony to their 
 extreme accuracy. Little of physiology was 
 known at this time, so that the principles laid 
 down are often false ; but his reasoning upon 
 these principles is remarkably clear and con- 
 clusive, and where the intentions of nature 
 are not very obscure is often most accurate. 
 Nothing can be more excellent, and indeed 
 more elegant, than his account of the uses of 
 the hand. He has written upon every part of 
 anatomy ; so that his works may be consi- 
 dered as a system, exhibiting every thing 
 known or discovered in this branch of know- 
 ledge in his time. 
 
 After the death of Galen we do not find 
 that the spirit of improvement continued 
 among his successors, but anatomy began to 
 decline with other learning. The later pe- 
 
19 
 
 riods of the Roman empire, which compre- 
 hended the greater part of the then civilised 
 world, were not very favourable to the pro- 
 gress of science. The emperors were not dis- 
 posed to patronize it ; corruption of manners 
 had already advanced to an incredible height; 
 and the empire was distracted by continual 
 alarms from the inroads of external enemies. 
 
 It is besides probable that the great repu- 
 tation of Galen might have had some ten- 
 dency to obstruct the progress of anatomy. 
 Men are not disposed to exertion when they 
 despair of rivalling what has been already 
 done ; and they are still less apt to labour 
 when they are satisfied that the object of their 
 pursuit is incapable of improvement. To 
 these reasons we are probably to attribute 
 the decline of anatomy after the time of Ga- 
 len till the downfall of the Roman empire, 
 when Europe became overwhelmed in a 
 darkness which was not dispelled for many 
 centuries. 
 
 During this interval we are not, however, 
 to suppose that anatomy was entirely neg- 
 lected. Physicians and surgeons continued 
 to study Galen : but when they were con- 
 
 c 2 
 
20 
 
 tented with studying him, it is evident that 
 anatomy would always be losing ground. 
 
 After the downfall of the Roman empire 
 in the West, learning was still cultivated at 
 Alexandria, which had continued for ages to 
 be a flourishing school, and was enriched 
 with a most inestimable library. It seemed, 
 however, destined that every persecution 
 should interrupt its progress. About the 
 year 640 the city of Alexandria was besieged 
 by the Saracens, and this magnificent library 
 was burnt. 
 
 These barbarians, not content with the 
 ravages they had already committed, after 
 having conquered all the countries adjoining 
 to Arabia, crossed the Mediterranean, and 
 in 717 besieged Constantinople, where the 
 small remains of learning were still preserved. 
 It was fortunate that they did not succeed in 
 this attempt, but were obliged to raise the 
 siege. 
 
 Being satiated with conquest, and having 
 at length begun to experience the advantages 
 of peace, these destroyers gradually acquired 
 a taste for learning. Some of the Greek 
 books which had escaped destruction were 
 
21 
 
 translated into the Syriac and Arabic lan- 
 guages. Schools were opened in many of 
 the chief cities of the Saracen empire, and 
 learning began to be generally diffused. 
 Anatomy, however, made no progress under 
 the Saracen government. Physicians and 
 surgeons were disposed to be content with 
 what Galen had told them ; and as most of 
 them were Mahometans, they were prevented 
 by their religion from touching any dead 
 body. 
 
 Avicenna, who lived during the period we 
 have been mentioning, has written a volume 
 upon anatomy ; but his work is to be consi- 
 dered merely as a compilation from Greek 
 authors, particularly Galen ; and whenever 
 Avicenna ventures to differ from them he is 
 generally wrong. 
 
 The time at length arrived when the Ara- 
 bians were to suffer the same calamities from 
 the barbarous ambition of the Turks which 
 they had themselves inflicted on the eastern 
 part of the Roman empire. The Tartars took 
 Bagdad in 1258 ; and sometime afterwards 
 they carried their hostilities against Constan- 
 tinople and the neighbouring cities. Men 
 
22 
 
 of learning fled from the danger that threat- 
 ened them, and took refuge in Italy. Thus 
 was literature transferred from the East to the 
 West; and the light of knowledge began to 
 dawn upon Europe, after a long night of the 
 most impenetrable ignorance. 
 
 Anatomy revived at this period, along with 
 other learning ; but under such circumstances 
 that it was impossible for it to make great 
 progress. Men were so infatuated with their 
 admiration of the ancients as to believe them 
 incapable of error ; and thought that no other 
 task was reserved for them, than to endea- 
 vour to understand and to admire what they 
 had done. The ancients were to them the 
 only source of knowledge ; they were the 
 means by which they had been civilised from 
 ignorance, and they looked up to them as 
 having arrived at the perfection of human 
 nature. This could only, however, retard 
 the progress of knowledge for a short time. 
 We are most disposed to admire what we 
 have only lately known ; but this impression 
 becomes lessened by familiarity. It only re- 
 quired a vigorous mind to be able to see er- 
 rors, and to venture to announce them ; the 
 
23 
 
 spell would then be broken, and science 
 would begin to advance rapidly. 
 
 Such a mind was that of Vesalius. Before 
 his time anatomy was cultivated with ardour 
 by Mundinus, Achillinus, Berenger, Fernel, 
 and especially by Sylvius ; but they had been 
 still too much fettered by their admiration of 
 the ancients to trust much to their own ob- 
 servation, and were astonished, as well as 
 offended, at the audacity of Vesalius. 
 
 Vesalius was born at Brussels in 1514, of 
 a family that had for a long time cultivated 
 medicine. His grandfather and his father 
 had both of them followed that profession ; 
 and the former especially had risen to some 
 degree of eminence. Vesalius himself was a 
 man of uncommon talents, and possessed a 
 degree of ardour in the pursuit of knowledge, 
 and a firmness of mind, which were not to be 
 damped by any difficulties. With such en- 
 dowments his progress was rapid and extra- 
 ordinary. In a few years he excelled his 
 teachers Fernel and Sylvius, who were rec- 
 koned the first anatomists of their time. So 
 great was his industry, and his passion for 
 this study, that at the age of twenty-five he 
 
24 
 
 had collected materials sufficient to publish a 
 better system of anatomy than any that had 
 then appeared. What, however, is perhaps 
 more to be admired in Vesalius than any other 
 quality, is his being able to shake off all blind 
 respect for the authority of great names, and 
 to trust to his own observation. This strength 
 of mind was wonderful at a time when oppo- 
 sition to the authority of the ancients was 
 considered as a species of sacrilege. Trust- 
 ing thus to himself, and being unwearied in 
 his dissections, he was soon able to detect er- 
 rors in Galen and in his own masters. These 
 errors he was not afraid publicly to mention 
 and correct ; but such conduct was not likely 
 to meet with the approbation of contemporary 
 anatomists : all of them united against him 
 with one common voice ; and Sylvius carried 
 his bitterness to so great a pitch, that in some 
 of his controversial writings he has not scrupled 
 to call him Vesanus instead of Vesalius. This 
 great man, however, possessed a mind which 
 was not to be crushed by the opposition of 
 envy. He answered their objections, and 
 came off victorious, because truth was on his 
 side. The reputation of Vesalius at length 
 
25 
 
 became so great as to attract the attention of 
 the court ; and he was made physician to 
 Charles the Fifth, but he did not long enjoy this 
 distinguished situation. An occurrence hap- 
 pened which drove him from Spain to avoid 
 the vengeance of the Inquisition. Having 
 attended, during his illness, a Spanish gentle- 
 man who died, he obtained permission to 
 examine the body ; and when he laid open 
 the chest, he was astonished to perceive the 
 heart palpitating. This circumstance having 
 reached the ears of the relations, he was pur- 
 sued by them as a murderer, and accused 
 of impiety before the Inquisition. By the 
 influence, however, of Philip the Second, 
 who had succeeded his father Charles the 
 Fifth, he was allowed to escape on condition 
 of making a pilgrimage to the Holy Land. 
 Such superstitious times were not unwilling 
 to cancel any action, however base, by one 
 so meritorious. Vesalius had the appearance 
 of guilt, although what he had done was not 
 only innocent but laudable, and he was obliged 
 to exhibit this public proof of his contrition. 
 On his return from his pilgrimage he was in- 
 vited by the senate of Venice to teach ana- 
 
26 
 
 tomy in that city ; but he perished by ship- 
 wreck before he reached it. when he was 
 about fifty years of age. Vesalius had been 
 a very diligent dissector, preferring the evi- 
 dence of his senses to any other sort of tes- 
 timony. The description he has given of the 
 bones is excellent ; and in his description of 
 the muscles he has been very careful to sepa- 
 rate what is found in monkeys and quadru- 
 peds from what he observed in the human 
 subject. His delineation of the bones and 
 muscles shows the most minute attention. In 
 every other part of anatomy he has also la- 
 boured ; and he has been liberal in mention- 
 ing what means he employed. He has no 
 little secrets, but he gives plain practical di- 
 rections how he has proceeded. His general 
 description of the blood-vessels is accurate ; 
 but he had not the smallest conception of the 
 circulation, adhering in this respect very 
 closely to the ancient opinion. He had 
 marked very well the olfactory nerves, al- 
 though he considered them rather as processes 
 of the brain than like the other nerves ; and 
 the fourth pair has entirely escaped his ob- 
 servation : but his description of the nervous 
 
27 
 
 system at large shows a most unwearied in- 
 dustry. There is no part of the body which 
 he has overlooked. He has not only exa- 
 mined the relative situation, but the structure 
 of the different viscera ; and he has been very 
 careful all along to mark the errors of Galen. 
 
 He perfectly got the better of the preju- 
 dices of authority. In one part of his works 
 he has said, “ Haudquaquam adeo Galeni 
 verbis est acquiescendum , lit omnia , quce illic 
 in Aristotelem congerit vera et indubitata 
 esse put emus.” For his account of the or- 
 gans of generation he deserves less praise 
 than for that of the other parts of the body, 
 his description being very inaccurate, and 
 the physiology ill-founded. Fie has, how- 
 ever, done much by being able to throw off 
 the prejudices of established opinion by think- 
 ing for himself, and by having pointed out 
 the true method of studying the human ana- 
 tomy. 
 
 So much curiosity had now been excited 
 in anatomy, and it had become so much an 
 object of cultivation, that it began to be 
 rapidly improved : the barriers to investiga- 
 tion were broken down, and men had only to 
 
28 
 
 observe and think. Under such circum- 
 stances it was likely that many anatomists 
 should arise of distinguished reputation ; but 
 many we shall be obliged to omit, as it is our 
 present object to give only the history of 
 great improvements. The proper method of 
 studying anatomy was now introduced and 
 practised, so that every day was adding some 
 discovery : but in a short history it can only 
 be allowed to trace the most considerable, a 
 longer account being left to the gratification 
 of a more prepared and opportune curiosity. 
 
 The greater discoveries and improvements 
 in anatomy must comprehend either the ex- 
 planation of a general system, or the inven- 
 tion of the means to investigate more accu- 
 rately the structure of an animal body. The 
 one really adds to physiology, and the other 
 produces a more intimate acquaintance with 
 the minuter structure of parts, which furnishes 
 the materials for physiology. 
 
 The greater discoveries in anatomy may 
 be confined to the doctrines of the circula- 
 tion and absorption ; and the application of 
 microscopes, together with the invention of 
 injections, may be considered as the chief 
 
29 
 
 means to develope the minuter structure of 
 an animal body. 
 
 Before entering upon the history of the 
 circulation, it will be necessary, in order to 
 render it intelligible, to explain what the dis- 
 covery is : but this shall be done very briefly. 
 
 By the circulation is meant the distribution 
 of the blood through the body, and its return 
 again to a certain point, in order to undergo 
 a succeeding distribution. This is a very 
 important function in the animal economy, for 
 by it every part of the body is nourished and 
 preserved ; is increased in growth, or is sup- 
 plied when deficient. It furnishes the mate- 
 rials for the preservation, the growth and the 
 repairs, of that very complex and delicate 
 machine, an animal body. 
 
 To carry on this important office, a reser- 
 voir is employed, with tubes passing out and 
 entering into it ; so that the fluid which has 
 been carried out from the reservoir is re- 
 turned again, after having served its purposes, 
 undergoing a complete circulation. This 
 whole apparatus in an animal body consists 
 of the heart, the arteries, and the veins ; the 
 heart being the reservoir of the blood, and 
 
30 
 
 the chief active power of its propulsion ; the 
 arteries being the tubes conveying the blood 
 from the heart to every part of the body, and 
 the veins being the tubes conducting the 
 blood back to the heart to renew its circula- 
 tion. The whole forms one great system 
 complete in itself, the separate parts being 
 dependent on each other. In order, how- 
 ever, to understand the progress of this dis- 
 covery, it will be necessary to describe a little 
 more particularly the apparatus, and the 
 course of circulation in the human body. 
 
 The human heart consists of four cavities, 
 two of which have been named auricles, and 
 two ventricles. The right auricle communi- 
 cates, by a large opening, with the right ven- 
 tricle ; and the left auricle communicates, by 
 a similar opening, with the left ventricle ; 
 but the auricle and ventricle on the one side 
 are generally entirely separate from those on 
 the other. The veins open into the auricles, 
 by which blood is poured into the heart ; and 
 the arteries pass out of the ventricles, con- 
 veying the blood to the lungs, where it un- 
 dergoes some change, and distributing it over 
 the whole body. This forms what has been 
 
31 
 
 called the complete circulation, being a pro- 
 cess that is repeated in very quick succession 
 while an animal is alive. The importance of 
 the supply of materials to an animal body 
 was always understood ; but it remained for 
 a long time unknown what circuit was really 
 taken, and what means nature so wonderfully 
 employed, to produce a continual repetition 
 of supply. This was a most important dis- 
 covery ; for it explained one of the principal 
 operations which are carried on in an animal 
 machine. 
 
 It appears clearly from the works of Galen 
 and of others who have copied from him, 
 that the ancients had not the most distant 
 idea of the true circulation. They believed 
 that the blood was generated in the liver, 
 and that there was a kind of flux and reflux 
 of it in the veins ; that the finer part of it 
 transuded through the septum of the heart, 
 from the right to the left side, where it was 
 mixed with the air inspired into the lungs, 
 forming a vital spirit, and moving by a sort 
 of flux and reflux in the arteries. 
 
 This opinion continued from the time of 
 the ancients, even for many years after the 
 
32 
 
 revival of learning, till by a more attentive 
 observation of the structure of the heart and 
 its vessels greater light was thrown upon this 
 part of the animal economy, and at length 
 the true circulation was completely discovered. 
 
 The first step towards this discovery was 
 made about the middle of the sixteenth cen- 
 tury by Michael Servetus, who was bora in 
 Villa Nueva, in Arragon, in the year 1509. 
 He engaged himself warmly in theological 
 disputes, and had the misfortune to reject the 
 doctrine of the Trinity. This dreadful heresy 
 brought upon him the persecution of Calvin 
 and his adherents, which only terminated 
 with his death, for he was burnt alive at Ge- 
 neva in 1553. 
 
 Servetus has published a book entitled He 
 Trinitate Divina , in which he exhibits many 
 proofs of his knowledge of anatomy ; and it 
 contains a very important step towards the 
 discovery of the circulation. The passage 
 expressing this new opinion is here quoted in 
 a very faithful translation : “The vital spirit,” 
 says he, “ has its origin in the left ventricle 
 of the heart, the lungs being subservient to 
 its generation. It is a subtile spirit elaborated 
 
33 
 
 by the power of heat, is of a yellow colour, 
 and has the quality of fire ; so that it may be 
 considered as an exhaling vapour from the 
 purer blood, containing water, air, and fire. 
 It is produced by a mixture taking place in 
 the lungs, of the inspired air with the elabo- 
 rated subtile blood, which the right ventricle 
 of the heart communicates to the left. This 
 communication, however, does not happen 
 through the septum of the heart, as is the 
 common opinion ; but by a wonderful con- 
 trivance the subtile blood is agitated in a 
 long passage through the lungs, from the 
 right ventricle of the heart, and is poured 
 from the arterious vein into the veinous 
 artery. In the veinous artery it is mixed 
 with the inspired air, and becomes purified 
 by expiration. Thus at length the mixture 
 is attracted from the left ventricle of the heart 
 by diastole, being a fit material for the for- 
 mation of vital spirit. That there is such a 
 communication through the lungs is proved 
 by the various union and anastomosis of the 
 arterious vein and veinous artery in the lungs. 
 There is an additional proof from the bulk of 
 the arterious vein, which would neither be of 
 
 D 
 
34 
 
 such a nature, nor so large, nor send so much 
 pure blood from the heart into the lungs, 
 simply to nourish them ; nor would the heart 
 be subservient after this fashion to the lungs. 
 
 “ The mixture, therefore, takes place in 
 the lungs, and the yellow colour is given to 
 the spirituous blood by the lungs, and not by 
 the heart. If any person will compare this 
 with what Galen has said in his 6th and 7th 
 books De Usu Partiuin, he will plainly see 
 that it has not been discovered by Galen*.” 
 
 We may observe from this passage, that at 
 this period a considerable step had been 
 gained towards the discovery of the circu- 
 lation. The whole of the circulation from 
 the right side of the heart through the lungs 
 into the left was made out, and confirmed 
 by very powerful arguments : but Servetus 
 had no idea of the veins and arteries in the 
 body as belonging generally to the same sy- 
 stem, and being subservient to the convey- 
 ance of the same fluid. He retained the an- 
 cient distinction between blood and vital 
 spirit, but detected the absurdity of the blood 
 
 * Vide pages 143, 144, 145. 
 
35 
 
 transuding through the septum of the ven- 
 tricles, and clearly discovered its real course 
 through the pulmonary artery, or what was 
 then called the arterious vein. 
 
 This passage in Servetus seems, however, 
 to have been overlooked by anatomists in 
 general ; and from most of their writings it 
 would appear that no hint had yet been 
 caught about the true circulation. 
 
 Not long afterwards, Columbus also made 
 out the lesser circulation through the lungs. 
 He was professor of anatomy at Padua, and 
 had been a scholar of Vesalius. It is impos- 
 sible to determine whether he might not have 
 been acquainted with the opinion of Servetus ; 
 but we have the testimony of himself for its 
 being a discovery of his own, which we ought 
 not to refuse. 
 
 In a part of his works he has said, “ There 
 is a septum between the ventricles of the 
 heart, through which every person thinks 
 there is a passage to the blood from the right 
 to the left ventricle. They mistake, however, 
 very much, for the blood is carried through 
 the arterious vein into the lungs, and is there 
 attenuated ; from whence it is carried, along 
 
 d 2 
 
36 
 
 with the air, to the left ventricle of the heart 
 through the veinal artery, which no one has 
 either observed or left written, although it 
 ought to be very obvious to all.” 
 
 The lesser circulation through the lungs 
 has here been distinctly described, but no- 
 thing has been added to what had already 
 been said bv Servetus. It had this advantage, 
 however, that it was now brought more be- 
 fore the observation of anatomists. The title 
 of Servetus's book must have prevented it 
 from being much known to persons of this 
 class, by whom alone such a hint could at all 
 be apprehended. 
 
 The lesser circulation has also been men- 
 tioned by Caesalpinus, an Italian physician, 
 who lived a little after the same period ; and 
 he has even given some obscure hints about 
 the general circulation through the body. 
 He has remarked the swelling of the veins 
 beyond the ligature, and is at a loss how to 
 explain it upon the common idea of the use 
 of these vessels ; for, says he, “ debuisset (in- 
 tern opposito mode contingere” He has re- 
 marked, too, the course of the fluid in the 
 aorta, and has derived a very strong argu- 
 
37 
 
 ment from the valves formed at its origin. 
 “ Membranis quibusdam ad ostia vasorum ap- 
 positis, ut impediant retrocessum.” Still, how- 
 ever, he was entirely ignorant of the con- 
 nexion between the arteries and the veins, 
 and that the blood passes from the one to the 
 other on its return to the heart. 
 
 We have here a difficulty striking only an 
 observing mind ; and many ages might have 
 elapsed without the discovery of the circu- 
 lation, if there had not arisen some pene- 
 trating genius, such as that of Harvey. 
 
 Before we come to speak of the complete 
 discovery of the circulation, it will be neces- 
 sary to mention the discovery of the valves 
 of the veins, which so much tended to facili- 
 tate it. In the cavities of veins are placed 
 little processes, which are so contrived as to 
 allow the blood to pass readily from every 
 part of the body towards the heart, but most 
 effectually prevent an opposite course. These 
 processes consist of very fine membranes, 
 which, when the veins are empty, fall col- 
 lapsed upon their coats, so as easily to es- 
 cape observation. This will account for their 
 not being known to the very early anatomists, 
 
38 
 
 especially as it is more than probable that 
 they were not much accustomed to cut open 
 or invert veins. 
 
 The valves of the veins, if they were not 
 discovered, were at least first delineated and 
 made publicly known by Fabricius Ab Aqua- 
 pendente, professor of anatomy at Padua*, 
 under whom Harvey studied. It was this 
 discovery which probably first led Harvey 
 to reflect on the course of the fluid in the 
 arteries and veins, — an inference which now 
 appears sufficiently obvious ; but it might 
 long have remained concealed, if it had not 
 met with an observing mind, which readily 
 caught it, and thus unfolded the most im- 
 portant general action in an animal body. 
 
 William Harvey, than whom there is 
 scarcely any character of more celebrity in 
 the annals of science, was born in the year 
 15?8. His parents were in easy circum- 
 stances, and could therefore afford him a very 
 complete education. He first attended a 
 
 * Charles Stephens, Jacobus Sylvius, Cannanus, and Ve- 
 salius, had seen the valves of the veins, but they were im- 
 perfectly known to them. Fallopius and Eustachius denied 
 their existence. 
 
39 
 
 public school in Kent, his native county, 
 where he was initiated in the languages ; 
 and at the age of fifteen he went to Cam- 
 bridge, where he became a member of Caius 
 College. There he remained for six years, 
 attentive to all the philosophy of the times ; 
 but he found that he could pursue with little 
 advantage his favourite studies of anatomy 
 and medicine, where neither of them was 
 taught with any degree of reputation. He 
 therefore left Cambridge, and went to Padua, 
 at that time the most celebrated university 
 for medicine, where he attended the lectures 
 of the celebrated Fabricius on anatomy. It 
 was there he acquired the greater share of 
 his anatomical knowledge ; and the particu- 
 lar attention of Fabricius to dissections, to- 
 gether with the discovery of the valves of 
 the veins, seems to have directed the channel 
 of Harvey's future inquiries, and to have laid 
 the foundation of his future fame. 
 
 He continued three years in the university 
 of Padua, where he took the degree of Doc- 
 tor of Physic, and returned to England when 
 he was about twenty-four years of age. After 
 his return to his native country, he continued 
 
40 
 
 the same industry and ardour for knowledge. 
 Every day was adding to his reputation, 
 which at length pointed him out as the most 
 proper person to be chosen President of the 
 College of Physicians. He afterwards be- 
 came physician to St. Bartholomew’s Hos- 
 pital, and was appointed to give lectures 
 there on anatomy and surgery. It was in 
 these lectures, probably, that he first threw 
 out his doctrine of the circulation ; but he 
 did not publish it till the year 1628*. 
 
 We shall not enter at large into all the ar- 
 guments and experiments by which Harvey 
 confirmed this doctrine, for they could not 
 be made intelligible without more knowledge 
 of anatomy than you are at present supposed 
 to possess. It is sufficient to mention that 
 Harvey has employed every argument at pre- 
 sent known upon this subject, except those 
 derived from microscopical observation, and 
 that his language is clear and decided. 
 
 It is pleasant to observe how naturally he 
 speaks of his first apprehension of the circu- 
 
 * He taught this new doctrine in his lectures about the 
 year 1616. 
 
41 
 
 lation. “ I began,” says he, “ to think whe- 
 ther there could be any motion of the blood 
 as in a circle ; which I afterwards found to be 
 true, and that the blood is propelled from 
 the left ventricle of the heart through the ar- 
 teries to every part of the body, as it is to 
 the lungs from the right ventricle through 
 the arterious vein, (now the pulmonary ar- 
 tery,) and that it again returns through the 
 vena cava into the right auricle, as it returns 
 from the lungs into the left ventricle through 
 the veinous artery (now the pulmonary veins) 
 as has been already mentioned.” 
 
 This passage of Harvey, which is very 
 faithfully translated, contains a most accu- 
 rate and pointed description of the circula- 
 tion, without any ambiguity, and would of 
 itself be enough to establish his claim to this 
 discovery ; but he has extended it into a con- 
 siderable work, by a great variety of experi- 
 ments and arguments, so as to leave nothing 
 to be done by his successors. 
 
 In this manner was completed the discovery 
 of the circulation, perhaps the greatest in the 
 animal economy ; and if it may appear to 
 any person viewing it at present, that after 
 
42 
 
 what had been done by Servetus, Columbus, 
 Caesalpinus, and Fabricius, it required no very 
 extraordinary effort of genius, it ought to be 
 recollected how disposed the mind is to be 
 governed by former opinions, and how little 
 apt it is to be observant of what is unknown. 
 
 When the discovery of the circulation be- 
 came generally diffused, it met with an un- 
 favourable reception from many anatomists. 
 Some of them denied the truth of what had 
 been asserted ; and others ascribed the dis- 
 covery to some of the ancients. Arguments 
 and experiments soon overcame the first kind 
 of opposition ; and the other was easily seen 
 through, having arisen from those feelings of 
 envy which will not bear even a merited su- 
 periority. But all is now hushed. Harvey 
 is in full possession of the discovery, and the 
 envious clamour of contemporary anatomists 
 has ceased for ever. 
 
INTRODUCTORY LECTURE, 
 
 PART II. 
 
 We have now traced the progress of ana- 
 tomy to the discovery of one of the most im- 
 portant functions in an animal body, — the 
 mode of conveying the materials for its pre- 
 servation and support. These materials are, 
 however, always exhausting, so as to require 
 a system of supply. This is accomplished by 
 a certain order of vessels called lacteals, 
 which arise from the inner surface of the in- 
 testines, and which, after having passed 
 through a number of glands, terminate in a 
 considerable duct, opening into a large vein 
 near the heart. These vessels absorb the 
 chyle from the intestinal canal, and convey 
 it into the general mass of circulating blood, 
 
44 
 
 into whose nature it is assimilated, thus be- 
 coming fitted for all the purposes of nourish- 
 ment and growth. Such an apparatus was 
 absolutely necessary, as there is a continual 
 waste of blood from the various secretions of 
 the body. 
 
 More, however, was still required. An 
 animal must not only grow ; but there must 
 be a certain regulation of its growth, giving 
 a determined shape. It would be necessary 
 also that an animal should be endowed with 
 some internal power of removing what may 
 be hurtful, or may irritate the body. This 
 can only be given to a certain extent ; be- 
 cause, unless the power was in an infinite de- 
 gree, there would always be some irritations 
 sufficient to overcome it. For these purposes 
 an animal is provided with a set of vessels 
 arising from every surface, cavity, and inter- 
 stice of the body, passing through similar 
 glands with the lacteals, and having their ter- 
 mination in the same duct. Such vessels 
 have been called lymphatics , from their 
 being commonly filled with a transparent 
 fluid. They are the same sort of vessels with 
 the lacteals, and carry on the general action 
 
4 5 
 
 of absorption throughout the body, pro- 
 ducing thereby various effects according to 
 circumstances. 
 
 This order of vessels is only of late dis- 
 covery, probably because they are small, co- 
 lourless, and often empty, so as not to be 
 distinguishable from the neighbouring parts ; 
 and because anatomists were formerly little ac- 
 customed to dissection. In the present times 
 they have risen to the notice which they de- 
 serve, since they are employed for as impor- 
 tant purposes as any in the animal economy. 
 The principles of their action are probably 
 as well understood as that of the blood-ves- 
 sels, but their particular anatomy is more 
 imperfectly known. 
 
 It appears clearly from the testimony of 
 Galen that white vessels had been seen by 
 Erasistratus on the mesentery of kids. This, 
 however, was not a discovery, for he did not 
 distinguish them from veins ; he had only 
 observed what was presented to his eyes, 
 without making any conjecture ; and it was 
 very long indeed after his time before they 
 were known as a separate order of vessels. 
 
 Towards the beginning of the seventeenth 
 
46 
 
 century, Asellius*, a professor of medicine 
 at Pavia, discovered on the mesentery of a 
 dog some small vessels filled with a white 
 fluid. This was a new appearance, and at- 
 tracted his observation. He thought at first 
 that they might possibly be nerves ; but when 
 he pricked one of them, and perceived a 
 white fluid to pass out, he was immediately 
 struck with the impression of a discovery, 
 and in the fullness of his heart called out 
 Et^jjjsa. The natural feelings of a mind in 
 such a situation are most forcibly described 
 by him. “ Quo viso , cum tenere latitiam non 
 possem , conversus ad eos qui aderant , ad Alex- 
 andrum Tadinum et senatorem Septalium im- 
 primis utrumque de amplissimo medicorum or- 
 dinis Collegio , et cum hcec scriberem tuendce 
 publicce sanitati pvcefectum , Ev^ku, inquam 
 cum Archimede ! •]-” 
 
 This new appearance had so excited the 
 attention of Asellius, that he was eager to 
 establish and confirm it by other trials. He 
 therefore laid open the belly of another dog, 
 with the expectation of seeing the same sort 
 
 # Asellius was born at Cremona. 
 
 t Vide page 24. 
 
47 
 
 of vessels ; but he was disappointed. This 
 mortified him exceedingly ; but he recol- 
 lected that the first dog had been opened a 
 few hours after having eaten a hearty meal, 
 and he thought that something might depend 
 upon this circumstance. He therefore made 
 the experiment upon a third dog, which had 
 been plentifully fed a short time before ; and 
 was rejoiced to see the same vessels again. 
 He was now convinced of its being an uni- 
 form appearance, and he prosecuted his in- 
 quiries by extending these experiments to 
 other animals. His enthusiasm was so great, 
 that a week scarcely elapsed without the sa- 
 crifice of a living animal ; and he expressed 
 a regret that similar experiments could not 
 be made upon the human subject. He was, 
 however, fully persuaded that this order of 
 vessels could not be wanting in the machinery 
 of so perfect an animal. From the circum- 
 stance of their being discoverable or not, ac- 
 cording as the animal had been lately fed, or 
 had been a long time fasting, he was naturally 
 led to think that their office was connected 
 with the food, and he believed it to be ab- 
 sorption. 
 
48 
 
 Although he had clearly distinguished the 
 lacteals to be a particular system of vessels, 
 yet he was mistaken about their termination; 
 for he believed that they ended in the liver, the 
 trunk of the absorbents being still unknown. 
 Attention to this subject was now, however, 
 awakened among anatomists, and the error of 
 Asellius was soon corrected. Picquet traced 
 the lacteals into the receptaculum chyli; and 
 he has mentioned this subject very clearly, 
 and with singular modesty. “ It is to be at- 
 tributed,” says he, “ to ill fortune rather than 
 want of attention that anatomists should not 
 know the chyle is neither carried to the liver, 
 nor the vena porta, nor the vena cava, near 
 the emulgents, as is the general opinion : but 
 any one by dissection may perceive, as clearly 
 as sunshine, that the lacteal vessels pass from 
 the intestines to a certain receptacle, which, 
 in brutes at least, occupies the space between 
 the 4 1 0Ul ” Prom the receptaculum chyli he 
 traced the trunks of the absorbents to their 
 termination in veins, so as to discover the 
 whole route of the chyle. This, however, 
 was only in brutes ; nor w T as it the first time 
 that the thoracic duct, or trunk of the ab- 
 
49 
 
 sorbents, had been noticed by anatomists. 
 Eustachius had many years before seen it in 
 the chest of a horse, and had called it vena 
 alba thoracis. 
 
 It remained still, however, to make the 
 same progress in the human subject. 
 
 Veslingius is said to have observed in the 
 year 1634 the lacteal vessels in man, and 
 in the year 1649 the thoracic duct. This 
 duct was afterwards brought to the general 
 knowledge of anatomists by Peirish and Van 
 Horne, and the lacteals were soon traced to 
 their termination in it. The whole route of 
 the chyle was in this manner completed in 
 the human subject, which entirely overthrew 
 the ancient idea, that the liver was employed 
 in forming blood. 
 
 The lacteals, however, form only a small 
 part of the absorbent system ; it extends over 
 the whole body, absorbent vessels taking 
 their origin from all cavities, and surfaces, 
 and interstices. Much, therefore, still re- 
 mained to be discovered ; and Olaus Rud- 
 beck, a Swede*, has the honour of being the 
 
 * Olaus Rudbeck, born at Arosa in 1630. 
 
 E 
 
50 
 
 discoverer of the lymphatic vessels. They 
 had first, indeed, according to Haller’s ac- 
 count, been seen by Veslingius, going from 
 the spleen along the pancreas ; but he had 
 not established by experiments their parti- 
 cular nature. This discovery is therefore to 
 be considered as Rudbeck’s, who so examined 
 them, as clearly to distinguish that they were 
 a peculiar set of vessels, which had hitherto 
 escaped the observation of anatomists. The 
 account he has given of his discovery is very 
 clear and natural. He says that in the months 
 of October and November of the year 1650, 
 and in the months of January, February, 
 March, April, September, October, and No- 
 vember of the year 1651, he made many dis- 
 sections in order to ascertain whether the 
 lacteals accompany the vena port arum, and 
 terminate in the porta of the liver, as was the 
 common opinion among anatomists. For 
 this purpose he made ligatures surrounding 
 the vena portarum , and watched if he could 
 perceive the course of the fluids in the lac- 
 teals. He found, however, no lacteals, and 
 was surprised to discover some vessels filled 
 with a transparent fluid, turgid on the side of 
 
51 
 
 the liver, and concluded immediately that 
 they were not lacteals, but a new set of ves- 
 sels hitherto unknown ; and he called them, 
 from the sort of fluid which they carried, 
 vasa serosa. In the year 1652, in the months 
 of February and March, he discovered the 
 same sort of vessels passing to the glands of 
 the groin, and traced them on to the thoracic 
 duct. 
 
 These circumstances were sufficient to se- 
 cure the discovery to Rudbeck, if he were 
 ■not anticipated by any other anatomist. 
 Thomas Bartholin, a Dane*, has laid claim 
 to the discovery ; but by his own account he 
 was not acquainted with the lymphatic ves- 
 sels till the month of December 1651, and 
 had not traced them on to the thoracic duct 
 like Rudbeck. Indeed there is great reason 
 to suspect that Bartholin has been uncandid 
 upon this subject. It is more than likely 
 that he had heard something of Rudbeck's 
 discovery, from some inadvertent expressions 
 in his own work ; and it is probable that a 
 hint had been given him from the manuscripts 
 
 * Born at Copenhagen in l6l6. 
 E 2 
 
52 
 
 of Veslingius, which came into his hands, 
 and were afterwards published by him. Bar- 
 tholin speaks as if he were sore about the dis- 
 covery, a circumstance always of suspicion. 
 “ We envy/’ says he, “ no one’s reputation ; 
 let the palm of fame lie open to all ; only let 
 the honour of the invention be left to us, as 
 we trust we deserve it.” 
 
 The same discovery has also been attri- 
 buted to an English physician, named Jo- 
 liffe. This rests upon the authority of Glis- 
 son, who has stated that in June 1653, 
 when Dr. Joliffe was taking; his degree at 
 Cambridge, he mentioned to him that he had 
 observed in various parts of different animals, 
 as in the limbs, testicles, womb, <Scc., vessels 
 filled with a watery fluid, which was directed 
 in its course towards the root of the mesen- 
 tery. It is very possible that Joliffe* may 
 have remarked these vessels without any hint 
 from others, because it is very possible for 
 different persons engaged in the same pur- 
 suits to make the same discovery : yet as 
 Rudbeck has fixed on a particular date, 
 
 # Joliffe himself has not written any thing upon this subject. 
 
53 
 
 prior to that mentioned by Glisson, he must 
 still remain in possession of the honour. 
 
 Although the lymphatic vessels were now 
 certainly discovered, yet anatomists were en- 
 tirely ignorant of their use, and their relation 
 to the absorbent system. They considered 
 them as appendages to the arteries, and sup- 
 posed that they served the purpose of carry- 
 ing back the watery part of the blood. There 
 was, therefore, still room for a most important 
 discovery in the physiology of these vessels. 
 This was reserved for Dr. Hunter, who taught, 
 so early as the year 1747, that the lymphatic 
 vessels were not continuations of arteries, 
 but were the real absorbents, arising from 
 every surface and interstice of the body, and 
 that they were a part of the same system of 
 vessels with the lacteals, forming together one 
 general system of absorbent vessels. This he 
 proved by the strongest arguments, drawn as 
 well from the minute injection of blood vessels, 
 while the absorbents were not filled, as from 
 the resemblance of the lymphatic to lacteal 
 vessels, and their termination in the same 
 common trunk. This discovery has been 
 claimed by a celebrated professor of anatomy 
 in Edinburgh ; but I shall avoid entering 
 
54 
 
 into the dispute. It is enough to say that 
 Dr. Hunter taught this doctrine in the year 
 1747, six years before that professor declares 
 himself to have made the discovery. Dr. 
 Hunter has therefore an undoubted claim to 
 priority, whatever praise may belong to any 
 other person for having made the same dis- 
 covery without assistance. 
 
 The arguments proposed in support of the 
 opinion, that the lymphatics and lacteals 
 should be considered as belonging:; to the 
 same system, were so strong, that they im- 
 mediate^ brought with them conviction ; and 
 this opinion was therefore readily embraced 
 by anatomists. But still, as the vessels which 
 had been seen were generally small, and had 
 not been traced in every part of the body, it 
 was believed that the lacteal and lymphatic 
 vessels were not sufficient of themselves to 
 carry on the absorption of the body, and that 
 they were intended only to assist the veins in 
 the performance of this function. It became 
 necessary, therefore, in the prosecution of 
 the subject, to discover whether the lacteals 
 and lymphatics were the only absorbents. 
 The idea of their being a distinct and com- 
 plete system of vessels, fully equal to manage 
 
55 
 
 the absorption of the body, forcibly struck 
 the mind of Mr. John Hunter, and he im- 
 mediately instituted experiments to confirm 
 or overthrow it. For this purpose he made 
 many experiments on living animals, by 
 throwing different fluids into the intestines 
 for absorption ; and found that the lacteals al- 
 ways became filled with the fluid, but never 
 the veins. The same opinion he confirmed 
 also by injections, so as to establish it be- 
 yond a doubt. 
 
 All the observations and experiments re- 
 lating to absorbent vessels had been hitherto 
 confined to quadrupeds ; and although it was 
 natural to conclude that they likewise be- 
 longed to the other orders of animals, yet 
 the subject was incomplete till this point was 
 determined. FiXaminations were accordingly 
 made for the purpose. Mr. John Hunter 
 discovered absorbent vessels in birds and in 
 amphibious animals ; and these discoveries 
 were extended by the late Mr. John Hewson, 
 who was the first to ascertain the existence of 
 absorbent vessels in fishes. In this manner 
 were enlarged the views of the absorbent 
 system, by showing that it belonged to all the 
 
56 
 
 different orders of animals, very much con- 
 firming the idea that it was sufficient of itself 
 to carry on the purposes of absorption in the 
 body. 
 
 These ideas of the absorbent system began 
 very soon, at least in this country, to be 
 generally adopted, though it was still be- 
 lieved to be confined in its action to the 
 absorption of fluids. Mr. John Hunter ex- 
 tended the influence of its action to the 
 solids, which he deduced from the various 
 changes in the growth of the body, and the 
 different effects that take place in many dis- 
 eases of the solids. This opinion is beginning 
 at present to be generally received ; and the 
 merit of having first formed it has been 
 claimed by the same distinguished professor 
 before alluded to, but no sufficient evidence 
 has been offered in support of this claim. 
 
 In viewing the present state of our know- 
 ledge concerning the absorbent system, it 
 appears that the phenomena of its action 
 are tolerably well understood ; but the course 
 of particular vessels has not been traced in 
 every part of the bod} r . This is a work of 
 much patience and of considerable difficulty; 
 
57 
 
 but it will be gradually rendered more and 
 more perfect. Upon this part of the system 
 Mr. Cruikshank has laboured perhaps more 
 than any other person in this country, and 
 with what success I need only appeal to the 
 high reputation of his work. A. most splen- 
 did work on the same subject has also been 
 lately published by Mascagni. 
 
 The discoveries of the circulation and the 
 absorbent system are certainly the two great- 
 est in the animal economy. The one ex- 
 plains how every part of the body is nou- 
 rished and preserved, and the other explains 
 the mode of supplying the necessary waste 
 in the support of the body. There have be- 
 sides been many smaller discoveries ; such 
 as the structure of a particular viscus, a par- 
 ticular vessel, an excretory duct, a gland, 
 &c. ; but the history of such discoveries 
 would be leading you into minutiae which 
 you could not at present understand, and 
 therefore it is omitted. This enlarged detail 
 is left to future inquiries, when your curiosity 
 may be gratified with more advantage. 
 
 The general means, however, by which 
 the investigation of an animal body may be 
 
58 
 
 extended and facilitated, are so important 
 with respect to the functions of the animal 
 economy, that an inquiry into their invention 
 is very closely connected with even a general 
 view of the progress of this branch of know- 
 ledge. It does not confine itself within nar- 
 row limits, but reaches to the very foundation 
 of anatomy and physiology. 
 
 The utmost perfection of examination into 
 animal structure appears to be, that the parts 
 should be rendered exceedingly distinct to 
 the senses. This can only be managed in 
 two ways ; viz. by making the senses more 
 acute, and the parts themselves more distinct. 
 On these two circumstances must rest all the 
 improvements which can be made in exami- 
 ning the structure of an animal body. W e 
 are therefore to look for improvements in the 
 examination of animal structure to the in- 
 vention of magnifying-glasses, and to the arts 
 of preparation, particularly of injection. 
 
 The first step in the progress of anatomy 
 is to observe large and obvious parts. These 
 would for some time sufficiently occupy the 
 mind, and it would not occur that any thing 
 further could be done. The whole of anatomy 
 
59 
 
 would appear to be confined to what is 
 readily observable. When the mind had, 
 however, advanced further, and been enlight- 
 ened by the general principles of natural 
 philosophy, showing the infinite divisibility 
 of matter, it would immediately occur that 
 there was a large field of discovery, beyond 
 what had formerly even been imagined, and 
 a terra incognita lying open for research. 
 This would appear the more important, as it 
 must have occurred, whenever men were dis- 
 posed to reason on the subject, that the ac- 
 tions of an animal body are not to be referred 
 to the larger parts, but to the smaller, of 
 which these are composed. Hence the ex- 
 amination of minute structure is evidently 
 more connected with physiology ; and if ever 
 the latter is to be known at all, it must be 
 through the medium of the former. 
 
 Anatomy was so far advanced as readily to 
 receive these improvements about the time 
 of Malpighi, an Italian anatomist, bom near 
 Bologna in the year 1638. In the early part 
 of his life, before he cultivated medicine, he 
 was singularly fond of philosophy, and it was 
 probably this which led him to the application 
 of the microscope to anatomical purposes. 
 
60 
 
 He was the first who pointed out a new field 
 in anatomy, by the application of an instru- 
 ment, which must however, at that time, have 
 been employed for many purposes of natural 
 philosophy. It had been invented about the 
 beginning of the seventeenth century by a 
 Dutchman*, and was probably coming into 
 considerable use. 
 
 As soon as the microscope was employed, 
 it must have furnished new lights to anatomy. 
 Malpighi accordingly made many new ob- 
 servations. He examined the minute struc- 
 ture of the parts most essential to life, espe- 
 cially the organs of secretion, and gave a 
 new opinion about their structure. This ex- 
 ample excited other anatomists to pursue the 
 same plan, till at length microscopical obser- 
 vation went hand in hand with the larger and 
 more palpable anatomy. 
 
 Leeuwenhoeck, a Dutch anatomist -f-, who 
 lived soon after the period of Malpighi, con- 
 
 * Dribbel, a Dutchman, is said to have invented the mi- 
 croscope in l621. This invention is also claimed by Fon- 
 tana, a Neapolitan. Malpighi used it for anatomical pur- 
 poses about the year l66l. 
 
 F Leeuwenhoeck was born at Delft. He began his mi- 
 croscopical observations in anatomy about the year HiSO. 
 
61 
 
 siderably improved microscopical instruments 
 by being extremely careful in polishing the 
 glass, and giving them an increased magni- 
 fying power. He was thence enabled to ex- 
 amine parts with the utmost minuteness ; 
 and the calculations he has formed often 
 astonish, and almost stagger the belief. This 
 kind of observation became at length very 
 generally diffused among anatomists, so that 
 they were rather too much attached to it, 
 for the mind is naturally pleased with wonder. 
 In their enthusiasm, however, they made 
 many real and useful discoveries. The com- 
 ponent parts of the blood, of milk, of oil, and 
 of other fluids, were detected ; the circulation 
 of the blood was brought under the exami- 
 nation of the eye, in the transparent mem- 
 branes of animals ; and the structure of many 
 of the solid parts of the body was much better 
 ascertained. The same kind of investigation 
 has been continued among succeeding ana- 
 tomists, so that every part of the body has 
 been minutely examined ; but they have used 
 more caution, as they have been more aware 
 of the fallacies and errors which attend very 
 minute microscopical observations. 
 
62 
 
 It is not, however, sufficient for the purpose 
 of examining into animal structure, that the 
 vision should be more acute, but further that 
 the parts should be so developed as to be more 
 fitted for observation. This comprehends 
 the art of preparation, which was not at all 
 known among the early anatomists. Such 
 an art would arise gradually, beginning with 
 what was least artificial, and what might be 
 observed in natural processes. The skeleton 
 would therefore be the first sort of prepara- 
 tion, being suggested by the frequent expo- 
 sure of the carcases of animals, where the 
 flesh has been dissolved away by putrefaction 
 and the bones have been left bare. This 
 would soon be followed by the preservation 
 of some of the soft parts. 
 
 It must have been observed that the flesh 
 of animals, when not very bulky and free 
 from fat, became upon exposure to the air so 
 thoroughly dry as not afterwards to imbibe 
 moisture, and could then be preserved for any 
 length of time. The power of certain anti- 
 septic substances must have been known ; 
 and anatomists must have heard something 
 of the mode of embalming among the Egyp- 
 
63 
 
 tians. Some art, upon the same principle, 
 would naturally be transferred to the pre- 
 servation of parts for anatomical purposes. 
 Many of the soft parts too, when left acci- 
 dentally in water for a considerable time, 
 would be found to separate, and their minuter 
 structure to be evolved ; and this would na- 
 turally suggest the employment of similar 
 means for the more accurate examination of 
 structure. Such modes of preparation re- 
 quired little art, and were pressed upon the 
 attention from many common occurrences ; 
 and we find, accordingly, that this was the 
 state of progress in preparations among the 
 early anatomists, even a long time after they 
 had been accustomed to dissections. 
 
 Swammerdam, in speaking of the advance 
 of this branch of anatomy, has said, “ that in 
 the art of preserving parts, Van Horne ex- 
 celled all other anatomists ; and that next to 
 him was De Bils, who showed his industry 
 by drying the muscles of the whole body, and 
 covering them with balsam. Hallpert Vander 
 W iel succeeded him, the scholar of V an Home, 
 and much superior both to him and De Bils. 
 He knew the art of varnishing over the parts 
 
64 
 
 of the body, of clearing vessels from fat and 
 parenchyma, of filling cavities with air, and, 
 what was still more wonderful, of drying in 
 the air moist bodies ; and he was very liberal 
 in permitting his preparations to be seen.” 
 By this quotation from Swammerdam we 
 see the state of the art of making prepara- 
 tions before that of injection had been dis- 
 covered, and it is obvious how imperfect it 
 was. Parts are in some measure confounded 
 together and shrunk by being dried, so as to 
 show nothing of structure ; and this method 
 can be used only in preserving whole parts, 
 which are better examined and understood 
 by fresh dissection. The art of separating 
 by maceration in water would teach more ; 
 but it requires great care that the parts be 
 properly unravelled, and that nothing be lost. 
 This is therefore liable to considerable diffi- 
 culties, and can at best only reach to a cer- 
 tain degree of accuracy. It cannot show the 
 distinction between small empty vessels and 
 fibres, so as to reach to the very minute 
 structure of parts ; and we must therefore 
 look to the discovery of other means more 
 adequate to this end. Such means are af- 
 
65 
 
 forded by the art of injection. In its be- 
 ginning this was very rude and imperfect ; 
 but it has gradually advanced to very great 
 perfection, and has become the chief means 
 of developing the smaller component parts 
 of an animal body. Indeed, the advantages 
 arising from the invention of the art of in- 
 jection are almost incredible. It has shown 
 the course of the smaller branches of vessels, 
 and the comparative vascularity of parts ; 
 has displayed the structure of many glands ; 
 has confirmed the doctrine of the circulation ; 
 has discovered the mode of union between 
 the vessels of the mother and the child during 
 pregnancy ; and has assisted in disproving 
 the connexion between absorbents and blood- 
 vessels. This invention becomes therefore 
 an object of considerable magnitude, even in 
 a very general history of the progress of 
 anatomy. 
 
 Very simple and imperfect means of in- 
 jecting vessels were at first employed. Air 
 was inflated to distend them, or some co- 
 loured fluid was thrown in ; as milk, quick- 
 silver, ink, and solutions of metals. Such 
 means were liable to many inconveniences. 
 
 F 
 
66 
 
 If a vessel be distended with air, and is after- 
 wards to be dissected, when the least punc- 
 ture is made through its coats, all the air 
 escapes, the vessel collapses, and returns to 
 its former obscurity. It affords, however, a 
 ready means of showing the course, number, 
 and size of vessels, which in that state may 
 not be intended to be traced more accurately 
 by dissection. 
 
 When fluids, such as milk, ink, and solu- 
 tions of metals are employed for injection, 
 although they render the vessels much more 
 distinct to the eye, yet they will not allow 
 any accurate tracing by dissection ; for punc- 
 tures must occasionally be made, and the 
 fluid will escape. It is probable too, that 
 even when no puncture has been made, the 
 fluid would gradually evaporate, or transude 
 through the vessels, so as to leave them empt}^. 
 
 For these reasons it became necessary that 
 other materials of injection should be dis- 
 covered, such as would not escape by punc- 
 tures, nor leave the vessels dry by evapora- 
 tion. When this difficulty was overcome, a 
 contrivance was still wanting to apply a force 
 capable of propelling the materials of injec- 
 
67 
 
 tion uniformly through the minuter branches 
 of a vessel. These two requisites were soon 
 supplied by the ingenuity of two different 
 persons. De Graaf*, a Dutch anatomist, 
 about the middle of the seventeenth century 
 invented the syringe, by which the force em- 
 ployed to throw the injection into vessels can 
 be applied in a sufficient degree, and pro- 
 perly regulated. This very much resembles 
 the syringe at present used ; but the pipe he 
 employed was curved and was much longer. 
 
 The proper materials of injection were dis- 
 covered by Swammerdam -f- a little after this* 
 period; for De Graaf recommends the use of 
 metallic solutions. 
 
 In his Miraculum Naturce , Swammerdam 
 has mentioned the composition of his injec- 
 tion, which is as follows : 
 
 “Take of white wax what is sufficient; 
 melt it, and mix with it when melted a red, 
 yellow, green, or any other colour which may 
 be reckoned most suitable ; draw up the in- 
 jection with a syringe, and inject it into an 
 
 * De Graaf was born at Schoonhaven in Holland in 1 64 1 . 
 t Swammerdam was born at Amsterdam in 1637. 
 
 F 2 
 
68 
 
 artery and vein.” This was a very great im- 
 provement in the art of injection, but it af- 
 terwards admitted of some amendment. 
 
 Not long after this period injections were 
 much employed by some anatomists ; and 
 Ruysch*, especially, carried this art to a very 
 high degree of perfection. He exhibited to 
 the world the specimens of his skill, but he 
 could not prevail on himself to be so liberal 
 as to discover the secret. A writer of his 
 life, speaking of the perfection of his art, has 
 said, “ Tali arte condita cadavera per plurimos 
 servabat annos, lit dormire potius quam mortua 
 viderentur 
 
 While the injection remains surrounded 
 by a quantity of fleshy substance, although 
 it may give an idea of general vascularity, 
 yet it is obvious that the course and number 
 of single vessels must be obscured. This 
 disadvantage would be most striking in fleshy 
 and very vascular parts, such as the glands 
 of the body ; and it suggested another im- 
 provement, — that of destroying the flesh which 
 surrounded the injection, so as to leave it 
 
 # Ruysch was born at Haye in 1638. 
 
69 
 
 bare. This was accomplished by the appli- 
 cation of a fluid which dissolved the flesh, 
 but did not act on the materials of the in- 
 jection. Dr. Nichols, who taught anatomy 
 in London about forty years ago, was the 
 author of this invention ; and it has since 
 been carried to much greater perfection, es- 
 pecially by Mr. John Hunter. Such is the 
 general history of the invention of injections, 
 an art which has been the source of many dis- 
 coveries in anatomy, and has particularly 
 rendered minuter anatomy more distinct and 
 certain. 
 
 In this account we have endeavoured to 
 be as general as possible, in order to avoid 
 perplexing you with circumstances which 
 might be unintelligible. We regret that this 
 plan has prevented us from here paying a 
 tribute of respect to many anatomists of the 
 most distinguished eminence, — such as Wins- 
 low, Albinus, Haller, &c. ; but as we proceed 
 you will be made acquainted with them and 
 with their various merits. 
 
 By the united efforts of men of distin- 
 guished talents during many centurie s , human 
 anatomy has at length arrived at great per- 
 
70 
 
 fection. Every part of the body large enough 
 to be examined by the naked eye has been 
 often noted and described, and magnifying- 
 glasses have been for a long time employed 
 to develope the minuter structure. Much, 
 however, still remains to be done in physi- 
 ology. There is scarcely a great function 
 going on in the human body which is clearly 
 understood. The uses of respiration, the 
 change of the food into chyle, and of the chyle 
 into blood, the impregnation of the female, 
 the mode of action in the nervous system, 
 the mode of action in muscles, are all as yet 
 very imperfectly known. These functions 
 go on apart from observation, and depend 
 upon the action of the minutest parts of the 
 body. What still remains to be known can 
 only be accomplished by a long chain of ju- 
 dicious experiments ; and probably some of 
 them will baffle the utmost efforts of human 
 ingenuity. It is our duty, however, to go on. 
 Experiments are every day affording new 
 light, and enlarging the bounds of knowledge. 
 
 Anatomy has of late years been much more 
 cultivated in this island than formerly. This 
 has been very much owing to Dr. Hunter, 
 
71 
 
 who, to a most acute understanding, added 
 a very singular enthusiasm and love for the 
 art. If anatomy be more generally or more 
 perfectly known ; if surgery has received any 
 improvements from it, — it is to be attributed 
 in a great measure to the spirit of this single 
 man. 
 
 He began the world with very moderate 
 prospects ; yet by his industry and talents, 
 without any meanness in his manner of ad- 
 vancement, he rose to be one of the first cha- 
 racters in this country*. He had been in- 
 
 * He was the second son of John and Agnes Hunter. 
 H is father was descended from the Hunters of Hunterstown 
 in Ayrshire, a family of great respectability. His mother 
 was a daughter of Mr. Paul, who was engaged in the malt 
 trade, and was treasurer to the city of Glasgow. JDr. Hunter’s 
 father lived upon a small estate called Long Calderwood, in 
 the parish of Kilbride, near Glasgow. He was a man of ex- 
 cellent understanding and of great integrity, but of an anxious 
 temper. His mother was a woman of great worth, of a 
 handsome person, and considerable talents. There were ten 
 children, most of whom had more than the usual share of abi- 
 lities. The females were handsome, and most of them died 
 young. James, the eldest brother, who was of great promise, 
 died young also, being not more than twenty-eight years of 
 age. He had been bred to the law ; but disliking that pro- 
 fession, he intended to become a physician. He was con- 
 
72 
 
 tended originally for the Scotch church ; 
 but disliking many circumstances in that 
 profession, he was easily persuaded by his 
 friend Dr. Cullen to turn his attention to 
 the study of physic. He began his medical 
 education under the direction of Dr. Cullen, 
 at that time settled in Hamilton, with whom 
 he lived some years ; and he afterwards stu- 
 died both in Edinburgh and London. It was 
 intended that he should return to Dr. Cullen 
 and take a share of his business ; the one to 
 practise surgery, and the other medicine : 
 but Dr. Cullen very generously gave up the 
 
 sidered by Dr. Hunter as the cleverest of the family ; and I 
 have heard him say that if James had lived, he thought 
 nothing could have prevented him from being the first phy- 
 sician in London. It would have been very remarkable to 
 have seen at die same time three brothers at the head of the 
 three departments of physic. James at the head of medicine, 
 William of midwifery, and John of surgery. Dr. Hunter’s 
 father was occasionally obliged to sell portions of his estate, 
 to meet the necessary expenses of so large a family, though 
 managed with great frugality. This increased the constitu- 
 tional anxiety of his mind; and he was often kept awake in 
 the night by thinking on the difficulties of his situation. 
 Those portions of the estate which had been sold were many 
 years afterwards repurchased by Dr. Hunter, when he had 
 acquired some fortune from the exercise of his profession. 
 
73 
 
 scheme when he learnt that better prospects 
 were open to Dr. Hunter. 
 
 During his residence in London, Dr. Hun- 
 ter, from his industry and fondness for ana- 
 tomy, procured the good opinion of Dr. 
 James Douglas, who engaged him to give 
 his assistance in anatomical pursuits. He 
 was now beginning to see some prospect of 
 advancement, when Dr. Douglas died, leav- 
 ing behind him a widow with a son and 
 daughter. Dr. Hunter had lived but a short 
 time with Dr. Douglas when this melancholy 
 event happened ; but from his good sense 
 and good behaviour, he remained in the fa- 
 mily as formerly, and was afterwards intrusted 
 with the care of young Douglas in an excur- 
 sion to Holland and to Paris. The ambition 
 of Dr. Hunter, and his enthusiasm for ana- 
 tomy, were so great, that his exertions were 
 not crushed by the death of Dr. Douglas, 
 but he continued his anatomical pursuits with 
 unabating ardour. He very early communi- 
 cated his ideas on the structure of cartilage to 
 the Royal Society, which gave a very favour- 
 able impression of his industry and talents. 
 
 His taste for anatomy probably suggested 
 
74 
 
 to him the idea of teaching it ; and it 
 was not long before he had an opportunity 
 of showing himself in this character to the 
 public. In the winter of 1746 he was en- 
 gaged by a society of navy surgeons to give 
 a few lectures on the operations of surgery, 
 and the structure of the parts more imme- 
 diately concerned in them. Upon this trial 
 he met with such general approbation, that 
 he was encouraged to take up anatomy the 
 ensuing winter on an extended scale. What 
 has been his success, and what his reputation, 
 you need not be told. No one ever pos- 
 sessed more enthusiasm for the art, more 
 persevering industry, more acuteness of in- 
 vestigation, more perspicuity of expression, 
 or indeed a greater share of natural elo- 
 quence. He was uncommonly ready in his 
 apprehensions, and singularly happy in mak- 
 ing others understand what he knew himself. 
 His arrangement of any subject was clear 
 and judicious ; he knew how far the attention 
 would reach, and when it was beginning to 
 decline ; and he had a most happy talent 
 of introducing anecdotes which might excite, 
 amuse, and instruct. 
 
75 
 
 He had first been intended for surgery, 
 but he very much disliked all operations 
 which might give pain. He was therefore 
 easily induced to quit it, and to follow mid- 
 wifery, for which he was singularly calculated 
 by the delicacy of his manners, and a very 
 quick perception of the caprices of the world. 
 Not long after this change in the line of his 
 profession, when his reputation was rising 
 high, the University of Glasgow was proud 
 to recollect him among her offspring, and to 
 show a testimony of their respect by con- 
 ferring on him the degree of Doctor in Physic. 
 
 At a very early period, having foreseen 
 that he would soon be so much distracted by 
 the multiplicity of business, as to prevent him 
 from carrying on anatomy on the extended 
 scale he wished to do, he sent for his brother, 
 John Hunter, to assist him in these pursuits. 
 What judgement he has shown in this choice 
 the distinguished reputation of the latter has 
 long ago determined. He was afterwards 
 assisted also by Mr. Hewson and Mr. Cruik- 
 shank, whose merits as anatomists have been 
 deservedly honoured by an ample testimony 
 of the public good opinion. 
 
76 
 
 Although the hurry of business a good deal 
 interrupted the attention of Dr. Hunter from 
 his favourite pursuit, yet this was in a great 
 measure counterbalanced by the enthusiasm 
 and vigour with which he devoted to it every 
 moment of his leisure time. He very fortu- 
 nately was not much influenced by the pre- 
 judices of common opinion, so that his mind 
 was left clear in its exertions. This, joined 
 to quickness of apprehension and a very 
 chaste talent for reasoning, led him often to 
 discover what had been overlooked by others. 
 Considering the advanced state of anatomy 
 in his time, he has acquired much more of 
 this sort of honour than could have been ex- 
 pected. Had he only classed the lymphatics 
 and lacteals together, so as to form them into 
 one general system of absorbent vessels, it 
 would have been enough to have secured the 
 immortality of his name, for this compre- 
 hended nothing less than the discovery of one 
 great universal principle in the animal eco- 
 nomy. He has, however, enriched anatomy 
 and physiology with many other discoveries. 
 
 That of the decidua refiexa has added to 
 his reputation ; and he has delineated the 
 
77 
 
 whole anatomy of the gravid uterus in its 
 progress towards maturity, from its earliest 
 state, in a work which will ever be highly 
 valued while there is any taste for anatomy 
 remaining in this country. 
 
 He explained the anatomy of aneurysm 
 more perfectly than had been done before 
 his time, and has established a more clear and 
 certain reasoning upon it. A new species of 
 aneurysm, called the Varicose Aneurysm, 
 was discovered by him ; which, although ari- 
 sing from an accident not very uncommon, 
 had entirely escaped the observation both of 
 anatomists and surgeons ; and, what does not 
 often happen to discoverers, he explained all 
 the circumstances of it as fully and certainly 
 at first as they have since been known. 
 While reflecting upon what Baron Haller 
 had discovered relative to the descent of the 
 testicles, and the hernia congenita , he ex- 
 plained the true cause of that species of 
 hernia sometimes found in adults, in which 
 the contents of the hernia are in contact with 
 the testicle. This explanation has been sa- 
 tisfactory to all future anatomists, and has 
 been universally adopted. He also first de- 
 
78 
 
 tected the true nature of the retro verted 
 uterus, and made it generally known in this 
 country. Such are his greater discoveries ; 
 but his mind was ever active, so as to be full 
 of new observation. 
 
 What a share of discovery for one man ! 
 Has he not earned his reputation well ? I am 
 not fettered by delicacy on this occasion : I 
 look upon relationship as nothing — as an ac- 
 cident. I consider Dr. Hunter only as an 
 ardent cultivator and friend of science, and 
 I speak of him as I feel and believe. 
 
 His reputation soon procured him the 
 highest rank in his profession, and in time 
 the honours he deserved. He was not only 
 a member of the Royal and Antiquarian So- 
 cieties in this country, but a few years before 
 his death he was elected one of the foreign 
 associates of the Royal Academy of Sciences, 
 and of the Royal Medical Society, at Paris, 
 honours that are only conferred on a very 
 limited number of the most celebrated literary 
 characters throughout Europe. 
 
 It is well known that the success of Dr. 
 Hunter in his profession afforded him the 
 opportunity of amassing a large fortune. 
 
79 
 
 This he in a great measure expended in the 
 promotion of science, by forming a collection, 
 which not only reflects honour on him as an 
 individual, but has become in no small degree 
 an object of public interest to this country. 
 Whatever may be at any time the reputation 
 of the teachers in this school, let it be re- 
 membered that it is to him they owe the most 
 ample materials for diffusing and advancing 
 the knowledge of anatomy. 
 
 Anatomy and surgery have recently suffered 
 a most severe loss by the death of Mr. John 
 Hunter*. His mind was bold and inventive, 
 treading constantly in a path of its own, 
 without regard to the common track which 
 had been followed by others. This was aided 
 by an industry and enthusiasm, of which it 
 would be difficult to find any superior ex- 
 ample. With such singular endowments for 
 the cultivation of science, his progress was 
 proportionably great. There is no subject 
 which he has considered, to which he has 
 not added new light ; and many branches of 
 
 * This was added after the death of Mr. Hunter in 1793. 
 
80 
 
 science he has very materially improved. 
 That two brothers should have become so 
 eminent in the same pursuits is almost with- 
 out example ; and it is equally rare that two 
 brothers should have formed collections of 
 such magnitude for the public interests of 
 science. These will remain to future ages as 
 monuments of their industry and talents, and 
 will call forth the grateful acknowledgements 
 of posterity. By such examples may we like- 
 wise be excited to exertions that may not be 
 unworthy the approbation of our country. 
 
 Every branch of knowledge ought to be 
 more or less interesting; according; to its uti- 
 lity. None can be considered as useless, be- 
 cause there is an universal chain of connexion 
 throughout nature ; but some are much more 
 important than others. Some afford little 
 else than objects of speculation for the em- 
 ployment of the mind, while others are most 
 closely connected with the happiness and 
 welfare of man. If there be a superior claim 
 upon such grounds to any branch of know- 
 ledge, it is due to anatomy. It teaches the 
 structure of an animal body, and explains 
 
81 
 
 its actions, as far as they are discoverable by 
 the efforts of human ingenuity. If this only 
 related to an animal in health, it would be 
 more an object of curiosity than of real use. 
 It would then only afford the means of in- 
 dulging the mind in agreeable researches : 
 but how infinitely it rises in importance when 
 we consider it as the chief guide in restoring 
 health to a body deranged by disease ! 
 
 Disease may be said to be a wrong action 
 either of the body generally, or of particular 
 parts. Sometimes disease terminates by a 
 gradual diminution of the diseased action, 
 without any visible effects being left behind; 
 while at other times it produces some al- 
 teration of structure, or the formation of a 
 new substance ; but these ultimately depend 
 on diseased action. 
 
 A disease must always have relation to a 
 healthy action, or healthy structure of parts, 
 for it is only a deviation from them ; so that a 
 knowledge of disease would appear to rest 
 on a knowledge of the body in its healthy 
 state. 
 
 It is unfortunate that the peculiar mode of 
 deviation is not always discoverable ; but it 
 
 G 
 
8 2 
 
 is evident that we cannot on any occasion 
 become well acquainted with the deviation, 
 without having previously known the ori- 
 ginal state. It is in this point of view that 
 anatomy and physiology become so very im- 
 portant, as affording the most likely means 
 of relieving the body when suffering under 
 disease. 
 
 When the structure and natural action of 
 any part is understood, it will best assist 
 us in discovering what causes may influ- 
 ence the action which produces a morbid 
 change, and how the application of other 
 influences may probably counteract these 
 causes, so as to protect the body from them. 
 It will still go further ; for when the causes 
 have been applied so as to produce their ef- 
 fects, it will be most likely to point out what 
 may be serviceable in bringing back the 
 parts to a natural mode of action. 
 
 The symptoms of a disease are appearances 
 which take place while the body is under a 
 diseased action, and depend on something 
 more secluded from observation. If they 
 arise simply from diseased action, no other 
 change having been produced, they leave no 
 
83 
 
 traces after death ; and there is only room for 
 conjecture, which will be more or less rea- 
 sonable, according to the understandings of 
 different persons, or their degree of know- 
 ledge of the animal ceconomy. But diseased 
 action often produces a change of structure, 
 or the formation of a new substance, or a 
 new situation, such changes becoming them- 
 selves the cause of many symptoms, and 
 being as it were intermediate between the 
 symptoms and the diseased action. This 
 gives the opportunity of anatomical exami- 
 nation, so as to trace more distinctly the na- 
 ture of the disease, to establish a better rea- 
 soning upon it, to point out how we should 
 act, what we may hope, and what we may 
 fear. 
 
 It is by no means uncommon that diseases 
 very different in themselves should have 
 symptoms a good deal resembling each other. 
 These may very often be confounded, es- 
 pecially by superficial observers ; but even 
 men of the soundest judgement are liable to 
 be mistaken. When, however, bodies are 
 examined after death, and the disease is as- 
 certained, the mind will be naturally led to 
 
 G 2 
 
84 
 
 attend minutely to symptoms on a future oc- 
 casion, endeavouring to detect some marked 
 difference, by which the disease may be dis- 
 tinguished in the living body. Thus opi- 
 nions and conjectures will be corrected by 
 facts, and physic be daily advancing upon 
 surer grounds. 
 
 Medicine, as far as has been hitherto known, 
 has little power over some diseases; and it is 
 of importance to separate these diseases from 
 others, where it can really be of service. In 
 such cases we should avoid teasing the pa- 
 tient with violent remedies, but endeavour to 
 soothe and palliate. We shall be much better 
 able to judge of these diseases when we have 
 examined them in the dead body. Our ideas 
 then become clear and defined, and we be- 
 come more decided how it is proper to act. 
 
 There is nothing which renders a person 
 so capable of discovering new diseases, as a 
 knowledge of anatomy. AI ho can be so well 
 fitted for this purpose as he who is familiar 
 with the natural structure, and the diseased 
 appearances in an animal body ? What per- 
 son but an anatomist could have discovered 
 the varicose aneurysm, or, taking advantage 
 
85 
 
 of Baron Haller’s observations upon the her- 
 nia congenita , could have explained the 
 cause of that species of hernia in which its 
 contents are in contact with the testicle ? 
 
 There are diseased appearances which are 
 very common in an animal body, and which 
 are of no great consequence ; and it requires 
 a familiarity with the human body to be able 
 to distinguish them from appearances strictly 
 natural, or from diseases that are really se- 
 rious. This last circumstance is of great im- 
 portance, when we consider how often we 
 are desired to examine bodies after death for 
 the satisfaction of friends, or are called 
 upon to do so by the laws of our country. 
 Upon our judgement may depend the life of 
 a fellow-creature. What reflection can be 
 more serious to a man of humanity ? But 
 independently of these circumstances, there 
 will be many cases of doubt presenting them- 
 selves to our minds, which we would wish to 
 settle, but shall not be able, unless we are 
 acquainted both with natural structure and 
 diseased appearances. Indeed how otherwise 
 is physic to be improved ? 
 
 Anatomy is still more closely connected 
 
86 
 
 with surgery than medicine. The first, being 
 concerned in local diseases, is capable of re- 
 ceiving more light from it than the other, 
 which is more employed about general dis- 
 eased action. A. surgeon who has taken care 
 thoroughly to study anatomy, besides having 
 a chance to be better acquainted with disease, 
 and better able to distinguish between two 
 diseases which are similar, is better fitted to 
 act in any operation. His hand is acquainted 
 with the knife, and he can cut more certainly 
 and surely. The knowledge of anatomy fits 
 a surgeon for performing operations in un- 
 common and difficult situations, teaching 
 him where he should cut with freedom, where 
 with extreme caution, and where not at all. 
 It fills his mind with resources. It points out 
 to him where an operation may be improved, 
 and suggests to him what steps he should take 
 when circumstances prevent an operation 
 from being done in the usual manner. In a 
 new situation it will tell him whether he may 
 operate or not, and what plan of operation 
 he is to follow. In fact, anatomy is the basis 
 of surgery, and without it a surgeon can 
 neither act with safety, nor accommodate 
 
 4 
 
87 
 
 himself to the infinite variety of circumstances 
 which may occur. 
 
 If then anatomy be of so much use in 
 physic and in surgery, it ought to be earn- 
 estly cultivated by those who really wish to 
 understand their profession, and to become 
 respectable in it. This is not a trifling 
 matter. Justice and humanity require every 
 exertion where the lives of our fellow-crea- 
 tures are concerned. There are many pro- 
 fessions where negligence or inattention may 
 be reckoned a folly, but in ours it is a crime. 
 
 We ought, therefore, to pursue with eager- 
 ness every branch of knowledge which may 
 render us more useful in the profession we 
 have chosen. I trust that from what you 
 have heard, you are convinced how much 
 anatomy is connected with it ; but it can only 
 be learnt by much labour, by patient and re- 
 peated observation of parts, by clearness of 
 arrangement, and a disposition to reason 
 upon what you see. 
 
 The parts of an animal body are so nu- 
 merous and complicated, that in order to be 
 retained in the memory they require a strong 
 impression. This cannot be made by the 
 
88 
 
 eye alone. The eye is quick, and so impa- 
 tient as to run over a number of objects 
 in a short time. It is therefore necessary 
 that the hands should be employed, to con- 
 fine the wandering of the eye, and attach it 
 for a sufficient length of time to one object. 
 It is for this reason that lectures by them- 
 selves never did make, nor ever can make a 
 good anatomist. Too many objects pass be- 
 fore the eye in a short time to produce a 
 proper impression. The practice of anatomy 
 or dissection must be added, without which 
 a man can only attain a wavering knowledge. 
 But it ought to be our aim to have our know- 
 ledge certain and ready, resembling as much 
 as possible original impressions, upon which 
 we may be able immediately to judge and 
 act. Without this, relief will sometimes be 
 withheld till the opportunity of affording it 
 is past ; and it is always a pitiful business to 
 hunt for knowledge as circumstances offer. 
 There should be at all times a considerable 
 fund ready to satisfy demands. 
 
 Anatomy cannot be learnt without the em- 
 ployment of the knife upon the dead body, 
 that great basis on which we are to build the 
 
89 
 
 knowledge that is to guide us in distributing 
 health and life to our fellow-creatures. N eed 
 I say more to influence men of conscience, 
 of humanity, of ambition, to be zealous and 
 industrious ? I am not willing to believe that 
 you are difficult of persuasion. 
 
 Every man of sense will soon discover what 
 is the most profitable method of study ; but 
 still it is right to direct you, and to save 
 you as much as possible the expense of ex- 
 perience. 
 
 At lecture very short notes should be taken, 
 notes rather of arrangement than of matter. 
 The attention will in this way be more closely 
 fixed, and there will be sufficient time to em- 
 ploy the eyes on the dead body, or the pre- 
 parations, so as to receive proper impres- 
 sions. These short notes should afterwards 
 be extended in the evening, while impressions 
 are distinct; an exercise which will teach 
 you to think, to arrange, and to write. Be 
 careful at lecture never to commit to paper 
 what you do not understand, for you are not 
 to attend to the words of the lecturer, but to 
 his ideas. Be determined in not suffering 
 the business of one day to encroach upon 
 
90 
 
 the next ; for if you once relax, you must 
 either hurry too much, neglect some things, 
 throw up your plan in despair, or have re- 
 course to the notes of another, which are but 
 a poor substitute for your own impressions. 
 
 In dissecting, it will be right to attend to 
 every thing that is exposed to view : render 
 every thing as distinct as possible ; notice 
 the relative situation of parts ; continue to 
 observe them till they can be drawn in your 
 fancy. This is knowledge. 
 
 I beg you will believe that the time of edu- 
 cation is the most important in any man's 
 life. He is then to decide his character and 
 his success in the world. If education be 
 pursued with industry, there will be a thou- 
 sand occasions afterwards of oTatifi cation and 
 
 © 
 
 comfort from it. If neglected, there will 
 soon be much room for repentance ; but it 
 will come too late. The opportunity will be 
 past, and it will be necessary to submit to 
 circumstances of humiliation. What feelings 
 are these for a man of spirit, who knows that 
 he once commanded the means of acting 
 through life with honour, confidence, and 
 satisfaction ! 
 
91 
 
 And success as well as character depends 
 on attention to education. It is an ill-founded 
 notion, arising from deserved disappointment, 
 to say that merit is neglected. It is some- 
 times joined with circumstances that may 
 have some influence in counteracting it, as 
 for instance an unfortunate temper, or a dis- 
 agreeable manner ; but generally it meets 
 with its due reward. The world does not 
 often judge erroneously ; persons of merit 
 have at least the best chance of success ; and 
 who would be ambitious of the public appro- 
 bation, if it had not the power of discrimi- 
 nating ? 
 
 Thus you see, Gentlemen, that you are at 
 present in a very critical situation, and that 
 almost every thing depends upon your own 
 exertions. A teacher can do little more 
 than point out the proper road to improve- 
 ment. I trust you will not be backward in 
 doing justice to yourselves, and I hope you 
 will not find here any want of attention, or 
 even of enthusiasm in your service. 
 
. ‘ 
 
 
 
 
 \ 
 
 
 N 
 
THE 
 
 GULSTONI AN LECTURES, 
 
 Read at the College of Physicians , May 17 94 . 
 
THE 
 
 GULSTONI AN LECTURES, 
 
 Read at the College of Physicians, May 1794. 
 
 INSTITUTIS hujus Collegii Magnifici, et 
 Praesidis mandatis, viri summa veneratione 
 admodum digni, obtemperandi perstudiosus, 
 quaedam de cerebro et nervis proponere co- 
 natus sum. In hac corporis humani parte 
 multa sunt penitus ignota, plurima per sese 
 tam obscura, quam sententiis eruditorum di- 
 versis perplexa. Argumentum nimis est co- 
 piosum, ut de omnibus quae isti pertinent 
 tractare, et nimis difficultatibus implicitum 
 ut ab illis expediri possim. De istis igitur 
 argumenti partibus, quae, magis sint observa- 
 tion dignae, et quid verisimile videatur se- 
 
96 
 
 quens, potius quam quid caeteri putaverint, 
 pauca proponere aggredior. Oro ut huic 
 incepto benigne arrideatis, auditores dignis- 
 simi, sentio enim quantopere benevolentia 
 indigeam vestra. 
 
 LECTURE I. 
 
 THERE is no part of an animal body more 
 curious in its structure, or more interesting in 
 its examination, than the nervous system. 
 This is the source of action and sensation, 
 and in man is also the medium of connexion 
 between the body and the mind. This system 
 is composed of a considerable mass, called 
 the brain, which is situated at one extremity 
 of the body; from whence various processes, 
 in the form of cords, pass to the other parts. 
 In the different orders of animals the nervous 
 
97 
 
 system bears a very different proportion to 
 the general mass of the body. In quadrupeds 
 the brain is larger in proportion to the size 
 of the body than in any other class, man 
 only excepted . In amphibious animals, fishes, 
 and insects, it is proportionably much smaller ; 
 and some tribes of animals are so simple in 
 their organization, as apparently to be with- 
 out nerves and a brain altogether. Of this 
 kind is the hydatid in sheep, which is an ex- 
 ample of the most simple kind of animal. 
 In these we may either suppose that the ner- 
 vous fibrils diffused through the body are so 
 small, as not to be capable of detection ; or 
 we may suppose that nervous matter is so 
 blended with the general structure of the 
 body, as not really to form a distinct orga- 
 nization. In animals of so simple a structure, 
 which of these two conjectures is true it is 
 perhaps impossible to ascertain, but Mr. Hun- 
 ter was inclined to believe the latter. 
 
 In man the relative proportion of the size 
 of the brain to the whole body is greater 
 than in any other animal ; and in comparing 
 the human brain with that of the common 
 quadrupeds of a much larger size than man, 
 
 H 
 
98 
 
 as the horse, the ox, &c., the difference is 
 very striking. The brain does not bear the 
 same relative proportion to the size of the 
 body in the very early periods of growth, 
 and in the adult state. In a child at birth 
 the brain is much larger in proportion to the 
 size of the body, than when the growth is 
 completed ; and in the early months of preg- 
 nancy this difference is still more remarkable. 
 In proportion as the body more completely 
 evolves itself, the relative size becomes less, 
 the other parts of the body having then a 
 quicker growth than the brain ; and it is a 
 very considerable length of time after birth 
 before the brain and the other parts of the 
 body acquire their proper balance. The 
 brain at an early period of existence is also 
 a good deal different in its structure from 
 what it is afterwards. It is much softer; and 
 in proportion as the child advances in growth 
 it is found to be more and more firm. The 
 difference between the appearance of the cor- 
 tical and medullary substance, is at a very 
 early period of life less strongly marked than 
 it afterwards becomes. The power, too, of 
 the brain to sustain pressure, is at this very 
 
99 
 
 early period different from what it is when 
 the child has made a further progress, and 
 especially when it has arrived at the adult 
 state. In a child before birth, and even for 
 some time afterwards, the brain is capable of 
 sustaining a great degree of pressure without 
 injury ; and indeed this was necessary on ac- 
 count of the compression to which it was to 
 be exposed in passing through the pelvis ; 
 but the adult brain can hardly bear the 
 smallest pressure without mischief. 
 
 The brain in the human subject, as well as 
 in many other orders of animals, is inclosed 
 in a bony case, called the cranium, which is 
 intended for its protection. The degree of 
 protection depends upon the thickness of the 
 bones, and this thickness becomes greater as 
 the protection becomes more necessary. It 
 is very obvious that an animal can hardly be 
 constructed so as to be protected against all 
 degrees of violence. The thickness of the 
 bones of the cranium is therefore suited to 
 the degrees of violence which generally occur. 
 Where the bones of the cranium are most 
 exposed to injury from external violence, 
 with fewer means of natural defence, there 
 
 n 2 
 
100 
 
 they are thicker. Where they are protected 
 by a thick application of muscles, or by the 
 instinctive defence of the arms, they are 
 thinner. Accordingly, at the posterior pro- 
 jecting part of the cranium the bones are 
 thicker than any where else. Nature is will- 
 ing to do enough ; but wherever the for- 
 mation of bony matter may be safely spared, 
 it does not take place. 
 
 There is a long process derived from the 
 brain, consisting of the same matter with the 
 brain itself, and requiring the same protec- 
 tion, viz. the medulla oblongata and spinalis. 
 The first is inclosed in the bones of the cra- 
 nium, along with the brain ; and the other is 
 lodged in a canal surrounded with bone, so 
 as to be equally protected. This canal is 
 situated in the spine, and the bones compo- 
 sing it are so firmly connected together, as 
 hardly to be liable to any risk either of dislo- 
 cation or of compression from angles being 
 formed by the motion of the bones upon 
 each other. Although the general amount 
 of the motion of the spine is very consi- 
 derable, yet the motion allowed between 
 any two contiguous bones is very small. 
 
101 
 
 When the bones of the cranium are at any 
 part removed, the brain does not come im- 
 mediately into view, but there is a series of 
 membranes which surround it. The most 
 external has been named the dura mater. 
 This is a membrane of great firmness, of a 
 white colour, and with a few branches of ves- 
 sels on each side ramifying upon it. It ad- 
 heres very firmly to the cranium at every 
 part, so as to require considerable force to 
 separate it. This adhesion is chiefly by 
 the medium of small branches of arteries, 
 which pass from the membrane into the sub- 
 stance of the bones of the cranium. The ad- 
 hesion is likewise very much strengthened 
 by the close application of the membrane 
 itself to the inside of the bones, and especially 
 by the membrane running into the foramina 
 of the bones at the lower part of the cranium. 
 The adhesion is always so firm, as to keep 
 the dura mater closely applied to the inside 
 of every part of the cranium ; but sometimes 
 it is praeternaturally strong. In this case it is 
 impossible perfectly to separate the dura 
 mater from the bone, and portions of the 
 membrane will be left adhering to it. 
 
102 
 
 The dura mater consists of fasciculi of 
 white fibres compacted into a firm membrane. 
 These are more readily observable upon the 
 outside of the dura mater than on its inside, 
 because there they are coarser. The internal 
 surface of the dura mater is finer and of a 
 more shining colour than the external ; and 
 here the fibrous structure is less observable, 
 except in particular situations, where coarse 
 fasciculi are interwoven with the membrane, 
 in order to give it greater strength. The 
 dura mater may in some degree be consi- 
 dered as consisting of two laminae, — a coarser 
 upon the outside, and a finer upon the in- 
 side ; but these cannot be separated from 
 each other, so as to leave natural surfaces. 
 A number of fibres are always seen passing 
 between the one and the other, by which 
 they are united. 
 
 The dura mater in its use is partly to be 
 referred to the cranium itself, and partly to 
 the brain which it envelopes. It is the prin- 
 cipal source of nourishment to the cranium ; 
 and in separating the dura mater from the 
 bone, a prodigious number of fine vessels 
 are ruptured, which pass from the one to 
 
103 
 
 the other. With regard to the brain, the 
 dura mater seems to have two uses. The one 
 is that of forming septa between different 
 parts of the brain, so that one part shall not 
 press too much upon another; and this is 
 particularly observable in the septum, which 
 divides the posterior part of the cerebrum 
 from the cerebellum. The other use is that 
 of forming considerable canals for carrying 
 back the blood towards the heart. The dura 
 mater consists of materials very well adapted 
 for the formation of large channels in the 
 neighbourhood of a substance so little able 
 
 O 
 
 to sustain pressure as the brain. These 
 channels or sinuses are not capable of being- 
 distended by blood in the same manner as 
 common veins, and therefore there is no risk 
 of any considerable pressure upon this im- 
 portant organ. The brain can bear the pres- 
 sure produced by the accumulation of blood 
 in the small veins of the pia mater , when it is 
 not carried to an extreme degree ; but it could 
 not bear the pressure arising from the dis- 
 tension of veins of the same size as the larger 
 sinuses of the dura mater. 
 
 The dura mater was at one time supposed 
 
104 
 
 to be capable of contraction like a muscle, 
 and to act upon the brain for the expulsion 
 of a nervous fluid ; but it is now well known 
 to be perfectly inactive. It consists of a 
 structure, having the same essential properties 
 as ligament and tendon, and is totally in- 
 capable of any contraction ; it is also insen- 
 sible when in its healthy state. Indeed it is 
 wonderful how this opinion could ever have 
 been formed, when it is considered that the 
 dura mater adheres closely to every part of 
 the cranium, and therefore could not exert 
 any power of contraction were it possessed of 
 such a power, and when it is considered 
 that the brain could not sustain the pressure 
 which must necessarily arise from this con- 
 traction. The dura mater accompanies the 
 spinal marrow through the whole of its course ; 
 but this will be afterwards more particularly 
 noticed. 
 
 The next membrane which surrounds the 
 brain is called the tunica arachnoides. This 
 is a very fine transparent membrane, inter- 
 posed between the dura mater and the pia 
 mater. It is in most places applied very 
 closely to the pia mater , so as to be separated 
 
105 
 
 from it with some difficulty, and is so very 
 fine and transparent as to escape observation. 
 In some places, as under the junction of the 
 optic nerves, or between the lobes of the ce- 
 rebellum behind, it may be seen separate, 
 and then it appears to be a membrane with- 
 out any vessels large enough to admit the 
 globules of the blood. When a fluid resem- 
 bling thin jelly is thrown out under this mem- 
 brane, as frequently happens during fevers, 
 it may be seen in many parts separated from 
 the pia mater , and is then somewhat thick- 
 ened. It also attends the medulla spinalis 
 through the canal of the spine ; but of its 
 use no satisfactory opinion has hitherto been 
 formed. 
 
 The pia mater lies in immediate contact 
 with the substance of the brain. It is a very 
 fine transparent membrane, upon which are 
 spread a great number of arteries and veins. 
 These contain partly a florid and partly a 
 dark-coloured blood, so as to produce a va- 
 ried appearance ; and there are few objects 
 more beautiful than the pia mater crowded 
 with blood-vessels. In most parts there is 
 no adhesion between the pia mater and the 
 
106 
 
 dura mater ; but in some they are connected, 
 as in the neighbourhood of the larger sinuses 
 of the dura mater , into which the veins of the 
 pia mater pour their contents. To the in- 
 ternal surface of the pia mater there are at- 
 tached a great number of processes, which 
 consist of a shaggy membrane crowded with 
 very fine vessels. The vessels do not indis- 
 criminately enter every part of the sub- 
 stance of the brain ; but in the cerebrum 
 they enter between its foldings, which have 
 been named convolutions ; and in the cere- 
 bellum they enter between its concentric la- 
 minae. Neither do they pass in an equal 
 number to every part of the brain ; but they 
 chiefly carry their blood to the cortical sub- 
 stance, and rather seem to pass through the 
 medullary substance, in order to reach any 
 cortical which may lie within it, than to ter- 
 minate in the medullary substance itself. In 
 cutting through a portion of the medullary 
 substance, a great number of very fine ves- 
 sels are divided ; but these seem to be pass- 
 ing through that substance, and not ramifying 
 in it. When a portion of the cortical sub- 
 stance is cut, there is no appearance of ves- 
 
107 
 
 sels in it whatever ; but this arises from the 
 vessels being very small, and from the colour 
 of the cortical substance which obscures them. 
 The vessels appear very numerous upon a 
 successful injection, or when a part of the 
 cortical substance is inflamed. 
 
 The brain consists of the cerebrum and 
 the cerebellum, and is formed of two kinds 
 of substance, the cortical and the medullary 
 substance. The first is of a cineritious, and 
 the second of a pure white colour. There is 
 a layer of the cortical substance placed on 
 the outside of the brain : this does not form 
 a smooth uniform plane, but in the cerebrum 
 is moulded into convolutions, a good deal re- 
 sembling the convolutions of the intestines ; 
 and in the cerebellum it is formed into con- 
 centric laminae. The convolutions are of a 
 considerable depth ; and if any of them be 
 cut through, it is seen to consist both of cor- 
 tical and medullary substance. The cortical 
 forms a layer of considerable thickness ; and 
 if you look attentively upon its divided edge, 
 there will be « seen passing through it, and 
 following it through all its windings, a very 
 narrow lamina of medullary substance. This 
 
108 
 
 is sometimes distinctly marked and some- 
 times obscurely, and has, I believe, been 
 very little, if at all, observed by authors. The 
 concentric laminae upon the surface of the 
 cerebellum are composed also of cortical 
 and medullary matter. By this contrivance 
 the quantity of cortical substance, as well as 
 the extent of its surface upon the outer part 
 of the brain, is very much increased, but 
 with what view has not been hitherto dis- 
 covered. 
 
 When the cerebrum is divided at the lower 
 surface of the hemispheres, and upon a level 
 with what is commonly called the corpus cal- 
 losum, there is seen a large oval plane of me- 
 dullary substance, which is skirted on the 
 outside by the convoluted cortical substance. 
 A little deeper than this plane, where you 
 come to cavities of a considerable size, and 
 bodies of regular but various shapes, there are 
 many different mixtures of the cortical and 
 medullary matter. Where bodies seem from 
 their outside to be formed of cortical sub- 
 stance only, upon cutting into them there 
 appears to be a considerable mixture of me- 
 dullary matter, as in the corpora striata ; and 
 
109 
 
 where they seem from their outside to be 
 formed of medullary matter only, upon cut- 
 ting into them they are found to have a mix- 
 ture of the cortical. The cortical is some- 
 times in a large proportion, as in the thalami 
 nervorum opticorum , and pedes hippocampi ; 
 and sometimes it is in a smaller proportion, 
 as in the tuberciilum annulare , and the crura 
 of the cerebrum. I hardly think that there 
 is any particular structure of the brain com- 
 posed purely of the one kind of substance or 
 of the other, although the proportions of each 
 in the various parts may be very different. 
 
 Of the intimate structure of the cortical 
 substance I believe very little is satisfactorily 
 known. Some have thought it to consist of 
 nothing else than a congeries of very fine 
 blood-vessels. It is evident, however, that 
 no mere collection of vessels could be made 
 to resemble the cortical substance. The pul- 
 piness so remarkable in that substance could 
 not be produced by a simple collection of 
 vessels, however minute ; nor can one ima- 
 gine a collection of vessels to have the same 
 properties with any part of the brain. When 
 a part of the cortical substance is injected 
 
110 
 
 with fine injection, it appears to be very 
 plentifully supplied with small blood-vessels ; 
 but still it is very far from being entirely 
 composed of them. 
 
 Others have supposed that it was a glan- 
 dular substance. There is no satisfactory 
 evidence, however, in support of this opi- 
 nion ; and if we consider the analogy between 
 it and the structures in the body which we 
 know to be glandular, we shall be led to the 
 belief that this opinion also is ill-founded. 
 
 Some modern anatomists and naturalists 
 have examined the cortical substance with 
 microscopes of very great magnifying powers, 
 but the result of their observations has been 
 different, — a strong proof that much depen- 
 dence is not to be placed on their accuracy. 
 Some have thought it to consist of verj 7 small 
 rounded bodies placed in a transparent jelly; 
 others have thought it to consist of rounded 
 bodies placed in a fine cellular structure : and 
 others have supposed that it consists of very 
 fine tortuous tubes, with some small rounded 
 bodies intermixed. With regard to myself, 
 I cannot trust my own accuracy in making 
 very minute microscopical observations ; and 
 
Ill 
 
 I frankly own that 1 am totally unacquainted 
 with the minute structure of this substance. 
 
 The structure of the medullary substance 
 is rather better known. In some parts of the 
 brain, as the pons varolii , crura cerebri , &c., 
 it appears evidently fibrous; and therefore 
 in other parts, where the fibrous texture can 
 hardly be detected, it is very probable that 
 there is the same kind of structure. The 
 fibres may be so small, and so uniformly ap- 
 plied to each other, as to escape observation. 
 With regard to the minuter structure of the 
 medullary substance, I believe that nothing 
 satisfactory is known. By some modern ob- 
 servers its minute structure has been thought 
 to be the same with that of the cortical. 
 
 In the brain there are four cavities of a 
 considerable size, which are called ventricles. 
 These are surrounded by distinct and peculiar 
 structures of the brain, and contain a little 
 water. This water is more limpid than what 
 is found in the other cavities of the body, 
 and very little or no coagulable matter is 
 dissolved in it. 
 
 The two largest of these cavities have been 
 called the lateral ventricles, and they are se- 
 
112 
 
 parated from each other by a thin medullary 
 septum. Jt has been thought by a distin- 
 guished modern anatomist, that there is a re- 
 gular aperture of communication between 
 them, under the anterior extremity of the 
 fornix ; but other anatomists have been un- 
 successful in detecting this direct mode of 
 communication. The other cavities, called 
 the third and fourth ventricles, are much 
 smaller than the former, and communicate 
 together by a small short canal. 
 
 Connected with the brain, or its mem- 
 branes, there are some small bodies of a pecu- 
 liar structure. These are the pineal gland, 
 the pituitary gland with its infundibulum, and 
 some small white bodies adhering to the pin 
 mater and the dura mater , which have been 
 named the glands of Pacchionus. Of their 
 minute structure, or their use, nothing is di- 
 stinctly known. 
 
 The brain is very plentifully supplied with 
 blood, but this is not carried in an equal pro- 
 portion to every part of its structure. The 
 cortical substance has a much greater pro- 
 portion carried to it than the medullary ; 
 and indeed blood-vessels seem to pass only 
 
113 
 
 through the latter to get at the former. 
 There is no reason to suppose that the blood 
 carried to the brain is different from the blood 
 of the rest of the body, although this has 
 been the opinion of some physiologists ; but 
 it is here conducted with more contrivance 
 than any where else, in order to diminish its 
 momentum. 
 
 The blood of the brain is conveyed to it 
 by four arteries of a large size ; these are the 
 two internal carotid, and the two vertebral 
 arteries. The blood in all of these is much 
 checked in its impetus as it is about to pass 
 into the cranium. The horizontal and varied 
 channel of the canalis caroticus must exceed- 
 ingly diminish the momentum of the blood 
 in the branches of the internal carotid ar- 
 teries ; and the winding course of the ver- 
 tebral arteries between the atlas and the cra- 
 nium, before they enter at the foramen mag- 
 num occipitale , must have the same effect 
 upon the current of blood passing through 
 the branches of these vessels. The junction, 
 too, of the internal carotid arteries, and the 
 basilary round the sella turcica , must be sub- 
 servient to the same purpose. It may be 
 
 i 
 
114 
 
 observed that the branches of these vessels 
 have thinner coats than the branches of ar- 
 teries of the same size in other parts of the 
 body, a circumstance which I believe has 
 been little noticed. This may perhaps be 
 intended with the same general view, viz. 
 that they may have little power to act upon 
 the blood which they contain, so that it shall 
 be propelled almost entirely by the force of 
 the heart, which has already been very much 
 moderated by the contrivances formerly men- 
 tioned. 
 
 The veins of the brain terminate in the 
 different sinuses of the dura mater , the use 
 of which particular structure we have already 
 endeavoured to explain. 
 
 The absorbent vessels of the brain have 
 not as yet been discovered, or at least are 
 not generally known. Some anatomists, above 
 a century ago, supposed that they had ob- 
 served absorbent vessels in different parts of 
 the brain ; but their observations are not sa- 
 tisfactory, and have been of no assistance to 
 the inquiries of those who have succeeded 
 them. An Italian anatomist has lately thought 
 that he has detected some of these vessels 
 
115 
 
 within the cranium, at its basis. He has not, 
 however, traced them, by injection, into ab- 
 sorbent glands ; and other anatomists have 
 not been able hitherto to detect the same ap- 
 pearances. There is every reason, however, 
 to suppose that the brain has absorbent ves- 
 sels as well as arteries and veins ; but they 
 cannot be very obvious, or they must have 
 been long ago ascertained. The nature of 
 the substance of the brain must add very 
 much to the difficulty of their detection ; but 
 time, perseverance, and favourable opportu- 
 nities will at length overcome every difficulty, 
 and the absorbent vessels of the brain will be 
 as certainly known to anatomists as those of 
 other parts. Many circumstances show that 
 absorption takes place in the brain, and it 
 cannot be believed that it is carried on by a 
 different apparatus, or on different principles, 
 than in other parts of the body. 
 
 The medulla oblongata and medulla spinalis 
 may be considered as an elongation of the 
 brain, being formed by the junction be- 
 tween the cerebrum and cerebellum. The 
 medulla spinalis is merely the continuation of 
 the medulla oblongata passing into a canal of 
 
 i 2 
 
116 
 
 the spine, and forming a convenient source 
 for the nerves of the trunk and the extremi- 
 ties. It consists of a conical flattened mass, 
 terminating in a point at the upper end of 
 the loins, and gives off a great number of 
 nerves upon each side, at regular distances 
 from each other. The nerves which arise 
 from its lower extremity are very large, and 
 consist of fibres but loosely connected to- 
 gether, so as to bear some resemblance to 
 a horse's tail; and from thence they have 
 been called the cauda equina. 
 
 The medulla spinalis, as well as the me- 
 dulla oblongata, consists of the same kind of 
 substance with the brain itself, but differently 
 arranged. The medullary substance is placed 
 upon the outside, and the cortical within ; 
 and the proportion of the former to the latter 
 is evidently greater than either in the cere- 
 brum or the cerebellum. 
 
 The medulla oblongata, lying within the 
 cavity of the cranium, has of course the same 
 coverings with the brain itself ; and they are 
 continued into the canal of the spine, accom- 
 panying the spinal marrow. The dura mater 
 in the canal of the spine has exactly the same 
 
117 
 
 appearance as within the cavity of the cra- 
 nium, but does not adhere firmly to the bones 
 of the spine. Upon each side, in the dura 
 mater , there is a chain of small irregular ca- 
 vities between its outer and inner laminae, into 
 which the veins of the spinal marrow pour 
 their blood. These are of the same kind, 
 and formed with the same view, as the sinuses 
 of the dura mater within the cranium. The 
 dura mater attending the spinal marrow is 
 perforated on each side by foramina, for the 
 passage of lateral nerves. 
 
 The tunica arachnoides is continued along 
 the spinal marrow from that membrane within 
 the cranium. Within the canal of the spine 
 it is but loosely applied to the pia mater , so 
 that it can easily be separated by inflation ; 
 and it then appears to be a very distinct 
 membrane. 
 
 The spinal marrow is, last of all, covered by 
 the pia mater ; but this appears to be a less 
 vascular membrane than where it covers the 
 brain. This no doubt arises from the less 
 quantity of blood, in proportion, which is 
 wanted for the medulla spinalis , which con- 
 sists chiefly of medullary substance. Had it 
 
118 
 
 consisted principally of the cortical, the ves- 
 sels to be seen on the pia mater would have 
 been both larger and more numerous. Small 
 processes of membrane pass into the sub- 
 stance of the medulla spinalis from the pia 
 mater ; but these do not put on any regular 
 form, as in the cerebrum or cerebellum. 
 Upon each side, the external surface of the 
 pia mater is joined to the inner lamina of the 
 dura mater , at regular distances, by short 
 processes from a small firm tendinous sub- 
 stance. This has been named the ligamen- 
 tum denticulatum , and is peculiar to the co- 
 verings of the spinal marrow, there being no 
 such junction between the dura mater and 
 pia mater of any part of the brain. 
 
 The arteries of the spinal marrow are small, 
 and are derived chiefly from the upper ex- 
 tremities of the two vertebral. From the 
 mode of their origin, the blood must circu- 
 late in them with very little impetus, which 
 corresponds with the general plan of the ar- 
 terial system in the brain. In some places 
 small branches pass in by the lateral foramina 
 of the spine, from the intercostal and lumbar 
 arteries. The veins of the pia mater open 
 
119 
 
 into the chain of small sinuses in the dura 
 mater , and from thence the blood is conveyed 
 by short communicating branches to the in- 
 tercostal and lumbar veins. The absorbent 
 vessels of the spinal marrow have not as yet 
 been discovered, but still there can be no 
 reasonable doubt of their existence. 
 
 There are a number of cords passing from 
 the brain, or its appendages, to different 
 parts of the body, which have been named 
 nerves. Those within the cranium arise partly 
 from particular structures in the brain itself, 
 as the corpora striata , thalami nervorum opti- 
 corum , and partly from a substance formed by 
 the junction of the cerebrum and cerebel- 
 lum. A great number arise from each side 
 of the medulla spinalis. None can be said to 
 arise out of the common mass of the brain. 
 
 Nerves at their origin are either formed of 
 one cord, as the optic nerve, or are composed 
 of a single plane of fibrils, which afterwards 
 unite together, as the eighth and ninth pairs 
 of nerves ; or they are made up by the union 
 of a double plane of fibrils, as the nerves de- 
 rived from the spinal marrow. 
 
 Some of the nerves are composed of pure 
 
120 
 
 medullary matter, as the optic nerve ; but in 
 the greater number this matter is so enve- 
 loped in a tough cellular membrane, as to 
 render its appearance less distinct. In the 
 olfactory nerves there is an evident junction 
 of the cortical with the medullary matter, 
 but in some of the others there is clearly no- 
 thing but medullary matter; and it is ex- 
 tremely doubtful whether in the nerves ge- 
 nerally, of the body, there be any mixture at 
 all of the cortical. 
 
 The nerves appear to consist of little cylin- 
 drical masses of medullary substance inclosed 
 in a tough cellular membrane. In this cel- 
 lular membrane there are distributed a num- 
 ber of small blood-vessels ; but I have never 
 been able to observe any distinct coverings 
 of the dura mater and the pia mater , as many 
 anatomists have supposed. With regard to 
 the minute structure of the ultimate fibrils, I 
 believe that nothing satisfactory is known ; 
 and it would exceed the limits of this lecture 
 to enter into an examination of the opinions 
 upon this subject. 
 
 The nerves are distributed to different parts 
 of the body in very different proportions. 
 
121 
 
 The organs of sense and of motion are the 
 most plentifully supplied with nerves ; the 
 glands of the body, in many instances, spa- 
 ringly; and tendons, ligaments, bones, &c., 
 either not at all, or the nerves which reach 
 them are so small as to prevent their being 
 distinctly traced. 
 
 In some parts of the body little swellings 
 are occasionally formed in the nerves, which 
 have been called ganglions. These have a 
 very different appearance from a common 
 portion of a nerve, being somewhat of a red- 
 dish-brown colour, and having a minute 
 fibrous texture. Some nerves in the body 
 form an intimate junction with each other, 
 which has been called a plexus. This is re- 
 markably the case with the nerves of the 
 upper and lower extremities, and also with 
 the nerves which supply the abdominal vis- 
 cera. To enter into a minute account either 
 of the ganglions or plexuses of nerves, would 
 carry us much beyond the limits of such a 
 lecture ; and this inquiry would be the less 
 satisfactory, as much upon both of these sub- 
 jects is to be considered only as conjecture. 
 
LECTURE II. 
 
 HAVING given in the former lecture a very 
 general view of the anatomy of the nervous 
 system, we now come to the explanation 
 of the purposes to which it is subservient. 
 There is hardly any part of physiology at- 
 tended with more difficulties in its investi- 
 gation, or more imperfectly known, than that 
 of the nervous system. 
 
 We may be said to be entirely ignorant of 
 the uses of particular modes of structure, 
 both in the brain and nerves. The distinct 
 use of the cortical and medullary substances 
 in the brain has not been hitherto discovered. 
 We are, if possible, less acquainted with the 
 uses of their particular modifications and 
 mixtures in the different parts of the brain. 
 Why they are formed, for instance, into con- 
 volutions upon the surface of the cerebrum, 
 and into concentric laminae upon the surface 
 
123 
 
 of the cerebellum ; why the corpora striata 
 have such a proportion, and such an ar- 
 rangement of the cortical and medullary sub- 
 stance ; and why in the thalami nervorum op- 
 ticorum , or tuberculum annulare , both should 
 be so very different. We are in the same 
 state of ignorance with regard to the use of 
 particular modifications in the structure of 
 nerves, and more especially of the uses of gan- 
 glions and plexuses. The authors who have 
 attempted to scrutinize nature in the detail 
 of her wonderful formation of the nervous 
 system, have not been aware of the weakness 
 of their own powers, and how much they have 
 exposed their presumption and ignorance. 
 
 Although we may be considered as totally 
 unacquainted with the uses of the particular 
 modifications of structure in the nervous sy- 
 stem, yet the chief purposes to which this 
 system in general is subservient are not un- 
 known to us. It is the system through which 
 impressions are communicated from the dif- 
 ferent parts of the body to the brain, thereby 
 producing sensations ; and it is the system 
 through which the influence of the mind, as 
 connected with the brain in volition and va- 
 
124 
 
 rious excitements, is communicated to many 
 different parts of the body. 
 
 The different parts of the body are not 
 equally capable of receiving impressions 
 which might afterwards be communicated to 
 the brain, and therefore are not equally sen- 
 sible. Some may be said to be highly sen- 
 sible ; as the organs of sense, the muscles, 
 and many of the viscera ; while others seem 
 in general to have no sensibility whatever. 
 Of this kind are the bones, ligaments, car- 
 tilages, and tendons of an animal body. In 
 such parts the distribution of nerves has not 
 hitherto been traced, and therefore we are 
 not surprised at their want of this property ; 
 but how all of them should be capable of 
 sensation, when diseased, is a fact which it 
 appears extremely difficult to explain. 
 
 In order that sensation be produced in any 
 part of the body, it is necessary that several 
 circumstances should take place. First, it 
 is necessary that an impression be made on 
 the nerves. This may take place either from 
 the immediate application of the object itself 
 to the nerve, as in the sensation of touch ; or 
 from the application of extremely minute 
 
125 
 
 particles which fly off from different bodies, 
 as in seeing or in smelling. Whatever be 
 the variety in the modes of impression, the 
 same general rule is still applicable, and the 
 impression must be made in some form or 
 other. Secondly, a communication by nerves 
 must exist between the brain and that part 
 of the body where the impression is made. 
 There is no other medium through which an 
 impression can be communicated ; and it may 
 be interrupted by a variety of causes, which 
 will be very soon explained. It is very na- 
 tural to inquire whether there be any change 
 produced in a nerve when conveying im- 
 pressions? In answer to this we may say, 
 that there is no change whatever produced 
 in the external appearance of a nerve during 
 this part of its function ; but what change 
 may take place in its very minute structure, 
 is probably much too subtile to be detected. 
 
 The particular state of nerve which takes 
 place while it is conveying impressions to the 
 brain, may be interrupted or destroyed by 
 various causes. It appears to be necessary, 
 in order that the impression may be con- 
 veyed, that there be no discontinuation of 
 
126 
 
 ( 
 
 the matter of the nerve between the seat of 
 the impression and the brain. Hence, if a 
 portion of a nerve be cut out, it becomes 
 unfit for conveying impressions ; and even if 
 it be merely divided, the same incapacity 
 takes place. The application of the divided 
 parts to each other, so as to be closely in 
 contact, will produce no change in the effect, 
 for the impression will not pass from the one 
 to the other. Some persons have supposed 
 that when a portion of any nerve was divided, 
 it not only lost its power of conveying im- 
 pressions, but never recovered it. This opi- 
 nion is, however, ill-founded ; there can be 
 no doubt of the real matter of nerve being re- 
 generated; and there have been w r ell-marked 
 instances of nerves, after being divided, reco- 
 vering their capability of conveying impres- 
 sions, although they recover it very slowly. 
 
 When a ligature is made upon any nerve, 
 it is also rendered incapable of conve3 r ing 
 impressions to the brain. That particular 
 state of nerve which takes place while it is 
 performing this function is prevented by the 
 ligature from being propagated to the brain, 
 so that this organ receives no impression. 
 
127 
 
 Tumours, according to their degree of 
 pressure upon nerves, will produce more or 
 less of the same effect. Every person has 
 frequently experienced a temporary external 
 pressure upon a particular nerve, when im- 
 pressions have been conveyed imperfectly to 
 the brain, in consequence of which there has 
 been indistinct sensation. Tumours growing 
 in the neighbourhood of nerves, especially 
 hard tumours, occasionally produce the same 
 effect. If such a nerve, or nerves, be near 
 a bone, they may be so squeezed . between 
 the tumour and the bone as to convey im- 
 pressions either very indistinctly, or entirely 
 to lose this power. 
 
 The causes just now enumerated as inter- 
 rupting or destroying the power of nerves to 
 convey impressions may be said to be ex- 
 ternal, and exist where there is supposed 
 to be no fault in the nerves themselves. There 
 are changes also taking place in nerves, which 
 produce the same incapacity. 
 
 One of these changes is when the nerves of 
 any part become paralytic. When this is the 
 case, there is usually no alteration produced 
 in their appearance, but they look in every 
 
128 
 
 respect like healthy nerves. They would 
 seem only to have lost the power of taking 
 on that state which is necessary for convey- 
 ing impressions to the brain ; but as we 
 cannot tell what that state realty is, we must 
 be unable to discover what is the particular de- 
 fect in the nerves which are so incapacitated. 
 We know from experience that nerves re- 
 cover themselves very slowly from this state, 
 and in most instances very imperfectly. 
 Changes are occasionally observed in the 
 structure of nerves which are incapable of 
 conveying impressions. I recollect a re- 
 markable instance of this in one of the optic 
 nerves, which was of a much smaller size 
 than usual, and had entirety lost the common 
 medullary appearance, being converted into 
 a blueish, half-transparent matter. Under 
 such circumstances of change it is probable 
 that nerves will never recover their power of 
 conveying impressions. 
 
 When an impression is carried along nerves 
 to the brain, we are totally unacquainted 
 with the change produced there, in order 
 that sensation may take place. We cannot 
 tell whether it is a change produced only at 
 
129 
 
 the origin of the nerves along which the im- 
 pression had been conveyed, or whether it is 
 a change diffused over the whole mass of the 
 brain. We may be said, if possible, to know 
 less of the various changes produced by va- 
 rious modes of impression, from whence the 
 great variety of sensations, of which the body 
 is capable, is derived. Notwithstanding the 
 state of our ignorance upon this subject, 
 we know by experience that several circum- 
 stances may take place in the brain, by which 
 it may either be unfitted to receive impres- 
 sions at all, or will receive them very imper- 
 fectly. These circumstances are commonly 
 various causes of pressure applied to the 
 brain, of which the principal are the accu- 
 mulation of water, and the extravasation of 
 blood. The first produces its effect more 
 slowly, and most frequently happens at an 
 early age. The other produces its effect 
 suddenly, and hardly ever happens but at the 
 middle, or more advanced periods of life. Tu- 
 mours of different kinds growing in the brain 
 itself, or in its neighbourhood, occasionally 
 produce the same effect ; but these happen 
 rarely in comparison with the two former 
 
 K 
 
130 
 
 causes, and generally make a slow progress. 
 It is also not improbable that changes may 
 take place throughout the general structure 
 of the brain, by which it may be unfitted to 
 receive impressions from the nerves, or will 
 receive them very imperfectly. We know 
 that the brain is frequently changed from its 
 healthy structure, so as to receive false im- 
 pressions, as in many instances of mania ; 
 and therefore we may suppose that there are 
 certain changes by which it may be incapa- 
 citated from receiving impressions distinctly^, 
 or perhaps from receiving them at all. If, 
 however, there be such changes, they are, I 
 believe, at present not well ascertained. 
 
 Most parts of the body are only capable 
 of conveying different impressions which 
 produce sensations of pain. These are very 
 different in the same parts, according to the 
 degree or the mode of the impression, — so 
 that sensations of pain vary a good deal. 
 There are some parts of the body where the 
 sensations of pain may be said to be pecu- 
 liar, as for example that of the testicle upon 
 pressure. Were patients in general capable 
 of comparing accurately these sensations, 
 
131 
 
 and giving a precise description of them, it 
 would afford more ready and certain means 
 of discriminating many diseases than has 
 been hitherto attained. 
 
 Some parts of the body are not only ca- 
 pable of receiving various impressions that 
 produce sensations of pain, but also a great 
 variety of other impressions, from whence 
 other sensations are derived. These are the 
 organs of sense; and they form, from this 
 circumstance, the principal channels of our 
 knowledge of the external world. They are 
 five in number, and each has a very distinct 
 and peculiar organization, suited to the kind 
 of impressions which it is intended to receive. 
 They have larger nerves of communication 
 between them and the brain than belong to 
 the other parts of the body, and in some the 
 nerves are of a peculiar structure. Most of 
 the organs of sense are placed near the brain, 
 so that their impressions are communicated 
 by a short route to this principal part of the 
 nervous system ; but the organ of touch is 
 placed at a considerable distance. The or- 
 gans of sense, except that of the touch, are 
 each of them employed in receiving and 
 
 k 2 
 
132 
 
 transmitting to the brain a great variety of 
 impressions belonging to the same genus ; as 
 the nose different impressions of smell, and 
 the ear different impressions of sound ; but 
 the touch is capable of receiving and trans- 
 mitting impressions which produce sensations 
 of a kind quite distinct from each other. 
 The sensations of figure, and of hardness or 
 softness in bodies, may be said to be different 
 in kind. The same observation may be 
 thought applicable to the eye ; for we derive 
 from it not only sensations of colour, but of 
 form, extension, &c. It is, however, pro- 
 bable, that in producing the last kinds of 
 sensation, the eye is educated by the touch. 
 We know that it is always corrected by the 
 touch when it is wrong, or in doubt about the 
 accuracy of these sensations ; and they can 
 be produced totally independent of the eye. 
 But the eye may be said to stand in a relation 
 to the touch which it does not to any other 
 organ of sense. It communicates many of 
 the impressions which properly belong to 
 touch, and even more readily than this sense ; 
 but it cannot be educated to convey any im- 
 pressions of sound, or smell, or taste. Im- 
 
133 
 
 pressions are conveyed from all the organs 
 of sense, except the eye, directly to the brain, 
 without any intermediate state being pro- 
 duced ; but in the eye an image is formed, 
 which is necessary for exciting the sensations 
 peculiar to this organ. 
 
 These organs, conveying to the brain a very 
 great variety of impressions, become the prin- 
 cipal source of our knowledge ; but as they 
 are only capable of receiving and transmitting 
 impressions of qualities of matter, its real es- 
 sence must always remain unknown. Al- 
 though all impressions are conveyed through 
 the medium of nerves to the brain, in order 
 to produce sensation, yet all sensations are 
 not felt in this organ. On the contrary, this 
 organ has no sensations referable to itself 
 but when impressions are made immediately 
 upon it, or in some sympathetic sensations 
 connected with impressions made on other 
 parts of the body, as for example the stomach. 
 Sensations are generally referred to the parts 
 of the body where the impressions have been 
 made, and they vary according to the degree 
 and the mode of the impressions. In some 
 cases the sensations are referred to a part of 
 the body at a distance from the seat of the 
 
134 
 
 impression. Thus when water is accumu- 
 lated in the bladder to a considerable quan- 
 tity, the principal seat of the sensation is at 
 the end of the penis. Although there is an 
 unpleasant sense of fullness in the region of 
 the bladder, yet the most acute and marked 
 sensation is at the other part. Indeed the latter 
 always takes place, while the former is only 
 produced when the accumulation of water is 
 unusually large. There is no deceit in this 
 reference of sensation, for by experience we 
 know that it is connected with such a state of 
 the bladder; and indeed, independently of 
 experience, it is attended with a strong desire 
 to empty the water, and a full conviction that 
 with proper efforts this effect will take place. 
 
 There are many other instances where im- 
 pressions and sensations produced in one 
 part of the body are accompanied with sen- 
 sations in another. Thus in certain affec- 
 tions of the head and kidneys, the sensation 
 of sickness is produced in the stomach ; and 
 the same thing frequently happens when the 
 uterus is pregnant. It may be observed, 
 that sensations take place in the stomach, in 
 consequence of impressions or sensations 
 being previously excited in other parts, much 
 
135 
 
 more frequently than they are produced in 
 any other part of the body. These may be 
 called sympathetic sensations, some of which 
 would appear capable of being explained by 
 a connexion among the nerves of particular 
 parts ; but others cannot be explained upon 
 this principle. It may be observed that these 
 sympathetic sensations are not the same in 
 all individuals, but often differ very much, 
 such sensations taking place between certain 
 parts in one individual, and between very 
 different parts in another. 
 
 Sensations are sometimes referred not to 
 the seat of the impression, but to the small 
 extremities of nerves which have been ac- 
 customed to receive such impressions. Thus 
 in an amputated limb, impressions made upon 
 the extremity of the stump produce sensations 
 which are referred to the toes or fingers of 
 that limb. The impressions now conveyed 
 from the cut extremities of the nerves of the 
 amputated limb, used formerly to be com- 
 municated from the smaller extremities of 
 these nerves in the toes or the fingers ; and 
 the mind for some time refers the sensations 
 to these smaller extremities, till this error is 
 
136 
 
 corrected by habit. On some occasions it 
 would appear that these false references of 
 sensation are continued for years after the 
 amputation of a limb, and perhaps in such 
 cases they are never entirely corrected. 
 
 It is not intended to enter here into the 
 detail of all the various circumstances which 
 can produce change in our sensations. This 
 would lead to a very extended inquiry, and 
 therefore some of the principal will only be 
 at present noticed. 
 
 When one kind of sensation is destroyed, 
 some others become increased in consequence 
 of it. Thus when all sensations communi- 
 cated by the eye are lost, the sensations com- 
 municated by the touch and by the ear are 
 improved. This improvement does not arise 
 directly out of the loss of the other class of 
 sensations, but it becomes in some degree 
 necessary for the protection of the body that 
 these other sensations should be improved ; 
 and by great attention to them when excited, 
 and by frequently repeating them, an as- 
 tonishing improvement at length is made. 
 
 After what has just been said, it is hardly 
 necessary to observe that great improvement 
 
137 
 
 may be made by a certain education in dis- 
 criminating the sensations derived from every 
 organ of sense. This education merely con- 
 sists in a very close attention to sensations 
 when produced, and in their being frequently 
 subjected to this attention. Thus we can ar- 
 rive at a great degree of accuracy in discri- 
 minating between different sensations of taste, 
 or of smell, or of hearing, which are separated 
 from each other by such nice shades of dis- 
 tinction, that they would be confounded by 
 persons who had not paid attention to this 
 particular species of education. 
 
 Habit has considerable influence in regu- 
 lating our sensations, as well as many other 
 functions of the body. In general it dimi- 
 nishes the force of sensations according to 
 the degree of habit, or the frequency of their 
 being excited. It connects sensations with 
 objects with which they are not naturally 
 associated. It can even change the nature of 
 sensations, rendering those which were ori- 
 ginally agreeable indifferent, or perhaps 
 even disagreeable ; and, on the contrary, 
 rendering those at length pleasant which 
 were originally disagreeable to us. 
 
138 
 
 In many instances the sensation remains 
 for some time after the impression producing 
 it has ceased. Thus, if the hand is put into 
 water either hot or cold, the sensation re- 
 mains for some time after it has been taken 
 out. This depends on the nerves continuing 
 for some time in that particular state into 
 which they had been thrown ; and this state 
 of nerve is conveyed to the brain, which pro- 
 duces the continuance of sensation. 
 
 Sensations are much varied in their de- 
 gree of intensity by the sensations which im- 
 mediately precede them, and in many in- 
 stances are altogether changed. This is 
 particularly evident in the comparative sen- 
 sations of heat and cold. 
 
 The force of sensations is a good deal va- 
 ried by the expectation of the mind. When 
 they fall below this expectation, the}? - seem 
 less ; and when they rise above it, they seem 
 greater, than they would otherwise be. There 
 are many other circumstances to be remarked 
 which have much influence upon our sen- 
 sations ; but to enter into their consideration 
 would lead us far beyond the ordinary limits 
 of these lectures, and therefore they are en- 
 
139 
 
 tirely omitted. What has been noticed here 
 has reference only to those sensations pro- 
 duced by impressions from without. There 
 is also a great variety of sensations produced, 
 not by external objects, but by the general 
 affections of our nature, and our power of 
 distinguishing between right and wrong. We 
 receive a sensation of pleasure from the ob- 
 servation of virtuous conduct, and a sensation 
 of pain from the observation of the contrary. 
 
 We are conscious of the various operations 
 of our own minds, which may be said to pro- 
 duce another class of sensations. Both of 
 these form very interesting and extended 
 subjects of investigation, which it is impos- 
 sible at present to consider. 
 
LECTURE III. 
 
 The nerves are not only employed in con- 
 veying impressions to the mind, so as to pro- 
 duce sensations, but also in conveying the 
 influence of the brain to the different parts 
 of the body which are capable of being ex- 
 cited into motion. These parts of the body 
 are called muscular, and have a peculiar or- 
 ganization, which it would be foreign to our 
 present purpose to explain. The nerves are 
 capable of being variously impressed, so as 
 to excite muscles into motion. 
 
 The most common influence which is con- 
 veyed along nerves to excite the action of 
 muscles is volition. We do not understand 
 what is the particular state, either of the brain 
 while volition is exerted, or of the nerve while 
 an influence is conveyed along it to muscles ; 
 and both of these subjects are perhaps be- 
 yond the boundary of human investigation. 
 
141 
 
 We know that to the eye there is no ap- 
 parent change in a nerve when conducting 
 volition, and it is probable that there is also 
 none in the brain while this power of the 
 mind is exercised. The change, therefore, 
 must take place in the very minute structure 
 of the parts, which cannot be an object of 
 examination. It is remarkable, that although 
 the effect of volition upon muscles, when con- 
 veyed along nerves to them, is that of their 
 being put into motion ; yet the volition is 
 never exerted towards the muscles them- 
 selves, but towards that change which is in- 
 tended to be produced by their action. One 
 might naturally be inclined to think that the 
 volition would be directed to the muscles 
 themselves which are called into action. 
 Upon a little consideration, however, it is 
 easy to see why this should not be the case. 
 Were volition to be directed towards the 
 muscles themselves, it would be necessary to 
 understand what muscles ought to be called 
 into action, in order to produce every variety 
 of change in the motions of the body of which 
 it may be capable. This, however, would 
 be totally impossible in an infant, and indeed 
 
142 
 
 is a knowledge which the most perfect phy- 
 siologist has never yet been able to attain. 
 Were it possible for such a knowledge to be 
 attained, still a good deal of consideration 
 would be requisite every time any complex 
 action was to be performed, to know upon 
 what muscles the volition Av*as to be exerted ; 
 and if our judgement should be wrong, the 
 volition would be improperly directed, and 
 we should be disappointed in the effect which 
 we intended to produce. It is managed by 
 nature much more simply, and without any 
 risk of mistake. It is enough to know what 
 effect we desire to take place, and to exert 
 our volition towards that effect, and the mus- 
 cles which are calculated to produce it are 
 immediately called into action. There is no 
 difference in this process, whether the effect 
 can be produced by the action of one or two 
 muscles, or whether the nice cooperation of 
 many be required ; it is enough to will the 
 effect, and this nice cooperation takes place 
 as readily and as easily as the most simple 
 action. 
 
 When the volition is exerted tow*ards an 
 effect which is to be produced by a long 
 
143 
 
 succession of the same actions, these actions 
 take place without our being conscious of 
 any volition continuing to be exerted. Thus 
 in walking, one step is taken after another 
 without our being conscious of a succession 
 of volitions, and the mind may be deeply 
 engaged in the mean time in the most ab- 
 struse inquiry. Still, however, the muscles 
 employed in walking will not act unless they 
 receive the influence of volition ; but we lose 
 the consciousness of it in other exertions of 
 the mind which are more interesting. 
 
 The volition cannot be exerted for any 
 great length of time upon the same muscles 
 without producing the feeling of fatigue ; 
 but this, like many other states of an animal 
 body, is very much regulated by habit. The 
 greater number of the muscles of the body 
 are under the influence of volition, and these 
 have been called for this reason voluntary 
 muscles. Of this kind are all the muscles 
 whose actions are not necessary to any vital 
 function, and are only occasionally to be 
 called into exertion. 
 
 There are other muscles upon which vo- 
 
144 
 
 lition has a partial influence. Of this kind 
 are such muscles as are employed in carry- 
 ing on a vital function, but which are also 
 employed for purposes that only occasionally 
 take place, and are to be regulated by vo- 
 lition. Thus the muscles of respiration may 
 be said, with regard to their common func- 
 tion, to be involuntary muscles. They are 
 as invariable in carrying on respiration as 
 the heart is in carrying on the circulation, 
 and are as little dependent upon the atten- 
 tion of the mind. They are not, however, 
 purely involuntary muscles ; for respiration 
 can be varied by volition, both in the quan- 
 tity of air taken into, and thrown out from 
 the lungs, and in the frequency of inspiration 
 and expiration in a given time. It was con- 
 venient, and often necessary, that this ope- 
 ration should in some measure be under the 
 regulation of our will. The muscles subser- 
 vient to respiration are also capable of pro- 
 ducing certain effects upon some of the ab- 
 dominal viscera, assisting them to expel what 
 they may contain ; and this was to be in some 
 degree regulated by our volition. For these 
 
145 
 
 reasons, the muscles of respiration have been 
 made partly voluntary, and partly involun- 
 tary muscles. 
 
 There are again other muscles upon which 
 volition has no influence whatever. These 
 are employed in carrying on functions which 
 are intimately connected with life, and where 
 there would have been a great disadvantage 
 if they had been at all dependent on volition. 
 Of this kind is the muscular structure of the 
 heart and blood-vessels ; and of the same 
 kind, likewise, is the muscular structure of 
 the stomach and bowels. The first of these 
 structures is employed in the distribution of 
 blood over the body ; and the other in pre- 
 paring a fluid capable of being converted 
 into blood, which is intended to supply its 
 waste, besides expelling the excrementitious 
 matter. Had either of these operations been 
 dependent on volition, they would have re- 
 quired constant attention in order to be car- 
 ried on, and therefore the mind could not 
 have employed itself in other pursuits ; they 
 would frequently have been managed very 
 imperfectly, and would have run much risk 
 of being altogether stopt. Indeed, upon the 
 
 L 
 
146 
 
 supposition of these actions being voluntary, 
 the body could never enjoy the refreshment 
 of sleep, and must have been constructed in 
 this respect upon a plan totally different from 
 what it is at present. Although volition be 
 a principal cause of the action of muscles, 
 yet it is regulated according to circumstances, 
 exerting on some muscles its full force, on 
 others a partial influence, and on others none 
 at all. 
 
 The different emotions of the mind are also 
 conveyed along nerves to different muscles 
 of the body, exciting them to contraction. 
 Each emotion, when raised in a considerable 
 degree, sets in action its appropriate muscles, 
 producing a change in the countenance and 
 attitude, which is expressive of the emotion. 
 This becomes a natural language, and is 
 perfectly understood in all countries ; for it 
 depends upon an universal principle inhuman 
 nature, and is not connected with any arbi- 
 trary customs of society. The expressions of 
 the countenance and attitude in anger, re- 
 venge, fear, &c., when strongly excited, are 
 the same in every country, and are uni- 
 versally understood. Volition has no share 
 
147 
 
 in these actions : they may indeed be some- 
 times repressed by volition, when in a mode- 
 rate degree ; but when raised to a high pitch, 
 they readily overcome its opposition, which 
 is then very feeble, and produce their full 
 effects. Muscles are capable of being thrown 
 into a much greater degree of contraction by 
 emotions of the mind than perhaps by any 
 other cause ; and it is this circumstance which 
 gives the astonishing strength sometimes ex- 
 erted by maniacs. 
 
 The principle of imitation is also another 
 cause of the action of muscles. This may 
 be said on most occasions to be influenced 
 by volition, for we generally imitate what we 
 have previously willed to imitate ; but the 
 principle of imitation is sometimes quite inde- 
 pendent of the will. This is best exemplified 
 in the imitation of any gesture or motion 
 which may have been singular, and may very 
 much have called up the attention of the mind. 
 This state of mind acts through the inter- 
 vention of nerves upon certain muscles, ex- 
 citing them to action, and producing an imi- 
 tation of the particular motion or gesture. 
 This is so far from being dependent on vo- 
 
 l 2 
 
148 
 
 lition, that the mind is often not conscious of 
 its taking place ; and whenever it becomes 
 so, the imitation is repressed by an exertion 
 of volition. 
 
 Internal impressions in some parts of the 
 body are a cause of muscular action. Thus 
 the application of the blood to the internal 
 surface of the cavities of the heart, appears 
 to be the cause which excites it to contract. 
 Although the small nervous fibrils of the 
 heart have perhaps never been distinctly 
 traced to its cavities, yet there can be little 
 doubt of their reaching them ; and the im- 
 pression made upon their extremities is com- 
 municated to the other branches, so that 
 those exert their influence also in exciting 
 muscular action. It has been a doctrine 
 very lately advanced, that there are no nerves 
 whatever passing to the muscular substance 
 of the heart, but that they all terminate in 
 the coats of the coronary arteries. This, I 
 believe, from what I have observed myself, 
 not to be well founded ; and it should seem 
 wonderful that the muscle of the heart should 
 not be stimulated to action, through the im- 
 mediate connexion with nerves, like the other 
 
149 
 
 muscles of the body, but through the inter- 
 vention of blood-vessels. This is to bestow 
 upon blood-vessels an office which one would 
 not be willing to admit but upon the most 
 unequivocal evidence. 
 
 In the intestinal canal, the peristaltic mo- 
 tion is excited by the impression of the con- 
 tents of the intestines upon the very fine 
 nerves which reach the villi of the inner 
 membrane. These are branches of the same 
 nerves which supply the muscular coat of the 
 intestines, and the impression is communi- 
 cated from the former to the latter. The 
 peristaltic motion is therefore produced with- 
 out any impression being immediately ap- 
 plied to the proper nerves of that motion, but 
 by a principle which has been established in 
 the animal ceconomy, — that impressions ap- 
 plied to the nerves of the villous are capable 
 of exciting the nerves of the muscular coat. 
 Over these actions volition has no power, 
 and we are not conscious of their taking 
 place : they go on entirely without our 
 knowledge. 
 
 Nerves may be excited by external stimuli 
 so as to produce the action of muscles. If a 
 
150 
 
 nerve be pricked by any sharp instrument, 
 as a needle, or be half divided, — or if any 
 stimulating matter be applied, as a drop of 
 concentrated acid, — the muscles which its 
 branches supply will be thrown into a violent 
 state of contraction. The nerve itself, how- 
 ever, remains perfectly still ; nor does it ap- 
 pear to undergo any change whatever. In 
 the same manner, whether the influence of 
 volition, or of excitements of the mind, or 
 influence of any other kind be conveyed 
 along nerves to muscles, the nerves them- 
 selves seem to undergo no change, however 
 great may be the effect produced on the mus- 
 cles in which they terminate. 
 
 Mechanical or chemical stimuli, applied 
 immediately to muscles themselves, will ex- 
 cite them to contraction. This probably 
 depends upon the very minute fibrils of the 
 nerves being impressed, which are distri- 
 buted through muscles in great numbers, al- 
 though they are too small for observation ; 
 and therefore in this case the impression is pro- 
 bably still conveyed from nerves to muscles. 
 
 In animals of so simple an organization 
 that nerves have not yet been discovered in 
 
151 
 
 them, the application of stimuli is known to 
 be capable of exciting them to motion. Thus, 
 if an hydatid from the liver of a sheep be put 
 into water heated to the degree of heat of 
 the human body, motion will be excited in 
 it. This may be supposed either to depend 
 upon fibrils so very minute as to elude ob- 
 servation, which are impressed by the con- 
 tact of the heated water ; or it may be sup- 
 posed that a nervous matter is mixed through 
 its whole substance, without any nerves being 
 formed, which nervous matter receives the 
 same impression, and communicates it to 
 the muscular structure. It is perhaps im- 
 possible to ascertain this point anatomically, 
 and therefore every thing which can be said 
 concerning it must be considered as merely 
 conjectural. 
 
 These are the principal impressions which 
 are known to be conveyed along nerves, and 
 to excite muscles to contraction. They may 
 be interrupted by a variety of accidents, 
 which are of the same kind as those which 
 sometimes interrupt the progress of impres- 
 sions to the brain, and thereby prevent the 
 different sensations from taking place. 
 
152 
 
 If a nerve be divided, or a portion be cut 
 out, it is rendered for a time incapable of 
 conveying volition, or any other mode of im- 
 pression, to muscles. At length, however, 
 the divided ends of the nerve will be united, 
 or a new portion of nerve will be formed to 
 supply what had been removed, and the 
 power of exciting muscles to action will be 
 recovered. 
 
 If strong pressure be made upon any nerve, 
 whether by a ligature, or by a tumour, or 
 some other external cause, its power of ex- 
 citing muscles to action is very much im- 
 paired, and on some occasions may be lost. 
 It will, however, be recovered after the pres- 
 sure has been removed, but more or less 
 slowly, according to the degree of injury 
 which the nerve had sustained. 
 
 The most common cause which impairs 
 in nerves the power of exciting muscles to 
 action, is that change which is called para- 
 lysis. This sometimes originates in some 
 pressure upon the brain, but very often it 
 belongs merely to the nerves themselves. 
 Sometimes there are only a very few nerves 
 affected with this morbid change, but it very 
 
153 
 
 commonly extends to all the nerves of one 
 side of the body. The nerves themselves, 
 upon inspection, generally appear to have 
 undergone no change ; but still there must 
 be some, although it be of such a nature as 
 not to be observable. Upon almost every 
 occasion the recovery of nerves from this 
 condition is very slow, and generally very 
 imperfect. It would be an inquiry of great 
 public benefit, to examinein to the causes 
 why this complaint is more common in men 
 than in women, and especially why in this 
 very large town it is so often found in men, 
 even at an early period of life. 
 
 Changes may take place in the brain by 
 which it is rendered incapable of affecting 
 the nerves with those different modes of im- 
 pression, which are to be conducted along 
 them for the purpose of exciting the contrac- 
 tion of muscles. These changes depend 
 chiefly upon pressure, which may arise from 
 a great variety of causes. 
 
 The power of nerves to excite the action 
 of muscles may not only be morbidly di- 
 minished, but also morbidly increased. In 
 this case, the muscles of some part of the 
 
154 
 
 body are thrown into strong and repeated 
 contractions, or may be continued in a state 
 of permanent contraction. In neither of 
 these cases are the muscles at all influenced 
 by volition ; and however strongly it may be 
 exerted to moderate the contractions, the ef- 
 fort is attended with no effect. On many 
 occasions the cause of these complaints can- 
 not be ascertained, although it is generally 
 supposed to be some strong excitement ap- 
 plied to the brain. In some cases it has 
 been found by examination after death to be 
 a mechanical stimulus applied, — as for in- 
 stance, a little bony process growing from 
 the dura mater , and irritating the brain ; and 
 in cases of permanent contraction, it is al- 
 most constantly found to be an irritation of 
 some nerve, occasioned by a wound. Where 
 the disease consists in a repetition of con- 
 tractions, it is frequently in time removed, 
 and therefore in such cases can hardly be 
 supposed to depend upon any mechanical 
 irritation applied to the brain. Where it 
 consists in a permanent contraction, and 
 where the cause is ascertained, the disease 
 is most frequently fatal. 
 
155 
 
 Habit has much influence in regulating 
 the force, the velocity, and the succession of 
 muscular contractions ; but it would lead me 
 far beyond the limits of the present plan to 
 enter into this subject particularly. Neither 
 is it proposed to notice the changes produced 
 in muscles during their contraction ; for this 
 does not properly belong to our subject, 
 which is intended merely to treat of the in- 
 fluence of the nervous system in exciting 
 muscular action. 
 
 The nervous system and the body generally 
 are after some time exhausted by the number 
 of impressions which are conveyed along the 
 nerves, for the purpose of producing sensation, 
 or of exciting to action ; and some means are 
 necessaryfor recovering from this exhaustion. 
 This is done by sleep, which is a state wherein 
 all the vital functions are carried on in the 
 same manner as when a person is awake ; but 
 where the functions not necessary to life, and 
 which have been called the animal functions, 
 are suspended. Authors have amused them- 
 selves by forming opinions about the precise 
 state of the nervous system during sleep. 
 Some have supposed that the nervous fluid 
 
156 
 
 being previously exhausted, sleep was there- 
 by produced ; and during that state that a 
 new stock of nervous fluid was formed. 
 Others have supposed that the mobility of 
 the nervous influence was much diminished, 
 and that during sleep this property was gra- 
 dually recovered to its full extent. It is ob- 
 vious, however, that all opinions upon this 
 subject must rest merely upon conjecture. 
 We do not know the state of the nervous 
 system during the full activity of its func- 
 tions, and therefore we must be little able to 
 discover what is its state when many of these 
 functions are suspended. Although we are 
 unacquainted with the exact state of the ner- 
 vous system during sleep, yet we know many 
 of the remote causes which lead to it. These 
 are chiefly fatigue, either of body or mind ; 
 the gratification of appetites ; a certain at- 
 tention to the regular recurrence of the same 
 impressions ; an almost total want of im- 
 pressions ; and a powerful and long-continued 
 application of cold. Most of these tend to 
 exhaust the body, and therefore seem to lead 
 very naturally to sleep, by which the powers 
 of the body are recruited. It would appear 
 
15 ? 
 
 likewise to be necessary, in order that a per- 
 son should be kept awake, for a certain de- 
 gree of excitement to be applied to the ner- 
 vous system; and when this degree of ex- 
 citement is not supported, a state of sleep is 
 gradually produced. This seems to be the 
 most probable cause of sleep, where there is 
 a regular recurrence of the same impres- 
 sions, or where hardly any impressions at all 
 are made upon the nervous system. There 
 is probably no state, during the time that a 
 person is awake, when there is a total want 
 of impressions ; but every person must have 
 experienced a situation approaching to this, 
 when impressions have been made very 
 faintly, and sleep has very soon taken place. 
 
 It has been the opinion of many that the 
 mind is always active, even during the 
 soundest sleep. Of this, however, there ap- 
 pears to me to be no good evidence. It can 
 only rest upon our recollection of what has 
 passed during that state ; and where nothing 
 is recollected, I cannot see upon what ground 
 of proof we are to infer that any exertions of 
 the mind have taken place. Exertions of the 
 
158 
 
 mind very usually attend what is generally 
 supposed to be an imperfect sleep, but all its 
 faculties are not equally exerted. The imagi- 
 nation is very active, while the exercise of the 
 judgement is very imperfect. The imagi- 
 nation during sleep cannot, any more than 
 when a person is awake, create new objects, 
 but is only capable of forming new combi- 
 nations. These combinations are often in- 
 congruous ; but however great the incon- 
 gruity may be, it is not, during a state of 
 sleep, perceived by the judgement. 
 
 When sleep has been continued for a cer- 
 tain length of time, the powers of the body, 
 and likewise of the mind, are recruited ; but 
 this time is much regulated by habit and by 
 the different periods of life. 
 
 We ought next to take notice of the dif- 
 ferent opinions which have been formed 
 about the manner in which impressions are 
 conveyed along nerves, to excite the contrac- 
 tion of muscles. This, however, would lead 
 to an extensive field of inquiry, carrying me 
 far beyond the limits of this lecture ; and 
 little satisfaction could be derived from it, 
 
159 
 
 for every opinion which has hitherto been 
 formed upon the subject may be said to be 
 conjectural. 
 
 From experiments which have been lately 
 made by Louis Galvani of Bologna, and re- 
 peated and improved by others, it might be 
 supposed that nerves excite muscles to con- 
 traction by conveying to them an electric 
 fluid. It does not, however, follow from 
 these experiments, that electricity is the or- 
 dinary means employed to excite muscles to 
 action when volition is exerted, or the va- 
 rious emotions of the mind are called forth 
 which produce the contraction of their ap- 
 propriate muscles. But it is not intended to 
 enter upon this very intricate subject, where 
 it is not likely that at present we should ar- 
 rive at any satisfactory knowledge. 
 
 Sic, Preeses venerande, et Audi tores dig- 
 nissimi, quod hoc tempore proposui de ce- 
 rebro et nervis disserere, ad finem perduxi. 
 Multa fuerunt prsetermissa ut in argumento 
 
160 
 
 nimis copioso ; plurima in obscuro relicta. 
 In quaestione tam difficili, quid verisimilius 
 videatur, sequi conatus fui, si non veritatem 
 ipsam attingere potuissem. Benevolentiae 
 assuetae confido vestrae, de hoc parvulo in- 
 cep to vos humaniter existimaturos. 
 
SOME BRIEF OBSERVATIONS 
 
 DRAWN FROM MY OWN EXPERIENCE 
 
 UPON 
 
 A CONSIDERABLE NUMBER OF DISEASES. 
 
 M 
 
I HAVE now practised as a physician for 
 more than thirty years, and have for the 
 greater part of that time been so much oc- 
 cupied with visiting patients, that I have 
 seldom been able to write notes of individual 
 cases. It has occurred to me, however, that 
 some advantage might be derived from my 
 leaving a short record of the results of my 
 experience in a considerable number of dis- 
 eases*. 
 
 I am convinced that the most successful 
 treatment of patients will depend upon the 
 
 # The plan of recording the results of his experience ap- 
 pears to have been first adopted by Dr. Baillie in 1819, 
 when in consequence of some arrangements which he made, 
 he hoped to have had more time at his disposal. There is 
 reason to believe that he meant to have given a more ex- 
 tended account of his own experience : but almost every 
 moment of the short remainder of his life continued to be oc- 
 cupied with the active duties of his profession; and he was 
 besides constantly harassed with the feeling, that notwith- 
 standing his utmost exertions, he was unable to answer all 
 the demands made upon him, or to perform the various duties 
 that were continually presenting themselves to his conscien- 
 tious mind. 
 
 M 2 
 
164 
 
 exertion of sagacity or good common sense, 
 guided by a competent professional know- 
 ledge ; and not by following strictly the rules 
 of practice laid down in books, even by men 
 of the greatest talents and experience. It is 
 very seldom that diseases are found pure and 
 unmixed, as they are commonly described by 
 authors ; and there is almost an endless variety 
 of constitutions. The treatment must be 
 adapted to this mixture and variety, in order 
 to be as successful as circumstances will per- 
 mit; and this allows of a very wide field for the 
 exercise of good common sense on the part 
 of the physician. A physician who should 
 be guided strictly by the rules laid down in 
 books would be a very bad practitioner. In 
 the following short observations on the treat- 
 ment of various diseases, I shall state im- 
 partially the result of my experience, with- 
 out entering into any speculative reasoning, 
 which is often very fallacious. 
 
 Hanger Hill # , July 22, 1S19- 
 
 * During the period of Dr. Baillie’s attendance at H ind- 
 sor, he resided for one summer at Hanger Hill, near Acton. 
 
COMPLAINTS OF THE HEAD. 
 
 Many persons of both sexes are affected 
 daily with Headaches of more or less se- 
 verity, for many months, and often for some 
 years. They chiefly prevail towards the 
 middle time of life, but occur often at an 
 earlier period. They may take place in 
 any part of the head, but are more com- 
 monly felt in the forehead, or over one eye, 
 or in the back part of the head. Such head- 
 aches I have found in general to be very little 
 benefited by bleeding, either general or to- 
 pical. In the accounts which patients have 
 given me of the effect of this remedy, they 
 have said that they have either received from 
 it no benefit at all, or that it has lasted but a 
 few hours ; or that the headaches have even 
 been worse after cupping or the application 
 of leeches. I have generally found such 
 headaches to be most benefited by temperate 
 living, great attention to avoid improper diet, 
 purgative medicines, and bitters. The best 
 common medicine is rhubarb and soap, in 
 
166 
 
 such doses as to give two motions daily. A 
 few grains of calomel with an aperient 
 draught, such as an infusion of senna with a 
 drachm or two of Epsom salts given occa- 
 sionally, as for instance once in a fortnight 
 or three weeks, are sometimes of much use. 
 A due degree of exercise taken daily, both on 
 foot and on horseback, is likewise in some 
 cases very serviceable. Some headaches I 
 have known relieved by nervous medicines, 
 but not frequently. In some cases this 
 complaint is relieved by no plan of medi- 
 cine or management whatever, but will gra- 
 dually, after some months or years, subside. 
 The seat of such headaches is, I believe, in 
 the scalp, and not in the inside of the cra- 
 nium. They depend chiefly for their cause 
 upon the state of the stomach and bowels, or 
 upon an irritable state of some of the nerves 
 of the scalp. In most headaches of severity 
 it is right to make one or two trials of the 
 effect of topical bleeding, but not to perse- 
 vere in the repetition of this measure for 
 many months, as is often done, even though 
 it produce no benefit. 
 
 The cutting the hair of the scalp very short, 
 
167 
 
 and the application of cold, by a large sponge 
 wrung out of cold water and applied to the 
 upper part of the head, will often give great 
 temporary relief when the skin has been pre- 
 viously hot. 
 
 APOPLEXY. 
 
 This disease, in its most severe form, de- 
 pends commonly upon blood being poured 
 out into the substance of the brain from some 
 ruptured blood-vessel. This generally takes 
 place in the medullary substance, hear one 
 of the lateral ventricles, but it may occur in 
 any part of the brain. The milder forms of 
 Apoplexy depend upon a distention of some 
 of the vessels of the brain, from an undue 
 accumulation of blood in them. I have known, 
 however, one instance of fatal apoplexy where 
 many of the blood-vessels were found, upon 
 examination after death, to be much distended 
 with blood, but no blood had been extrava- 
 sated in any part of the brain. 
 
 The chief remedy in Apoplexy is large 
 bleeding, to be repeated according to cir- 
 cumstances. Topical bleeding by cupping 
 and leeches is likewise often of use. The 
 
168 
 
 next remedies in importance are purgative 
 medicines of considerable power, and acrid 
 glysters. The head should be kept high or 
 elevated, and cold may be applied with ad- 
 vantage to the top of the head. If the pa- 
 tient should recover by these means, the best 
 plan of management, in order to escape from 
 another attack, is to live almost entirely 
 throughout future life upon vegetable food, 
 and to abstain from wine, spirits, and malt- 
 liquor. It will be of considerable advantage 
 to avoid any strong or long-continued ex- 
 ertion of the mind. In a few instances, when 
 the full state of the vessels of the brain had 
 for some time subsided, I have derived con- 
 siderable advantage from the moderate use 
 of tonic medicines, and more especially of 
 steel. 
 
 HYDROCEPHALUS. 
 
 I have known in my own experience but 
 one instance of this disease being cured when 
 fully formed. In this case all the symptoms 
 were well marked, and the disease had made 
 such progress that squinting and an irre- 
 gular pulse had taken place. There had 
 
169 
 
 been no peculiar treatment, except that mer- 
 curial ointment was applied daily to a con- 
 siderable sore on the upper part of the head, 
 which had been produced there by a blister. 
 The individual is now alive, and is a young 
 lady of good talents, which she has highly 
 cultivated. 
 
 I have seen a few cases, in which there ap- 
 peared to be a strong threatening of Hydro- 
 cephalus, that got well by the application of 
 leeches and blisters to the head, and brisk 
 mercurial purges ; but I cannot determine 
 whether these cases, if less actively treated, 
 would have terminated in true Hydrocephalus 
 or not. 
 
 EPILEPSY. 
 
 This disease appears to me to have be- 
 come much more frequent within the last 
 twenty years than formerly. If this remark 
 be generally true, it may perhaps be ac- 
 counted for by the progress of luxury, which 
 must render the nervous system more irri- 
 table. I have known very few instances of 
 Epilepsy radically cured, but a considerable 
 number of cases in which the intervals be- 
 
170 
 
 tween the attacks have been rendered much 
 longer. The medicines which have appeared 
 to me to have most influence in removing or 
 retarding the attacks of Epilepsy have been 
 the argentum nitratum, viscus quercinus, and 
 the oleum succini. Of these, the first is the 
 most powerful ; but when it has been used for a 
 good many months, it tinges the skin of some 
 individuals of a dark colour. I have known 
 two instances of this effect from it in my own 
 experience. The bowels, too, should always 
 be kept open, and the effect of brisk purga- 
 tives should be tried in the beginning of the 
 disease. 
 
 It is of great use in the treatment of Epi- 
 lepsy that the patient should live very tem- 
 perately, and should avoid every thing which 
 may tend suddenly to excite or to harass the 
 mind. Patients should eat animal food spa- 
 ringly, and should abstain from wine, ale, 
 and porter altogether. The hair should be 
 cut short, and cold applications should be 
 applied to the head whenever the skin of it 
 feels hot. This management is often of much 
 use in rendering the attacks both less fre- 
 quent and less violent. The causes pro- 
 
171 
 
 ducing Epilepsy are various ; but I believe 
 that in this disease there is commonly a ten- 
 dency to a greater accumulation of blood 
 than is natural in the vessels of the brain. 
 
 THE TIC DOULOUREUX. 
 
 The Tic Douloureux seems to me likewise 
 to have become more common of late years, 
 and I think it is more frequent among men 
 than women. I do not recollect to have seen 
 any instance in which it has been perma- 
 nently cured, either by internal medicines 
 or by an operation. I have known some 
 instances of its being cured for a time (that 
 is, for several months or even a year) by me- 
 dicines ; and those which have appeared to 
 me of most use are Peruvian bark and ar- 
 senic. The operation of dividing the nerve 
 has in some instances prevented a return of 
 the disease for one or two years, but has not, 
 as far as I know, prevented it permanently. 
 The courage and patience under suffering in 
 this complaint, displayed by some individuals, 
 have been truly astonishing. 
 
172 
 
 OF SOME DISEASES OF THE NECK, 
 
 The most common disease in the neck is 
 the swelling of one or more lymphatic glands. 
 This is most apt to take place in young per- 
 sons who have fair complexions and delicate 
 constitutions. It is always a very tedious 
 disease, and is seldom much benefited by 
 medicine. The remedies which I have found 
 of most use have been sarsaparilla com- 
 bined with soda, Peruvian bark combined 
 with soda, and some form of steel. These 
 medicines will, however, often have but a very 
 imperfect influence upon the complaint. Sea 
 air and tepid sea-water bathing are often be- 
 neficial ; but I think that the air and waters 
 of Malvern are more useful than any other 
 remedy. I have known a good many cases 
 which had been but little improved by the com- 
 mon remedies, and by a residence upon the 
 sea coast with all its advantages, which have 
 afterwards got quite well by the patients re- 
 siding three or four months at Malvern. 
 
 O 
 
173 
 
 BRONCHOCELE. 
 
 This disease is not very uncommon in this 
 country : it is more frequent among women 
 than men, and much more so among young 
 than old persons. It is not often much be- 
 nefited by medicine, but will frequently dis- 
 appear of itself. Sometimes the swelling 
 grows even in this country to an enormous 
 size ; and I have known one or two cases 
 in which the patient was destroyed by the 
 swelling compressing the trachea and the 
 oesophagus. The medicines which I have 
 found of most use have been burnt sponge, 
 soda, and mercury used externally, either as 
 an ointment or in the form of plaster. 
 
 CHRONIC INFLAMMATION OF THE LARYNX 
 AND TRACHEA. 
 
 This disease occurs frequently in this 
 country, and upon the whole I think is more 
 common among men than women. It is 
 often confined to the inner membrane of the 
 larynx and the upper part of the trachea, 
 but frequently it spreads downwards, even to 
 the inner membrane of the bronchia. This 
 
174 
 
 disease always continues several months, and 
 often, with short intervals of amendment, for 
 years. Not unfrequently it lays the foun- 
 dation of future phthisis. Remedies generally 
 produce only a very gradual influence upon the 
 disease, and sometimes none at all. Benefit 
 is not unfrequently derived in some degree 
 from the repeated application, at short inter- 
 vals, of leeches to the fore part of the neck, 
 or the skin covering the upper bone of the 
 sternum. The frequent application of small 
 blisters to the same parts will occasionally be 
 of use ; but perhaps the most useful remedy 
 is a small seton inserted under the skin of 
 the side of the neck, very near the larynx. 
 Internal medicines often produce very little 
 good effect ; but the medicine which I have 
 found upon the whole to be the most bene- 
 ficial has been the extractum conii. I have 
 sometimes directed five grains of it to be 
 taken three times a day for many weeks to- 
 gether, with manifest advantage. 
 
 OF THE QUINSY. 
 
 I have but one observation to make with 
 regard to this disease, which is of some little 
 
175 
 
 importance. It is usual to endeavour through- 
 out the course of it to prevent suppuration 
 from taking place, by the repeated application 
 of leeches under the angles of the lower jaw. 
 It is certainly very desirable that suppu- 
 ration should be prevented, and that in- 
 flammation of the tonsils should gradually 
 subside by resolution. I have found, how- 
 ever, by experience, that suppuration is by 
 such means very often not prevented, but only 
 that inflammation proceeds more slowly to 
 this issue. Hence the patient suffers for a 
 considerably longer time ; and the suffering 
 in this disease is often very great. If, there- 
 fore, one or two applications of leeches do 
 not lessen materially the inflammation of the 
 tonsils and velum pendulum palati, I should 
 recommend the progress of the inflammation 
 to be encouraged by the inhaling of warm 
 vapour into the mouth, and the application 
 of poultices to the external fauces. In this 
 way the disease will go through its progress 
 more quickly, and the patient will suffer 
 much less. 
 
176 
 
 OF SOME DISEASES OF THE 
 CHEST. 
 
 I have very little to say either with respect 
 to pleurisy or peripneumony. The earlier, 
 after inflammation has taken place in the 
 pleura or in the lungs, that blood is taken 
 away from the arm, the sooner will the dis- 
 ease be subdued. Blood should in these dis- 
 eases be taken away largely, and if necessa^ 
 should be repeated again and again after 
 short intervals. All other remedies are in- 
 significant in comparison of the abstraction 
 of blood from the system. 
 
 When this remedy has not been applied 
 early enough, nor in sufficient quantity, and 
 an abscess has been formed in the lungs, 
 which has burst, patients have, in the greater 
 number of instances that I have seen, reco- 
 vered but very slowly. Under these cir- 
 cumstances the medical attendant has little 
 to do but avoid mischief. The constitution 
 should be moderately supported, without 
 being too much stimulated. Moderate doses 
 
177 
 
 of myrrh, decoction of bark, or infusion of 
 some bitter, are sometimes of use. Light 
 animal diet, and even a little wine, are some- 
 times useful in such cases, but great care 
 should be taken that no new inflammation 
 be excited. 
 
 In the course of my experience throughout 
 many years I have known a few instances 
 of abscess being formed in the lungs without 
 any previous pain in the chest, or difficulty 
 of breathing, or observable fever. Such pa- 
 tients, upon some exertion of the body, or 
 even without any exertion, have suddenly 
 coughed up a considerable quantity, perhaps 
 half a pint or more, of pus ; and this has been 
 to the patient the first intimation of disease. 
 In such cases the inflammation of the lungs 
 must have proceeded so slowly as to have 
 produced little or no pain in the chest, and 
 not to have alarmed the constitution so as to 
 excite fever. 
 
 OF PHTHISIS PULMONALIS. 
 
 In the course of my medical experience I 
 have known one or two cases of patients who 
 recovered from phthisis which was apparently 
 
 n 
 
178 
 
 fully formed. It is probable, however, that 
 with regard to these cases I may have been 
 mistaken ; and that if I had inquired with suffi- 
 cient accuracy into their history, I should have 
 found that they were small abscesses of the 
 lungs, of a common, and not of a strumous 
 nature. 
 
 I have known a good many instances in 
 which persons threatened with consumption 
 have recovered by going into mild climates, 
 or even into Devonshire or Cornwall ; but I 
 do not recollect a single instance in which 
 they recovered when the disease had de- 
 cidedly been formed. Change of air should 
 be adopted very early, in order to give it the 
 best chance of success. Such a variety of 
 accounts has been given by patients, and 
 even by medical gentlemen, of the compara- 
 tive advantage of one place over another 
 abroad, that I have found it impossible to 
 decide which is to be preferred. I am dis- 
 posed, however, to think that Madeira, the 
 Hyeres, some parts of Portugal, Malaga, Nice, 
 and Naples, are the best. It is very possible 
 that different places may suit better with the 
 constitutions of different individuals ; and 
 
179 
 
 this conjecture, if well founded, may ex- 
 plain the cause of there being such a variety 
 of opinions upon the subject. A patient 
 should, if possible, spend two or three suc- 
 cessive winters abroad, in order to give the 
 best chance of the disposition to the disease 
 being subdued. 
 
 When no active inflammation is going on 
 in the chest in phthisis, I have sometimes 
 found advantage from patients being allowed 
 to take a little white fish or light animal food 
 at dinner. In a very few instances I have 
 found benefit derived from their taking one, 
 or even two glasses of wine diluted with 
 water, after dinner; but wine is generally 
 improper. 
 
 I have known of no medicine which has 
 been of permanent and substantial use in 
 phthisis ; but I have sometimes found a good 
 deal of temporary advantage derived from 
 myrrh, from ammonia, and from light bitters 
 united to the acetic acid. The frequent re- 
 petition of blisters, or a seton inserted under 
 the skin in some part of the chest, are oc- 
 casionally of considerable use. 
 
 n 2 
 
180 
 
 OF HYDROTHORAX. 
 
 When dropsy of the chest does not depend 
 upon any diseased structure of the heart or 
 lungs, I have found it much more readily af- 
 fected by medicine than ascites or dropsy of 
 the ovarium. Not unfrequently, under these 
 circumstances, I have known water of the chest 
 relieved, or for a time cured, by medicine. 
 
 The medicine which I have found most 
 beneficial has been mercury combined with 
 squills and digitalis. Five grains of the pi- 
 lula hydrargyri, combined with one grain of 
 the dried powder of squills and half a grain 
 of the dried powder of digitalis, given twice 
 or thrice a day, have in many cases under 
 my care either very much mitigated or for a 
 time removed the disease. There has been 
 some advantage from the mercury affecting 
 slightly the salivary glands. Squills and digi- 
 talis are by themselves much less efficacious 
 than when combined with mercury. 
 
 I do not recollect one instance of Hydro- 
 thorax being permanently cured, although 
 1 remember a good many cases in which the 
 
181 
 
 symptoms were repeatedly removed by the 
 same means in the same patient. 
 
 Where the difficulty of breathing has been 
 very great, and the legs and thighs have 
 been much swelled from anasarca, I have 
 known much relief afforded by a scarificator 
 and small cupping-glass being applied above 
 the inner and outer ankle of each leg ; 
 and I do not remember any mortification at- 
 tacking these small sores. The difficulty of 
 breathing in such cases probably depended 
 in part upon the water accumulated in the 
 cellular membrane of some parts within the 
 chest, and this was gradually emptied through 
 the small openings made in the skin of the 
 legs. 
 
182 
 
 OF PALPITATION OF THE HEART. 
 
 Palpitation of the heart may take place 
 at any period of life ; but it is more common 
 at an early period than any other, as for 
 instance from fifteen to twenty-five years of 
 age. Perhaps, too, it may be more com- 
 mon in females than in males ; but of this I 
 am not very certain. At an early period of 
 life it does not in general depend upon any 
 diseased structure of the heart, but either on 
 a morbid irritability of the nerves of this 
 organ, or upon some imperfect state of diges- 
 tion. When it takes place from either of these 
 causes, it always continues for a long time, 
 (often, more or less, for two or three years), 
 but at length generally subsides. Rest of body 
 and quietness of mind are two of the chief 
 means which contribute to remove this dis- 
 ease. All quick motion of the body, and more 
 especially walking up ascents, increases the 
 complaint, and should as much as possible 
 be avoided. Every thing which tends to ex- 
 cite or harass the mind has the same effect, 
 
183 
 
 and should be shunned whenever it is pos- 
 sible. To rest of body and mind should 
 be joined very temperate diet ; and when this 
 general plan of management has been con- 
 tinued for many months, or perhaps for a 
 year or two, the disease usually subsides. 
 Digitalis has sometimes been useful in miti- 
 gating this complaint, but frequently it pro- 
 duces no good effect. 
 
 Where the palpitation depends either alto- 
 gether or chiefly upon the state of the sto- 
 mach, it is gradually removed by temperance, 
 by improving the condition of the stomach, 
 and by keeping the bowels free from costive- 
 ness. I remember one case in which palpi- 
 tation of the heart had taken place, and had 
 continued for six months, in consequence of 
 gout having attacked this organ. In this 
 case the palpitation ceased suddenly and en- 
 tirely when the gout attacked one of the feet 
 in a full and decided form. This person is 
 now alive, and has continued generally in 
 good health, although it be nearly twenty 
 years since the attack of palpitation. 
 
 In some young persons palpitation de- 
 pends upon an enlargement of the several 
 
184 
 
 cavities of the heart, produced not unfre- 
 quently by rheumatism attacking this organ. 
 This cause of enlargement of the heart was 
 overlooked by the physicians of this country, 
 till it was discovered by the sagacity of my 
 esteemed friend the late Dr. David Pitcairn. 
 The enlargement in general goes on increas- 
 ing till life is destroyed ; but I have known 
 two cases where the enlargement stopped at a 
 certain point, the increased action of the heart 
 in a great measure subsided, and the patients 
 acquired a tolerable share of health. They 
 are both now alive, and they have the pro- 
 spect of living, with care, to the ordinary term 
 of life. Such a fortunate issue is very rare ; 
 but the disease may be generally retarded in 
 its progress by much rest of body, quietness 
 of mind, and a very temperate mode of liv- 
 ing. Wine and every other fermented liquor 
 should be avoided, and patients under such 
 circumstances should live almost entirely upon 
 
 vegetable food. 
 
 At the middle and more advanced periods 
 of life, palpitation of the heart often depends 
 upon a diseased structure of some of its valves. 
 This condition of the heart does not admit 
 
185 
 
 of any remedy, but must gradually become 
 worse, until life be extinguished. But the sym- 
 ptoms may be mitigated, and the progress of 
 the disease retarded by little exertion of the 
 body, by great temperance, and by a few 
 ounces of blood being occasionally taken 
 from the arm. 
 
 ANGINA PECTORIS. 
 
 This distressing disease almost constantly 
 depends upon an ossification of the coronary 
 arteries of the heart, and admits of no effec- 
 tual relief from medicine. I have met with 
 two cases, however, in the course of my me- 
 dical experience, in which symptoms exactly 
 resembling those of angina pectoris depended 
 upon an imperfect digestion ; and the patients 
 ultimately recovered entirely, by correcting 
 the disordered condition of the stomach. 
 
186 
 
 OF DISEASES IN THE CAVITY OF 
 THE ABDOMEN. 
 
 ASCITES. 
 
 With respect to this disease I have very 
 little to say. When it depends upon a mor- 
 bid state of any of the abdominal viscera, — 
 as for instance, the liver or the spleen, — it is 
 never permanently removed, and very seldom 
 even relieved till the morbid condition of 
 these viscera is cured, if this event should 
 fortunately take place. Even where the vis- 
 cera in the abdomen are sound, or at least 
 cannot be discovered by an accurate exami- 
 nation to be otherwise, ascites is rarely, ac- 
 cording to my experience, cured by medicine. 
 The ordinary diuretic medicines, as squills 
 and digitalis, have commonly very little effect 
 upon it. The medicines which I think upon 
 the whole to have most influence upon this 
 species of dropsy are supertartrate of potash 
 and small doses of elaterium. In two, or 
 perhaps three cas^s, during my medical ex- 
 
187 
 
 perience, ascites has gradually got well with- 
 out medicine, after the common remedies had 
 been sufficiently tried and had failed. I can 
 entertain no doubt, from some late publi- 
 cations, that taking away blood from the arm 
 will often be a valuable remedy in ascites, 
 where there has been too much arterial ac- 
 tion, or even some degree of inflammation 
 in the early part of the disease ; but of this 
 remedy I have not had sufficient personal 
 experience to enable me to appreciate its 
 value. 
 
 INFLAMMATION OF THE PERITONAEUM. 
 
 Where this disease has not been connected 
 with any peculiarity of season, or any epi- 
 demical complaint, I have found it to be 
 cured by bleeding and purging, like other 
 inflammations. Upon the whole, however, 
 I think that it has been more relieved by re- 
 peated applications of leeches than by ge- 
 neral bleeding. I do not wish it to be un- 
 derstood that general bleeding is of no ad- 
 vantage in peritonitis, for sometimes it pro- 
 duces the greatest benefit. I think, however, 
 that in most cases more benefit will be de- 
 
188 
 
 rived from the repeated application of leeches, 
 according to circumstances, than from a re- 
 petition of the general bleeding. The pur- 
 gative medicines which have appeared to me 
 to be of most value are calomel and the 
 neutral salts. 
 
 OF SOME AFFECTIONS OF THE STOMACH. 
 
 There is no complaint more common in 
 this country than an imperfect condition of 
 the functions of the stomach. This generally 
 shows itself by more or less of flatulence, by 
 acidity, by a bitter taste occasionally felt in 
 the mouth, and often by some degree of cos- 
 tiveness. This condition of the stomach ge- 
 nerally arises from something wrong in the 
 quantity or quality of the food, from anxiety 
 of mind, and from a due degree of exercise 
 not being regularly taken. It makes its pro- 
 gress very gradually, continues always for 
 some months, and often even, more or less, 
 for years. 
 
 The first object of attention should be to 
 remove as far as possible the causes which 
 produce it. Every kind of food should 
 be avoided which the patients may have 
 
189 
 
 found, from their own experience, to have 
 disagreed with their stomach. Most com- 
 monly animal food that is very fat, or much 
 salted or fried, is difficult of digestion, and 
 should either be eaten very sparingly, or 
 should be altogether avoided. Young and 
 white animal food is in general more diffi- 
 cult of digestion than what is brown and of 
 middle age. The vegetables which are eaten 
 should be very well boiled, and should 
 be taken sparingly by such persons as are 
 subject to flatulence or acidity. The waxy 
 potatoe is almost constantly very difficult 
 of digestion, and in general should be avoid- 
 ed altogether. There should never be so 
 much food taken at a time as to give the 
 feeling of fullness or distention in the sto- 
 mach ; and except under very particular cir- 
 cumstances, there is no advantage in eating 
 oftener than three or four times in twenty- 
 four hours. The best common beverage in 
 disordered conditions of the stomach is water, 
 or toast and water ; and three or four glasses 
 of wine may be taken at or after dinner, ac- 
 cording to the habits of the patient, or other 
 circumstances. That wine is to be preferred 
 
190 
 
 which agrees best with the stomach, of 
 which he is himself the most competent 
 judge. Daily exercise is almost constantly 
 necessary in order to preserve good diges- 
 tion. Riding on horseback is upon the 
 whole the best, for it gives a motion to the 
 abdominal viscera, which no other exer- 
 cise is capable of ; but walking is also very 
 useful. A combination of the two is pre- 
 ferable to either; for riding on horseback 
 chiefly exercises the abdominal viscera, and 
 walking chiefly exercises the limbs and the 
 thoracic viscera. Anxiety of mind should 
 be avoided, whenever it can fairly be done ; 
 but it is often impossible to take advantage 
 of this remedy. 
 
 With respect to medicines, there are none 
 for this complaint which can be called spe- 
 cific. The most beneficial, however, which 
 I have known are rhubarb, and some form 
 of bitter medicine combined with alkalies. 
 Eight grains of rhubarb formed into pills 
 with soap, taken every night at bed-time, 
 and some bitter, — as infusion of cascarilla, 
 calumba, quassia, or gentian, with some 
 grains of soda or potassa dissolved in it, 
 
191 
 
 taken in the morning and before dinner, — will 
 often be very useful in this kind of disordered 
 stomach. These remedies should be con- 
 tinued for five or six weeks at a time, should 
 be omitted for two or three weeks, and oc- 
 casionally resumed. If the alvine evacua- 
 tions should be considerably lighter in their 
 colour, or much darker than natural, mer- 
 cury, given in moderate doses, and not for 
 so long a time as to injure the constitution, 
 will often be of great use. The large and 
 indiscriminate employment of mercury in 
 complaints of the stomach has, I think, 
 been often very hurtful. Where acidity 
 has been particularly prevalent in the sto- 
 mach, I have sometimes found it more ef- 
 fectually corrected by the diluted mineral 
 acids than by alkalies. Ten or twelve 
 drops of the diluted sulphuric or diluted 
 nitric acid, mixed with an infusion of some 
 bitter, and taken twice a day, will sometimes 
 be very beneficial in this condition of the 
 stomach. 
 
 There is an affection of the stomach in 
 which the digestion is very imperfect, and in 
 which considerable quantities of a transparent 
 
192 
 
 viscid mucus is formed. This often produces 
 nausea, and is occasionally brought up by 
 vomiting. According to my experience, this 
 condition of the stomach has been fre- 
 quently little benefited by medicine ; but 
 sometimes I have found the tinctura benzoes 
 composita of considerable use. A drachm of 
 it may be taken mixed with water and some 
 mucilage of gum acacia, three times a day. 
 
 There is another affection of the sto- 
 mach less common than the former, but far 
 more serious, viz. where the stomach throws 
 up in large quantity a fluid like cocoa. A 
 quart of this fluid will often be thrown up at 
 a time, and this will frequently be repeated 
 for many days together. This condition of 
 the stomach is sometimes connected with a 
 diseased state of the liver, but sometimes it 
 is independent of it, there being, at least 
 apparently, no disease in this latter organ. 
 In several instances it has proved fatal ; 
 but in others, and especially in two cases 
 which I recollect, the complaint subsided 
 for several months at a time, and the 
 persons enjoyed in the interval tolerable 
 health. This state continued many years, 
 
193 
 
 and the patients are still alive. In one case 
 I had an opportunity of examining the con- 
 dition of the stomach after death. It was very 
 capacious, and was half filled with this brown 
 fluid, but did not appear to be at all diseased 
 in its structure. The neighbouring viscera, 
 as the liver and spleen, were, as far as I re- 
 collect, perfectly sound. The fluid would 
 appear to be formed by a diseased secretion 
 of the inner membrane of the stomach, with- 
 out any apparent morbid structure. 
 
 This disease, according to my experience, 
 is but very little influenced by medicine or 
 by diet. In two or three cases some benefit 
 seemed to be derived from astringent medi- 
 cines combined with moderate doses of opium, 
 — as for instance, from tincture of kino, or 
 tincture of catechu, with a few drops of lau- 
 danum, taken three or four times a day. The 
 bowels should be at the same time kept free 
 from costiveness. 
 
 In some cases the stomach will lose almost 
 entirely the power of digestion ; the patients 
 will become pale and emaciated, and ap- 
 pear as if they were . affected by some fatal 
 visceral disease ; at the same time no morbid 
 
 o 
 
194 
 
 structure in the region of the stomach or liver 
 can be detected by the most attentive exami- 
 nation. In some of these cases the patients 
 have been completely restored to health by a 
 course of the Bath waters. 
 
195 
 
 OF INFLAMMATION OF THE 
 BOWELS. 
 
 Of this very formidable disease I have very 
 little to observe. Where the symptoms had 
 been fully formed, the greater number of 
 cases which I have seen have terminated fa- 
 tally. One case, however, in which the vo- 
 miting was of stercoraceous matter, reco- 
 vered. The chief remedy in this very dan- 
 gerous disease, is bleeding largely both from 
 the system, and topically by leeches. It is 
 very desirable that the inflammation should 
 be subdued, or at least be much lessened, 
 before any active purgative be admini- 
 stered. A purgative during the violence of 
 the inflammation will rarely produce any 
 evacuation, and may even do some injury, 
 by stimulating a part still highly inflamed. 
 Fomentations have been very commonly ap- 
 plied to the belly, and they give some tem- 
 porary relief. I am inclined to think that 
 cold applications may be useful in assisting 
 to subdue the inflammation, but this I have 
 
 o 2 
 
196 
 
 not hitherto tried. The tobacco glyster, and 
 cold water thrown upon the lower limbs, have 
 in some cases excited the bowels to action 
 when very powerful purgatives had failed. 
 
 OF DYSENTERY. 
 
 In this disease opiate and astringent me- 
 dicines have sometimes appeared to me to 
 be administered too early. Mild purgative 
 medicines, of which I think castor-oil upon 
 the whole the best, should be administered 
 till the alvine evacuations have become free 
 from mucus and blood, and have recovered in 
 a considerable degree the appearance of a na- 
 tural fluid motion. Astringent medicines with 
 opium may then be directed with much ad- 
 vantage. As there is always an inflammatory 
 condition of the bowels in this disease, leeches 
 may be applied to the seat of the sigmoid 
 flexure of the colon, and the upper extremity 
 of the rectum, with a considerable chance of 
 benefit. 
 
197 
 
 OF SOME AFFECTIONS OF THE 
 LIVER. 
 
 There may be, and often is, a deficiency 
 in the quantity of bile mixed with the al- 
 vine evacuations, without any disease in the 
 structure of the liver. The faeces are more 
 or less pale ; but there is no hardness nor 
 fullness in the region of the liver. Every 
 thing there, upon the most attentive exami- 
 nation, is discovered to be soft and per- 
 fectly natural to the feeling. Mild purga- 
 tive medicines, with small doses of the pilula 
 hydrargyria are commonly very useful in such 
 cases. Four or five grains of the pilula hy- 
 drargyri should be given every night for 
 some time, and the purgative every morning 
 or every other morning. The mercurial medi- 
 cine should not be carried so far as to make 
 any impression upon the constitution, if this 
 can be avoided ; it is only intended to sti- 
 mulate the ducts of the liver. The best pur- 
 gative medicine, upon the whole, is the sul- 
 phate of magnesia in moderate doses, so as 
 
198 
 
 to produce two or three evacuations daily. 
 When the alvine discharges have for some 
 little time resumed their natural colour, the 
 pilula hydrargyri should be given up. 
 
 Sometimes the bile discharged from the 
 liver is of a dark colour, and the motions be- 
 come darker than usual. The intensity of 
 the colour differs very much in different in- 
 dividuals, and occasionally it is nearly as 
 black as ink. The liver at the same time 
 may be, and commonly is, quite sound in its 
 structure. The treatment should in this case 
 be in a great measure similar to that in the 
 former, but a little more active. Small doses 
 of calomel may be used instead of the pilula 
 hydrargyri , and the purgative medicines may 
 be a little more powerful. When the colour 
 of the motions has for a short time (eight 
 or ten days) become natural, the calomel may 
 be given up ; but the purgative medicines may 
 be continued longer, at somewhat greater 
 intervals, as for instance every third day. 
 Where the motions are very green in their 
 colour, magnesia or some alkali may be 
 mixed with the purgatives. In the above 
 cases the Cheltenham and Leamington waters 
 
199 
 
 have been often very useful ; but I think that 
 many practitioners of the present day have 
 erred in administering mercury too long, and 
 in too liberal doses. When mercury is car- 
 ried beyond the point that is necessary, it 
 often injures the constitution by weakening 
 it, and by rendering the nervous system very 
 irritable. 
 
 There is sometimes a greater fullness and 
 greater sense of resistance over the whole 
 region of the liver than natural, with more 
 or less of tenderness upon pressure. This 
 arises from some chronic inflammation of the 
 substance of the liver. In such a case, the 
 repeated application of leeches to the seat of 
 the liver, and the occasional application of a 
 blister, are often of the greatest use. A mild 
 course of mercury should be recommended, 
 so as in some degree to aflect the constitution ; 
 and this should be administered both exter- 
 nally and internally. It should not, however, 
 be carried beyond the necessity. Long and 
 repeated salivations will seldom be required, 
 and often have done much and permanent 
 injury to the constitution. When the liver 
 has become soft, has lost its tenderness and 
 
200 
 
 resumed its natural size, the mercury may be 
 given up. If the liver shall not have returned 
 altogether to its natural state, and the consti- 
 tution appears to be suffering from the course 
 of mercury, a seton may be inserted under 
 the skin in the region of the liver, and the 
 mercury may be given up or suspended. In 
 some cases I have found a fullness of the liver 
 which had eluded the effect of mercury, to 
 be removed by a seton. The administration 
 of purgatives is of great advantage in all such 
 cases, and the Cheltenham waters are often 
 highly beneficial, 
 
 OF ABSCESS IN THE LIVER. 
 
 Inflammation of the liver will occasionally 
 terminate by forming an abscess. The ab- 
 scess will in time break externally, or it will 
 communicate with the lungs, with the sto- 
 mach, or with both of these viscera. When 
 the abscess breaks externally, the part gra- 
 dually heals unless there be something very 
 unfavourable in the constitution ; and the pa- 
 tient recovers entirely. When the abscess 
 communicates with the lungs, the matter is 
 brought up by coughing, and the patient, if 
 
201 
 
 prudent in the management of himself, and 
 possessed of a tolerably good constitution, 
 will sometimes at last entirely recover. When 
 the abscess communicates with the stomach, 
 the matter is sometimes discharged by vo- 
 miting, and sometimes by the bowels. In 
 this case, too, the patient will not unfre- 
 quently recover ; and the same observation 
 may be extended to an abscess of the liver 
 which communicates both with the stomach 
 and the lungs, although the circumstances 
 are more unfavourable in this than in the 
 other two cases. In these various cases little 
 benefit is produced by medicine, but great 
 injury may be done by imprudent or un- 
 skilful management. The bowels should be 
 kept always free from costiveness : if there 
 be any considerable feverishness, it may be 
 lessened by saline draughts; or if the con- 
 stitution be weak, it may be strengthened by 
 the prudent use of tonic medicines. The diet 
 should be light and nourishing, and in ge- 
 neral wine should be avoided. The exer- 
 cise, if the weather be favourable, should be 
 gentle, but it should not be taken at all if the 
 weather be ungenial, or if it be attended with 
 
202 
 
 pain or much fatigue. A stimulating diet, 
 too much or too violent exercise, and expo- 
 sure to a cold atmosphere, may do much 
 mischief, or even lead on to a fatal event. 
 
 OF TUBERCLES IN TEE LIVER. 
 
 Tubercles of different kinds are formed 
 not unfrequently in the liver at a middle or 
 more advanced age. They are often con- 
 nected with an intemperate mode of living, 
 but they will sometimes occur in persons who 
 have passed an uniformly temperate life. 
 They are frequently the cause of Ascites, but 
 sometimes they do not produce this effect. 
 No medicines, as far as I have seen, are at- 
 tended with any permanent benefit in this state 
 of disease. By temperate living, by gentle 
 exercise, and by the bowels being kept rather 
 open, patients will not unfrequently live for 
 some years with such complaints ; but I do 
 not recollect any instance of a patient ac- 
 tually recovering from them. 
 
203 
 
 OF HYDATIDS IN THE LIVER. 
 
 I have known only two instances of this 
 disease in the living body. The one was in 
 an old lady who had been subject from time 
 to time, for many years, to symptoms very 
 much resembling those of gallstones. At 
 length, after a more severe attack than usual, 
 the constitution gradually sunk and she died. 
 Cysts containing hydatids were discovered 
 upon examination of the body after death. 
 
 The other case was that of a young lady 
 who had suffered occasionally a good deal of 
 pain in the region of the liver, and at length 
 passed some hydatids by stool. She for the 
 time recovered, but what became of her af- 
 terwards I have never learned. It is ob- 
 vious that the formation of hydatids in the 
 liver, even when the existence of this disease 
 can be perfectly ascertained in the living 
 body, can receive no essential benefit from 
 medicine. If inflammation should take place 
 in the progress of this disease, it may be re- 
 moved or lessened by taking away blood 
 from the arm or topically ; and if at any 
 time violent pain should occur, it may be 
 
204 
 
 mitigated by opium and the warm bath. The 
 bowels should be kept rather open ; and there 
 will always be some advantage in patients 
 affected with this disease living temperately. 
 Patients may live many years with this com- 
 plaint; but if it be gradually making pro- 
 gress, even though slowly, it must in almost 
 every instance have ultimately a fatal termi- 
 nation. 
 
 OF GALLSTONES. 
 
 The formation of gallstones in the ducts of 
 the liver or in the gall-bladder is not a rare 
 disease, and I have known many instances 
 of it. The paroxysms of this complaint are 
 generally attended with exquisite pain ; but 
 I have known a few cases where the pain has 
 been moderate. Some cases I have likewise 
 known where patients have been subject to 
 symptoms of indigestion for many months, 
 without paleness of the stools, yellowness 
 of the skin, or any other symptoms which 
 denote the existence of gallstones ; yet this 
 condition of the stomach has ultimately led 
 on to the symptoms of gallstones being formed 
 in the most distinct manner. It is obvious 
 
205 
 
 that no solvent can be successfully applied 
 to a gallstone within the living body. While 
 the symptoms of gallstone exist, it must either 
 be in some duct of the liver, or in the cystic 
 duct, or in the ductus communis choledochus. 
 But a solvent introduced into the stomach 
 cannot come in contact with a gallstone in 
 any of these situations. As soon as a gall- 
 stone drops into the duodenum, where a sol- 
 vent might reach it, all symptoms belonging 
 to gallstones immediately cease ; and for the 
 time the patient becomes quite well. In the 
 treatment of gallstones, therefore, the sym- 
 ptoms can only be mitigated by medicine. If 
 any inflammatory symptoms have been pro- 
 duced, 'which is sometimes the case, they can 
 be removed or lessened by general and to- 
 pical bleeding. The exquisite pain which is 
 commonly felt during a paroxysm of gall- 
 stones, can be generally mitigated by large 
 doses of opium, by fomentations, and by the 
 warm bath. Purgative medicines should be 
 given, of sufficient power to counteract the 
 effects of the opium. Mercury appears to 
 me to have no power over a pure case of 
 gallstones unmixed with any fullness or hard- 
 
206 
 
 ness of the liver ; and the Cheltenham or 
 Leamington waters are of much less advan- 
 tage than in the more ordinary cases, where 
 the functions of the liver are merely deranged. 
 No particular mode of life will protect a pa- 
 tient against the recurrence of gallstones ; but 
 there is always some advantage in such per- 
 sons living temperately, and keeping their 
 bowels free from costiveness. 
 
207 
 
 OF SOME DISEASES OF THE 
 PANCREAS. 
 
 The pancreas is upon the whole less liable 
 to disease than any other important gland in 
 the body. I do not recollect that in private 
 practice I have met with one case in which 
 there was satisfactory evidence of the pan- 
 creas being diseased ; and I have only known 
 of a solitary example of it during the thirteen 
 years in which I was a physician of St. 
 George’s Hospital. This case was under the 
 care of another physician*, and the pancreas 
 was not known to be diseased till the patient’s 
 body was examined after death. The pain 
 in the epigastric region, sickness, uneasiness 
 or pain in the loins, which belong to inflam- 
 mation and enlargement of the pancreas, be- 
 long also to other diseases, and therefore do 
 not particularly indicate a disease in this im- 
 portant viscus. Were the enlargement so 
 great that it could be ascertained by an at- 
 
 * Dr. Heberden, junior. 
 
208 
 
 tentive examination of the living body, no 
 difficulty would remain in ascertaining the 
 disease. This, however, will very seldom 
 happen ; for I have not found a single in- 
 stance in all the dead bodies which I have 
 examined, of the pancreas being so large 
 that it could have been ascertained by the 
 most careful examination in the living body. 
 If the pancreas were to be much increased 
 in size, and the patient much emaciated, so 
 as to ascertain this disease while the patient 
 was alive, it would probably be in general 
 too late to receive any substantial benefit 
 from medicine. 
 
 Calculi formed in the ducts of the pancreas 
 constitute a still rarer disease than the inflam- 
 mation or enlargement of this gland. 1 have 
 not myself met with any instance of it in 
 the living body, nor do I remember to have 
 heard any physician say that he has seen this 
 disease. While the calculi remain within the 
 ducts of the pancreas, it is evident that no 
 solvent could reach them ; and if they should 
 be discharged into the duodenum, there would 
 be a cessation of the disease for a time. 
 
209 
 
 OF SOME DISEASES OF THE 
 SPLEEN. 
 
 The spleen is much less subject to inflam- 
 mation than many other of the abdominal 
 viscera. I do not recollect a strongly marked 
 instance of it in my practice, and I have never 
 met with an abscess in the spleen in all the 
 dead bodies which I have examined. The 
 peritonaeum is not uncommonly inflamed in 
 that quarter, and the coat of the spleen is 
 more or less involved in the inflammation. 
 I am not aware that inflammation of the 
 spleen would require a different treatment 
 from that of other viscera. 
 
 I have met with several examples of en- 
 largement of the spleen. The enlargement 
 has been very different in different patients. 
 In some the spleen has not been more than 
 twice its natural size, and in others it has 
 been so large as to occupy nearly all the left 
 side of the abdomen, extending from the 
 diaphragm to the pelvis. When the enlarge- 
 ment is so considerable that the lower end of 
 
 p 
 
210 
 
 the spleen can be felt under the margin of 
 the ribs upon the left side, there can be no 
 doubt with respect to the disease. The spleen 
 when enlarged is always felt to be harder 
 than in a natural state, but pressure upon it 
 with the hand seldom produces pain. An 
 enlargement of the spleen is sometimes fol- 
 lowed by Ascites ; but there will frequently 
 be no dropsy of the abdomen, even where 
 the spleen has been for a long time much 
 enlarged. Where enlargement of the spleen 
 has been connected with ague, it more fre- 
 quently subsides than in any other case : 
 where the enlargement has taken place in- 
 dependently of this cause, it hardly ever sub- 
 sides of itself, or is materially diminished by 
 medicine. According to my experience, 
 mercury, administered both externally and 
 internally, produces very seldom any good 
 effect : I have seen, I think, more advantage 
 from a seton inserted under the skin which 
 covers the spleen. In some cases it has ap- 
 peared to be diminished in size by this re- 
 medy, and to be rendered softer ; but I do 
 not recollect a single instance, except after 
 ague, in which it has been reduced to nearly 
 
211 
 
 its natural size. Temperate living, abstain- 
 ing from violent exercise, and keeping the 
 bowels open, must be to a certain degree 
 useful in retarding the progress of the disease. 
 
 I have not met with any case of hydatids 
 being formed in the spleen ; but such a disease 
 now and then occurs. A patient may live 
 very long with this complaint; but it can re- 
 ceive no cure, nor even amendment, from 
 medicine. 
 
 p 2 
 
212 
 
 OF SOME AFFECTIONS OF THE 
 KIDNEYS. 
 
 The kidneys are more liable to disease than 
 most other glands of the body, and are more 
 frequently diseased in men than in women. 
 This may arise from greater intemperance 
 in the former than in the latter sex, and like- 
 wise from the more violent bodily exertions 
 which men are often called upon to make. 
 I have known a few instances in which the 
 two kidneys entirely lost the action of sepa- 
 rating urine ; and this has been chiefly in 
 persons advanced in life. The patients soon 
 became very comatose, and died in the course 
 of two or three days : no medicine was of 
 the least advantage ; and every case, as far as 
 I recollect, terminated fatally. There is a 
 great difference, in the hazard of a patient’s 
 situation, whether the kidneys separate a 
 little urine or none at all. In the first case 
 they generally recover, and in the second 
 very rarely. It is curious that life should 
 
213 
 
 terminate so soon when the functions of the 
 kidneys have become totally suspended. A 
 person who receives no nourishment what- 
 ever into the stomach, or by any other 
 means, will live much longer. 
 
 OF ABSCESSES IN THE KIDNEYS. 
 
 When inflammation of the kidney has not 
 been removed by the usual means, an abscess 
 takes place in it. The pus which is formed 
 is sometimes of a common kind, but is often 
 of a strumous nature. It comes away along 
 with the urine, in greater or less quantity ; 
 and this circumstance, together with the hi- 
 story of the case, ascertains in the most satis- 
 factory manner the nature of the disease. 
 The kidney in such cases is sometimes nearly 
 of its natural size, but is often much en- 
 larged ; and this circumstance can be ascer- 
 tained by an examination in the living body. 
 Patients will continue to live with this com- 
 plaint for many months, and even for several 
 years. The formation of matter will some- 
 times be suspended for several months, and 
 patients will recover in a considerable degree 
 
214 
 
 their general health. The disease will return 
 either from imprudence in diet or exercise, 
 or without any known cause, and the patient 
 will become as ill as ever. It very rarely 
 happens that a patient permanently recovers 
 from this disease, and I do not at present re- 
 collect an instance of it. Medicines, as far 
 as my experience has reached, do not pro- 
 duce any great or'permanent good effect. A 
 seton inserted in the loins, or in the flank of 
 that side where the diseased kidnej 7 is si- 
 tuated, is sometimes of considerable use. 
 The uva ursi, and the tinctura benzoes com- 
 posita, have sometimes been serviceable as 
 internal medicines. The same observations 
 may extend to cooling and mucilaginous re- 
 medies. Great quiet of body and uniform 
 temperate living are useful in mitigating 
 symptoms, and retarding the progress of 
 the disease. A patient labouring under this 
 complaint should live almost entirely upon 
 vegetable food, and should abstain from wine 
 and other fermented liquors. 
 
215 
 
 OF HYDATIDS IN THE KIDNEYS. 
 
 This is a very rare disease, but I have 
 known two or three instances of it. Its ex- 
 istence cannot be ascertained in the living 
 body, unless an hydatid should occasionally 
 be discharged along with the urine through 
 the urethra. A patient may live very long, 
 perhaps a good many years, with this disease, 
 but it cannot receive any advantage from 
 medicine. 
 
 OF CALCULI IN THE KIDNEYS. 
 
 One of the most common diseases of the 
 kidneys is the formation of calculous matter 
 in them. This may either be in the form of 
 sand, producing in the kidneys temporary ir- 
 ritation ; or in the form of a calculus, which 
 may either produce temporary irritation, or 
 a permanent and fatal disease. When the 
 calculus is small and of a favourable shape, 
 it may pass by one of the ureters into the 
 bladder, and be altogether discharged from 
 the body by the urethra. When the bulk of 
 the calculus is considerable, and more espe- 
 cially if it be of an arborescent form, it can- 
 
216 
 
 not pass into the bladder, but must remain 
 in the kidney, or in the pelvis of the ureter 
 very near the kidney, producing there more 
 or less of irritation, frequently some degree 
 of inflammation, and not unfrequently an 
 abscess. The existence of a calculus in the 
 kidneys may be guessed at with high proba- 
 bility from the symptoms ; but it can only be 
 perfectly ascertained when sand or small 
 fragments of calculous matter are occasionally 
 discharged through the urethra. In the treat- 
 ment of this formidable complaint, symptoms 
 of inflammation, when present, should always 
 be promptly removed by general and topical 
 bleeding, by cooling and mucilaginous me- 
 dicines, and by mild purgatives. When the 
 inflammation is removed, the proper medi- 
 cines should be determined by the nature of 
 the calculus, where this can be ascertained. 
 If the calculus be of the common kind, (con- 
 sisting chiefly of litliic acid,) magnesia and 
 alkaline medicines should be given, and be 
 continued for a great length of time. If the 
 calculus should consist of the triple phos- 
 phate, moderate doses of some of the mineral 
 acids, properly diluted, should be given : and 
 
217 
 
 of these the muriatic acid is perhaps the best. 
 I do not recollect any instance in which pa- 
 tients have by these medicines been perma- 
 nently cured ; but I have not unfrequently 
 known the symptoms very much mitigated 
 by them, and even for a time suspended. 
 
 Patients labouring under this complaint 
 should live with great temperance, but should 
 adopt chiefly a light animal diet, because, if 
 acid be formed in the primae viae in consi- 
 derable quantity from vegetable food, the 
 symptoms of the complaint will probably be 
 aggravated. 
 
 OF HAEMORRHAGE FROM THE KIDNEYS. 
 
 I have known a few cases in which blood 
 has been discharged from the kidney, and 
 has passed out of the body along with the 
 urine. In most of these cases the quantity 
 of blood has been large, amounting often to 
 nearly a pint at a time, so that the mixture 
 of urine with the blood hardly appeared to 
 dilute it. The recurrence of the bleeding is 
 commonly very frequent, and the disease will 
 often continue with intermissions for several 
 
218 
 
 weeks. The loss of blood must arise from 
 one or more considerable vessels being rup- 
 tured in one or both kidneys ; but I believe 
 that generally one kidney only is affected. 
 The blood-vessels of the kidney may be so 
 distended with blood, that one or more of 
 them may burst ; or the sharp edge of a cal- 
 culus may cut through one or more of them, 
 and in this way occasion the haemorrhage. 
 Whether the haemorrhage has been produced 
 in the one way or the other, can generally 
 be determined by an accurate attention to 
 the history of the case. 
 
 General and topical bleeding, but more 
 especially the latter, are sometimes of great 
 use in mitigating the disease. Cold appli- 
 cations to the loins and belly are also very 
 serviceable. As internal medicines — nitre, 
 the diluted sulphuric acid, and the tincture 
 of muriated iron, have often produced great 
 benefit. The last medicine has, I think, upon 
 the whole been the most useful. 
 
 The patient should be kept perfectly quiet, 
 the chamber cool, and the diet for a time 
 should consist entirely of vegetable sub- 
 
219 
 
 stances. I do not recollect any instance in 
 which the patient has not recovered from 
 this complaint, when it has not been con- 
 nected with an abscess, or some other for- 
 midable disease of the kidney. 
 
 OF DIABETES. 
 
 I have in the course of my medical life 
 seen a good many instances of this formidable 
 disease. Of late years a considerable pro- 
 portion of such cases have got well under my 
 care, or have had the symptoms very much 
 mitigated. The most successful plan of treat- 
 ment has been, to give considerable doses of 
 opium combined with rhubarb or some other 
 bitter : fifty drops of laudanum, for instance, 
 may be given three or four times a day, mixed 
 •with some infusion of rhubarb or infusion of 
 calumba. The rhubarb may also be given 
 separately in the form of pills. Under this 
 treatment the disease will often gradually 
 subside, and at length cease altogether. It 
 is, however, very apt to recur, and therefore 
 this plan of treatment, in more moderate 
 doses, should be continued for some months 
 after the patient is apparently well. Bleeding 
 
220 
 
 from the system generally, and topical bleed- 
 ing from the loins, are often useful ; for the 
 blood-vessels of the kidneys in this disease 
 are generally more or less distended with 
 blood. The diet should be temperate, and 
 should consist chiefly of animal food; and 
 the best kind of drink is, upon the whole, 
 Bristol water. 
 
 OF A LOOSE TUMOUR IN THE REGION OF 
 THE KIDNEY. 
 
 In four or five instances I have felt a loose 
 tumour in the situation of one of the kidneys, 
 which could be easily moved up and down 
 with a slight pressure from the hand. The 
 tumour is of considerable firmness, and has 
 a good deal the shape and size of the kidney. 
 It is attended with very little uneasiness to 
 the patient, and the general health is very 
 little, if at all, affected by it. When felt in 
 women, it has been mistaken for an en- 
 larged ovarium; but it has neither the shape 
 of an enlarged ovarium, nor is it in the si- 
 tuation in which an enlarged ovarium is 
 commonly found. I have not had an op- 
 portunity of examining this disease in the 
 
221 
 
 dead body; I am therefore not certain about 
 its nature, but I am rather disposed to think 
 that it is a kidney more loosely attached 
 than usual to the subjacent and surrounding 
 parts. 
 
222 
 
 OF SOME DISEASED AFFECTIONS 
 OF THE URINARY BLADDER. 
 
 It is not unusual for the urinary bladder to 
 become for a certain time paralytic, and to 
 lose its power of expelling the urine. This 
 is more apt to occur in young women than 
 in any other persons, and for the following- 
 reason. The complaint is generally produced 
 by the calls to evacuate the urine being re- 
 sisted, so that the muscular coat of the bladder 
 becomes very much stretched in consequence 
 of the accumulation of the urine. By the 
 stretching of the muscular coat, its power of 
 acting as a muscle is for a considerable time 
 lost, and is only gradually recovered. Young 
 women, from being long in a carriage, or long- 
 in company, and from their natural modesty, 
 often resist the desire to evacuate the urine 
 for such a length of time as to induce a 
 
 A 
 
 paralytic state of the muscular coat of the 
 bladder. Older women manage this function 
 more wisely ; and men are not much exposed 
 to the causes which induce them to resist the 
 
223 
 
 desire of evacuating the urine. — When this 
 disease has taken place, and is not accom- 
 panied with any morbid change of structure 
 in the bladder, the bladder gradually recovers 
 its power by the water being regularly drawn 
 off twice or thrice in twenty-four hours for 
 some weeks. Women may soon be taught 
 to draw off the water themselves, so that they 
 may avoid the very distressing assistance of 
 a surgeon, as well as have an opportunity 
 of relieving themselves whenever there is 
 the least painful distention of the bladder. 
 Internal medicine is of no use in this com- 
 plaint, but the diet should be temperate, and 
 drink should be taken sparingly. 
 
 The bladder will sometimes have only 
 its sphincter muscle paralytic, while the 
 muscular coat of the bladder shall retain its 
 natural power. This complaint prevents the 
 water from being properly retained ; and 
 when there is a certain accumulation of urine 
 in the bladder, it passes off involuntarily. 
 This species of complaint is more common 
 in persons advanced in life than in young 
 persons, and more common in men than in 
 women. The sphincter muscles generally 
 
224 
 
 throughout the body become more weak at 
 an advanced period of life ; and the bladder 
 of men is more exposed through life to the 
 causes which impair its powers, than that 
 of women. When this disease has taken 
 place, it is seldom entirely cured. It is oc- 
 casionally benefited by small blisters being 
 applied to the perinaeum or near the neck of 
 the bladder. Tonic medicines of different 
 kinds, and proper doses of the tinctura lyttae, 
 are sometimes attended with advantage. 
 
 OF A DISEASED SECRETION FROM THE 
 BLADDER. 
 
 The inner membrane of the bladder, more 
 especially near its neck, has the power of 
 secreting mucus, and is always secreting it 
 in a small quantity, in order to protect the 
 internal surface of the bladder against the 
 stimulus of the urine. This secretion is some- 
 times very much increased in persons at a 
 middle or advanced age, and is a good deal 
 altered in its properties. Instead of being 
 in a great degree transparent and void of 
 colour, it becomes opaque and yellow, so as 
 very much to resemble pus. It becomes 
 
225 
 
 what is now generally called purulent mucus, 
 and will often be nearly equal in quantity to 
 the urine itself. When the urine has been 
 evacuated, and has been allowed to rest in a 
 vessel for a little time, the purulent mucus 
 subsides from the urine, and often adheres 
 with considerable tenacity to the sides of the 
 vessel. This mucus is often formed, without 
 there being any morbid structure in the 
 bladder, or any substance contained in the 
 bladder which produces irritation ; but it 
 almost constantly attends more or less the 
 presence of a calculus there. 
 
 When this complaint is independent of a 
 calculus, it commonly receives but little be- 
 nefit from medicine. The balsam of copaiba, 
 the uva ursi, and soda, sometimes appear to 
 be useful, but they very seldom produce any 
 considerable or permanent good. When the 
 existence of a calculus in the bladder is the 
 cause of the disease, the removal of the cal- 
 culus will effectually cure it. 
 
 Q 
 
226 
 
 OF A CALCULUS IN THE BLADDER. 
 
 When a calculus is in the bladder, the dis- 
 ease can in general be ascertained by an ac- 
 curate attention to the symptoms ; but it can 
 always, or almost always, be ascertained in a 
 satisfactory manner by a sound or catheter 
 being introduced into the bladder by an ex- 
 perienced surgeon. I have known a good 
 many instances in which this disease has been 
 alleviated by medicines, but none in which it 
 has been cured. Mucilaginous substances, 
 fomentations, opiates, magnesia, and alkaline 
 remedies are sometimes of considerable use 
 in lessening the symptoms. Where the cal- 
 culus has been ascertained, by portions of it 
 or by gravel which may have been occa- 
 sionally discharged with the urine, to consist 
 of the triple phosphate, much advantage has 
 sometimes been derived from taking moderate 
 doses of the muriatic acid properly diluted. 
 
 OF A COMMUNICATION BY ULCER BETWEEN 
 THE BLADDER AND THE RECTUM. 
 
 I have known two cases of this kind ; one 
 of which was in a man, and the other in a 
 
227 
 
 woman. They both lived between two and 
 three years, but they died from the conse- 
 quences of the disease. Both sometimes suf- 
 fered considerable pain in the very lower 
 part of the abdomen, but they were both 
 often quite free from pain for many hours 
 together. The pulse was sometimes of a na- 
 tural frequency, and sometimes was accele- 
 rated. It hardly ever happened that urine 
 escaped from the bladder into the rectum, 
 but very often air escaped from the rectum 
 through the urethra, and frequently more or 
 less of faeces was discharged by the same 
 channel. Whenever faeculent matter was dis- 
 charged by the urethra, great pain was felt 
 about the neck of the bladder. It is very 
 obvious that medicine could be of no sub- 
 stantial use in those cases. Opiates, fomenta- 
 tions, and mild purgatives sometimes pro- 
 duced an alleviation of the symptoms, but 
 the constitution became at length very much 
 exhausted, and the scene was then soon 
 closed. 
 
 q 2 
 
228 
 
 OF SOME DISEASED AFFECTIONS 
 OF THE WOMB. 
 
 One of the most common diseases of the 
 womb is prolapsus uteri. It is in very dif- 
 ferent degrees in different individuals. In 
 some the womb is only a little lower in its 
 situation than it ought to be, but the mouth 
 of the womb is still considerably within the 
 vagina. In others the neck of the uterus 
 shall be at the external opening of the va- 
 gina; and in a few a considerable portion of 
 the womb shall be without the body. 
 
 According to my experience, this disease, 
 when in a considerable degree, is often very 
 imperfectly relieved. When the degree of it 
 is slight, and the vagina not very relaxed, 
 the complaint may sometimes be removed by 
 a horizontal posture being continued through- 
 out the greater part of the day for several 
 months, by the judicious use of tonic medi- 
 cines, and by astringent fluids being injected 
 into the vagina twice a day. In a moderate 
 degree of the prolapsus, pregnancy taking 
 
229 
 
 place has often proved the means of curing 
 the disease. 
 
 When the prolapsus is in a great degree, 
 both internal and external remedies have 
 generally been of little use. The incon- 
 veniencies, however, of the disease may in 
 a great measure be prevented by a pessary 
 being constantly worn in the vagina. When 
 the pessary is well adapted to the circum- 
 stances, it does not produce pain, and in 
 time the patient is hardly sensible of its pre- 
 sence. I need not say that the pessary should 
 be removed for a few minutes every two or 
 three days, in order that it may be cleaned 
 and not produce irritation. 
 
 OF POLYPUS OF THE WOMB. 
 
 This disease, although by no means so 
 common as the former, is not very rare, and 
 I have not unfrequently been consulted about 
 it. If the symptoms be not inquired into 
 with some attention, it may be confounded 
 with the malignant ulcer, or what is usually 
 called Cancer of the womb ; but a minute in- 
 quiry into the symptoms will enable the prac- 
 titioner in most instances to distinguish be- 
 
230 
 
 tween the two diseases. When an exami- 
 nation has been made per vaginam , no doubt 
 can remain; and therefore, before an opinion 
 is decidedly given, an examination should 
 always be made. 
 
 In this disease no permanent advantage is 
 gained by medicine. The strength of the 
 constitution may be a little kept up by tonic 
 and astringent medicines, and the profuse 
 discharges of mucus and blood may be 
 moderated by the application of cold and 
 astringent fluids ; but the disease can only 
 be removed by an operation, which consists 
 in tying the neck of the polypus by a liga- 
 ture. This can be done safely, and with 
 great dexterity by many practitioners in mid- 
 wifery. In a few days after the operation, 
 the polypus drops off, and the patient gra- 
 dually recovers her usual health. In many 
 instances the polypus does not return ; but a 
 new polypus is occasionally formed, which in 
 due time may be removed by a similar ope- 
 ration. 
 
231 
 
 OF CANCER OF THE WOMB. 
 
 This disease is not uncommon, more es- 
 pecially at the middle and more advanced 
 periods of life, and I have frequently been 
 consulted respecting it. I have never known 
 any medicine produce the least real amend- 
 ment of the disease. Opium and other se- 
 datives will not unfrequently relieve the 
 greater attacks of pain ; and in that way will 
 prevent the constitution from being so soon 
 worn down by the disease. It is to be ob- 
 served, however, that different women suffer 
 naturally very different degrees of pain in 
 this fatal disease, and that its progress is much 
 more slow in one woman than another. The 
 diet should always be very temperate, con- 
 sisting chiefly of vegetable substances, and 
 the patient should abstain from wine and 
 other fermented liquors. 
 
 OF AN ENLARGEMENT OF THE WOMB. 
 
 This disease is not uncommon, although 
 by no means so frequent as cancer of the 
 
232 
 
 womb. It is more apt to occur at or near 
 the middle period of life than at any other, 
 and may be distinguished by a moderate at- 
 tention to the circumstances of the case. 
 There are considerable mucous discharges 
 by the vagina, as in some other diseases of 
 the womb, and the monthly evacuations are 
 profuse. When the disease has made some 
 progress, a tumour of a pyramidal shape and 
 of considerable hardness may be felt imme- 
 diately above the pubes. The neck of the 
 uterus is likewise found to be enlarged by an 
 examination per vaginam. These circum- 
 stances sufficiently characterize the disease. 
 It generally continues for many years, and 
 the general health is often not much affected 
 by it. In the course of my experience I have 
 known three cases of this disease cured by 
 medicine. Five or six grains of the pilula 
 hydrargyri were directed to be given every 
 night for many weeks, from half a pint to a 
 pint of decoction of sarsaparilla was ordered 
 to be drunk daily, and a large mercurial 
 plaster was applied over the tumour and the 
 whole lower part of the abdomen. The dis- 
 
233 
 
 ease in these instances gradually subsided, 
 and at length disappeared altogether. One 
 of these patients, who was about thirty-five 
 years of age, afterwards became pregnant, 
 and bore a very healthy child. 
 
234 
 
 OF SOME DISEASED AFFECTIONS 
 OF THE OVARIUM. 
 
 The most common disease of the ovarium is 
 that of its being dropsical. It may take place 
 at almost any period of life. It is not un- 
 usual in young women, and often occurs 
 about the middle age. This disease may in 
 general be readily distinguished from Ascites 
 by an examination of the swelling, which is 
 almost constantly more or less uneven upon 
 its surface, and often more or less hard in 
 different parts of it. Sometimes, however, 
 in Dropsy of the ovarium, when the disease is 
 of considerable standing, the swelling is uni- 
 form, and a sense of fluctuation is felt upon 
 striking the tumour with the hand, almost as 
 distinctly as in Ascites. Under such circum- 
 stances the two diseases will be distinguished 
 from each other by inquiring accurately into 
 the history of the case. 
 
 I do not recollect any instance in which 
 Dropsy of the ovarium has been materially 
 diminished by medicine. I have long, there- 
 
235 
 
 fore, given up the trial of active remedies in 
 this disease, which I have found to be inef- 
 fectual, and sometimes injurious to the con- 
 stitution. I have contented myself with keep- 
 ing the bowels regular, and with directing 
 such diuretic medicines as would not impair 
 the general health. I have not found mer- 
 cury, even when continued for several months 
 together, and having its full influence upon 
 the constitution, produce a cure or any ma- 
 terial change in this disease. The disease 
 will sometimes remain stationary for a good 
 many years, and the general health will be 
 very little impaired by it. In one instance, 
 after it had existed for nearly thirty years, 
 the disease disappeared spontaneously^, and 
 the lady, who is still alive, remained after- 
 wards in good health. In three cases where 
 the women were young, and the dropsy con- 
 fined to one large cyst in the ovarium, I have 
 known them to be effectually relieved by 
 tapping, and the disease not to return for 
 several years. In one of these the dropsy 
 did not return for ten years. When the pa- 
 tient is young, and Dropsy of the ovarium 
 under favourable circumstances, it is always 
 
236 
 
 worth while to make a trial of this remedy. 
 When the Dropsy of the ovarium is composed 
 of several cysts, the disease may be partially 
 relieved by tapping ; but it almost con- 
 stantly returns, and after a certain time very 
 rapidly, so that there is only a short in- 
 terval between the operations. Still, how- 
 ever, some relief is afforded by each opera- 
 tion ; and patients will be ready to undergo 
 the operation for this relief every two or three 
 months for several years. 
 
 A firm swelling, about the size of the fist or 
 a large orange, is sometimes to be felt in the 
 situation of the ovarium, either upon the 
 right or the left side of the abdomen. It will 
 sometimes remain stationary, will sometimes 
 go on enlarging to a much greater size, and 
 is not, as far as I have seen, suppressed by 
 any remedy. This solid structure of the 
 ovarium is found not uncommonly blended 
 with the dropsical cysts which have been 
 lately mentioned. 
 
237 
 
 OF MY EXPERIENCE IN FEVERS. 
 
 While I was a physician of St. George's 
 Hospital, which was during a period of thir- 
 teen years, I saw a good many cases of ty- 
 phous fever. There were generally three or 
 four cases of such fevers under my care at a 
 time. Since 1 have ceased being a physician 
 to that hospital, and more especialty since 
 my patients have been chiefly in the upper 
 ranks of society, I have not seen more than 
 three or four of such fevers in a twelvemonth. 
 With respect to the contagious nature of 
 these fevers, I am convinced that it is in ge- 
 neral not considerable. I do not recollect 
 an instance in which a patient in that hos- 
 pital communicated the infection to a patient 
 lying in the next bed. When patients are 
 crowded together, and the apartments are ill 
 ventilated, I entertain no doubt of this spe- 
 cies of fever being capable of being commu- 
 nicated readily from one individual to an- 
 other. 
 
 These fevers are sometimes without any 
 
238 
 
 symptoms which denote a local affection of 
 a vital organ, but very frequently there are 
 symptoms which indicate an inflammatory 
 action of some of the viscera in the chest or 
 belly, or of the brain. 
 
 In these fevers I have met with no reme- 
 dies which possess any specific powers of 
 cure, or which are capable of shortening in 
 any material degree their duration. Before 
 they are fully formed they are sometimes cut 
 short by an emetic, by active purgatives, by 
 profuse perspiration, or by cold affusion ; but 
 when they are quite established, I do not re- 
 collect that I have seen any instance in which 
 they have been shortened by these means. 
 The most successful method of treating these 
 fevers, as far as I have seen, is to remove or 
 mitigate the symptoms as they arise. The 
 symptoms denoting an affection of the brain 
 should be relieved as speedily as possible by 
 cupping, leeches, and the application of cold 
 to the head. Cloths dipped in iced water, 
 and kept almost constantly applied to the 
 shaved scalp, have appeared to me more ef- 
 fectual in removing delirium than any other 
 remedy. 
 
239 
 
 When there is pain in any part of the chest 
 or difficulty of breathing, these symptoms 
 should be relieved as soon as possible by 
 cupping or leeches, or blisters, and by saline 
 medicines. 
 
 If there be any pain in the abdomen, or 
 any symptoms denoting an affection of the 
 liver, the stomach, and the bowels, these are 
 to be relieved by their appropriate remedies. 
 
 If there be too vigorous a circulation over 
 the body, without any apparent local affec- 
 tion, it may be corrected by a very cautious 
 bleeding from the arm, by purging, and by 
 saline medicines. If the actions of the con- 
 stitution be feeble, they may be strengthened 
 by tonic and stimulating remedies, the best 
 of which I believe to be wine in suitable 
 doses. By this mode of treatment fevers 
 will often terminate favourably, which other- 
 wise would have been fatal. 
 
 During the greater part of the time in 
 which I have practised medicine, physicians 
 in general, and myself among that number, 
 have, I believe, been too sparing in taking 
 away blood in typhous fever. It was hardly 
 ever directed to be taken away from the arm, 
 
240 
 
 and not often locally, except by the appli- 
 cation of leeches to the head. Of late years 
 many physicians have gone into the opposite 
 extreme, and have taken away blood too pro- 
 fusely. In the course of a few years this re- 
 medy, like every other, will find its proper 
 level. During the course of a fever, patients 
 require but little nourishment, and this should 
 in a great measure consist of farinaceous 
 matter. Even when the fever has entirely 
 subsided, animal food should be taken for 
 some time very cautiously and sparingly. I 
 have known some instances of the most se- 
 rious relapses of fever from patients having 
 taken animal food too soon and in too large 
 quantity ; and I am disposed to think that 
 the greater number of relapses arise from 
 this cause. 
 
 OF INTERMITTENT FEVERS. 
 
 I have always practised in London, and 
 have therefore not had many cases of inter- 
 mittent fever under my care. While I was a 
 physician of St. George’s Hospital, I perhaps 
 saw five or six cases of it in a year ; and this 
 chiefly occurred among the poor Irish who 
 
241 
 
 lived or lodged in St. Giles’s. In some of 
 these cases the origin of the disease could be 
 clearly traced to marshy effluvia ; but in others 
 this cause could not be traced, as the pa- 
 tients reported that they had lived in St. 
 Giles’s for several years, and had always 
 been employed as labourers in London. 
 They may, however, have been exposed to 
 marshy effluvia in the neighbourhood of 
 London, without knowing or recollecting it. 
 
 I have known a good many cases in which 
 bark alone would not cure an ague. In all 
 of these cases, as far as I now recollect, when 
 a grain of calomel was given every night for 
 eight or ten nights, bark cured the ague in 
 the course of a few days. This practice I 
 learnt from my friend Dr. David Pitcairn. 
 The powder of bark I consider as a more ef- 
 ficacious remedy for agues than the extract 
 of bark. 
 
 According to my experience, arsenic cures 
 agues in general sooner than bark, and pro- 
 duces no bad effect if it be given in proper 
 doses, and be not continued too long. When 
 the ague has been stopped for three or four 
 days, the arsenic should be given up, and 
 
 R 
 
242 
 
 half a drachm of bark, in powder, should be 
 given three or four times a day, for perhaps 
 a week. 
 
 I have known some cases of ague cured 
 by the powder of calamus aromaticus, and I 
 have understood that it is not an uncommon 
 remedy among the lower orders of people in 
 Sussex. 
 
 THE END. 
 
LONDON: 
 
 PRINTED BY RICHARD TAYLOR. 
 © 
 
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