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CONTRIBUTION
TO
MEDICAL LITERATURE,
BY
J. RUTIERFURD RUSSELL, M.D.,
PHYSICIAN TO THE LONDON HOM(EOPATHIC HOSPITAL, ETC.;
AUTHOR OP A 'TREATISE ON EPIDEMIC CHOLERA;'
ETC. ETC. ETC.


LONDON:
LEATH AND ROSS, 5, ST. PAUL'S CHURCHYARD,
AND
9, VERE STREET, CAVENDISH SQUARE.
LEAMINGTON:
LEATH AND WOOLCOTT, 18, LOWER PARADE.




PRINTED BY J. E. ADLARD, BARTHOLOMEW CLOSE.




PREFATORY NOTE.


IN selecting the following essays for republication,
I have avoided all of a merely controversial character.
The first one in the volume may, indeed, be considered
somewhat an exception to this rule, but it treats rather of
the principles involved, in what in Scotland would be
called, the " great ganging plea," between the old and
new schools of medicine, than attempts a full argument
of the questions at issue.
The papers were all written for the 'British Journal
of Homoeopathy,' with which I was editorially connected
for the first fifteen years of its existence, and which
continues its career under the management of my late
esteemed colleagues Drs. Drysdale and Dudgeon, whose
labours for the advancement of the Art of Medicine
will only be fully appreciated by its future historian.








CONTENTS.
CHAPTER I.                          PAGE
Young Physic...    1
CHAPTER II.
On Diet...   2
CHAPTER III.
On the Structure and Uses of the Liver...  84
CHAPTER IV.
On Digestion..... 131
CHAPTER V.
On the Water-Cure.. 168
CHAPTER VI.
ScaTION 1.
On some Affections of the Heart.                             208
SECTION II.
On some Organic Diseases of the Heart                           2.  236
Hypertrophy of the Heart...            ib.
Pericarditis....           258




Viii                  CONTENTS.
CHAPTER VII.
On Pneumonia... 282
CHAPTER VIII.
The Skin and its Diseases.. 329
CHAPTER IX.
On Affections of the Nervous System.. 462
Cases......  488
On some Lesions of the Nervous Centres... 491
On Epilepsy.... 507
CHAPTER X.
On Mesmerism...536
CHAPTER XI.
On Sir H. Holland's 'Medical Notes and Reflections'. 557
CHAPTER XII.
On Cholera. 598
CHAPTER XIII.
Medical Novels.                                   629
CHAPTER XIV.
Samuel Brown... 643




CONTRIBUTIONS


TO
MEDICAL LITERATUIRE.
CHAPTER I.
YOUNG PHYSIC.
THERE is a point in the development of a complex
science, such as medicine, at which it seems to be
overburdened by the multitude of its facts and the
insufficiency of its generalizations. When it has reached
this stage, and come to a dead lock, it gets no aid from
those who have the reputation of being its most successful cultivators. For the very endowments which
gave them renown at the time when the science required
merely the accumulation of materials, or the critical
selection of facts and their lucid arrangement, disqualifies
them from the higher task of grasping the subject as
a whole, and viewing it by the light of general philosophy, discovering the true centre from which it must
be re-organized. This great achievement requires more
than.the highest powers of analytical acumen, it requires
1




2


YOUNG PHYSIC.


the intuition of synthetic genius. And when the voice
of the great discoverer, who is destined to renovate his
department of knowledge, makes known the central
truth, there is none on whose ear it falls more repulsively than on that of the high-priest of the special
science itself.   Great discoveries belong to philosophy
rather than to science; and no class of minds is less
prepared to receive them than are those who have
devoted themselves to the study of scientific details
alone.                    0
There is nothing more strange or more lamentable
than the total absence of philosophical discernment displayed by those who are now the appointed guardians of
medicine. While deploring its present uncertain and
unscientific character, they do not seem at all aware
of the real cause of its poverty, and propose remedies
which would be as useless if got as they are impossible
to obtain.    Their inability to perceive what medicine
stands in need of, arises from the same cause as their
rejection of Homoeopathy.      If there be any thing more
striking in Dr. (now Sir John) Forbes' memorable article'
than this, that throughout the whole of it he speaks
of theory in medicine as if it were quite an unimportant
thing, and as if the whole end of the labours of the
medical philosopher were attained if he made himself
1 "Homceopathy, Allopathy, and Young Physic," first published in the
' Brit. and For. Med. Review,' of which Dr. Forbes was editor, it has since
"grown into a book, now in its second edition, entitled, ' Nature and Art in
Disease.' The article well deserves the epithet "memorable," for it has
produced a greater impression upon the mind of the medical profession than
anything of the kind during the present generation. By many the writer
was looked upon as having betrayed the secrets of the confessional, and was
denounced with such clamour as to make him resign his editorial post; by
others he was applauded; by all his influence was felt.




YOUNG PHYSIC.


3


sure of a sufficient number of facts, it is the constant
recurrence of the expression "philosophic practitioner,"
-whose philosophy seems to consist in doubting much
and in doing nothing. Unsparingly as he condemns
Homceopathy as tending to degrade physic by making
its practitioners artisans, the position he would appoint
to medicine is singularly opposed to the usual requirements of an art and a science.  Science is certain knowledge, giving the power of prediction; art is the application of that knowledge.    But his science consists in
knowing that we can know nothing, and the art he
recommends us to practice is the dolce far niente! He
speaks of Homceopathy as "an ingenious system       of
medical doctrine, tolerably complete in its organization,
tolerably comprehensive in its views," and says that "it
is as good and rational a theory as most of our medical
theories." With the gTeat leader of philosophic practitioners it seems a very light matter whether a theory
be right or wrong. He seems to regard it very much in
the light of the shell of an oyster, useful only for containing a nutritious body of facts. It is not surprising
that, considering theory to be. so very insignificant a
matter, he lightly observes, with an inconsistency which
might be culpable in one who took a more serious view
of the value of theory, "that we may indeed have sufficient proof to satisfy any reasonable mind that the
theory, or doctrines, or principles of Homceopathy are
false," although he does not enter into any such proof,
but waives it till a more convenient season.  He turns
away contemptuously from the consideration of the
theory, doctrines, or principles, and eagerly asks what
the facts are worth.




4


YOUNG PHYSIC.


The facts arrest and startle him. He finds that under
the guidance of this theory practitioners of medicine
restore to health more patients than under the orthodox
method, which disdains, as an infringement upon the
liberty of the faculty, to acknowledge obedience to any
theory whatsoever. This fact of the greater success
of Homceopathic treatment, is a hook in the nose
of Allopathy, which   must in some way or other
be extracted.   The problem  is this:-By the most
authentic returns, more cures are effected in certain
dangerous diseases under Homoeopathy     than  under
Allopathy; how, then, is the inference to be prevented that, therefore, Homoeopathy is good, and the
position to be established that it is radically bad? This
is done in the simplest and most ingenious way. Good
and bad are relative terms: it is the same thing to say
that a man is better than a monkey, as to say that a
monkey is worse than a man. If we say Homoeopathy
is better than Allopathy, we suppose some good in the
former-more good at least than in Allopathy.  But we
have only to say Allopathy is worse that Homoeopathy to
get rid of the dilemma. And this is the position our
great antagonist assumes! But it is urged, if Homceopathy be bad, and Allopathy still worse, how do you retain your allegiance to Allopathy?  To this he answers:
it is bad in esse, but good in posse; it contains the.germs
of its entire renovation, and it only requires proper attention to foster the latent rudiments of good into vigorous
growth. How comes it, a sceptic might inquire, that you,
who have so long held a chief place in the cabinet of
Medicine,-you, her appointed, acknowledged, respected
minister, should, till now, never have whispered your be



YOUNG PHYSIC.


5


lief that the system you have been directing requires a
thorough reformation?  How is it that this momentous
truth has been forced from you by the doings of so insignificant a body as the Homoeopathists? Surely, in the.,history of our art, among the triumphs of Homceopathy
will be recorded,-" It forced Dr. Sir John Forbes to
give his candid opinion of the state of medicine. It
forced him to make confessions during his life, which
otherwise he might have reserved for his testament."
But let us follow out the process of Young Physic,
and see exactly what it is, and to what it leads:-Allopathy and Homoeopathy are both bad. In their hospitals many patients die, although more recover. The
average mortality in both is much alike; the kind of
diseases which kill them is much alike. It is plain that,
as there is no great difference in the amount of recoveries
under the two systems, they must both derive their
efficacy from the same cause. Now, as the methods of
treatment are wholly opposite, the benefit must accrue
from something beyond or outside of the treatment
altogether. The only thing beyond that, common to
both, is the natural power of recovery.  Here, then, is
the real explanation of the cause of the equality in the
mortality and recovery in the two sets of hospitals:that those who are able to stand the treatment and
the disease, get well; and those who are unable, die.
The practice of medicine (medendi, curing) turns out
to be nothing. All that the physician can do, is to open
his wards and see fair-play between Nature and Death.
If the struggle between them end in favour of the
latter, he has the satisfaction of confirming his diagnosis;
if in favour of the former, of dismissing his patient.




6


YOUNG PHYSIC.


Is it, then, really come to this-that, after two thousand years of observing disease, we are no further
advanced in its treatment? In what respect is Young
Physic superior to Hippocrates? They both advise the
same thing: Watch, say they, the progress of disease,
but do not interfere. Young Physic, however, remarks,
that all who have deviated from this rule have done
mischief.   All that his greater experience has taught
him is, to have greater confidence in the canon of Hippocrates.   How long is this new cycle to run?    Are we
to stand, like sentinel-stars, for other two thousand
years, silently watching the course of disease, while ever
and anon an eccentric man of action suggests some practical innovation, till, at the expiry of this double millennium, another Forbes arises, and with his critical
crowbar demolishes the systems of these practical men,
and dooms his fellow-mortals to endure all the pangs of
sickness, with nothing but the consolations of philosophy
to alleviate them? In short, what is the germ of Allopathy on which Dr. Forbes rests his hopes? The only
positive recommendations we can find are-carefully to
watch the progress of* disease, to employ all proper
hygienic measures, and to use the numerical method in
noting down the effects which have been or may be
observed to follow the administration of the medicines.
The first two recommendations, however excellent, can
hardly be considered as at all differing from those given
by Hippocrates; and as Dr. Forbes evidently expects
much good to accrue from the last, it is to it we shall now
direct our sole attention: and if we can establish that
the only results of such a method are increasing perplexity, rank error, or total disbelief in the powers 'of




YOUNG PHYSIC.


7


medicine, we must acknowledge the incapacity of Young
Physic to be of any use,-except in the way of a
pioneer.
"Life is short and the art is long; the opportunity
quickly passes; experience is fallacious, and decision difficult:"  how, then, can any man, in the short term of
his life, discover for himself what remedies are certainly
useful in the all but infinite variety of diseases he has to
treat? Suppose even that he has the advantage of a large
hospital, is it possible for him to make experiments in
such a way as to arrive at certain knowledge? The Young
Physic school, which prides itself upon its philosophy,
recommends the use of the numerical method, that, by
noting down the result of each medicine in each form of
disease, we may at length arrive at positive data to direct
us in future cases.  Let us inquire what philosophers of
established reputation think of this plan.
M. Comte scouts with the same severity as Sir John
Forbes, all ontological speculations, and founds his
system on the ascertainment of positive phenomena
alone, leaving the mystics to pry into the causes of these
phenomena.    He has, moreover, a profound respect for
mathematical science, places it as the first and fundamental science in his scheme of human knowledge, and
is most anxious to carry the numerical spirit as far into
general science as it will legitimately go. He would
apply the method of numerical notation to every department of human knowledge, where it could be of any
avail. Surely if any philosopher of note is likely to
countenance Young Physic's brave attempt to 'reform
medicine by introducing into it the accuracy of arith' Hippocrates' first Aphorism.




8


YOUNG PHYSIC.


metic, it must be M. Auguste Comte.      His opinion is
given in the following words:
"Indeed the spirit of calculation tends in our day
to introduce itself into this study, (Physiology) especially
into that part of it relating to medical questions, by a
much less direct method, under a 9~uch more specious
form, and with infinitely more modest pretensions.     I
wish to speak of that pretended application of it which
is called the statistics of  medicine, from whicl  many
savans (e.g., Young Physic) expect wonders, and which,
from  its very nature, can lead only to profound and
direct degradation of the medical art, (reduced by it to
a blind enumeration.)    Such a method, if we may be
allozoed to call it by the name of method at all, cannot, in
reality, be any thing else than absolute empiricism, disguised under the frivolous garb of mathematics.  Pushed
to its extreme logical consequences, it will tend to makce
all rational medication radically disappear from medicine, by conducting the practitioner to make chance trials
of certain therapeutic measures, for the purpose of noting
down with minute precision the numerical results of their
application.  It is evident, on principle, that the continual variations to which all ogyanism is subjected, are
necessarily even more pronounced in a pathological, than
in a normal state, as a result of which, the cases must be
even less exactly similar, whence results the manifest
impossibility of making a judicious comparison between
two curative methods derived from data furnished by statistical tables alone, independent of some sound medical
theory: No doubt some direct experimentation, restrained
under proper limits, migyt be of great importance to
medicine as well as to physiology, but it is precisely under
the strict condition that it shall never be simply empiri



YOUNG PHYSIC.


9


cal, but that it shall always attack itself either in its
institution or in its interpretation to an entire system of
corresponding positive doctrines.   (A 1'ensemble systematique des doctrines positives correspondantes.)   Notwithstanding the iymposing aspect of the forms of exactness, it would be dificult to conceive of an opinion in
therapeutics more superfcial and more uncertain than
that which rests solely on the easy computation of fatal
and favorable cases, to say nothing of the pernicious
practical consequences of such a manner of proceeding,
where one could not beforehand exclude any kind of
attempt.
" It is really deplorable that geometricians have sometimes honoured with some kind of encouragement, such a
profoundly irrational aberration, by making vain and
puerile efforts to determine, by their illusory theory of
chances, the number of cases sufficient to make these statistical results legitimate." 1
We must again remind Young Physic that M. Comte
is one of the first of living mathematicians, and one who,
more than any other philosopher, insists upon the prolongation of the mathematical method as far forward
into the more special and complex sciences as it can be
made to go.
There can be no greater contrast than that presented
by Sir John Forbes, as a destroyer, and as a builder.
Nothing can be clearer, more precise, more acute than
his objections to the systems or practice of others; but
when he makes his own system        known, he becomes
vague and obscure in the extreme, and falls into declamation about the medical profession being " grand and
1 ' Cours de Philosophie positive,' par M. Auguste Comte. Tome 3me.
pp. 418, 420.




10


YOUNG PHYSIC.


glorious in its essence, aims, and aspirations!" Wearied,
it would seem, with the work of demolition, he sinks
into the state described   by Horace, when he says,
" Auditis? an me Icdit amabilis insania?" and in the
dim perspective he sees the future progeny of Young
Physic flit past like Banquo's shadowy race, but cannot
catch or paint their lineaments.
The system   which is thus faintly suggested in the
article of Sir John Forbes is more fully expounded by
Dr. A. Combe in his letter " On the Observation of
Nature in the Treatment of Disease."     This letter is
very remarkable for its candour and high moral tone.
It contains also much truth, and shows that the writer,
to some extent, perceives the real cause of the backward
state of medicine when he says that, " notwithstanding
the ardour and success with which facts are sought for,
yet, inasmuch as the ultimate facts remain unknown, the
others lead to no useful result." If by ultimate fact,
Dr. Combe means the largest possible generalisation, and
this is the only idea that a disciple of Bacon can attach
to the phrase, then we entirely agree with him, but we
look upon the homoeopathic principle as being that ultimate fact which he seeks. Although to a certain extent
Dr. Combe feels the necessities of medicine, and truly
says it is by the ascertainment of an ultimate fact, that
is, a general law, that we.can advance our science, yet
the means by which he strives to reach the point of vantage are as vague as his general conception of what it
would be, when gained, is just and exalted.
The system which Dr. Combe expounds is founded on
a radical error in philosophy. His view is this:-If we
observe the progress of disease, we shall find that it runs




YOUNG PHYSIC.


11


a determinate course; it has its origin, its growth, and
its decline; in these it obeys certain fixed laws given to
it by the Creator. It is for man to learn these laws-to interpret these laws, but not to interfere with them.
Nature alone cures, not man. It is presumptuous in man
to usurp the prerogative of Nature, and attempt to improve upon her efforts. Man is the interpreter, not the
master of nature.  Such seems -the general drift of his
opinions, which, lest we misstate them, we shall give in
his own words;-" The grand object of medicine is to
preserve and restore the healthy action of all the different
organs and functions of the human body, so as to insure
their efficiency, and fit the individual for the successful
discharge of the duties devolving upon him as a created
being and a member of society. Here, then, the first
step to be taken is obviously to become acquainted with
the mechanism of the body, the structure of its constituent organs, the conditions or laws under which these
act, the purposes which they respectively serve in the
animal economy, and the relations in which they stand to
each other, and to the external agents by which man is
surrounded and acted upon from the moment of conception down to his latest breath. In other words, the first
step towards rational principles of cure must consist in a
knowledge of the laws of the healthy functions. The
second ought to be the observation of the manner in
which the various disturbing causes act upon the different functions, and the kind, course, duration, and
termination, of the morbid action which they produce.
Having investigated these points, we become qualified to
inquire, in the next place, what circumstances will best
favour the intentions of Nature, and remove the obstacles




12


YOUNG PHYSIC.


which may have arisen to impede or thwart her efforts.
To succeed in these aims, or even to make a rational
attempt at succeeding, we must be profoundly impressed,
or, I may say, saturated, with the great principle or
truth, that all the operations and actions of the living
body, whether healthy or morbid, taking place according
to fixed and discoverable laws, and that God has left
nothing to chance. With this grand fact before us, it
becomes palpably evident that we can do nothing rational
in the way of either prevention or cure, except in so far
as we act in accordance with those laws. Many medical
men have, however, a very different impression from this.
A good physician will always seek to be, and never aim
at being more than, Bacon's ' servant and interpreter of
Nature.'   A greater than he created man, and ordained
the laws of his being, and no surer road can be found
than that traced by the hand of his Creator. Overlooking this truth, and viewing disease as an entity, ungoverned by any definite laws, and not destined to run
through any definite course, many medical. men talk as
familiarly of their ' curing' and ' arresting disease' as if
they had an absolute control over the whole animal
functions, and could alter their laws of action at pleasure.  To my mind, no clearer proof of presumption
and philosophic ignorance can be found than this usurpation of the prerogatives of Deity; and its results are
-often very unsatisfactory,"
The great error contained in this view consists in confounding the so-called laws of Nature with the laws of a
moral Creator. The tap-root of the false school of philosophy to which Dr. Combe seems to belong, and which
has recently been fully expounded in many popular works,




YOUNG PHYSIC..13


is confounding the real obligation of man to obey the.moral laws of his Creator with his assumed submission
to the laws of the creation. The so-called laws of the
creation have no existence out of the mind of man.
They are but the summary expressions of his knowledge;
they are but the ultimate facts or laws he has arrived at.
" Ultimate laws," says Mr. Mill, "are observed uniformities of Nature which cannot be resolved into more general
laws." 1 All that they express, in any case, is the constant relation of certain facts to certain other facts. This
is all that gravitation expresses.  Because gravitation is a
law of Nature, would any sane man argue that therefore
it ought not to be interfered with?  What is the whole
active life of man, but a struggle with this great law of
Nature?   What is death but a sinking under it-becoming obedient to it-being let down, pulled down, we
might say, in submission to this grand natural law? It
cannot, then, be argued that because a process occurs in
obedience to a law of physiology or pathology, that on
that ground alone we ought not to interfere with it.  It
must be shown that it would be. injurious to the patient if we did. This, which is the only real point at
issue between us and the Naturalists, Dr. Combe does
not attempt to touch.  He shows, indeed, that in certain
cases it is very hazardous to use the ordinary depleting
measures; but he does not even attempt to show that
there are not, or may not be, means which are innocuous,
yet potently beneficial. He does not show that there
may not be a science of therapeutics, or curing; but he
implies, from the position he at first assumes, that there
cannot.
'Mill's Logic,' vol. ii, p. 3.




14


YOUNG PHYSIC.


Miserable as are the conclusions Dr. Combe arrives at,
we believe they are the logical consequences of working
out Sir John Forbes' system; and for this reason we
attach much value to his letter, independently altogether
of the high and generous tone which pervades it, and
which gives great weight to its influence over others. If
ever Medicine suffer utter degradation, it will be brought
about by means of this new school. The leaders of the profession are engendering a scepticism in Medicine which,
unless counteracted, will blight it to the core.  Practitioners of physic will become divided into two classes,the one believing nothing, but yet acting as if they did,
and giving the countenance of their high talents and acquirements to the rankest hypocrisy; the other class believing anything or everything, but having no substantial grounds for their belief: cold, cultivated sceptics will
be the aristocracy, and ignorant but energetic dupes of
their own credulity the democracy, of this noble and
glorious profession.  No wonder that one of Sir John
Forbes' correspondents exclaims, " What more melancholy
fact can be presented to the mere prescriber, when he
first enters upon the duties of his benevolent profession
with the enthusiasm of unsoured philanthropy, than the
continual assurance of the Nestors of the profession, that
the greater our experience the more positive our conviction that we can do nothing? And it only proves the
immense force of habit that, with such convictions, we
do not see men quit a profession which, under such circumstances, requires a constant exercise of hypocrisy and
a constant sacrifice of principle."
While the great majority of those who have expressed;
their opinions on the state and prospects of medicine




YOUNG PHYSIC.


15


agree in the main with Sir John Forbes and Dr. Combe,
yet a few avow their dislike at being thus consigned to
the negative pole of usefulness. The best exponent of
the views of this class seems to be Dr. Bartlett, who
says, " the seat, the character, and the tendencies of the
disease being known, the next thing to be done is to find
out the best means of preventing, modifying, and of
curing it." To do this he goes on to say, "we must
know the effects and influences which all substances and
agencies in nature are capable of producing upon it, and
this we can know only by direct observation of the effects
themselves." That is, we suppose medicine improved by
a system of experimentation with individual drugs upon
individual diseases.  This is what another writer likewise
proposes. Let us again apply to some philosopher of
acknowledged reputation, to ascertain what may be expected from such experiments when not conducted in the
light of some previous theory.
It most fortunately happens, that the very case in
point is used as an illustration by Mr. J. Stuart Mill, in
his work upon Logic.     The great modern authority
upon. the subject writes thus:-" Let the subject of inquiry be the conditions of health and disease in the
human body, or, for greater simplicity, the conditions of
recovery from a given disease; and in order to limit the
question still more, let it. be confined,.in the first instance,
to this one inquiry,-Is, or is not, a particular drug,
Mercury, for example, a remedy for that disease?..
When we devise an experiment to ascertain the effects of a given agent, there are certain precautions which we never, if we can help it, onmit.  In
the first place, we introduce the agent into the midst of




16


YOUNG PHYSIC.


a set of circumstances which we have exactly ascertained.
It need hardly be remarked how far this condition is
from being realized in any case connected with the phenomena of life; how far we are from knowing what are
all the circumstances which pre-exist in any instance in
which mercury is administered to a living being. This
difficulty, however, though insuperable in most cases,
may not be so in all; there are sometimes (though I
should think never in physiology) concurrences of many
causes in which we yet know accurately what the causes
are. But when we have got clear of this obstacle we
encounter another still more serious.    In other cases,
when we intend to try an experiment, we do not reckon
it enough that there be no circumstances in the case the
presence of which is unknown to us, we require also
that none of the circumstances which we do know of
shall have effects susceptible of being confounded with
those of the agent whose properties we wish to study;
we take the utmost pains to exclude all causes capable
of composition with the given cause; or if forced to let
in any such causes, we take care to make them such that
we can compute and allow for their influence, so that the
effect of the given cause may, after the subduction of
those other effects, be apparent as a residual phenomena.
These precautions are inapplicable to such cases as we are
now considering....   Anythiny like a scienific use of the method of experiment in these complicated
cases is therefore out of the question. TWe can, in the most
favorable cases, only discover, by a succession of trials, that
a certain cause is very often followed by a certain effect." 1
We find, then, that logic as unceremoniously discards the
1 ' ill's Logic,' vol. i, p. 529.




YOUNG PHYSIC.


17


experimental method proposed by Dr. Bartlett as philosophy condemned the statistical method sanctioned by
Sir John Forbes. Indeed, the two methods are very
nearly allied, the one almost involving the other; and if
they both be abandoned, and if young physicians be
not content with being the mere spectators of disease
and superintenders of diet and ventilation, and revolt at
the idea of hospitals for the cure of the sick being nothing but museums for the study of morbid natural
history, and registries of mortality, to what side are
they to turn for escape from the alternatives presented
to them? How shall they be followers of nature and yet
energetic? How shall they know all that is to be known,
and not be sceptical; and do all that is to be done, and
not be dangerous?
If the simple observation of the natural course of
disease; if the application of the numerical method to
all recorded cases; if experiments with various medicines
upon various diseases, are each and all fallacious modes
for the improvement of medicine, what conceivable
method yet remains by which it may be raised from its
present uncertainty to become amenable to known laws,
by which it may be worked? The answer to this we
have already anticipated, at the commencement of our
article. The accumulation and complexity of facts in
medicine rendering the inductive process inapplicable, it
is absolutely necessary, for the regeneration of the
science, that some successful hypothesis be made which
shall express the law of relation between the curative
and some other discoverable property of a   drug, by
which we may know beforehand what we are to select
in a given case of disease. There has been but one such
2




18


YOUNG PHYSIC.


attempt in medicine, (for we need not stop to show that
the old Galenic maxim, " Contraria contrariis opponantur," is not such an hypothesis, involving, as it does,
the previous ascertainment of conditions as impossible to
recognise as they are incapable of being tested;) that is,
that medicines tend to cure diseases similar to those they
tend to produce.' This is a perfect hypothesis for the
circumstances; because it embraces all the circumstances
coming within the range of medication, and it is possible
to establish the truth or falseness of it by experiment.
How vain and ignorant it is of those who profess themselves philosophic practitioners, to reject this proposition,
and to stigmatize the practice thence flowing, on the
ground of its being at the first hypothetical, is shown
from the fact that all complex sciences have become perfect by means of some successful hypothesis.    What was
Kepler's law of planetary motion, which has introduced
such accuracy into astronomy that the accession of a new
member to our system      can now be infallibly predicted,
but an hypothesis verified by calculation?      What was
Dalton's atomic theory, which has given such systematic
beauty to chemistry, but, an hypothesis verified by calculation?   What was Torricelli's grand discovery of the
pressure of the atmosphere, which      opened a new    era
in physics, but an hypothesis verified by an experiment?
It is the same with Hahnemann's great law of medicine
-it is an hypothesis proved true by its results.
Had Sir John Forbes and his followers been alive to
the necessity of such a discovery, had they perceived
1 We believe this is the most accurate way of stating the law of homceopathy, and it would obviate many objections if this mode of expressing it
were generally adopted.




YOUNG PHYSIC.


19


that it woas not a Bacon, but a Newton, that medicine
stood in need of, they would have formed a very different
estimate of the grandeur of homoeopathy; they would
not have harped with puerile pertinacity upon the assertion that Hahnemann was mistaken in supposing that the
symptoms of ague he felt stood in relation of cause and
effect to the doses of Cinchona bark he had previously
taken. They would have perceived that it was of very
little consequence what gave rise in the mind of Hahnemann to an hypothesis which, if substantiated, would
make medicine ever afterwards a deductive science, and
not an empirical one; and they would have directed all
their energies to ascertain whether this hypothesis be true
or false; for if true, it must change the whole character
of the art.
There were three possible ways open for disproving
the truth of homceopathy: first, by showing that it was
opposed to some already established natural law; second,
by showing that the facts on which it rested its claims
for belief were either false or too few; third, that when
tried as a guide in practice, it led to failure.
The first way was never attempted. No one has yet
ventured to assert, that the proposition that a medicine
tends to cure diseases similar to those it tends to excite,
is.radically opposed to any general fact. On the contrary, were this the place for it, it would not be difficult
to demonstrate, that this primary law of homoeopathy
presents many striking and interesting analogies with
some of the most important doctrines that have recently
been advanced by the greatest writers in the various
fields, of physics, ethics, and psychology.
Neither Sir John Forbes, nor any of his school, have




20


YOUNG PHYSIC.


devoted themselves to the task of undertaking the second
way, and showing that there is not a marked similarity
between the curative and noxious effects of very many
drugs. Nay, Sir John Forbes himself admits, in these
words, that there is such a resemblance.  " Indeed, it is
supported by several strong analogies, afforded both by
pathology and (allopathic) therapeutics."
The only other way which remained was to show,
that where this law had been applied for the cure of
diseases, it had entirely failed to effect its object.  How
far our opponents have succeeded in this, we leave
those to determine who have carefully and critically
studied Professor Henderson's letter to Sir John Forbes,
as well as the evidence from which his arguments are
drawn.
Hitherto we have contemplated homoeopathy as an
abstract scientific truth, " won from the void and formless
infinite," by the genius of its discoverer; a truth which
would remain the same, although disease were to disappear, and there were no occasion for its application to
human affairs; and we have considered the reason why
the value of this truth has not been appreciated by the
foremost men in our profession. But between such an
abstraction and the requirements of daily life, there lies
the province of art. The truth might be revealed, but
might remain for ever unprofitable to us, if we were not
instructed in the mode of its application.  Art is to
science what action is to thought. The discovery of the
law of homceopathy made medicine as a science perfect;
it required another discovery before an element of perfection was imparted to medicine as an art. Discoveries
in art are of a wholly different kind from those in science.




YOUNG PHYSIC.


21


They are simply empirical rules obtained from observations or experiment, and proved true by experience. They
never can have the same absolute value as fundamental
scientific principles, nor are they susceptible of the same
amount of proof. The rules of art occupy, as it were, a
middle point between science and its application. They
rest upon a surface of fluctuating observations, and they
derive their coherence and stability from a source different
from that of their origin.  That source is the abstract
scientific truth to which they are united. In estimating
the value of these rules of art, it is necessary always
to keep in view this their double connection; and it
would be as unfair to judge of them, separated from
the scientific principle which gives them support, as
it would be to insist upon a child living in its mother's
womb after the umbilical cord had been divided. This
is the injustice which has been practised upon the rule of
art connected with the science of homceopathy;-the rule
that medicines when administered in accordance with the
principle " similia similibus," should be given in minute
quantities. If the proposition had been advanced that
medicines, in doses infinitely minuter than had ever
hitherto been imagined, were capable of curing diseases,
as a simple fact of observation, it might fairly have been
met with the ridicule that has assailed it.  But when
advanced under the protection of a more general proposition, it ought to have been always viewed as related to
this general fact; and in that light, whether it be true or
false, it ceases to be ridiculous.
While, then, we charge Sir John Forbes with committing a fundamental error in philosophy, by not appreciating the necessity of some general hypothesis by which




22


YOUNG PHYSIC.


the science of medicine may be made deductive, we charge
him and his followers with a second error in judging of a
rule of art without taking into consideration the cognate
scientific principle from which it derives half its force.
This misapprehension of the properpoint of view, from which
the system of giving small doses ought to be regarded,
on the part of all English writers, is the less excusable,
since those who have adopted their side of the controversy in Germany, have admitted and given full prominence to the fact, that the dose must vary according to
the principle by which the medicine is selected.     "' On
the other hand," observes Dr. Jorg, " medicines operate
most powerfully upon the sick when the symptoms correspond with those of the disease. A very small quantity of medicinal arnica will produce a violent effect upon
persons who have an irritable state of the oesophagus and
stomach. Mercurial preparations have in very small doses
given rise to pains and loose stools, when administered in
an inflammatory state of the intestines. Yet why," he
exclaims, " should I occupy time by adducing more examples of a similar operation of medicines, since it is in
the very nature of the thing that a medicine must produce
a much greater effect when it is applied to a body already
suffering under an affection similar to that which the
medicine itself is capable of producing?"1
Another great error which the various writers upon the
subject have fallen into, when treating of minute doses,
is confounding the amount of force required to originate
a series of changes in the animal system, and that which
1 Materiellen zu einer kiinftigen heillmitellehr& durch versuche der
Arzneien an gesunden Menschen gewonnen und gesammelt von Dr. Johan
C. G. Jorg, p. 16.




YOUNG PHYSIC.


23


is required to modify those changes where already
going on. It is, if we may so express it, applying to a
question of dynamics, calculations derived from data
afforded by statics.  Contented  as the   disciples of
Young Physic are with allowing morbid processes to
proceed without any intervention, and simply supporting the powers of life, that the system may not sink
under the continuance of the disease; and accustomed
as they and all allopathic physicians are to look upon therapeutic agents as operations beyond, or outside of the
actual morbid forces, (the derivative system of medicine,)
they do not perceive that if it be possible to introduce a
force within the actual sphere of diseased action, that
force will be incalculably intensified in its operation by
acting on other forces already in a state of preternatural
and violent activity.  A breath of air will deflect an
arrow from its course, although shot from  the bow of
Apollo. We do not intend to dwell upon the point
last mooted, partly because our space is exhausted, and
partly because it has already been fully and ably handled
by various writers, especially by Dr. Henry Madden, in
a work entitledC 'Reformed Medicine.'
Before we close this fragmentary paper, the design of
which has been rather to discover, if possible, and to
indicate the chief sources of the errors of our opponents,
and in this very search to point to the refutation of those
errors, than to expose, by argument, the numerous fallacies which have marked their winding course throughout
the controversy, we wish to do full justice to Sir John
Forbes. We look upon him as the ablest exponent of
the sceptical era in medicine.  He expresses for the
Medicine what others have done for the Philosophy of




24


YOUNG PHYSIC.


our period, which has been characterised as " an age of
unbelief, and yet afraid of scepticism."  By giving expression to prevailing scepticism  in medicine, Sir John
Forbes has rendered an immense benefit to the profession;
he has brought out and made czurable the hitherto latent
psora. The element of faith which he would fain mingle
with his confession of general unbelief is too foreign to
the rest of the system to have any influence upon his
disciples. The reform he has so powerfully advanced
will soon become a revolution beyond his power to control. -His influence for the future will be purely destructive. But destruction of the bad must precede construction of the good; and for having with great talent
and boldness attacked and shaken a dynasty whose
speedy termination is with certainty predicted by this
revolt of its chief supporter, as the doom of the Corn Laws
was pronounced by the leader of the party which had
maintained them-for having rendered this service, and
opened the gate of scepticism for the admission of truth,
we feel deeply indebted to him, and we have no doubt
that his school will prove to many the halting-place
between old physic and homoeopathy; and the title of
his great article should be, not ' Homoeopathy and Young
Physic,' but HOM(EOPATHY via YOUNG PHYSIC.




CHAPTER II.


ON   DIET.
WHETHER it be true, as some historians affirm, that
Napoleon lost the battle of Leipzic owing to his having
eaten a bad dinner, is certainly questionable; but there
can be no doubt whatever that bad dinners and bad food
generally are at the bottom of much domestic and national
misery and disaster. And there is no subject which
more imperatively demands special attention than the
one we are about to enter on.  For from the promulgation of the system founded and taught by Hahnemann,
numerous specialities in diet have been inculcated with
more or less rigour by himself and his followers, and so
prominent have these innovations become to the eye both
of the public and the medical profession, that while the
former frequently seem to suppose that if they only consume a sufficient quantity of homoeopathic cocoa, they
will be entitled to all the benefits of the new system of
medicine, the latter discovers with its usual sagacity,
that although the success of our treatment is beyond dispute in very many cases, yet that we owe our superiority,
not to the total difference of the principle according to
which we select our remedies, but to our better judg



26


)T I.


ment in the regulation of the diet of our patients; although the subject of diet has been one carefully studied
and ably handled, since the time of Hippocrates, and
although by this assumption our opponents pay us the
highest possible compliment, by yielding us the palm of
victory in the field common to us and them. In fact if
they are right in this explanation, it would be tantamount to saying, that as there is no law by which we
profess to be guided in our choice of food analogous to
that which directs us in the choice of the proper medicine, each individual who practises homceopathy displays
a higher amount of intelligence than his allopathic brethren, and is in their sense of the term the better physician of the two. This is a fatal argument for young
physic, which professes rather to cure diseases by diet
and regimen, than by medicines. They acknowledge
themselves thrown in their own ring: how strange is
their inconsistency!   It is considered disgraceful to
admit the superiority of homceopathic medicine, a novelty
which old physicians might pardonably plead ignorance
of, and they prefer to proclaim their inferiority in the
only branch of the physicians' art on which they build
their reputation; while on the other hand we find among
ourselves a pertinacious adherence to certain dietetic formulas, which rest on no authority but that of accidental
prejudice, and which derive no support from the enlarged
experience that we have now within our reach.
There are but two methods by which we can hope to
arrive at any thing like unanimity in our dietetic creed;
the one is to assume Hahnemann's writings as our Leviticus, and to ban all he banned, and admit all he admitted; or to inquire into the principles by which he




DIET.


27


was directed in the rules he lays down, and to follow out
these principles, if they be sound, into their full development by all the lights which modern science and observation have shed upon the subject.
As Hahnemann did not assume the infallibility of
inspiration, we may safely decline accepting any Leviticus at his hands, and examine with that care and
respect which all his writings deserve, what they contain
"upon the subject of diet, and we shall be satisfied that if
in some instances he was led into extravagance and error,
yet that the principles of his doctrine are eminently
sound and sagacious.
In endeavouring to form a just valuation of Hahnemann's dietetic rules, we must bear in mind that before
he had discovered his grand formula for the selection of
medicines, he had already written extensively upon
various topics connected with diet and regimen, and
that he carried over into the new province of homceopathy, where he so long ruled supreme, some of the old
adopted notions which he had already too vehemently
expressed to admit of his recanting them. The most
striking illustration of this was his antipathy to the use
of coffee.  "The cold, considerate earnestness of our
forefathers," such are Hahnemann's words, "the firm
stedfastness of will, of resolve and of judgment, the
endurance of continued and yet powerful exertions of the
body, adapted to the object in view, that used to constitute the original national character of the Germans, the
whole sublime stamp of our descent disappears before
this medicinal beverage, and changes into over-hasty
disclosures, hurried resolves, immature judgments, frivolity, changeableness, talkativeness, irresolution, too




28


DIET.


easy mobility of the muscles without any endurable
result, and theatrical behaviour."' The extravagance of
this passage makes it read like a temperance lecture. In
fact what truth is in it is certainly applicable to the
abuse not the use of coffee.  It would be interesting if
we could discover the origin of this excessive hostility to
coffee, which belongs to the family of narcotics, and is a
sort of foster-brother of tobacco, that "foul and loathsome weed," as an irreverent lecturer calls it, which
Hahnemann is said to have loved, if not wisely, at least
too well. It may have been an idiosyncratic dislike,
or more probably he fell into a common opinion of
the time in which he wrote, and which was strongly
shared by the philosopher Kant,2 and by many French
physicians, that coffee was an injurious beverage, and he
afterwards rested his opinion upon the basis of unsound
experiment.   That it was an unsound deduction from
the effects which follow the use of coffee when taken in a
way to produce derangements in the system, to forbid its
use in all circumstances, is obvious, if we reflect that we
could all make ourselves as ill as many of our patients,
if we were only to take dinner at time of breakfast, and
tea at dinner time for a few days.
We cannot, however, dismiss the subject of experiments
in diet, without some further remarks. And the first is,
that although in the particular example we have quoted,
Hahnemann committed a great mistake, yet that on the
whole he is perfectly sound, and does not seek to lay
down any positive rules about diet, but acknowledges
that food must be regulated by the special appetites and
Lesser writings, Dudgeon's translation, p. 458.
3 See De Quincy's 'Last Days of Kant.'




DIET.


29


instincts, as well as circumstances of those who take it;
and he gives in his 'Friend of Health' several illustrations of the superiority of the popular over the
scientific judgment upon this point.
In the whole of his intellectual career he seems to
have been looking for some law of relation between diseases and their curative specifics, but nowhere does he
hint that there can be any such law to guide us in
the choice of food; and as an obvious corollary to this
tacit conviction, while he from the first insists upon the
necessity of instituting a series of rigid experiments to
discover the effects of a drug upon the animal economy,
he nowhere suggests that similar experiments should.be
made in regard to food. He seems to have recognised
the important difference between that kind of knowledge
which we reach by experiment, as in chemistry, and
that other kind which we gain by observation, as in
geology, where nature has made the experiments for us,
extending over incalculable surfaces of space and periods
of time. The feeding of the human race has been going
on in every conceivable circumstance for many thousand
years. In the language of Schleiden "The Gaucho who
in the wild pampas of Buenos Ayres, managing his halfwild horse with incredible dexterity, throws the lasso or
bolus to catch the ostrich, the guanacho or the wild bull,
consumes daily from ten to twelve pounds of meat, and
regards it as a high feast day, when in any hacienda lie
gains a variety in the shape of a morsel of pumpkin. The
word bread does not exist in his vocabulary. The Irishman, on the other hand, regales himself in careless mirth
on his potatoes and point, after a day of painful labourlie who cannot help making a joke even of the name he




30


DIET.


gives to his scanty meal.   Meat is a strange idea to him,
and he is happy indeed, if four times a year he can add
a herring to season the mealy tubers. The hunter of
the prairies lays low the buffalo with sure bullet, and its
juicy, fat-streaked hump, roasted between two hot stones,
is to him the greatest of delicacies: meanwhile the
industrious Chinese carries to market his carefully fattened rats, delicately arranged upon white sticks, certain to find a good customer among the epicures of
Pekin; and in his hot smoky hut, fast buried beneath
the snow and ice, the Greenlander consumes his fat,
which he has just carved, rejoicing over the costly prize,
from a stranded whale.     Here the black slave sucks the
sugar cane and eats his banana-there the African merchant fills his wallet with sweet dates, his whote sustenance in the long desert journey-and there the
Siamese crams himself with a quantity of rice from which
a European would shrink appalled.        And wheresoever
over the whole inhabited earth we approach and demand
hospitality, in almost every little spot a different kind of
food is set before us, and the daily bread offered in
another form."'
After perusing such a passage as this, we naturally ask,
what conceivable advantage could the world derive from
the experiments of Dr. Stark, who contrived to kill himself
in about six months, by a succession of simple dishes?
Before his promulgation of homoeopathy, Hahnemanni,
with the exception of his disapproval of coffee, did not
differ in his views on diet from other writers of his age
and country.    " There is not," he says, " and cannot be
1 The Plant-a biography, in a series of popular lectures, by M. J.
Schleiden, Professor of Botany in the University of Jena, &c.




DIET.


31


anything, which, as a general rule, is absolutely wholesome, or unwholesome, * * * * None of the general
maxims of the dietist can be accounted good: such as,
veal is the most wholesome butcher's meat, &c. * * * *
There is a time for everything, says Soloman, and to my
mind he speaks much more sensibly than most of the
dietists."'  There is much more to the same effect in his
early writings.
It is a very striking fact, that whereas, before he had
discovered and taught the great law of healing, his position in regard to medicine, was very similar to that of
young physic of the present day, and he relied much
upon sanitary and dietetic rules; after he had made
good his grand discovery that the obstacles to certainty
in medicine were not insuperable, the power of diet
as a method of cure, and its general importance seems to
have assumed a very insignificant value in his eyes.
What before had occupied whole treatises, now shrinks
into this solitary observation in the ' Organon,' (p. 308.):
-" Considering the minuteness of the doses necessary
and proper in homoeopathic treatment, we may easily
understand, that during the treatment everything must
be removed from the diet and regimen which can have
any medicinal action, in order that the small dose may
not be overwhelmed and extinguished, or disturbed by
any foreign medicinal irritant." In a note he adds,
"Coffee, fine Chinese and other herb teas, and many
other things ought to be avoided by patients, as they
should avoid excesses in eating and drinking, sitting up
long at night, damp rooms, penurious living, and so
forth."  The note concludes with the following remark.
SLesser Writings, page 227.




32


DIET.


" Some of my disciples seem needlessly to increase the
difficulties of a patient's dietary, by forbidding the use
of many more tolerably indifferent things, wticl is not to
be commended."   Here we have the common sense rule
laid down, that patients are to avoid things hurtful to
themselves, and likely to interfere with the operation of
a minute dose of medicine.
On this note of things to be avoided, have been built,
with a somewhat slavish adherence to the text instead of
the spirit, the majority of those homoeopathic diet tables,
which are in such large circulation, although some of
the most acknowledged authorities have expressed an
opinion in favour of a more liberal interpretation of
Hahnemann's doctrines upon this subject. Thus Hartmann remarks, " Every intelligent physician will at once
perceive, that every patient cannot be subjected to such
a rigorous diet, and that a man of sixty years old, for
instance, who had been in the daily habit of taking coffee,
tea, wine, brandy, or of smoking tobacco and using
snuff, cannot be suddenly deprived of those things without detriment to his organism.    Hahnemann allowed
smoking and snuff; he forbade wine, brandy, and coffee
with great severity. This seems inconsistent, and leads
to suppose that in a more advanced age we may except
some other things from the general rule of abstinence."
While in this country2 there is undoubtedly a disposition
to enlarge the table of our patients, in America our
energetic friend Dr. Hempel seems inclined to surpass
Hahnemann in the rigour of his regulations-one of his
golden rules, as he styles them, running thus:-" Avoid
all stimulating drinks, brandy, beer, wine, and content
S 'Acute Diseases,' vol. i, p. 82.
2 See Laurie, Chepmell, and others.




DIET.


33


yourself with cold water, milk, light and unspiced chocolate, weak black tea, and syrups made of currants, raspberries, strawberries, or other kinds of wholesome and
unmedicinal fruits.  Never use tobacco in any shape,
except for medicinal purposes."'  We suspect that beyond the confines of the State of Maine Dr. Hempel's
gospel will hardly find believers in the land of liberty
and tobacco. Setting aside all extravagances, the subject assumes a very simple form, and may be divided
into two questions.
1st.-Is it possible for our patients to avoid all medicinal substances in their diet; and
2d.-Is it conducive to the better action of the medicine, to enforce a very rigorous diet.
At present, let us observe, we are considering the
question solely in the view of its relation to homceopathic medicine, not to general health.
1st.-Is it possible to confine our patients to a nonmedicinal diet? Suppose we restrict them to a prison
fare, and desire them to drink a tumbler of water, and
eat four ounces of bread for a meal, and repeat this three
times a day. This would appear simple enough with a
vengeance. We shall suppose the scene London, and
just inquire into the character of the bread and water
diet we had prescribed. To begin with the water, it is
an incontestible fact, that, in the words of Dr. Hassall,
"The waters at present in use in this metropolis are all
hard, and have all the disadvantages of hard water; they
are moreover river waters, and for the most part contami1 Hempel's 'Organon,' p. 31.
3




34


DIET.


nated to a great extent with organic matter, dead and
living; add to these points the fact of their further deterioration by contact with lead cisterns, and by the
accumulation and growth of animal and vegetable productions, which take place in these receptacles, and the
case is proved against the whole present supply of the
metropolis."' It is indeed impossible to contemplate the
world of monsters contained in a drop of London water,
without being satisfied that a score of globules would go
but a little way in affording them a satisfactory repast.
Besides these living impediments to the action of our
globules, and besides the lead derived from the pipes
and cisterns, which will be a stronger dose of Plumbum
than our rigorous dietists ever employ, there are no less
than from 20 to 30 grains of inorganic matter, carbonate
of lime, of magnesia, &c., in every gallon of London
water.2
So much for our patient's morning draught of pure
water-now for his slice of bread.
Dr. Hassall examined twenty-four samples of bread,
obtained indiscriminately in various parts of London:
his verdict is, that the whole twenty-four samples were
adulterated with alum. But perhaps it may be said, the
quantity is trifling; on the contrary, according to another observer, Mr. Mitchel, in ten loaves there were no
less than 819- grains of alum     discovered.  And the
reason for the presence of alum heightens the enormity
of the pollution. It is put there to enable spoilt flour
to be mixed with sound flour!
'Food and its Adulterations,' by Arthur Hill Hassall, M.D., p. 52,
ct seq.
2 Johnston's ' Chemistry of Common Life,' p. 38.




DIET.


35


With such facts staring us -in the face, would it not
be absurd to insist upon bread and water as a simple
diet for any unhappy patient who has the misfortune to
fall into our hands.  Unless we could keep our patients
in a conservatory, and prepare by artificial means the air
they breathe, the water they drink, and the food they
eat, it would be absolutely impossible to prevent them
being assailed by so-called medicinal influences every
hour in their lives. In fact, all nature would be in a
conspiracy against them, to avenge the sentence of outlawry we should thus have pronounced upon her. This
is the answer to the second question. For if we strive
to attain as near as possible a supernatural immunity
from the influences at all times powerfully acting upon
the human organism by any method of isolation or abstinence, we thereby intensify in a corresponding degree
the sensitiveness of the frame, and our patients reared
in a hot-house fade away before the first breeze, which
had they been of out-door growth, would have invigorated instead of destroying their tender natures.
Is there then to be nothing peculiar in homoeopathic
diet, and are there no rules to be enforced?  The only
rule, and we may enforce it with peculiar rigour, that I
can conceive as universal, is, that every one should eat
and drink what his own experience has taught him
agrees best with him, and we on our part need not be at
all afraid of the efficacy of our medicines being seriously
impaired by what contributes to the well-being of the
individual.  It may seem very strange to order a dose of
Capsicum to a man who dines upon curry. But is it
more strange than ordering a dose of Calcarea to a man
who drinks a thousand times the amount of the dose in




-36


DIET.


every glass of water? These are both strange, but life
is stranger still, and we are utterly unable to unravel
the complex influences on which its integrity depends,
and we therefore cannot understand how powerfully substances act in their curative sphere of operation which
are quite inert in their nutritive. If we were to throw
out a conjecture, it would be that the medicinal action
of a substance resembles a distinct impulse upon the
nervous system  like a note of music, and as an impulse,
that is purely dynamically, takes effect, _whereas the
same substance conveyed through the system for the
purpose of nutrition, does not secure the attention of
the nervous system at all. Be the explanation what it
may, fortunately for the possibility of our method of
practice, the fact admits of no doubt, that infinitely minute quantities of a body produce important effects,
while at the same time large masses of the same are quite
inoperative, and therefore it is not necessary on the theoretical ground, to insist upon abstinence from all stimulants and condiments as the indispensible initiative to a
successful course of homoeopathic treatment.     I am
aware that these views will be considered by many as
somewhat heretical, and perhaps as too speculative, but
although I would now rest them upon the reason of the
thing, they were forced upon me slowly by my own
observations in practice. It is now many years ago
since I had a curious illustration of the possibility of
a minute dose succeeding, even although the system
was at the time being stormed at by massive ones. A
patient of mine who had long been liable to megrim,
was always cured by a few globules of Pulsatilla.  She
was also subject to ague, imported from India, which I




DIET.


37


could not cure. So she was put under the old system,
and ordered full doses of the Sulphate of Quinine.
While taking this, she had an attack of her old headache,
and took a few globules of Pulsatilla, but expecting
nothing from it; for I had told her, so long as she was
taking her Quinine it was impossible homoeopathy could
do her any good. Homceopathy, however, showed itself
more liberal than its practitioner, and after a single dose
of Pulsatilla she got better. This case made a deep impression on my mind, and I often thought from that
period that perhaps our diet code was too rigorous. Then
during a long course of observation, extending over some
eighteen thousand cases treated at the Edinburgh dispensary, I found that it was on the whole impossible to
interdict successfully the use of tea and spirits, and that
notwithstanding these infractions, and a thousand other
disadvantages, the proper medicine produced its expected
result with so much exactitude as to reduce to an insignificant point the deranging influence of these condemned
enjoyments. And quite lately I had under my care a
gentleman who took a wineglassful of Laudanum  daily,
and yet was as speedily relieved by the proper medicine
when attacked by pain and spasms of the heart, from
which he suffered in consequence of organic cardiac disease, as if he had been an absolute teetotaller.
These facts, and many more such could be adduced,
ought at least to make us pause before we lay down any
imperative rule against the use of coffee, tea, tobacco,
and other excisable articles, as being necessarily destructive to the efficacy of homceopathic medicines. For my
own part I seldom now make any change in a patient's
diet out of respect to homceopathy. And with these




38


DIET.


observations we pass on to the more general part of our
subject, and consider the principles by which we are
likely to be assisted in advising our patients in reference
to the most difficult affair of regulating their food and
drink so as best to lead a long, healthy, and happy life.
The difficulty that meets us at the very threshold of
our investigation, and which we cannot get rid of
throughout its whole course, and which seems to be
strangely overlooked by most professed writers on the
subject of the food of man, is, that man occupies an exceptional position in the animal kingdom: although in
it, he is not of it.  The fundamental instinct of animals
is the preservation of their life, and the escape from
death.   The idea of manliness is contempt of death.
The preservation of life is frequently a secondary feeling
in man.    The reason is, that upon the animal life of
man is erected a life of sentiment, emotion, and imagination, which always modifies his animal instincts, and
sometimes entirely supersedes them.      Hence come the
long fasts and vigils of the saints of old, and of the
modern Fakirs in the east.     Fasts implying a continuance of abstinence from all food, which modern physiologists, deriving their knowledge from      the effects of
starving dogs and birds, and from      the enforced abstinence of shipwrecked mariners and buried miners, insist
upon ignoring, as they are so opposed to the conclusions
of their experiments and observations.      But the testimony in favour of these long spontaneous fasts is as
trustworthy as any in favour of the other class, and
certainly deserves attention, especially as it shows us a
little farther into an every-day occurrence, that is, the
power of abstract thinking, or very strong emotion, to




DIET.


39


arrest more or less the animal functions.  It is the most
common observation, that thought is incompatible with
violent muscular exertion.  Who ever heard of a mathematician trying to solve a problem in the hunting field?
If he were found there at all, it would be to escape
from thought. When thought is both very prolonged
and very intense, and confined to one object, it may induce a kind of trance, in which there is an entire cessation of all other vital action; but long short of this,
there can be no doubt that the over-active brain monopolizes the vital energy, and paralyses to a greater or
less extent, the other portions of the nervous system,.and cuts off the supply of cerebral stimulus required for
the nutrition of the body; that is, which enables the
capillary vessels to exercise their elective affinities as to
what they shall absorb, and what they shall reject.
Nutrition then, or the continual action    and  reaction of the living world within upon the chemical
one without, depends upon two factors, the one the
nature of the materials presented to the body to be
incorporated into it, to increase its bulk by growth, or
to repair its decay, and the other the reception given
by the body to these substances presented by the hand
of external nature.  The character of this reception depends, among other modifying circumstances, upon the
state of the mind, and the whole doctrine of the fitness
of aliments f6r their proposed end, must begin by
assuming that end to be known. Hence the grand difficulty of laying down laws upon the subject, for the ends
of life are so dissimilar in different men. The scale runs
from the sensualist, whose avowed end is corporeal enjoyment, to the ascetic, whose object is bodily morti



40


DIET.


fication.  And it is the duty of a physician to appreciate all these varities, and to administer advice, not
according to his own preconceived notions of the proper
ends of life in general, but the most healthful, or least injurious method of securing for each person his peculiar, if
innocent object of desire. If we were practising in the millennial times, we might tell men to avoid all excess, of
eating, drinking, loving, hating, sleeping, waking, working, talking, &c.; perhaps when such advice can be
followed, it will not be needed; certainly to talk so to
men as they are now, would be in many cases simply an
impertinence, or an affront. What would become of a
popular preacher if he could not fill a large church with
his voice for an hour together, or a popular alderman, if
we forbade him to taste turtle? In short we must make
the best of our materials, accommodating our rigging to
the state of our vessel, and sometimes too thankful if we
can secure a jurymast to save our ship from impending
wreck. After these preliminary remarks, let us consider
how our bodies are built up from day to day, and of
what materials the structures consist.
" According to Quetelet, a full grown man weighs on
an average 154 lbs., and if we substract the great quantity of water which runs through all parts of our body,
keeping them supple and pliant, some 38 lbs.; 14 lbs. of
this comes from the bones, and 24 lbs. from all the remaining parts. The former contains about 66 per cent.,
the latter 3 per cent. of earthy constituents which are
left behind after combustion.   Man consists, therefore, in
more than a third part, of inorganic substances which
are necessary to his existence, and which he must there



DIET.


41


fore receive with his food.    He must in fact as the evil
spirit says in Faust, 'feed upon dust.' "1
It is to supply this dust for the stony skeleton of the
fabric, that birds instinctively swallow sand and gravel,
and not to assist the comminution of their food merely.
Chossat found that birds deprived of sand, and fed upon
grain, died in seven or eight months, and the bones became so brittle, that they broke with the slightest touch.
Total abstinence from    salt, the constituents of which
enter largely into the composition of the blood, is productive of various evils, among which, according to
Woodward, scurvy is one of the most remarkable, and
Dyer ascribes the frequency of tapeworm in the negroes,
who eat but little or no salt, to the same cause. The necessity of salt is greater if the food be of vegetables, as
less is contained in them than in animal diet. In strange
contradiction to these well-authenticated facts, accepted
by so cautious and critical a writer as       Moleschott,3
stands the extravagant nonsense of one of the apostles of
abstinence, Mr. Sylvester Graham,3 that "salt is a
mineral substance, and is wholly innutritious and indigestible."   Does this gentleman, and      do those who
crusade with    him  against the traditional symbol of
hospitality, ignore the fact that bones are necessary, and
that without mineral and innutritious articles of food we
cannot have them?
Besides the salt we take with our food, we obtain a
1 Schleiden, op. cit.
2 'Die Physiologie der Nahrungsmittel, ein Handbuch der Dietetik,'
von Dr. J. Moleschott.
3 'Lectures on the Science of Human Life,' by'Sylvester Graham,
People's Edition, p. 270.




42


DIET.


large quantity of mineral substances from the water we
use so copiously in all articles of consumption, even if
we do not indulge in libations of the limpid element.
And it has been observed that waters artificially deprived
of their saline ingredients are unfit for domestic purposes.
The phosphates, however, we must get either from.
animal food, or from  grains, in which they exist in considerable quantity, and Mulder ascribes the frequent
fractures he observed in a poor-house, to the exclusive
potatoe diet.  This disposition was rectified by giving
the inmates rye-bread and butcher's meat, and the hint
may be useful in dealing with various conditions met
with among our own poor.
There is no great difficulty in comprehending how the
inorganic materials are used in building up the body,
for they undergo no other changes in it than those ordinary chemical de- and recompositions we are familiar
with in the laboratory. The component mineral matters
of the bones and other parts are all found in the blood,
into which they are conveyed by the chyle the product
of the food, and out of the blood they are selected by
the capillaries of the bones according to laws of vital
affinities of which we are totally ignorant. But this we
do know, that it is now an ascertained fact, that there
are no transmutations of elements in the body, that if
phosphorus and iron are found in the blood, they must
be previously discoverable in the food, and that there is
not a -tittle of evidence for the assumption that out of
silica iron can be made, or out of oxygen phosphorus.
So much for the inorganic components of our frame.
A much more difficult task is the description of the
organic remainder. This has been divided into those




DIET.


43


substances which contain nitrogen and those which contain none. The nitrogenous elements (using the word
element in a larger sense) of food are chiefly albumen, as
it presents itself in the white of egg, or, in a slightly
modified form, as it exists in the blood; fibrin, whether
as found in blood, or in flesh, and caseine, or cheesy
matter.   Vegetable albumen, fibrine, and caseine, are
identical with the animal substances so named. Gelatine,
though'nitrogenous, is generally considered not to be truly
nutritive, as it cannot form blood; but it may form membrane, and so assist in nutrition. The non-nitrogenous
elements are chiefly starch, sugar, and fat, in their various
forms. Let us then proceed to consider how we obtain
these substances, and what changes they undergo during
their strange  metamorphosis-we might almost say,
without irreverence, their miraculous transubstantiation
-from dead dry bread into living juicy flesh.
Before doing so, however, it may be well to point out
the enormous importance of the facts just mentioned,
that the body imperatively demands for its health a
supply of certain mineral substances, among which soda
and phosphorus hold an important place, and that various forms of disease, such as scurvy and softening of the
bones, are the consequence of starving it in this direction.
The obvious deduction for us is that to cure such
unsound states of body, it is as essential to feed it with
what it wants, as it is to give food to a famished man.
Here we touch upon one of the limits of the application
of the homceopathic or any possible therapeutic formula.
Diseases arising from insufficient supply of any of the
constituents of the frame, cannot be cured by any medicine whatever, and can only be cured by giving in some




44


DIET.


form or other the required aliment. This holds true, as
was first demonstrated by Boussingault,1 for the vegetable kingdom, and upon this fundamental law of nutrition the whole modern system    of agriculture is based;
and in consequence of the violation of this law, and
growing potatoes upon a soil richly manured, arose the
potato-disease, so eventful in its social and political consequences.2
Let us resume the previous enquiry as to the means
by which the body gets its supply of nitrogenous ingredients.  The answer will be sufficient if we can trace
them into the blood, for the blood is the body in a fluid
state; nothing is found in any part of the animal frame
which does not exist, in some form     or other, in the
blood.  We must begin with an analysis of this allimportant fluid.
The nitrogenous constituents of the blood are:
1st. Albumen, of which, according to Becquerel and
Rhodier, there are from 71 to 87 parts in a thousand.
Salts of phosphate of lime, of sulphate of potash and
soda, and chloride of sodium, are intimately mixed with
this albumen, which, according to the formula of Mulder,
consists of N"s CGs8 O0 S8 P00
2d. Fibrine, which differs chemically from  albumen,
chiefly in containing more oxygen and less sulphur.
Mulder's formula for it is N8s C67 H53 O' S     T P. The
quantity of fibrine varies from  2*1 to 2-8 parts in a
thousand.
' Rural Economy in its relations with Chemistry,' &c., by J. Bonssingault.
2 See Johnston, op. cit.




DIET.


45


3d. Caseine.   A   substance of a very complicated
chemical nature, and found in a very small quantity in
the blood.
4th. Globuline. A very important constituent, forming the white membrane of the blood-globules. It differs
in many of its chemical aspects from the albumen, fibrine,
and caseine, and according to Le Cann, amounts to
125"6 parts in a thousand. Mulder's formula for it is
N94 C694 H522 S6.
5th. Hsematin, on which    the colour of the bloodglobules depends. It amounts to about 2-3 parts in a
thousand, and its most interesting feature is its peculiar
chemical nature, for it contains neither sulphur nor phosphorus, but consists of N3 C1  H22 Fe.  Hence the necessity of iron for the proper nourishment of the body, and
especially for the ruddy glow of health produced by the
rich red blood.
Such, then, are the nitrogenous constituents of the
body, which we must supply it with to preserve life and
health, and we shall now consider whence the supply is
derived, and in what form, and what changes it has to
undergo before it is converted into this liquid flesh and
bone.
The supply must come from either the vegetable or
animal kingdom, for although we read of tribes who
consume as their chief food large quantities of elay, yet
it is now a recognised fact, that unless the clay contain
animal or vegetable matter in some form, it may be
merely as a multitude of those infusoria Ehrenberg describes, it is in itself as clay, or mountain meal, or any
other merely mineral substance, incapable of sustaining




46


DIET.


life, although for a time it may appease the cravings of
hunger.
Let us turn then to the vegetable and animal kingdom, and set out with this important observation of
Mulder, " that those who feed on flesh, and those who
feed on vegetables, partake of the same nutriment; they
have both their albumen, the one derived from plants
the other from animals, but for both the albumen is the
same."1
It is obvious that the albumen, and its modification
gelatine, which we derive from our animal food, requires
less transformation to prepare it for returning to a condition almost precisely similar from that which it had
previously held, than the vegetable albumen does to
enter for the first time the portals of animal life.   Indeed, all that it needs is to be dissolved, and this is
done, first by the processes it undergoes in the kitchen,
which holds to man somewhat the same relation that the
first stomach or paunch does to ruminating animals;
next by the mastication and insalivation it is subjected
to in the mouth; and lastly by the solvent action of the
gastric juice, which according to the observations of
Beaumont on the Canadian, Alexis St. Martin, the operations of whose stomach were open to inspection by an
accidental perforation, takes from two to three hours to
dissolve an egg.
Albumen is first coagulated, and then dissolved by
the gastric juice; gelatine is simply dissolved, and thus
passed onwards, as chyme, to be absorbed into the
blood. The nutritiousness of animal food is generally
1 G. J. Mulder en W. Wenckenbach, ' Natur-en Scheikundig Archief.,'
s. 128, quoted by Moleschott.




DIET.


47


calculated by the quantity of albumen it contains, and
hitherto there has been a disposition to consider that
gelatine only afforded material for cartilage and bone,
and not for muscles. This opinion rested upon some
experiments of the French commissioners appointed to
investigate the qualities of different aliments, who succeeded in starving dogs by giving them nothing but
pure gelatine to eat. However, these experiments, at
once unphilosophical in their conception and cruel in
their execution, are entirely refuted by the fact, that
dogs not only lived, but throve and fattened upon a diet
consisting of nothing but bones; a fact corroborated by
the history of every convalescent, who is nourished by
arrowroot and pure soup, as Mulder remarks.' Why
dogs thrive upon bones, and starve upon the pure aliment the bones contain, is a problem of which there
are many examples, some of the most curious are
several instances where horses on a voyage pined away
under the exclusive use of grain as food, and, impelled
by the instinctive requirements of their organism, tore
and eat all the dry wood within their reach; on this
hint they got chips of wood, and very soon recovered
their flesh and spirits.2 From this we gather, that the
vital processes, as well as the chemical products, are
necessary for the maintenance of health, and it should
make us hesitate before we subscribe to any diet-table
submitted to us by the chemist, unless it be in accord1 It is right to observe that this view of the utility of gelatine is not
generally accepted by chemists, who say that both bones and soup contain other matters besides gelatine, a substance they consider incapable of
forming blood, and consequently of sustaining life.
3 Graham's c'Lectures,' &c.




48


DIET.


ance with the findings of popular experience. It may
be that hereafter the chemist shall discover the value of
some of those substances, such as kreatine, which exists
in very small quantity in animal food, but which, as its
name implies, is supposed to be a sort of essence of
flesh-if the phrase be allowable; and it may be, that
as the slight chemical difference in the amount of sulphur and oxygen makes the distinction in the laboratory
between fibrine and albumen, so equally minute portions
of chemical ingredients may induce totally different
forms of the aggregation of the atoms from which the
various tissues are evolved; and it is impossible not
to recognise here how very small quantities of medicinal agents, properly administered, may exercise an
enormous effect upon the development of the organism.
How great may be the effect of Sulphur, of Phosphorus,
of Silica, for example?
While the nutritiousness of food depends chiefly upon
the quantity of albumen it contains, its digestibility
seems to depend upon the form in which it is presented
to the system. Various attempts have been made to
classify the ordinary articles of animal diet, and some
writers, such as Robertson, give a regular schedule
beginning with mutton and ending with pork. It is
enough to observe upon such schemes, that they rest
upon purely arbitrary assumptions, or upon the fallacious experiments of Beaumont; " who, when he saw
mutton-suet dissolve in his Canadian's stomach in five
hours and a half, must evidently have mistaken," as
Moleschott observes, "mechanical division for chemical
solution."  What vitiates his conclusions most, however,
1 Robertson on 'Diet and Regimen.'




DIET.


49


is, that he employed mixed substances in his experiments, and also that with    him   solution, or rather,
reduction into a homogeneous mass, was equivalent to
digestion.  A more recent case of a similar conveniently
perforated stomach, taken advantage of by Grunewald
and Schroeder, gave results diametrically opposed to
Beaumont.'    The Germans found raw meat and veal
more rapidly digested than boiled beef! In the absence
of all satisfactory experiments, we must rely much
upon popular experience.   It is certainly better to tell
those who ask our advice upon the point, that although
it may not be true, that after attaining maturity every
man should be his own doctor, yet certainly every man
may have discovered what agrees and what disagrees in
the ordinary articles of animal food; and to stigmatise
as unlawful the eating of the flesh of hogs, in a country
which was never either Jewish or Mahommedan, is what
may be called an infraction of Christian liberty. Pork is
the cheapest animal food, and therefore the only attainable form for many, and because it does not agree with
some, there is no reason to ban it with such Levitical
austerity. Much depends, in this as in most things, on
the form  in which it is prepared, and we must take a
peep into the kitchen before we dilate further upon what
is digestible.  On this matter we cannot do better than
quote from the work of Professor Johnstone."
"In cooking animal food, plain boiling, roasting, and
baking, are in most general favour in our islands.
1 'Brit. and For. Med.-Chirurg. Rev.,' Jan., 1855.
2 This passage, although quoted from Johnstone, is actually derived by
him from Liebig's work on the ' Juice of Flesh.' It is a pity lie should
have left this fact to be stated by others.
4




50


DIET.


During these operations, fresh beef and mutton, when
moderately fat, lose on an average, aboutIn boiling. In baking.  In roasting.
4 lbs. beef lose... 1b..... 1lb. 3 oz.... 1lb. 5 oz.
4 lbs. mutton lose... 14 oz..... 1 lb. 4 oz..... 1 lb. 6 oz.
"The greater loss in baking and roasting arises chiefly
from the greater quantity of water which is evaporated,
and of fat which is melted out during these two methods
of cooking.    Two circumstances, however, to which it
has not hitherto been necessary to advert, have much
influence upon the successful result of these and some
other modes of cooking.
" If we put moist flesh into a press and squeeze it, a
red liquid will flow out; this is water coloured by blood,
and holding various saline and other substances in solution. Or, if after being cut very thin, or chopped very
fine, the flesh be put into a limited quantity of clean
water, the juices of the meat will be gradually extracted,
and by subsequent pressure will be more completely
removed from it than when pressure is applied to it in
the natural state, and without any such mincing and
steeping. The removal of these juices renders the beef
or mutton nearly tasteless.
" When the juice of the meat, extracted in either way,
is heated nearly to boiling, it thickens, or becomes
muddy, and flakes of whitish matter separate, which
resemble boiled white of egg. They are, in fact, white
of egg, or albumen, and they show that the juice of flesh
contains a certain quantity of this substance, in the same
liquid and. soluble state as it exists in the unboiled egg.
Now, the presence of this albumen in the juice of




DIET.


51


butchers' meat, is of much importance, in connection
with the skilful preparation of it for the table. The first
effect of the application of quick heat to a piece of fresh
meat, is to cause the fibres to contract, to squeeze out a
little of the juice, and, to a certain extent, to close up
the pores, so as to prevent the escape of the remainder.
The second is to coagulate the albumen contained in the
juice, and thus effectually and completely to plug up the
pores, and to retain within the meat the whole of the
internal juice. Thereafter the -cooking goes on through
the agency of the natural moisture of the flesh.  Converted into vapour by the heat, a kind of steaming takes
place within the piece of meat; so that, whether in the
oven, or on the spit, or in the midst of boiling water, it
is in reality, when skilfully done, cooked by its own
steam.
" A well-cooked piece of meat should be full of its own
juice or natural gravy.  In roasting, therefore, it should
be exposed to a quick fire, that the external surface may
be made to contract at once, and the albumen to coagulate before the juice has had time to escape from within.
And so in boiling: when a piece of beef or mutton is
plunged into boiling water, the outer part contracts, the
albumen which is near the surface coagulates, and the
internal juice is prevented either from escaping into the
water by which it is surrounded, or from being diluted
and weakened by the admission of water among it.
When cut up, therefore, the meat yields much gravy,
and is rich in flavour.  Hence a beef-steak or a muttonchop is done quickly, and over a quick fire, that the
natural juices may be retained.
" On the other hand, if the meat be exposed to a slow




52


DIET.


fire, its pores remain open, the juice continues to flow
from within as it is dried from the surface, and the flesh
pines, becomes dry, hard and unsavoury. Or if it be
put into cold or tepid water, which is afterwards gradually brought to a boil, much of the albumen is
extracted before it coagulates, the natural juices for the
most part flow out, and the meat is served in a nearly
tasteless state.  Hence to prepare a good boiled meat, it
should be put at once into water already brought to a
boil. But to make beef-tea, mutton-broth, or other meat
soups, the flesh should be put into cold water, and this
afterwards very slowly warmed, and finally boiled. The
advantage derived from simmering, a term not unfrequent in cookery books, depends very much upon the
effects of slow boiling, as above explained."
This passage contains the whole theory of the art of
cooking meat. If we want to give our patients the full
richness of the flesh, we must order a chop or steak, or
something of that sort; if we want the flavour chiefly,
and not the strength, we give beef-tea; if we want bulk
rather than either flavour or strength, we can order the
meat to be boiled to rags. This knowledge gives us all
the command of the kitchen which we can expect to
have.
So much for animal food; let us now consider what
the vegetable world affords in the shape of albumen, and
how it is to be prepared for the table.
1st. Soluble Vegetable Albumen exists in a greater or
less quantity in the juices of all plants, and in greatest
abundance in the so-called grains. In its proportion of
nitrogen, carbon, oxygen, and hydrogen, it is exactly the




DIET.


53


same as animal albumen, but differs somewhat in the
amount of Sulphur and Phosphorus.          It is soluble in
water and various acids.
2d. In the seeds of leguminous and corn plants,
besides the vegetable albumen, is formed a substance
called cleber, by Beccaria, by Leibig, vegetable fibrine.
It is insoluble in   water, but soluble in alkalies and
acids.
3d. A modification of this is vegetable gelatine, which
like kleber is insoluble in water, and soluble in alkalies
and water.
4th. The last and most recently discovered albuminous ingredients in vegetables, has so close a resemblance to caseine, as to be called, by Liebig, vegetable
caseine.  Vegetable caseine is formed chiefly in leguminous plants.    The Chinese make a cheese from       peas
and beans, closely resembling skimmed        milk  cheese.'
From these chemical facts, we are able now to infer the
digestibility of vegetables, as well as their nutritive property, for, as a general rule, while their power to nourish
the body is in direct ratio to the total amount of their
albuminous contents, the facility with which they are
reduced to a state fit for assimilation depends upon the
relative quantity of the soluble and insoluble form of
this albumen.    Besides this important explanation, chemistry also suggests the reason of dressing some vegetables with vinegar; for all forms of cabbage contain a
large quantity of insoluble albumen, which is rendered
One of the most distinguished chemists in this country informed me
that he had prepared cheeses, la Chinois, i. e., from peas and beans, and
that they were hardly to be distinguished from skimmed-milk ones.




54


DIET.


soluble by the addition of this acid. It is probable that
in the preparation of vegetables for the table, we have
yet much to learn, and no doubt the indefatigable efforts
of the vegetarians will be of use.
The comparative amount of nutriment contained in
the most nutritious form of animal and vegetable food,
is, according to Professor Johnstone, about 3 to 1.1 c" Or
a pound of beef-steak is as nutritive as three pounds of
wheaten bread, in so far as the nutritive value depends
upon this one ingredient," i. e. albumen. Thus we find
that as Coleridge defined a rogue to be a fool with
a circumbencibus, so we may consider a man who lives
on vegetables alone, to be a roundabout flesh eater; for
by a circuitous route he gets the same albumen as the
beef-eater gets directly. Whether it is well to live
solely on vegetables, or solely on animal food, or on
a mixture of both, is a question to be decided by the
whole circumstances of the eater. The appeal to nature
made by the vegetarian propagandists, is manifestly
futile; for man's nature is progress, and as one generation succeeds another, man alone of all creatures that
dwell upon earth, inherits the accumulated acquisitions
of those who lived before, and every child born stands in
a new relation to the external world to what its parents
did. Man is "the heir of all the ages," as such he
accepts on his birth new duties in a new sphere of action
from  those who went before him.   Is he to be denied
the right of innovation, perpetual innovation and general
progress in the food which is so essential to his life?


I Op. cit., p. 128.




DIET.


55


His nature is himself.  He alone can resolve the problem of his duties for himself.  If he finds that for their
fulfilment he requires to abstain from flesh, let him
abstain;  but let him    not insist upon  putting  a
strait jacket upon his neighbour who    is under no
such necessity, and who on the other hand finds he
can do his work better if he live on meat.    Above
all, it is lamentable that the apostles of this vegetable creed should be so carried away by their fanatical
exclusiveness, as to convert the board of hospitality,
where the bread, the meat, and the salt, are spread to
satisfy the. various instincts of our bodily requirements,
and to express the oneness of our origin, our progress,
and our destiny, into a conspirator's meal, at which each
guest pledges himself against the common food of his
fellow-men. In former times, when men fasted, they
went some days' journey into the wilderness, not to
annoy their neighbours with their lugubrious faces.
Might not all exclusionists in diet do well to follow this
example? But we have said enough, perhaps too much,
upon this head, and we must conclude with the saying
of Goethe--"That is good      which  does us good."
Newton wrote his treatise on optics living upon wine
and water, biscuits and tobacco. That was good for
him.   We might have injured his labours if we had
insisted upon his eating a mutton-chop. But it does
not follow, that if we confine ourselves to biscuits and
sherry, in process of time we shall be transformed into
Newtons.   In short, the reason of every man is, or
ought to be, the absolute lawgiver upon this matter to
himself, only the reason should be enlightened by the
fullest knowledge of how he can best secure the ends it




56


DIET.


seeks.  But as these ends vary infinitely, so should the
means also vary, and the whole dispute between the
vegetarians and non-vegetarians is terminated by the old
proverb-" One man's meat is another man's poison."
Having thus briefly described the inorganic and nitrogenous ingredients of food out of which the bony skeleton with its ligaments, and the muscular fibres of the
body are procured, let us proceed to investigate the
character of the materials which furnish the non-nitrogenous remainder of the animal frame, and the complex
series of transmutations which they undergo, before their
final adjustment to the parts they play in the living
organism.
The starch group is the first we here encounter, and
the most important.   It consists of1st. StarcA or fecula. A substance found generally
in those parts of a plant to which light does not penetrate.  It exists in the greatest abundance in the potato,
and forms above sixty per cent. of most grains. Its
formula is C0 H10 010.  It is soluble in warm water, and
readily transformed into a substance called dextrine, of
similar atomic constitution, but of different physical and
chemical properties, by the contact of saliva and various
organic substances.
2d. Cellulose. Of the same atomic constitution as
starch, and like it, by long exposure to the action of
acids, being converted into dextrine, but insoluble in
water.   It abounds    in  green  vegetables, especially
cabbage.
3d. Pectin.   Of the same atomic constitution as the




DIET.


57


former two.    It is imperfectly soluble in water, but if
exposed to the action of acids at a higher temperature,
it passes into a substance called metapectic acid, which is
soluble.  Pectin is met with in large quantities in various
roots, such as carrot, turnip, &c., and still more in the
fleshy fruits, such as raspberries and apples. The gelatinous-looking substance so abundant in Carrhageen
moss, is nothing more than a modification of Pectin.
4th. -Dextrine, or gum. These are essentially alike,
but the term gum has a more limited application. Dextrine may be called the father of all the gums. It exists
in large measure in all ripe fr-uits, and is the transition
form of the - metamorphosis of all feculent bodies into
sugar. It derives its name from its action on light; the
polarized ray is thrown by it to the right; probably the
ray thrown to the left, acting upon similar elements,
forms true gum.
5th. Grape sugar and glucose, are closely allied, and
only distinguishable by the difference of their action
on polarized light, and the crystallizable character of
grape sugar, which glocuse cannot attain. Besides being
readily produced by the action of various substances
upon other forms of fecula, it exists naturally in figs,
apricots, and many other sweet fruits, as well as the grape.
It is readily soluble in water, and if any nitrogenous
body-be present it undergoes fermentation, as it is called,
and is converted into alcohol. Sugar of milk has the
same composition as grape sugar, but cannot pass spontaneously into alcohol; it requires first to be changed
into grape sugar, a transformation readily effected by the
action of an acid.




58


DIET.


Cane sugar differs atomically from all the other sugars,
its formula being C2 I 1 011; or, as there is probably
one atom of water in this, the truer formula will be C12
ITI  O10.  Like sugar of milk, it is incapable of direct
fermentation, and   to acquire the useful property it
has to become grape sugar, through the action of an
acid.
Thus we see that all the varieties of starch may be
promoted into grape sugar, that highest point of advancement of the class, at which it undergoes the astonishing transformation from a sweet and harmless
material for the nourishment of the body, into a fiery
stimulant called  alcohol, the most fertile source of
every human crime, the great parent of madness and
suicide.
The second non-nitrogenous group consists of substances from which fat is derived; for although grape
sugar may be converted into fat, yet this transformation
is made more easily if ready made fat be present, and it
exists in large quantities in various forms of food.  The
most widely distributed form of fat is elain, which constitutes nearly eighty per cent. of olive oil. Its formula
is calculated at C35 HSS O4.  It is generally met with as
an elaic acid, and as such, or as a soap, is received into
the blood.   Next in abundance to elain is margarin,
which constitutes sixty-eight per cent. of butter, and
enters largely into the composition of all solid fats.  Its
formula is C35 H"6 O4.
Stearine is much more rarely met with; it is found
in mutton suet and cocoa. Its formula is C37 H37 O".
The last member of this group which is of any importance in a dietetic point of view, is Butyrine, which is




DIET.


59


a constant constituent of milk, although it is in the small
proportion of two per cent. It is readily decomposed.
Its formula is Cn H" O1.
The above group, as will be perceived, abounds in
carbon, and yet the demand for this element is so large,
both for the purposes of respiration, and to form the
many carbonates that exist in the body, that besides the
contributions derived from the various forms of fat,
a considerable amount is afforded by various acids,
which constitute the third and last non-nitrogenous
group.
The most important of these are the oxalic, malic,
citric, tartaric, acetic, and lactic. All these acids are
very similar in atomic constitution, consisting generally
of four atoms of carbon, two of hydrogen, and from three
to five of oxygen. The formula of lactic acid deserves
more specific attention, for it is readily formed from
grape sugar, it stands thus: C6 H O1.  As this acid is
found, in combination with alkalies, in the muscles, it is
probable that it passes unchanged into the blood. As
also the acetic, for it is met with in the perspiration,
although in small quantities, and, no doubt, much the
largest quantity of the acetic acid we use, is changed into
carbonic acid and water. All the acids we have enumerated are readily decomposed, and form new combinations with the various complex bodies they encounter in
the blood. It would be out of place here, to attempt to
follow their chemical progress, and we shall now proceed
to the more interesting task, of describing the process by
which the most important members of the non-nitrogenous
groups are adapted for the various offices they have to
fulfil in the state corporeal.




60


DIET.


Let us first pursue the history of starch, which enters
so largely into most vegetable diet, from its entrance into
the mouth, to the transformed existence it presents in the
blood.
When food is taken into the mouth, there is, or ought
to be, an immediate flow of saliva from the various glands
connected with that cavity. The action of this saliva
upon starch is very remarkable, as it gradually converts
it first into dextrine, and then into sugar.  Digestion
then begins in the mouth, and from this important fact,
too much lost sight of, we may deduce several dietetic
rules. The first that occurs is an old adage, that food
"w well chatted is half digested:" a curious example of the
popular instinct anticipating the scientific discovery; for
it is literally true; the chatting during a meal prolongs
the process of mastication, and has also the effect of
conveying the requisite amount of nervous influence to
the salivary glands. No part of the system is more
under the influence of the emotions than these organs.
"The mouth waters for dainties," is a literal fact.  The
sight and smell of food make the mouth weep in pleasurable anticipation of the " sweet morsel" it will soon "roll
under its tongue."   How exact is this     description!
While gaiety thus improves what we may call the oral
digestion, fear and anxiety exercise as powerful an effect
in the opposite direction. The dryness of the mouth is
a symptom of terror, suggesting the expression, "vox
faucibus haeret," or, " the tongue cleaves to the roof of
the mouth." In India a thief is detected by desiring him
to chew rice in his master's presence; the saliva will not
flow from fear, for " conscience doth make cowards of us
all," and the thief is unable to make any impression upon




DIIET.


61


the dry hard grain. So much for the importance of
recommending social meals, and the obvious risk of
throwing an undue amount of labour upon the stomach
by bolting food. Is it not possible, that this habit, which
is said to be so common in America, is one of the causes
of the remarkable leanness of the people? For, as we shall
see afterwards, the ultimate destination of this starch
and sugar is to supply fat to the frame.
Another question of great practical importance here
suggests itself, viz.-whether we do wisely in restraining our patients from all spices. The action of mustard
and pepper, and of seasoning generally, is very powerful
upon the salivary glands; and it is a remarkable
fact, that while the taste for sweet things is the characteristic of childhood and boyhood, the love of tarts and
sugar-plums, as a rule, entirely gives place to a relish
for spices in maturer years. If we condemn our patients
to eat tasteless farinaceous food, shall we not incur the
risk of subjecting them to the punishment of the thieving
Hindoo, and will they not be too glad to get rid of the
insipid stuff as expeditiously as possible, that is, little
digested in the mouth, and gulp it down, c" unhouseled,
unannointed, unannealed," to the sepulchre of their
stomach, where it can hardly expect a proper welcome,
coming in so unmannerly a fashion. If this is in any
measure true of mature manhood, it will be much more
so of advancing years, when the apparatus for disintegrating food, so that it may be well kneaded with saliva,
is all broken and useless, and at the same time the sense
of enjoyment is diminished, and there is less lively participation of the cerebral functions in those of nutrition.
To insist upon an old man eating his beef and bread




62


DIET.


without mustard, is almost as cruel as to give him mustard
without bread or beef. The mustard, -to him at least, is
an essential; without it he could not instigate the glands
of' his mouth to pour out their contribution to the first
act of digestion.
The starch, then, on its arrival at the stomach, has
already undergone a partial transformation into sugar, the
process is there completed by the action of the pancreatic,
fluid, which bears a close resemblance to saliva, and by
the secretions of the stomach itself, the most important
of which is the complex substance called pep~in, whose
characteristic peculiarity is, its power of inducing active
molecular changes in all organic matters susceptible of
its influence.  It is, in short, the digestive principle in its
purest form. Besides converting the unreduced remnant
into sugar, it acts upon the sugar in such a way as to
transform a portion of it into lactic acid. This is also
done by the bile, but the full action of the bile upon the
chyme is yet unknown, and how sugar is converted into
fat is still an unsolved problem-possibly an insoluble
one, for it is the step out of chemistry into vitality. This
first act of vital generation, by which the -hard and angular chemical sugar is transformed into the soft and
globular vital oil, wherewith the lamp of life is fed' at the
lungs, and the whole bodily machine kept pliant and
warm, seems to be in some way or other under the direct
control of the brain. The nervous system, the differential
between what is vital and what is chemical, here asserts
its claim for the first time over the contribution to the
reconstruction of the living body presented by external
nature. This important fact has come to light during
thle investigations into the cause of the curious disease




DIET.


63


known by the name of diabetes mellitus, which seems to
result from the incapacity of the brain to discharge its
requisite office, and transform the sugar, presented to
the organs of assimilation, into fat, so that, as sugar it
enters the blood, and as sugar leaves the body by variouis
emunctories, and thus the body is starved of its fat, and
extreme emaciation, going on generally to death, is the
consequence.'
No doubt a portion of sugar, and a large portion, may
continue unchanged in the blood, till it passes through the
lungs, where it may be oxydized and converted into carbonic acid and water; but there is as little doubt, that
what we consume as sugar is largely converted into fat;
and hence the fattening effect of a purely sugar diet
upon the negroes who work at the sugar-cane plantations. The facts which seem to me of such immense
importance to us practically, are these two, that we are
now on the road to discover what substances yield the
elements of fat to the body, and what the condition of
the body is which enables it to turn its opportunities to
account; and what the bodily states are, on the other
hand, which debar it from the privilege of converting the
bounties of nature into that ductile element, which
rounds the harsh masculine features of bone and muscle
into feminine beauty, and tends to mollify the temper
and tranquillise the mind.
Besides the fat we obtain from the starch and sugar
we consume, there is a considerable quantity of it in
the principal grains employed in making the various
kinds of bread, or the cakes and other forms in which
1 This subject forms the matter of the next Chapter, "On the Structure
and Uses of the Liver."




64


DIET.


meal is prepared for use. And it is of consequence to
know the proportion in which it exists in the different
varieties of these bread-stuffs, for upon the amount of
fat seems to depend the laxative or binding action of
these articles of diet upon the alimentary canal. Professor Johnstone, in the book we have before so often
alluded to, gives the following proportions:
In fine English wheaten flour..  2 per Cent.
In bran of English wheat..  6,
In Scotch oatmeal...  6
In Indian corn.....  8
From this table we learn that fine wheaten bread contains only one third the quantity of oil contained in oatcake or bread made from bran, and that we may derive
a useful hint fr-om this in the management of cases attended with constipation. It was generally supposed,
that the bran acted as a foreign body upon the mucous
membrane, and that from the irritation it produced, the
peristaltic action was increased. This may be partly
true, but the presence of the oil is undoubtedly highly
conducive to the greater activity of the bowels. Rice
contains very little fat, and hence its binding tendency
upon the bowels. Indian corn, on the other hand, is,
very rich in fat, and might probably be more extensively
used in this country, with great advantage. All travellers in America dwell with much gusto on the delicious
cakes of Indian corn that are there served up at breakfast.
Although we derive the elements of the fat, which
enters into the composition of every tissue of the body
except the enamel of the teeth, and constitutes the bulk




DIET.


65


of the brain and nerves from various forms of fat that
present themselves both in the animal and the vegetable
kingdom, yet the modifications these endure before they
take their new place in our frame, is much greater than
any which the other primary constituents undergo. In
the brain it is found in the form of two acids, the one
called cerebric, the other oleophosphoric; the latter possesses the interesting property of being resolved by heat
and water into Elaine and phosphoric acid. This fact
maythrowa light upon the important observations recently
made by Dr. Bence Jones, upon the amount of phosphates in the urine being the measure of the waste of
the nervous system.
It does seem strange that with such facts as this one
and many others staring us in the face, to show the immense value of fat as a source of nourishment to all parts
of the body, and chiefly to the most noble parts of allthe brain, it should be the fashion of chemical physiologists
to speak of fat as if it served no other. purpose than to
be burned at the lungs to warm the rest of the body.
Surely, the curious fact of hibernation alone might teach
us that fat went far to sustain life, for from the store accumulated in themselves during summer and autumn,
must the beasts and other animals which pass the winter
in sleep, without food, draw the whole nourishment during
the months of their retirement from active life. To deny
the name of nourishment to that which sustains the life
of an animal, involves a paradox; and in this instance
the paradox results from an exclusive application of the
term nourishment to substances which supply the materials for constructing the fleshy parts of our tabernacle,
5




66


DIET.


and ignoring the existence of the earth and fat, which
are essential to the formation of the organs of sensation
and locomotion.
The sophism   implied in this paradox lies at the root
of the entire misrepresentation of the effects of alcohol,
by those who deny to it any nutritive qualities; and as
the subject is one of unsurpassed importance and interest
to us as physicians, it will be right to inquire fully into
the properties of alcoholic drinks, regarded, not as medicinal stimulants, but as articles of strictly dietetic or
nutritious use.
The ground we are now entering on, demands from us
a most dispassionate investigation, for it is beset with
difficulties on all sides, and requires that we should at the
outset clearly define what are our special duties in this
matter, as contradistinguished from those who are most
prominent in leading public opinion upon it.
To those who devote themselves to the arrest or mitigation of the frightful evils produced by intoxication,
whether by popular lectures, or by addresses from the
pulpit, or by the organization of societies, we wish to
express the deep sense of our obligations, for their noble
and patriotic efforts, and in so far as it is in our power
to advance the great cause of temperance, in our capacity
of citizens, it is surely our bounden duty to do so.  But
the restraint of excess is a wholly different question from
the proper use of any article of food; and if out of dread
of offering an obstruction to the promoters of a great
philanthropic movement, we shirk a candid investigation
of the alleged benefits to be derived from  a temperate
indulgence in all the drinks they find it expedient to
condemn, we should be abdicating our position as ad



DIET.


67


visers of those who consult us as to what is best for
them, and be betraying their interest and our duty for
the promotion of a remote and hypothetical good. We
have no right to sacrifice our patients upon the altar of
temperance. There is no more inconsistence in promoting
the cause of temperance, and recommending the use of
wine, than in doing all we can to advance a Fire-Insurance
office, with all its machinery for extinguishing a conflagration, and each of us at the same time making these
very efforts by the comfortable warmth of his " ain fire
side." Temperance is the law of life; the torrid and the
frigid zones are equally inimical to man, nor less so pro.
bably would be found the universal abstinence from wine
and all its kindred. Nay, we do not take up a merely
negative position in reference to temperance, while thus
claiming a fair hearing for what its soi disant advocates
condemn, we go further, and maintain, that if it be shown
that the use of wine, spirits, and beer, be conducive to
health in certain circumstances, by recommending their
use, we are really doing more for the ultimate triumph of
temperance, than by passing no end of Maine-liquor
laws; for it is a fact beyond all denial, that one of the
most fertile causes of intemperate indulgence is traceable
to some bodily infirmity or depravity, and that intoxication is hardly possible for those whose bodily and mental
conditions are in the highest state of vigour and refinement.
I have been thus free in the expression of my sentiments, because I find myself opposed to the views of
many, whose opinions deserve the highest attention and
consideration at our hands, and with none more than Dr.
H. Madden, who, in an article published in 1846, in the




68


DIET.


'British Journal of Homceopathy,' makes the following
observation.  " Alcohol when acting not as a stimulus,
but substantially, is not and cannot be a pabulum to any
organ, and for the following reasons:--first, its chemical
composition disqualifies it from taking any share in the
formation of muscular fibre, or other azotized compound,
since it possesses no azote; and it has now been proved
that the higher orders of animals have no power to
compound their proximate principles, but must obtain
them ready formed: second, although its chemical con.
stitution has some approximative relationship to nervous
matter, we have no proof that it is or can be transformed
into that substance, while numerous arguments may be
drawn from transcendental chemistry, to show its extreme improbability."
In opposition to this statement, we think we shall be
able to show that alcohol may supply a pabulum to every
organ by affording it the materials whence to derive its
fat, which is essential to its healthy action, and also that
there is every probability of its nourishing as well as
cherishing the nervous system. Human fat, according to
Chevreul, contains 79 per cent. of carbon, while alcohol
contains 53 per cent. of the same element, and the conversion of alcohol into fat is farther rendered probable by
the examination of the blood of persons who have imbibed alcohol in large quantities: their blood has been
observed to be of a whitish, milky appearance, from the
quantity of fat globules that float there.- There is a case
on record in which all the organs of the chest and
abdomen, and even the muscles in the body of a drunkard,


1 Wilson on the 'Pathology of Drunkenness.'




DIET.


69


were found conveited in a great measure into a fatty
substance.1
So much for the first proposition, that alcohol goes to
make fat in the body: a statement which, although we
cannot assume as a fact, we may assert as a very probable conjecture. As to the second, that alcohol by
loading the blood with fat, probably affords special nourishment to the nervous system, which consists in a great
measure of this substance, it seems also probable, not
only from the fact of the chemical composition of the
two, but from its physiological action as a narcotic.  We
know, indeed, as a positive fact, that the brain is nourished during sleep, and we also know that, as a general
rule, the tendency to sleep is in direct proportion to the
quantity of fat in the body. Fatness and somnolence
are mutual cause and effect, as we see in the example before referred to, of hibernating animals who do not go to
sleep till they have laid in a great store of fat, and who
then pass their whole time in this condition, and the
converse we see in the effects of sleeplessness producing
all the evils of insufficient nutrition on the brain.  " All
the causes," says Dr. Bucknell, in a recent article in the
"British and Foreign Medico-Chirurgical Review,' " even
of the acute forms of insanity, point to an interference
with the due nutrition of the brain. Starvation causes
raving delirium, mortification produces muttering delirium. * * ~ If anything is positively known of the
brain and its functions, it is that it expends its powers
during the waking state; and that it is nourished and its
powers are recruited by cell-growth, or otherwise, during
sleep, *  *  *  and   during  the prodromic period of
1 Rosch 'Der Misbrauch geistiger Getriinke,' p. 93.




70


DIET.


threatened insanity, opiates often act like a charm." 1
That -alcohol does act narcotically, especially if combined
with another narcotic, such as that of hop, requires no
proof: it is an admitted fact. And now we are in a position to perceive how it is that the English and the
Germans are a fat race, while the French and the Scotch
are lean. The former drink beer, which contains about
the same amount of alcohol as the light French wines,
but in combination with a narcotic and nutritive extract
to the extent of from 4 to 8 per cent; while in milk,
the model food, the nutritive matter is about 12 per cent.
So that a pint and a half of good beer is equal, in respect of solid nourishment alone, to a pint of milk.
But it has this immense advantage over milk, that it
soothes the over-active nervous system at the very instant that it presents to it its means of nourishment. It.
cherishes and nourishes at once. Shall we then, misled
by the crude speculations of modern chemists, reject the
evidence of all history in favour of the mighty boon conferred by Bacchus on our race? When we reflect that
in the present age the work is done more with the brain
and the nerves, than with the muscles and the bones,
that we have now bones of iron and muscles of steam,
which relieve to a great extent those of the human frame,
and that this substitution is daily progressing; while,
on the other hand, the strain upon the mental and cerebral system is proportionally increased, for we cannot
multiply brains by any process of machinery yet invented, and that this very liberation from the toil of the
hands begets greater and greater competition in the race


' Brit. and Foreign Med.-Chirurg. Rev.,' Jan., 1855.




DIET.


71


of mental achievement; when we reflect on all this, is
there not something very presumptuous in venturing
against the most advanced investigations of physiology,
to enforce more than monastic ascetism upon those who
instead of the dawdling life of the monastery, with the
trifling expenditure of its hibernating existence, have
daily to undergo a waste of cerebral and nervous matter
in the furnace of a city, to an amount hitherto unknown
in the annals of our race? If we forbid alcohol in all its
forms, is there not a danger of oiu' starving the brains
and the nerves?  May not a portion of this substance
be absolutely necessary for those who like pleaders have
to go through a work of intense cerebration, so to speak,
for hours together? Certainly in my own practice I have
met with many instances where the health was kept in a.
state of deterioration by abstaining from alcoholic drink,.
and where the addition of a glass of ale or a glass of
wine permanently improved the health and comfort of
the persons; and I believe, notwithstanding all the
averments of the teetotallers, will contribute to the prolongation of a life it has already made happier.  There
is wisdom in the adage that wine is the old man's milk.
Before considering the comparative value of different
forms of alcoholic drinks, let me observe that the cases
in which marked benefit was derived from their administration as articles of regular diet, not occasional stimulants, were all characterised by the feebleness of the
pulse, and a difficulty of obtaining a sufficient quantity
of sleep.  This entirely corresponds with what our physiological investigations might have led us to expect.  In
such instances, alcohol in its proper form at once propitiated the appetite of the nervous system, and presented




72


DIET.


to it its most appropriate aliment.   At the same time it
is right to state, that the greatest caution is required in
deciding on the class of cases which are suitable for this
method of treatment, for it certainly is extremely injurious
in many cases characterised by a feeble pulse, if there is
preternatural general irritability present.  In such cases
it acts not as a sedative, but as a stimulant, and increases
instead of mitigating the evil. I have known immediate
improvement to follow the withdrawal of all stimulants,
in cases where the heart is at once feeble and irritable.
Indeed I do not believe there is any matter connected
with the management of those who consult us that requires so much     care, and about which, with all our
caution, we shall so often commit errors in giving a reply
to the question: what must I drink? Perhaps it may be
well to give Dr. Bence Jones's resume of the various
qualities of alcoholic drinks, as it may afford us some
guide in the solution of this intricate and perplexing
problem.' " Generally then, it may be said, that beer
contains much saline matter, wines contain very little,
and spirits contain none at all.  Each year our knowledge of the chemical composition of these fluids will increase, and with advancing knowledge we shall obtain
more clearness regarding the dietetic and medicinal properties of all fermented liquids. At present, the answer
to the question which is the best wine, cannot be given,
because of the imperfect knowledge which we possess of
the chemical composition of different wines.    But even
when full knowledge is obtained, no universal answer
can be given; for that wine which is best in one state,
or for one person, may be the worst in a different state,
S' Medical Times and Gazette,' for Sept., 1854.




DIET.


73


or for another person. Generally, however, it may be
said, that that wine is best which contains least alcohol,
least acid, least sugar, and highest flavour.  This is the
best for a person in health, while for a person in a state
of low fever, that wine which contains least salts, most
sugar, most astringent acid, and most alcohol, will cause
least irritation of the bowels, will furnish most nutriment, be most febrifuge, and most supporting. Where
there is much irritation and much depression, brandy
will be better than wine. In some states in which diuretic action is desirable, Moselle wine, by the excess of
salts it contains, may prove almost as energetic and far
less heating than the essential oil in gin or whiskey. The
difference in action being that between cream of tartar
and oil of turpentine. In diabetes, ale and porter, which
contain much sugar, cannot on rational gromunds be advised, while claret, which is free fromi sugar, and contains
perhaps much tannic acid, is highly beneficial. While
cider, though free from sugar, contains much malic acid,
and is diuretic. In dyspepsia and gout, the wine which
is freest from ultimate acidity, and which is least stimulating, is best.  The least acid claret wines, first, and
then some sherry, and even perfectly dry champagne,
when very free from excess of acid, are not unsuitable.
When a taste is acquired for good Mansanilla, it answers
all the requirements, and is obtained at a far cheaper
rate than fir'st rate Amontillado sherry, which may be
procured free from all sugar, and with little acid, and
scarcely stronger than Mansanilla, and so far surpasses it
in flavour, that the difference in expense is almost forgotten. But by adding water to brandy, or other spirit,
a fluid is obtained which is far less acid than any wine,




74


DIET.


and which may be made of any strength, and be free
from  all sugar. Theory, then, as well as practice, leads
to the belief that if any stimulant is taken in dyspepsia,
the best is brandy and water.   With regard to porter
and stout, these containing little acid, have much sugar,
and hence give rise to much more acidity than some pale
ale.  [But at the same time are pro tanto more fattening
if they agree.]  Some pale ale may be found more sweet
and acid than ordinary sherry, but generally pale ale is
more acid than sherry, and less stimulating. Yet for
this, compensation is made in the greater quantity of ale
drank. The larger quantity of salts also in malt liquors
must always be borne in mind.    Such is the meagre information which at present is the best I can bring before
you to enable you to answer the question: what may I
drink?"
The question of how much, must also receive answers
as various as are the habits and capacities of those who
ask it.  One man's extremest idea of temperance conveying to another the horror of a debauch. I recollect
a celebrated writer, who is now far advanced in years,
remarking to me in reply to my question of whether he
took much wine, "I drink very little now," he said in
the quietest tone, "I seldom  take more than eight or
perhaps ten glasses of sherry at dinner." A limit of indulgence which would have entitled him to be enrolled on the
books of a temperance society instituted towards the
close of the 14th century by the Landgrave of Hesse,
the rules of which restricted its members to     seven
bumpers of wine along with each meal, which at three
meals a day, and allowing six bumpers to a quart, would
give each man more than three daily bottles.




DIET.


75


We should have here considered the effects of the
other sources of fat, and especially of cod-liver oil, but
that the subject has been ably handled by so many
writers, as to make it a work of supererogation. There
is one observation, however, it may be right to make, in
order to prevent disappointment from the results of this
fashionable remedy, and it is this: In cases of phthisis
it may fatten the patient to such a degree as to give a
delusive appearance of restored health, while all the time
the mortal malady is making rapid progress to its inevitable end. As to the value of inunction, a still more
fashionable mode of introducing fat into the body, I
confess myself to be very dubious, from the few trials I
have made of it.    I have found, in several instances, unspiced turtle soup one of the most digestible forms of
presenting fat to patients in a state of extreme emaciation.
Of the dietetic value of cocoa, in this point of view, I
shall speak presently, when considering its claims as a
beverage, along with those of tea and coffee.
Before doing so, it may be right to state, that howeven important fat is to the economy, yet both oil and
sugar are so readily decomposed and converted into a
variety of acids, some of which are of a highly indigestible character, that, practically, they are usually found
unsafe articles of diet, unless presented in circumstances
well adapted to secure their admission without decomposition.
Sugar is safest in the form of grape sugar, and it is
owing to this that the grape-cure owes its efficiency probaebly, in cases to which it is suited. It is said to be
specific in certain forms of diarrhoea or dysentery, but I
am not aware of any trustworthy details of the way in




76


DIET.


which it is used. Milk thickened with mutton suet, has
an excellent effect upon children who are weak and lean
from long-continued diarrhoea. And broiled bacon is
found by many to be a useful substitute for butter
at breakfast.  No doubt in this, as in other forms of
aliment, individual peculiarities of taste and disposition,
impossible to specify by anticipation, must be taken into
account.
The importance of coffee, tea, and cocoa, as articles of
diet, requires no enforcement.     Of coffee alone, the
consumption in the United Kingdom, amounted, in
1853, to   thirty-seven  millions of pounds; and yet
coffee  is  of comparatively   recent introduction   into
Europe.
According to Abd Alkader Ebn-Mohammed, who
wrote a treatise in 1566, entitled, ' The Prop of Innocence, in Reference to the Lawfulness of Coffee,' a very
learned and pious sheikh became acquainted with this
beverage in Abyssinia, and introduced it into Aden
about the beginning of the fifteenth century, under the
name of kahwa. In the year 1554, an alarming tumult
arose in Constantinople, no less than an emeute of the
priests against the sultan, because the opening of coffeehouses had been attended with such irresistible attractions to the true believers, that they had all deserted the
mosques. With the sagacity of one born to rule, the
sultan settled the matter by heavily taxing the coffeehouses, thus relegating to the mosques the poorer portion of those who frequented them, satisfying the priesthood, and enriching himself. In 1652, a Greek, of the
name of Pasqua, opened the first London coffee-house,
in George Yard, Lombard Street; and in 1671, the first


/
I!




DIET.


77


was opened in France, at Marseilles; it was niot till 1721
the first coffee-house was opened in Berlin.
Thus began the second Byzantine empire, which is
likely to be more enduring and fruitful of great political
results than the first. For it is hardly too much to say,
that if there had been no caf6s in Paris, there would have
been no French revolution, or, at all events, its history
would have been very different.
The most important chemical ingredients of roasted
coffee are: 1st, a volatile oil produced during roasting;
2d, a variety of tannic acid, modified by this process;
and 3d, a substance, called caffeine, similar to the thcine
and theobromine of tea and cocoa.
The physiological effects of the infusion or decoction
of coffee are very peculiar.  It seems to act especially
upon the spinal and respiratory system of nerves, rather
than on the cerebral, as alcohol does. It is well worthy
of consideration, that while wine induces sleep, coffee
and tea prevent it. And it may be, that the increasing
number of spinal affections, which are undoubtedly met
with now, are, in some measure, due to the much larger
quantities of tea and coffee consumed.  It has, besides,
a most remarkable effect in retarding the waste of the
tissues, and thus, is indirectly nutritious; it husbands
the strength of the person who drinks it, and so increases his wealth: as a man's riches depend upon the
excess of his revenue over his expenditure, and what
diminishes the latter, augments the former.  Some interesting experiments have been made upon this subject,
and the result was to prove, in the instances recorded,
that by the use of one and a half ounce of coffee daily,
the absolute quantity of urea and phosphoric acid voided




78


DIET.


from the system in a day was diminished one third, while
the absolute quantity of urine was increased by a fifth.
If this experiment be confirmed, it shows that coffee, to
some extent, gives us the control of the waste of our
bodies, and when we recollect that life is an incessant
stream, the rapidity of which, in a great measure, determines the amount of health and strength; that the
rapid exhaustion of fever is the acceleration of the river
of life in the body, and, that the arrest of decay implies
increased energy and prolonged vigour, there is no
wonder that those who are exposed to great wear and
tear of the body, especially of the nervous-ingredients of
it, should cling with desperate tenacity to those beverages, which experience, now ratified by scientific observation, tells them, tends to reduce to a minimum the expenditure of substance during the efforts they are obliged
to make. And, while to deprive a man of his wine may
be to starve his brain and his nerves, by withholding
from them their requisite sources of food, to deprive a
man of his tea and coffee, may operate with equally disastrous consequences, by involving him in an expenditure to which his means are inadequate.
The quantity of tea consumed in the United Kingdom
in 1853, amounted to fifty-eight millions of pounds,
while in Germany, with a population of four millions
more than the British, it was only one million and a
half, and in France only half a million. This accounts
for the ghastly parody of the refreshing beverage with
which the traveller in these countries is generally
mocked, and displays the absurdity of homceopathists
transferring  Hahnemann's inhibition   against  coffee
to this  country, while tea, which takes the same




DIET.


79


place here held by coffee there, is allowed to be used
with certain faint admonitions against its excess. For
the physiological effects of the two are very similar,
depending, in a great measure, upon the presence of the
peculiar highly nitrogenous principle, called theine or
caffeine. The difference between black and green tea
depends entirely, according to Mr. Fortune, our great
authority in this matter, upon the mode of preparation.
Green tea is dried rapidly, while the leaves are fresh;
while black tea is exposed for some time to heat and air,
which induce various unknown chemical changes in their
substance, and mitigate its sleep-destroying properties.
It is usual in China to prepare the green tea for the
foreign market with a small quantity of copper to intensify its colour, and to the deleterious action of this
substance, some of the evils of green tea are ascribed.
However, recent investigations have proved, that the
amount of copper employed is so minute, as hardly
to be of any consequence -at least, so it is maintained.
All that has been said of the action of coffee upon the
nervous system, is equally applicable to tea, and does not
require to be re-stated.  I believe its moderate use to be
perfectly harmless, and that it in no way interferes with
the action of homoeopathic medicines.
The quantity of cocoa consumed in this country, although still greatly inferior to that of tea or coffee, is
rapidly on the increase, being no less, in 1853, than
4,126,000 pounds, while in 18332, it was only 1,150,000.
Like tea and coffee, it contains a peculiar highly azotized
principle, called theobromine; the composition of this is,
N4 C14 H8 04; while that of theine is N2 C8 H5 02.  And




80


DIET.


if cocoa were prepared and used in the same way as
coffee, it is probable the effects would be much the same.
This, however, is not the case; it is not roasted and infused, and the infusion drank, but boiled, and eaten in
substance; and besides various ingredients in common
with tea and coffee, it has a much larger proportion of
oil, amounting to between fifty and sixty per cent. while
in coffee there is only ten per cent. and in tea none at
all.  It is to this difference the fattening properties of
cocoa are due, and this too is the reason why it is found
to be indigestible by many. In Spain, and other countries where it is much used, it is not the practice to use
bread and butter with it, but generally a species of rusk
or roll of biscuit. In a chemical point of view, there is
not much difference between a breakfast consisting of tea
and bread and butter and one of cocoa, and the attribute
homoeopathic, applied to the latter, seems to be somewhat arbitrary, if not clap-trap. The so-called homceopathic cocoas are no way different from the other cocoas,
except in being mixed with various proportions of sugar
and arrowroot, or potato-flour, which lessens the proportions of oil, and improves their flavour to most
palates, and their digestibility to most stomachs.  On
this admixture Dr. Hassall has made some very severe
strictures, denouncing it as a fraudulent adulteration, on
the ground that the only design the chemists who prepare the cocoa can have in view, is to increase their
gains, by selling a cheaply prepared article at a high
price. With his condemnation of those - and I am
sorry to say they are a considerable number - who
adulterate their cocoas with earths, it is impossible not to
concur in the fullest extent, but I do not see that those




DIET.


81


who prepare a wholesome and nutritious article of
food, the basis of which is cocoa, are to be blamed for
selling it under the name of homoeopathic, or dietetic, or
any other title they fancy; as to the price, that is
their affair and the public's. The whole idea of trade is
gain. To buy in the cheapest market, and sell in the
dearest, is the fundamental principle of commerce. Shall
we blame tradesmen for obtaining the highest price for
their wares? Shall we not rather say, if the price be
too great, let it be brought down by competition. There
is no monopoly except that obtained by superior skill,
capital, and reputation.
MILK.
We have still a few words to say about milk.
This is called the model food, because it contains in
nice proportions, albumen, gelatine, and fat. In a dietetic
point of view, the chief point of interest is, to determine the kind of milk best suited to various purposes.
The modification of milk called colostrum, on which the
first days of the infant's life are sustained, differs from
the after-milk, in containing a considerably larger quantity
of all the solid parts. Thus, at birth, the caseine amounts
to 40 parts in 1000, while at the end of the fourth day,
it is only 35 or 36 parts, the sugar is as high as 70 instead of 41, and the butter 50 instead of 35.     This is
an important fact to bear in mind, when we are required
to supply an artificial substitute for the natural aliment
of a new-born infant. In the course of lactation, there
is a gradual tendency to an increase of caseine, and a
diminution of sugar and butter; at the fourth month, the
6




82


DIET.


relative quantities of these ingredients, as compared to
the first fortnight, are, caseine 40 instead of 22; sugar
45, instead of 56; and butter 23, instead of 27. There
is also a marked difference in the quality of the milk of
fair and dark women.    This observation, which is a
popular notion, has been scientifically corroborated by
'Heretier, who subjected the milk of fair and dark
nurses, of the same age, to chemical analysis, and found,
that while in the fair the amount of solids varied from
108 to 118 parts in 1000, in the dark nurse's milk they
amounted to 146 and 147 parts in 1000.   The milk of
the cow is nearer in chemical constitution than that of
any other animal, to the human milk. By the addition
of one third part of water and some milk-sugar, the resemblance is made nearly as perfect as we can expect.
The milk of the ass contains much less butter than that
of the cow, and for this reason it is preferred for many
delicate persons.
The effects of disease upon the secretion of milk have
not been much investigated, but Labillardiere has made
the very important observation, that the phosphate of
-lime is increased no less than seven-fold, in the milk of
cows suffering from a tuberculous affection of the lungs.
This fact should put us on our guard, when we give an
opinion as to the propriety of a mother suckling her
child, and we must not allow ourselves to be induced,
by the laudable efforts which are now fashionable, in
favour of the mother being nurse to her own offspring,
to endanger the future constitution of the infant, by
supplying it with improper food at an age when growth
is so much more rapid than at any future period of its
life, and when, consequently, any imperfection in the




DIETr.                             83
elements on which it lives, is most likely to be attended
with important results.
The publication of this paper in the 'British Journal of Homeopathy,'
in the year 1855, excited much interest among the adherents of the
homeopathic system in Germany. The greater part of it appeared in the
"cAllgemeine Hom. Zeitung.,' and thle accomplished editor of the 'Horn.
Vierteljahrschrift,' Dr. M. Miller, wrote an able and liberal article upon it
in his valuable quarterly journal. His article in its turn became the exciting cause of various others all more or less learned and ingenious. It
would be out of the question here to do more than refer to these numerous
articles, as a proof that the question was ripe for discussion, and I take
this opportunity of acknowledging my obligations to the critics who have
written about my imperfect little treatise, for the kindness and candour
'with which they have expressed their opinions when they differed, and the
cordiality with which they agreed.




CHAPTER 111.


ON THE STRUCTURE AND) USES OF THE LIVEiR.
IN the annals of the liver we might read the history of
science and the progress of human thought. It was
probably first attentively scrutinised by the Augurs, the
most primitive anatomists, and from its colour and
shape political predictions were drawn, and inspiration
given to the i1ionitezers and Times of those days:
and
"CcWhen science from creation's face
Enchantment's veil withdrew,"
so far from the " glorious visions" yielding " their place
to cold material laws," it was found that the more the
matter was examined the greater grew the interest, and
that one discovery only made way for another; so that
although during the last two hundred years about one
hundred and fifty treatises have been written, many of
them by the greatest men of their age-such as
Malpighi, Hoffman, Haller-upon the structure and functions of this organ, yet it was reserved for a manl of our
own time to announce a series of discoveries about the
uses of the liver, of so new and startling a character as
to attract the attention of the world at large, and which,
if confirmed, wviii place the name of Bernard beside that
of Hailer. Interesting, in a general way, as these discoveries are to all, they must have a special interest for
us whose high prerogative it is to convert all that is true




STR'UCTURE AND USES OF THE LIVER.


85


in the science of medicine into something fruitful in the
great art of healing.
The liver is the largest gland in the body, even in
adult life, although then very much smaller, proportionally, than in the foetal condition; in the human species
it is one third of the weight of the whole foetus at the
end of the first month, and one eighteenth at the end
of the ninth month.1 Its average weight in a healthy
man is from three to four pounds; it measures about
twelve inches in length, and six to seven inches in depth;
its bulk corresponds to nearly one hundred cubic inches.
This great mass is made up of a multitude of lobules,
and the variation in its dimensions in different classes
of animals depends much more upon the number of
lobules than upon their size. Between the lobule of the
liver of a mouse and of an elephant there is but a comparatively trifling difference, the enormous magnitude of
the latter depends upon the enormous multitude of
-lobules.  In some animals, as the pig, these lobules are
distinct, but generally they are only discoverable by dissection.  Each lobule may be looked upon as a little
liver, and the anatomy of one is the anatomy of the
whole. The fundamental requirements in a lobule are
three-fold: 1st, Vessels to bring blood to it; 2d, Cells
to operate upon that blood; and 3d, Vessels to carry
away what has been analysed by the cells. The analysis
consists in the separation of bile, which flows off by the
biliary ducts, and the formation of sugar, which passes
into the venous blood and is carried on to the heart and
lungs. The first set of vessels, or those which supply
the liver, are the hepatic artery and the portal vein. The
1 Burdach, vol. iii, p. 483.




86


STRUCTURE AND USES


hepatic artery, a branch of the abdominal aorta, is the
feeder of the liver; as such, it is distributed upon the
coats of the ducts and capsule: after discharging its
functions there its contents are collected by venous
radicles and discharged into branches of the portal vein.
The portal vein is formed by a union of all the veins of
the intestines, except those of the kidneys and bladder.
It comes direct from the seat of digestion, and contains
Fig. a.
LOBULE OF THE LIVER, OF A PIG.
This represents tihe branches of the portal vein in the liver of a pig forming an imperfect circle round the centre of the lobule where the hepatic
vein lies, but which is not represented in this plate.
the blood in its rawest condition.      Its distribution in
the liver is very peculiar, and unlike that of any other
vein in the body. The ordinary office of veins is to
collect the blood, not to distribute it, and in their course
the branches naturally diminish in number and increase




OF THE LIVER.


87


in size; but the branches of the portal vein' ramify like
an artery, and encircle the lobules-as represented in
this woodcut.
The cells of the liver are the seat of the vital force
which operates incessantly upon the blood, inducing in
it, in a wholly mysterious manner, those molecular changes
which it is the appointed office of the organ to effect in
the general economy of the body. These cells are very
minute, varying from 1-800th to 1-2000th of an inch in
diameter.1 Each cell contains a nucleolus of a circular
or oval form, and about 1-3000th of an inch in average
diameter. Besides these nucleoli the cells contain oilglobules and granules of yellow coloring matter, and are
remarkable, as compared with other gland-cells, for the
variety in their form and size, and their high refractive
power.   It has been, and still is, a disputed point, whe.
ther these little cells lie simply imbedded among the capillary vessels, or enjoy a private dwelling-place in what
is called a basement membrane. Dr. Beale is decidedly
in favour of the latter opinion, and represents the cells as
occupying a tubular network radiating from the centre
towards the circumference of the lobule like a spider's
web.   In the foetus the distinction between the capillary
and the tubular network is manifest, but the partition
walls being of the most delicate material, what was originally an interlacement of tubes, tends to become a common cavity, and it is very difficult to demonstrate this
arrangement in the liver of the man.     Whether such a
net of fine tubes containing these secreting cells exists
or not is not apparently a question of any great importS Dr. Handfeld Jones, ' Philos. Trans.,' 1846-49-53, and 'Med. Chirurg.
Trans.,' 1852.




88


STRUCTURE AND USES


ance, except to the anatomist.  It is enough for the physiologist that a mechanism  exists by which the blood of
the portal vein, loaded with the drainage of the stomach
and bowels, should be exposed to the action of these resolving cells by which its division into blood and bile is
effeeted.  How it happens that the bile should percolate
the walls of the capillaries and the blood flow onward,
belongs to the elective affinities of the organism, which
must be recognised as an ultimate fact, at which we may
wonder, but which we can never comprehend.
We have now arrived at the centre of the liver, to
which the blood has been conveyed by the ramifications
of the portal vein, to be exposed to the influence of the
cells and decomposed. Let us trace the course of the
vessels which carry out of the liver the two fluids sepa..
rated from the portal blood.  These vessels are the hepatic duct and the hepatic vein. The hepatic duct is a
tube of a firm fibrous structure, dividing into branches
which lie alongside the branches of the portal vein.  In
the fibrous walls of these tubes are a row of small apertures, which, on being traced, are found to lead into a
corresponding number of little pouches. It has hitherto
been generally believed, that these pouches were for secreting the mucus of the bile, but, as Dr. Beale acutely
remarks, a pouch with a very narrow neck would be a
bad contrivance for a viscid secretion, besides, in those
animals in whose livers these pouches are most numerous
there is no corresponding increased viscidity of bile.  It
is more likely that they are diverticula or little gallbladders. This view seems highly probable when we
consider the sudden and very copious secretion of bilc
which is observed to follow the taking of food. For ex



OF THE LIVER.


89


ample, Bidder and Schmidt (p. 166) observed, that while
a dog fasting yielded    1558 grammes of bile in an hour,
the same dog, after drinking 185 grammes of water,
yielded 5165 grammes of bile in the same time. The
manner in which the branches of the hepatic duct terminate has been much canvassed, and the opinion of many
most distinguished investigators was in favour of the
termination consisting in blind extremities; Dr. Beale,
however, maintains that these ducts which carry off
the bile are directly continuous with the tubes which
contain the cells where the bile is secreted, and that he
has succeeded in injecting the latter from the former.
He has given some plates in which this is shown.
Fig. b.
DUCT OF LOBULE OF THE LIVER.
This represents the distribution of the duct upon the surface of a very
small lobule of a pig's liver, a. Duct with little sacculi in its coats.
b. Small branches of the duct which are distributed upon the surface of the
capsule: these are represented at least twice as wide as they ought to be.
c. Inter-lobular branch of portal vein.




90


STRUCTURE AND USES


That the bile is formed in these cells and does flow along
these, biliary tubes, whether entering them by a free opening or by percolation through their walls, is a certain fact;
but it is not known by what force the bile is propelled.
Some have assumed it to be from the pressure of the full
stomach upon the liver, but this notion is refuted by
Bidder and Schmidt, who observed the contents of the
gall-bladder and the biliary tubes to begin to discharge
rapidly in a cat some hours after a meal; their opinion
is that it is by a contractile power of the tubes themselves,
although they have not been able either to detect muscular fibres in them, or to succeed in making them contract by galvanism. And they attribute much importance
to the descent of the diaphragm during respiration. The
lquestion, however, is by no means satisfactorily settled as
yet, and demands farther investigation. The office of
the  gall-bladder is obvious enough, being simply a
reservoir of bile which is emptied into the intestines at a
short interval after a meal.  The bile collects in it after
digestion ready for a recurring demand.  In connection
with the hepatic duct should be noticed a system of vessels
accurately described by Weber, of Leipsig, and named
by him vasa aberrantia. They are most numerous at
the transverse fissure of the liver, where they form an
intricate  net-work  communicating   with  the  larger
branclws of the biliary duct.  By means of this vascular
reticulation the ducts arc connected with one anotherthey are, in fact, the anastomosing apparatus, and have
been injected by Dr. Beale not only in the transverse
fissure, but high   up  in the portal canals.    They
are thickly set with ccecal pouches, which are probahll  not mucous glands, but, like those of the duct




OF TH  LIVER.


91


itself,  little  reservoirs    of
mimnature.


bile or gall-bladders in


Fig.    c.


Part of surface of an injected human liver, showing the manner in which
the vessels are distribuited.  The duct is not represented.  a. Artery, of
which only two small branches are represented.   6. Branuches of the portal
vein. c. Branches of the hepatie vein.  d. Part of the capillary net-work
of a lobule.




92


STRUCTURE AND USES


The distribution of the hepatic vein is the converse of
that of the portal.  The portal divides in its course into
diminishing branches and ends in capillary vessels. In
these capillaries the hepatic vein takes its origin, and the
smallest of its ramifications is larger than the extremities
of the portal vein: thus from the first its special office
of a collector, not a distributor, is indicated. Its position
is about the centre of the lobule; into it the blood from
the portal vein is poured through the capillary vessels
lying in immediate contiguity with the liver cells, so that
in its passage from the portal to the hepatic vein it has
a full opportunity of being subjected to their influence.
The branches of the hepatic vein unite and enlarge as
they proceed outwards to the circumference, and in some
animals, as the seal, which require to abstain long from
breathing, they form sinuses capable of containing a large
quantity of blood, so as to prevent the gorging of the
liver on one hand, and of the heart on the other. After
uniting into large branches they pour their contents into
the vena cava inferior, the largest vein in the body, which
enters the right auricle of the heart, whence it is immediately passed on to the right ventricle, and from thence
to the lungs to undergo further changes. What we may
call hepatic blood then is to be found only in the hepatic
veins, and in a diluted condition in the vena cava inferior.
Lymphatic vessels are met with in abundance in the
portal canals and transverse fissure, and materially contribute to the capacity of the liver for receiving a large
addition to its fluid contents without inconvenience.
Thus, for example, a pig's liver may be easily made to
contain a quantity of water equal to its own weight,
which may be injected from the portal vein.-(Beale.)




OF THE LIVER.


93


We have now described the mechanism         of the liver,
which may be rudely likened to a sponge placed between
the stomach and the lungs, receiving the blood from the
one organ and passing it on, after certain changes,
to  the other.    To enable it to    effect these changes,
however, a supply of nervous force is required, and this
it derives from two sources: one the cerebro-spinal,
and the other the sympathetic.      In the human subject
this double origin is not easily demonstrated, for the
cerebro-spinal nerve, the pneumogastric, is lost in      the
solar plexus on the right side, where it becomes blended
with the great sympathetic, and on the left it is distributed on the stomach. In the dog and rabbit, however,
the two pneumogastric nerves, after penetrating the
diaphragm, give off distinct twigs, which accompany the
hepatic artery, and become lost in the intimate structure
of the lobules.--(Bernard, p. 323.) We may fairly presume that they proceed as far as the capillary network
and the secreting cells.   It also receives. branches from
diaphragmatic, which are distributed chiefly upon the
walls of the hepatic vein. The explanation of the
functions of the liver, both in health and disease, hinges
so much upon the fact of the double supply of nerves,
that we give a woodcut from Bernard's work in which it
is shown (from p. 322).1
1 Fo? the whole of the facts and the woodcuts contained in this paper
we are indebted to the following interesting and important Works:
Ist. 'On Some Points of the Anatomy of the Liver of Man and Vertebrate Animals,' by Lionel S. Beale, M.B., Lond., 1856.
2d. c Legons de Physiologie experimentale appliqu6e a la M6decine, faites
an College de France,' par M. Claude Bernard, &c. &c., Paris, 1855.
3d. 'Die Verdauungssaefte und der Stoffwechsel. Eine physiologischchemische Untersuchung von Dr. F. Bidder und Dr. C. Schmidt, Professoren in Dorpat. Mitau und Leipzig, 1852.




91


STRLUCTURE AND USES


Fig. d.


-Representing the cerebro-spinal axis and splauchnic nerves of a rabbit
and showing the relation of the nerves of the lungs, liver, &c. a. Br-ain.




OF THE LIVER.


95


b. Cerebellum.  c c. Spinal cord.  d d. Trunk of the pneumogastric
nerves, e. Upper cervical ganglion. f. Common trunk of the two pneumogastric nerves, reunited below the lungs. g. Inferior cervical ganglion
h. Filament of connection between the superior and inferior cervical ganglia.
i. Cardiac filament of the pneumo-gastric. j. Cardiac filament going from
the first thoracic ganglion of the great sympathetic. m m. Filaments of
connection of the different ganglia of the great sympathetic with one another.
1. Thoracic ganglion. n. Filament of connection between the spinal cord
and the great sympathetic. o. Hepatic nerves going from the great sympathetic. p. Renal nerves going from the great sympathetic. q q. Ganglia
of the solar plexus.  r. Hepatic nerves going from the pneumogastric.
s. Renal nerves. t. Hepatic nerves united. u. Olfactory nerves. v. Optic
nerves. x. Nerves of the third pair. y. Nerves of the fifth pair. 1. Heart.
2. Aorta. 3. Vena cava. 4. Portal vein. 5. Inferior vena cava below
the renal veins.  6. Lungs.  7. Liver, 8. Gall bladder. 9 9. Suprarenal capsules. 10. Kidney. 11. Ureters.
Let us now inquire into the functions of the liver, or
what changes the blood undergoes in its passage through
its intricate net-work     of vessels on its way      from   the
stomach to the lungs. An obvious plan of commencing
this inquiry, is to subject the two kinds of blood which
we call the gastric and hepatic to a careful chemical
analysis, so that the difference between them may be
ascertained. This has been done by Professor Lehmann,
of Leipzig, whose paramount authority on questions of
organic chemistry is universally acknowledged in the
scientific world, and the result was communicated on the
12th of March, 1855, to the French Academy.              As the
matters this memoir embraces belong to science militant
as distinguished from science dogmatic, it may be well to
give a literal translation of the whole of Lehmann's short
and satisfactory paper.




96


STRUCTURE AND USES


" Comparative analysis of the blood of the vena portae
and of tMe bloodl of Mte hepatic veins, -c., to serve as a
history of the production of the sugar in the liver, by
M. C. G. LEHMAANN, Professor        of  Physiological
Cheemistry in the University of Leipzig.
"CC The results of the following analyses have been obtained from dogs and horses taken in different states of
alimentation, (care has always been taken to place ligatures round the vessels to prevent a mixture of the kinds
of blood under examination). I will not delay by describing the analytical processes, which will be found in
my treatise on organic chemistry; and I shall likewise
abstain from certain details of the composition of the
blood of the portal and hepatic vein contained in my
published memoir ('Einige vergleichende Analysen des
Blutes der Pfortader und der Lebervenen'). I shall only
hern insist upon the points which serve to exhibit the
formation of the sugar in the liver.
" 1st. Surar.-The blood of the vena portm never contains the slightest trace of sugar in dogs in a fasting condition, or those fed on animal food.   In the same animals fed on vegetables (such as boiled potatoes), sugar is
discernible in the portal blood, but in quantities so
minute as to be incapable of measurement. In horses
fed upon rye-bran, chopped straw and oats, the portal
blood contains slight traces of sugar. In one case I
found gr. 0"055 of sugar to 100 grains of blood. In
another case the serum of the portal blood of a horse
contained gr. 0"052 of sugar in 100 grammes of blood.
"cc The blood of the hepatic veins always contains sugar




OF THE LIVER., in considerable quantity. In three dogs fed upon animal food, I found the following prbportions of sugar to
dry blood: gr. 0-814 to 100, gr. 0-799 to 100, and
gr. 0-946 to 100.    In other three dogs which had for
two days been in a state of complete abstinence, I found
in the blood of the hepatic veins the following quantities
of sugar: gr. 0-764 to 100, gr. 0-638 to 100, and
gr. 0-814 to 100. In two other dogs fed upon cooked
potatoes, the   blood of the hepatic veins contained
gr. 0-981 of sugar to 100 of blood in one, and gr. 0-854
to 100 in another.     In two horses fed on vegetable
food (hay, straw, and oats), the hepatic veins contained
in one case gr. 0-635 of sugar to 100, and in the other
gr. 0-893 to 100.     The following table exhibits the
results of the preceding analyses.
QUANTITY OF SUGARB.
Animals.  Conditions as regards Food.  In the blood of the In the blood of the
vena portse on its en-  hepatic  veins  as
trance into the liver,  they leave theliver.
Grammes.     Grammes
Dog     Fasting for two days.    0"000     0"764 to 100
S 0638,
0-, 804,
Fed on animal food.,        00814,
)...1)                    0-799,,,                     0-946,
Fed on potatoes.  Atrace, too small 0981
to estimate,  0981......                     0"854,,
Horse Fed on hay, straw, and oats.  0-055 to 100  0-893
S,,,         0052 to 100   0'635,
" It is enough to cast the eye upon the comparative
quantity of sugar contained in the blood of the vena
portae and the hepatic vein, to see that the opinion of
7




98


STRUCTURE AND USES


the formation of sugar in the liver which M. Bernard
was the first to announce, is put beyond a doubt.
" 2d. Pibrine.  Albumen. -The blood of the vena
portse in horses and dogs contains fibrine which does not
sensibly differ either in kind or quantity from the fibrine
of other veins. The blood of the hepatic vein if carefully collected without admixture of other blood, contains no fibrine. The few flocculi which arc sometimes
obtained by beating up the hepatic blood of the horse,
are almost entirely composed of white globules, which
are very abundant in the blood of the hepatic veins as
compared to that of the portal vein. The blood of the
hepatic veins of the dog exhibits the same character as
regards fibrine, that is to say, this substance almost
entirely disappears in the liver.
"Very careful comparative analyses of the blood of
the portal and hepatic veins, have convinced me that a
remarkable quantity of albumen also disappears in the
liver, and that this quantity is relatively greater in dogs
than in horses: upon the incontestable fact of the disappearance of the fibrine in the liver, I have established
the opinion already expressed in my first memoir, that
the sugar formed in the liver is derived from     the
fibrine.
"3d. Fat and Blood globules. --The blood of the
vena portae always contains much more fat than that of
the hepatic veins. The serum of the portal blood in
dogs fed upon animal food, is generally much richer in
fat than that of horses; notwithstanding this, no more
fat is found in the serum of the hepatic blood of dogs
than of horses.    In horses the blood-globules of the




OF THE LIVER.


99


portal vein are much richer in water, and especially in
iron, and on the other hand much poorer in globuline,
extractive matters, and salts, than those of the hepatic
veins.  In dogs as well as horses the blood of the
hepatic veins is much richer in blood-globules and extractive matter, than that of the portal vein. I have observed in dogs as well as horses, that a considerable
quantity of iron always disappeared from the blood in
its passage through the liver. But the difference in the
quantity of iron found in the blood at its entrance into,
compared with the quantity at its exit from the liver, is
greater in dogs than in horses. It results from this that
a portion of the hematine of the blood disappears in the
liver, and probably goes to the formation of the colouring matter of the bile, which would prove again the
complete analogy between bilifulvine and hematoidine,
as one of my pupils is about to demonstrate.
" Comparative analysis of the blood of diferent veins
with arterial blood (all the comparisons have been made
from blood taken from the same horse.)     The blood
which leaves the liver by the hepatic veins, always contains incomparably the most sugar of any in the body.
This blood mixes with that of the vena cava inferior to
mount to the heart. I can here but confirm the statement long ago made by M. Cl. Bernard, that the blood
of the vena cava inferior is that which always contains
the greatest amount of sugar after the hepatic veins.  I
found in the solid residue of the blood of the vena cava
of a horse, sugar to the amount gr. 0-346 to 100,
gr. 0-211 to 100, and gr. 0-492 to 100 of blood. After
the blood has passed through the lungs and become
arterial, no sugar is to be detected as a general rule.  I




100


STRUCTURE AND USES


have never found any in the arterial blood of horses, although they had been fed upon starch and oatmeal. In
that of dogs and rabbits, sugar could be detected in
arterial blood, if the venous blood contained more than
0-3 per cent. of it.  This is the case in all the conditions in which sugar is passed with the urine; for
example, in those instances after Dr. Bernard's operation, after the injection of large quantities of sugar into
the veins or into the stomach, or finally in the instances
of rabbits which had eaten largely of carrots and beet
root. But in all these instances it is always the hepatic
vein which contains most, then the vena cava, &c.
"The blood of the small veins, such as the cephalic,
digital, temporal, and external abdominal of the horse,
contains always a smaller quantity of blood-globules and
more serum, and therefore more water than arterial
blood. But the blood of the larger veins, especially the
vena cava inferior, contains blood of the same or even
greater concentration than the arterial. All my experiments go to prove that a remarkable quantity of bloodglobules disappears in the general capillaries of the body.
The equal or superior density of the blood of the vena
cava inferior as compared with the arterial blood, is not
due altogether to the expulsion of water by the urinary
secretion, but is chiefly owing to the influx of the blood
from the hepatic vein. This was shown in a striking way
by the analysis of the blood of a horse which had not drunk
for twenty-four hours before it was killed. The comparison of all these analyses goes to prove that two functions proceed simultaneously in the liver,-the formation
of sugar, of blood-globules, and of bile, as M. Bernard
has long ago established. The blood of the smaller veins




OF THE LIVER.


101


contains more fibrine than the arterial blood, and than
that of the vena cava and the jugular vein. In the vena
cava I found only one half the quantity of fibrine that I
found in arterial blood.. The arterial blood always contains more mineral salts than the venous blood."
This Leipzig manifesto embraces and exhausts all the
chemical elements of the question. It demonstrates the
fact that the blood comes to the liver rich in fibrine,
albumen, and fat, wholly devoid of sugar, and comparatively poor in blood-globules; that the blood which
leaves the liver always contains a quantity of sugar, and
is rich in blood-globules but not in fat, while the bile is
full of fat; hence the inevitable inference that in the
liver-cells the blood coming from the seat of digestion is
decomposed, the fibrine certainly, and probably also
some of the albumen transmuted into sugar, and passed
onwards by the hepatic vein towards the hmungs, and the
fat and some other ingredients separated and expelled in
the form of bile. This transmutation of fibrine into
sugar is utterly opposed to the theories of Liebig, which
have met with so general an acceptance hitherto, that no
such power existed in the animal economy, but that all
the.chemical principles of the nature of sugar were only
absorbed, and never generated by the purely vital forces.
It would be out of place to follow up to its possible
consequences this important revolutionary doctrine promulgated by Bernard, and established by Lehmann and
other chemists. We have enough at present on hand in
stating merely the bare facts, and before passing to the
consideration of the conditions which regulate the manufacture of sugar, and the uses this sugar subserves in




1019.


STRUCTURE AND USES


the economy, it will be well to say a few words about its
chemical character.
There are many kinds of sugar met with in both the
vegetable and animal kingdoms, but for practical purposes they may all be divided into two classes, according
to the action of acids and alkalis upon them. The firstclass sugar, or cane sugar, is found in the sugar cane,
beetroot, the maple, and many other vegetables. Its
chemical equivalent is 012 H9 09 + 2HO. When brought
into contact with the lining membranes of a calf's stomach,
or with caseine, it is transformed into lactic acid. When
boiled with diluted sulphuric acid this cane sugar is converted into sugar of the second class, known as grape
sugar or glucose.  This is the sugar found in the liver
and hepatic veins. It differs from cane sugar in being
readily acted on by alkalis, while cane sugar is not, and
not being affected at all by weak acids, which decompose
cane sugar rapidly. Alkalis convert it into a brown matter, and strong sulphuric acid dissolves without charring
it, and forms sulphosaccharic acid. "Notwithstanding
the fact," says Professor Gregory,c "that cane sugar is
easily converted into grape sugar, and that the formulm
differ only by three equivalents of water, it is evident
that these two kinds of sugar differ more than if they
wvre merely different hydrates of the same compound.
Strong mineral acids instantly decompose cane sugar,
but have little action on grape sugar; while alkalis which
combine with cane sugar to form crystalline, compounds,
rapidly convert grape sugar into dark compounds, glucic,
and melassic acids. And though both sugars agree in


1 c Outlines of Chemistry,' p. 389.




OF THE LIVER.


103


undergoing the same (vinous) fermentation, yet it is most
probable that cane sugar before fermenting becomes grape
sugar." The most certain test by which the presence of
sugar can be established, is its fermentation; when
mixed with yeast or diastase, it is transformed into alcohol, which may be obtained pure by the distillation of
the residue, and carbonic acid which may be collected
and tested as it escapes. In all instances where Cl.
Bernard affirms the existence of sugar anywhere, he had
ascertained it by this infallible experiment, which he performed by a simple apparatus consisting of a tube into
which the substance to be tested was put in contact with
yeast, while a smaller tube was passed down to the
bottom  of the first, and curved over it at the other
extremity, where it passed through a firmly fitted cork.
Thus when    fermentation took place, the liquid   was
forced up through the small tube, and its alcoholic character determined, and the gas remaining behind was
also  examined.   As some of the objections to M.
Bernard's experiments take a chemical direction, and
deny the sufficiency of his analyses, it is right at the
outset to put this to rest by stating that the sugar he
asserts to exist was not known only by its action on
copper, &c., but by its property of fermenting.
M. Bernard examined the livers of mammalia, birds,
reptiles, osseous and cartilaginous fishes, and molluscous
animals, and in all he found sugar.    The quantity is
seldom  greater in health than 4 parts of sugar to 100
of fresh liver, and the average is between 1 and 2 per
cent. The opportunities of investigating this subject in
man are very rare, for it is only found in the bodies of
those who die in a state of health, and soon after death.




104


STRUCTURE AND USES


These conditions are seldom to be met with in ordinary
circumstances except in criminals who have been executed. All the experiments that have been made are
here represented.
Date of observation.  Age. Alimentation. Weiht of  Quantity of  Total  antity
the lver.  sugar per cent.  in liver.
Kilog.  Grammes.  Grammes.
1. 22d May, 1850  43  Fasting  1-300   1-79      23-27
2. 1st Feb. 1851  45,,     1330  ascertained not calculated
3.,,   1851,,           1-175 not weighed not weighed
4.,,   1851   22  Mixed.   1-200   2-162     25-704
5.,,   1851,,           1-175  ascertained
In a sixth instance, that of a man killed by a musket
shot, although in consequence of the examination not
being made till two days after death, the liver was in a
state of incipient putrefaction, yet it contained gr. 1-10
to 100 parts, and the total calculated to exist in the
whole liver, was 171.0 grammes.     If these results stood
alone it might give rise to the suspicion that the presence
of sugar in the liver of a person dying by violence was
an attendant upon the mode of death, and did not represent the natural contents of that organ. But when we
take into consideration that in all the animal kingdom
the liver is found to contain sugar, and that it disappears
very readily under the influence of very many morbid
conditions, the natural and fair inference is, that man
is not an exception to the general rule, but that what is
exceptional, is having an opportunity of examining the
body of a healthy person recently killed; and as when
this exception is met with, it corresponds with what our
previous knowledge of the liver of animals led us to




OF THE LIVER.


105


expect, the exception in this case certainly confirms the
rule.
That the character of food has not much influence
upon the quantity of sugar contained in the liver, is
shown by the following table:
Per centage of
sugar in liver.
1st Dog fed on animal food...     1-90
2d,,...     1-40
1st Dog fed on animal food and bread.     1-70
2d,,,,...     1-30
3d,,,,...     130
1st Dog fed exclusively on faecula and sugar    1-88
2d,,   for 6 days exclusively on sugar     1-50
In all these examples the dogs were killed at the same
period of their digestion, and the experiments show that
the nature of the food made only a fractional if any difference in the quantity of sugar.   That a sugar diet had
hardly increased the sugar in the liver, and that a purely
animal diet did not diminish it.   In carnivorous animals
there is a great difference in the quantity of sugar which
passes into the blood at different times.    When digestion is not going on, the quantity delivered by the hepatic
veins is about 1 per cent., which when this blood is further diluted in the right auricle is much diminished in
proportion, and entirely disappears after the blood passes
through the lungs; but after a full meal the liver is
filled like a sponge, and its activity greatly increased,
so that there is a great augmentation in the quantity of
sugar it delivers, not all secreted at the time, perhaps,
and when a certain excess arrives at the lungs, it is not




106


STRUCTURE AND USES


all destroyed there, but some passes into the arterial
capillaries, and is found in the excretions.
If the early appearance of a function in the foetus, and
its universal distribution over the whole animal kingdom
be a proof of its importance, then unquestionably the
sugar function in the liver must rank very high among
the vital actions, and such being the case, it is surprising
to find that it is so easily arrested.  It seems that all
morbid states attended with fever, immediately put a
stop to the formation of sugar. This is the explanation
of the disappearance of sugar in diabetic patients when
they are attacked by some acute disease, a change in
their condition liable to be mistaken for an improvement,
although it is generally the reverse.  It is probably to
this arrest of the sugar formation in the system by fever,
that the rapid loss of strength is due in that process, for,
as we shall afterwards see, the sugar seems to be one of
the primary requirements for the renovation of the body;
and we all know how wonderfully rapid is the decline of
strength in fever, so much beyond what any mere loss by
perspiration or otherwise could account for. It is not
that the body wastes; properly speaking, it is that it
is not made.
Besides acute disease, many external unnatural conditions have the same effect. If an animal be exposed to
intense cold, either by immersing it in a freezing mixture, or by coating its surface with varnish, so as to destroy the non-conducting efficacy of its fur, in the course
of a few hours there is a total disappearance of sugar
from its liver.  Heat at first augments the quantity of
sugar produced; but if intense and long continued,
it exerts the same influence upon it as cold. As a general




OF THE LIVER.


107


rule, abstinence from food lessens the quantity of sugar
pari passm with the diminution of the whole mass of
blood; but the sugar entirely disappears a considerable
time before the death of the famished animal. However, there is a remarkable exception to this rule in the
case of hybernating animals. In a marmot the quantity
of sugar was found to be in its usual abundance after
thirty-nine days' total abstinence.  In the stomach of
this marmot a neutral brown fluid was formed, and from
this Bernard supposes the blood derived the materials
for having sugar made at the liver. In other animals
long before death by starvation the stomach is perfectly
empty.
It is rather singular that while the liver should be so
delicately affected by general causes which affect the
whole system, such as fever, as to have its glycogenic
function rapidly arrested, yet that the formation of sugar
should go on with unimpaired vigour when the whole
substance of that organ presented the characters of the
well-known foie gras.' Even the existence of cysts,
hydatids, and cancer in the liver, does not prevent the
formation of sugar in those parts which are not the imamediate seat of the disease. Endowed apparently with
remarkable general sympathies in respect to other organs,
especially the lungs and spinal cord, it seems to have
little internal relationship with itself. This may be accounted for by its anatomical structure; and it may,
perhaps, be looked upon rather as a congeries of little
formations depending on central influences, like a group
of island dependencies upon an empire, than as one large
1Lereboullet sur le Foie Gras. 'MCui. de 1'Acad. de Med.,' Paris,
t. xvii, 1). 4.77.




108


STRUCTURE AND USES


independent organ. Be the explanation what it may,
the facts that a liver greatly diseased may yet continue
to produce sugar, and that this important operation is
instantly suspended whenever fever invades the frame,
are of paramount practical interest.
We have already given a tabular view of the comparative effect of different kinds of diet upon the formation of sugar. This, however, was rather to establish
the fact, that the sugar which was found was not contained in the aliment.  The influence of various articles
of food upon the glycogenic function of the liver has
been more fully examined, and yielded interesting results. In the first place, Bernard found that fat is incapable of conversion into sugar. Dogs fed on fat soon
lost all their sugar; so that, in a certain superficial way,
the dietary of Rollo for diabetic patients is justified by
these experiments. No doubt feeding a person on fat
will prevent the formation of sugar at the liver, and consequently cause its disappearance in the urine; but as
diabetic urine is merely a symptom  of some profound
lesion of the nervous system, probably the so-called cure
is nearly as deceptive as is the disappearance of the
sugar in a diabetic patient attacked with acute disease.
In neither case does the absence of the symptom indicate the non-existence of the thing signified. The fog
that prevents the danger-signal from being seen does not
contribute to the safety of the line, nor does the suppression of indications of danger by allopathic expedients secure the safety of the patient.
In the second place, he found that pure gelatine and albumen, so far from reducing the quantity of sugar below its
average amount, had rather the opposite effect. This, how



OF THE LIVER.


109


ever, although at first it excited his surprise, is what we
should now expect to have been the result. But the experiments with the remaining one of the three primitive elements of diet, the sugar and starch group, gave most
unexpected results. He found that, although at first
dogs did not like an exclusively starch and sugar diet,
yet after a few days they got used to it, and it seemed to
nourish them; and on examining the liver, there was no
excess of sugar found there, but almost exactly the
same quantity as when the dogs had been fed exclusively on albumen.   One of the dogs was fed for three
days with potatoes and starch, and killed three hours
after the last meal. In the liver the proportion of sugar
was 1 88 to 100 parts; but the liquid obtained from the
liver, instead of being clear, as is usually the case, was
of an emulsive and opalescent appearance.   The sugar
had been absorbed from the stomach and intestines, and
had been carried by the vena portaw to the liver, but it
had not there been converted into the true diabetic or
grape sugar, and continued to mix with the blood in a
sort of transition state between cane and grape sugar;
no more than the average quantity of hepatic sugar
being formed out of this exclusively sugar diet. This
demonstrates the futility of the attempts made to cure
diabetes by withholding feculent food. Whether animals
live on starch or albumen makes little difference in the
amount of sugar delivered by the hepatic veins into the
vena cava, but other conditions have an immense influence, and chiefly the nervous system.
The action of the nervous influence upon the liver has
been demonstrated by Dr. Bernard, by a series of experiments not less distinguished for ingenuity of design than




o1.0


STRUCTURE AND USES


for anatomical expertness in their execution. The liver,
as we have seen, is chiefly supplied by the pneumogastric
nerves.   These nerves have their origin in the medulla
oblongata, behind the olivary and very near the restiform
bodies, by one or two rows of filaments from five to six
lines in length, and disposed in regular order. After
leaving the skull they accompany the internal jugular
vein; on entering the thorax there is a difference in the
distribution of the right and left pneumogastric nerve.
However, they are both lost in a plexus of nerves situated
upon the stomach. From this plexus the liver derives
its nerves. Before descending to the organs of the abdomen, however, it gives off large branches, which supply
the lungs.   In the rabbit this nerve gives off a distinct
branch after supplying the lungs, which goes to the
liver; so that    in that   animal there    is a double
nervous distribution, the one direct from the main
trunk of the vagus, the other from the plexus of the
stomach.
When the pneumogastric nerves are cut in the neck,
and the animal is killed on the day after the operation, no   sugar is found    in the liver.   The first
explanation of this effect that offers itself is naturally
that the nerves so divided were the channels by which
a vital 'force was conveyed, which the liver required
to enable it to convert the fibrine of the blood into
sugar.   In that case substituting a current of galvanism   might have the same effect.      This was accordingly done, and     Bernard found    that when the
galvanic stream was directed downwards to the liver
it had no influence, but if sent upwards towards the
origin of these nerves it restored in an exaggerated




OF THE LIVER.


111


degree the glycogenic action of the liver. The following explanation of this was pro'posed. The pneumogastric nerve is a mixed or compound nerve; on the one
hand it transmits an influence from the centre to the
circumference, giving rise to muscular contraction in the
oesophagus and to secretions in the stomach; while on
the other hand it carries inwards impressions received in
outlying organs, and transmits them first to the centre,
and where they may be perceived and give rise to
sensation, or from whence they may be at once forwarded,
without being read off like a telegraph message, to some
other outlying organ. The two organs in this instancewhich
are thus united are the lungs and the liver. Before the
liver will act it must receive a message from the lungs;
but if the pneumogastric nerves are divided in the neck
then the lungs are cut off from the centre, their call for
aid is not taken up to the brain, and therefore cannot be
sent down to the liver.  In order to test the correctness
of this explanation, Bernard performed a crucial experiment.    He divided the branch of the pneumogastric in
the rabbit, which comes off from the main trunk at a
point below the origin of the pulmonary branches.
The place will be seen at once in the diagram (p. 94); it
is marked r. By doing this he left intact the circle from
the lungs to the liver by way of the spinal cord, but he
cut off the direct influence of the brain from the liver.
The result was that the formation of sugar went on at
the liver. Thus it is an ascertained fact that the stimulus
given to the liver by which this special function is called
into play begins at the lungs.
Before this experiment, Dr. Bernard had instituted a
series of most interesting ones upon the effect of irri



112


STRUCTURE AND USES


tating by a sharp-pointed instrument the portion of the
spinal cord whence the pneumogastric nerves arise. The
exact spot where the wound was made is limited by a line
drawn transversely above from one of the tubercles of
Wenzel to the other, and below from the two sets of the
pneumogastric nerves.   After the operation "the rabbit
looks a little astonished at first," (semble etre un pen
etonne sur le moment), but it soon recovers its senses,
and it does not seem to be the worse. The effect of this
irritation or wound of this portion of the spinal cord is,
that in the course of an hour or so the urine is diabetic.
We are now prepared for this effect; but when it was
first announced it had a most startling effect. The
explanation of the effects of the operation is simply that
an extraordinary excitement was produced at the centre,
simulating the ordinary stimulus which goes from the
lungs to the liver through this centre, and that in
consequence the liver discharged a greater quantity of
sugar into the hepatic veins and vena cavae than the
lungs could use up, and the excess was passed on by
the arteries of the body; from one of these arteries (the
renal) the kidney separated it, along with the water in
which it was held in solution, and hence the diabetic
urine. That such is the true explanation of the phenomenon of artificial diabetes is certain; and it is highly
probable that when this disease is' met with it depends
upon some diseased state of that part of the brain from
which the pneumogastric nerves take their origin, and it
is therefore not likely to be cured by feeding patients on
bread made of gluten, or by means which tend to affect
the symptom, not the cause.




OF THl LIVER.1


113


Fig. -5.,P
CC
IrI
R
C -......T
THIS MIAGRAM ILLUSTR&TES THE WHOLE PROCESS OF DIABETES.
The source of the saccharine matter is the liver (F.) where it is produced, and in the substance of which it is always to be found. The liver receives the materials to make sugar from the blood which is brought by the


8




114                   STRUCTURE AND       USES
vena port.a (V. P.), and which contains no sugar in carnivorous animals.
This blood consists in part of the blood of the mesenteric arteries, which
passes by the capillaries into the branches of the vena porte at b, and somep
of this blood is made up of the materials absorbed directly at a from the intestine at I. The unsugared blood of the vena portic (V. P.) enters into the
liver, diffuses itself there, is subjected to metamorphoses in contact with
the elements of the gland, becomes full of sugar, and then passes into the
hepatic vein (I-I. S.). We have thus the blood entering the liver at V. P.
(the portal vein) without containing a particle of sugar, and full of it at
H. S., where it leaves the liver. The sugar then must have been generated
at the liver. The sugared blood of the hepatic vein (H. S.) then arrives at
the vena cava inferior (V. C.I.) near the heart, mingles with the nonsugared blood of the vena cava, and enters with it into the heart (C.), where
it again mixes with the blood of the vena cava superior (V. C. S.); so that
the quantity of sugar is diluted from being in the proportion of 0'980 to
100 at H. S. to 0-300 to 100 at the heart (C.). The sugared blood of the
right ventricle (C.) is driven through the lungs by the pulmonary artery
(A. P.), it arrives at the capillaries of the lungs (P.), where the sugar is
almost entirely destroyed, the blood returns to the left side of the heart
by the pulmonary vein. Thence the blood, having thus lost all its sugar,
passes by the arterial or aortic system (A. A.) on to the general capillaries
of the body (C. C.). There the blood undergoes further changes, and becomes converted into venous blood, to return by the vena cava superior and
inferior (V. C. S., V. C. I.). The blood of the mesenteric artery (m) expands in capillaries upon the intestines, and absorbs from the intestine the
matters there dissolved at I, and then goes on to the liver. The blood of
the renal artery (R.) arrives at the kidney (R.), and yields the products
which form urine, but has no sugar to give in its normal condition. This
only happens when the quantity of sugar contained in the right side of the
heart is more than 0-300 to 100, for this is all that the lungs can destroy.
When more than this the excess passes into the arterial circulation, and the
renal arteries carrying sugared blood deliver the same to the kidneys. The
xidneys then become eliminators of sugar, and the individual diabetic.
It is now    an  established fact that there is a constant
formation of sugar at the liver, and an equivalent destruction of that sugar at the lungs, in health, and that this
subterranean     operation    is only manifest either when the
liver yields too much or the lungs consume too little.
The questions that remain to be considered are, what




OF THE LIVER.


115


becomes of the sugar, and what purpose does it serve in
the economy.   The first supposition was, that, as sugar
was a very combustible material, it was united with
oxygen at the lungs, and was emitted thence in the form
of carbonic acid, and some experiments seemed to corroborate this hypothesis. It was found that animals became   diabetic on  the administration of ether and
chloroform, which was ascribed to the inability of the
air loaded with these vapours to consume the sugar,
which accordingly passed into the general circulation.
However, Bernard demonstrated the fallacy of this
theory, which at first he felt inclined to adopt, by exposing blood which contained sugar to the action of
various gases. He divided a quantity of blood taken
from the jugular vein of a dog in a state of digestion,
and  consequently sugared, into three equal portions;
one he mixed with oxygen, one with nitrogen, and one
with carbonic acid gas. The sugar disappeared in the
portion mixed with nitrogen, but was unaffected by the
oxygen and carbonic acid. We cannot detail his other
experiments, but they were quite enough to satisfy him
that the disappearance of the sugar was not owing to a
conversion into carbonic acid at the lungs. Neither was
it owing to the action of the alkalis of the blood.
It is true that the blood always is alkaline, and that an
acid, or even neutral, condition of the blood is incompatible with life; but it was chemically demonstrated
by Lehmann that the amount of alkali in the blood was
not enough to destroy the sugar.     The explanation
proposed and accepted by M. Bernard is, that the
disappearance of the sugar at the lungs is owing to
its transformation into lactic acid by a species of fer



110)


STRUCTUIRE AND USES


mentation.   The chemical constitution of the two is
isomeric.  Sugar being represented by C1,,H.i,O,, and
lactic acid by C1,Hi0,00,,,+HO, or an atom of water;
and  this precise transformation may be imitated in
the laboratory by mixing sugar and yeast, prepared in
a particular way, when instead of converting the sugar
into alcohol and carbonic acid, it changes it into tartaric
acid and water.
Up to this point we have advanced step by step upon
a series of facts, or what we must accept as facts until
they have been disproved by counter-experiments and
observations; but we now enter the region of conjecture,
and although we may admit that M. Bernard's suggestion of the purpose the sugar he unquestionably
discovered to be formed at the liver serves in the animal
economy is extremely ingenious, perhaps perfectly true,
yet it would be unjust to him as well as to science to
place it on the same level as his great discoveries.  The
explanation he offers is this. If we take yeast and pass
it through a filter, the filtered liquid will contain albuminous matter;- now    if we divide this fluid into
two parts, and to    one add sugar, and to the other
nothing, in the course of a certain time the sweetened
liquid gets turbid, and minute egg-shaped bodies appear
in  it, which  gradually enlarge and give off similar
bodies like themselves, until at length a sort of chaplet
is formed, more or less simple, or branched, as may
be.  No such change takes place in the other portion.
We have here the most primitive development of the
vegetable kingdom   in the form of this fungus, which
appears when sugar and dissolved yeast granules are
left in contact at a sufficient temperature. If instead of




OF THE LIVER.


117


yeast we take a little serum of the blood, and divide
it into two portions, exposing both to a sufficient temperature, but to one only adding sugar, we shall find that,
in the course of four or five days, the unsugared portion
has putrefied, but the sugared has had formed in it a
quantity of cellules, not like the little cells that appeared in the yeast, but having a. close resemblance
to the white blood-globules.     Here then is a sort of
animal germination in the presence of sugar. If we
follow up this hint, we find that throughout the vegetable kingdom the phenomenon of germination is invariably attended by sugar; and if we examine the
animals in the foetal state, we find that in all the muscular tissues and in the lungs there is a large quantity
of lactic acid when soaked in water; but when treated
with alcohol, instead of lactic acid we meet with glucose.
The object that the sugar always present is supposed to
serve is to present to the tissues during their formation the materials of their growth in a sort of nascent
condition.  Sugar, as we know, is a very unstable compound; it is very readily decomposed; it is in a state
of constant fermentation, as the word is popularly used;
and if a substance is brought in contact with it, deand recomposition are quickened. Thus it promotes life
by a sort of catalytic action, imparting to what it
approaches the molecular restlessness of its own nature.
In this way it is supposed to promote the formation of
blood-globules in the liver, and serves as the nursery of
the body.
While the genius of Bernard has thus disclosed the
wonderful action of the liver in forming sugar, the labours
of Professors Bidder and Schmidt have been directed to




118


STRUCTURE AND USES


ascertain the history of the complementary function of
that organ in the elaboration of bile. The sugar and the
bile have this in common, that while the whole of the
former is disposed of in the vital processes without appearing at the surface, except in morbid conditions of
the system, the latter too is partially used up in the
same way, while the remainder is cast out as refuse. In
order to determine the exact quantity of bile secreted,
and what became of it after it was poured into its proper
channels, it was necessary first to institute a series of experiments to collect the bile as it was made in the liver,
and this was done by introducing a tube into the bile.
duct of various animals, measuring and analysing it, and
comparing the conditions of the animals when deprived of
their bile with their natural state. Bidder and Schmidt
fomud that when the tube which gave them the command
of the bile was successfully introduced, it did not materially affect the health of the subject of the experiment;
and although the experiments in some respects have been
considered fallacious, yet enough of undisputed conclusions remain to make the results highly valuable.
The bile is a clear fluid, varying in colour from golden
yellow to grass-green. These variations depend upon the
nature of the food and the action of the substances it is
in contact with. The yellow bile is the result of animal
and the green of vegetable food, but the clearest yellow
becomes green very soon when exposed to the action of
the atmosphere, and when retained for many hours in the
gall-bladder, but the bile of the gall-bladder taken two
and a half to three hours after a meal is as yellow as that
taken directly from the liver. We may thus ascertain
whether ejected bile has been long or recently secreted




OF THE LIVER.


119


by the colour it presents, if we know what the person
has been eating.    When first secreted the bile is always
neutral, and it derives any alkaline character it may
afterwards acquire from the mixture of mucus from the
gall-bladder.
As to the quantity of bile secreted in a given time, for
example, in twenty-four hours, this is only approximately
ascertained by comparing the amount of different periods
after food is taken. The following table shows the fluctuation it underwent in a cat.
One kilogramme of cat afforded in one hour:
Hours after the last meal 21-3 12-16  24  48  72   168   240
Of fresh bile (grammes)  0-600 0-807 0-410 0-291 0-179 0-153 0-094
Of dry residue... 0-033 0-045 0-025 0-020 0-018 0-011 0-007
From   this table, which is only one of many that give
the same result, it will be seen that immediately upon
taking food there is an increase in the flow of bile, be--
fore digestion can have taken place to such a degree as
to have at all enriched the blood with chyle, and, consequently, simply from the greater quantity of blood which
the stimulus of food retains in the organs where it is first
received; that this increase gradually augments and
reaches its maximum from twelve to fifteen hours after a
full meal, by which time, probably, all the products of
the digestion have been received into the blood. At this
point a diminution begins in the amount of bile secreted,
so that in twenty-four hours after the meal the quantity
is far less than two hours after.      From these data we
may strike an average of the daily secretion of bile in
the cat with tolerable exactness; and this gives 0-608
grammes of fluid bile, and 0-034 grammes of dry to a




120


STRUCTURE AND USES


kilogramme of cat. A dog yields one fiftieth of its weight
in the day, and a rabbit no less than one eighth of its
weight. It is most probable that a man yields about the
same proportion as a dog: this would give about 60
ounces to a man of ten stone. We may observe in
passing that there is a partial but not complete coincidence in the increase of sugar and bile delivered by the
liver.  The sugar at once attains its highest amount
after a meal is taken, but although even then the quantity of bile secreted is much above its average, yet it does
not attain its maximum   till long after the sugar has
begun to diminish. Let us now consider what becomes
of all this bile that is poured into the intestines. Does
it pass off by the alvine channel or by the kidneys? An
analysis of the solid constituents of bile disproves the
latter supposition: they are not found in the urine. But
they are in the feces, but not nearly the whole quantity.
In order to ascertain this, the quantity of solid matter
yielded daily by a dog fed on animal food was accurately determined, and then the faeces were subjected
to a careful analysis. The result is shown in the following table:
Water.... 56-4 grammes.
Solid residue....40-9
Of these neutral fat soluble in
ether.. 2-82
S Fat with traces of bile  4-97,,   Bile products soluble
in alcohol.. 380
In this organic matter.. 3-42 with 0-70 sulph.,,  inorganic,,.. 038 grammes.




OF THE LIVER.


121


Extracted by muriatic acid and boiling alcohol:
Not derived from the bile.  9'60 grm. with 0'084 sulph.
Fat, oils, acids, and ox. of
iron.. 6-35
Hair, sand, &c.. 13-36
40-90
From this it is proved with absolute certainty that the
larger part of the bile discharged into the intestines is
there absorbed into the blood, for only a small portion
of the 40 grammes of solid residue of the faeces was
derived from the bile, while the quantity of solid matter
delivered in the same period was nearly equal to the
whole of the faecal residue, being 39 grammes, while
the other is only 40. The fact is brought out by attending to the Sulphur. In the 39 grammes of solid
bile discharged by the liver in the five days into the
intestines,- there must have been 2"37 grammes of Sulphur: now the whole quantity of Sulphur contained in
the faeces was only 0"384 grammes, and more than half
of this was derived from the hair, &c., so that almost
all the Sulphur which is contained in the bile is absorbed by the blood again, and about seven eighths
of the whole of the solid contents of the bile. As
the bile then does not obtain an exit by the alvine
or urinary channel, there remain but the lungs to be
examined. Bile consists chiefly of a feeble acid called
bilic, or cholaic combined with soda.    The composition of this acid is thus atomically represented:
C44, H26, NOi3, = C41, H25, N012, 110. (Gregory).  We




122


STRUCTURE- AND USES


see from this what a large proportion of carbon there is
in bile, and we know that carbon is being constantly
emitted from the lungs in the form of carbonic acid;
hence the conclusion is irresistible, that the expired air
must carry off a portion of the secreted bile.  Some
chemists have gone so far as to declare that all the
carbon discharged from the system passes through the
liver, but this undoubtedly is not the case; for a dog fed
on animal food yields at the rate of 8-6 grammes of
carbon for every kilogramme of its weight in the air it
expires, while during the same period the liver does not
discharge above 1 gramme of bile into the intestines,
and out of this not above 0"5 grammes of carbon are
absorbed by the blood. So that about six per cent.
only of the carbon which is given off by the lungs as
carbonic acid comes from the liver.
Let us now consider the uses of the bile in the animal
economy; a subject only imperfectly known as yet, notwithstanding all the labour and skill which have been
brought to bear upon it. From the following description of the effects of depriving a dog of its bile we may
gather much information; it is given by Bidder and
Schmidt, and is a fair specimen of what was generally
met with by them in the whole series of their experiments. After an opening had been made in the side
of the dog, and a tube inserted intothe hepatic duct,
which received every drop of bile furnished by the liver,
and carried it outside, where it was of course of no use
to the dog; for the first two days the animal refused its
food and seemed much indisposed; but from the third
day it ate greedily of flesh to the amount of 160 and
even 403 grammes a day. The weight of the dog at




OF THE LIVER.


123


the beginning of the experiment was 6 kilogrammmes, and
at the end of a month it weighed only 3"10 kilogrammes.
In thirty-four days it had lost two fifths of its weight,
notwithstanding the large quantity of flesh it had consumed. The emaciation proceeded gradually from the
first, and consisted chiefly in the disappearance of all
the fat, so that the muscles of the body looked like
long ribbons seen under the skin, which hung in loose
folds over the skeleton. The muscles too wasted away,
and there was great feebleness of movement from the
first. The hair came out in handfuls and left bare
patches. Durii'ig the whole of this miserable spectacle
the digestion seemed to go on with perfect regularity.
The alvine evacuations were infrequent, at first slimy and
white with gray and green portions, but latterly of the
normal colour and consistence; but during the whole
1)eriod they had a strong assafretida smell, owing to the
putrefaction of the food in the intestines. Although the
breath Was also most fetid and disagreeable during the
whole of the experiment, there seemed to be no tendency
to dissolution of the fluids, as there was neither ecchymosis nor haemorrhage. The urine was small in quantity,
but of high specific gravity. Notwithstanding the extreme emaciation, the dog retained its animation to the
last, and although it could hardly stand, it rose when we
(i.e. Bidder and Schmidt) entered the laboratory of a
mornitug and followed us to the balance. There was no
disturbance either of the respiration or of the heart's
action, but a most marked decrease of animal heat: a
thermometer inserted into the rectum indicated 34-6 C.
degrees, and fell even so low as 29 C. The death of the
animal was without a struggle. On dissection, the body




124


STRUCTURE AND USES


disclosed no abnormal appearance of importance, except
the almost absolute absence of fat and thinness of the
muscles. The naked eye could not detect an atom of
fat in the cellular tissue under the skin, and it had entirely disappeared from  the kidneys. It would seem
from this that this dog, although largely fed with its appropriate food, was simply starved to death, because,
although it could digest, it could not assimilate its meat
when deprived of its bile. Besides being starved, it was
made cold by cutting off some of the charcoal which
should have been burned at the lungs. Let us now
end.eavour to ascertain how it was starved by its bile
being cut off, in other words, to the assimilation of what
portion of the aliment bile is essential. Taking the
usual division of food into the albuminous, the feculent,
and the oily, Bidder and Schmidt made the following experiment to determine the action of the bile on each
species. They gave a dog, which they had absolutely
deprived of bile, 3-035 kilogrammes of liver and lungs,
from  the 29th of March to the 2d of April.     This
quantity of flesh contained 806"8 grammes of solids, of
which 693"2 grammes were albuminous and salts, 113 6
grammes were fat. The alvine evacuations of this dog
during that period yielded 124 grammes of solids, of
which 72"2 grammes were fat, and only 51-8 grammes
were albuminous matter and salts. The difference between 693.2 and 51"8 represents the quantity of albumen
digested by the dog in these five days without the aid of
bile. From this and similar experiments we may conclude that it is not in virtue of its action on the albumen
of the food that bile is required for its assimilation.
Another dog was fed for eight days upon black bread.




OF THE LIVER.


125


The alvine evacuation was very voluminous and had an
acid reaction; on being tested with iodine to determine
whether starch was present, only a few blue spots appeared here and there, and not more than was observed
in similar circumstances in a dog in its normal condition.
The dog increased in weight, and the same observation
was made in an experiment with another dog fed upon
white bread after its bile had been withdrawn. In this,
for instance, in eight days the dog increased in weight
from 5-325 to 5-590 kilogrammes. The inference drawn
from  this seems undeniable, that feculent food can be
perfectly digested without the assistance of bile, and
that it therefore takes no part in the assimilation of this
portion of the aliment.
The influence of the bile upon the fat alone.remains
for consideration, and that fat too can -be assimilated
without it, is proved by the experiment first detailed.
This dog, whose weight was 5300 grammes, received in
the first series of observations 95 grammes of fat in
eight days, and in the second, 41-4 grammes in five days,
while there were found 85 grammes of fat in the alvine
evacuations in the first experiment, and 72 grammes in
the second.   So that in one case the dog assimilated
11-88 grammes of fat daily, and in the latter 2"24
grammes. Similar results were obtained by Lenz, who
made many experiments on this subject, which are published in his thesis.' Although there can be no doubt
from these experiments that some fat may be absorbed
into the system without the action of the bile, yet it
would seem that the quantity is far less than when this
secretion is present.  For a dog not much larger than
S De adipis concoctione et absorptione diss. inaug. Dorpati, 1850.




126


STRUCTURE AND USES


the one previously employed, absorbed no less than
446'9 grammes of fat in five days, which is about seven
times as much as was possible for the dog to do when deprived of its bile. That bile enables fat to be received
into the animal economy seems to be an established fact;
but the method of its operation in this process is still a
matter of uncertainty.  It evidently influences the absorption of fat by the lacteals, for while the average of
fat in the chyle is 32 per mille, it was only 2 per mille
in animals deprived of their bile. If the fat were acid
the soda of the bile might neutralize it, and it does
when this is the case: but the fat for the most part is
neutral, so it is not in this way it acts. Nor does it act
by making a sort of emulsion with oil globules as has
been supposed, for such an emulsion would not be more
easily absorbed than fat in a state of minute division.
Its true mode of action, according to Bidder and Schmidt,
is by moistening the epithelial cells of the mucous membrane of the intestine, and so disposing them to permit
the permeation of the oil-globules: without this the fat
is not absorbed. Its action is thus purely mechanical,
and affects the molecular attraction of the interstices
through which the oil passes, and may be imitated by
moistening a capillary tube with bile, and dipping one
end in oil, while a dry tube of the same diameter is
similarly placed; the oil rises higher in the tube moistened with bile than in the other.  Thus it would seem
that an animal actually dies of starvation, because it
cannot absorb fat without the aid of the bile; and one
of the chief offices of the bile is to lubricate the passages
by which the fat passes into the blood!
The inordinate appetite observed in dogs deprived of




OF TIE LIVER.


127


the use of their bile, arises from an instinctive perception
of the large quantity of food that is required to compensate the want of fat which should have been absorbed.
Hunger is one of the constant effects of a deprivation of
bile. The exact difference in the quantity of albuminous
diet required to sustain a dog in its full weight without
the aid of bile, is thus computed: a dog of 4 kilogrammes in weight consumed daily 250 grammes of
flesh; and now, by direct experiment, it was ascertained
how much carbonic acid this dog expired, and the quantity represented 34"36 grammes of carbon in the day.
If the flesh he ate had been pure albumen, it would not
have been enough to meet this consumption at the
lungs, for it would only have given 27 grammes of
carbon, but the deficiency was made up by 19 grammes
of fat, which gave 15 grammes of carbon. This, with
the carbon contained in the salts of the meat, was sufficient for the demand at the lungs. The dog got 39
grammes of carbon in all, and only required about 34.
But how was it with the dog that had its bile turned
off?  It was found to consume 47 grammes of carbon
at the lungs in a day; but it lost 3-5 grammes of carbon
by the escape of the bile, which had also to be made up,
so that its demand was 50 grammes of carbon a day.
Now all the fat he could get into his system, owing to
the want of bile, was 10 grammes a day, yielding 7"8
grammes -of carbon; so that there was a deficit of 42
grammes of carbon to be made up by a corresponding
increase in the quantity of albumen, to no less an
amount than 400 grammes of raw meat to cover this
enormous loss of carbon. This dog actually consumed
525 grammes of flesh, and required it all to keep him



128


STRUCTURE AND USES


self in condition, while his fellow who had the use
of his own bile, required only 250       grammes: hence
the hunger.
It would, however, be an error to suppose that the
only function of the bile was the assistance it gave the
system in the absorption of fat; undoubtedly, after its
absorption, it discharges most important offices, in aiding
those wonderful transmutations by which the external
materials, out of which the body is made, are converted
into flesh and blood. But into this mysterious region
chemistry   cannot follow; it notes its entrance and
awaits its exit; but what transpires in the secret chambers
of life, where conception is constantly going forward, is
beyond its utmost efforts to penetrate. Again we see
the fallacy of hoping to find in chemistry, a key to the
cure of the morbid alterations in the vital actions, from
which even in their normal state the chemist is entirely
excluded. The chemist tells us that in the bile absorbed,
there is always a minute quantity of sulphur, and that
this sulphur plays an important part in the transformation of the tissues; but this is all, and the physiological
chemists most candidly confess that there are probably
an infinite number of uses of the bile within the economy,
of which they know absolutely nothing. We have seen
how important was the action of the nervous system
upon the glycogenic function of liver, and we cannot
doubt it is equally potent in its influence upon the quantity, and probably also the quality of the biliary secretion, as shown by the sudden yellowness of the skin
from anger or jealousy: but, of all this, beyond the
naked facts, we know absolutely nothing.
Even of the much more accessible department of know



OF THE LIVER.


129


ledge-the influence of different kinds of aliment upon
the quantity of the bile secreted-we know         extremely
little, and that little provokingly proves that this influence
is very great. In the series of experiments made by
Bidder and Schmidt to ascertain the effects of discharging the bile directly from the liver, and depriving the
animal of it, the effects upon the quantity secreted within
a given time by different aliments, are noted by the way,
and afford some curious and interesting, although imperfect information.   The most certain fact ascertained
was, that abstinence rapidly reduced the quantity of bile
secreted, while flesh and water, on the contrary, as certainly increased it. That eating flesh should do so is
not surprising, but that purewater should augment not
only the quantity of fluid bile, but of its solid constituents, was an unexpected result. The following table
exhibits the fact.
While fasting the Dog yields.  Fed.   Now yields.
Day of experiment. In.th of  Fresh  Solid  Beef  Water  In th of  Fresh  Solid
an hour.  bile.  residue.  ee  er.  n hour.  bile.  residue.
Grms. Grms.  Grms. Grms.         Grms.  Grms.
Nov. 7   4   1-558 0"040    -    185    4     5-165  0-143,5    2   1-009 0-028   -      60    2     2-217  0-062,3    4   2-689 0-085    25   158    4     4-030  0-177,2    4   2-109 0-103   140   140    4     4-105  0-138
S15    2   0-397 0-046  160           2     2814073  01295,, 17  4   2-001 0-217   185    -      4    2-883  0-135
S14    2   0-74  0.061  200     -           1486   01008
{ P442  0-058
It will   be seen   that in   the first experiment, the
drinking of 185 grammes of water increased the quantity
of the bile delivered in an hour from 1-558, to 5-165,
9




1306


STRUCTURE AND USES OF THE LIVER.


or more than four-fold. Here is an important fact for
the Water-cure! The effect of lard and butter was rather
to diminish the quantity of bile as compared to the
effects of a meal of flesh; but it would be rash to draw
too many inferences from tables recording experiments
made for a different purpose.      The difficulty of the
subject is very great, but as the zeal of experimental
physiologists seems setting at present towards the liver,
we may hope for much important addition to the
present   stock  of  our  knowledge in regard     to the
action both of alimentary and medicinal agents upon
this important organ; and we cannot but look forward.
with hopeful anticipation to a rapid increase in our
practical ability to cope with the multitude of affections
which depend more or less upon some disorder of the
hepatic structures, when we are made more fully acquainted with the value of each of its functions, the
methods of gauging their efficiency, and recognising
their aberrations, so as to bring them under better
control, by more enlightened management and medication..




CHAPTER IV.


ON DIGESTION.
THEsE are   bad times for the young    and earnest
physician of the old school of medicine. Let him round
the circle of the sciences; let him master the stethoscope and the microscope; let him perfect himself in
all chemical knowledge; let him  understand the most
occult anatomy of the body of man and of all living
beings; let him advance into physiology as far as it is
possible for him to penetrate, and if he then attempt to
apply all these vast acquirements to the simplest problem his patient gives him to solve, by asking him to
explain how he digests a mutton chop and a potatoe,or why.he can't do it,-which is the more likely form of
the interrogation, our young philosopher will be compelled to make the humiliating confession that from the
moment these representative constituents of the material
of the flesh and blood enter the mouth till the period of
the accomplishment of their mission, their analysis,
appropriatioi, and rejection, every stage of their progress presents subjects for controversy so keen that, but
for the improvement in the manners of this age, we
should have discoverers brandishing their knives at one
another, and only too thankful that they escaped the
fate of George Wirsung, who was assassinated for his




132


DIGESTION.


daring  innovations about the pancreas.     " Wirsung
mourut assassine, dit on, le 22 Aoit, 1643.      Nous
constatons de nouveau    ici que les decouvertes anatomiques et physiologiques suscitent aujourdhui moins
de passions."  So says Bernard in Paris, and we fancy
we hear I-errn Bidder and Schmidt mutter, " Gott sei
dank" from   Dorpat.    For there is scarcely a single
proposition made by the brilliant Frenchman that is not
met either with a point blank contradiction by the patient
painstaking Germans, or at least subjected to very rude
handling.  And the subjects of these controversies are
not minute or trivial, but no less that the effect of almost
every different agent on the fecula, the albumen, and the
fat from the entrance of these substances into the mouth
till their disappearance in the intestines.  They differ
about the action of the saliva upon the fecula, about
the action of the gastric juice upon the albumen, about
the action of the pancreatic fluid and bile upon the oil
and upon the albumen.    We shall not be guilty of the
presumption of attempting to decide which is in the
right, but shall satisfy ourselves with stating the most
important conclusions that each party has arrived at,
leaving to future investigators the ultimate decision.
And we do not think that it is a waste of time to
discuss these matters, even although we cannot arrive
at positive and final opinions upon them, for among
the various knowledges we do well to acquire there
is none more important than the knowledge of our
ignorance.
Without farther prologue we shall at once proceed to
detail the observations of Bernard, and Bidder and
Schmidt, upon the action of the different agents to whose




DIGESTION.


133


operation every kind of food is exposed in the process of
digestion.
The first of the long series of changes which food
undergoes to prepare, it for incorporation takes place in
the mouth where it is subjected to the process of mastication and insalivation: the former being a purely
mechanical division of its parts so as to form a mass
"which can be easily swallowed, the latter being partly
mechanical in so far as the lubrication of the mass is
concerned and its admixture with the air, and partly
probably chemical from the action of the saliva upon the
fecula it may contain. This saliva, which is generally
spoken of as a simple secretion is, in fact, a combination
of three secretions derived from three different glands,
and each of the three possesses peculiar qualities.  The
first we shall consider is the secretion from the -parotid
glands. This consists of about 95 per cent. of water,
and its action  according to Bernard, is to facilitate
mastication. He found that after its obstruction in the
horse the animal took much longer to eat its hay, oats,
and straw, and that the quantity of the secretion was in
proportion to the dryness and hardness of the food.
Thus while eating 250 grammnes of bread in 3 minutes,
185 grammes of parotid fluid flowed from the ducts,
which were exposed so as to be. subjected to experiment,
while no less than 932 grammes were secreted in 12
minutes when the horse was masticating     hay.  The
absence of this secretion increases the thirst in a marked
manner, so that an animal which before the obstruction
was satisfied with about 20 kilogrammes of water in
the day, required after the operation about 30 kilogrammes to appease its thirst. And this thirst does not




134


DIGESTION.


arise from dryness of the fauces, for the mere swallowing
of water has no effect in abating it, if that water does
not reach the stomach and intestines, as happens when
an artificial fistula is made in the cesophagus. Thirst is
a general not a local appetite, and can only be satisfied
by increasing the fluids generally.
The parotid fluid is a slightly alkaline clear watery
secretion, containing a peculiar substance called ptyaline
along with a trace of albumen; it is under the influence
of the facial and the fifth pair of nerves, and when these
are excited a corresponding increase of action in the
gland is observable. It is essentially an appendix to the
function of mastication, and this is probably its only use.
There is indeed some discrepancy about its chemical
action on starch.   Bidder and Schmidt distinctly affirm
that it has no action at all upon starch, even after being
some hours in contact with it, while, on the other hand,
Jacobowitsch maintains the contrary. However, we may
safely conclude that at all events the chemical action of
the parotid fluid is quite insignificant, and that Bernard
is justified in representing it as subserving mastication
and that alone.
The second source of saliva is the submaxillary glands.
The secretion from these is limpid like the parotid fluid,
but much more viscid, and becomes gelatinous on
cooling; it is also decidedly alkaline, even more so than
the secretion of the parotid.   Its inorganic constituents
are chiefly chlorides, carbonates, and phosphates of lime
and   soda.   According    to Bernard    the use of this
secretion is to assist the functions of taste.  The quantity that is poured out by these glands is determined by
the greater or lesser degree of sapidity of the food.




DIGESTION.


135


Thus he found that when sugar and water was applied to
the fauces of a dog, there was hardly any action excited
in the submaxilliary glands, but when the gullet was
moistened with diluted vinegar or extract of colocynth
there was an   immediate and copious secretion.    In
accordance with this view he also found that while the
nerves which supply the muscles of mastication on being
irritated increased the discharge from the gland of mastication, viz., the parotid, in like manner when the gustatorynerve was excited by galvanism there was an immediate
action observable in the submaxillary gland.    Their
sympathies are with the stomach, for when the secretion
of gastric juice takes place it induces an action in the
submaxillary glands and not in the others. The submaxillary, (like the parotid fluid,) seems to have a
very trifling if any chemical action on the food, for
Bidder and    Schmidt   found  that starch  remained
unchanged when left for some hours in a mixture of
the saliva derived from the parotid and submaxillary
glands.
The third and only remaining gland is the sublingual.
The existence of this in the dog and some other animals
has been denied by many anatomists, but Bernard
contends that this has arisen from an oversight on
their part, and that the sublingual glands are always
present, and the secretion from them possesses properties
wholly different from those of the other two sources of
the saliva. The difference consists in the much greater
viscidity of the secretion, and its richness in ptyaline, and
the traces of sulpho-cyanide of Potassium, which are
always to be met with in it. It is, in fact, a sort of
mucus, and approaches the true mucus of the buccal




136


DIGESTION.


cavity in all its essential characters, and as we shall
afterwards see, this mucus performs a most important
part in digestion.
The distinctive qualities of the three sets of glands are
thus, according to Bernard, that the parotid secretion is
almost entirely water, and assists deglutition; the submaxillary more viscid and gelatinous on cooling, and is
associated with the property of taste; while the sublingual
is also very viscid, and does not jelly on cooling, contains
much ptyaline, and cooperates with the mucus in its
chemical action upon fecula.
Bernard relates some curious experiments exhibiting
the elective power of the. salivary glands to pass or to
refuse various substances carried to them by the blood.
He injected into the jugular vein of a dog, 25 grammes
of warm water containing 5 grammes of yellow prussiate
of potash, 5 grammes of iodide of potassium, and 4
grammes of grape sugar. As soon as the operation was
over, he provoked the salivary glands, and on collecting
their discharge he found iodine, but not a trace of the
prussiate of potash or sugar.  After seven minutes, the
observation was repeated with the same result. The
urine was then examined, and, there, prussiate of potash
was found, but neither sugar nor iodine. In twenty-five
minutes more they were both examined, and now the
urine contained prussiate of potash and a trace of sugar,
but no iodine, while the saliva was full of iodine, but
without sugar, and prussiate of potash. In three hours the
iodine was recognisable in the urine. Thus, the prussiate of potash appeared in seven minutes, the grape
sugar in twenty-five to forty, and the prussiate of potash
not for three hours. While in the saliva iodine was




DIGESTION.


137


found in four hours in its former abundance, but still
not a trace of the other two substances which had been
injected along with it, and which had both been passed
by the kidneys. This experiment, often repeated, never
failed to give the same result; and Bernard considers it
an established fact, that iodine is at once and constantly
discharged by the salivary glands when present in the
blood; indeed, its power of passing is so great, that its
presence affords an entree to substances, of which iron is
one, which without it would be refused admittance into
the salivary vessels. This he proved by various ingenious experiments which we have not space to detail,
but the result was that while, in general, salts of iron are
not to be found in the saliva, although they have been
injected into the blood or stomach, yet iodide of iron
forms an exception. But a still more remarkable fact,
and one of special interest to us, is, that when a solution
of two grammes of iodide of potassium were injected
into the stomach by an artificial fistula, long after all
trace of it had disappeared from the urine, it was still
found in the saliva, and in the gastric secretions even after
an interval of three weeks. This observation has an
important bearing upon the duration of the action of
medicinal agents, for its persistence is manifestly due to
vital, not chemical laws, and we may now understand
the reason of our inability to affect our patients beneficially with our medicines, if they have in their system a
poisonous spring, the existence of which we are ignorant.
And even if we did know of it, how    could we either
stop or neutralize this stream of mischief, deranging the
healthy actions, and paralysing  our remedies?   The
wonder is, that in the old poisoned patients who come to




138


DIGESTION.


us, we can ever do any good at all, and not that we
cannot produce, as they expect, immediate and constant
improvement!
To return from this digression to the action of saliva;
it is a well-established fact that the mixed saliva found
in the mouth has properties peculiar to itself, and different from any of its constituents. The most probable
theory is, that when the secretion from the salivary
glands meets the mucus in the mouth, there is then a
peculiar action of the nature of fermentation engendered,
and that the result of this is to produce a combination
which has a very rapid and intense action upon all feculent articles of food.  MM. Bidder and Schmidt give a
table of the time required to convert starch into sugar in
the presence of different secretions, and the chief facts
brought out by it are, that this change was instantaneously
begun, when saliva from a man, a child of three months
old, or a dog was brought in contact with it, while it
required twenty minutes to make its appearance when
the mucus of the mouth without the secretion of the
parotid gland was employed, and one to three hours
when the parotid and submaxillary glands were substituted.   It seems, then, that neither the buccal mucus,
nor the saliva by itself, can do what the two together at
once effect. The mixture is required for the ferment.
Although it is an established fact that the saliva found
in the mouth has a most rapid and energetic action upon
the fecula of the food, which it converts, as far as its
action goes, into sugar; yet we meet with the singular
contradiction of there being no sugar discoverable in the
stomach, even although the morsel swallowed be at once
removed and examined. The explanations offered of this




DIGESTTON.


139


apparent anomaly are not satisfactory; on the one hand
it is advanced that the exposure of the feculent materials
to the action of the ferment is too short, and that the
condition of the starch in the food is not favorable to
its being acted on by the saliva; while on the other hand
it is supposed that the sugar is either absorbed on its
passage to the stomach, or if it reaches that cavity, is
immediately converted into lactic acid by the gastric secretions.  Such are the explanations; but it is admitted
that as yet the difficulties are far from being satisfactorily
removed. Thus, at the very outset of the investigation
of the process of digestion we encounter an unsolved
problem, and we cannot affirm with confidence what
chemical changes are undergone by a morsel of bread in
its passage from the mouth to the stomach.
The existence of sulpho-cyanide of potassium in the
saliva is a curious fact that has given rise to much fanciful speculation. It is known that this salt is a powerful
poison, and it is conjectured that the poisonous action of
the saliva of rabid animals may arise from an increased
quantity of this natural ingredient of that secretion.
This notion rests on no evidence of any weight, and we
may at once dismiss it as wholly insufficient to account
for the phenomena of hydrophobia.   At the same time
it is certainly important to know that this very poisonous
substance is liable to be generated in greater quantity
by the salivary organs, when a morbid action is developed in them. Thus Lehmann' examined the saliva
of a patient suffering from mercurial salivation, and
found its properties very different from the normal secretion: it was thick, gelatinous, flocculent, and very
1 Jahibuch dor Phy. Chem.,' B, II.




140 '


DIGESTION.


poor in ptyaline; but, on the other hand, contained a
large quantity of sulpho-cyanide of potassium. It is
certainly not improbable, that some of the noxious effects
of this dreadful drug-mercury--may be attributed to
its exciting this poisonous secretion, some of which
must be swallowed and thus complicate the evils the
original poison has inaugurated.
Among the other morbid secretions of the mouth,
may probably be reckoned the tartar of the teeth.  This
consists, fundamentally, of phosphates; but although
these salts form the basis of the deposit, particles of
carbonate of lime, epithelial cells, &c., are mechanically
combined with it, and form a notable portion of the
whole. The origin of this was supposed to be simply
the evaporation of the saliva; but Bernard has advanced
the supposition, that it is the result of a slight inflammatory action of the alveolar processes, a chronic periostitis, depending upon irritation of the organs of digestion, and partial denudation of the roots of the
teeth. It is more abundant always in the lower than
the upper jaw, because the gums are more pressed froi
the teeth of the former during mastication; and he
found it take place rapidly in dogs, when their digestion
was disturbed by a partial closure of the orifice of the
gastric fistula, and when the exciting cause was removed,
and the normal condition of the digestive functions restored, it as speedily disappeared. This observation has
an important practical bearing, and if it is confirmed,
the state of the teeth and gums may be found to have a
constant relation with certain specific affections of the
alimentary canal, and be thus both remediable in themselves, by appropriate medication, and a guide to the prac



DIGESTION.


141


titioner in the selection of the remedy proper for the
cure of the original malady, on which this lesser one has
supervened.    Thus the lights of advancing science,
which exhibit with increasing clearness, the baleful action
of the mercury, the iodine, and the other poisoned
arrows which fill the quiver of old physic, are so many
safety lamps to us, improving our practice by giving us
more exact indications of morbid actions, for the excitement of which, we are not accountable.
We have made but small progress as yet, all we have
done is the division of the food into smaller parts, its
mixture with a watery fluid containing much atmospheric
air, and the conversion of a portion of its starch into
sugar; in this condition it is projected into the stomach.
Here it is exposed to the action of two substances, the
one an acid, the other a peculiar principle called pepsine.
These two, combined, constitute the gastric juice, and
the presence of both is necessary to effect digestion
Till of late, our knowledge of the properties of the
gastric juice in its physiological relations, were chiefly
derived from the experiments of Dr. Beaumont on his
patient, who had a fistulous opening in the stomach;
but, recently, various experimenters have found that
such an opening being easily made in animals, without
causing them much inconvenience, they had in their
power to repeat and vary these original observations, and
have arrived at many more exact conclusions than before were possible.
It seems ascer'tained by a great number of experiments, that this gastric juice varies much both in quantity and quality at different times, these variations depend upon the nature of the food received into the




142


142             DIGESTION.


stomach; and it is probably owing to this,' that there is
so much discrepancy about its chemical composition
among the highest authorities.     As regards the quantity,
Bidder and Schmidt found that a dog of 12 kilogrammnes
yielded
In -1 an hour  63 grammes, 3 hours after having been fed on meal and
water.
1 hour   21.3        with a perfectly empty stomach.
2an hour 33-5       when bones were in. the stomach.
1 hour   62-2       in the same circumstances.
il21an hour 120,   with a perfectly empty stomach.
1)21an hour 38-0     3 hours after a meal of flesh.
So that in four hours this dog, of 12. kilogramines in
weight, Yielded   23 grammes of gastric juice.       If the
human stomach is equally productive, an ordinary sized
mian would secrete 6-4 kilogrammes of gastric juice in the
twenty- four hours. This estimate is considered very
high, but it corresponds with the experiments of Lehmann    as to the quantity-of gas 'tric juice required    to
dissolve albumen. However., as it appears that all the
albumen received into the system is not dissolved in the
stomach, the correspondence is of less consequence, and
when we observe such anl enormous difference in the.yield of different hours, we may well suppose that there
is an equal difference in different stomachs, and that be..
fore it is possible to strike an average, it. will require an
almost infinite multiplication    of  observations,    It  is
of more interest to know that there is this difference,
and that it is affected by various causes. For example,
it was found that the mere sight of a. piece of meat
called forth a copious secretion of gastric fluid, after the
salivary duct had been obstructed. So that the stomach




DIGESTION.


143


as well as the mouth waters at the sight of proper
food.
Again it was noticed that while this necessary secretion was thus excited by the prospect of eating, an op
posite change took place if the animal had been exposed
to a painful operation, then the gastric juice lost its digestive power entirely; this, however, was from a change
in its quality not its amount.  It lost its acidity without
which it has no power to perform its office. This was
probably owing to the large quantity of saliva which
pain often produces: in animals, a sort of weeping from
the mouth, and this saliva being alkaline neutralized the
acid in the stomach. Thus the operation of sorrow if it
gives rise to copious tears may produce a chemical incapacity to digest food, as well as physiological depression
of the digestive organs.
While it is an undisputed fact that free acid is present in the stomach, and that its presence is an essential
condition of the action of the gastric juice upon the aliment, what that free acid is has occasioned much keen
controversy. Some, as Prout, Tiedeman, and Gmelin,
maintain that it is hydrochloric, while Lehmann and
Heintz are of opinion that it is lactic.  Sometimes there
is free phosphoric acid present, or at least acidity is given
by the presence of super-phosphates, but only after the
animal has been fed on bones. The result of eighteen
analyses made apparently with the greatest possible care
has led Bidder and Schmidt to a conclusion which reconciles the conflicting views. They found that in carnivorous animals, after fasting for eighteen or twenty
hours, pure hydrochloric acid alone, without a trace of
lactic, was present in their stomachs, whereas the stomach




144


DI GESTION.


of herbivorous animals contained a certain small and
variable amount of lactic acid, which was probably derived from the food. We may assume, then, that the
acidity of the gastric fluid in man, if normal, is due to
the presence of free hydrochloric acid.
Of pepsine little is known chemically; it so far resembles albumen as to be coagulable by heat, and that
it is indispensable for the action of the gastric fluid is a
certain fact. Neither the acid nor the pepsine suffices
alone, for if it be neutralized by carbonate of soda it
loses its power, and regains it when the alkali is removed,
and equally destructive is the application of heat, which
coagulates and destroys the pepsine. The fact of an
alkali destroying the effect of the gastric fluid, and instantly arresting its digestive power, explains the mischief
bile does when it gets into the stomach. It was found
that a very small quantity of bile when mixed with the
gastric juice at once and entirely suspended its chemical
action upon the substances which it was vigorously
handling before the addition. So that after all the
phrase in every patient's mouth about being bilious may
sometimes have a sounder foundation than we are apt to
imagine.
Such being the constitution of the secretions from the
stomach embraced under the designation of the gastric
juice, let us proceed to inquire what is the character of
its action upon the three constituents of all digestible
food, viz., fat, fecula, and animal or vegetable fibrine.
Its only action on the fat is to dissolve the walls of
the cells which enclose it, and to liberate their contents;
by this, fat is rendered fluid, but undergoes no other
change either physical or chemical.




DIGESTION.


145


The fecula contained in vegetable cellular tissue, as in
a potato for example, is likewise enlarged from its confinement by the solution of the walls of the cells, and is
brought into immediate contact with the gastric juice.
The only effect of this upon the starch is to produce a
hydrate either by its acidity or temperature.  This is
merely a physical change and not a chemical one, and its
reaction with iodine is unaffected by it. Nor are the
sugars affected materially, except that cane sugar if long
exposed to its action is converted into grape sugar, and
this in its turn into lactic acid.  However, from the
length of time required to effect these transmutations, it
is probable that they seldom, if ever, occur in ordinary
digestion.
Its main work is with the azotized matters.  A piece
of flesh, for instance, when exposed to the action of the
gastric fluid, either in or out of the stomach, is softened
and transformed into a grey paste to which the name of
chyme has been given. On examining this with the
microscope, it is found that the change consists in the
separation only of the fibres by the solution of the cellular tissue which bound them together, and that the
original structure of the muscle is quite distinguishable,
so much so that it is found to be much the best way of
procuring the primitive fibres to expose for a length of
time a muscular tissue to the action of gastric juice.
This separation of the muscular fibre is much more
rapid if it have been previously cooked, as was proved by
experiments upon dogs. So that, in fact, a great portion of the work of the stomach as regards flesh may be
anticipated in the kitchen. Milk and albumen it first
coagulates then dissolves; bones it dissolves and removes
10




146


DIGESTION.


from them their azotized portion which is very considerable, leaving behind the insoluble earths to be expelled.
In this the action of the gastric juice is the converse of
acid fluids which dissolve the earths and leave the animal
parts of the bone.  In all these instances the action of
the secretion is strictly physiological, but it has also the
power of acting chemically in virtue of its acid nature
upon various salts.
Considering the  wonderful energy with    which it
attacks and destroys animal tissues, the question natu.
rally arises, Why it should not act upon the stomach
itself? and the common reply is, that it is owing to the
fact of the stomach being endowed with life which in
some mysterious way preserves it from this otherwise
inevitable suicide. That this is not the true solution
of the difficulty is proved by some experiments of Bernard, who introduced portions of live frogs into the
stomach of a dog, and found that during the life of the
unfortunate victim  of science it was partially digested.
And the explanation he gives is that the immunity to its
own secretions enjoyed by the stomach is due to the
epithelial coating which is quite impermeable by the
gastric juice, and entirely resists its corroding power,
and that it is the absence of such a protecting film in
the frog that makes it liable to be digested alive. This
theory is probably the true one, and it may serve to explain the curious fact that the poison of the most venomous snakes may be received with impunity in its raw and
native state into the stomach, while it produces rapidly
fatal effects when injected into the blood. But it would
be contrary to all analogy to suppose that because when in
its concentrated state it did not act ini the stomach being




DIGESTION.


14.7


probably digested and decomposed, that therefore it
would not do so when presented to the system    in a
diluted form, so as to be readily absorbed into the blood,
or without this absorption to be brought into direct
contact with an extensive surface of the mucous membranes on which nerves are largely distributed. This
may reassure us of the probable activity of snake
poisons when given as we give them in a highly expanded
or diluted state, even in the face of their inactivity,
when swallowed in their natural bag, as is done in India.
Although it is established beyond a doubt that the
gastric juice has the power of dissolving albumen, yet
from the experiments of Bidder and Schmidt it appears
no less certain that it requires a large quantity of the
fluid to dissolve a small portion of the solid, a much
larger quantity, in short, than is met with in the stomach.
Not only in experiments made with gastric juice taken out
of the body, but in all experiments made by dropping portions of coagulated white of egg into the stomach,
through an artificial opening, they found without a single
exception, that even after six hours, and when there was
an excess of gastric fluid present, yet that all the albumen was never dissolved, seldom more than half of it.
This startling fact leads to the inevitable conclusion that
albumen is only partially digested in the stomach, and
we must follow the course of the food down the alimentary canal, before we can account for the digestion even
of the albumen, the only one of the three parts of the
aliment which undergoes a certain gastric digestion. The
pultaceous mass, called chyme, when it leaves the stomach
and enters the duodenum, consists of disintegrated food,
fecula, free oil, and albumen, in a state of solution,




148


DI GEST'ION.


along with fibres of flesh, &c., before it has proceeded
far on its downward course, it encounters the secretions
of the pancreas and liver, which entirely change its chemical character, and arrest instantly the gastric digestion
by throwing down the pepsine, and neutralizing any free
acid that may have passed over. The action of the pancreatic fluid has hitherto been regarded as similar to that
of saliva, and the pancreas has always been considered
as an internal salivary gland, of comparatively little consequence in the process of digestion. Bernard entirely
objects to this received opinion, and maintains that the
action of the pancreatic fluid is of immense importance.
This belief rests upon the following series of facts:1st. The consequences of a destruction of the pancreas
in the human body by disease.       2d. Its destruction in
animals artificially.  3d. That the changes in the aliment, which he ascribes to the presence of this secretion,
do not take place in the duodenum of those animals in
which the pancreas discharges itself lower in the intestine until the point where this discharge takes place;
and, lastly, upon the experiments he has made upon the
action of the pancreatic fluid extracted from animals and
brought in contact with the elements of food.     In order
fully to understand his views it will be necessary to state
his experiments, as well as those of Bidder and Schmidt
upon the same subject. Unfortunately, the results are
in some respects conflicting.
The pancreas is an oblong gland, with a duct running
from one end to the other in a line with its longest diameter; as this central canal approaches the duodenum,
where it debouches, it separates into two branches, the
larger of which in man unites with the ductus choledo



DIGESTION.


149


chus, while the smaller empties itself separately into the
intestines a little higher up.  The same disposition of
parts is met with in most animals, so that the bile and
pancreatic fluid are at once mixed, and operate upon the
food in combination with one another.   The lesser duct
instead of enlarging after its separation becomes smaller,
and seems rather to serve the purpose of a reservoir than
an outlet; in some animals it has a blind extremity.
The position of the pancreas makes it somewhat difficult to perform the operations upon it required for establishing its uses; however, this has been done, and the
secretion collected by means of a silver tube connected
with an external receptacle. Bernard minutely describes
the method he employed.     On exposing the pancreas
during digestion, it is found red and tumid, and if the
duct is opened, the fluid escapes with such rapidity, that
a moderate sized dog will yield 5 to 6 grammes in an
hour. According to the calculations of Bidder and
Schmidt, if the pancreas secretes at the same rate in the
human subject as in the dog, a man of average size will
elaborate 150 grammes of pancreatic fluid in the course
of twenty-four hours. Normal pancreatic secretion is a
colourless, limpid, and viscid liquid, which flows slowly
in large pearly drops; it has no peculiar taste, but is
slightly saline, like the serum of the blood.  Its chemical
reaction is always alkaline, never either neutral or acid.
When exposed to heat it is converted into a solid white
mass, possessing many of the properties of albumen.
Notwithstanding this similarity there is no identity between the two, according to Bernard; on the contrary,
the pancreatic fluid has altogether peculiar properties, as
we shall see by and by.    In the mean time it is to be




150


DIGESTION.


observed that this is true only of the normal pancreatic
fluid, for there is an abnormal secretion from the pancreas.
The liquid just described is only obtained in general for
the first few hours after the operation, then, if the animal
exhibits symptoms of inflammatory action, or even great
distress, the secretion from the pancreas is wholly changed,
and instead of being viscid it becomes watery, and has a
nauseous taste; it no longer coagulates with heat and
acids, or at least the coagulation is very imperfect.  It
still exhibits an alkaline reaction, but is of much less
density. Bernard considers that it is owing to the
morbid secretion being so easily produced in some animals, as the horse, that we meet with so much diversity
of statements as to its properties in the writings of different physiologists of equal authority; and he makes a
more important observation to the effect that this is one
of the distinguishing characteristics of pancreatic fluid
from saliva with which it is commonly compared, for
while we may take all sorts of liberties with the salivary
organs, without affecting the chemical constitution of
their secretions, that of the pancreas is, on the other
hand, very easily disturbed, and      the  modifications
induced in it by pain or general derangement of the
system entirely deprive it of its specific digestive properties. If this view be correct, it is not impossible
that some of the forms of indigestion we meet with
in practice arise from an organic or functional disease
of this organ, and we may, perhaps, be able when
we know its functions more exactly, to adjust our remedial measures with more precision and consequently with
more success.
Without entering minutely into the chemical consti



DIGESTION.


151


tution of the pancreatic fluid which is given in great
detail by Bidder and Schmidt, we may observe that it
consists of from 90 to 92 per cent. of water, and of
from 10 to 3 per cent. of solid ingredients; that of the
solid part 90 to 92 per cent., consist of an organic
matter which may be precipitated by alcohol, and which
always contain a little lime, and the remaining 10 or 8 per
cent. of that remainder are composed of salts of carbonate
of soda, chloride of sodium, chloride of potassium, and
phosphate of lime. This coagulable matter holds a
middle position between albumen and caseine, possessing
certain properties of both, but exactly resembling neither.
Upon it the peculiar physiological virtues of the pancreatic fluid depend, for it is abundant or the reverse in
direct proportion to the greater or lesser activity of the
secretion. It seems to be of the nature of a ferment,
and doubtless it is owing to its presence that one of the
most marked and important of the functions of the
pancreas is due. This function is the transformation of
fecula into dextrine and sugar. The change of starch
into sugar begins instantaneously when the pancreatic
fluid is brought into contact with any amylaceous material, even at a temperature much below that of the living
animal. Unlike the saliva which acquires its fermenting
power by combining with the secretions of the mouth,
the pancreatic fluid possesses the property in its own
right. The full extent of its power in this direction has
not as yet been accurately determined; it seems, howevec, probable that it is in general sufficient to account
for the perfect digestion of the starch contained in the
aliment, at least in so far as its conversion into sugar is
concerned; and it is of importance to observe that




152


DIGESTION.


neither bile nor gastric fluid has any appreciable influence in arresting or modifying in any way this function.
Bernard maintains that sugar to be digested must pass
through the liver, and hence, that after the conversion of
starch into glucose or cane sugar, it is absorbed not by
the lacteal vessels but by the vena porta.  In confirmation of this view he states, that when 2 or 3 grammes
of sugar are injected into a superficial vein, so far is it
from  being assimilated, that it is actually rejected by
means of the kidneys in the course of a few minutes;
while, on the other hand, if injected into the vena portae
so as to be exposed to the action of the liver, it is perfectly assimilated, and disappears in the blood precisely
as if it had undergone the previous gastric digestion.
If this idea be true, we can now follow one portion of
our original morsel of food from its entrance into the
mouth until it is lost in the body.  Entering in the form
of a piece of bread or potato that is a succulent or
starchy substance, it is first rolled about by the tongue,
and well mixed by the process of mastication with the
saliva and a small portion is converted into sugar, then
it descends into the stomach where the sugar is changed
into lactic acid; it passes on to the duodenum, where it
encounters the pancreatic fluid, which rapidly converts
the starch into sugar. This sugar is absorbed by the
branches of the vena portae, and carried to the.liver,
where it undergoes a sort of ultimate digestion before it
is fit to be absorbed into the blood in such a form as to
become subject to the action of the atmospheric air
upon that fluid in the lungs, where it serves the purpose
of fuel, and is, in part at least, consumed to maintain




DIGESTION.


158


the vital heat of the frame.      What other purposes it
serves it would be beyond the scope of our present inquiry to consider. When it has once been assimilated
by the blood it has passed from the region of.chemistry
into that of vitality, it is no longer aliment, but is become
a living element, and not till after it has fulfilled its purpose and is cast out dead will it be subjected to a chemical inquest.
While there prevails entire unanimity among physiologists in regard to the transformations of the feculent
portions of the food, and the agents by which they are
affected, the case is very different with the fat, and on
this subject the views of Bernard are novelties well deserving our earnest attention, but which we are hardly
yet justified in  regarding   as established facts.    Such
as they are we shall state them, waving in the mean
time till that is done the objections that have been advanced against them.
According to M. Bernard, one of the special functions
of the pancreatic secretion, is to assist in the digestion of
fat.  The property this fluid possesses of transforming
all fat and oils into glycerine and elaic, or some cognate
acid, does not depend upon its alkaline character, but is
an inherent principle, which it derives from its vital constitution; that is, the more pancreatic fluid presents its
distinctive animal characteristics, the more rapid and decisive is its action upon oil; and so soon as it begins to
assume its thin and watery appearance, it loses some of
its decomposing power.     If fresh, strong pancreatic fluid,
be mixed with half its weight of olive oil, or fresh
butter, or mutton suet, or pork fat, a perfect emulsion
is formed when the two have been gently shaken toge



154


DIGESTION.


ther; and if the vessel in which they have been mixed
be kept in a warm temperature, no separation takes
place. It is found on examination, that the oils and fats
have been decomposed into glycerine and a fat acid.
This property of acting with such immediate energy
upon oil and fat, is quite peculiar to pancreatic fluid,
and is not found in any other secretion of the body. If
bile, which is alkaline, be mixed with oil, at first it forms
an emulsion similar to what we may call the pancreatic
soap; but after having been left at rest for a few minutes,
the oil rises to the surface, and the uncongenial union is
at once dissolved. It is the same with saliva, gastric
fluid, and the serum of the blood, only when saliva is
very alkaline it succeeds in effecting a true emulsion with
oils, but so soon as the alkali is neutralized by the addition of an acid, it entirely loses this power. This is not
the case with the pancreatic fluid, which retains its influence over fat and oil after it has been deprived of its
alkaline character by acidulation. The change it works
is due to its own specific nature as an animal product,
and not to its chemical constitution.
Such are the conclusions of M. Bernard, from experiments with pancreatic fluid out of the living body. They
are confirmed by the following statements. If, he says,
we trace the progress of the oil or fat from its leaving
the stomach, we shall find that until it comes in contact
with the secretion from the pancreas it has undergone no
change, except such as is the effect of the increase of
temperature to which it has been exposed; but so soon
as it has passed the orifice of the pancreatic duct, it loses
all its old properties, and instead of oil, is a pultaceous
creamy emulsion coloured with bile.   He further states,




DIGESTION.


155


that when these ducts are tied, so as to exclude the pancreatic secretion from  the intestines, that this emulsion
does not take place. It happens that in the rabbit the
orifice of the pancreatic duct is placed some inches below
that of the biliary duct, and hence it affords an easy
mode of verifying the observation, if we ascertain whether or not the transformation of the oil into this emulsion takes place before it descends beyond the pancreatic
opening. This seems a point which may be easily and
certainly determined. M. Bernard accordingly made the
following experiment: he introduced into the stomach of
a rabbit which had been fasting for twenty-four or thirty
hours, from 1 5 to 20 grammes of pork fat, previously
liquefied by a gentle heat, and then gave the animal its
natural food of grass and carrots to force the fat down.
In three or four hours the rabbit was killed, and the
abdomen opened with all possible speed, when it was
easily perceived that the formation of the fat into an
emulsion, began to take place 35 centimetres below the
orifice of the ductus choledichus, at the point where the
pancreatic canal entered the intestines, and that not till
this point were lacteals full of white chyle to be observed.
This seems a most satisfactory observation, but unfortunately we have a counter statement by Messrs. Bidder
and Schmidt to the following effect. They, too, gave
several rabbits a dose of oil after a fast of twenty-four
hours' duration, and killed them at intervals of a diminishing ratio, from  six hours and a half to half an hour
after, when they found that in the majority of the instances, white milky chyle was to be found in the vessels
of the mesentery, above the opening of the pancreatic
duct, and they convinced themselves by microscopic ex



156


DIGESTION.


amination, that this chyle did really contain oil-globules.
In short, the Frenchman and the Germans are at war
upon this point, and we must wait for a new peace congress before we can hope for a final settlement.
As we cannot admit these experiments on the rabbits
to be conclusive either one way or the other, let us consider the other methods of arriving at a knowledge of
the functions of the pancreas, pursued by M. Bernard.
The chief difficulty encountered by experimenters on
this gland, is that its extirpation is attended with such
serious injuries, that the operation is generally fatal.
I-ence it occurred to M. Bernard to attempt its destruction by means of injecting various substances into its
tissue, through the pancreatic duct. After many failures,
he succeeded in doing so with oil; a small quantity of
this has the effect, when introduced into the substance
of the pancreas, of causing its entire disintegration;
and when the animal survives the immediate danger of
the operation, we have then the interesting experiment
of the effects of the withdrawal of the food from the
influence of the pancreatic fluid, while it is exposed to
all the other ordinary mechanism of digestion. Thus,
on an old dog, Bernard performed the experiment with
the following results. He injected about four cubic centimetres of mutton suet, liquefied by heat, into the pancreatic duct.  On the following day the dog drank a
little milk; three days afterwards it ate some flesh; on
the seventh day it was not so well, but seemed recovered
upon the eleventh day, when the wound was quite cicatrized. On the twelfth day, the dog got a pork chop,
and also on the following day. The excrements contained a quantity of oil mixed with fecula; this oil had




DIGESTION.


157


not been observed in them before the operation. Next
day, again, he was fed on a pork chop mixed with boiled
potato, and the same appearances were observed in the
stools. The same diet was continued, and with the
same results, that is, the stools contained an enormous
quantity of oil and undigested starch, which reacted naturally with iodine. The experiment was persevered in
for twenty-three days, and although the animal became
much emaciated, there was no appearance of any more
disturbance of the system than was to be accounted for
by its inability to digest so large a portion of its food;
and, latterly, the quantity of oil in the faeces diminished.
It was killed on the twenty-third day; and on examina..
tion, nothing abnormal was found in the intestines, and
the liver appeared healthy. The pancreas was atrophied
in a large portion of its extent, but in the centre there
was still some which seemed healthy. The ducts were
full of the suet which had been injected into them, and
which had penetrated the greater part of the substance,
and effected this destruction of its tissue, and consequent
suppression of its secretion.  M. Bernard made several
other experiments of a similar kind, and the result was
always the same, the destruction of the pancreas caused
a large quantity of the fat and of the fecula of the food
to appear in the excrements, and hence, the probable inference, that pancreatic fluid is one of the agents by
which the absorption or digestion of fat and oil is effected.
This view is further supported by the observation of
diseases of the pancreas in the human subject.
Hitherto, the number of cases of unquestionable alteration of the pancreas verified by post-mortem examination, and manifesting, during the life'of the patient,




158


DIGESTION.


inability to assimilate fat, that have been reported in
medical literature, is perhaps hardly sufficient to establish
so important a dogma. Some, however, are very striking,
especially the following one, which rests on the high authority of Dr. Bright.
A man of 40 years of age, had long been subject to
intestinal haemorrhage, which, latterly, had become very
severe, and attended with great sensibility of the epigastrium, alternating with diarrhoea. In the month of December, 1836, after having worked all day in a damp
cellar, he was attacked with febrile symptoms and pain,
obstinate constipation, followed by diarrhoea. The evacuations contained no bile, but a large quantity of blood,
and there was excessive tenderness of the epigastric
region. After the lapse of fifteen days, the presence of
fatty matter was first observed in the excrements.   For
some months this appearance continued, the oil passed
was in such quantity as to form a thick layer at the surface, which became firm after a time. It had the look
of beef fat. The patient affirmed that for six weeks he
had observed this fatty deposit to the amount of half a
pound a day; but he was positive that it only appeared
when he had eaten fat soup or meat. When he discontinued fat diet, the stools no longer presented this appearance, but at once resumed it when he returned to his fat
food. Towards the end of August, the existence of a
painful tumour was discovered, situated in the epigastric and right hypochondriac region, extending as far as
the umbilicus. He died suddenly on the 10th of September. On examining the body after death, a tumour,
four inches in length and breadth, was found occupying




DIGESTION.


the situation of the pancreas, the whole normal structure
of which organ had undergone a change, having in fact
wholly disappeared, while what remained was shrivelled
up, and the whole substance was full of hard concretions. It was manifest that no pancreatic fluid could
have been secreted. This is certainly a very remarkable
case; but one cannot but regret that we have no mention of the effect of the disease upon the feculent food.
Starch, as well as oil, should have been present in the
stools, unless the intestines have the power of effecting
a modification of these substances without the aid of the
pancreas.
The following case is reported by Dr. Elliotson.  A
man of 45 years of age, complained of pain in the abdomen and back, and of diarrhoea. The pains were
very violent, indeed intolerable, notwithstanding the administration of opium: he lay doubled up in his bed, as
he thought that gave him some relief. The evacuations
were pale and covered with a yellow oily substance,
which on being brought in contact with the fire burned
with a vivid flame. On its first evacuation, this substance was liquid, but it gradually consolidated itself as
an envelope round the foeces.  Sometimes it appeared in
large quantities, at other times it was absent. The
patient got very emaciated before his death. On an examination of the body, the intestines presented a yellow
oily appearance, with a number of black spots on some
parts of their mucous membrane; the liver was healthy,
the gall-bladder full of thick dark bile. T/ze pancrealic
duct, and its ramifications, were flled with white calcili.
The fact of both these cases being quoted by M. Ber



160


DIGESTION.


nard and M. Fauconneau Dufresne,' is a sufficient proof
that they belong to the curiosities of medical literature;
and, however gladly we would accept of this explanation
of the functions of the pancreas, we are forced to admit
that we are not yet entitled to assume, as an established
truth, that the pancreas is necessarily the organ by whose
influence the assimilation of fat and oil is effected; although it is highly probable that it exerts some influence
upon the process, notwithstanding the emphatic assertion of MM. Bidder and Schmidt, that they consider the
Bernard-doctrine of the importance of the pancreatic
fluid, in reference to its action upon the absorption of
fat, altogether erroneous (in allen Stiicken irrige); and
that this secretion has nothing whatever to do with the
absorption of fat, and its total sphere of action is the
conversion of starch into sugar.
When such doctors differ, it would be presumptuous
to dogmatise about the doctrine in question, and we
must consider the mode in which fat is assimilated as
one of the out-standing problems. Bernard maintains
that a chemical decomposition is effected by the pancreatic fluid, and that the oil-acid which is this formed, is
again neutralized by the free alkali of the bile. He also
maintains, that while the sugar produced from the starch
and the albumen both pass through the liver, being absorbed directly into the blood of the portal system, the
oil and fatty matters pass into the lymphatic vessels, and
with the lymph, form the chyle, that they do not pass
through the liver, but into the blood as it enters the vena
cava; that this is constant throughout the animal king

1 ' Prcis des Maladies du Foie et du Pancreas,' Paris, 1850.




DIGESTION.


161


dom, and that those animals in which there is no separate chyliferous system, there is such a distribution of
the veins as to allow of a direct communication between
those of the mesentery, which receive the oil, and the
vena cava, so as to enable the fatty part of the aliment
to reach the lungs without making the circuit of the
liver. Still the difficulty remains of how globules of oil
pass into the lymphatic vessels or the veins, how they
penetrate the membranes, which they must do, as there
are no open pores, and while doing so, they must apparently violate the well-established laws of endosmotic
action; for if an emulsion such as that formed by the
pancreatic and bilious fluid, and olive oil, be placed in
proximity to a fluid of the consistence of blood, with an
intervening animal membrane, it is found that the watery
parts of the emulsion are passed through the membrane,
and the oil-globules left behind. As we have before observed in speaking of the action of the bile, it seems
probable that in some way the secretion facilitates the
entrance of the oil. But notwithstanding many ingenious hypotheses, and much careful anatomical research
by Professor Goodsir and other accomplished anatomists,
the question of how one of the elements of all food
enters the system at all, has not yet received a satisfactory answer. This incontestible fact is the keenest satire
we could pronounce upon the physiological school of
medicine, which professes to be, now-a-days, so perfectly
acquainted with the whole mechanism of the living
organism, so as to be able to manage it by suitable diet
and regimen, and speak of regulating it, as a watchmaker talks about putting a watch to rights. We must
remember, too, that in addition to their ignorance of the
11




162


DIGESTION.


simple process of digestion, they are equally ignorant of
the million influences which modify this, and every other
vital phenomenon, forces within and without the body,
infinite in number, incessant in their action, and ever
varying in their degree.
We have now accounted for the fecula and the fat, the
conversion of the former into sugar by the saliva and
pancreatic fluid, its passage through the liver, and final
absorption into the blood; while the fat after being
liquefied by the heat of the stomach, and the solution of
the cellular tissue in which it is contained by the gastric
secretion, is either absorbed by the lacteals, after having
been formed into an emulsion by the bile and pancreatic
secretion, or is partially decomposed by the latter into an
oil acid and glycerine, and in either case is represented
by Bernard to pass into the venous system directly without passing through the liver, and all that remains to do
is to account for the large residue of the albumen which
escapes the action of the gastric fluids and passes into
the intestines in its original condition. The digestion of
the remaining albumen seems to take place in the intestines. This fact is established by a series of experiments
made by MM. Bidder and Schmidt.
These bold and indefatigable physiologists performed
the following operations on nineteen cats and two dogs.
They opened the abdominal cavity, exposed the duodenum
and jejunum, tied a ligature below the orifice of the
biliary and pancreatic ducts, and another some distance
lower down; they then introduced into the intestine as
high up as possible a piece of flesh and a portion of
coagulated albumen, which they had previously carefully
weighed, they closed the opening of the parietes with a




DIGESTION.


163


-ligature and let the animal go.  The effect of this apparently most severe operation was very different in different
individuals, some were quite exhausted by it, but others
did not seem to have suffered at all, and went about as
if nothing had happened. In the course of from four to
six hours the portions of meat and albumen were generally advanced a considerable way in the intestines, and
in every instance they had lost a considerable proportion
of their original weight. To avoid any error from mechanical abrasure of their surface, they had been previously enveloped in a piece of lace or muslin, and as the
experiments were all made after the animals had been
fasting for at least twenty-four hours, there could be very
little secretion from the stomach, liver, or pancreas present in the intestines.  Hence, we are conducted to the
inevitable inference that the secretion from the surface of
the intestines acts as a solvent upon the albuminous
portion of the food, and that the digestion of this element of diet begins in the stomach and continues through
a portion at least of the alimentary canal.
The important action of this secretion is not confined
to its effect upon albumen, for it appears to have the
power of transforming starch into sugar, although it
certainly does not do so with so much rapidity as either
the mixed saliva or the pancreatic fluid. Still it was observed that whether when removed from the body or in
situ, when an amylaceous preparation was brought in
contact with the intestinal secretion, a change was speedily
observed in the tint of the blue it struck with iodine
which was sensibly paler, while on the other hand the
tests for sugar revealed the existence of that substance.
Thus we perceive that the feculent element of diet is the




164


DIGESTION.


one most acted on, its chemical transmutation commencing the instant it enters the mouth, and continuing during
its whole course through the alimentary canal, and in
this progress it is subjected to the influence of agents
which all effect its transformation into some form of
sugar, which in its turn is capable of being absorbed by
the veins it encounters in every portion of its course.
We are now approaching the termination of our immediate object-a review of the recent investigations
connected with digestion-and it is certainly disheartening to consider how few and meager are the results of so
much labour expended by men of so much knowledge
and ability; it would seem that they have unsettled
everything and settled nothing; the old established notions on which the chemical school have built so many
imposing fabrics, with Liebig for master-mason, are
found to be a shifting sand instead of a sure rock; it is
now quite certain that the animal organism possesses a
chemical power of transmuting proximate principles; it
is not true that the sugar, the fat, and the albumen are
only absorbed from the food which must contain them if
they pass thence into the living body; on the contrary,
we nowknowthat albumen is changed into sugar, and there
is good reason for believing that a much larger quantity
of fat is found in the body than entered the stomach,
and most remarkable of all is the fact stated by Bernard that if albumen from the blood, or white of eggs
be injected into the veins, it is not invested by the body,
but passed off by the kidneys to the detriment of the
health of the animal. It would seem that a special elaboration of the aliment was required for the specific
requirements of every individual, and that one man




DIGESTION.


165


could never digest for another, if the term digestion is to
mean not merely the cooking of the food in the stomach
and intestines, that is dissolution, but its preparation
into such a condition as to be appropriated by the body
for its own reconstruction.
The new observations and conclusions are but the beginning of many that we may expect to follow, and, in
the mean time, these will be a warning to us how we
venture to dogmatize upon the subject of diet, for until
we possess some certain knowledge what the body can
make of its food, all reasonings upon the subject are
likely to be fallacious. For example, it is positively
affirmed that alcoholic liquids are innutritious, but can
we be sure that alcohol may not be decomposed by the
liver and converted into sugar or fat? Certainly, a few
years ago, if any one had asserted the transformation of
albumen into sugar, he would at once have been mobbed
by the chemists, and yet the chemical constitution of
sugar is farther removed from that of albumen than
alcohol is from fat.
The practical inferences to be derived from a general
survey of the established facts and suggestions contained in the works of the physiologists are so clear that
we do not need to prolong this paper by lingering over
them. It is sufficiently obvious that, if under the name
digestion we embrace the total transformations that the
aliment undergoes from the crude material that enters
the mouth to the matters which are received into the
blood to constitute the vital fluid, which penetrates all
the organs, and affords to each its proper nourishment,
and the elements out of which to fabricate its peculiar
secretions, the process is a very long and complex one,




166


DIGESTION.


and that its abnormal states, known by the general term
of indigestion or dyspepsia, may arise at any one of its
many stages. It may begin at the mouth, there may be
insufficient mastication and insalivation; it may be in the
stomach, from a want of proper gastric fluid; it may be
the pancreatic secretion that fails, or the liver may not
perform its important and numerous functions satisfactorily; and, lastly, it may be that the membrane of the
intestinal tube is incapable of performing its portion of
the joint labour. Now it is obviously essential to a
radical and rational system of medication that we should
if possible ascertain the exact source of the disorder in
any individual case of indigestion, and we may be able
to do so better if we attend to the conclusions afforded
by these investigations. Not only, however, will this
careful application of physiological inferences enable us
to attain greater exactitude in diagnosis and consequent
selection of a specific remedy, but it will also assist us
to some extent, at least, in a judicious arrangement of
the diet. We observe, for example, that albuminous
food, besides undergoing a gastric digestion, is dissolved
and absorbed by the jejunum, and hence it follows that
even when we know the gastric functions are too weak
to perform the necessary changes upon animal food, we
may give an ample supply of this nourishment to the
body in the form of soup, in fact almost the whole of
the work of the stomach may be imitated in a. stew-pan.
As for the feculent principles, we have seen that there is
no portion of their course from the mouth to their final
disappearance, in which they are not exposed to the
transforming process which makes them into a sugary
compound capable of absorption except during their so



DIGESTION.


167


journ in the stomach. While fat and oils require for
their admission conditions of which we are as yet very
ignorant, but if the view of Bernard be correct, perhaps
in cases where there is a manifest difficulty of digesting
these in any of their natural forms, a substitute might
be found in glycerine1 or in some preparation of this
substance. We are evidently on the threshold of many
important discoveries in connection with the great practical question of how best to feed our patients, and we
cannot but anticipate rapid progress in this direction now
that the fact is beginning to be acknowledged by the
advanced school of medical naturalists that the less the
ailing body is tormented with drugs, and the more it is
helped by a nice selection of proper food, the sooner and
the safer will its health and strength be restored.    The
rude empiricism, that destroys the vital powers and perverts their functions in the wild hope that out of a general perversion and anarchy a conversion to order will
eventuate, is rapidly passing away, and when a rational
system of management by diet and regimen has been
once fairly introduced, and its deficiencies made manifest,
we may hope that the way will be prepared for the admission of a rational system of medication founded upon
the great truths promulgated by Hahnemann.
Dr. Chapman has recently directed the attention of the profession to
the importance of glycerine as an article of diet.




CHAPTER V.


ON THE WATER-CURE.
THERE is a vague idea in the minds of many, that
there is some near relationship between homceopathy
and the water-cure or hydropathy.  This seems an erroneous opinion; for if we carefully analyse the two
systems we shall find that they do not spring from
the same root, but are radically different. Indeed the
water-cure is in its theory much more nearly allied to
the allopathic than to the homceopathic system.    It
seeks to accomplish, by the use of water, the same kind
of effects which the old school attempts to gain by
drugs: that is, to produce certain general commotions
of the animal economy, which shall result in the restoration to health: and the only distinction between the
two-a very important one it is-consists in the fact,
that the substance employed is not of a noxious character,
and that measures are taken for securing the best possible conditions to promote recovery, during the period the
body is put through its purgation. The water-cure
may be considered as a sort of rectified spirit of old
physic, a distillation which separates the grosser and
offensive parts from the pure, simple, and limpid: the
residue being those impurities which medicine has contracted throughout its descent from the primitive age of




WAT'lR-C UE.


169


Hippocrates; and this spirit being a restoration of the
fine natural system which was taught and practised by
the priests of Hygaea. It might be called a quantitive
method in opposition to homoeopathy, which is a qualitative system. For while the one alters the distributions of
the fluids and induces changes in the mass of the solids,
the other acts upon the seat of the morbid changes
alone, and affects only the quality of the action in these
parts.
Such being, as it seems to us, the undeniable and
irreconcilable difference between the two systems, it
becomes a question for those who avow their general adherence to homoeopathy, how far they can avail themselves of the other method: and this is one of those pressing questions which every practitioner must be prepared
to answer as it were on the spot; for the growing popularity of the water-cure, and the confidence which so
many have in its efficacy, exposes the physician continually to interrogations from his patients, as to whether
such and such a case be a fit one for water treatment,
and whether he can recommend that it should be tried,
or whether he is prepared to apply himself any of their
celebrated processes.  To be able to give a satisfactory
reply, he must first make up his mind on the general
question, of how far he is entitled, and if entitled, we
might almost say bound, to employ certain auxiliaries in
addition to administering the appropriate medicine; if
this question is answered in the affirmative, as it has been
by the common sense of Britain, then he will have to inquire whether there are any appliances used by the practitioners of the water-cure which he may adopt without
so disturbing the system of the patient as to prevent it




170


WATER-CURE.


from obeying the specific antidote to his disorder; and
also whether there is a class of cases for which the watercure is better adapted than homoeopathy, and how he is
to recognise this class, so that when a patient belonging
to it seeks his advice, he may be prepared to say, "this
is not a case for me to treat, you must go to a watercure establishment." My belief, founded upon considerable observation and the perusal of the scanty literature of the subject, is, that there is an exceptional,
although numerous class of invalids whose complaints will
altogether defy the best and most patient homoeopathic
treatment, and who will rapidly improve under a course
of water-treatment, and also that there are several of the
applications of water which might be advantageously
employed as auxiliaries to homoeopathic treatment.
In enumerating the cases in which water-treatment
seems to me unquestionably advantageous, I should not
wish to be understood to limit its applicability to those
cases alone, for I do not profess to have made sufficient
study of the subject to attempt to fix its limits; all I
am prepared to do is to point out some few well-marked
maladies, for which I have reason to believe this system
is certainly suited, and in which, as far as my own experience has gone, I have had but unsatisfactory results
from unaided homoeopathy.
The first case I select for illustrating this position, is
one to which the objection may arise, whether recovery
could not have been effected under homoeopathic treatment. My belief is that it might, but that it would
certainly have been a very tedious cure, and that it was
such a case as we should be in no way particularly ambitious of staking the credit of homoeopathy upon. It




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is related by the distinguished patient himself, Sir E.
Bulwer Lytton, and done so pleasantly and well that,
although somewhat long, it well repays perusal. "I
have been a workman in my day," he says; "I began
to write and to toil, and to win some kind of a name,
which I had the ambition to improve when yet little more
than a boy. With strong love for study in books-with
yet greater desire to accomplish myself in the knowledge
of men, for sixteen years, I can conceive no life to have
been filled with more occupation than mine. What time
was not given to action was given to study; what time
not given to study, to action-labour in both! In a
constitution naturally far from strong I allowed no pause
or respite. The wear and tear went on without intermission-the whirl of the wheel never ceased.  Sometimes, indeed, thoroughly overpowered and exhausted, I
sought for escape. The physicians said 'travel,' and I
travelled; 'go into the country,' and I went. But in
such attempts at repose all my ailments gathered round
me -made themselves far more palpable and felt. I had
no resource but to fly from myself, to fly into the other
world of books, on thought, or reverie-to live in some
state of being less painful than my own. As long as I
was always at work it seemed that I had no leisure to be
ill. Quiet was my hell. At length the frame thus long
neglected, patched up for awhile by drugs and doctorsput off and trifled with as an intrusive dun-like a dun
who is in his rights, brought in its arrears, crushing and
terribly accumulated through long years, worn out and
wasted, the constitution seemed wholly inadequate to
meet the demand. The exhaustion of toil and study
had been completed by great anxiety and grief. I had




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watched with alternate hope and fear the mournful
death-bed of my dearest friend-of the person around
whom was entwined the strongest affection my life had
known-and when all was over I seemed scarcely to live
myself. At this time, about the January of 1844, I was
thoroughly shattered: the least attempt at exercise exhausted me; the nerves gave way at the most ordinary
excitement; a chronic irritation of that vast surface we
call the mucous membrane, which had defied for years
all medical skill, rendered me continually liable to acute
attacks, which, from their repetition and the increased
feebleness of my frame, might at any time be fatal.
Though free from any organic disease of the heart, its
action was morbidly restless and painful. My sleep was
without refreshment; at morning I arose more weary
than I had lain down to rest. *    *  *  I resolutely
put away books and study, sought the airs which the
physicians esteemed most healthful, and adopted the
strict regimen, on which all the children of _Esculapius
so wisely insist. In short, I maintained the same general
habit as to hours, diet (with the exception of wine, which
in moderate quantities seemed to me indispensable), and
so far as my strength would allow of exercise, as I found
afterwards instituted at hydropathic establishments. I
dwell on this to forestall in some manner the common
remark of persons not well acquainted with the medical
agencies of water-that it is to the regular life which
water-patients lead, and not to the element itself, that
they owe their recovery.  Nevertheless, I found that all
these changes, however salutary in theory, produced little
practical amelioration in my health. All invalids know,
perhaps, how difficult in ordinary circumstances is the




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alteration of habits from bad to good; the early rising,
the walk before breakfast, so delicious in the feelings of
freshness and vigour, which they bestow upon the strong,
often become punishments to the valetudinarian. Headache, languor, a sense of weariness over the eyes, a
sinking of the whole system towards noon, which seemed
imperiously to demand the dangerous aid of stimulants,
were all that I obtained by the morning breeze and the
languid stroll by the sea-shore.  The suspension from
study only affected me with intollerable ennui and added
to the profound dejection of the spirits.  The brain, so
long accustomed to morbid activity, was but withdrawn
from its usual occupation to invent horrors and chimeras.
Over the pillow, vainly sought two hours before midnight-, hovered no golden sleep. The absence of excitement however unhealthy only aggravated the symptoms
of ill health." In this condition he went to Dr. Wilson's
establishment at Malvern. The results of his experience
are thus detailed.
" The first point which impressed and struck me was
the extreme and utter innocence of the water-cure in
skilful hands-in any hands indeed not thoroughly new
to the system. Certainly when I went I believed it to
be a kill or cure system. I fancied it must be a very
violent remedy-that it doubtless might effect magical
cures, but that if it failed it might be fatal. Now I speak
not only of my own case but of the immense number of
cases I have seen-patients of all ages- all species and
genera of disease-all kinds of conditions of constitutions
when I declare, upon my honour, that I never witnessed
one dangerous symptom produced by the water-cure,
whether at Dr. Wilson's or the other hydropathic esta



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blishments which I afterwards visited. * * * The next
thing that struck me was the extraordinary ease with
which good habits are acquired and bad habits relinquished. The difficulty with which under orthodox
medical treatment stimulants are abandoned is here not
witnessed. Patients accustomed for half a century to live
hard and high, wine-drinkers, spirit-bibbers, whom the
regular physician has sought in vain to reduce to a daily
pint of sherry, here voluntarily resign all strong potations,
after a day or two cease to feel the want of them, and
reconcile themselves to water as if they had drank nothing
else all their lives.  Others who have had recourse for
years and years to medicine, their potion in the morning,
their cordial at noon, their pill before dinner, their narcotic at bedtime, cease to require these aids to life as if
by a charm.    Nor this alone.  Those to whom mental
labour has been a necessary, who have existed in the excitement and stir of the intellect, who have felt, these
withdrawn, the prostration of the whole system, the lock
to the wheel of the entire machine, return at once to the
careless spirits of the boy in his first holiday.  Here lies
a great secret; water thus skilfully administered is in
itself a wonderful excitant, it supplies the place of all
others-it operates powerfully and rapidly upon the
nerves, sometimes to calm them, sometimes to irritate,
but always to occupy. Hence follows a consequence,
which all patients have remarked, the complete repose of
the passions during the early stages of the cure; they
seem  laid asleep as if by enchantment.   The intellect
shares the same rest; after a short time mental exertion
becomes impossible, even the memory grows far less
tenacious, of its painful impressions, cares and griefs are




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175


forgotten; the sense of the present absorbs the past and
the future; there is a certain freshness and youth which
pervade the spirits and live upon the enjoyment of the
actual hour. Thus the great agents of our mortal wear
and tear, the passions and the mind, calmed into strange
rest-nature seems to leave the body to its instinctive
tendency, which is always towards recovery. All that
instructs and amuses is of a healthful character. Exercise,
instead of being an unwilling drudgery, becomes the
inevitable impulse of the frame braced and invigorated by
the element. A series of reactions is always going onthe willing exercise produces refreshing rest. The extraordinary effect which water taken early in the morning
produces on the appetite is well known amongst those
who have tried it even before the water-cure was thought
of; an appetite it should be the care of the skilful doctor
to check into moderate gratification: the powers of
nutrition become singularly strengthened, the blood grows
rich and pure-the constitution is not only amended, it
undergoes a change. The safety of the system then struck
me first; its power of replacing by healthful stimulants
the morbid ones it withdrew, whether physical or moral,
surprised me next; that which thirdly impressed me was
no less contrary to all my preconceived notions. I had
fancied that, whether good or bad, the system must be
one of great hardship, extremely repugnant and disagreeable. I wondered at myself to find how soon it
became associated with pleasurable and grateful feelings,
as to dwell upon the mind amongst the happiest passages
of existence. For my own part, despite of all my ailments, or whatever may have been my cares, I have ever
found exquisite pleasure in the sense of bein1, which is




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as it were the conscience, the mirror of the soul. I have
known hours of as much and as vivid happiness as can
fall to the lot of man, and amongst all my brilliant recollections I can recall no periods of enjoyment at once
more hilarious and serene than the hours spent on the
lovely hills of Malvern, none in which Nature was so
thoroughly possessed and appreciated. The rise from a
sleep sound as childhood's, the impatient rush into the
open air, while the sun was fresh and the birds first sang,
-the sense of an unwonted strength in every limb and
nerve, which made so light the steep ascent to the holy
spring,-the delicious sparkle of that morning draught,the green terrace on the brow of the mountain, with the
rich landscape wide and far below,-the breeze that once
would have been so keen and biting, now but exhilarating the blood and lifting the spirits into a religious joy;
and this keen sentiment of present pleasure, seconded by
a hope sanctioned by all I felt in myself and nearly all I
witnessed in others, that that very present was but the
step-the threshold     into  an  unknown     and  delightful
region of health and vigour-a disease and a care dropping from    the frame and the heart at every stride."'
The upshot of the whole trial was restoration to health.
Now we think all our readers will agree with us that Sir
Edward did well to go to Malvern; that had he staid in
London, even in the hands of the most skilful homoeopathic physicians, he would not have recovered so rapidly
' Confessions of a Water-patient, in Colbourn's New Monthly Magazine. Sept., 1845. Although we have reason to believe that there is a
good deal of exaggeration in all this, and that if Sir E. B. Lytton were to
write the account now that he would tone it down considerably, yet we think
it is instructive as showing the state of excitement and exhilaration produced by the water-cure on a sensitive nature.




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177


or so pleasantly.  It was "tute cito etjucunde."  And
the case is especially interesting as illustrating the
immediately anodyne influence of the water treatment
upon the brain and whole nervous system. This observation I have had frequent opportunities of making; and
those who have felt the importance of having some safe
anodyne at their command in the treatment of the disorders of the cerebral and nervous systems will fully
appreciate the importance of this discovery.  We think
it fortunate for science that so skilful a painter as Sir E.
Lytton Bulwer has given us two such pictures as those here
presented, the one of his feelings before, the other after
his water-cure. Nor do we regret the omission of all
details of his treatment, the important point for us practically is that it was effected at a water-establishment,
and that it required all the accessories of such an institution, including mountain air, fine scenery, good weather,
to effect the result. The next case we shall quote presents
interesting features both of resemblance and of contrast;
it is related by Dr. Gully.
"For several years, a lady of 48 years of age, had been
subject to most distressing and alarming head symptoms; intense prostrations; headaches; giddiness, that
caused her to reel; bursting sensation of the skull;
violent irritating pains constantly in the head. To these
were added great nervousness; bound bowels; scanty
urine; constant feverishness; vehement flushings of the
face, and cold feet. The pulse was large, but yielding
and most irregular; appetite small; sleep very much
disturbed.   She had undergone violent medication at
the hands of the first provincial and metropolitan autho12




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WATER-CURE.


rities, whose object appears to have been to derive powerfully from the head by such remedies as five grains of
Calomel at night, with some drastic draught in the morning; whilst little attention seems to- have been given to
the diet.  However, between the original malady and
the excessive irritation set up by the medicinal treatment,
the nerves, both ganglionic and cerebral, and their
centres were in the most alarming condition."     The
treatment was the following:" August lst.-Hot fomentations to the abdomen for
an hour at bedtime. The flannels changed every ten
minutes, and a wine-glassful of cold water drunk at each
change. Damp compress on the bowels to be worn
night and day. From three to four tumblers of cold
water to be taken during the day, to be taken in small
quantities at a time. Breakfast of cold toast and a little
butter-no liquid whatever. For dinner, three ounces
of animal food-mutton, beef, poultry, or game, three
times a week, with as little liquid as possible. On other
days the dinner to consist of a cup of cocoa, with cold
toast and butter, or of some farinaceous pudding eaten
nearly cold, very weak and almost cold tea. The pulse
becoming less hard and bounding; after this I proceeded with more decided treatment.
" 4th.-Packed    in wet sheet for an hour before
breakfast. Dripping sheet after it.  All the rest as before.
"c 5th.-The same, except that the shallow bath was
used instead of the dripping-sheet after the packing.
The patient remained four minutes in it, was well
rubbed, and had water repeatedly poured over her
head.




WATER-CURE.


179


" 9th.-Sitz-bath, at 700, for a quarter of an hour at
noon, was added to the above. Did not agree; headache came on an hour or two afterwards.
"12th.-Packing and shallow bath before breakfast;
a foot-bath of cold water, with some mustard flour in it,
for ten minutes, twice in the day; fomentations at night;
abdominal compress, three to four tumblers of water.
This was the treatment up to the 10th.
" 27th.-The head suffering a good deal, ordered footbath of mustard and water; also that the nape of the
neck should be rubbed for fifteen minutes with the same
mixture. Head immediately relieved. This instead of
the packing.
" 28th.-Packing as usual, then footh-baths in the
course of the day.
" September 2d.-Pulse considerably reduced by the
long-continued packing, fomentations, &c.    Somewhat
inclined to hysterics too; nervous headache. All these
signs indicating that the lowering process had been carried as far, or at least as fast, as the system could bear.
Therefore, on the
" 3d.-I only ordered the cold shallow bath before
breakfast, and the foot-baths as usual.
" 4th.-Shallow-bath on rising; foot-baths as usual;
sitz-bath at noon for half-an-hour. Rode out in a wheelchair at two o'clock for half-an-hour; came home and
vomited copiously until five o'clock. Here was the beginning of an internal crisis which the packing fomenta.
tions, &c., by removing the irritative state of the internal
organs, had enabled them to effect. The nervous condition of the second was the symptom of the commencing
effort which terminated in this manner.    The matter




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WATER-CURE.


vomited consisted of clear, frothy mucus, mixed with a
black, tenacious, heavy substance. A cold sitz-bath for
quarter of an hour after it, and fomentations at night,
removed all traces of the emetic tumult.
" 5th.-Shallow-bath in the morning; foot and handbaths three times in the day; sitz-bath for half-an-hour
at noon, and a quarter of an hour at five p.m. Discharge  of blood from   the bowels in the morning.
Another character of the internal crisis; head altogether
free from pain; and she said she felt lighter and better
than she had ever done.
" 6th.-Treatment as above. Fomentations at bedtime; walked more than a mile steadily; much better
to-day. In the course of the night colicky pains, followed by free diarrhoea, the bowels acting twice.
" 7th.-Treatment the same. Walked and then drove
out for an hour. Felt better than she had done from
the beginning.
" 8th.-Nothing but the shallow-bath. But as she
became languid from going to church she took a footbath, which soon restored her. Quite well in other
respects.
" 10th.- Some little feverish disturbance induced me
to order a packing to-day. Foot, hand, and sitz-baths
as before. * Head became bad from too long a drive.
Fomentations at bedtime.
"l lth.-After a good night felt well; ordered footbaths. Suddenly seized with copious vomiting and purging. Took sitz-bath after them, and went out quite
well.
" 13th.-Walked out twice and drove once; packed
in the morning in wet sheet. Two sitz and two foot



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181


baths, and several hand-baths in the day. A considerable quantity of blood passed from the bowels.
" 15th.-Sick again.
" 19th.-Head from the last week perfectly well, and
admitting of a good amount of exercise. This day, however, she overdid it, and the head became bad in the
night. Had not packed for three days; but on account
of the increased headache she, on the
"20th-Packed; did not walk out at all, took one
foot and one sitz-bath and a drive.
" From this time to the 24th.-When the patient left
Malvern she continued to take shallow-bath in the morning, two foot-baths, and two hand-baths. Throughout
the latter month of the treatment, the vomiting and
purging, with occasional discharge of blood from the
bowels, continued in various degrees; but I have only
noted the days when either of these were excessive.
Fomentations were frequently employed at night for
twenty or thirty minutes, according to the transitory
condition of the head; when it was worse, with increased strength of pulse, they were used; when it was
bad without that sign, additional foot-baths and sitzbaths were beneficially taken. This lady left Malvern
on the 20th of September, taking with her the following
directions, to be pursued at home.
"Shallow-bath, at 580, every    morning   for two
minutes.
" Two foot-baths, of ten minutes each, in the course of
the day.
"A sitz-bath at 650 for half-an-hour every other day at
noon, or at any time three hours after a meal.
"Wear the compress all day.




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WATER-CURE.


" It would be well to pack in the wet sheet once a
week or so, with the shallow-bath as above; but if all is
right in the head and bowels; that is, if the head is free
from  heat and pain, and the bowels sufficiently open,
omit this.
"Vegetable diet, except three times a week, when animal food may be taken at dinner.
"The deafness with which the patient was affected
varied in the course of her treatment at Malvern, but on
the whole diminished so much, that by the time she
left she could hear perfectly well, if too many voices were
not crossing each other at once. Perseverance in the
above directions at home completely relieved it.
"It should be recalled that previously to trying the
water treatment this lady, whose position in society is
high, had been rendered incapable of entering it; the
excitement of the smallest ' reunion' was too much for
her heart: besides which, the headaches were so frequent and so intense, that she could form  no engagement with the smallest certainty of being able to fulfil
it; whilst her increasing deafness was daily rendering
society impossible and distasteful to her. Neither could
she find pleasure in travelling; for ten or twelve miles
in the easiest carriage was more than she could bear in
one day. But after going through the above treatment
all was changed. Her headaches had gone-gone so far
that between September, 1844, when she left Malvern,
and May, 1845, when she returned, she had not more
than three attacks for a few hours (induced by mental
excitement), and of a vastly mitigated character, instead
of one or two bad attacks every week, and more or less
of it every day. The restoration of her hearing was her




WATER-CURE.


188


restoration to society.  And the certainty she had, that
at any time when the head had been tried by talking or
listening, she could put herself to rights with a wet
sheet and a foot-bath, rendered the life worth possessing
which had been for a long time previously intolerable.
In this altered state of circumstances she passed through
the winter of 1844-45. In the month of May of the
last year a considerable amount of mental excitement,
experienced whilst undergoing the physical excitement
of travelling from place to place, added to irregularities
of times of eating inseparable therefrom, brought back
some of her ailments; that is to say, some degree of
flushing, and a considerable degree of deafness; in all
other respects she remained well, showing the partial
character of the mischief.  Still the causes had been reapplied, and the effects were inevitable; and I therefore
recommended her return to Malvern for a short course of
more active treatment. Into this I need not enter; it
was as nearly as possible the same as on the former occasion, allowance being made for the safer condition of
the brain, and the consequent possibility of carrying on
the treatment more     fully at once.   Assiduous wet
sheet packing and fomentations soon brought on the
vomiting and diarrhcea crisis as before; the deafness disappeared still more suddenly than on the previous year;
and in every other particular her state has been one of
health since. Constantly taking medicine for years she
has not taken one drop or grain of any sort of physic
from the time she came under my care nearly eighteen
months ago. Undoubtedly, being of an excitable and
anxious nature, she will be obliged to minager her nervous system. However, she is able to visit and receive




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WATER-CURE.


company; she enjoys life, and is free from all chance of
apoplexy; none of which points she could attain under
the medicinal plan of treatment to which she had been
so long subjected, but the enjoyment of which she now
owes to the water-cure. It is very satisfactory to be
able to add to this case the following letter I received
from the husband of the patient, in January of the
year  1847;-' I   am   truly happy, at   the  commencement of the present year, to be able to tell you,
that during the space of the last eighteen months, my
wife has been in the enjoyment of good health, thanks
to your kind and judicious treatment by your excellent
hydropathic system.   She has been seventeen years
married, during which time I never knew her to be even
tolerably well, and latterly she had been getting worse
and worse, with constant pains in her head, tormenting
her by day, and depriving her of her rest by night. At
whatever place we visited we were obliged to call in
medical advice; and I may say that she had the first,
in and out of London, that could be obtained. Some of
them attributed her complaint to one thing, some to
another. There was no end to the application of leeches
and blisters, and her inside was literally inundated by a
variety of medicines, till she was visibly about to sink
under her complaint.   When I took her to Malvern,
such was her distressing state that, though the distance
from my home is only thirty-five miles, we were obliged
to stop a night on the road. A two months' residence
at Malvern, under your care, worked wonders, and now
enables me to say that she has been ever since, and still
continues, perfectly well, is quite free from all pain, and
is able to eat, drink, and sleep, as well as any one could




WATER-CURE.


185 "


desire; and our neighbours who know her former state
look at her with perfect astonishment. From the time
she first commenced your treatment to the present she
had not had recourse to any medicines or professional
assistance whatever," &c. &c.  " One of the accusations
against the water treatment is, that it is apt to produce
fulness of blood in the head and apoplexy. This is said
by persons who have no experience whatever of it, who
have never seen a single case of any sort treated by it.  I,
who have treated disease in no other way for the last six
years and a half, find a very different result of large experience, and were the choice given me of diseased conditions, wherein I could produce the most certain and
satisfactory effects, and show in the clearest manner the
safety and speedy efficiency of the treatment, I should,
beyond all comparison of cases, choose one of apoplectic
fulness."1
We have selected this somewhat long case for quotation for various reasons. We cannot but regard it as
one of unequivocal cure by water treatment, not merely
of recovery during the process, the length of the previous
illness, the immediate relief afforded, the ultimate completeness of the restoration of health entitle it to rank as
a cure. It is besides a very characteristic cure; it was
attended by those wonderful crises which remind one of
the medicine of the ancients, the improvement so frequently corresponded with a crisis as to leave no doubt
in the mind of Dr. Gully that the two stood to one
another in the relation of cause and effect. It would
lead to too long a digression to enter into a full discus1 'The Water-Cure in Chronic Diseases,' by James Manby Gully, M.D.,
&c., &c., 4th edition, London, 1851, pp. 220, et seq.




186


WATER-CURE.


sion of these critical discharges, but there are some practical inferences from their occurrence, it would be well to
bear in mind. Without venturing to assert that, in
every case, these violent perturbations of the system are
the result of setting loose the drugs which have been
previously taken, we cannot but think it is not improbable that such may be the case; for in the course of
treatment the perspiration is described as becoming impregnated with the most disagreeable odours, and in some
cases gamboge and other drugs are distinctly recognised. Now, it is hardly possible that when such drugs
are dissolved by the water imbibed into the system, and
enter into the circulation, as they must do before they
are thrown off by the cutaneous secretion, that they
should not display some of their characteristic effects on
the system; so that the copious draughts of water and
the solicitation of the augmented mass of fluid in the
body to the skin, forcing it in this way, to permeate a
great extent of capillary circulation, must have the same
effect as injecting into the blood a solution of various
medicinal substances, diluted by a large quantity of
water. In this respect, indeed, the water-drinking and
sweating process resembles the trituration of our inert
mineral medicines, by which their activity is brought
into play.   Whether this hypothesis of the cause of
these profuse, so called critical discharges, be admitted
or not, we think it is quite manifest, that during such a
process of severe handling, it would be absurd to expect
any action from  homoeopathic medication.    In fact, the
conditions for homceopathy do not exist. The symptoms
most prominent are not those of the disease, but those
of the treatment; and it would be as reasonable to




187 


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attempt to treat homceopathically a patient under the
action of the waters of Cheltenham as those of Malvern;
that is, to attempt to unite the two systems in effecting a
radical cure; for as we shall afterwards see, that watertreatment may be a good auxiliary to homceopathy; so
here, while the main treatment is by the power of water,
yet the transitory annoyances which attend this process
may be removed or alleviated by specific medicine; so
that while the water is effecting a radical reformation in
the constitution, homoeopathic medicine may prevent
many of the inconveniences which would otherwise attend
such a rude mode of cure. We are then brought to the
conclusion that there are cases better suited for the watercure than for homoeopathy, and that in these homceopathic medicine must play a quite subordinate part.
We shall find as we proceed that this class is small and
quite peculiar; and it is, of course, as much our duty to
discover and define the maladies which are thus curable
as it is to be prepared with the specific medicines for
those which we treat homceopathically.
My present opinion, formed after some months' residence at Malvern, in constant intercourse with patients
who had been, or still were, undergoing the water-cure,
and the careful perusal of the best authenticated cases
is, that the only kind of affections in the treatment of
which this method is unequivocally superior to any
other, is the class represented by the two examples
which I have cited, and which are both very well described, although from different points of view. It would
be difficult to designate them by any pathological denomination; but they must be quite familiar to all who
have had considerable practice in any large town, more




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WATER-CURE.


especially if the kind of pursuits most followed there,
involve severe and continued mental exercise or excitement; and on looking back upon my own experience, I
could at once point out several similar cases which held
out against all homceopathic medicines, and could not be
entirely reduced, although considerably mitigated in
severity.  In limiting thus the efficiency of the watercure, as compared to homceopathy, I should not wish to
be understood as rejecting the numerous cases which are
related as having been accomplished by it, more especially those of diseases of the stomach and the other
digestive apparatus, admirably described in Dr. Gully's
work. All I mean is, that there would be no difficulty
in finding parallel cases in the practice of every homceopathic physician; and while it may be in many instances
the wisest and pleasantest thing a dyspeptic can do to
pay a visit for six weeks to a good water-cure establishment, yet I do not consider that it is the duty of a
homoeopathic physician to recommend the step at once,
unless the case be quite an exceptional one; whereas I
do think that it is the duty of every physician to advise
a person in the condition Sir E. Lytton Bulwer described
himself to be in, rather to try the effects of the watercure than to put himself under a course of homceopathic
treatment. Not that this would inevitably fail to relieve
or cure, but that the chance of his speedy recovery is
greater in a water-cure establishment than anywhere
else.
Besides the class of cases which, unfortunately, in
this land of luxury and labour, is a very numerous one;
there can be no doubt that, as a detergent process to get
rid of the accumulation of drugs introduced into the




WATER-CURE.


189


body by the officious zeal of old physic, it is in many instances almost a necessary preliminary before successful
homoeopathic treatment, and it is held in high esteem by
many in the treatment of gout, rheumatism, and skin
diseases. Dr. Gully candidly admits he has never cured
gout by it, although he has mitigated the severity of the
attacks; we rather believe that most homoeopathic physicians would say the same; and it may be a question
which of the two systems is most effectual for restraining
this cruel disease. Probably it will be found that an
alternation of the two will be attended with the best
results. In regard to rheumatism, I am inclined to think
that there are some varieties of this complaint which
utterly defy all homoeopathic medicines from the deeply
morbid condition of the blood; and that in these cases a
thorough water-course by effecting a rapid and total
renovation of this fluid might enable our remedies to act
more benefically.
That the water-cure, unassisted by specific medicine,
cures any of those inveterate forms of skin disease which
defy other treatment I see no proof whatever, although I
know   that it affords temporary relief and transient
removal of the complaint in many instances; and I should
feel inclined to advise its trial in obstinate cases of lepra
and psoriasis, although I disbelieve its power of radical
cure in this unmanageable complaint.
Having now attempted to ride the marches, as it were,
of the province of the water-cure, in its character of an
independent power, asserting well-grounded claims over
a peculiar and definable class of subjects, let us pass on
to the second important consideration of the matter, and
try to ascertain what water-appliances may be usefully




190


WATER-CURE.


adopted by us as simple auxiliaries to homoeopathic practice. Nothing is more desirable in the present state of
homoeopathy than the addition of safe palliatives.   This
must be felt by all practitioners; and we are constantly
in danger of losing cases from our inability to afford
immediate relief without risking or greatly retarding the
ultimate radical recovery. Take for example a case of
long-standing, habitual constipation of the bowels. Is
it not most embarrassing either to permit or to countermand the use of some purgative? If we yield to the
patients' importunities we retard the cure, and in some
measure descend from our vantage ground of principle,
although we may be justified in so doing; if we hold out,
the patient is made very wretched for many days, even
weeks, and he may possibly throw up the treatment in
disgust. Now, it seems that water applications of many
kinds are agreeable and innocuous palliatives, and it is
right that we should number them among our resources.
So that we shall briefly detail those which seem to us
most useful, and indicate the kind of cases for which each
is best adapted.
To begin, with much the most celebrated and the most
common, CC wet sheet or towel packing," consists of the
following process:-a bed is so prepared, that laying a
wet sheet upon it shall not injure it. A sheet is dipped
in cold water and wrung out so that it shall not drip.  It
is then spread upon the bed, and the person who is to
undergo the process lies down flat on his back upon this
wet sheet. The attendant then folds the sheet over his
trunk and lower limbs, leaving his arms free. He is then
firmly enveloped in five or six folds of blankets, and
allowed to remain in this state of humid mummyism for




WATER-CURB.


191


about an hour; he then gets out, and a wet sheet is
usually thrown over him, with which he is forcibly
rubbed; after undergoing this process for a minute or so
he is very thoroughly dried with towels, and so the affair
ends. This is called wet sheet-packing; but instead of
involving the whole body, it is sometimes desired to envelope only a part; it may be the trunk or the chest; in
this case a wet towel is substituted for a wet sheet.
Although the prdcess has been often described, and
there has been a wonderful amount of extravagant talk
and writing about it, yet the only attempt at a scientific
determination of the physiological effect of this curious
artifice of Priesnitz that we are aware of is contained in
a work recently published by Dr. Howard Johnstone,
entitled  'Researches into the Effects of Cold Water
upon the healthy Body, to illustrate its Action in Disease;' and from this work we shall extract some tables
of considerable interest, showing the effect of wet-sheet
packing upon the action of the heart.
"First series of operations performed on an excitable
temperament.
Operation 1st, of one hour's duration.
Pulse  Respiration
per minute. per minute.
Before the process.. 104... 24
Immediately after... 84... 32
10 minutes after...76.. 28 Feels warm all over.
20 minutes after.... 72... 24
30 minutes after.... 66... 24 Still warm and con60 minutes after... 60... 22   tinuing so during
In shallow bath.... 72.. 24  the rest of the opeIn drying sheet.... 88... 28  ration.




192


192           WATER-CURE.


Temperature of the wet sheet, which was still wet and
steaming, 930.
Temperature of water in. shallow bath raised from
48-50' F. to 49-250 F.
st.  lb.  oz.
Weight prior to the operation... 8  0   6-1
Weight subsequent to the operation 8  0  5-2
Loss...        1oz.
In this experiment it will be perceived that on bringing the body in. contact with the wet sheet the pulse at
once fell twenty beats in the minute, nearly one fifth of
its whole -number of pulsations. It then for the space
of one hour, that is., the whole period of envelopment,
continued gradually sinking till, it counted only eighty
strokes, being rather more than two fifths less rapid than
it was before the process.
Operation 2d, -of one hour's duration.
Pulse  Respiration
per minute. per miun-te.
Before process... 100....24
Immediately after. - 7 2...36
10 minutes after.. 72... 28 Feels warm and corn2 0 minutes after -. 69..  27  fortable, and con.3 0 minutes after -. 64.... 18 -5 tinues so during
6 0 minutes after..60.. 19  the operation.
Temperature of the wet sheet, still wet and steaming,
910 F.
Temperature of the water in shallow bath raised from
52' F. to 52-75'.




WATER-CURE'.13


193


st.  lb.  oz.
Weight prior to the operation.  8   0  O-,
Weight subsequent to the operation 8 0 0
Loss..
Operation 3d, for one hour and ten minutes' duration.
Pulse   Respiration
per minute. per minute.
Before process...100....24
Immediately after. 80....32
10 minutes after..6 6... 23-5 Feels warm    and
2 0 minutes after..6 6.... 20   comfortable, and
30 minutes after..62..    23   remains so
60 minutes after.. 58..    18   throughout, be70 minutes after..58      IS.1  coming towards
In shallow bath..  96.... 26    the end quite hot.
In drying sheet..  77....27
Temperature of -the wet sheet, 930 F.
Temperature of the water in shallow bath raised from
480'F. to 49-33 F.
st.  lb.  oz.
Weight prior to the operation'...  8  0 1 0-4
Weight subsequent to the operation 8  0  9
Loss....   1 -  oz.
Operation 4th, of one hour and a half's duration.
Pulse   Respiration
per minute. per minute.
Before process...104....18
Immediately after. 82L.. 40
13




194


WATER-CURE.


Pulse   Respiration
per minute. per minute.
10 minutes after... 72.... 23 Feels warm.
20 minutes after... 70.... 24 Feels quite hot, but
30 minutes after... 64... 22     moist.   There   is
60 minutes after... 63.... 19 no perspiration on
90 minutes after... 60.... 19 forehead.
In shallow bath... 74.... 26 -
In drying sheet... 84.... 26
Temperature of the wet sheet 93~ F.
Temperature of the water in the shallow bath raised
from 45-250 F. to 500 F.
st.  lb.  oz.
Weight prior to the operation...8    0   7~
Weight subsequent to the operation 8    0   6
Loss....        1   oz.
Operation 5th, for one hour and forty minutes' duration.
Pulse   Respiration
per minute, per minute.
Before process.... 92.... 22
Immediately after.. 64.... 32
10 minutes after.. 64.... 24 { c,. comfortable; no
20 minutes after.. 71...... 24 Feels quite warm.
30 minutes after.. 64.... 22
60 minutes after.. 625... 22
1 h. & 40 min. after. 53....22
In shallow bath... 84.... 21
In drying sheet....84.... 29
Temperature of the wet sheet 99~ F.
Temperature of the water in the shallow bath raised
530 to 56~ F.




WATER-CURE.


195


st.  lb.  oz.
Weight prior to the operation... 8  0  4 -Weight subsequent to the operation 8  0  22
Loss....         2 oz.
Operation 6th, of two hours and a half's duration.
Pulse  Respiration
per minute. per minute.
Before process.... 96.... 19
Immediately after.. 84.... 32
10 minutes after. 70.... 22 Becoming warm and
20 minutes after. 72.... 22    comfortable.
30 minutes after. 72.... 21
1 hour after......64.... 21
2 hours after......64.... 24 Forehead still dry.
2 h. & 30 min. after. 64.... 27 Nowhere sweating.
In shallow bath... 76.... 24
In drying sheet... 76.... 24
Temperature of the wet sheet 950 F.
Temperature of the water in the shallow bath raised
from 60"75' to 61"75'F.


st.  lb.
Weight prior to the operation... 8 1
Weight subsequent to the operation 8  1


Oz.
51


Loss..


2- oz.


Operation 7th, of four hours' duration.
Pulse  Respiration
per minute. per minute.
Before process.... 72.... 17
Immediately after.. 52.... 18




196


WATER-CURE.


Pulse
per minute.


Respiration
per minute.


10 minutes after.. 54.... 25 Gett
20 minutes after.. 52.... 22
30 minutes after.. 48.... 18 Mo(
1 hour after..... 44.... 18
2 hours after..... 42.... 18-5
3 hours after......42.... 18
4 hours after..... 46.... 26
In shallow bath... 72.... 26
In drying sheet... 72.... 24
Temperature of the wet sheet, 950 F.
Weight prior to the operation...
Weight subsequent to the operation
Loss....;ing slowly warm.
lerately warm;
never hot.


st.  lb.  oz.
10 7 10
10   7   64


31 oz.


Operation 8th, of four hours' duration.


Before process..
Immediately after
10 minutes after
20 minutes after
30 minutes after
1 hour after...
2 hours after...
3 hours after...
4 hours after...
In shallow bath.
In drying sheet.


Pulse  Respiration
per minute. per minute..72.... 20. 54.... 20 Aft. 52....24..47....25. 45.... 22.42.... 31.. 42...22   1. 43.... 26. 44.... 26. 60.... 26.60.... 26


ter the first few
minutes he     describes himself as
very comfortable,
but neither warm
nor cold during
the   whole   process.


Temperature of the wet sheet, 930 F.




WATER-CURE.


197


st.
Weight prior to the operation... 10
Weight subsequent to the operation 10


lb.
6
6


Oz.
81
61
2


Loss....


3 oz.
4


Operation 9th, of four hours' duration.
Pulse   Respiration
per minute. per minute.


Before process.... 60.
Immediately after.. 56.
10 minutes after.. 48.
20 minutes after.. 46.
30 minutes after.. 44.
1 hour after....42.
2 hours after..... 40.
3 hours after..... 40
4 hours after..... 44.
In shallow bath... 56.
In drying sheet... 72.


24. 25 Experiences what he.  20   calls a comfort-... 25  able, pleasing and. 21    soothing   effect,.  19   but is not de-.  20   cidedly warm..  19-5... 20
S. 28... 28


Temperature of the wet sheet, 92~ F.
Temperature of the water in the shallow bath raised
from 47-50 to 490 F.


st.
Weight prior to the process......10
Weight subsequent to the process. 10
Loss....


lb.
6
6


oz.
OZ.
0


z.
2 oz.


The obvious deduction from these important experiments is, that wet sheet packing acts as a direct sedative
upon the heart's action.   It does not reduce the whole




198


WATER-CURE.


weight of the body to any appreciable amount, so that
there  can  be but little loss by perspiration.  The
rationale of the operation seems to be, that heat is
slowly abstracted from the body, while the temperature
of the skin is maintained, so that there is no sensation of
cold.  In fact, it might be called a slow dose of cold.
The fall of the pulse and the general sense of languor and
sleepiness are exactly similar to what is described as the
first effects of severe cold. And we cannot but regard
it as a valuable discovery, that we should be able to command the action of the heart so effectually without producing any unpleasant or dangerous symptoms. There
are many cases of over-action of the heart which are in
themselves very distressing, and which often give rise
ultimately to organic lesions, either of that organ, or of
the brain, and which are sometimes difficult to subdue
by any homoeopathic medicines; in such cases, I am of
opinion that wet sheet packing might be resorted to with
great advantage. Of its perfect safety there seems to be
but one opinion on the part of all who have had such
experience of it as to make their testimony of any
value.
Next in frequency to the wet sheet packing, both on
account of the novelty of the appliance, and its manifold
utility is the wet-compress.  This consists in a strip of
sheeting or table linen of sufficient breadth to reach from
the pit of the stomach to the hips.  So much of this is
wetted as is enough to go round the body except about
four inches on each side of the spine, and several plies
are then wrapped over it so as completely to exclude the
air and prevent evaporation: or, instead of this somewhat cumbrous method, a piece of Mackintosh-cloth is




WATER-CURE.


* 199


bound over the wet portion. This is frequently worn
night and day, and is changed as often as it becomes
dry. The operation of this constant poultice is of a very
complicated kind. It acts by simple mechanical pressure upon the abdominal muscles, and gives relief in this
way: it also acts as a soothing application when there is
much irritation of the viscera, so that it has been called
an opiate to the abdomen, and is found very beneficial
in cases of nervous indigestion attended with sensitiveness of the surface to pressure. Dr. Gully recommends
its removal during a meal, especially dinner, and for an
hour after it, as it seems to increase the sense of fulness
and discomfort in the stomach if worn at that time.
Besides acting in this soothing way, it must also operate
as a counter-irritant, for sooner or later it causes an
eruption of some kind on the part where it is applied.
This is not surprising, but it has another very curious
effect, which seems to depend upon some endosmosic
action, for there is generally, or at least frequently, an
exudation of glutinous matter. " In one case," Dr.
Gully says (of bad nervous headache in a lady who had
taken enormous quantities of physic for it), " I saw an
exudation of matters of a brownish hue, which stiffened
the compress as if with starch, and gave out the unquestionable odours of colocynth and aloes.    It continued
for one week in varying quantity, then ceased, and broke
out again in five weeks afterwards, continuing for a fortnight, and smelling of aloes, gamboge, and, at times, of
camphor. I have often seen colours and smelt odours
of various kinds pervading the compress, but could
never be certain of either beyond a strong medicinal
smell.  In the instance alluded to, there was not the




200


WATER-CURE.


slightest doubt upon the subject."      One of the most
important of its effects in a practical point of view for us
to be aware of is, that it acts in very many cases as a
certain and mild aperient, if worn for three or four
hours. It would be interesting to know whether it
acted in this way by inducing a transudation of medicine, already in the system, through the skin, or by
stimulating the torpid bowels, or by allaying the irritability of the spinal nerves.  For it is manifest that the
laws of reflex action must come into play when so considerable a stimulant or sedative is applied to the large
surface of the abdomen.      Indeed, there seems a most
interesting field for observation and experiment in regard to the whole modes of action of this and many
other applications used by those who practise the watercure, and, I trust, that either Dr. Gully, or some one
else of large experience and ability, may, before long,
treat the subject in a more scientific and less popular
style than has hitherto been the fashion of the writers on
this department of medicine.
The value of local wet bandages in rheumatic inflammation of the joints is pretty generally admitted. They
are used, at least cold water is employed, very freely by
Dr. Fleischmann, in the Vienna Hospital, and there
seems to be no ground whatever for the notion, at one
time prevalent, that there was a danger of their inducing
a metastasis to the heart.  On the contrary, the allaying
of the pain and the subsidence of the local inflammation,
tend to prevent rather than to excite endocarditis, which,
according to some very high authorities, is a constant
attendant, in some degree, of all acute rheumatism.
The compress is said to be of use in that form       of




WATER-CURE.


201


enuresis which depends upon over-sensitiveness of the
neck of the bladder. In such cases, it should be worn
upon the perineum by means of such a bandage as is
used to support the testicles.  It is not found generally
to be of any avail against neuralgic pains, although it is
said that in paroxysms of sciatica, a large wet compress
round the thigh gives pretty certain relief. After the
compress is removed, the part should be washed with
cold water to prevent its too great sensitiveness to the
air, on the same principle that the whole surface is
spunged after a wet sheet packing.
We consider that a case is now made out for admitting the wet compress into our army of auxiliaries, and
employing it in various forms of nervous and mucous
indigestion as a sedative and aperient, as well as in local
inflammations, and as far as my observation goes, it is
not only quite harmless, but positively agreeable to
most patients.  It would serve no good purpose to enter
into a minute detail of all the various kinds of baths and
other methods of applying water employed by those who
practise the water-cure.  It will be time enough to do
so when they are agreed among themselves as to the particular cases for which each is appropriate. And it is
hardly possible to hear without a smile the merciless.
criticism with which one frequently dissects the treatment recommended by another; for, in fact, it is as yet
an entirely empirical mode of cure, and its promoters
explain the benefit derived by totally opposite physiological principles. Indeed, all the books hitherto published upon the water-cure in this country, are full of
gratuitous assumptions, many of which are denied by
all physiologists, and the others, even if admitted, would




202


WATER-CURE.


be refused the exclusive prominence given to them by
what might be called the medical unitarianism of the
writer. Nevertheless, as it is impossible for the physician to have' too large a supply of resources in the management of the numerous and tedious and complicated
diseases he may have to treat, it may be as well to mention one or two of the more favorite processes at present
in vogue at Malvern, and I presume elsewhere. One of
the most agreeable is the soap-lathering, as it is called.
This consists of covering the whole surface with soap, made
into a lather with tepid water, by means of a piece of
flannel, and then washing it off with pure tepid water. Of
course, this is nothing but a simply detergent process, combined with more or less friction. It probably induces a more
rapid and healthy exfoliation of cuticle than is usual, even
in perfect health, and the soap, by uniting with the oleaginous matter continually being secreted by the sebiparous glands, favors its ready expulsion from their ducts,
which are intimately connected with the hair-bulbs, and
thus promotes the healthy growth of the hairs. The
immediate relief given by this in many acute affections
is worth knowing. I have at present under my care a
gentleman affected with a very severe and long-continued
attack of rheumatic ophthalmia, attended with intense
pain in the head.  His suffering is immediately relieved
by the soap-lathering, and the feverish symptoms abate,
and are succeeded by a sense of ease and comfort which
it would be impossible for any medicine to afford. The
effect is probably due to the soothing influence of the
soap-rubbing and washing, reducing the excessive sensitiveness of the nervous system, which makes the other
nerves sympathise too keenly with the morbid sensation




WATER-CURE.


203


in the eye. Whatever the explanation may be, there is
no reason why patients suffering from   local inflammations of a similar kind, should not enjoy the alleviation
afforded by this simple and cleanly process.   And it is
so agreeable, that many persons continue it after the
reason for its first administration has passed away, from
the grateful general sensation it usually promotes in the
system.
The dripping sheet is another highly fashionable appliance. A large sheet is dipped in cold water and
thrown over the patient so as to cover his head, the bath
attendant then rubs his whole body very smartly with it,
and afterwards dries it with a hardish towel. This
produces a pleasant glow of the surface, and stimulates
the whole system into a condition of conscious vigour.
It is generally used in the morning, and is a very pleasant
and healthy kind of cold bath.
The sitz bath is so familiar to all practitioners as not
to require any special description. The immersion of
the lower part of the trunk in water for half an hour at
a time, more or less, has often a very beneficial effect in
cases of constipation, haemorrhoids, and leucorrhoea. It
obviously acts at once as a sedative and gentle stimulant,
allaying morbid irritability, and promoting the action of
the muscular system of the abdomen. In common, I
presume, with most of my colleagues, I have long been
in the habit of employing this form of bath, and can
confidently recommend it in the class of cases I have just
indicated.
The douche belongs so exclusively to the province of
the water-curist, that it would be profanation on the
part of the uninitiated to speak of its mysteries, but




204


WATER-CURE.


there is a sort of miniature douche recommended by Dr.
Gully, and thus described by him, which is well worthy
of our consideration, as he gives tolerably precise indications for its use. " The patient sits on a board placed
across the lower end of a shallow or sitz bath, with his
back turned towards the bath. The bath attendant then
dips a towel into a large can of cold water, and rubs it
up and down the length of the spine, not waiting till it
is warmed by the patient's body, but constantly changing
the water in the bowl, so as to renew the shock of
the cold as often as possible. This is continued from
three to ten minutes.
"The operation of this application will be sufficiently
Sobvious from what has preceded.   It stimulates by the
constantly renewed cold; and the reaction is so great as
to amount to the sensation of burning along the track of
the spine. Applied, too, as it is, immediately over a
great nervous centre, it has a more direct and powerful
action on the nerves of locomotion and sensation proceeding thence over the whole frame.  By virtue of this
it clears the head, when it is confused, pained, or lethargic;
it gives alacrity to the limbs, and spreads over the skin
a sense of comfort which is due to the stimulus propagated along its nerves.  Further, by the sympathy with
the organic nerves, it expels flatus from the stomach and
intestines, and occasionally acts as a very speedy aperient."
So far Dr. Gully.  It seems to resemble in its effects the
application of galvanism to the spine, and is certainly,
on the whole, much more easy of administration, and
attended probably with greater advantages.    I have
seen excellent effects from galvanism in cases of torpid
bowels and imperfect digestion, depending   on some




WATER-CURE.


205


forms of spinal irritation, and   for such  cases in
future I should be inclined to try spinal washing in
preference.
Hand and foot-baths are frequently used, and are said
to relieve nervous headaches.  A shallow foot-bath taken
at bed-time is undoubtedly useful in warming the feet
when they are so cold as to interfere with the sleep of
the patient, and the same remark applies to general
washing of the whole body before going to bed.
With regard to the potations more than pottle-deep of
water once so much in vogue, they have rather fallen into
abeyance, but are still employed when there is torpidity
of the system, and a glass of cold water on rising in the
morning not unfrequently procures a motion of the bowels
in persons subject to constipation, and supersedes all
other treatment.
Such is a brief survey of the water-cure from  the
purely practical point of view, and before closing these
remarks, it may be well to point out the kind of cases
which we believe are not likely to benefit by it, for the
ultimate responsibility falls upon the permanent medical
adviser, and not altogether upon the water-cure practitioner. 'He naturally gives as encouraging a report of
the probability of a patient's deriving benefit from a
course of treatment as he well can, and this added to the
sanguine expectation of those who have made a considerable effort to reach the waters of healing, very frequently
induces patients to remain for months, and afterwards to
leave no better and often worse than they came. For
there is this manifest difference between the water system
and all others that it cannot be given up at once. The
person who undergoes it is told he must expect to be




206


WATER-CURE.


worse before he is better, and finding the first part of
the promise fulfilled, he lingers on in the hopes of the
fulfilment of the second, and at length, after wasting
months and undergoing great pain it may be, and certainly discomfort, he has the mortification to discover that
his was not a suitable case for the treatment, and returns
to his old medical adviser complaining of his disappointment.   One   of the   most distinguished   and  liberal
physicians in the kingdom lately told me, that he very
frequently met with such cases, and the observation is
corroborated by my own experience. I do not wish to
impute blame to the practitioners of the water-cure, but
to guard against having too sanguine expectations from
the process; for there is something so imposing in the
popular description of these places, and in the magnificent
water-palaces where the local Neptunes hold sway, and
in the whole armament of water power which meets the
eye, that it requires considerable scepticism to doubt
that before such a stupendous machinery of healing
force, disease of every kind must not at once capitulate.
However, this is not the case, and, as a general rule, few
specific organic diseases seem to be much affected by it,
and I believe that cases of spinal irritation and uterine
diseases are very often positively aggravated by watertreatment. I mention these two especially, because they
have come under my own observation, and because it is
rather the fashion to send patients of this kind to some
of the water-cure places.  Of course it is hardly necessary to say anything about chest-complaints, the common
sense of this country is sufficiently alive to the risks persons so afflicted must inevitably run. Neither are renal
diseases likely to be benefited, but liver complaints cer



WATER-CURE.


207


tainly are very often improved by the water-cure, and
some of the most striking cures Dr. Gully has published,
are of this disease. However, there are few diseases
over which homceopathic medicine has more power, so
that it would be unfair to give the preference to the
water-cure, although it is quite fair to admit its innocuousness and even great utility in these cases. We cannot
conclude without expressing a hope that those who preside over these important institutions may be penetrated
with a deep sense of the responsibility of their position,
and by the integrity of their conduct, and the purity of
their lives, and the dignity of their proceedings, silence
the charge of cupidity which is so often advanced against
them, and, as they occupy a very prominent place in their
little locality, they may set such an example as to give a
high moral tone to the devotees who congregate round
their shrine, and repress to the utmost the evils naturally
engendered by perfect idleness, and the continual meeting of people whose sole subject of interest is their
own complaints and those of their neighbours. And as
the washing of the body has been accepted in all ages
as an allegorical symbol of the purification of the mind,
may this symbol be still respected, and may the physician
and the patient alike remember that the rite of baptism,
if properly pondered, has a daily significance in a christian land.




CHAPTER VI.


SECTION I.
ON SOME AFFECTIONS OF THE HEART.
rTHAT diseases of the heart are generally incurable, and
suddenly fatal, is a popular, but altogether erroneous idea.
No doubt most cases of sudden death arise from some
affection of this organ, but the proportion of persons
affected with heart-complaint of a necessarily fatal
character, compared with those in whom it exists of a
kind and in a degree which brings it within the sphere
of successful medical treatment, is comparatively trifling:
in fact, there is no class of organic affections in which
the art of medicine can effect so much, nor any other of
which we can speak with so much certainty as to the
consequences, both direct and indirect. Nor should thi's
surprise us,, when we examine the subje -ct 'witli the calm
light afforded by physiology; and by a dispassionate
consideration of the nature and functions of the heart,
free our minds from the vulgar dr-ead of some impending
mysterious and appalihng calamity, which is apt to lurk in
the phrase of " disease of the heart."
The heart is the most muscular organ of the body, the
fibres are more highly developed than in. any other
muscle, and its enormous power may be estimated by the




SOME AFFECTIONS OF THE HEART.


209


fact, that, although no bigger than the fist, it exerts a
force equal to more than fifty pounds.1     This is in its
normal state; when enlarged by hypertrophy of its walls
its power must be much greater. It has been for long,
and still is a question, how far the circulation is due to
the heart alone. There is no doubt that a circulation is
possible without a heart: the first blood that flows in
foetal life flows to, not from, the centre of the circulation;
and instances are on authentic record, of foetuses growing
to maturity without a heart, and in some of the cases
without any communication with a heart, although in
general this malformation occurs when there are twins.
And after all the heart possesses no structure, nor is it
capable of any action which is not also found in a less
degree in the arteries and veins; so that, viewed from
its mode of growth and transformation, it may be regarded
as a portion of artery and vein enormously developed in
particular directions; and in some of the lower tribes of
animals, it is impossible to say whether they have several
hearts or no heart at all, and only a main artery.consisting of a series of pouches. The experiments of various
distinguished physiologists leave no doubt about the fact,
that both arteries and veins are capable of spontaneous
contraction, and the former of dilatation on the application of certain stimuli after the vessels have been removed
from the body.2 Although with such evidence before
us we cannot doubt, that in primitive and abnormal
states of the system, the blood-vessels may powerfully
1This is an approximative statement, resting on the experiments of
Keil, Hales, and Poiseuille, and accepted by Burdach in his work on
physiology.
2 See 'Verschuir de venarum et arteriarum vi irritabili.'
14




210


SOME AFFECTIONS


contribute to the circulation of their contents, yet for all
practical purposes, we may safely regard the heart as the
sole propulsive force in mature life, and in almost all
circumstances, both of health and disease.   And the
simplest and most correct view to take of its action is
that of a machine combining the powers of a force pump
and an air-pump: during its contraction acting as the
descending piston of the fire-engine, and propelling with
great force a column of blood into the arteries, and during
its dilatation acting as an air-pump, and sucking from
the veins an equivalent amount. And let us add to this
simply mechanical idea of the heart, that it is also so
largely supplied by nerves of emotion, that every feeling
of sufficient intensity provokes in the centre of organic
life some corresponding change, and that thus the
spiritual and animal existence are here united in wedlock.
And hence it is by no accident that the heart is accepted
as a symbol of the affections, and has retained this figurative dignity, from the earliest records of our race, and
will probably continue so to do to the end-the symbol
of a range of feeling extending from that of the devotee
kneeling in his cell before the transfixed heart, to the
cottage girl blushing over a first valentine.
Not only with the brain, the original material source
of all mental and emotional perturbation, but with
every part of the body endowed with sensation, does the
heart maintain an active sympathy; and thus by the
pulse is tested how far the general well-being of the
animal economy is compromised by any local lesion.
To enable the heart to perform its work as a pump, it
requires that, like any other pump, it should be provided
with valves to regulate the ingress and efflux of the fluid




OF THE HEART.


211


whose cujrreilts it urges and directs; and as for such a
purpose, muscular tissue is obviously unfit, the internal
lining of the arteries and veins is gathered into folds
and filled with muscles and tendons, which brace them
down when closed, and permit them to flap freely when
open. So that we observe, the heart is mechanically
the most complicated organ, and functionally, and in its
intimate structure, one of the most simple organs in the
body. It is this peculiarity which renders the knowledge of its diseases comparatively easy, however difficult
their treatment may be. For here we have not to do
with inscrutable molecular actions, such as those which
originate and regulate the various secretions, the morbid
alterations and degenerations of which, are only cognizable, and not explicable-tubercle and malignant transformation generally, for example-but all we have to
investigate in diseases of the heart, at least in by far the
greatest proportion of them, requires far less knowledge
of physics than is to be found in every engine-factory:
and by the simple application of facts, plain to the unassisted eye and reason, the whole complicated and dismaying phenomena, which follow a derangement in the
structure of the heart, become resolved into the inevitable results of the opening of a valve when it should be
shut: as all the horror and disaster and confusion of the
explosion of a steamer results from placing a few extra
pounds on the safety-valve.
Why so much mystery should have been made about
the sounds of the heart, is difficult to understand, far
more difficult than the matter itself.  If there had been
no sounds from the working of such an enormously
powerful force-pump, with its double set of valves formed




212


SOME AFFECTIONS


of elastic material, alternately relaxed, and suddenly, by
a violent jerk, stretched to their fullest tension, and this,
too, in a chamber full of fluid, and containing also a
sensible portion of air, then, indeed, we might be expected to be overwhelmed with wonder. However, we
may now look upon the days of this mystery as over;
the thing is so simply explained, and the rational explanation so generally accepted, that in future we may be
favoured with treatises on heart diseases, which do not
occupy a hundred pages in explaining what may easily
be done in as many words. If we have once clearly
before our eye what takes place in the heart during
health, nothing can be simpler than the deductions of
the changes that must have preceded the appearance of
any morbid phenomena arising from       this source.   Let
us suppose the blood, gathered by the veins from the
various parts of the body, and flowing from     the great
main trunks into the two auricles, which are of a similar
nature to themselves, and, indeed, may be looked upon
as mere venous pouches, with a large development of
muscular tissue; these pouches bear       distension with
venous blood, which is congenial to their own nature, up
to a certain extent, and then, from a sense of being over
full, they quietly pour their contents into the two ventricles.  But the moment the dividing sluice between
the two chambers is open, a sudden change takes place;
for, in the first place, the advancing column of blood is
not allowed to flow at the sluggish rate impressed upon
it by the auricle, it is sucked into- the ventricle with
great force,1 and this powerful hollow muscle having
I That the ventricle expands with muscular activity, is proved by experiments in which no pinching, pricking, or galvanizing could arrests its ex



OF THE HEART.


213


filled itself, discharges its contents with still greater
energy along the channels prepared for it-that is, along
the aorta and pulmonary arteries, which lie with open
mouths to receive the column thus propelled into them,
while at the same moment, the valves which separate the
auricles from the ventricles flap to like folding doors of
hide, and as they close vibrate throughout their whole
extent, and set the chords which brace them to the floor
of the chamber ringing in unison, and thus the prolonged cleek, the so-called first sound of the heart, is
produced. Scarcely a moment after the ventricle has
contracted does it again expand, and suck a new supply
of fluid out of its feeding auricles, but not out of the
arteries, else there would be no circulation-only agitation.  To prevent this, the valves which hang at the
mouths of the arteries, are closed by the action of the
over-distended arteries themselves, which repeat the
stroke of the ventricle, and in suddenly shutting their
valves make a sharper, quicker sound-a sort of click;
hence the double sound, the cleek-click of the heart,
which might, without any great stretch of fancy, be compared to the challenge and reply of the two sentinels at
the gates of life: the one at the mitral and tricuspid
valves uttering its loud challenge, and the one at the
semi-lunar valves repeating the countersign in a shriller
voice.
As it is the same stroke that closes the ventricular
valves and sends the blood along the arteries, by which
they are made to throb, it is plain that any imperfection
in the mitral valve, which gives rise to an unnatural
pansion when once begun. See experiments by Fontaine, referred to in the
sixth vol. of Burdach's ' Physiology,' p. 301, French translation.




214


SOME AFFECTIONS


sound, instead of the "all's well"-cleek, will occur at the
instant of the filling of the vessels, and may be perceived by the finger upon the pulse.    If the abnormal
sound correspond with the beat of the pulse, the chances
are, it arises from  some mischief about the mitral valve.
Of this we shall speak more fully in the sequel, we
merely advert to it now as an obvious inference from the
construction of the heart.  Another equally obvious one
is, that the imperfect closure of either sets of valves will
allow of a reflux of blood along the channel by which it
arrived; if the mitral gate, then it will flow back into
the left auricle and oppress the lungs; if the right ventricular valve be deficient, then it will flow back upon
the right auricle; and the pulsations of the heart will be
transmitted along the great veins, gorging the liver, preventing the proper descent from the heart, and generally
impeding the whole capillary circulation; and thus producing dropsy and other-dreadful consequences. And
it will readily be perceived, that although at first only
one half of the circulation may be affected by the destruction of a portion of one side of the heart, yet that
in reality our so-called double circulation is in such intimate union, that neither portion can long remain injured
without seriously compromising the integrity and regularity of the other, on mechanical principles alone, independent of the living sympathy which specially unites
them.   Thus, if we suppose an injury to be done to the
mitral valve, so as to make it useless; the first effect
will be, that the blood is forced back upon the lungs,
the lungs, thus gorged and irritated, are no longer in a
fit state to receive the allotted quota from the right
ventricle; this part of the machine finds unusual obsta



OF THE HEART.


215


cles to contend with, and in accordance with the law of
muscular development, waxes stronger and larger in
consequence.  Hence hypertrophy of the right side,
with all its consequences, is the inevitable result of imperfection of the mitral valve. We might prosecute the
illustration in all directions, but it is sufficient for our
present purpose to bear in mind the fact, that disease of
one, part of the. heart will inevitably cause -disease in
other parts, if it be allowed to go on, and that, in treating heart complaints, we must regard the organ as a vital
whole, and not as merely a pump with two separate and
independent cylinders.
One of the most gratifying and important objects we
attain by an accurate knowledge of the principles by
which we can ascertain the real condition of the heart,
is, that it enables us to distinguish, with absolute certainty, between nervous palpitation and organic disease,
and in this way to give immediate and unspeakable relief
to the sufferers, who generally aggravate their distress
by their anxiety; and thus simple and certain knowledge
becomes a remedial power of the highest value, by extinguishing one of the chief feeders of.the malady. And
it is fortunate that the symptoms of nervous palpitation
and organic disease, although so nearly alike to the unpractised eye, are yet so essentially dissimilar as to put
it in the power of a mere tyro in medicine to assume,
without presumption, the dogmatic confidence, without
the ambiguity, of an oracle. The stethoscope, here,
well deserves its name; it realises the legendary request
to Jove, and actually, so reveals the state of the heart,
that it could not be more perfectly understood, even
though seen instead of heard; and if, by so doing, it




216


SOME AFFECTIONS


sometimes communicates a death-warrant, it much more
frequently britlgs a reprieve.
That an organ so endowed with sympathetic sensitiveness, should be subject to great functional irregularity,
is no more than we might have anticipated. The kinds
of irregularity arise from three different sources.  First,
from the heart itself being in a morbidly irritable state;
second, from the blood which reaches it being unnatural
in its conditions; and third, from the direct over-stimulation of strong emotions, acting through the nervous
system.
Palpitation of the heart, arising from too great irritability of its substance, may be readily distinguished from
that which originates in structural disease, by the
suddenness of the accession of the attacks, and the
pulsations of the heart, however vehement they may be,
not having that force which characterises palpitation from
hypertrophy.  They rather resemble the flutter of a
caged bird than the successive strokes of a hammer.
It is not easy to say on what this over-irritable condition depends, and systematic writers on the heart do
not seem to have paid sufficient attention to it as a specific
affection, which I believe it to be.  I have met with it in
otherwise robust and healthy men, who have suffered from
fevers, especially the Indian fevers, and also in those who
had had the cholera, and I am disposed to think, that
the animal poisons, which occasion these diseases, act
specially upon the nervous tissue of the heart, and leave
the organ in a state of preternatural irritability. Whatever be the cause, it is an affection attended with great
alarm and distress, and very difficult to subdue.  It
occurs as frequently in men as in women, and seems not




OF THE HEART.21


217


in any way related to the hysterical palpitations which
are so common among the latter. Some years agol, I
met with a very troublesome case of this kind, an outline
of which will better indicate the signification of the term
"C irritable heart, " than the mi-ost laboured generic
description.
I was sent for one night at twelve o'clock, to see a
gentleman who lived a few miles out of Edinburgh. Trhe
patient was a remarkably vigorous, healthy man, about
sixty years of age: I found him in bed in a state of the
greatest alarm; he told me that for some hours he had
been suffering from the most violent palpitation of the
heart, and that he feared he was going to die. On
examining the chest I could detect no symptoms of
disease; his tongue was clean too, and he did not
complain of any gastric symptoms. Except a certain
paleness of the face, and this tumultuous action of the
heart, which heaved and throbbed in a most irregular
and violent manner, there was no other symptom of
illness about him. I tried to give him confidence, thinking that the violence of the attack, whatever might be
its origin, was aggravated by his alarm at- its imagined
consequences; and I gave him a dose of aconite. In the
course of half-ani-hour he was a little better, and against
his urgent request I went home (it was during the prevalence of cholera, and I did not like to be away at
night; besides, I was sure there was no danger).  At
six o'clock I was again sent for, and I found the gentleman in the same state as before; he said it had come on
immediately after I had left, and continued till the time
of my second arrival. He was very much alarmed, and
expressed  a strong  wish  for a consultation.   Dr.




218


SOME AFFECTIONS


Henderson was called in; he gave a very decided opinion
that there was nothing the matter, and we did what we
could to reassure the terrified patient. Ignatia and
Lachesis were left with him, to be taken alternately: the
attack gradually subsided, and he was restored to his
former state of health in the course of the day.  The
only cause I could assign as exciting the attack, was,
that he lived in a large lonely country house, and from
being deprived of the society of an only child, he had
fallen into a somewhat nervous condition. But there
was nothing about his manner or appearance to indicate
such a state of the heart. Although this patient seemed
perfectly well, yet he died in the course of the following
autumn, under the superintendence of an allopathic
surgeon, nominally of pneumonia. Whether the violent
nocturnal attack of palpitation had any connexion with
his subsequent fatal illness, I cannot say; but I can
hardly suppose that so peculiar a functional derangement
could have gone on for a whole night without some
organic cause, and this cause, I imagine, was a condition
of excessive irritability of the heart. I had for some
years under my care a married lady, who had suffered
from almost constant tumultuous and irregular action of
the heart, attended at times with very acute pain: she
described the sensation as if her heart were tightly
grasped.  Neither in this case, nor the one just related,
was there any material disturbance of the respiration.
The absence of this complication may be regarded as
decisive against serious organic disease. The case of the
lady proved an exceedingly difficult one to manage; she
was subject to neuralgia, and of highly organized nervous




OF THE HEART.


219


constitution altogether.  However it will be best to defer
till late all reference to treatment.
How far the presence of gout in the constitution gives
rise to these anomalous actions of the heart, it is not easy
to say; it is quite certain that in gouty people all kinds
of odd affections of the heart are met with, and they are
among the most puzzling complaints that present themselves to our observation. Among them we place a
tendency to faint; from some peculiarity we may call it,
perhaps loss of tone in the heart.   It is not easy to
understand the ultimate pathology of a faint, but in a
rough way we may say, that it is either from deficient
stimulus being applied to the heart, as in deliquium, from
loss of blood, or from  deficient activity, and perhaps
amount of nervous matter in the heart, on which its
contractile power depends. Although generally merely
death's image and attended with no danger, yet there
seems no doubt that in some csaes it is its forerunner,
and in cases where there is no organic change of a
scrutable character.  This was the case with the distinguished divine, the late Dr. Chalmers. He fainted into
death.  There was no appreciable disease of the heart,
and the probability is that had there been any person
present to apply some stimulus.to the inanimate frame
at the moment of fainting, he would have recovered.
Dr. Hope in his 'Treatise on the Heart,' speaks of
members of the medical profession as being very subject
to palpitation of heart, which deludes them    into the
notion of having disease of that organ.  I have met with
it very often in clergymen. It seems to be a natural result of much mental exertion, combined with anxiety,
Of the bodily causes which give rise to it there is none




220


SOME AFFECTIONS


so powerful as masturbation, and this may be suspected
when we meet with much palpitation in young men
without any corresponding wear and tear of the nervous   system, or irregularity of regimen to account
for it.
These are some of the chief forms of inorganic palpitation of the heart which are met with in practice, and I
would; before proceeding to remark on their treatment,
repeat the observation that they do not seem as yet to
have attracted sufficient attention from those who have
written  specially  upon   the   subject  of heart-affections.
We must not forget to enumerate among the predisposing causes of this affection what I believe to be one
of the most common, an over-indulgence in tea, coffee,
and tobacco.   How far the health of the next generation
will be affected by the substitution of these stimulants of
the spinal cord and nerves, of the sympathetic or respiratory system  for the alcoholic stimulants, whose action
was chiefly confined to the brain, is a question which
ought to make us pause, to say the least, before we yield
implicit faith in the regenerative efficacy of teetotalism.
There is one obvious danger connected with tea and
coffee as compared to wine, that they are insidious in
their operation, and not being intoxicating have a certain moral respectability which makes it difficult to
attack them successfully, whereas the evils of excess in
wine have been painted with a passionate vividness
manifestly inspired by itself.    Of course we do not
mean to defend excess in either; all we wish to do is to
point out the danger of tea and coffee, and tobacco, and
to warn those who satisfy themselves with having avoided




OF THE HEART.


221


the Scylla of the wine-cup, to beware of the Charybdis
of the tea-pot.
Of the medicines best suited to relieve this kind of
of palpitation, I have most confidence in the following:
A,8safcelida is particularly useful in the palpitation of
females, in whoni the heart is irritable, and when the
cause of the attack is some suppressed secretion or bodily
exertion.  The symptom   that seems to point to it most
is "pressure in the region of the heart, as from  congestion and distension of the vessels, with small pulse."
A small and infrequent pulse, with violent action of the
heart, and no disturbance of the respiration, indicate
nervous weakness of the organ, and for such a state
assafcelida is often useful.
Baryta carbonica has the following characteristic symptoms: "Throbbing stitches in the left side of the chest
from the pit of the stomach upwards. Violent beating
of the heart in the first fortnight.  Palpitation of the
heart when lying on the left side, renewed 6y tklinkiyjq of
it, with feeling of anguish mostly at noon."      The
italicized clause seems to show that the palpitation was
of a directly nervous kind, and not from any sympathetic
action connected with the gastric symptoms this medicine produces.
Canpor has certainly a most powerful effect upon the
heart, and may be given with great confidence in such
affections, especially if the palpitation is attended with
coldness of the surface and paleness of the face.  The
symptom most indicative of its relation to the heart is" after a meal he feels and hears his heart beating
against the i~bs." However, its value in practice is not




222


SOME AFFECTIONS


fully expressed by the proving, probably on account of
the transient character of its action.
Carbo animal. and ve etab. should not be lost sight of,
but these will be more appropriately taken in the next
class of disorders of the heart, and another medicine
of whose efficacy in allaying this kind of palpitation I
have no doubt, has but few or indeed no symptoms in
its proving indicating its virtue, and that is coffee.
A  cup of good strong coffee will be found to give immediate relief in many cases of palpitation from irritable
heart, even when that does not arise from derangement
of digestion through errors in diet.
Coniurm has a powerful and direct action on the heart,
and is suitable to many cases of palpitation. Among
its symptoms we find-" Violent palpitation of the Aheart
after drinking.  Palpitation of the heart when rising
from bed.   Frequent and visible palpitation.  Frequent
shocks in the region of the heart."
Cotyledon umbilicus, according to the excellent proving
of Dr. Craig, seems likely to be valuable in this class of
affections.  In his physiological sunmary he says" The character of the Cotyledon-symptoms of the heart,
lungs, throat, and mind, correspond very closely with
that of the effects produced on these organs by strong
emotions when suppressed." "Full, bursting feeling, as
if from  obstruction of the heart."  Further on he says,
" a pathological group of symptoms, similar to that first
mentioned, is observed to occur when the functional
lesion begins at the heart.  Violent exercise, as quick
running, for instance, occasionally produces the same
obstructed feeling, and this functional difficulty is not
unfrequently so persistent, as to become the subject of




OF THE HEART.


223


medical treatment, I would expect benefit from the use
of Cotyledon in such a case."'
Digitalis.-" The action of Digitalis on the circulating
organs,"' writes Dr. Black in an able treatise upon this
medicine, published   in the fourth volume of 'The
British Journal of Homoeopathy,' "is very characteristic: the heart becomes irregular and weak, palpitation
readily excited, attended with uneasy sensations in the
chest, especially in the left side; in some instances
amounting to pain, and extending to left shoulder and
upper part of arm; in others there is distressing precordial anxiety. Palpitations are readily excited in bed
when lying on the left side.    The pulse is slow, but
much more frequently quick, weak, and fluttering, and
frequently intermittent; but the marked change is the
facility with which the pulse is rendered irregular and
the heart's action laboured.  So diminished does the
power of the heart become that fatal syncope has been
produced by the patient suddenly changing his position."
And again, speaking of its therapeutic action, he says" It may be administered in functional derangement of
the heart. In two cases where no other disorder of consequence existed, I found it useful; these two cases were
characterised by very frequent and distressing palpitation, with a quick, weak, and slightly irregular pulse."
So that we may give Digitalis a high place in the treatment of the palpitation from an over-irritable heart.
Gratiola has a decided action on the heart, as indicated by the following symptoms-" Strong and quick
palpitation of the heart. Violent palpitation of-the heart,


S' British Journal of Homceopathy,' vol. x, p. 616.




224


SOME AFFECTIONS


which shakes the whole body, and seems to proceed
from the pit of the stomach."
Hcematoxylum campechianum seems to have a special
relation to the heart.  Among its comparatively few
symptoms we find the following-Pain in the region af
the heart, with sensation as if a bar were extending from
the heart to the right side, and violent pain in the left
upper region of the heart; great painfulness of the
region of the heart; oppressive anxiety; increased beating of the heart; small pulse; hot hands; chilliness
over the whole body. Palpitation of the heart (with
diminution of habitual sweat of the feet).
We omit Ignatia, as its action upon the heart is not
very well marked, although it is useful in palpitation
caused by emotions.
Among the imponderables are magnetism     and mesmerism. The use of the magnet in angina pectoris is
highly recommended by Laennec, and among the symptoms of the South Pole of the Magnet, we find palpitation of the heart italicized.  Mesmerism has a direct
and powerful influence on the heart's action.   I once
saw an American mesmerist stop the action of the heart
in a young man. The place was at the house of a distinguished Professor of the Edinburgh University, and
besides myself there were only other three or four persons present, two of whom were men of high scientific
attainments. The subject of the operation was a student
of about twenty years of age. The operator pointed his
fingers at the cardiac region while I felt his pulse.
Very soon it became quick and weak, and in the course
of about two or three minutes entirely vanished, as the
pulse disappears in a cholera patient.    He became




OF THE HEART.


225


ghastly pale, but did not fall. After the operator ceased
the heart slowly resumed its natural functions. From
this experiment, as well as from my own observations, I
feel satisfied that great and immediate relief may be frequently given in palpitation from irritable heart, by
applying the palm of the hand to the cardiac region.
lodium has a well-marked action on the heart: we
find "Violent pulsations in the chest and palpitation of
the heart, increased by every muscular exertion to such
an extent that she was unable to support herself for one
minute without being near fainting. Palpilalion of Ike
heart which might have been heard at the distance of a
few paces. Palpitation the whole day."
Kalmia latifolia is highly recommended by Dr.Hering,
who says no medicine except Digitalis has so much influence upon the pulse.  The indications for its special
use are not, however, very pronounced in the proving.
In iuy own practice, I have given it, but with entirely
negative results, in a case of simple hypertrophy combined with nervous irritability.
Of Lachesis I need hardly speak, its.action in these
cases is so universally acknowledged, and I can from
personal repeated experience testify to the great efficacy
of the poison of the Naja trip. I have now given it in
several cases of palpitation of long standing with the
most decided advantage. One was that of a lady about
fifty years of age, who for about a year had been constantly distressed with almost unintermitting palpitation.
No organic disease existed, and it was from the other
symptoms manifestly an example of irritable heart. I
gave her a dose of the one hundredth of a grain of the
Naja poison, and the relief was almost immediate, and
15




226;SOME AFFECTIONS


the palpitation did not return for about six weeks, when
it was again relieved by the same remedy. Another
case was that of a dissenting minister, who suffered severely from this cause after preaching, and had tried with
more or less success from  time to time various homoeopathic medicines.  In this instance, too, the relief afforded
by Naja was rapid and enduring.   I have no doubt from
my own experiments, and from   these and other similar
facts, that the heart symptoms will occupy a prominent
place in the proving of this medicine.
fMercurialis perennis.-From this medicine we should
expect good service in this class of affections: we find
among its symptoms-Confused, undulating sensation
in the region of the heart, with fulness and feeling of
anxiety in the left chest.  Oppressive contraction in the
region of the heart.   Peculiarly undulating and throbbing motion in the region of the heart, the precordia
and the upper part of the abdomen; or a remarkable
rolling and throbbing, with trembling or undulating in
all the blood-vessels without heat: he feels the pulsation
of the abdominal arteries when sitting down.  Repeated
palpitation of the heart with oppression.  After having
stooped, palpitation of the heart with oppression on the
chest, as if the heart were laced tight.
Although Secale cornutum more properly falls into the
next division, yet it may be also useful in simply irritable
heart, as we find it produces-" Violent palpitation of
the heart with contracted and frequently intermittent
pulse.  Spasmodic throbbing of the heart.    The beats
of the heart are diminished from    ten to fifteen in a
minute, one horn- after the exhibition of Secale."
Sepia has many distinctive symptoms of relation to




0]? THE HEART.27


227


this affection, e. 9c.-" Gurgling or bubbling sensation in
the left chest. Beating in the pit of the stomach in the
morning, followed by orgasm of the blood in the chest,
resembling palpitation of the heart, afterwards burning
heat in the face and body, without any heat or redness
being perceptible to the hand, and without thirst, but
somie. sweat.  Beating of the heart in the evening for a
quarter of anl hour. Palpitation of the heart with
stitches in the left side of the chest.  Palpitation of the
heart with feeling of anxiety, obliging one to take deep
breath, without depressing the spirits, for several days.
Intermission of the beats of the heart with anxiety."
In regard to general treatment the great rule is to restore the strength of the nervous system by a wholesome
and generous diet.   I have observed this state of the
heart produced by too rigid adherence to rules of ascetic
severity, especially by patients who had adopted the
water-cure notions, and believed in water to the exclusion of all other beverages. These true hydropathists,
or water-sufferers, frequently take no food after their
Zghostly tea which is taken about seven o'clock. T~his is.insufficient- for the restoration of the nervous exhaustion,
and they ýawake at three or four o'clock in the morning
with palpitation of the heart. I have seen this nervous
palpitation entirely cured by the bold administration of
a chop and glass of wine or spirits and water for
supper.
The next class of palpitation of the heart to which
we shall advert, is what is called the anammic, or that
which depends on a deficiency of blood.
The abstraction of the sanguineous fluid produces
effects commensurate in magnitudze with the importance




228


SOME AFFECTiONS


of "the blood which is the life," in the figurative language of Scripture, or in the scientific phraseology of
Bichat, which bears in all the tissues of the body a
direct proportion to the amount of vitality they are capable of displaying. To what extent this primary element of life may be withdrawn without extinguishing
vitality, has been the subject of many experiments which
offer considerable differences in their results. According
to those of -Rosa, Hales, Blundell, and Piorry, the
medium    amount required   to  be withdrawn    before
death occurs is about three fourths or seven eighths of
the whole, but in many cases a much smaller quantity is followed by fatal consequences. It does not
require anything like this amount, however, of loss to
produce a violent effect upon the system, and the symptoms of anaemia form a well-marked group which is thus
described by Hope-" The complexion is unusually, sometimes singularly pallid or exsanguine; the lips, the in-'
terior of the mouth, and the inside of the palpebrwe,
partake more or less of the same paleness; the pulse is
quick, small, weak, and jerkin#q (the pulse of unfilled
arteries), and during palpitation it often presents a thrill;
its average frequency is generally from 80 to 90, and
during excitement is easily raised to 120 or 130, and
occasionally even to 140 or 150.   The slightest causes,
even corporeal efforts, suffice to produce palpitation,
breathlessness, and faintness; the body is usually constipated, there is anorexia, with an especial distaste for
animal food, and a predilection for sour articles, as acids
and fruits, salads, &c. The catamenia are deficient, and
usually replaced with leucorrhcea; or, what is too often
over-looked, they are profuse, lasting from six to ten




OF THE HEART.                   229
days, consisting of blood instead of the normal secretion, and, in fact, constituting a passive hemorrhage,
which is often the cause of the anemia; the muscular
system is very feeble, lassitude and aching pains being
produced by trifling exertions; the intellectual powers
and energies are also often greatly impaired. In many
patients there are transitory neuralgic stitches and aches
in various parts of the body, and sometimes exquisite
sensitiveness of the skin, especially that of the mamme
and abdomen; more or less headache is almost always
experienced, generally with vertigo, rushing noises in the
ears, and in severe cases, with intolerance of light and
sound, delirium, and even fatal coma, of which I have
recently witnessed two instances. Such are the general
signs of anemia, and, therefore, of anemic palpitation.
We proceed to the physical signs. The impulse of the
heart is less remarkable for force than for an abrupt
bounding character, with throbbing of the arteries, often
universal, and a jerking pulse. Hence this species of
palpitation is more audible to the patient than perhaps
any other, the sound appearing to rush through his ears,
especially when he lies on his side in bed, and each arterial throb causes a movement of his pillow. When the
anemia is considerable, palpitation occasions a weak soft
bellows-murmur in the aortic orifice with the first sound,
and a corresponding whiff is heard in the carotids, subclavians, and other considerable arteries, especially when
compressed with the edge of the stethoscope.      These
murmurs of the heart and arteries occur whenever the
action of the organ is excited, and in some patients the
slightest causes suffice  to  produce the   excitement.
Venous murmur invariably attends these murmurs in




230


SOME AFFECTIONS


the heart. The following characteristic case is related by
M. Bouillaud.x " I was summoned," says he, " on August
21st, 1834, to see, with the surgeon-major of the 3d
Lancers, the son of a chef d'escadron, aged 16, who,
after a leech-bite, had lost an enormous quantity of florid
blood, very probably furnished by a small divided artery;
syncope was imminent; lips and face colourless; eyes
turned up and livid; general coldness; long and sighing
inspirations; pulse exceedingly quick and weak; on
listening to the beats of the heart, which were feeble,
but very abrupt and frequent, so as scarcely to admit of
being counted, I heard a clear smart bellows-murmur,
like the puff with which one blows out a candle. I
made the surgeon-major and assistant attest the phenomena. I was of opinion that the murmur depended
solely on the fainting and anmmic state, during which,
from the hurried palpitation of the heart, the smaller
column of blood contained in the ventricles was expelled,
if not with much force, at least with a sort of convulsive
rapidity. I revisited the patient on the following day at
the same hour: the haemorrhage had ceased for more
than twenty hours; there did not exist a trace of the
murmur, which, according to the surgeon-major's account,
had completely disappeared ever since the preceding
evening."  In this case there was no organic disease of
the heart.
The anaemic murmurs may be distinguished from
those arising from organic disease of the organ, by being
always confined to the aortic orifice and attending only
the first sound, and by being invariably accompanied by


S'Trait6,' ~ i, p. s10.




OF THE HEART.


231


venous murmurs, and by being of a soft, weak, and
bellows sound. The anaemic palpitation may be distinguished fromi the nervous and dyspeptic by being very
much aggravated by any movement, however slight,
whereas the other kinds are often relieved by gentle
exercise.
In the treatment of anamic palpitation, the most important remedy is undoubtedly some preparation of iron.
That the operation of this medicine is not chemical but
dynamical, is proved beyond a doubt, by the success of
the infinitesimal dose. I lately met with the following
striking case which may be worth recording, as illustrating this class of affections.
I was sent for, one night about ten o'clock, to see a
patient whom I had not seen before. I found a young
lady, about twenty years of age, lying on a sofa, deadly
pale; she could not speak, but tossed her head and
arms to and fro, and seemed in a state of extreme agitation. The action of the heart was visible through her
clothes, it was bounding and throbbing in the most
violent and tumultuous way; the pulse was so small and
rapid that I could not count it. Not having a stethoscope I could not determine accurately the state of the
sounds, but they seemed to me normal. I gave her
Ignatia, and remained with her some little time: the
attack gradually subsided. I saw her on the following
day, aid found her of a pale waxy hue, the lips almost
colourless; she complained of great languor, giddiness,
ringing in the ears, and occasional headache, and on inquiry I was told that the catamenia was very profuse
and too firequent; she was very weak, and had been in
this state for about six months. I ordered her a close of




232


SOME AFFECTIONS


the fir~t dilution of Ferrum aceticum,' a drop three times
a dayi   In the course of a week there was the most
wonddrful improvement in her appearance-indeed she
hardly looked like the same person: she said she felt a
great deal better every way. The course was continued
for another week, and the improvement went on. Finding herself so well, she left off the medicine, and at the
expiry of a week she had again an attack of palpitation,
though not so severe as on the former occasion, and she
had fallen off in her appearance, being again much more
pallid.  She resumed the use of the Ferrum, and she was
soon restored. When we calculate that the total quantity of iron taken could not amount to a. grain, the idea
of its acting chemically is out of the question.
Among the other medicines suitable in anemic palpitation the following are the most important:
C/ina   officinalis affords this peculiar indication.
" Strong violent beats of the heart, with feeble pulse and
cold skin." It is generally useful when there is exhaustion of the vital powers, accompanied with a tendency to
passive haemorrhage.   Noack and Trinks recommend it
in palpitation of the heart from loss of animal fluids, and
in palpitation of the heart with distension of the veins.
I have always found this medicine fully answer all that
we have a right to expect from it.
Graphites is more indicated when, along with anaemic
palpitation, there is amenorrhcea, while the two former
medicines are more useful when the menses are overabundant.   The   special symptom     expressive  of its
relation to this affection is, "violent throbbing about the
1 This is not a good preparation of Iron, it is not easy to get a good
soluble one. I now often give the Ammoniaco-citrate.




OF THE HEART.


233


heart and in the rest of the body at every little movement."
Natrum   muriaticum   has the following characteristic
symptoms.    "Palpitation of the heart from the slightest
movement; palpitation    of the heart while standing;
palpitation of the heart without anxious thoughts, even
for hours; fluttering motion of the heart; irregularity of
the beats of the heart."  It is recommended by Rmumel
in cases of protracted chlorosis, with deficient nutrition
and flaccid torpid skin. This too, is most likely to be
useful where there is amenorrhoea.
Plumbum must not be omitted from this list, although
the symptoms which correspond with the affection are
not very well pronounced.   Among them we find, " pain
in the region of the heart, and violent spasmodic palpitation of the heart, and in violent palpitation of the
heart." It is also useful in so-called chlorosis, although
the term is somewhat vaguely used.'
Pulsatilla is useful in the early stages of anaemic
palpitation, but the indications for its employment are
not very precise.
Secale cornutum   and Sepia we have already adverted
to as useful in irritable heart; they may be given in cases
of anaemic palpitation with great advantage.      Secale,
when there is too great thinness of the blood, and tendency to excessive menstruation, with general erethism
of the system, and especially if the skin is marked with
livid spots which come and go. And Sepia when there
is deficient menstruation.
Anaemic palpitation of the heart being much more
SSee a paper by Dr. Chapman, in vol. iii, p. 170, of the 'British Journal
of Homoeopathy.'




234,                SOME AFFECTIONS
common    in  women    than men, perhaps an       undue
prominence has been given to the symptoms of the
catamenia; however, the practical physician will have no
difficulty in selecting the remedy proper for a male
patient, if he be familiar with the characteristic peculiarity
of each medicine in its relation to females.
The only division that now remains to be noticed is
palpitation from  moral causes.  Although the phrase,
" dying of a broken heart," may be slightly figurative,
yet it is a certain fact, that, depressing emotions, such as
long sorrow or anxiety, not unfrequently induce a constant
palpitation of the heart, which may go on to hypertrophy
and death.   I have at present under my charge such a
case: the palpitation began some years ago, and has
never altogether subsided; it was caused originally by
grief from  a brother's and father's death. There is in
this case very great hypertrophy with all its attendant
dangers. However, we wish at present to speak of simple
palpitation without hypertrophy; and for relieving this
the best medicines are Aconite, Ignatia, Moschus, Pulsatilla, and Tabacum.   Aconite has so direct an action
on the heart that it is not easy to make out, from the
proving, what may be called its sympathetic relations to
that organ.  But there is ample evidence for the beneficial effects of Aconite in palpitation caused by grief or
fear, or indeed by any mental emotion.   The indications
for its preference must be sought rather in the general
condition and habit of the body of person, than in
anything peculiar in the symptoms of the palpitation.
Ignatia, according to Hahnemann, whose authority on
matters of this kind is altogether paramount, is most
suitable for persons subject to sudden alternations of




OF THE HEART.


235


feeling, passing rapidly from  grief to joy-in short, of
mobility of temperament; and it is most serviceable in
allaying the evil consequences of anger or grief, if the
subjects are not given to paroxysms of anger, but rather
tend to the concealment of their feelings.   Among its
characteristic symptoms is "palpitation of the heart
during deep meditation."
Moschus is an invaluable remedy in many of the
slighter cases of palpitation combined with hysterical
symptoms. It does not seem to be so deep in its sphere
of operation as either Aconite or Ignatia, corresponding
rather to the general tendency to perturbation of the
nervous systems when set with too fine an edge, and
allaying the excessive action of the whole, than bearing
special relation to the heart; and its action is well
expressed by this symptom: " great anxiety with palpitation of the heart, as from anxious expectation."
Pulsatilla is useful after Aconite in palpitation caused
by sudden fear, grief, or annoyance. There are no very
specific indications afforded by the proving to give precision to the selection of this, in preference to other
medicines, in simple palpitation from moral causes, and
so we must fall back upon the general suitability of
Pulsatilla to particular temperaments and states of body.
Nor can we say more of the last medicine in this list,
Tabacum.    That tobacco produces a most powerful and
direct effect on the heart is certain; among its symptoms
we find, "violent palpitation of heart," and that it
also acts upon the spirits, producing great depression, is
equally well known; and we may safely say, that from
these two indications of its action, the one on the brain,
the other on the heart, we shall find a most useful remedy




236


SOME ORGANIC DISEASES


in this form of palpitation. I have given it occasionally
in such cases, but have not sufficiently full details of the
cases to make them of any avail. However, my impression is in favour of the important usefulness of the much
calumniated herb.
In this enumeration of the various kinds of palpitation
of heart, I have omitted all reference to those which are
simply sympathetic and incapable of self-continuarnce
after the removal of the exciting cause; as for example,
the numerous fornis of dyspeptic palpitation, for these
affections can hardly be the subject of individual and
specific treatment; and I have reserved for future consideration all those forms of palpitation which depend
upon some organic change in the heart.
SECTION II.
ON SOME ORGANIC DISEASES OF THE HEART.
HYPERTROPHY OF THE HEART.
THE natural size of the heart, according to Laennec,
is about that of the fist of the person; its weight should
be from eight to nine ounces; the four cavities'should be
of nearly the same size; the walls of the left ventricle
ought to be considerably more than double the thickness
of those of the right. It may increase in all its dimensions, its walls becoming thicker and its cavities larger,
to such an extent that the left ventricle alone will admit
an orange, and the weight of the whole rise to between




OF THE HEART.


237


two and three pounds; or its walls may become thicker,
and thus diminish its cavities, to such a degree that one
of these will hardly admit a small walnut; or lastly, the
cavities may be enlarged at the expense of the walls.
The first, which is much the most common, is generally
called simple hypertrophy; the second concentric hypertrophy, or hypertrophy with contraction; and the third,
eccentric hypertrophy, or hypertrophy with dilatation.
Each of the cavities may be singly affected, but the
ventricles are so much more liable to it than the auricles,
that for practical purposes dilatation or hypertrophy of
the auricles need not be considered; and of the two ventricles the left is much more apt to become hypertrophic
than the right.
The causes which induce these changes in the structure of the heart are, either impediments to the flow of
the blood through its natural channels, some diseased
condition of the substance of the heart itself, some undue
restraint upon its movements, or a combination of two or
all of these conditions. Almost all diseases of the valves,
by overworking the ventricles, induce an increase in their
growth and size; and besides this obvious and easily
detected cause, there is sometimes a narrowing of the
channels through which the blood flows, which can only
be  detected  after death.   Andral, in his 'Treatise on
Diseases of the Chest,' mentions several cases of this kind;
in some the contraction of the aorta and pulmonary
artery were truly surprising, these vessels being no larger
than the usual size of the carotid arteries.  It is of great
consequence to bear this fact in mind, for persons affected
with such congenital malformations may enjoy perfectly
good health for many years, the heart, by the slowness of




238


SOME ORGANIC DISEASES


its contractions, accommodating the supply of its contents
to the narrowness of the receiving vessels, but when by
any sudden and long-continued exertion or agitation a
turbulent 'and energetic action of the heart is engendered, then a permanent incurable and rapidly fatal
disease of that organ ensues.  Thus the practitioner requires to guard his prognosis of the curability of a case
of simple hypertrophy which is generally favorable, by
specifying the possibility of some conditions existing
beyond the plummet of our science to sound.    Another
ground of caution is suggested by the microscope, for
this reveals that in hypertrophy of the substance of the
heart the muscles are not in a natural state, there is deficiency of transverse fibres and a superabundance of fatglobules, so that, according to Rokitansky, this affection
is allied to fatty degeneration. It is these considerations
which make us fear that Hope, in his otherwise trustworthy treatise on this subject, "has told a flattering
tale" of the success which we may securely anticipate
from  judicious treatment.  His reasoning at first seems
p1lansible.  "After all," he says, " what is hypertrophy
of the heart but overgrowth of a muscular structure; now
we know that muscles are easily reduced in size, as may
1)e seen by tying up a blacksmith's arm, how    soon it
shrinks; all we have to do is to lessen the work of the
heart, and it too will shrivel into more healthy proportions."  We admit the deduction, but how shall we give
the heart rest?  The heart must go through its work
well or ill, it cannot lie by for a week, not for a minute,
and we cannot secure it from   sudden and violent exertion, for even if we could always command      absolute
bodily repose, where is the physician who can secure his




OF THE HEART.


239


patient against mental agitation?    Not only are we
unable to ensure the external conditions for certain recovery, but we are too ignorant of the molecular changes
which accompany the diseased state of the muscle to be
at all sure of arresting or modifying their progress.
Hence, although we firnmy believe that with our superior
therapeutic appliances we are in a much better position
than the old school to manage with success this malady,
yet we must always look upon hypertrophy of the heart,
if of any considerable amount, as a most formidable and
even dangerous disease.
Another frequent predisposing cause of this affection
is the result of pericarditis; for if this be not perfectly
cured, instead of the effused lymph being absorbed it
forms bands over the substance of the heart which oppose
an impediment to its natural action, and in order to overcome this obstacle great efforts are made, which by the
law of muscular development necessarily increase the size
of the muscle.
Of the exciting causes which give rise to hypertrophy,
the most important are violent physical exertions, longcontinued moral excitement, and excess, either in stimulating drinks or other indulgences.  It is said to be a
common consequence of rowing-matches at Cambridge,
and of ascending mountains, and hence it is of importance to warn young men of the danger they incur from
exploits of this kind.
When the disease is once developed there is no great
difficulty in recognising it.  Even without the aid of the
stethoscope we can generally detect by the hand laid
over the cardiac region the strong blows of the heart as
it beats against the walls of the chest. The pulse in sim



210


SOME ORGANIC DISEASES


pIle hypertrophy of the left ventricle is regular, full, and
frequently jerking; when both ventricles are affected the
pulse is often irregular, and there is always more or less
difficulty of breathing.   It is not easy to determine
with certainty whether the right or left ventricle is
most at fault by physical diagnosis, although it is said
that in the case of its being chiefly on the right side,
which is a rare variety, the beat of the heart is felt more
towards the sternum.     As we should expect on anatomical grounds in this form of the disease, the breathing
is more oppressed and haemoptysis is more common.
However, as it rarely happens that the right ventricle is
enlarged without some corresponding change in the left,
the differential diagnosis is not of much practical importance.   It certainly is rather surprising that a disease
which one would suppose could not fail to attract the
attention of the patient, should frequently exist for a long
time without being discovered. And yet the best authorities on the subject inform us that it is no uncommon
occurrence for persons to come to the hospitals labouring
under very great hypertrophy of the heart, so great as to
be discernible even through the clothes, and yet quite
unconscious that there was anything the matter with them
in that quarter.   I had at the same time three cases of
heart disease under my care: in the one there was very
great hypertrophy; in the other extensive disease of the
valves, of fifteen years' standing; and in the third aneurism of the aorta; all of them must have suffered for a
long time from     unmistakable   symptoms of organic
disease of this organ, and yet none of them had the least
idea of this till I told them of it, and attributed their
bad health to derangement of the liver, for which they




OF THE HEART.


241


had been treated with great assiduity by the good old
school of medicine. Hence the importance of instituting
a careful examination of the chest in every case where
the symptoms are at all suspicious, for mistakes are much
more frequently made by simple negligence than from
ignorance, and the consequences of such mistakes if they
happen to a practitioner of homceopathy are most serious.
Among the indications which should lead us to suspect
hypertrophy of the heart is a peculiar brilliancy of the
eye, and even a tendency to protrusion of the ball. This
is attributed to the increased force with which the blood
is forced into its substance by the ophthalmic artery.
There is also much-pain in the head, and frequently a
constant beating or ringing in the ears.  In a case of
aneurism of the aorta lately under my charge there was a
curious modification of beating sound in the ear, which I
do not recollect to have seen alluded to by any writer on
this subject. As long as the patient was erect he heard
the beating in his left ear alone, but when he lay down
the noise was heard only in the right.  The explanation
seems to be that the aneurism involves that portion of
the aorta from which both carotids spring, and that the
arch being more curved by the weight of the heart when
he is erect, the chief impetus of the blood is directed
along the left carotid, which is then more in the line of
the column as it leaves the heart; while on lying down
the arch assumes a larger curve, and the force of the
stream is first felt at a point of the aorta beyond where
the left carotid has its origin. At least this is the only
explanation of the fact, of which there is no doubt, that
I have been able to imagine. In advanced cases the
violent action of the heart may be seen distending the
16


/




242


SOME ORGANIC DISEASES


carotid artery, and the jugular vein is generally enlarged,
although, except when there is also imperfection of the
valves, it does not pulsate synchronously with the arterial
pulse.
Formidable as hypertrophy of the heart is in itself, even
more serious must we regard it when we consider the
dangers with which it threatens other vital organs; and
first in the list of dangers we find apoplexy.  It is only
of late years that the close connection of these two
diseases has been accurately ascertained.   Out of 39
cases of fatal apoplexy which occurred at the Marylebone
Infirmary, when Dr. Hope was physician to that institution, in no less than 27, or nearly three fourths, there
was disease of the heart found to be present on examination after death.  But large as this proportion is, it by
no means gives an adequate idea of the danger from this
cause, for this number includes all the cases of apoplexy
that occurred, and several of these were either at an
earlier or later period of life than that at which apoplexy
is most common. The apoplectic decades in human life,
so to speak, are from 40 to 50, and from 70 to 80, and
these are the precise periods when disease of the heart is
most frequently the cause of the fatal stroke. In nine
out of ten observed cases of apoplexy occurring between
40 and 50, and in ten out of eleven occurring between
70 and 80, there was disease of the heart present. The
reason of these two periods being more liable than any
other to this fatal complication appears to be, that in the
former the muscular power is at its maximum, and the
force-pump sends the blood to the head with the greatest
violence.  After 50, there is a diminution of the energy
of the muscles, but then a little later the changes to which




OF THE HEART.


24.3


we have before adverted of the substance of the bloodvessels themselves, are more frequently developed, and
thus their walls are weakened and are less able to resist
the impetuous stream that has up to that time been
rushing with impunity through the channels of the brain.
These well-established facts suggest this serious practical
reflection. In apoplexy of old age no good is likely to
accrue from the abstraction of blood, because this will
not prevent the rupture of an ossified or otherwise disorganized cerebral artery, and the first intimation of the
attack will be the symptoms produced by the effusion of
blood into the substance of the brain. Medical aid is
not sought till the mischief is done, and nothing remains
but to make the best of the wreck, with the melancholy
certainty that before very long another, and perhaps yet
another attack must take place, and quench entirely the
life which may have lingered for some years in the paralysed and half dead body.    Sometimes, however, the
attack is not so instantaneous, and then the administration of homoeopathic remedies may avert it. The only
case of this kind I ever met with was in a lady of about
74 years of age-her brother and sister, I believe, at all
events more than one near relation, had died of apoplexy.
She seemed in her usual health when she suddenly felt
an oppression of the head, and when I saw her in an hour
or two afterwards I found her lying in a state approaching to coma; the breathing stertorous; the pulse slow
and full; the mouth drawn to one side; in short presenting all the characters of incipient apoplexy. I gave her
Arnica, Nux vomica, and afterwards Lachcsis, and in the
course of the night she gradually recovered, and is now,
after an interval of some six or seven years, perfectly well.




244


SOME ORGANIC DISEASES


In such cases the question of the propriety of bloodletting can scarcely be mooted, it is not countenanced by
pathology, and would hardly be recommended even by an
old school practitioner. But suppose we are called in to
a man of 45 years of age, of a robust muscular frame,
and find him insensible and the pulse thumping away
like a sledge hammer; suppose on applying the ear to the
chest we detect hypertrophy of the heart, and are thus
convinced that there is instant danger of the rupture of
a blood-vessel from the enormous impetus and quantity
of blood that is driven into the vessels of the brain, in
such a case shall we open a channel for the escape of this
destructive  stream, that  threatens  every  moment
to break down the dykes of life?   This seems to me
rather a question of hydraulics than of pathology. The
relief to be derived from bloodletting can scarcely be
doubtful, and the only counter question we can put is,
have we in our pharmacopoeia remedies as certain and as
speedy as bloodletting, and will bloodletting prevent
their use P From my own experience I am unable to give
an answer to this question. I am thankful to say I
never saw such a case, but I think it a cowardly thing
not to look the danger fairly in the face, and have our
minds made up as to how we should act in such an
emergency. And for my part I am free to avow, that
if I found such a state of things as I have just described,
I should feel disposed to call in a surgeon, and bid him
do his duty, and bleed my patient, as if he were his own,
leaving the after treatment and the responsibility to me.
These remarks are perhaps equally applicable to
another dangerous consequence of hypertrophy of the




OF THE HEART.


245


heart, I mean apoplexy of the lungs. This, as we might
naturally expect, is more likely to follow hypertrophy of
the right than of the left ventricle; it is attended with
intense oppression of the breathing, and may be recognised by sudden and circumscribed dulness of a portion
of the chest. The danger to life is hardly less imminent
than in cerebral apoplexy, and the distress much greater.
All writers concur in stating the relief by a copious abstraction of blood to be immediate, and for my part I
question whether we can conscientiously register a vow
in heaven not to practise it in such a case.
Besides sudden sanguineous effusion into the chest
and head, serous infiltration of the lungs and cellular
tissue are common consequences of organic diseases of
the heart, with or without affection of its valves. Although this form of dropsy is seldom rapidly fatal, yet
there are instances on record of suffocation from this
cause taking place in twenty hours. Such a case is related by Andral, who saw   a patient pass from a condition of perfect organic soundness of the lungs to suffocation and death within that period of time. Dropsy of
the body, however, is never so rapid in its progress, and
it may be laid down as a rule, that when this dreadful
complication arises from disease of the heart it always
affects the upper and lower extremities simultaneously,
and the hands and feet swell at the same time; if ascites
be first discovered, we may safely presume it is not directly caused by the condition of the heart, but is probably owing to an intercurrent attack of peritonitis.
Although for some time the upward progress of the
dropsy may be slow, and although it may be restrained
by proper treatment, yet it is almost certain to recur




246


SOME ORGANIC DISEASES


again and again, each attack being more unmanageable
than its predecessor, till it bids defiance to all our remedies; and then, when the limbs are swollen almost to
bursting, and the patient cannot rest either night or day
from the uneasiness he suffers, it may be a question whether we should not give him temporary relief by allowing
the fluid to escape by small punctures in the skin. Of
course we know that relief so obtained is merely temporary, and that there is danger of the punctured spots
becoming gangrenous; still in such desperate cases I
think we are entitled to employ measures which in other
circumstances we would reject.
While organic diseases of the heart tend thus to destroy the patient by sudden or lingering death, as their
inevitable and often irremediable consequences, the sufferer runs a continual risk of being carried off by an
acute attack of inflammation of some vital organ, especially of the lungs. In advanced cases, dyspnoea is a
constant symptom, and this arises from some impediment to the lesser circulation.  That the capillaries of the
lungs, if not absolutely in a state of inflammation, are at
all events in imminent risk of being so, and bronchitis
along with heart-disease is a very dangerous affection.
However, we may almost certainly check it by Aconite
and Bryonia, and from considerable experience I would
strongly advise that in such cases the strongest doses of
these medicines should be given. I have frequently
checked an attack by a drop of the first decimal dilution
of each of these, in alternation every hour.
Having now briefly adverted to the causes, symptoms,
consequences, and complications of hypertrophy of the
heart, let us direct our attention to the treatment of this




OF THE HEAR'T.


24.7


disease. Although, as we have already said, we must
season our confidence with caution, yet it is gratifying to
be able to affirm that in cases of simple hypertrophy, if
the valves be not affected, we may hold out to the patient a certain assurance of relief; and, if the case is not
very far advanced, a considerable prospect of permanent
cure. The following case, which occurred in my own
practice, I have the less hesitation in relating, because
hitherto, as far as I can discover, there is a great want
of recorded cases of the treatment of organic diseases of
the heart in homoeopathic literature. The subject of the
following narrative was a lady of about sixty years of
age. She was very thin, her head very large and her
chest very small; she had an incessant short cough;
even without a near inspection I was struck with the
great size of the jugular vein, which seemed to throb like
an artery.  She complained of pain in the right side,
and said she was, she believed, suffering from liver complaint, for which she had been treated for many years by
one of the titled dignitaries of our profession, who saw
her daily for many months during the previous year.
On questioning her about her heart, she said that from
her childhood she had been subject to dyspnoea and palpitation on any exertion, but that ever since she had
undergone much mental distress by the death of her
father and only brother, about fifteen years ago, she had
suffered from almost constant palpitation of the heart.
This had become much stronger about two years ago,
when she was at Malvern. Besides constant cough,
dyspnoea excited by any exertion, and a sense of beating
of the heart, she was subject to intense pain in the head,
chiefly the back part, but the most distressing symrntonl




248


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of the case was that she could not lie down, and she was
obliged to sleep propped up with pillows. She fell
asleep in this position, but in about twenty minutes she
woke with a sense of suffocation. The pulse was large,
full, rapid, and irregular. On examining the chest, I
found it very small in all its dimensions, and whenever
the clothes were removed there was the heart visibly
beating with great force over a large space of the left
side. The impulse was felt as low down as the seventh
rib. On applying the stethoscope I could not detect
the sounds at all distinctly, but there was no abnormal
murmur. I should have mentioned that besides cough
she had of late frequent attacks of haemoptysis.  Of
course there could be no possible doubt of what the
matter was. It was manifestly a case of simple hypertrophy of both ventricles, probably rather more of the
right than the left. There was an increase in the size
of the cavities, and of the thickness of the walls.  I
confess my opinion of the probability of her recovery
was very small, and I looked for a fatal termination as
a probable and speedy event. The disease seemed to
have advanced to a stage in which cure is seldom effected.  However, the result was most gratifying; by
pursuing the treatment which I shall describe in the
sequel slie gradually improved, and when I last saw her
she was so well as to undertake a journey in a carriage
to Cheltenham in one day. She could sleep for several
hours in perfect tranquillity; she could lie with her head
almost as low as other people; the pain had left her
head; she had seldom any difficulty of breathing; and
the cough was no longer troublesome. The heart was
still too large, but the discomfort fi'om the violent palpi



OF THE HEART.


249


tation was gone; in short, she is now not only relieved
from the apprehension of speedy death, but from all the
distressing symptoms from which she had suffered for
many years.
One of the greatest difficulties I had to encounter in
the management of this case was the regulation of the
diet, and as this is a point of primary importance, it
may be as well to advert to the principles which must
guide us in all similar cases. The patient felt very weak,
and thought it necessary to sustain her strength by taking
animal food twice a day and a couple of glasses of wine.
It was no easy task to convince her that she would be
stronger if she ate less. It is, however, quite obvious
that if we wish to reduce a muscle we must stop its
supply of blood as much as we can. In the cure of the
heart it is doubly necessary, for not only does too profuse an allowance of blood tend directly to increase its
already preternatural growth, but by adding to the
weight it has to move, it compels it to make greater
exertions, so that it is at once over fed and over worked;
and, moreover, this superabundance of blood greatly
increases the danger, both to the brain and to the
lungs.  It is in such cases that bloodletting is generally
resorted to by the practitioners of the old school, and
with much better reason and better consequences than
in the majority of the instances where they employ depletion. Although I am not prepared to say that it does
positive harm in such cases, at all events at first, yet I
believe it to be quite unnecessary, and that by diminishing the food we shall accomplish our object more
speedily and more safely than by withdrawing the pabulum vitae. We may safely limit our patients to one




250


SOME ORGANIC DISEASES"


meal of animal food in the day, and it is well gradually
to lessen even this, and let dinner consist chiefly of rice
or vegetables, with only a flavour of meat, and we must
withdraw all stimulants. This system of rigid abstinence ought to be persevered in for years, indeed most
likely for life.  It is here that the vast importance of a
correct diagnosis shows itself, for if the palpitation be
caused not by organic disease of the heart, but if it be a
sympathetic condition in connection with debility, or
some affection of the nervous system, such as I had
occasion to speak of in the first section of this chapter,
a straitened allowance of food and of stimulants so
far from being beneficial, is positively injurious, and
many patients are kept in great suffering by being denied
their mutton chop and glass of sherry. There is no such
risk, however, in cases of true hypertrophy, and we may
lay it down as a well-established rule, that we should do
our utmost to reduce the strength of the pulse by reducing the quantity of nourishment, and by absolutely
forbidding stimulants in every form; and we shall find
that the patient instead of feeling weaker, feels gradually better and stronger in consequence of this temperance.
Having settled the point with our patient and obtained his concurrence to be very moderate in food, we
may then open our trenches against the disease by a
course of medicine, and it fortunately happens that the
indications for their selection are as well marked as their
effect in controlling the action of the heart and modifying
its nutrition is certain, rapid, and in most cases surprisingly beneficial.
Without entering upon the vexed question of how far




OF THE HEART'.


25,1


hypertrophy is always preceded by inflammation, properly so called, we are, at least, safe in affirming, that
the pathological state of the blood-vessels which attends
active increase of growth of any part is so closely allied
to the inflammatory condition, that we may securely
anticipate that any medicine which has a powerful action
in subduing inflammation of the heart, will afford valuable aid against hypertrophy of this organ. And no
medicine has a more direct antiphlogistic operation on
this disease than aconite.  Were we not in possession of
this invaluable remedy, we might justly be blamed for
refusing to employ bloodletting, but Aconite does all the
good and none of the harm of the old fashioned lancet.
Professor Arnold found that on giving Aconite to a frog
the beats of the heart were first increased, and then diminished to such an extent that the auricles contracted
twice for every contraction of the ventricle, and an intermittent pulse was produced; and the following symptoms, which were produced in a medical student by
taking 2386 drops of the tincture in the course of sixty
days, read almost like an acute attack of inflammation
of the heart.1 After experiencing tearing pains in the
knees and elbows for several days, there commenced violent palpitation of the heart twice a day; the pains and
palpitation came on in alternation; after the pains ceased
a second time, violent palpitation returned, attended
with anxiety and oppression of the chest, and sometimes
great dyspnoea.  In the famous case of the robber who
was poisoned by Aconite, Mathiolus describes that, although he spoke boldly, and had a look of animation
SSee Dr. Dudgeon's article on Aconite in the ' Hahnemann Materia Medica.'




252


SOME 'ORGANIC DISEASES


with perfect consciousness, yet the pulse was almost imperceptible, and he complained of great weight about the
heart.  However, it is not necessary to multiply proofs
of the fact that Aconite has a powerful effect upon the
heart, and we may give it with great confidence as an
intercurrent remedy in cases of hypertrophy. We naturally have recourse to Aconite when from any cause there
is unusual perturbation of the heart's action from some
sudden excitement, either mental or bodily. By the immediate use of Aconite we believe the life of a patient
suffering from great hypertrophy may often be preserved,
and we should advise that such a person should always
have a supply of the 1st or 2d dilution beside him, that
he may immediately apply it on any sudden emergency.
Besides its value as an extinguisher of these outbursts,
it may be usefully given in smaller quantities and at
longer intervals, for a week or two at a time, in the
course of the cure. I think we do not give Aconite its
due as a deeply working medicine, and its high credit in
acute diseases has unfairly thrown it into the shade in
the treatment of many chronic diseases, of which hypertrophy of the heart is one.
Valuable as Aconite is, there is, however, no doubt
that Arsenic is of still greater importance in subduing
organic diseases of the heart. Dr. Wurmb, of Vienna,
an excellent authority on all practical points, observes:
" We think we do not err if, relying upon our own experience at the sick bed, we maintain that a large proportion of the symptoms connected with respiration we have
above described, must be ascribed to the baneful action
of the poison upon the heart; though at the same time
we arc far from denying that they may partly be owing




OF THE HEART.


253


to an idiopathic action on the respiratory organs or spinal
cord. Be this as it may, this at least is certain, that
symptoms indicative of an affection of the heart gene.
rally appear in a very violent degree at the commencement of poisoning by Arsenic, and are rarely absent."
This fact is so well known to the old school by the excellent work on poisons by Professor Christison, that the
only marvel is, how, knowing Arsenic to produce palpitation and irregularity of this organ, they can yet agree
with us in prescribing it as a proper remedy for a condition in the sick which they acknowledge it produces
in those who are well.
From among the writers of the homoeopathic school
who have directed attention to Arsenic, we may quote an
observation by Dr. Black, whose authority in practical
matters, like that of Dr. Wurmb, stands deservedly
high: " In organic affections of the heart," he says, " especially where there is dilatation or valvular disease, it
is the best remedy; and it is worthy of note, that under
its use the various pains, the distressing palpitation, the
dyspnoea, are relieved in a marked manner, and that
while the organic change remains unchanged." As far
as my experience goes, I fully concur in all that is said
of the value of Arsenic in the treatment of organic
diseases of the beart; not only do the pains frequently
subside by the use of this medicine, but the most formidable symptom we have to contend with-the tendency
to anasarca-is often arrested by a persevering admistration of this remedy.
I cannot say so much for the next medicine we find
generally recommended, I mean Baryta carbonica. I
have tried it several times, but never saw any good done




254


SOME ORGANIC DISEASES


by it; and I think a careful study of the proving will
show that it is only useful in cases of sympathetic palpitation. The following are the chief heart symptoms
given in Hahnemann's Cltronic Diseases:   Throbbing
with stitches in the left side of the chest, proceeding outwards from the pit of the stomach. Palpitation on lying on
the left side. Occasional strong palpitation.  Palpitation of the heart, increased by thinking of it, she then
had a feeling of anxiety; chiefly after dinner." Now,
in hypertrophy of the heart there is never absence of
palpitation, nor is it produced by thinking of it or by
eating, whereas nervous palpitation, with sympathetic
relation to the stomach, especially in a female, is commonly brought on by these causes. It seems of consequence to point out this inaccuracy, as it is by such
hasty inferences that serious errors become stereotyped
in our practical works, by far the greater number of
which consist of uncritical reproductions of the matter
contained in the earlier manuals. Noack and Trinks
very properly confine their recommendations of Baryta
to palpitation of the heart, especially of chlorotic and
hysterical females.
Digitalis being the great stand-by of the old school
in heart diseases, our patients have generally had enough
of it before they come to us, and it is not easy to specify
the exact character of the cases for which it is useful.
I should say, from my own observations, that it does most
good when there is great and sudden oppression of the
heart with hypertrophy. But I look upon it more as an
intercurrent remedy to get the patient out of an immediate embarrassment, than as one available for the radical
cure of the disease. And on the whole I agree with




OF THE HEART.


255


Dr. Black, when he says, " the diseases of the heart in
which it is indicated are those in which the action of the
organ is disordered and depressed. In simple hypertrophy, where there is increased power and energy of
the heart, it is contra-indicated, but promises to be useful,
especially in simple dilatation, and moderate hypertrophy
with dilatation; the more so in cases where the dilatation
is a primary disease dependent on deficient energy of
the heart, and not on the pressure or obstruction of the
circulation."
Of Lachesis I do not think it necessary to speak,
because I am now quite satisfied that the poison of Naja
tripudians or Cobra di capello will entirely supersede its
use in our future practice. It possesses this immense
advantage over Lachesis, that we can get it, whereas the
single drop of Lachesis launched by Dr. Hering into the
homceopathic world, must in the course of time be exhausted.  I do not think it is possible to exaggerate the
utility of the Naja poison in the treatment of organic
disease of the heart, whether of hypertrophy or of valvular
affections. This was the chief remedy I employed in the
case of the lady whom I described as having been rescued
from apparently inevitable death.  In her case there was
no possibility of deception; the disease was as well
marked as any disease could be, and the improvement
beyond doubt or denial. Nor is this the only case.   I
lately treated a very bad one of valvular disease, of fifteen
years' standing, and once or twice the limbs swelled to
double their natural size, and were reduced by giving
Naja. It seems to exert a direct action upon the heart.
About two years ago I injected a grain of the poison dissolved in oil into the facial vein of a rabbit; the operation




256


SOME ORGANIC DISEASES


did not last a minute, and before it was over the animal
was stone dead. On dissection the oil was found in the
abdominal vessels, showing it had passed freely through
the lungs; so that death was not owing to suffocation.
As far as my observations go, and I have now made a
good number, both on myself and others, it is a great
mistake to consider the poison of the Naja as a strong
poison.  A careful investigation of the history of all the
recorded cases of poisoning, along with experiments
upon rabbits and dogs, has convinced me that it requires
a very considerable quantity-as a general rule, probably,
at least twenty or thirty drops-to be inserted into a
wound, in order to produce a deadly effect, and even a
larger quantity might be taken with impunity by the
mouth. I have myself taken the one tenth of a grain
morning and evening for a week, without any serious
inconvenience, and I have frequently given it to patients
in as large a dose, and in no instance have I seen any bad
consequences. I can therefore strongly advise a bold administration of the 1st, 2d, or 3d trituration or dilution of
Naja in all cases of simple hypertrophy of the heart, and I
feel quite confident that the result of the experiment will
justify our most sanguine expectations.
The next medicine on whose beneficial action in hypertrophy of the heart we can confidently reckon, is Spigelia.
Among its well-marked symptoms we find, "unusually
strong beating of the heart-the beating could be seen
externally through the clothes. Palpitation of the heart
and anxious oppression of the chest. Palpitation of the
heart early in the morning after rising when sitting, with
anxious oppression of the chest, the heart seems to be in
tremulous motion. The palpitation of the heart increases




OF THE HEART.


257


by sitting down and by bending the chest forward. The
anguish increases during a deep inspiration, and when
arresting the breathing; he has then palpitation of the
heart and oppression; the heart beats more violently and
he feels the puilsations of the heart when laying the hand
on the pit of the stomach."   Noack and Trinks recommend it in chronic affection of the heart, particularly
valvular disease, hypertrophy, and dilatation of the heart.
This medicine stands by common consent at the head of
our remedial list against acute carditis and pericarditis;
and whenever the symptoms of a chronic organic disease
assume an acute character, we may safely consider Spigelia as well indicated.
We    find  Tobacco  mentioned    in this   catalogue
by some writers, but I think this medicine is more
suitable for functional nervous affections of the heart,
than for those in which there      is a  change of its
structure.
Besides having a store of what may be called sieging
munitions to reduce by slow and steady operation the
disease within the citadel of life, we must also be provided
with means to check the sudden sallies of the enemy,
which often threaten instant death.   Some months ago
I was sent for to see the patient whose case I have described as having been much improved by Naja, I found
her bent nearly double upon the sofa, her face and lips
deadly pale; although scarcely able to speak, she coma
plained of a dreadful pain extending downwards towards
the loins; on attempting to feel her pulse, it was almost
gone, it felt like a thread, and there was great dyspnoea.
I confess I expected to see her expire before my eyes.  I
gave her two drops of the Tincture of Camphor, every
17




258


SOME ORGANIC DISEASES


five minutes, and in the course of twenty minutes she
was better; under the continued use of this remedy she
gradually recovered her old standing ground. In another
case of great valvular disease, in which the patient is
awakened at night by a sudden sense of oppression of
the chest, and feels himself in the agony of death from
want of breath, I have found Camphor give constant
relief.  Indeed, so satisfied is this gentleman of its value,
that he is never at ease unless he has a bottle of it in his
pocket to apply to when these paroxysms attack him,
for now they do not occur only at night, but frequently
during the day likewise.   On these grounds, then, I
can recommend Camphor as the best remedy in the
sudden attacks of suffocation or paralysis of the heart,
which threaten to terminate instantaneously the remains
of life left to the sufferers from far advanced organic
disease of that organ.
PERIcARDITIS.
Perhaps in the whole range of medicine there is no
disease more trying to the skill, sagacity, courage, and decision of a practitioner than pericarditis; for it is obscure
in its symptoms, perplexing by its complications, rapid in
its course, often fatal in its termination to the life of the
patient, and still more fr'equently fatal to all comfort in
life.  Even now, when so much has been done to facilitate its diagnosis, it often escapes detection till too late,
and from  many causes the most skilful treatment may
prove unavailing. It is a comfort to us, however, that
there is no disease in which the superiority of homoeopathic treatment is more unequivocally superior, and




OF THE HEART.


259


none in which a careful study of morbid anatomy
justifies  us  in  believing   that  in   those  cases  in
which our efforts are unsuccessful, the cause is in
the inherent impossibility of the success of any medication.
The term pericarditis is applied to all inflammations of
the pericardium, and these are not only very different in
intensity and extent, but wholly unlike in their essential
characters. The only feature in which they all agree is,
that all are attended by some effusion, but the nature of
the effusion in each is characteristic, and depends upon
the general habit of body, which is plainly beyond the
physician's control at the time he has to treat the attack.
The sweeping term, pericarditis, in fact, stands for
various varieties of diseases, ranging from slight and
hardly dangerous inflammation attended with the secretion of absorbable lymph, to those kinds in which the
discharge is haemorrhagic or albuminous, and which
almost necessarily end, either directly or indirectly, in
death: and hence we should be on our guard to avoid
rash inferences from statistical returns, in which one
name stands for many very different things. In the first and
inost common variety there is an effusion of lymph upon
the naturally smooth opposite surfaces of the enveloping
membrane of the heart.      On examination, it resembles
butter in colour and consistence, and when the two surfaces are separated, by its partial adhesion it is raised,
so as to look like the pile of velvet; and hence, a heart
so affected was called by the old writers " cor villosum,
hispidum, hirsutum;" and in the ante-phrenological era
of creation, was assumed to indicate an irrepressible disposition to robbery, murderi and enormities of that sort




260


SOME ORGANIC DISEASES


-doing duty for modern " destructiveness."     However,
the connection of this villous state of the heart and villany
of character is not now generally believed, and it chiefly
interests us on historical grounds. This variety of deposit
upon the surface of the pericardium is capable of speedy
resorption, and may end in perfect recovery.     It may,
however, instead of being absorbed, undergo a series of
transformations, becoming organized, either fully or partially, and ending either in a perfect cellular tissue with
independent blood-vessels, or in so-called ossification,
although the hard substance into which it is generally
converted is not bone, but merely a form of lime. This
process of development, consisting of the formation of
elementary corpuscles, always begins within four days
from the time the deposit has taken place, and distinct
cells, from which a whole organized body proceeds, are
discernible on the fourteenth day.  After this false membrane is once fully formed, it becomes as much a part of
the body as one of its natural members, and bids defiance to all art to remove it.  All we can do is to lessen
the mischief its presence inflicts upon the heart: the
worst of this is that it partially paralyses the muscular
fibres of the heart with which it comes in contact, and
thus gives rise to the hypertrophy and irregularity which
we had occasion to speak of before, and ivhich are often
erroneously attributed to the bands of lymph restraining
the natural action of the heart's action.  This mechanical
explanation is only partially correct, the more common
cause of derangement being the vital one just adverted
to.  When the development of the membrane is arrested,
and when it is converted into a firm calcareous unvascular substance, then it does less harm apparently, and




OF THE HEART.


261


merely interferes mechanically with the free movements
of the heart.
Instead of fibrinous the deposit may be albuminous,
and this, being the matrix of tubercle, is much more
dangerous.   Albumen may be changed into pus or
tuberculous matter, but is not susceptible of healthy
organization, so that again we encounter an insurmountable obstacle to recovery or cure.    The albuminous
deposit takes place when the blood is in what the German
writers call the albuminous crasis, and is said by
Zehetmayer, of Vienna, who is one of the best authorities
on this subject, to be met with most frequently in children, during the progress of some acute exanthematous
disease, when the course of this is anomalous; during
the typhous process; in acute cases of Bright's disease
of the kidneys; and in drunkards, whose blood has not
got so low as to present the scorbutic character.
Next in order stands the serous effusion; this is sometimes very great, it may be seven or eight pounds, and it
is met with when there is from any cause much poverty
of the blood. It is usually attended with dropsical
effusion into the other cavities, and is, both in itself, and
from its inevitable consequences in displacing and
oppressing the heart and lungs, a very bad form of the
disease.  Lastly there is the haemorrhagic effusion, the
worst of all, indicating a pronounced dyscrasia of the
whole system, for it is only possible when there is a
general tendency to dissolution of the blood, and attends
diseases of a so-called putrid character, in which the
presence of petechiae, and the ready formation of pus,
indicate the hopeless degeneration of the mass of the
blood, which is then converted from vital food to a




262


SOME ORGANIC DISEASES


mortal poison.  Such are the chief primary results of
inflammation of the pericardium; upon the secondary,
which are also most important, we must here refrain from
entering.
As might be expected when an organ of such paramount importance to life as the heart is overwhelmed by
sudden and severe disease, the most characteristic feature
of the case is the general expression of mortal suffering
exhibited by the patient. The face is pale and pinched,
frequently the features are contorted and spasmodically
contracted, as in chorea, owing probably to the sympathy
between the heart and countenance, maintained by the
pneumogastric nerve; the pulse is rapid, and generally
irregular; the patient cannot lie on his left side, but only
on the back, or he cannot recline at all, but sits up and
bends forward, and may even be obliged to seek relief by
supporting himself on his hands and knees; the respiration is hurried and often attended with pain. There is
also always more or less pain at the region of the heart,
frequently sharp and violent, and increased by pressure;
on laying the hand upon that place the heart is felt
beating tumultuously and irregularly; in cases where
there is little effusion the action is powerful, but this is
subdued by much fluid in the pericardium; then instead
of this sign we have extended dulness.   On applying
the stethoscope, a rubbing sound is heard, not exactly
synchronous with the sounds of the heart, but lingering
behind these, and this is the diagnostic difference between
pericarditis and inflammation of the interior of the heart;
this friction sound is plainer when the patient holds his
breath for a moment, and by this experiment we exclude
the friction sound being due to pleuritis. When such a




OF THE HEART.


263


collection of symptoms is present, and more especially
when it occurs in a combination with rheumatism of any
of the joints, we may without hesitation ascribe it to
inflammation of the pericardium. Formerly it was supposed that this dangerous affection occurring during an
attack of articular rheumatism was due to metastasis of
the rheumatic action from. the extremities to the centre.
This opinion is now abandoned by recent pathologists,
who look upon the heart as itself a primary seat of
rheumatic inflammation, and it is as commonly affected
by rheumatism during the continuance of the disease in
the joints as at its termination; and Dr. Acworth, in
some interesting observations published in the Brit. Jour.
of IHon. has drawn attention to the important fact, that
true rheumatic inflammation of the heart may occur
without involving any other organ, and when this is the
case, it is very apt to be overlooked by even a skilful
practitioner.
When the disease is once established, its course is
sometimes frightfully rapid.  One of the most remarkable examples of this is recorded by Andral, and the
case is so interesting in many points of view, that I have
no hesitation in quoting it in a somewhat abridged form.
It will be found at page 416 of his second volume on
diseases of the chest, "The patient was a man of 31
years of age -the age we may observe when pericarditis
is likely to assume its most violent character-he had
suffered for a fortnight previously from rheumatic pain
in the various joints, which were red and swollen, attended with much fever. This was in the month of
August, 1822.   He was twice bled and the clot was
much cupped. On the following day there was no im



264


SOME ORGANIC DISEASES


provement, and he was bled again and again the next day.
On the fourth day, in spite of the four previous bleedings, the joints on the left side were red, swollen, and
painful: twenty leeches were applied to the knee.     On
the fifth day there was no change. On the sixth day he
was bled a fifth time, and a dozen leeches applied.
During the day, he seemed to be much better, the redness, pain, and swelling of the joints subsided; at six
in the evening the pain was entirely gone." What a
testimony in favour of bloodletting, had he gone on to
convalescence, but, alas! his improvement only lasted
four hours, for " at ten o'clock he was suddenly attacked
with a violent pain in his left side:" it continued all
night, and in the morning we find the patient in the following state. " He was screaming from pain about the
region of the heart; the pain was not increased by
pressure, by cough, or by respiration or change of position; the joints were quite painless. There was no abnormal sound connected with the respiratory organs.
The beats of the heart were frequent, tumultuous, irregular, and intermittent. The pulse corresponded in
character with the heart, it was small, and disappeared
under the finger. The face was pale, pinched, and expressed the utmost anxiety. The extremities were cold.
The patient appeared so weak that it was not thought
prudent to bleed him again. Thirty leeches were applied
to the precordial region, and sinapisms to the limbs, but
all was unavailing, and the patient died that evening,
just twenty-nine hours after the invasion of the pain at
the heart. On examination after death, the whole internal surface of the pericardium was covered with a soft
and yellow membranous exudation, and the pericardium




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265


itself was of a bright red colour. There was no effusion in its interior.  All the other organs were perfectly
healthy."
It is impossible to read this remarkable case without
being haunted by the reflection, of how far the remedies
employed were beneficial or injurious. That at the best
they were powerless, is plain enough, and knowing as we
do the wonderful effect of Aconite in such inflammatory
attacks, we cannot but think, that had Andral, instead of
lending his powerful name to the slovenly and stupid experiments on homoeopathy made in his wards, given a
fair trial to our medicines, even in so acute an attack as
this, he might have had the satisfaction of saving his
patient's life, instead of merely ascertaining the correctness of his diagnosis. I cannot resist the temptation of
quoting, in contrast to the fatal success of the renowned
Andral, the following case, which was treated about
twelve years ago by Dr. Drysdale, at a time when he
was only beginning to put to the test of personal experience the system which Andral so haughtily rejected.
"N. J., aet. 14, of lymphatic-sanguine temperament.
Five years ago had a severe fall on the head, since which
time has been subject to nervousness and irritability of
the heart. Five months ago had an attack of pericarditis, for which he was bled to a considerable extent, and
otherwise allopathically treated; he recovered, however,
according to report, perfectly, except that he has since
been liable to short breathing and palpitation on running
fast, but only then. About two months ago he had
another similar attack, for which he was treated in the
same way; the local symptoms were subdued, but




266


"SOME ORGANIC DISEASES


the general health and strength had not been completely
restored.
12th April, 1842.-Yesterday he was seized with
shivering alternating with heat; pain in the region of
the heart; quick pulse, &c. These symptoms continued
to increase till I saw him: he had received three doses
of Aconite 6. The symptoms observed by me were,
violent pains in the region of the apex of the heart,
stretching through to the back and up to the left shoulder;
tenderness on pressure over the apex of the heart; action
of the heart irregular; pulse hard and jarring, ranging
from 126 to 140; great oppression of breathing, respiration rapid and anxious; rheumatic pains in the knees
without swelling; skin hot and      dry; much     thirst;
tongue furred; urine high coloured and scanty; great
restlessness.
Physical signs.-Rubbing sound heard at the base of
the heart, chiefly along with the second sound; bellowssound in the left ventricle at the first sound (this was so
marked that it most probably was the effect of structural
change remaining from the previous attacks, in which
the endocardium had been likewise affected).
Prescription-Aconite 3d dil. dissolved in water, and a
dose given every three hours.
13th.-Has passed a very restless night, and, as reported, had no sleep at all; could not lie in one position
for any length of time, but was constantly tossing about;
was obliged to have the shoulders raised high in bed.
Great thirst; the pain in the heart greater, and more felt
internally between the sternum and scapulae, and towards
the left; anxiety and dislike to be left alone; since




OF THE HEART.


267


morning is quieter; less heat of skin; some perspiration; pulse 126, but not hard; less dyspnoea; bowels
opened once.
Spigelia, 9th dil. Bryonia, 3d dil. alternately, a dose
every three hours.
14th.-Better in every respect; slept a good deal;
pulse still 126, but quite soft and regular; pain at the
apex of the heart gone; less pain in the left side of the
chest, but a good deal of pain felt in the right shoulder
and pectoral muscle. Physical signs the same, and in
addition some increased dulness on percussion over the
region of the heart.
Continue Spigelia 3, and Bryonia 3, alternately every
three hours.
16th.-Much improved; pulse 98, soft; no pain in
the left side of the chest; some pain in the right pectoral
muscle; urine scanty and high coloured; perspiration;
tongue foul; no appetite; no stool. Physical signs the
same, but the rubbing sound no longer heard.
Mercury 2, and Spigelia 3, alternately every three
hours.
18th.-Pulse 70; symptoms nearly all gone; convalescent. A few doses of Nux vomica, Arsenic, and
Digitalis restored him within eight or ten days to perfect
health, except that the bellows-sound in the left ventricle
at the systole remained the same as (it most probably
was) before this attack."
By far the most important remedy in this as in so




268


SOME ORGANIC DISEASES


many other acute inflammatory affections, is Aconite.
The following description of the effects of a large dose,
given by a medical student, and published in the
'Austrian Homoeopathic Journal,' reads almost like a
case of pericarditis.  "Tearing in the legs, knees, and
arms for several days, then cessation of these pains and
violent palpitations in place of them, that came on at 3,
8, p.m. Two days afterwards, the tearing pains in the
limbs recurred, and the palpitation ceased. The next
two days the palpitation recurred with feelings of tight..
ness on the chest, the limbs keeping free from    pain.
The palpitation continued to increase, and was accompanied with great anxiety and oppression of the chest,
and sometimes great dyspnoea."
With the exception of the case I have quoted, I find
few examples of unequivocal pericarditis in our literature.
There is one published by Rothansel, in the Hygea, as
pericarditis, but from the presence of a bellows-sound
during the systole, and the absence of friction-sound and
irregularity of the pulse, I am inclined to look upon it as
endocarditis rather than pericarditis.  Of the cases published in the Brit. Journ. of Horn. by Dr. Laurie, in
1847, in No. 1, besides other deficiencies, there was "total
abscence of pain in the region of the heart." No. 2 is certainly a very puzzling case, and probably there was some
inflammation of themembranes of the heart, but as the pain
in the side was much aggravated by breathing, I am disposed to regard it rather as a case of pleurisy with cardiac
complication.  The medicines employed by Dr. Laurie
were Lachesis, Arsenic, and Colchicum, and most benefit
is attributed to the last.  No. 3 is much the best marked
of the lot.  In this there was loud friction-sound over the




OF THE HEART.


269


cardiac region, strong, and very abrupt impulse; there
was also a grating murmur with the sounds of the heart;
the expression of the face was painfully anxious; there
was great restlessness; a full, strong, rapid, and regular
pulse. These symptoms supervening in a lad of fifteen
upon an attack of acute rheumatism, may be considered
as establishing the case to be one of pericarditis.   The
medicines employed were Aconite and Spigelia till the
acute symptoms subsided, and then        Arsenicum    and
Lachesis till the convalescence of the patient.    I have
again to regret the great dearth of well-described cases
of acute disease in our literature; the deficiency must be
a source of much anxiety to young practitioners who
have to encounter dangerous attacks of such dreadfully
rapid and distressing affections as those of the heart,
surrounded by opponents eager to catch them tripping,
and by the incredulous and often officious relatives of
the patient.
Next to Aconite we come to Arsenicum        as a most
important remedy in this affection, and as a rule it may
be selected in preference to all others, in that form of
pericarditis attended with effusion of serum into the cavity,
while Aconite is preferable for cases characterised by the
preponderance of fibrinous depositions.
Of Bryonia it is difficult to speak with confidence.
Certainly there is nothing in the proving of that medicine
which coincides with the symptoms of pericarditis; this,
however, may be in part owing to such symptoms being
masked by its action on the adjacent pleurae.   It is said,
by Professor Zlatarovich, to produce injection of the
pericardium and redness of the heart in animals poisoned
by it; but we all know how fallacious such appearances




270


SOME ORGANIC DISEASES


are.  On the whole I should be inclined to reserve
Bryonia for cases complicated with pleuritic inflammation.
Nor do I see any proof of Lachesis or Naja being
suitable for the acute stage of inflammation of the heart or
its membranes, although I believe theyare of immensevalue
in treating the consequences of these affections.  I have at
present under my care an elderly lady, who has had pericarditis at some former period, which has entirely wrecked
her health.  The action of the heart is strong, irregular,
and tumultuous, but not attended with any abnormal
sound, nor is it much increased in size; she suffers
constant pain in the cardiac region, and is subject to
severe headache with dreadful depression of spirits, almost
to the extent of true melancholia. In this case I have
found great benefit from the Naja, and I have given it
for months at a time without any bad consequences, and
steady relief of all her sufferings.
The only other remedy on which I would place reliance
in such cases is Spigelia.  The relation of this powerful
medicine to the heart is so well marked and so universally
acknowledged, that it is not necessary to enlarge upon
its suitability.  In the few cases of pericarditis I have
treated, it has done all that medicine could do, and I
have the utmost confidence in it, and I would give it
alternately with Aconite every hour or two hours, according to circumstances, and in the first dilution, in cases of
acute pericarditis.  It is a singular thing and worth
noticing, that in the proving of Spigelia by Hahnemann
himself, there is no indication of its having any effect upon
his heart.  This shows that to determine the qualities of
medicines, we must submit them to experiment on the




OF THE HEART.


271


persons of many individuals, for the most important indications may not appear when tested by the best observers, if they happen not to be susceptible to the action
of the substance; and we should from       this learn not to
disallow a medicine on account of merely negative
evidence brought against it by experiments on healthy
subjects.
How far we should trust to Mercury is rather a difficult question. There is nothing in its pathogenesis
warranting great confidence in its power over inflammation of the pericardium, but knowing as we do its great
value in affections of a similar character of other serous
membranes, and having the strong assurances of the
best observers of the old school as to its value in checking the plastic exudation, or hastening its absorption, I
should feel strongly disposed to place it after Aconite
and Spigelia in acute pericarditis of robust subjects; and
I would venture upon the general observation that without letting down our testimony in favour of the absolute
necessity of the proving of medicines, and the general
sufficiency of the homoeopathic law, yet it is quite manifest
that not only Hahnemann but all the most successful
practitioners among his followers, are always keenly alive
to the importance of remedies, which have been tested
and approved by empirical practice.1
The only auxiliary which it is well to employ in treating
this disease is cold water applications over the region of
1 Since this was written, I have found Mercurius most useful in two
cases of pericarditis which I have met with in practice; the one occurred in
a gentleman about thirty years of age, and was complicated with rheumatism
and pneumonia, he recovered perfectly in about a fortnight; the other in a
young lady of about fifteen years of age, in whom it was uncomplicated,
and who made a surprisingly rapid recovery.




272


SOME ORGANIC DISEASES


the heart, and even these are not applicable after the first
two or three days; at a later period there is a danger of
these lowering the vitality of the heart too much.
Acute endocarditis presents so many points of resemblance, both in its symptoms and treatment, to pericarditis,
that it is not necessary to recapitulate the diagnostic
signs or the remedial appliances common to both. Suffice
it to say, that one of the most distinctive differences is
absence of pain, and this suggests the extreme care
which should be taken by the practitioner to ascertain
the existence of this insidious disease, which, susceptible
as it is of rapid and speedy cure if recognised at once,
if overlooked, lays the foundation for those dreadful
morbid alterations of the valves, which once established,
generally remain for life a source of constant discomfort
and anxiety, and ultimately of sudden and premature
death. In the tenth volume of the Brit. Jour. of     Horn.,
Dr. Acworth has published a most instructive example
of this, where the disease was not recognised till medical
aid was too late and unavailing. The following case,
published by Dr. Huber, is a good illustration of the
successful treatment of endocarditis,
Franz. Rad., ret. 19, a weaver, feeble, of sanguine
temperament, has been free from disease since he was a
child. Three weeks ago he was affected, without known
cause, with shivering, then heat, violent shootings in the
right side of the chest, and strong palpitation and
dyspnoea. He thinks he must have been working too
hard.   The shooting pains in the right side diminished
in the course of these three weeks, but the dyspnoea and
beating of the heart increased so much as to keep him




OF THE HEART.


273


from his work, and he began to cough and spit up, but
only for a few days.
Feb. 21st.-Present state of the patient: Head free
from pain; yesterday evening epistaxis from right nostril;
tongue clean; much thirst; natural appetite and taste;
the pit of the stomach and region of the liver are rather
tender on pressure; faeces and urine normal: no cough;
heavy oppression of the chest; difficulty in breathing;
shooting pain in the right side of the chest when lying
on that side; constant palpitation, with anxiety; weight
on the heart; making him sigh frequently.  On percussion, the dead sound indicating the subjacent texture of
the heart was found, on one side as far as the middle of
the sternum, and on the other side over an unusual extent
of the left side of the thorax. The impulse of the heart
was very strong indeed, striking against the ear with
violence; in the left ventricle, instead of the usual
sounds, there were blowing and rasping sounds accompanying both the systole and diastole.   The   sound
which was heard with the diastole was particularly loud
over the aortic valves, and was distinguishable, with
diminished intensity, however, along its arch. The sound
heard over the pulmonic valves was particularly sharp.
The skin was dry and hot; pulse much accelerated,
beating 100 in a minute, full, strong, and bounding
against the finger; sleep disturbed by frequent crying
out; very-anxious, timorous state of mind.
Treatment-Aconite 1, a drop every two hours in
water.
In the night of the 21st February, he had the first
good -night's sleep he had enjoyed for some time. On
the morning of the 22d, the impulse of the heart was felt
18




274


SOME ORGANIC DISEASES.


to be much less, and does not lift the ear during auscultation. In the afternoon his nose bled a little; auscultatory signs as they were. Night's sleep good.
Feb. 23d,-Much the same; treatment the same. All
night the patient slept peaceably, and perspired strongly.
Feb. 24th.-The heart-stroke is much softer, and
abated in strength; at night sweating and good sleep.
Feb. 26th.-No change of any kind.
Feb. 27th.-He has nothing to complain of; the
breathing, action of the heart, and pulse, are quite
natural.  The noise over the aortic valves is gone; there
is only a little blowing murmur still heard over the
mitral valve during the ventricular systole, but much
feebler than before. The skin is cool, and all the functions normally performed. The same medicine was
continued.
March 2d.-The mitral murmur'has also disappeared
over the left ventricle; the clicking sound accompanying
both movements of the heart might be distinctly heard.
The valves acted perfectly. The patient is beginning to
be hungry again. The medicine continued.
March 3d.-On percussion, I found the dull sound
over the heart to be of normal extent. No medicine.
In four days more the patient was well enough to resume
work.
This was probably a case of inflammation of the
serous membrane which lines the heart, and forms by its
reduplication and combination with the fibrous tissue the
valves of that organ; and the cause of the murmurs in
this and similar cases may be owing to a partial paralysis
of the muscles by which these valves are stretched, for




OF TnHE HEART.


275


we know that this is a common effect of inflammation
in contact with muscular fibre. If this be the true explanation, it is easy to understand the rapidity of the
cure, and it disposes of the assertion of some able
writers that endocarditis once established must go on to
permanent alteration in the structure of the valves.
True, if the inflammatory process involve the fibrous as
well as the serous tissue, and there induces a deposit of
calcareous matter, or an organized metamorphosis into
true cartilage or bone, in such a case the structural
change in the valve is necessarily permanent and irremediable. But this is by no means a necessary, although a
very frequent termination of endocarditis, and it is of
the utmost importance to detect this affection and treat
it vigorously in time, so as to prevent this dreadful
catastrophe. By far the greatest number of true heartdiseases depend upon this cause. The inflammatory
action once set up in the lining membrane, extends over
its whole surface, and the fine margins of the valves are
converted into hard edges; the whole valve is contracted
and unable to prevent the return of the blood from the
vessel or cavity whence it comes, and thus the progress
of the current is partially arrested, and all the dismal
consequences of derangement of the entire circulation
ensue.  Modern science has done much to enable us to
detect with almost unerring certainty the nature of
lesions of this kind, and it is of importance, both
in reference to prognosis and treatment, to be exact in
determining the particular valve affected.
As a general rule, the valves on the left side of the
heart undergo organic changes twenty times more frequently than those of the right, whether owing to the




276


SOME ORGANIC DISEASES


great muscular strength of that side, the greater irregularity of the general as compared to the pulmonary circulation, or the quality of the blood, or a combination of
all these causes, has not yet been ascertained.  Suffice it
that such is the fact, and that in nineteen cases out of
twenty where we find some organic disease in the heart
it begins in the left side.  The mitral valve is most
commonly at fault. In disease of this valve the pulse is
almost always small and irregular, and when we find a
small and irregular pulse, combined with a preternaturally powerful impulse over the region of the heart, we
may almost certainly assume that this is owing to disease
of the mitral valve. On applying the stethoscope to the
region of the heart, instead of the teek-tak of health, we
hear a confused blowing sound. There are various varieties of these murmurs, but it seems an over refinement
to classify them; for all practical purposes it is enough
to ascertain that they arise from some organic change,
and are not merely functional. In certain anmmic states
of the system the blowing is heard, but the test by
which we distinguish these from organic sounds is a very
simple one. If the blowing be from the state of the
blood, as in chlorosis, then it is loudest in the arteries,
and becomes fainter as we approach the heart; the reverse is the case if it arises fr-om organic disease of that
organ.  Besides, the pulse of anamia is soft, while the
pulse of mitral disease is sharp and jerking, indeed so
peculiar that, after it has been felt once or twice, it can
hardly be mistaken.
Disease of the mitral valve, if moderate in degree and
not attended with hypertrophy of the heart, may go on
for many years without materially affecting the health of




OF THE HEART.


277


the person. There are examples of men living to 70, and
even 80, with this affection. If there is hypertrophy,
which is the natural consequence of imperfection of this
valve, then the -chances are much worse, and the health
is. always impaired and the life generally shortened.
Hence the immense importance of judicious treatment in
this class of affections, so that the consequences of an
irreparable injury may be delayed as long as possible.
Sometimes there is no pain, although there is great organic disease, but this is the exception, and as a general
rule, when the valves are affected, there is violent stabbing pain felt frequently in the heart. It is not easy to
account for the severity of the pain, and I feel disposed
to attribute it to spasm of the muscles, for it is of a
spasmodic character, both in its severity, uncertainty, and
duration. I have seen it cured permanently by Lachesis
and I have great confidence in this and Naja in relieving
the sufferings from disease of the mitral valve. I had
under my care a gentleman who        had   suffered  for
15 years from this complaint. There was very great
irregularity of the pulse, which was like a thread, with
violent action of the heart; he suffered dreadful pain at
the heart, and the limbs often swelled. He found
relief from Naja continued for some months; and it is a
curious fact that he should derive benefit from homoeopathic medicines at all, for he takes a wine glassful of
Laudanum every day. He has done so for many years,
and will not or cannot leave it off. Once he tried to
leave it off, but the most dreadful diarrhoea set in, and
nothing checked it till he resumed his laudanum. Of
course we must take patients as we find them, and we
cannot refuse a case because the patient has a bad habit




278


SOME ORGANIC DISEASES


which he cannot check. I certainly did not expect that
the homoeopathic medicines would do so much as they
have done in this case.
Insufficiency of the mitral valve implies regurgitation
of the blood from the left ventricle into the left auricle,
and hence there is an obstacle continually presented to
the free discharge of the contents of the pulmonary vein.
The consequence of this is obviously a state of repletion
of the lungs and a constant risk of cedema of these
organs; and as the blood can no longer pass freely
through the lungs it is not sufficiently arterialized, but
retains more or less of its venous character. Hence we
find a tendency to venous congestion of various organs,
and especially of the liver. It is a most important discovery of modern pathology that this supervenosity of the
blood is incompatible with the formation or growth of
tubercle, and whenever we find disease of the heart of
such long standing and of such a nature as to produce
this state of the blood, we may be quite certain that
tubercular phthisis cannot exist, or if it exists, that the
process of the development of the tubercles is cut short.
Rokitansky was the first to direct attention to this
important fact, and I have frequently found a knowledge
of it of great service in cases of difficult diagnosis. Any
state of the system in which the blood is venous gives
the same immunity, even curvature of the spine when it
is so great as to impede the movements of the chest.
And as it is sometimes difficult to distinguish spinal
curvature and irritation, attended with cough, pain, and
hkemoptysis, from phthisis, this fact is of great diagnostic
value. I have known a case treated by the most celebrated physicians of the old school as phthisis, for years,




OF THE HEART.


279


which I was able confidently to declare to be free from
all tubercular disease on the strength of this observation,
and the course of the cure justified the confidence.
Next in frequency to disease of the mitral valve is
disease of the semilunar at the orifice of the aorta. When,
this exists it is generally attended with a small and
intermittent pulse, but not so irregular as in mitral disease.
The blowing noise may attend only the first systolic
sound of the heart, if the margins of the valve are only
rough; if, however, there is imperfect closure, there is a
murmur heard during the heart's dilatation, as well as
during its contraction, from the regurgitation of the blood
into the left ventricle. It is important to know that
recent pathological investigations have established the
fact that this form of disease is very frequently associated
with an albuminous state of the urine, and we should be
on the watch for this complication, as, of course, it
impairs the chance of the patient's restoration, and will
modify both our prognosis and treatment.      We are
indebted for this observation to Dr. Hammernjk of
Prague.
Insufficiency of the tricuspid valve is very rare, and
when present can be readily detected by the pulsations
in the gorged jugular vein being synchronous with the
contractions of the heart and arterial pulse. It is almost
always combined with disease of the mitral valve, hypertrophy, and other organic changes, which preclude any
hope of recovery.
In regard to the treatment of organic valvular diseases
of the heart we must be content with very vague and
general directions. We do not know, nor are we likely
ever to discover, the finer relationships of the medicines




280


SOME ORGANIC DISEASES


to the tissues of the heart, for it is not to be expected that
experiments will ever be pushed so far as to induce
irremediable mischief to the experimenter; and very
serious changes may go on in the structure of the heart
without any definite sensations by which they can be
recognised by the sufferer. It is however very satisfactory
to know that much relief may be given by homceopathic
medicines, especially Aconite, Arsenic, Lachesis, Naja,
and Spigelia.   I have at present under my care a case of
aneurism of the arch of the aorta. The first thing that
directed my attention to the seat of the disease was the
preternatural strength of the pulsations of the carotid
artery.  On examining the heart I could find no material
enlargement, but there was a peculiar sound over the top
of the sternum, and a sense of weight there, with difficulty of breathing on making any exertion, or on lying
down. Dr. Black, who saw the case with me in consultation, concurred in the diagnosis, which the issue of the case
confirmed. The medicine which seemed to me to give
most relief here was Digitalis, given in doses of two or
three drops of the first decimal dilution daily.  Of course
in such a case cure is out of the question, but it is well to
know that even in these incurable cases relief may be
given by such doses of medicine as we are in the habit
of employing, and I have little doubt that the life of this
patient was prolonged by steady perseverance in homceopathic treatment.
On the whole, to conclude these desultory remarks
upon diseases of the heart, we may safely say that if we
take the trouble to master the diagnostic rules laid down
by allopathic writers, and to attend to their directions on
matters of diet and regimen, we may be able to surpass




OF THE HEART.                281
them immeasurably, both in the cure of those inorganic
and troublesome affections of the heart, and of all the curable organic ones; and that when we too are compelled
to deplore our inability to hold out hopes of restoration
to health, yet even in the vestibule of death we may do
much more than they to mitigate the sufferings we cannot
remove, and to tranquillize and prolong the life we cannot
save, without resorting to those baneful drugs which give
immunity to pain only by stupifying the senses, deranging the intellect, and extinguishing the affections.




CHAPTER VI.


ON PNEUMONIA.
BEFORE entering on the immediate subject of this
paper, we think it may be well to make some general
observations on the relation of Homceopathy to Pathology.
Homceopathy may be defined the law of relation between morbid action and the external specific forces of
nature. The relation is one of similarity and antagonism;
its perfect application implies two knowledges, frst, the
knowledge of all the morbid actions which are liable to
arise spontaneously in the animal economy; second, the
knowledge of the effects of all specific forces in producing
morbid action. The latter kind of knowledge embraces
all that refers to the proving of medicines, and is not
now relevant.
Without going into any wire-drawn metaphysical disquisitions about what we mean by knowing morbid
action, we may state generally that we look* upon this
knowledge as of the same kind as that by which we recognise a person. The more intimate we are with anyone,
the more slight need be his indication-his footstep, his




PNEUMONrA.


283


knock, the most distant glimpse of his figure are enough
to identify him  beyond all doubt in our mind.  If we
were asked to state scientifically how we so recognised
him, we might say, we perceived with a rapidity almost
intuitive all the differentia between him and every other
individual. Could we abstract these differentia in imagination, they would become "his mark"-we may say
his symptom-not him. The qualities of mind required
for this simple process are of two kinds, the observational faculty and the imaginative, using the latter term
in a large sense. Isaac Taylor remarks in his work on
"Home Education,' that nothing shows the difference
between man and the lower animals so well as the effect
of a picture upon a dog and a child. It is the highest
compliment to a painter when a dog recognises the likeness of his master: the dog requires a full representation
of the object; but take a piece of chalk and draw anything like an upright, forked animal, with a hat on the
head, and immediately a child exclaims "papa!" The
child's imagination " bodies forth the forms of things
unseen."  So it is with a physician. Disease is the
total differentia from health superimposed upon an individual; the physician of the highest order knows the relation of all the members of the morbid group; if he
observe the presence of one he is sure of all the rest, as
Cuvier was of all the bones of a skeleton, from a single
articulation. To accomplish this great feat of art, he
requires as thorough a knowledge of all morbid processes
as Cuvier had of anatomy; and more than this, he requires the high faculty of imagination, or the power of
successful hypothesis.  "The bodying forth" (to return
to the phrase of him who knew the process better than




284


PNEUMONIA.


any man that ever lived) is a work of the higher reflective and imaginative rather than the lower observing
faculties; the faculties which relate us to the Creator as
contrasted with those which relate us to the creaturethe God-like as opposed to the sensuous. Herein lies
the explanation of a fact which we have often observed
but never heard accounted for-that all great physicians
have been distinguished more by their reflective than
their observing faculties. Let our readers recall the
cerebral development of those who have taken the highest
place in medicine, and observe whether the upper or
reflective. region does not immensely preponderate over
the   lower   or   observing.     Take    Hippocrates, Galen,
Hahnemann, Abercrombie, as examples.'
I It is not necessary to assume the truth of phrenology to gain consent
to the proposition, that a well-developed upper part of the forehead is
never absent in those gifted with high reflective powers. The testimony of
all ages, from Plato to Coleridge, "the wrapt one of the God-like forehead,"
as Wordsworth calls him, is uniform upon this point, nor is it necessary to
prove the genuineness of the likenesses of Hippocrates; it is more important for us to know what kind of head the Greek artists attributed to the
father of medicine than to know what lie actually had.
The following anecdote is told of Dr. Abercrombie, in a delightful
article upon Locke and Sydenham, which appeared in the 'North British
Review,' some years ago:-" The doctor sauntered into the reom in his
odd, indifferent way, which many must recollect, scrutinized all the
curiosities on the mantelpiece, and then, as if by chance, found himself by
the patient's bedside; but when there his eye settled on him intenselyhis whole mind was busily at work. He asked him a few plain questions,
spoke with great kindness, but very briefly; and coming back to consult
lie said, to the astonishment of the surgeon and young student (who had
been treating the patient for malignant disease of the stomach), 'His mischief is all in the brain; the stomach is affected merely through it. The
case will do no good; he will get blind, convulsed, and die.' He then in
his considerate, simple way, went over what might be done to palliate
suffering and prolong life. He was right; the man died as he said, the




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285


Wb cannot prescribe for the simplest case without a
pathological hypothesis. A patient complains of pain
in the face: must we not run over in our minds all the
probable sources of such a pain? it may be toothache,
neuralgia, rheumatism,!&c. We narrow the ground of
guess by, questions conceived by the aid of hypothesis,
and if we are fully answered, we gradually exclude all
but the particular form of disease which we wish to arrive at. This is the analytic part of the work, and even
here imagination is necessary; and having stripped the
symptoms of all deceptive associations, we proceed to
build up an entire body of disease, which is the morbid
picture Hahnemann speaks so much about. In the
spacious minds of the great physicians, all these morbid
pictures have their prototypes-they are already there;
hence such men, and they alone, at once recognise, in
the true sense, any disease with which they are familiar.
Besides intellectual imagination the physician must
also have what we may call moral imagination. He
must be able not only to picture the disease in its full
brain was found softened, and the stomach sound. The young student, who
was intimate with Dr. Abercrombie, ventured to ask him what it was in
the look of the man that made him know at once. C'J can't tell you, I can
hardly tell myself; but I rest with confidence upon the exactness and
honesty of my past observations. I remember the result, and act upon it;
but I can't put you, without infinite trouble myself, in possession of all the
steps.'C But would it not be a great saving if you could tell others?' said
the young doctor.C It would be no such thing; it would be the worst
thing that could happen to you; you must follow in the same road and you
will get as far and much farther. You must miss often before you hit;
you can't tell a man how to hit; you may tell him what to aim at.' ' Was,it something in the eye' said his inveterate querist. ' Perhaps it was,'
he said good naturedly; 'but don't you go and blister a man's jocciput
whose eyes are, as you think, like his.' "




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individuality, but he must realise to some extent the
effects of such disease upon his patient. To enter fully
into this would lead us to consider the moral attributes
required for a physician, and this would be quite beyond
the scope of these introductory remarks.  Suffice it to
say, that the place of a practical art in the intellectual
scale is fixed by the amount of thought required for its
development, and its place in the moral by the amount
of feeling required for its exercise; and that the art of
healing occupies the highest place in both, the power of
"healing all manner of diseases" being the natural attendant of that inward purity which dwelt as light in
the Physician of souls. So much for the absolute necessity of.a pathology to every medical practitioner.
In passing from these general observations of the necessity of pathology to a homoeopathist to the consideration of the subject immediately before us, we may observe, that the speed and certainty of a cure of any
acute disease, is in the inverse ratio of the extent of the
lesion, and the direct ratio of the amount of expression
of the changes. In neuralgia, for example, we have the
minimum of derangement of structure, and the maximum
of sensation; because the parts are in the most concentrated form, and 'are the seat of sensibility, and of no
disease is the cure so quick, perfect, and permanent as of
some cases of idiopathic " tic doulouroux."  All homceopathic practitioners must have met with such cases; we
remember two especially which occurred in our own
practice, they were both of long standing, the one patient had suffered almost constantly for years, and both
were cured by a few doses of medicine, and never had
any return of the complaint. The reason for our success




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in such cases is obvious: in all the " algias," as the name
implies, te paini  is tze disease.  As in Zeuxis' famous
painting, the curtain was the picture. Morbid anatomy
gives no additional information, the whole disease is expressed, in its most exaggerated form, by the sufferings.
All we have to do is'to find out a similar picture of pain
in some of the observed effects of a drug, and as certainly as a wave of sound, when rolling along its aerial
course, is brought to rest and silence by meeting with
one exactly equal and similar proceeding in the opposite
direction,1 so certainly will the entire flame of pain,
though it may have been burning for years, be extinguished for ever by the application of the specific remedy.
The farther we recede from this point, that is the
larger the lesion and the smaller its expression, the more
difficult and tedious, though not necessarily the less
certain (for reasons which will appear in the sequel) will
be the treatment of the disease.    And, as we may put
toothache at one end of the scale, we may put pneumonia at the other, for here we have, in some instances,
a most extensive lesion of a most important organ
taking place without any sensible expression whatever.
For example, Grisolle says" I shall never forget the history of an old woman in
the Salp6triere, who, in the month of May, 1831, presented herself for consultation; she was ordered a laxative
to restore her appetite, which she had lost for a day or
two.   This woman, who bore no trace of any serious
disorder, nor otherwise complained of any pain, had no
1 See a very well-written paper in a recent number of the ' Household
Words,' entitled "Chemical Contradictions," in which homceopathy is
spoken of. Who would have dreamt ten years ago of finding homceopathy
among the Household Words of England?




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PNEUMONIA.


heat of skin; her pulse was slightly frequent and irregular, which might be explained by an old heart-affection.
This woman still took her food, in the course of the day
made several turns up and down the court, and, towards
the close of the day, she sat down and suddenly            died
(elle s'assit et mourut subitement)." 1
It is not easy     to   exaggerate    the   importance    of
pneumonia to the practical physician.        Next to typhus
fever it is, according to Dr. Farr,2 the most deadly disease
in Britain. One out of every twenty-five deaths is owing
to this disease; so far from     an attack giving immunity
for the future, as is the case more or less with typhus
fever, it is its own most prominent predisposing cause.
Out of 175 patients ill of pneumonia, questioned by
Grisolle, fifty-four had previously been affected with the
disease.   Chomel3 attended a patient in his tenth attack;
and Rush mentions a German, in Philadelphia, who had
had twenty-eight attacks of the disease.' Not only is it
a frequent and fatal disease, but it is one which      can be
recognised by a skilful physician with infallible certainty,
and of which we know aý much as it is possible to know
of any disease, and it is one in which the difference of
I ' Traite pratique de la pneumonie aux diff6rens ages et dans ses rapports
avec les autres maladies aigues et chroniques,' par A. Grisolle, D.M.P.,
p. 435. As this is the first time we have had occasion to refer to
Grisolle, we may mention that he is recognised as the aulhority in pneumonia; and, as we shall have frequent occasion to quote from his work
in the sequel, it is well to know that Louis, and all the highest authorities
in France, Germany, and Britain, regard Mons. Grisolle as perfectly
trustworthy.
SReport of Annual Mortality.
SDiction. de MId., vol. xvii, p. 214.
4Cyclopted. of Pract. Med., vol. iii, p. 406.




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success in the application of medicine seems commensurate with the skill exhibited in the choice of the
remedy, and the timeliness of its administration.  Thus
the difference of the mortality, under the most approved
allopathic and homoeopathic treatment, is enormous; and
it is quite within the sphere of legitimate expectation,
that in proper hands and under favorable circumstances,
all cases of simple pneumonia will be cured with almost
absolute certainty.
We do not propose to enter into a consideration of the
amtiology or symptomatology of the disease, for, to do
them justice, would require a volume, not a section of a
paper; but observing, en passant, that long-continued
exposure to intense cold seems the great exciting cause
of the disease, we shall proceed at once to the structural
changes of the part which is the seat of the disease, as,
from  these, in this instance, we can deduce both the
symptoms and the remedy.
To have a precise idea of what inflammation of the
lungs is, we must first thoroughly understand the anatomical and physiological relations of the lungs; and,
secondly, be acquainted with certain general facts regarding
inflammation; and, at the risk of seeming both tedious
and pedantic, we shall make a general survey of both
these subjects.
The lobes of the lungs, viewed anatomically, have been
compared to cauliflower, consisting, as they do, of a main
stem, branching out into numerous small offshoots,
which end in blunt extremities, like minute sausages.
These stems are hollow air-tubes of elastic tissue, with
cartilaginous rings to support it, the rings becoming
plates towards the termination of the little branches, to
19




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PNEUMONIA.


enable them to contract and dilate with the entrance and
exit of air. All round these little blunt branches cluster
innumerable blood-vessels, which unite with one another
at every point, so as to make an inextricable mesh of
net-work.1 Physiologically, the lungs connect the blood
within to the air without.    Here the blood is made.
Blood consists of a fluid in which blood-globules swim.
This fluid contains a definite quantity of fibrine, and the
proportion of fibrine to globules is a matter of much
importance in a pathological point of view, and to it we
shall have frequent occasion to revert.  Blood-globules
consist of a central kernel or mass, having many of the
properties of fibrine, and round this there is a capsule
which enlarges and contracts, and undergoes a process of
development and death apparently.
According to the most recent observations, the most
probable explanation of the way blood is made is this.
In the chyle are small globules; these chyle or-lymphglobules, on entering the lungs by the pulmonary vein,
become endowed with a highly organized covering, which
probably has the power of secreting colouring matter and
the other secreted constituents of a true blood-globule.
This blood-globule once made, enjoys a sort of independent vitality, and reacts with different agents like a living
being.2   Simon says Henle coincides in this view:
"It cannot be doubted," says Schulz, " that the bloodcorpuscles are produced by the formation of a coloured
capsule round    the  lymph-globules."    These  bloodSSee Reisseissen's admirable work entitled 'De Fabrica Pulmonum,'
published at Berlin in 1832.
2 See Simon's 'Chemistry,' vol. 1st, 128--ilso Schulz, iiber die Gehemmte Aufl6sang, in ' Hufeland's Journal,' April, 1838.




PNEUMONIA.


291


globules then are formed in the lungs, and a condition of
their formation is, the integrity of the structure of the
lungs and of the respiratory process. Once formed, they
are carried in all the freshness of their youth to the left
side of the heart, which propels them    by its vis incita
through the system, where as "floating        centres  of
nutrition," to use the words of Dr. Martin Barry,' they
subserve their great purpose in the animal economy,
continually dying and being reproduced; so that our life
is maintained at the expense of the lives of these myriads
of monads which float in our arteries and veins.
As the due formation, the birth, so to speak, of these
globules implies the perfect integrity of the respiratory
organs, so the proper relation of the capillary vessels of
the body generally is required for the manifestation of
those changes on which nutrition depends. Inflammation implies an enormous change in the relation of the
capillary vessels to the contained blood.  Inflammation
consists of three stages; in the first the capillary vessels
are contracted, and, according to hydraulic laws, the
motion of the blood hastened-this is the latent stage,
the existence of which was long denied, and still is by
some physiologists, but which seems established beyond
the possibility of doubt by the researches of W. Phillip,
Kaltenbrunner, Wedemayer, Koch, and a host of others;
in the second, there is a dilatation of the capillary vessels,
the blood-globules are no longer transmitted.       They
adhere to the sides of the vessels, break up, their living
tunic is destroyed, the red colouring matter diffused
through the serum, and the central kernel escapes: it is
1 On the Nucleus of the Animal and Vegetable Cell, in 'Ed. New
Phil. Journal,' for 1847.




292


PNEUMONIA.


a question at present whether this central kernel is metamorphosed into a true pus-globule or not.      The death
and dissolution of the blood-globules implies the cessation
of all the reciprocal actions which in health take place
between the vessels and its contents, and with this arrest
there stop also all those electric and other phenomena
which Matteucci has shown to attend all vital processes.
It may be, as suggested by Mr. Roberts,' that the
inflammation is a de-electrifying process, and that a
certain amount of electric action is necessary to neutralise the capillary attraction, and permit the free passage of the blood in health through the minute tubes.
The blood also undergoes important changes. In all
pure inflammations there is a considerable increase of the
fibrine and a proportional diminution in the bloodglobules.2 At this stage the vessels are turgid, throbbing, the walls distended almost to bursting, the effect
of this is an increase either of the general or special
sensibility of the part; pain does not necessarily attend
inflammation, but very often, we repeat, increased special
sensibility, for each part has its own sensibility. This
distension of the blood vessels and increase of sensibility
disturbs the sympathetic relations of an inflamed part,
and the heart which, though the most independent, is
yet the most responsive organ of the body, participates
in the local disturbance to a degree depending chiefly
upon the amount of pain, and the extent of the lesion;
besides, being thus forced to become a link in the chain
1 lMagazine and Journal of Science,' 3d series, July, 1841.
2 Andral, 'Essai d'H6matologie Pathologique,' 1843.  A work we
shall have occasion frequently to refer to-it is the standard one upon the
subject.




PNEUMONIA.


293


of morbid phenomena by sympathy, if the inflamed part
be, as is the case with the lungs, a very vascular tissue,
it may thus cause an undue opposition to the passage of
the blood requiring increased mechanical force to overcome it. The third stage of inflammation consists in the
restoration of the capillaries to their normal state, and as
Talleyrand said that the worst revolution was a restoration, so in the capillary kingdom, the restoration of their
original constitution is seldom effected without the formation of new products of every variety of kind. The most
important for us at present is organizable lymph, which
consists of a strong solution of fibrine apparently, and the
tendency of this is to assume definite shapes, depending
upon the form of the part where it is laid down. This
is one of the most important terminations of inflammation.1
In applying these general facts to the peripneumonia
of Hippocrates,2 the pneumonia of the moderns, we find
that Stokes3 is one of the few writers who insists upon
the probability of a stage in pneumonia prior to the first
stage of Laennec. Whether this stage of the contraction
of the capillaries be recognisable or not, may be a question; of its existence there can be none, unless we were
to suppose a violation of all analogies in regard to inflammation of the lungs. In this stage of the pneumonic
process there is a contraction of the capillaries of a
Fletcher's 'Elements of Pathology,' art. "Inflammation."
2 Laennec observes in a foot note, that it is a common mistake to suppose the peri-pneumonia implied inflammation of the integuments as well as
of the lungs. This it does not do in Hippocrates. 'Trait6 de l'Auscultation
Mediate,' Paris, 1826, p. 393.
3 'Treatise on Diagnosis and Treatment of Diseases of the Chest,' part 1,
p. 310.




294


PNEUMONIA.


portion of the substance of the lung, that is of the minute
air-vessels in which all the larger tubes terminate.  As it
is impossible to recognise with precision the moment of
the accession of this change, so its exact duration cannot
be determined. It may be coincident with the shivering
which so frequently precedes an attack of pneumonia;
but even if it were, this is too uncertain and irregular to
be a good point de depart.
The first stage of Laennec, and all practical physicians
(except Stokes) is that of capillary dilatation and consequent engorgement.     The lung in this stage presents
just such appearances as might be expected, from the
retention of a surplusage of blood in a very vascular
spongy substance. It becomes firmer, of a livid or violet
colour, and when cut into a coloured serous fluid as well
as blood flows freely from the incisions.  We learn nothing particular from the microscopic examination of this
stage. The effects of the engorgement of the capillary
vessels of the organ on whose integrity all the functions
depend, must be numerous and important. The immediate physiological effect will be a sense of oppression,
such as felt in the first stage of suffocation. The stimulus to inspiration is the presence of carbonic acid in the
lungs, in undue amount; there is an instinctive sense of
its inadequacy to support life, and an instinctive effort
to get rid of the uneasiness its presence produces by
breathing afresh, the less complete the success of each
effort, the more frequently will it be repeated, even to
panting. In the case of pneumonia this dyspnoea and
accelerated respiration has a double origin, the first and
far the most important is, the increased specific sensibility of the lung.  The lung is specifically sensible to the




PNEUMONIA.


295


presence of carbonic acid, but the inflamed lung is preternaturally sensitive. This position which we have nowhere seen stated, seems to us proved by the following
considerations. First, the amount of abnormal excess
of carbonic acid is very trifling; according to Davy,1 the
difference of the quantity of air in the lungs before and
after an expiration is as 118 to 108 inches, that is, about
10 to 13 inches are changed each time, or not much
above a tenth. This is the amount of change in the
whole lungs. Let us consider how insignificant the effect
upon the general respiratory process, the occlusion of a
lobule must have. Again: all causes which increase the
pulmonary sensibility, augment the dyspnoea;2 as for
example, an exanthematous disease. Besides, the lung
may be occluded more completely, and to a much larger
extent, as in phthisis, and even in what is called latent
pneumonia, with little acceleration of the breathing, and
without a trace of difficulty.    Dyspncea then, which
Grisolle speaks of as a constant symptom, and which for
reasons obvious on a moment's reflection, is more important to us as homoeopathists than the physical signs
of the disease, depends, like all other vital phenomena,
upon the combination of two causes-the one a preternatural sensibility of the affected part to the natural
stimulus on which its action depends; and the other an
excessive amount of that natural stimulus. We have the
phenomenon analysed in nervous asthma, and suffocation
by carbonic acid gas. In the former the irritability is
excessive, the stimulus natural; in the other the irritability is natural, the stimulus excessive-we are speaking at present only of the dyspnoea that attends the first
I Simon's ' Chemistry,' p. 126.      2 Grisollc.




296


PNEUMONIA.


stage, that which attends the third, or fatal stage, has
different relations altogether.  The explanation of most
of the other phenomena are deducible from the accelerated respiration. The pulse is almost always full and
rapid, more constantly so, according to Grisolle, than in
ailost any other acute disease.   Without entering more
fully into the physiological considerations of the point, it
is enough to observe, that the heart is so related both by
the respiratory system of nerves, and mechanically to the
lungs that it is almost inconceivable that it should not participate in any disturbance affecting them. The blood
being the river of life which permeates the whole frame, it is
manifest that whatever troubles it, must produce general
derangement.    Now the blood is very much affected in
pneumonia.    In healthy blood the proportion of fibrine
is from  two to three per mille.1  According to Andral,'
in pneumonia it rises as high as ten per mille, higher
indeed than in any disease, acute rheumatism excepted.
With the increase of fibrine, there is a diminution of red
globules, the normal average of these is, according to
Lecanu, 127.    About 114 seems the average in pneuinonia.3
It is obvious that so important a change in the blood
and in the heart's action must affect both the cerebrospinal axis and the organs of digestion.   Hence we find
delirium frequent and intense, in proportion to the severity
of the local disease; also foul tongue, constipation, highcoloured urine, and the other attendants of insufficient
innervation of the alimentary canal and renal apparatus.
Before leaving this part of the subject, we shall briefly
Simon's 'Chemistry,' p. 245.
Op. cit., p. 86.
SAndral and Gavarret, Simon's ' Chemistry.'




PNEUMONIA.


297


advert to the question of whether these important changes
in the blood are primary or secondary. Dietl 1 argues
that the changes in the blood are primary, and that on
these changes the dyspnoea, delirium, &c. depend. The
question has been set at rest by an experiment of Professor
Henderson, who bled a patient at an early stage of pneumonia, and found that there was no increase in the
quantity of fibrine.2 Besides, Andral lays it down as a
maxim in hebmatology, that the exanthematous diseases
never increase the proportion of fibrine nor diminish that
of the blood-globules. Nay, that they seem to exert
an opposing influence to this effect, when produced by
an intercurrent acute inflammation; so that if a pneumonia be not very extensive, it will have no effect in
deranging the proportion of fibrine blood-globules if it
occurs in a person suffering under measles.        Now,
Grisolle mentions a case where there was slight pneumonia, but excessive dyspncea and other symptoms
occurring in the course of an attack of measles, which
proves that these symptoms could not be owing to the
change in the blood as none would take place.
We have one more observation to make on the cause
of the dyspncea in pneumonia, it is extremely similar to
that which precedes an attack of hmemorrhage from the
lungs.   Now, in all haemorrhages there is a diminution
of the fibrine, not an excess; in fact, the state of the
blood is diametrically opposite to that in pneumonia. The
pathology of such haemorrhages is simple enough; there
is a congestion of the lungs relieved by an effusion of
blood. They often happen in patients whose nervous
1 'Der Aderlass in der Lungen entiindung,' Wien, 1849.
2 See 'Essay on Palhology,' in 7th vol. of ' Brit. Journ. of Homcopathy.'




298


PNEUMONIA.


system is deranged, which may account for the excessive
dyspnoea which precedes an attack of haemorrhagedyspnoea, greater than the limited portion of the occluded
lung, accounts for on mechanical principles. The connection of haemorrhages with neuropathia is a subject of
great interest to the physician, and one hitherto but little
worked out.
In this stage when the blood is accumulated in the
vessels of the lungs, and the blood-globules broken down
and dissolved, there is an exudation of bloody serum
through the walls of vessels into the air-cells, whence
result the rust-coloured sputa, so characteristic of the
disease. It is probable that this takes place without any
rupture of the coats of the vessels, for Reisseissen1 found
that, when injecting a fine fluid into the pulmonary artery
or vein, however gently he did it, yet some escaped into
the air-cells. It may be some endosmosic process, or
there may be slight rupture. It is impossible to decide,
and it is no matter.  The other symptoms of the pneumonia, the cough and pain, are no way peculiar, and are
accounted for on the pathological principles which determine these phenomena generally. The cough is seldom
troublesome, sometimes altogether absent; the pain
quite uncertain in its seat, character, and degree.  A
fatal case of pneumonia of the     right lung  we once
attended began by excessive pain in the region of the
heart and dyspnoea.   The cause of the pain in this case
probably was owing to the anastomosis of the respiratory
and sensitive systems of nerves.  But a full explanation
of this would occupy too much space.    It is well, how

' Op. cit.




PNEUMONIA.


299


ever  to  remember     that latent pneumonia is often
attended with severe pain in parts distant from the seat
of the disease.
The second stage of pneumonia consists of the secretion and deposition of certain matters from the bloodvessels into the air-cells and minute bronchial tubes.
Meckel defines imflammation to be a congestion, with a
tendency to a new production.   The second stage may in
some respects be considered as the termination of the
diseased action, for if, as in haemorrhage from the lungs,
the matter secreted were capable of immediate expulsion,
then the congested vessels would at once return to their
pristine integrity, and the functions of respiration go on
unimpaired.    But this is not the case; the matter
secreted and effused must be looked upon as an altogether new formation which lies imbedded in the lungs,
and undergoes certain transformations according to fixed
laws of its being; and it becomes of the greatest interest
to ascertain what this substance consists of, and what
changes it tends to undergo. We may look upon this
subject as exhausted, it has been so thoroughly examined;
one of the best papers upon it is by Professor Henderson
in the Monthly Journal of Medical Science, published in
Edinburgh in 1841.     There is also a very full and concise paper by Dr. Aitken, of Glasgow, in the Edinburgl
Medical and Surgical Journal, No. 178.
"Viewed    under the    microscope,"   says Professor
Hasse, cc exudation of genuine pneumonia reveals a distinctly granulated condition, and, generally speaking, an
'Anatomical Description of the Diseases of the Organs of Circulation
and Respiration,' by C. E. Hasse, M.D., &c., &c.; translated and edited by
W. E. Swaine, M.D., p. 210-11.




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elementary composition varying as this second stage is
more or less advanced.    Numerous examinations have
induced me to believe that in this kind of pneumonia
the effused substances are originally fluid, then coagulate
to a tolerable degree of solidity; and finally, again
liquefy. In the primary form these substances, as above
stated, display a number of blood-discs imbedded in a
nearly amorphous, slightly granulated or striated mass.
On being treated with water this mass still exhibits no
cells (beyond a few shed ciliary cylinders), but numerous
elementary granules either scattered singly or collected in
groups.   Acetic acid dissolves the greater portion of the
mass, leaving unchanged only the elementary granules,
and more or fewer spherical nuclei of various magnitudes.
When some time elapses before the coagulation of the
effused  substances takes place, these nuclei become
previously sheathed in spherical cells-exudation cells.
After coagulation, the mass becomes amorpho-granular
by mechanical division, a display of certain forms only,
for the most part exudation-cells-is sometimes produced;
by treatment with acetic acid this mass is again almost
entirely dissolved, those elementary granules and spheroid
nuclei alone remaining.   With the ultimate liquefaction
of the coagulate effusion the true development of cells
appears to take place; and it now depends upon relations
not clearly definable whether more exudation-cells or
more pus-globules are developed. These two last forms
constitute by far the greatest portions of the mass, and
become readily discernible on the application of acetic
acid.  In this variety of pneumonia, granule-cells appear
to form  in very small numbers, and often not at all."
Professor Hasse adds in a note-" These microscopic




PNEUMONIA.


301


relations would hardly justify the adoption of the epithet
-' Croupal,' as applied by Rokitansky to genuine pneumonia, inasmuch as the false membrane in real croup
displays a different elementary composition."
The most important considerations in a practical point
of view in reference to this stage, are that the first and
second stages are almost always going on together in the
lung, though of course not in the same part of the lung,
that we can hope to arrest the progress of the first but
have no control over the second, and that the kind of
deposition depends upon the state of the general health;
thus  in  cachectic persons, the deposition  is more
granular, that is, more allied to pus, while in the
vigorous it is more fibrinous, and sometimes, whatever
Professor Hasse may say to the contrary, has all the
properties of the false membrane of croup. Cases are
recorded of pneumonia terminating in the coughing up
of tubes having the form of the minute ramifications
of the bronchia; so that it depends upon whether the
patient is in a dyscrastic or euchrastic state, the peculiar organization or disorganization of the secreted
deposit in his. lungs as the termination of their inflamed condition.
We may observe, that with the setting in of this
stage there is an immediate relief to all the sensible
symptoms of the patient.   In some cases this relief is
almost instantaneous.  The apparent relief afforded by
bloodletting is owing to its frequently being made at
the time when this second stage was just setting in. This
fact is established beyond a doubt by Dielt.1  However, we do not mean to deny that bloodletting does
SOp. cit.




302


PNEUMONIA.


give temporary relief in this affection if performed at
the time of the greatest engorgement of the lungs,
and before much deposition has taken place. It acts
by relieving the heart's action, lessening the amount of
load propelled by that overburdened organ, also by
reducing the quantity of blood in the gorged capillaries; but this it can only do by withdrawing blood
from  the general circulation, and thus augmenting the
risk of inducing a feebleness of the system    like that
of dyscrasia, and so making it more liable to deposit
rather the granular, inorganizable matter than the
healthy and organizable in the tissue of the lungs, with,
of course, the most disastrous ultimate issue to the
patient. However, if we had not specific medicines to
administer, notwithstanding all that Dietl says, we should
bleed in the first stage of pneumonia in all healthy per.
sons as a general rule.
Let us, before passing to the third stage, recapitulate
the characteristics of the second, technically called the
stage of red hepatization.  It consists of a deposit of an
organizable, partially reticulated mass, and of granules
in the air-cells, and ultimate air-tubes of the lungs.
The organizable portion consists of a semifluid substance
containing a quantity of half-dissolved, or suspended
fibrine. The granules are peculiar bodies, from which
pus is formed.
The third stage of the disease, or that of grey hepatization, consists in the transformation of this effused
jelly mass more or less entirely into pus by the agency
of these pus-granules.   The origin of pus-granules is
not known.     Some physiologists' suppose them   to be
Gendrin, Donne, &c.




PNEUMONIA.


303


transformed blood-globule kernels; but this is extremely
improbable.    Professor Gluge,' in his short and admirable treatise on the blood, rejects this notion.  He thus'
describes the appearance of a pus-granule when magnified 300 or 400 times.       "They consist of a whitish
grey mass, somewhat elastic and of no great consistency;
throughout the whole of this mass 4 or -5 dark points
penetrate; these black points can be separated from the
white pretty easily.   The edges of the pus-granule are
irregular, and slightly puckered (gefranzt); they preserve
their original form for 14 days. By what process these
bodies are formed is not known." Corruption and death
are as great mysteries as organization and life:-" from
hour to hour we ripe and ripe, and then from hour to
hour we rot and rot."
In a lung, which is the seat of red hepatization, the
two processes are going on simultaneously, the formation
of granules of pus, and the formation of organizable
material. On the relative amount of the two actions
depends the course and issue of the case.        If all the
effused material or the greater part were to be organized,
we should have membranous tubes, as in croup, filling
up the air-vessels and vesicles; and these might be permanent, and    give rise to solidity of the lung which
sometimes, though very rarely, remains after pneumonia.
There is a preparation in the Hunterian Museum          of
Glasgow, of the lungs of a dog quite solidified by a
cartilaginous deposit, which is only a different form of
this organizable substance. If, on the other hand, the
1 ' Anatomisch - microscopische lUntersuchungen zur allgemeinen und
speziellen Pathologie,' von G. Gluge. Minden und Leipzig, 1839.
2 Page 17.




301


PNEUMONIA.


whole effused substance become purulent, then the lung
is disorganized, for pus acts like a foreign body, and induces the destruction of the parts it touches, negatively
if not positively. Between these two extremes we have
every variety, depending upon the extent of the lesion,
the constitution of the patient, and various other modifying conditions too minute and numerous to specify.
We read constantly of the danger of tubercles supervening on pneumonia.     Now, this termination is certainly not suggested by a study of the morbid anatomy
of the diseases, and we find the highest authorities are
against it.  Louis,' the fountain of all our accurate
knowledge regarding phthisis, very specifically rejects
the notion after a most careful examination of eighty
phthisical patients; and Grisolle,2 who is an equally
high authority on pneumonia, sums up the question with
the following statements:-" I conclude, from what precedes, 1st, that phthisis does not immediately follow
pneumonia except in veryrare cases (less than one-thirtieth
of the whole number); 2dly, that even under these circumstances it is by no means proved that the tubercular
affection is a consequence of pneumonia-all presumptive evidence goes on the contrary to support the notion,
that the tubercles existed before the pneumonia, and
have, perhaps, acted as its cause.   3dly, that, in cases
of exceeding rarity (since for my own part I have never
observed such), where miliary tubercles appeared to form
in hepatized lung, the pneumonia has then acted as the
exciting, and by no means as the proximate cause. And
I consider the diffusion of tubercles through the influ1 Louis, 'Researches on Phthisis,' 1846, p. 495, et seq.
SOp. cit.




PNEUMONIA.


305


ence of pneumonia in persons simply predisposed to the
disease, as an occurrence- of great rarity. Thus, among
305 patients, whose cases I have analysed for this work,
twenty-two presented those peculiarities of constitution
which are commonly regarded as forming a predisposition
to phthisis; besides, more than one half of them had
had one or more of their nearest relations cut off by
phthisis, and yet all these individuals, without exception,
recovered from  the attack of pulmonary inflammation,
and left the hospital perfectly restored to health. Nor
did the pneumonia in these cases differ either in respect
of its cause, its symptoms, or its progress, from the ordinary pneumonia occurring in subjects not predisposed to
the tuberculous affection.''  The mutual corroboration
of two such men as Louis and Grisolle, we look upon
-as finally settling the question, and we have no doubt it
will relieve the anxiety of practitioners in treating this
class of affection.
Practically the most important thing to consider now,
is whether there are any means of recognising and arresting, or modifying the transformation of the red into
the gray hepatization, or the transition of the second
into the third stage. After a most careful examination
of the subject, Grisolle2 says-c"I conclude, from all
that has gone before, that the two first stages of pneumonia may be certainly diagnosed (seront diognostiqu6s
surement), and distinguished the one from the other, by
the aid of auscultation, but that there exists at present.no stethoscopic symptom, nor any character of the expectoration, by which we can affirm that the pneumonia


1 Op. oit4


1  Op. cit., p. 499.
20




306


PNEUMONIA.


has passed into the gray hepatization." That it is impossible to recognise the third stage we do not affirm,
but when so experienced a physician as Grisolle tells us
he cannot do it, we should certainly receive with considerable doubt the contrary assertion, however confidently made, of all ordinary practitioners, be they allopathic, hydropathic, kinesipathic, homceopathic, odylopathic, or any other pathic that is, or is to be.  A disease
we cannot know we cannot treat.      And, therefore, we
look upon the third stage of pneumonia, or that in which
the deposited material is undergoing its process of corruption, as beyond the reach of direct remedial appliances, just as much as morbid action occurring in a
foetus. Foetuses die of pneumonia; but how are we to
find it out? and if we did, how are we to affect it? All
we can do is to improve the mother's health. The individual is to the pneumonic mass, undergoing development,
in the relation of a parent to a child-he gave it birth,
and gives it nourishment, but it lives upon him for
itself.
Pneumonia terminates in recovery, more or less perfect, or death. The former is brought about by the
absorption, in whole or part, of the deposited material
into the mass of the circulation, where it is gradually
eliminated by various processes, leaving the lung either
perfectly sound or partially destroyed in structure, the
cell-walls being broken down and the affected part
lastingly weakened, and, in consequence, always more
liable to a fresh attack; or not ruptured but solidified,
by the formation of a thickened membrane upon the
air-cells and tubes.
Death by pneumonia is caused by suffocation.    This




PNEUMONIA.


307


does not imply a mechanical hindrance to the entrance
of air into the lungs, it implies the arrest of the reciprocal
action of the air upon the blood in the lungs. This
impairment of the pulmonary function may arise from a
structural change such as that caused by the pneumonic
process, or by a change in the blood itself, or by a change
in the innervation of the part.  All these causes are
combined in pneumonia: part of the lung is blocked up,
in it the blood is not purified, because neither air nor
blood pass through it.  The rest of the lung is acting in
most unfavorable circumstances. The blood is tainted,
full of old globules not properly vivified, pus-globules,
and the detritus of a corrupt lung. The lung, like
every other organ and more than most, requires a full
allowance of nervous influence (as is shown by the phenomena of asthma, which depends upon a partial paralysis of the pulmonary nerves), but the nervous centres
cannot be up to the mark if not properly nourished, and
impure blood does not nourish them. Last of all the
heart, that " primum  saliens et ultimum moriens," becomes involved in the fatal concatenation, it continues to
propel the blood till the last, but such blood as the
lungs furnish is of no use, and acts as a poison on the
brain, so that in this, as in all other kinds of suffocation,
a man dies poisoned by his own blood, to use the words
of Bichat. As it is of great consequence to the practical physician to have a clear idea of the phenomena of
asphyxia, we may sum them up in the words of the late
Professor J. Reid, who investigated the subject in the
most full and satisfactory way, and cleared up many
embarrassing discrepancies, and rectified much pirevailing error:




308


PNEUMONIA.


" We believe, then, that in asphyxia the order of succession in which the vital processes are arrested is as
follows: the venous blood       is first transmitted   freely
through the lungs, and reaches the left side of the heart,
by which it is driven through all the textures of the body;
as the blood becomes more venous, its circulation through
the vessels of the brain deranges the sensitive functions,
and rapidly suspends them, so that the individual becomes unconscious of all external impressions. The
functions of the medulla oblongata are enfeebled about
the same period that the sensitive functions are arrested
(delirium is always a bad sign in pneumonia), but are not
fairly suspended for some time longer. Immediately after.
the sensitive functions are suspended, and the blood has
become still more venous, it is transmitted with difficulty through the capillaries of the lungs, and, consequently, begins to collect in the right side of the heart.
A smaller quantity of blood must now necessarily reach
the left side of the heart, and this diminution of the
quantity of blood sent along the arteries, conjoined with
its venous character, and the ultimate arrestment of the
circulation, being circumstances incompatible with the
manifestation of vitality in the other tissues of the body,
general death is sooner or later induced."'
The indications for the treatment of pneumonia are
extremely simple. We must find a medicine which has
the power of arresting the first stage, that is of restoring
the capillaries engorged with blood, and preparing to
deposit the substances we have described as peculiar to
this disease, to their natural state, and, at the same time,
'Edinburgh Medical aud Surgical Journal,' vol. lv, p. 450, for the year
1841.




PNEUMONIA.


309


we should allay the sympathetic irritation of the system,
on which the general fever depends. If we can arrest
the progress of the engorgement, we quench the circumference of the conflagration, and we may leave the
morbific matter which has been deposited to be disposed
of according to the laws of morbid action.   If we can
find any medicines which act directly on the tissue of the
lung, and produce this inflammatory action, then we may
be satisfied that they will operate curatively in pneumonia. In considering the relative value of the different
medicines we are about to cite, we must place much more
reliance upon clinical experience in ascertaining their
worth in this disease than in most others, for pneumonia
offers so few unequivocal rational signs that we cannot
certainly predicate of the effects of a medicine, as exhibited
in its proving, that they are those of pneumonia. However, we need regret this the less as we have ample and
undoubted clinical experience to assist us, and we may
say that our knowledge of the treatment is now as perfect
as our diagnosis of the disease. In the observations we
are about to make, we have been much indebted to a
series of articles that appeared in the first three numbers
of the ' Homiopathische Vierteljahrschrift,' by its painstaking editor, Dr. C. Miiller, and we have no hesitation
in using the materials he has presented, without ourselves
verifying their accuracy by comparing them    with the
original sources whence he obtained them.
The only medicines which we propose to consider are
Aconite, Bryonia, Phosphorus, and Tartar emetic.   For,
on a careful perusal of the proving of the other medicines
cited in Dr. Miiller's paper, and the alleged cures of
pneumonia by their administration, we come to the con



310


PNEUMONIA.


clusion that the evidence for their being of such decided
use as to warrant their employment in pure pneumonia
was quite insufficient.    Even Belladonna we do not
admit, although we have high testimony in its favour.
This testimony, however, is qualified by the observation
of its great utility in pneumonia occurring with scarlet
fever, which entirely alters the case, and, as in this paper
we have refrained from noticing any other form of disease
than pure pneumonia, we do not deem it expedient to
enter into an investigation of the virtues of Belladonna in
this  complication.   There   would   be   abundance of
material for another paper upon the complications of
pneumonia and their treatment, and we trust some
experienced physician may take up this subject.      Our
chief reason for rejecting the evidence in favour of the
utility of Belladonna, Pulsatilla, Zinc, &c., is the extremely bald narration of the cases in which they were
said to be of use, and really we are ashamed to record that
out of a very large series of cases collected by Dr. Muller
from the various journals, there is hardly one in which
the diagnostic signs of pneumonia are given in a way to
satisfy a modern physician. To this general remark there
are some honorable exceptions. Without further preface,
we shall consider the claims of Aconite as a remedy in
the first stage of pneumonia.
The   proving   of Aconite   in  the   Oesterreichische
Zeischrift fiir Homdopathie, by Dr. Gerstel, of Vienna,
is so perfect that it leaves us nothing more to wish.
Experiments on animals prove that Aconite induces
engorgement of capillary vessels generally.  It was found
by Dr. Prevost,' that if Aconite much diluted by water
S' M6moires de la Soc. de Phys. et d'Hist. Nat. de Geneve,' t. vi, p. 1.




PNEUMONIA.


311


was brought in contact with the web of a frog's foot,
contraction and afterwards dilatation, &c., of the capillary
vessels ensued.  These experiments are corroborated by
others, and by many analogous facts, so that, to begin
with, we may say that Aconite tends generally to produce,
ergo, to cure, capillary engorgement.  Orfila' found, in
a dog poisoned with Aconite, that the lungs were thick-.ened, condensed (dicht), of a brownish colour and full of
blood, and did not crepitate as in the normal state. We
do not place much weight upon this observation, still it
seems to indicate a certain tendency to local action in the
direction of the lungs.
Most of the persons who proved Aconite experienced
symptoms of its direct effect upon the lungs.  Thus Dr.
Bihm,2 after taking five drops of the tincture, among
other symptoms felt a tickling in the larynx, which compelled him to cough, also frequent stitches in the middle
of the sternum (a common place to feel pain when the
lungs are affected, and not likely to be rheumatic). The
following day he took ten drops, and felt an inclination
to cough, and next morning he coughed up mucus
streaked with blood.  This we consider as almost an
unequivocal evidence of the lungs being directly affected
by the drug. Professor Joseph Von Zlatarovich,3 after
taking 200 drops of the tincture for some time, had
frequent inclination to sigh, from the distinctly felt
collection of blood in the lungs.
It would be easy to multiply instances; but we should
prefer that our readers would study this admirable
' Toxicologie,' 3te. Auflage, Bd. 3, s. 59.
2 Op. cit., p. 31.
Op. cit., p. 92.




312


PNEUMONIA.


proving for themselves, and we think that they will be
convinced that Aconite does tend to produce congestion
of the lungs, as well as general inflammatory fever, and
that, therefore, it is a priori well suited to the treatment
of the first stage of pneumonia.
The two following cases, although in neither have the
physical signs been    observed, still seem  to  possess
undoubted claims to our acceptance, as cures of pneumonia by Aconite.
A mason, seventeenyears of age, of strong constitution,
presented the following symptoms: throbbing headache,
chiefly frontal; eyes bright, with contracted pupils, and
over sensitive to light; face dark red, hot, and puffed;
dry lips, white coated tongue; bitter taste; much thirst;
constipation; scanty bright red urine; respiration short,
superficial, laborious; oppressive and painful pressure on
the chest, especially under the sternum; cough frequent
and short, with heavy blood-streaked expectoration;
stitches in the right side on inspiration, increased on
coughing, deep-breathing and every movement; inability
of lying on the side; continuous burning dry heat, with
cold feet, preceded by rigors; pulse quick, full, hard;
weariness and sense as if the body had been beaten;
sleeplessness, anxiety, and restlessness.  A  drop of the
12th dilution of Aconite every four hours for six times.
After the third dose, general perspiration set in, and
after waking, there was decided improvement in his
condition.  On the next morning the headache, thirst,
oppression of breathing, and pressure at the heart, beaten
feeling, anxiety, and restlessness were all gone.  There
was an alvine evacuation, the urine deposited a sediment,




PNEUMONIA.


813


there was a general transpiration from the surface, the
pulse was slower and softer, the breathing calmer and
freer, the cough less frequent, with a little pure slimy
expectoration; he could lie upon the side, and the
stitches were only felt on taking a full breath or coughing;
appetite also returned. The following night he slept
well, only coughed a couple of times, and went to his
work the succeeding day.
This case is recorded by Dr. Gulyas, in vol. xix of the
Horn. Arciv., and we concur with Dr. Muller in his
remark that this rapidly-cured and well-described case
makes us the more regret the absence of the physical
indications of pneumonia.
The next case is by Dr. Trinks, of Dresden, whose
name is in itself a guarantee for the correctness of the
diagnosis.
A robust maid-servant, thirty years old, after being
exposed to cold and wet, was attacked with severe rigors
and stitches in   the breast.    The next morning the
following symptoms manifested themselves: dull stitching,
pressing pain in both lungs, which obliged her to lie
upon her back and prevented deep breathing; frequent
short cough, with incessant inclination to it; great
dyspnoea and anxiety, which would not let her lie still,
and expressed itself in the countenance; face dark blue,
puffed; pulsation in the carotids; dryness in the mouth
and thirst; bloody taste in the mouth; general dry heat;
pulse slow (?), oppressed, small; drawing pain in the
limbs. After a dose of the 24th dilution of Aconite,
transpiration set in upon the first night; the breathing




314                   PNEUMONIA.
was freer; expectoration slimy and without blood; the
pains in the limbs were gone. The cure was completed
by Bryonia.'
We are disposed to regard this as a case of incipient
pneumonia, in the first stage of Dr. Stokes. If pneumonia at all, it was a wonderful cure, but far from  incredible. Dr. Wurmb,2 an excellent practitioner, expresses himself as convinced of the utility of Aconite in
pneumonia, and that it does not merely allay the fever
but has a specific action upon the lungs. Dr. Buchner,.
also expresses himself satisfied of its usefulness. We
should gladly avail ourselves of Dr. Miiller's sensible
concluding paragraph, had we space. We can only
recommend his whole article to the attention of our
readers.
If we admit, as we must, that Aconite is the proper
medicine at the beginning of a simple pneumonia, the
next thing to determine is the dose. We find all doses,
from the 1st to the 24th dilution, of use; and for our
own part we usually employ the third, but can lay down
no rule. We have ample facts to show the efficiency
of all dilutions, and none to show the superiority of
any.
BRYoNIA.-Although its effects upon the digestive
system, and upon the serous membranes and muscular
tissue are much more prominent in the admirable proving
published in the 3d vol. of the Austrian Journal, yet we
find unequivocal symptoms of its direct effect upon the
1 'Annal. der Horn.,' K. 1, 24.
' Hygea,' ix, 1, s. 53.
Ibid., xv, 6, s. 503.




PNEUMONIA.


315


parenchyma of the lungs; and we must remember that,
owing to the slight general sensibility of these organs,
and the great sensibility of those others affected by
Bryonia, that it will require fine discrimination to pick
out the pathogenetic signs of an effect upon the pulmonary tissue. The dumb sufferings of the lungs are
not easily recognised amid the clamour of the stomach,
bowels, and muscles. The appearance of the lungs in a
rabbit poisoned by it gave unequivocal evidence, however, of its direct action on these organs. This experiment was made by Loewy, of Vienna. After the animal
had taken three successive large doses of Bryonia, it
died; and on dissection, the lower half of both the
lungs were found of a dark flesh-red colour; they did
not crepitate, and sank in water.'
Among the provers, the most marked symptoms were
the following: Surgeon Huber, after taking Bryonia in
large quantities for several days, describes that one day,
about one o'clock, his respirations became greater while
driving, and he experienced the feeling as if the upper
part of the chest were too tight. (This is exactly the
sensation given by a congestion of the lung, as we have
frequently had opportunity of observing). The tightness of the chest, and a raw feeling under the sternum,
increased to such a degree as to oblige him to alight
from the carriage. Dr. Wiirstel, after the continued use
of the medicine for some days, states, that one day, after
he had taken twenty-five drops in the morning, he was
affected in the forenoon with stifled breathing (beklommenes athmen), and a weight in the middle of the


1 (Ester. Zeitsch. fiir Horn.,' vol. iii, p. 96.




316


PNEUMONIA.


breast."  This is either from  congestion of the lungs,
or from some effect on the nervous centres which Bryonia
does not produce.   "The saliva is twice mixed with
clear blood." Taken in connection with the oppression
of the chest, it is probable that the blood came from the
lungs; at all events, it produced a hIemorrhage of some
part of the mucous tissue which lines the respiratory
organs; and as we pointed out before, the first stage of
pneumonia is extremely analogous to the congestion
which ends in hmmorrhage. This evidence for the direct
effect of Bryonia on the lungs, though scanty, is goodand we have such ample clinical experience of the utility
of the drug, when administered in the disease, as to
supersede the necessity of any more a priori evidence in
its favour.
By far the most important book upon the treatment of
any disease which has yet appeared in homoeopathic, we
may say in medical literature, is one by Dr. Tessier on
the treatment of Pneumonia and Cholera. It is intitled' Recherches cliniques sur le traitement de la pneumonie
et du cholera suivant la methode de Hahnemann.'   Precedes d'une introduction sur l'abus de la statisque en
medecine, par le Docteur J. P. Tessier, Medecin de
l'H6pital Sainte Marguerite (H6tel Dieu Annexe), a
Paris.-Bailliere.  Our readers are no doubt already
somewhat acquainted with this book through the able
papers of Dr. Ozanne, which appeared in the.Homropat/dc Times. What gives this book such immense importance in our eyes is, that it is the first time the
system of homceopathy has been fairly carried out in a
public hospital by a physician of the old school who had
ample opportunities of comparing his former and later




PNEUMONIA.


317


success, and who has given us such unexceptionable reports of every case he treated. It is utterly impossible
for any one who is capable of appreciating evidence, to
gainsay the potency of this. The cases are admirably
described,-how different would homoeopathy be had all
the homoeopathic cases been so narrated! The total
number of cases treated was 41; of these, 38 recovered and 3 died. He comes to the following conclusions:
"1. In all, the disease was making progress up to the
moment of treatment.
"2. As soon as that had commenced, an aggravation
ensued, which lasted in general less than twenty-four
hours, and the remission began either partially or over
the whole extent. From this time everything converged
rapidly towards cure.  Sometimes the amelioration began
without previous aggravation, and went on without a
check to perfect cure.
"3. The pulse showed an extraordinary influence of
the Bryonia. - It was noticed to fall 20, 30 pulsations
on the day of its administration; on the succeeding, 65
after it had arisen to 110 or 120; it went down to the
time of the resolution of the pneumonia, to 60, 50, 44.
I saw it fall to 36 in an individual, the history of whose
case is not given. I have seen it fall from 120 to 80 in
the interval of the morning and evening visit, to go down
to 60 the following morning.
"4. In the case of old people who had passed whole
weeks previous to treatment, and in whose case the termination by induration appeared to be inevitable, this




318                  PNEUMONIA.
result did not occur in one single case; all that was observed was, that the disappearance of the physical signs
was somewhat protracted.
"5. Lastly, suppuration did not take place in one in
whom it had not begun before the commencement of
treatment. In the case of several it appeared to be
limited; in one case alone it was neither prevented nor
arrested, (in my view the two brought in in agony of
death are not to be taken into account (a mes yeux les
deux agonisants sont hors de cause.)"
We have made out a table showing the number of
days each was under treatment, and how long the patient
had been ill before he was treated.




PNEUMONIA.


-319


Cases.    Entered.    Undreernt.      Dismissed.       before
treatment                        entrance.
1st   Nov. 19th     33 days    December 21st         9 or 10
2d     Dec. 1st     33 do.     January 2d               7
3d     Dec. 1st     34 do.     January 3d               4
4th    Dec. 14th    21 do.     January 3d               8
5th    Dec. 24th     8 ado     Remained in hospital,  1
f though well, on 1st Jan.
6th   Dec. 21st     14 do.     January 3d               3
7th    Jan. 10th    20 do. -   February 7th             4
8th    Jan. 24th    36 do.     February 28th            7
9th    Jan. 24th    15 do.     March 7th               15
10th    Jan. 29th    29 do.     February 26th            3
11th    Jan. 29th    28 do.     Died                    12
12th    Feb. 6th     17 do.     Improved                 1
13th    Feb. 7th     27 do.     March 4th                3
14th    Feb. 15th    21 do.     March 6th                5
15th    March 20th   43 do.     May 2d                  15
16th    April 8th,  30 do.     May 7th                  4
17th    April 29th   19 do.     May 17th                 1
18th    May 16th     12 do.     May 27th                 2
19th    July 7th     12 do.     July 18th                3
20th    July 10th    14 do.     July 24th                6
21st    July 11th    11 do.     July 21st                1
22d     July 14th    11 do.     July 24th                3
23d     August 30th  14 do.     September 12th        1 night
24th    Sept. 18th   18 do.     October 5th              4
25th    Sept. 28th   17 do.     October 14th          1 night
26th    Sept. 23d    10 do.     October 2d               2
27th    Oct. 14th    18 do.     October 31st             1
28th    Oct. 18th    20 do.     November 6th             5
29th    Oct. 25th    13 do.     November 6th             5
30th    Nov. 20th    10 do.     December 11th            1
31st    Dec. 9th     52 do.     January 29th             6
32d     Dec. 30th    73 do.     March 12th               6
33d     Jan. 29th     8 do.     March 13th               5
34th    April 24th   17 do.     May 10th                 4
35th    July 10th    20 do      Died of another disease  5
36th    July 14th    26 do.     August 8th               4
37th    August 21st  23 do.     September 17th           4
38th    Sept. 6th    34 do.     October 10th             1
In almost all Tessier's cases, Bryonia at the 24th dilution was the sole, or nearly the sole medicine; in some,
Aconite was given before Bryonia. That they establish
beyond the possibility of a doubt the great efficacy of




320


PNEUMONIA.


Bryonia in this disease is certain; it may still, however,
be a question, whether the frequency of the aggravation
he noticed would not have been avoided by some doses
of Aconite.  It is a common practice to give Aconite
and Bryonia in alternation, and although it is a mode of
procedure at variance to the strict injunctions of Hahnemann, it certainly has much to recommend it.      It is
our usual method in cases of pneumonia and pleurisy to
give these two medicines alternately, and we are disposed
to think that the results were more favorable than if
either had been given alone. We have no space to enter
into an apology of this, but we think we could show,
from physiological principles, that it is not so inexcusable
in practice as it at first appears. And, certainly, the two
medicines do not counteract each other.
We have the same remark to make upon the dose of
Bryonia as upon that of Aconite.     We do not know
any facts proving the superiority of any dilution. Tessier
used the 24th; we generally use the 3rd or the 6th.
Perhaps both are right.
The adaptation of PHOSPHORUS to pneumonia can be
established both by the proving of the medicine, and its
extensive and most successful application.  The fumes
of Phosphorus produce an affection of the mucous membrane of the bronchial tubes, since cases of this kind,
which occurred in La Pitie, are related by Gendrin;
and  in the following case the inflammation seems to
have affected the smaller bronchia, and nearly approached pneumonia. The case is related by Bibra and
Geist:1 'Die Krankheiten der Arbeiter in den Phosphorziindholzfabriken,' von
Dr. V. Bibra und Dr. Lor. Geist, Erlangen, p. 11, 1847.




PNEUMONIA.


321


"John Zitman, 52 years of age, large, lean, but well
built, broad chested, strong constitution, without any
disposition to phthisis; was for three-quarters of a year
in a lucifer-match manufactory, and chiefly employed
with dipping the matches (Tunken der Halzchen); soon
after beginning the work he was attacked with a dry
cough, which disappeared under a warm regimen and
diaphoretic drinks.  In the course of half a year he
became ill of the same affection, which, however, was
now more severe, and obliged him to quit his work. On
examining him, the face was red and congested, the brow
covered with sweat, the tongue coated, the taste nauseous; there was frequent desire to cough, with flying
stitches under the sternum, and the right side of the
thorax, with a continual tickling and scratching feeling at
the bifurcation of the bronchi, anxious, short and quickened breathing, with heaving of the whole thorax, but
more especially of the left side. The percussion elicited
a clear sound in the middle of the right side; auscultation showed extensive mucous rale with pectoriloquy.
The pulse was quick, small, hard, the skin dry and hot,
much thirst, great weakness and prostration."
Although the narrator calls this a case of bronchitis, it seems to us manifestly one of hepatization
of the lungs, for without this or previous chronic
disease we are not aware of pectoriloquy ever taking
place.  The physical signs are somewhat anomalous
no doubt.
We do not think it necessary to quote from Hahnemann's Materia Medica the symptoms which correspond
to pneumonia, as the book is in the hands of all our
21




322


PNEUMONIA.


readers. The short frequent cough, with sense of oppression at the chest, and expectoration of mucus
streaked with blood, in combination with fever-symptoms point unequivocally to the direct action of this
substance upon the lungs. It is by the steady persevering use of this remedy, and of this one alone, that Dr.
Fleishmann has acquired such celebrity in the treatment
of pneumonia.    Up to the year 1844 lhe, and his pupil
Dr. Reiss, of Linz, had treated in all 379 cases, and had
lost only 19, or 1 in 20; the last 44 of Fleischmann,
and 34 of Reiss having all recovered. Dr. Fleischmann
is frequently blamed for what is called routine practice,
but we must recollect that pneumonia is a routine
disease, running a definite course, depending, as we have
shown, upon    certain simple and constant structural
changes, and we see no reason why there may not be a
specific for all cases of simple pneumonia occurring in
healthy persons. And, for our part, we greatly prefer an
undeviating adherence to a remedy which on the whole
suits the disease, than a striving after something which
seems to correspond to every little symptom of the individual case. We have seen some very remarkable examples of the efficacy of Phosphorus in this disease; for
the particulars of the following case we are indebted to
Dr. Black, in the accuracy of whose memory we have the
greatest confidence:
" I perfectly recollect," he says, " the general features of
a case of pleuro-pneumonia, treated in the Edinburgh Dispensary, in the spring of 1842, though I do not remember the details. The patient was a middle aged
apparently healthy man, and on examination there were




. PNEUMONIA.


323


all the physical signs of pneumonia of one side, with great
fever.  We gave him Aconite, and sent him  home in a
cab. Next day the fever still ran high, and there was
no improvement. As we had brought the Tincture of
Phosphorus with us, by mistake for the first dilution, we
gave him a drop or two of that in a cup of water, of
which he was to take some every one or two hours.
During that night the dyspncea had so increased after
every dose of the medicine, and he became so alarmingly
ill, that extreme unction was administered. At our visit
next afternoon we were surprised to find the patient so
much better, the pulse nearly natural, no dyspncea,
respiration natural, but still little or no diminution in
the physical signs.  He made a rapid recovery.  What
impresses the case on my memory was the aggravation of
the strong dose of Phosphorus, the speedy relief afterwards, and rapid disappearance of all rational signs
without any diminution of the physical."
We beg our readers to pay particular attention to this
most important case, it is full of instruction.  We shall
conclude our notice of Phosphorus by quoting Dr.
Fleischmann's words:
"I used formerly to employ the ordinary remedies,
Aconite, Bryonia, Cannabis, &c., in pneumonia, and that
with considerable success, but each of those remedies is
adapted only to particular cases, or rather to particular
phases of the disease. Thus it happened that besides the
difficulty I experienced in discovering the medicine
adapted to the particular case-which is no easy matter
-I was frequently left in a state of disagreeable uncer



324


PNEUMONIA.


tainty as to the remedy which had effected the cure.
Now, however, I have attained much greater certainty,
since for the last year and a half I have administered no
other substance than Phosphorus in every case of pneumonia, under what form soever it might present itself;
and I think I may, with perfect confidence, pronounce it
to be a true specific.  *  *  *  *
"I have seen the most violent cases of pneumonia in
every variety of constitution and season, come to a happy
issue by the sole employment of this remedy; cases in
which ahnost two thirds of one lung were hepatized.  *
*   *   I administered   the Phosphorus dissolved, as
Hahnemann recommends, in AEther, (         *  "*) only
quantitively stronger-10 grs. or drops to 100 of sugar
of milk or alcohol. The formula I employ is:
a. Phosp. 3-6 gtts. iv-viii.    Aquae disti. 3ii-iv.
A spoonful to be taken three to six times daily.!"
TARTRATE OF ANTIMONY was introduced into therapeutics as a cure for pneumonia by Rasori, who gave it
in very large doses, and since his time it has been
generally used by the old school. Of its specific action
upon the lungs there can be no doubt. Magendie, in
a memoir, entitled, "L'Influence de l'Emetique sur
l'Homme, 1833," describes its effects thus: " The lungs
present the appearance of the greatest alteration: they
are of an orange colour if the animal is young, violet
if it is older; the tissue is kepatized, gorged with blood
at some parts, and at others very analogous to the tissue
of the spleen." In whatever way introduced "it acts


1 Brit. Journal of -Iomceopathy,' vol. ii, p. 45.




PNEUMONIA.


325


specifcally in inflaming the    lungs and   the  mucous
membrane which lines the intestines from the cardia to
the anus."   Lepelletier, who has written an excellent
monograph upon this drug,' observes, " Its effects on the
respiratory organs is to produce dyspnoea in dogs which
were in perfect health before its administration, the
lungs were found hepatized, lost their colour, and
scarcely crepitated  at all.  One would imagine that
admitting its action in man to be similar, far from being
useful, its administration would be particularly pernicious in the treatment of pneumonia; but it is not so, for
we shall see that far from favouring engorgement of the
lung, it induces its resolution."
Out of 652 cases of pneumonia treated by Rasori, in
the Civil Hospital, 505 recovered, 147 died, giving a
mortality of 22 per cent.   Of the whole number 1 in
16 were bled. In the Military Hospital, 180 were
treated, 154 recovered, 16 died, giving a mortality of
14 per cent.     The   proportion  bled  was 1 in    16.
Ambroise Laennec treated 40 cases after Rasori's plan,
in the H6tel Dieu de Nantes; of these 1 died out of
every 13, giving a mortality of 8 per cent. We may.
here introduce a curious table by Dietl,2 giving the
comparative results of bloodletting, tartrate of antimony,
and nothing.
'De l'emploi due Tartre Stibi6; a haute dose, par Alm. Lepelletier de
la Sarthe.
2 Op. cit., p. 122.




326                        PNEUMONIA.
TABLE
Of the Numerical Results of the Treatment of Pneumonia.
A.
Of pneumonia there were treated with Venesection........85 p".tients.
large doses of Tart. antimony 106
diet alone..........139
With bleeding.  With large doses of With Diet alone.
Tart. Antimony.
B7.
Of these were cured...     68            84            175,,1died...         17            22             14
Mortality........... 20"4 per cent.   20"7 per cent.  7"4 per cent.
0.
The fever lasteda) from 5 to 9 days in..      41            66            140
b),,114-21,, ~.         27            18             35
The, average duration of
fever.............   11"1 days       9"2 days      9'] days
D.
Convalescence lasteda) from 5 to 21 days in.  30 patients      62            133
b),, 22-60,,.  38,,           22             42
Average duration was..   28"9 days     20"3 days      19"7 days
E.
The whole duration of
the pneumonia wasa) 10 to 30 days in....  27 patients   54 patients    119 patients
b) 30- 60,...        41,,       30,,         56
The average............   35 days      28"9 days       28 days
F.
Inflammation of both lungs
occurred in........, 10 patients       6 patients     11 patients
i Left lung..............28,,       41,,        73
Right lung                47,,       59             105




PNEUMONIA.                    327


Withbleeing. With large doses of  With diet aoe
Withbleeing. Tart. Antimony.              aoe


G.
Of inflammation of both
lungs there died...  4 patients  1 patient     2 patients
Rightlung............9,,      11   3,,        9
Leftilung...........    4,,      10             3
II.
In the stage of red hepatization, died....  5,,   11,,         7
Grey hepatization....  7,,     7,,         3
Purulent disorganization.  5,,     4,,        4
I.
01 pneumonia without all
complication, died...  7,,     2
With complication.... 10,,    20,,        14
K.
There died from  the
ages of
l0 to 20 years....... 1,,        1
20-30,,.1........1,,            2,,           1,,
30-40,,....3,,       1,,
40-50,.....        3,,       3,,        2,,
50-60,,.....4,        4,,         3
60-  70,,-....    4,,       6,,        5
70-80,.....1,,       5,,        3,,
We have now collected and arranged all the materials
at our command, which seemed to us to throw light
upon the nature and treatment of pneumonia, and we
must leave to each practitioner to select the particular
remedy for each particular case. We may add, that we
have not ourselves been able, either from an examination
of the proving, or of the recorded cases of treatment,
to arrive at the pathognomonic signs for determining a
selection among the substances we have enumerated, nor




328                  PNEUMONIA.
do we expect to obtain su'ch certain indications until we
have full, careful, and copious narrations of a great many
cases, such as those given by Tessier, by which we may
arrive at data enabling us t-o decide whether Aconite,
Bryonia, Phosphorus, or Tartrate of Antimony are the
most certain and rapid in their action; we confess our
own predilection for Phosphorus. In the mean time we
may conclude by observing of these remedies, as Go~the
did of himself, that Germany, instead of contending
whether he or Schiller were the greater, should be very
thankful that she had two such men to contend about:
so we may be very thankful we have four such remedies
to choose among in pneumonia, as Aconite., Bryonia,
Phosphorus, and Tfartrate of Antimony.




CHAPTER VIII.


THE SKIN AND ITS DISEASES.
THE morbid appearance of the external surface of the
body may be regarded from two essentially distinct
points of view; either as constant and characteristic
manifestations of some general derangement of the
whole system, or as independent affections of the skin
itself. This broad and obvious distinction seems to have
been constantly present in the mind of Hippocrates
whenever he mentioned this class of diseases. For example, in speaking of some eruptions which happen in
childhood, he says "Lichen, leprosy, and leuce, when
they occur in* young children and infants, or when they
appear at first small, and gradually increase in the course
of a long time,-in these cases the eruption is not to be
regarded as a deposit but as a disease; but when they
set in rank and suddenly, this case is a deposit."'
It seems scarcely credible that a distinction so fundamental and practical should have been allowed to slip
from the minds of later writers on dermatology. The
explanation of the retrograde movement is apparent if
we read almost any recent work on this subject.   Take,
for instance, the essay by Dr. Paget, which obtained
Alibert's prize in 1832.2 Here we find the prevailing
1 'The genuine works of Hippocrates,' Sydenham Society Edition, vol. i,
p. 269.
2 An Essay on the comparative merits of artificial and natural classi



330


THE SKIN


idea of classification derived from the systems of botany
and natural history, and the different methods of arranging diseases are tried by the canons of Decandolle.    It
seems almost a waste of words to show that this hopeless
departure from the rules of common sense can only deepen
the confusion of a subject in its nature sufficiently perplexed and   difficult.  All classification of objects of
natural history is essentially an arbitrary catalogue, arranged for some specific purpose. No sane man can suppose for a moment that the botanical characters of a plant,
however complete, express the whole properties or qualities of the individual so designated. If a cook were given
the most perfect botanical work in the world, and told
to make a dinner out of it for a party of vegetarians,
arranging her materials as she found them    arranged by
Jussieu or Decandolle, she would get no botanist at least
to partake of her repast, for he would know that plants
which stood side by side in conjugal amity in his table,
if transformed to the dinner-table after being subjected
to the matrimony of the stewpan, would effectually pre* vent him from ever making any experiments beyond the
province of toxicology. The botanist has no more to
do with the poisonous or gustatory properties of plants
than the astronomer has with the astral influences on the
lives of men; and it would be as reasonable for a believer in astrology to apply to I-Ierschel for his horoscope
as it would be for a gastronomist to go to Linnaeus for a
dinner.   Science does not pretend to deal with those
finer qualities of its subjects on which their practical
fication as applied to Diseases of the Skin, by John Paget, M.D., 'Edin.
Med. and Surgical Journal,' No. 115.




AND ITS DISEASES.


331


utility depends. But it subserves a most important end
in giving a perfect catalogue and a general nomenclature
to the seemingly innumerable objects around us. For a
power to fix a name upon a thing, or an animal, first
used by Divine authority in Eden and never become obsolete, will always continue to play an important part in
the subjugation of the material universe by man who got
along with this government the power of speech.
Even in the so-called natural systems, objects are not
arranged according to their nature, only according to
their agreement in possessing a certain number of constant characters; for science having its origin, end, and
limitations in the mind of man, can never attain the
entire knowledge of nature which stretches into infinitude around us: and there may be a multitude of arrangements all -perfect of their kind. The naturalist,
the painter, the poet, and the practical man, may each
make a classification sufficient for his purpose; but neither singly nor united do they exhaust all the relations
or qualities of their subjects. Medicine being essentially
practical or nothing, no good, but, on the contrary, much
evils results from  transferring systems which do not
yield practical service in the treatment of disease into
this department of art.  That to do so is both futile and
mischievous may be seen by the entire failure of the attempt even in the most learned and skilful hands. The
essential idea of classification, as we have already said,
is, that certain constant characters of an object are
taken according to which it is designated, and from
which it may always be recognised. Let us apply this
simple criterion to a so-called disease of the skin.  We
shall take scarlatina.  "The scarlet fever," says Bate



332


THE SKIN


man,' "is characterised by a close      and diffuse efflorescence of a high scarlet colour, which appears on the
surface of the body, or within the mouth and fauces,
usually on the second day of the fever, and terminates
about five days."    According to Mr. Erasmus Wilson,2
by far the best modern English writer on the subject,
" Scarlatina is an acute inflammation of the integumentary investment of the entire body, both cutaneous and
mucous, associated with fever of an infectious and contagious kind."    Inflammation is defined as being redness, heat, pain, and swelling: so that scarlet fever is
characterised scientifically by the presence of redness,
heat, pain, and swelling of the skin at least; at all
events, we may expect always to find redness and heat
of skin in this object (for at present we must regard
it as an object of natural history).  A few pages further
on we find that cases occur without any or scarcely perceptible efflorescence, i.e., inflammation of the skin.  So
the character on which the classification of this object is
founded vanishes!-as if we were to define man as an
animal with a head, a trunk, and four extremities, and to
add that occasionally men are met with who have none
of these peculiar signs of humanity!      Hence we maintain that the attempt to introduce into medicine the kind
of definitions which are suitable for the purposes of
natural history, and to found a classification of diseases
upon them, is manifestly futile.   The mischief done by
the attempt, although not quite so apparent, is not less
real; for, as the only object in grouping diseases together is to improve our treatment of them, it follows
S'A Practical Synopsis of Cutaneous Diseases,' 4th edit., p. 69.
2 'On Diseases of the Skin,' Erasmus Wilson, 3d edit, p. 62.




AND ITS DISEASES.


333


that there should be some similarity in the management
of members of a family that are linked together by fraternal propinquity.  Let us apply this test to the four
junior members of the ancient family of exanthemata
Urticaria, Roseola, Purpura, and Erythema. Except
Morison's Pills, we cannot conceive of any medicine which
could by any possibility be employed against one without
being almost certainly injurious to the others of this
group. So that if we were guided in our treatment by
this classification, we  should undoubtedly be doing
harm; and this we take it is a sufficient condemnation
of the system.
The most remarkable example of extravagance in
classification ever perpetrated in medicine is afforded by
Alibert's famous tree, and which should be a warning
against any such attempts in future.
Still, order is of such paramount importance to the
successful conduct of all human affairs, that the effort
to obtain a profitable arrangement of the numerous and
complicated maladies which affect the skin ought never
to be abandoned by the physician; and of late juster
principles have begun to be acknowledged, which promise to introduce a new era into this department of
study. Recurring to the felicitous expression of Hippocrates, every morbid appearance on the skin is either a
deposit or a disease-a deposit if it be merely a symptom
of an internal disturbance in the system, a disease if it
be a local affection of the cutaneous organs.    If the
prevailing idea that the true typhus of this country is
always attended by a specific eruption be adopted, it
would be as rational to call it a disease of the skin as to
give that appellation to measles or scarlet-fever or small



334


THE SKIN


pox; and had Willan been now alive and in the ascendant, we might have had typhus ranged beside urticaria
and pupupura.
In that class of diseases of which we may take measles
as the type, there is a tendency to deposit themselves
upon the surface, and when this effort is checked they
fall upon some other part of the frame, producing often
strange and unmanageable disorders. For example, there
is an instance narrated in the Archlives Generales, in
which the sudden disappearance of the eruption of measles
was followed by total loss of the power of speech, the
patient remaining dumb for two years; and the converse
of this has been also known to occur, and speech long
absent to have returned with the reappearance of measles.
Hence we see that although the eruption upon the skin
in those diseases does not constitute the true morbid
affection, yet there only it seems to find its natural seat
of expression; and the changes which the skin undergoes are a legitimate subject of investigation. For the
development of a pimple or a vesicle and pustule may be
exactly the same whether the exciting cause be from
within or from without. The pustule produced by Tartar
emetic seems quite identical with that of smallpox, and
as a pustule may be studied; so that in a scientific examination of diseases of the skin, all changes of structure
in that organ come under consideration, although the
part which the eruption plays in the total disease may be
quite subordinate and even accidental. As, for example,
in purpura, which is sometimes confined to the lining
membrane of the intestines.'  As the internal disturbSee a case which occurred in the Edinburgh Infirmary, referred to in
'Edinburgh Medical Journal,' No. 115.




AND ITS DISEASES.


335


ances of the body affect its external covering, so skindiseases of a purely local character may, by the irritation
they produce, react upon the general health of the rest of
the system; and, besides, there are affections which have
sometimes a local and sometimes a constitutional origin,
as, for example, erythema, which is produced either by
some stimulant applied directly to the skin, or occurs as
a symptom in the course of a chronic disorder of the
whole body.
The confidence we now feel of a great improvement
in our knowledge and consequent arrangement of diseases
of the skin, is derived from the immense progress recently
made in the anatomy, physiology, and pathology of that
organ.  It is certainly the most complicated structure in
the human frame; and until the various constituent parts
were separated, and the laws of their healthy and morbid
development ascertained, it was a hopeless task to introduce order into their arrangement. And the advance in
pathology will necessarily be followed by a corresponding
improvement in the treatment both general and specific,
-that is both hygienic and homceopathic; for as all just
views of hygiene are derived from physiology, so a more
accurate pathology leads to a nicer adaptation of the
similar remedy. Indeed a true pathological classification
or arrangement is identical with a homceopathic one; for
as homoeopathic practice consists in adapting to a diseased
action the remedy which excites the nearest possible
similar diseased state, it follows that a closely allied
morbid condition occurring riaturally in the system will
also be probably benefited by this remedy, which bears
to it too an approximate similitude,-for things equal or
like the same thing must be equal or like one another.




336


THE SKIN


It is for this reason that we propose to enter very fully
into the detail of the structure and pathology of the
skin, before making any mention of the treatment proper
for its various diseases; and we do so with less reluctance, because many of the most important discoveries
in dermatology are of so recent a date as not yet to have
been absorbed into the general medical mind.
The cutaneous covering of the human body consists of
epidermis, cuticleor scurf-skin, c; pigmentum nigrum; culis,
corium, or true skin, called in German Leder-haut, d, or
leather-skin, containing
}-"^ -T           -       muscular fibre and two
^  y ^setsof secreting glandsSthe sebiparous, h, yielding
I:             theunctuousmatterwhich
i.......... lubricates thesurface, and
j:h  Hthe sudoriparous, b, which
S..secrete the perspiration;
also  hair  and   nails.
Each of these may be
4                the subject of independent disease, and the
structure  and  morbid
Salterations of each we
r                         shall discuss in turn.
:.                 ' Theannexedwoodcutis
--,:              b taken from Simon'swork,
and  represents a perpendicular sectionof the skin as seen under the microscope.


f, hair-bulb. g, hair. e, adipose tissue. a, duct of the gland which secretes
the perspiration




AND ITS DISEASES.


337


The cuticle is a tesselated pavement laid over the
surface of the true skin.     The mosaic appearance it
presents is due to its cellular construction.  The cells of
which it consists are formed of granules similar to those
of the blood-globules whence they are derived.    On the
surface of the membrane which separates the cutis from
the cuticle such a granule is deposited.    This may be
called the embryonic spot of the epidermis.   It contains
the element of its own independent development, and
lives upon the skin, from which it derives the materials
of its increase.  The first step it takes is to associate to
itself other minute granules, out of which combination is
formed an aggregated granule, which is one ten-thousandth of an inch in diameter.    Around this little mass
as a centre other granules range themselves in a circular
form, in the centre of which lie the original granules,
somewhat changed in appearance by the pressure to which
they have been exposed, which being generally unequal
gives them an elongated form, and the space between
these bodies is filled with a transparent and homogeneous
matter. Besides the changes which the central or parent
nucleus of the cell undergoes, the granules which constitute its circumference become themselves centres of
aggregation of other granules, so that there is a continual
process of encroachment going on upon these respective
territories of the two, which, combined with constant formation of new layers of a similar nature taking place upon
the membrane which gives them nourishment, accounts
for the appearance of scales they assume as they become
external previous to their final exfoliation from the surface.
The scales are nothing but a congeries of compressed
cells, as the cells are nothing but associated granules.
22




338


THE SKIN


There is no vascular connection between the epidermis
and the skin, the one merely lives upon the other as
lichen on the bark of a tree, imbibing nourishment from
it by the process of endosmose, and turning the food so
obtained to its own use. It has no power of regeneration
or healing such as the rest of the body enjoys, and if a
division be made in its continuity the separated edges do
not reunite. It is of various degrees of thickness in
different parts of the body, and this variation does not
depend upon external causes but upon its own nature, for
the varieties are found in the foetus as well marked as in the
adult. The cuticle on the palms of the hands and soles
of the feet of the unborn infant being many times thicker
than that which covers the rest of the body. At an
early period of foetal life the epidermis round the mouth
does not consist of scales, but of polygonal cells filled
with fluid, such as are met with in plants.1 Among the
other alterations which the epidermis undergoes as it is
pushed outwards by the incessant growth from below is
one of a chemical nature. The young cuticle is soluble
in vinegar, but the old scales are transformed into horny
matter which resists this solvent.
The pigqmentum nizgrum seems to consist simply of
coloured granules, similar in all respects to those just
described, with a slight admixture of some colouring
matter of greater or less amount according to cir'cumstances. In the negro all the central granules are dark,
in the European a certain number of dark ones are mixed
with the lot.
We may close this description by a few words, ex

' Ruschkow 'Melemeta,' p. 12.




AND ITS DISEASI S.


339


plaining the so-called Rete Malpighi.      This appearance,
which was supposed to be owing to an intermediate
reticulated membrane between the epidermis and true
skin, is satisfactorily accounted for by the lower layers of
the cuticle having been moulded round the prominences
of the papillae of the culis, and thus when removed
presenting the aspect of holes in a flat surface, the holes
corresponding to the places through which the eminences
of the true skin protruded.      Hence the cribriform    appearance mistaken by Malpighi for a net, and called rete
mnucosum; for, as we have said, the lower strata of the
epidermis are of softer structure, more mucous-like, than
the more external layers.1
The nails may be included in the epidermic tissue.
They are in fact little else than thickened indurated
cuticle, consisting of two layers, both laminated, the external one harder and thicker than the one beneath it,
which rests upon the true skin.        They grow     upon a
furrowed bed, and increase both at the end, by which
they are attached to the finger or the toe, and along the
whole course of their connection till their free end.    The
bed on which they are moulded is composed of bundles of
papilla  arranged side by side lengthways, those nearer
the finger-end are fuller and richer than those at the root
of the nail.   Hence that obvious difference of colour in
1 This description is derived chiefly from the works of Erasmus Wilson,
Henle, 'Allgemeine Anatomie,' 1841, and an admirable treatise on ' Skin
Diseases,' by Dr. Gustav Simon, entitled 'Die Hautkrankeiten durch
anatomische Untersuchungen erliutert,' Berlin, 1851. As it would have
been quite out of the question to have quoted all the authorities referred
to by these writers, or to have entered into a discussion upon the grounds
for the views advanced, I have stated what seemed to me the most probable
opinion on the subject where these writers do not agree.




340


THE SKIN


the nail: the paler portion is called lunula. The rate of
growth of a nail does not seem much affected by disease,
but its thickness is diminished by any cause which reduces the strength of the system; and this difference is
easily seen by inspecting the nail, that part of it which
has been formed during illness being separated by a
transverse line from the remainder. Hence, as suggested
by M. Beau,' if we know how much a nail grows in a
given time, we may calculate by this line which divides
the healthy from the sick what has been the duration of
a chronic illness.  He maintains that the nails of the
hands grow four times as fast as those of the feet. The
former grow one millimetre a week, and as the length of
the thumb nail is twenty millimetres it takes twenty
weeks or five months to attain its full length, while that
of the great toe requires ninety-six weeks or nearly two
years to complete its growth. Thus, for example, a
groove  situate five millimetres from  the distant end
(allowing three millimetres to the covered part) dates the
attack of illness at eight weeks back; and about the
time the thumb nail has outgrown its power to afford
information, the mark on the nail of the toe is just be,
coming visible, and this lasts for two years. Dr. E.
Wilson   tried  the test upon   himself, and found it
approximately  correct.   The   observation  is  at all
events well worthy of attention by the practical physician.
As we should expect from the nature of its structure,
the diseases of the epidermis are very trifling, the most
important being no other than the common corn, which


' Archiv. Generales de Med.,' vol. xi, p. 44,7.




AND ITS DISEASES.


341


perhaps hardly deserves the rank of a disease. Its formation is abundantly simple, arising from the irritation
caused by pressure on some part of the foot. The natural
consequence of this irritation is slight inflammation of
the skin, and as a consequence increased vascularity of
its surface, and upon this enriched ground an excessive
growth of cuticle. This growth being confined on all
sides has no alternative but to shoot upwards and downwards, hence the almond shape of a corn.     Sometimes
the irritation of the descending root is so great as to cause
suppuration, according to Rayer:1 and Sir E. Home has
directed particular attention to the corns which are apt
to form upon the bursae on the lower surface of the
foot. He seems to have fallen into error in assigning
the bursa as a cause of the corn; it is in fact its natural
preventive, being placed on the points of greatest friction
and pressure, which are those where corns most readily
grow.   Tolle causam is the only therapeutic indication
for the' treatment of corns, which might in this instance  be   translated   to  give  up   tight   boots;
and when required to walk much, to extemporize an
external bursa  mucosa of soap    and  a thick worsted
stocking.
Almost the only change in the colouring matter in the
skin which need be noticed is Chloasma, for although
sunburns (Ephelis, rt Xtoc) and freckles are no doubt
caused by an excess of colouring matter at spots, they are
more usually remedied by cosmetics than drugs. Chloasma, called by Willan Pityriasis versicolor, is characterised by patches of a brownish yellow (maculae hepaticae)
'Theoretical and Practical Diseases of the Skin,' by P. Rayer, M.D.,
2d edition, 1835, p. 991.




842


THE SKIN


or saffron colour of considerable extent, frequently attended with itching, and followed by desquamation of the
epidermis.    In women it is generally met with on the
chest and epiastrium, and in men upon the abdomen.
It seems to consist of a preternatural increase of pigmentary cells, which being more friable and less adapted to
form scales than the other epidermic cells, give to the
surface the mealy appearance characteristic of the disease.
It depends upon some derangement of the general health,
in women generally on an abnormal state of their uterine
functions, and the treatment therefore does not fall under
the head of skin-diseases at all, although its description
does.
It is usual to describe the hairs in connection with the
epidermis; but as their relation to the ducts of the sebiparous glands are more important in a pathological and
practical point of view, we prefer postponing their history
till we speak of those glands.
The derma or true skin may be likened to cloth woven
of fibres of different kinds, and studded all over its surface
with minute eminences called papillce. The greatest part
of its substance is composed of common fibrous tissue,
the filaments of which interlace one another, and the
spaces between are filled with adipose tissue; in the external layer of the skin yellow elastic fibres are also observed, and in those parts of the body which are covered
with hair distinct muscular fibres have been discovered
by Kolliker.1    The accuracy of the observation is admitted by Bowman and Erasmus Wilson, and so we may
consider   this important discovery established.       It is
1 'Zeitschrift fiir Wissenschaftlichc Zoologie,' von V. Siebold und
Kolliker, 1 Bd., 1 Heft., 1848, ~ 48.




AND ITS DISEASES.


343


owing to the presence of these muscular fibres that the
erection of the hairs in cutis anserina takes place.  The
papille are so many little nipples as it were drawn out
of the upper surface of the skin. In the more sensitive
parts of the body they are arranged in small clumps side
by side, some eight in each clump, while in the less sensitive portions they are scattered irregularly. This accounts probably for the fact that in some parts, as the
finger, if two points at a slight distance from one another
be pressed or pricked, say with a pair of compasses, it
gives rise to two distinct sensations; whereas if spaces at
the same distance apart be similarly experimented on in
other places of the surface, the sensation of only one prick
or pressure is produced.
Into each papilla composed of fibrous and elastic
tissue, and padded all round with fatty support, there
enters a nerve and blood-vessel. In those papillae which
are for touch, the nerve terminates after forming a loop
at the top, and the blood-vessel also after a tortuous course
ends in a loop.   So that these rows of highly injected
elevations, thus amply supplied by nerves, are a kind of
erectile tissue, which expand themselves to their full
stretch when we exercise the faculty of touch, and lose
this fine power almost entirely when flaccid from cold or
other causes.   Man possesses the faculty of touch in
much greater perfection than any other vertebrated
animal; but among the lower classes in which the other
senses are either imperfect or altogether defective, this
remaining sense is given in compensating abundance, and
in some it is so exquisite, that, according to Cuvier,1 they


S Cuvier's 'Lectures on Comp. Anat.,' vol. ii, p. 551.




344


THE SKIN


are able by it to perceive light, so that a certain fulfilment
is given to the melancholy demand of our great blind
poet when he says--
Since light so necessary is to life
And almost life itself, if it be true
That light is in the soul,
She all in every part, why was this sight
To such a tender ball as the eye confined,
So obvious and so easy to be quenched,
And not as feeling through all parts diffused,
That she might look at will through every pore?
Samson Agonises.
It is natural to expect that living boundary which
separates the world within us with its multitudinous and
incessant operations from that without us whence all the
materials for the works are derived, the great medium of
intercourse between these two allied yet distinct creations,
which may also be regarded as the sky of the mind,
growing pale from    grief, fear, and dismay, flushing red
in hope or joy, glowing crimson in shame, and turning
even livid in intense rage, should be the seat of as many
morbid appearances as the number of its uses is great
and various.   To enter here into a minute detail of each
would be manifestly impossible, all we can hope is to
describe an example of the most characteristic forms of
these alterations, and seek in the light afforded by investigating the laws which regulate their successive changes,
a guide both to their arrangement and to that of their
remedies.
Inflammation of the corium may be either diffused or
circumscribed, and may terminate either by resolution,
by effusion of lymph or pus, or by the formation of




AND ITS DISEASES.


345


diseased cuticle, or some peculiar product. The diffused
form  of inflammation    embraces    Erythema, Roseola,
Urticaria, and Erysipelas; the circumscribed is the
origin of all papular, vesicular, and pustular eruptions,
and of boils and carbuncles.
In erythema the inflammatory process is so slight that
there is scarcely any sensible thickening of the skin,
merely redness, sometimes attended with considerable
itching; after its disappearance the affected part retains
for some time a purplish hue, and desquamation of the
cuticle takes place.   It occurs either as a symptom of
some internal disorder, frequently of the mucous membrane of the bowels, in which case its seat is the abdomen,
or it is caused by friction (erythema intertrigo) situated
in the folds of the skin, especially of infants, and is
attended with a very troublesome irritating seropurulent
discharge; it sometimes disappears on one part to reappear suddenly on another (fugax), and it is sometimes
attended with cedema of the affected surface (wdematosum).
The other varieties (papulatum, tuberosum, and nodosum)
need not detain us.
Boseola is a designation applied very loosely to various
slight red eruptions.   The only one of much constancy
and importance which is called Roseola variolosa, consists
of an erythematous inflammation of the skin, which
occasionally attends the fever of inoculated small-pox,
appearing the second day from the commencement of the
constitutional symptoms, and upon the ninth or tenth
day after inoculation. A similar eruption is also met
with after vaccination (Roseola vaccina). Rayer describes
an eruption which he observed in cholera after the period
of reaction, as Roseola cholerica.  No such eruption was




346


THTE SKIN


observed here as a constant symptom, and what he
describes has probably been owing to accidental causes
peculiar to the place-Paris, and the time-1832.
Urticaria, or nettle-rash, is very well named, the
whitish or red wheals on the skin bearing a close resemblance both in appearance and in the pricking, itching
sensation they give, to those produced by the sting of a
nettle.  The disease consists of an inflammation more or
less diffused over the surface of the skin, and without
that amount of heat and pain which generally attends
inflammatory action.    It seems to depend upon some
specific internal irritation, either occurring spontaneously
in the system or caused by food poisonous to the person,
such as shell-fish or bitter almonds.  The appearance of
the eruption generally coincides with the alleviation of
the general suffering; hence it may be considered as a
vicarious action of the skin. Its disappearance is sometimes attended with great constitutional disturbance.
Willan mentions a case which terminated fatally, the
improvement which had taken place while the eruption
lasted being converted into violent aggravation of all the
symptoms attended with delirium which ended in death,
notwithstanding the reappearance of a slight eruption
just before the end.
Erysipelas, both in severity and frequency, is much the
most important form of diffused inflammation of the skin.
According to its intensity and the depth to which it
penetrates does it vary in its symptoms; when slight,
differing little from Erythezma; when severe, going on to
extensive suppuration, and even gangrene.     It is always
attended with heat, pain, and swelling; when the swelling
is considerable it depends upon cedema of the part,




AND ITS DISEASES.


347


owing, according to Henle, to the deficient action of the
absorbing lymphatic vessels. When the more superficial
layer of the skin is chiefly affected and yet the inflammation severe it gives rise to blisters, and this variety
goes by the name of Erysipelas bzllosum.        The worst
form  is the phlegmonous, which spreads a gangrenous
destruction even below the skin into the areolar tissue
and subjacent fascice.
The causes of the disease are little known-it certainly
occurs much more frequently in certain seasons and in
particular localities than in others.  It is alleged to have
a strong affinity with puerperal fevers, and that these
two have the power of reciprocal propagation.2 From
whatever source derived, and whatever form     it assumes,
it is always attended with considerable, often severe,
constitutional symptoms; and, when it affects the head,
is a disease of great danger.  According to SimonS and
Sch6nlein the urine is affected at an early stage of the
disease, frequently being loaded with bile-pigment, and
of a reddish-brown or red colour.    It is generally easily
recognised by the rigors which usher it in, and the quick
hard pulse, nausea, and general malaise which precede the
appearance of the characteristic eruption.
Diffused inflammation of the skin gives rise also to a
superabundant development of cuticle, which is sometimes likewise unnatural in structure.    Hence arise the
squamous.diseases, Pityriasis, Psoriasis, and Pellagra.
The first of these, pityriasis, consists merely of excesS See a case related by Dr. Wielobycki, in the 'British Journal of
I-Iomceopathy,' January, 1852.
2 Ranking's 'Abstract of Med. Science,' vol. iv, 1846.
3 Simon's ' Animal Chemistry,' vol. ii, p. 278.




348


THE SKIN


sive desquamation, and occasionally occurs in phthisis
from the imperfect nutrition afforded to the dermoid
tissue which shows itself in the curved and weakened
nail, characteristic of that malady.  It may be a question whether the exfoliation of cuticle in this disease be
always the result of inflammation of the subjacent tissue;
in certain varieties (p. rubra) it certainly is so; in others,
and these the more common, there is little appearance of
any vascular change in the skin;-however, Hebra, a
great authority in this matter, does not allow any distinction of kind between the rubra and other forms.   At all
events, the cause of the disease is unquestionably some
change in the corium which induces too abundant a crop
of insufficiently formed epidermic scales. It may affect
any part of the body, and the predisposing causes are
but little known.
Psoriasis, called also lepra, differs rather in degree
than in kind from its predecessor, except that the papillae
of the skin are here enlarged so as to look like worts in
some cases, and the cuticular scales are more changed,
being loose in texture, which gives them a shining silvery
appearance characteristic of the disease. The amount
of these scales rubbed off in the course of the day is
sometimes very great, from 65 to 385 grains in one case,
related by Henle.1   The favorite seats of psoriasis are
the elbows and about the knees, where it generally assumes a circular form, and when it goes off the first
improvement is visible in the centre of the patch. Besides the epidermic scales which are thrown off, there is
too great a secretion of the intermediate semifluid sub

' Prager Vierteljahrschrift,' iii, Bd., ~ 104.




AND ITS DISEASES.


349


stance on which these grow, which produces a moist
state of the skin after their exfoliation, and there is often
intolerable itching of the affected parts.    It receives
different names according to the different parts of the
body it affects-as palmaris, on the palhns of the hand
-labialis, on the lips, and so on; but there is no essential difference in the nature of the affection wherever it
is located, and these subdivisions seem unnecessary. It
seems prone to attack persons of a gouty habit; and
there is one variety commonly associated with secondary
syphilis.
Pellagra is a disease almost confined to the northern
parts of Italy.  It consists of an excessive formation of
cuticle generally of a brown or black colour, on those
portions of the skin much exposed to the sun-rays. It
is usually preceded by a manifest erythematous condition
of the skin, but sometimes appears without this precursor. It is associated with a derangement in the
nervous and digestive system.
A papula or pimple is the first stage in most circumscribed inflammations of the skin, and the formation of
this has been accurately investigated by Simon.       He
rubbed tartar emetic ointment upon the skin of a dog
from which the hair had been shaved, and so soon as
the effects of this substance had been produced he killed
the animal and examined the affected skin.      He found
the cuticle healthy, and in the most superficial layer of
the true skin a small eminence about the size of half a
barley-corn. This little mound was caused by the injection of the part with blood; the injection extended to
about half-way through the skin, and below this, and all
round the mound there was an effusion of fluid. The




850


THE SKIN


fluid resembled the blood-serum in consistence, and contained minute molecules and fat-globules.    In the immediate neighbourhood of the inflamed spot there was
an unusual quantity of blood, and beyond this the skin
was perfectly healthy.   This description   corresponds
with that given by Henle and Rokitansky,i and differs
from  that of Rosenbaumn, Hebra, and others, who conceive the sebiparous glands to be implicated in papular
affections. The effused fluid may either be absorbed,
and so on the subsidence of the injection of the vessels
the pimple disappear, or it may be of so great an amount
as to convert the papula into a vesicle, and this vesicle
may in its turn be transformed into a pustule.
The papular eruptions are those of measles, strophulus,
lichen, and prurigo.
The eruption of measles consists of roundish red spots
slightly elevated above the surrounding skin, with little
swelling of the integument, except upon the face. It
assumes the form of semicircular patches divided from
one another by unreddened skin. The cause of this
peculiar form is not known, but it seems to depend upon
what may be called the general geography of the skin,
for the mottled appearance which it presents in healthy
children after exposure to cold has the same semi-lunar
aspect.  Simon2 cut out a pimple produced by measles
and examined it under the microscope; he found it to
consist of a spot injected with blood, but perceived no
fluid such as was observed in those pimples he had produced artificially; however, the absence of fluid might
be accounted for by the pressure employed during the
i' andbuch der Patholog. Anatomie,' Bd. ii, ~ 90.
Op. cit., p. 124.




AND ITS DISEASES.


351


operation, and it is most probable that the elevation of
the spot depends upon the presence of an effusion. The
cuticle adhered to the skin in a healthy manner, and
there was no increase nor any unnatural appearance in
the papillae of the skin. All the spots he examined were
p erforated by a hair, the ducts of which were healthy,
and he adduces good grounds for disbelieving that the
sebiparous glands are connected with this eruption, an
opinion maintained by some writers on the subject.
The eruption generally appears onl the fourth day of the
fever, and is attended with heat and itching; in children
with a very delicate skin it sometimes occurs onithe
third day, and in those exposed to cold it may be as late
as the fifth or sixth.  In ordinary cases it reaches its
height on the seventh day.  It appears first on the face,
then on the trunk, and lastly, on the limbs, and recedes
from the sixth day of its invasion in the same order of
march.   Of the general disease of which the eruption
is the symptom it would be out of place to speak here,
it demands attention now only because it furnishes
pimples which rise, and grow, and fade according to the
same laws which regulate other pimples.
Strophubts is an eruption of small pimples diffused
either partially or entirely over the body of infants.  It.is known by the name of red gum or gown, and is unattended with constitutional symptoms of any kind.
There are various varieties (intertinctus, conferlus, candidus, &c.), but the pimples which form the essential
character of the disease are the same in all.
]_iclien (from XEXrnv) is closely allied to strophulus,
but affects persons in adult life, while the other confines
itself to infancy.  It consists of an eruption of conical




352


THE SKIN


pimples of a red or natural colour over a part or the
whole of the surface of the body, attended with tingling
and itching.   The most remarkable form of the complaint is the Lichen tropicus or prickly heat, which is described by Dr. Winterbottom in a letter to Willan, from
personal experience, as consisting of munerous papilla
about the size of a pin's head of a vivid red colour, and
attended with intolerable itching, and the sensation as if
a number of pins were piercing the skin. Dr. James
Johnstone says-" The sensations arising from prickly
heat are perfectly indescribable, being compounded of
pricking, itching, tingling, and many other feelings for
which I have no appropriate appellation."
Prurigo, although sometimes an eruption of pimples,
more frequently consists of induration of the derma in
small flat elevations, caused by the swelling of the little
angular compartments between the lines traced upon the
skin.  Its diagnostic peculiarity, as the name implies,
is excessive itching. Mr. E. Wilson ascribes this itching
to a disordered condition of the nerves, and attributes
the affections of the skin to this as a consequence; sometimes it may be and is, but manifestly the cutaneous disease produced by neglect of cleanliness, is the cause and
not the consequence of the nervous derangement; and
the inference he draws that the ducts of the glands and
hair-tubes are primary seats of morbid action seems unwarranted, and is denied by Simon on the strength of
microscopic inspection of the parts.   Simon finds no
difference between the essential character of the eruption
in p'rurigo from that of the two other papular eruptions.
The pimple instead of being conical is a flat table of




AND ITS DISEASES.


353


skin thickened by excessive vascularity, and probably
also by some effusion into its substance.
The sufferings produced by this disease are dreadful;
patients describe themselves as being tormented " with
burning fires, maddening itchiness," and an unfortunate
ecclesiastic, " un malheureux eccl6siastique," as Alibert1
calls him, thus expressed himself-" Je suis sur le gril
et j'endure le martyre de Saint Laurent."
A still more dreadful form of the complaint is characterised, according to Cazenave and     Schedel in their
excellent treatise on skin-diseases, by the generation of
countless pediculi or such-like animals whenever there is
cover for them  to lodge themselves.   They call this revolting variety of the disease prurigo pediculaire, and
describe it as usually affecting old people, but give an
example of its occurrence in a young woman in Biett's
ward in the hospital of St. Louis. This species of the
disease is denied, both by Mr. E. Wilson and Simon, but,
as it seems to us, on insufficient grounds. That it usually
attends unclean habits is true, but it is equally certain
that it sometimes affects those whose position render such
an origin impossible; and that it was known among the
ancients, by whom it was attributed to the anger of the
gods, and who were notorious for their attention to
cleanliness, especially the Greeks. It is supposed to have
been some form of this malady which terminated the
criminal career of Herod Tetrarch of Galilee.
When an effusion of serum takes place upon the
surface of an inflamed spot then a vesicle or blister is
formed, and, according to the size and arrangement of
1 Alibert, op. cit., p. 703.
" 'Abr6g6 Pratique des Maladies de la Peau,' Paris, 1828, p. 283.
23




354


THE SKIN


the vesicles so formed, the affection of the skin assumes
various well-marked appearances, constituting the diseases
called-Bullce and Vesicule.     The most important of
these are-Pemphig   us, Rupia, Herpes, Eczema, iIiliaria,
Scabies, and Varicella.
Pemphigus    (rewt+, a   bubble), and     Pomph olyx
(ropooXv, a water-bubble), for these are merely varieties
of the same disease, is a blister varying in size from that
of a split-pea to a hen's egg, situated on an inflamed base
somewhat smaller than itself, filled with fluid at first
transparent and yellowish, afterwards pinkish, sanguineous, and turbid, which is discharged by the bursting
of the confining cuticle, and a thin dark crust remains.
These blisters generally occur in successive crops, often
unattended with constitutional symptoms, are either local
or general on the surface, and last from a few days to
several months or even years. When chronic it is often
associated with prurigo, particularly in old people, and
excites such distressing irritation as sometimes to cause
death.   The blisters sometimes extend to the mucous
membrane of the mouth; and in a case related by Rayer
which he attended, the inflammatory process involved
the intestines and bladder.' The disease seems sometimes to be vicarious with pulmonary affections. Rayer
mentions an instance of hemoptysis disappearing on the
occurrence of an attack of Pemphnigus, and adds, that the
sudden disappearance of this eruption is attended with
danger to the constitution.    It is generally connected
with some disorder of the gastro-intestinal system, and
Biett frequently found fatty degeneration of the liver in


1 Rayer, op. cit., p. 214




AND ITS DISEASES.


355


those who died of it.   Mr. E. Wilson' mentions a case
which seemed produced by some mercurial preparation;
it occurred in a girl of twenty-two years of age, who had
" poisoned " her hand some years before in cleaning brass
with a red paste (mercurial?), and from that time to the
date of Mr. Wilson's inspection had been affected with
ecchymosed spots and bladders on the wrist and forearm,
which he attributes to the poison.   If he be correct in
his inference, the case has great interest for us in many
ways.
]Rupia (puTroc, sordes) is a modification of pemphigus,
which occurs in persons of cachectic and debilitated constitutions.  It consists of small flattened blisters, few and
dispersed, each surrounded by a narrow red ring. They
contain a fluid, at first serous, but soon sanguinolent or
purulent, which leaves on its escape dark greenish or
blackish rough crusts. The larger ones look somewhat
like an oyster-shell, the smaller like that of a limpet.
When the crusts fall off they leave behind ill-conditioned
ulcers, which discharge much ichorous fetid fluid, and
are indisposed to heal.   Rupia is tedious in its course,
and lasts for several weeks or months.
The most formidable variety of the disease is called
]Rupia escharotica, known in Ireland under the name of
CC white blisters," "eating  hive," and "burnt holes."2
It attacked the ill-fed children of that once wretched
country. Sometimes it is preceded by a general livid
colour of the skin, but more frequently the blisters are
the first indication of the disease.  These are a little
larger than the pustules of smallpox, discharge a thin
1 Op. cit., p. 191.
2 See in 'Dublin Medical Essays,' 1807, a paper by Dr. Whitley Stokes.




356


THE SKIN


offensive fluid, and leave behind a painful spreading ulcer
with livid edges. It often affects the head, destroys the
ears and the eyes, and terminates in death, preceded by
convulsions or general lividity, upon the tenth or twelfth
day of the attack. We are not aware whether this
dreadful disease still occurs in Ireland. It was always
confined to certain localities, and it is to be hoped that
it will disappear as the general amelioration of that
opprobrium of this empire advances.
Closely allied to Rupia is Herpes (wTrE,, to creep),
which is an eruption of clusters of small globular vesicles
upon inflamed patches of irregular or rounded form and
of small extent. Each vesicle takes about ten days to
complete its course, and ends by absorption of the contained fluid or by rupture of cuticle, and the formation of
a brownish scab which soon falls off. In some forms of
the disease, Herpes p/hlyctenodes for example, the vesicles
assume no regular arrangement, but are scattered in
groups of various forms over the surface, and the complaint receives its specific appellation from its seat, being
called labialis, palpebralis, preputialis, and pudendalis,
according to its occurrence in the various localities indicated by those adjectives. At other times it assumes
regular forms, constituting Herpes circinatus and Herpes
zoster. In the former the vesicles form rings, and the
disease is called vesicular ringworm.
Herpes zoster, or shingles, consists of a belt of little
globular blisters, which generally -extend round half the
body. From the time of Pliny it has been a popular
belief that if the girdle completed the circle of the body
death ensued.   This seems to be an error.   It generally
occurs about the middle of the trunk and extends up




AND ITS DISEAsES.'


357


towards   the  shoulders   behind.  There   seems   good
grounds for adopting the opinion which Simon1 is inclined to, that this disease has its origin in some affection of the nerves; and that the form it assumes depends
upon the distribution of their underlying branches.
Whether this be so or not, there is no doubt that it is
both preceded and followed by severe neuralgic pain;
and we know one instance, in which neuralgia of the side
which commenced in      an  attack of Herpes zoster has
continued to afflict the patient for ten years, notwithstanding every variety of remedial measures which the
whole faculty allopathic and homoeopathic could suggest.
There is another rare and remarkable form      of this
disease called Herpes iris, from being composed of consecutive rings of different colours.  It is generally about
the size of a shilling, and the innermost ring is reddishbrown, the second from the centre yellowish and somewhat elevated, the third vivid red, and the fourth of a
pinkish hue which gradually shades off into the colour of
the surrounding skin. It may appear on any part of the
body, but has been most frequently observed on the face
and hands and round the joints. It usually lasts from
ten to twelve days.2
In the various vesicular diseases hitherto mentioned,
the vesicles remain for the most part separate during
their whole course from their origin to their decline.
This is not the case however with Eczema.        Eczema
(eKýCiv, to boil out) consists of an eruption of numerous
minute vesicles tending to unite. It spreads over a large
1 Op. cit., p. 186.
2 See a paper by Dr. Marshall Hall, in the ' Edin. Med. and Surgical
Journal.'




358. --THE SKIN


space, and terminates either by absorption of the fluid,
or by moist excoriations ending in thin crusts, or furfuraceous desquamation.   It is prone to affect those parts of
the body which are covered with hair.    It is sometimes
attended with considerable inflammation of the skin,
Eczema rubrum; and the fluid of the vesicles in one form
of the disease, Eczema imnetliginodes, becomes converted
into a turbid perulent secretion, which is effused upon
the surface of the skin, and hardens into yellow lamellated
crusts, which when removed leave the skin of a vivid
crimson colour, coated here and there with films of
whitish lymph, and secreting a quantity of ichorous fluid
of a reddish tint. When clhronic, the subcutaneous tissue
becomes dense and marked with numerous chaps and
fissures, from which there constantly oozes an offensive
discharge.  This form  is attended with severe itching,
which in some situations, as the anus and vulva, become
quite intolerable, and is aggravated by the patient's
fruitless attempts to relieve it by scratching.
A very frequent and troublesome variety of this disease
is met with in the heads of children, Eczema capitis; it
consists of numerous vesicles which form about the roots
of the hair, but are not perforated by them, when.it
continues, by the bursting of the vesicles and the discharge of their contents, the hairs become matted together at their roots, and then thick yellow    crusts are
formed, which are gradually raised from the scalp by the
growth of the hair at the edges first both before and
behind.   When chronic it may be either moist or dry,
according to the quantity of discharge; both varieties
are met with in the same scalp, and they pass insensibly
1 See a 'Practical Treatise on Skin Diseases,' by J. E. Erichsen, 1842.




AND ITS DISEASES.


359


into one another: the dry is composed of thin scales,
S which are sometimes cup-shaped in their centre, so as
somewhat to resemble those of Favus, from which, however, they are essentially different, as we shall afterwards
see.  It is observed by Rayer, and the observation
coincides with the popular belief here, that this disease
has a certain protective virtue, and gives immunity from
convulsions and diarrhoeas, and that its sudden subsidence is attended with danger.
The next vesicular affection, Miliaria, is widely different
from  the preceding, being, properly speaking, not a disease at all, but the consequence of the sudden restoration
of a suspended function. As we have already seen, the
cuticle is composed of layers of minute cells, and the
growth and healthiness of these depend upon the state
of their nourishing ground, the true skin. In diseases
in which this is dry, from want of perspiration, the
upper layers of the cuticle become thin and shrivelled;
and when the secretion of this fluid returns in its full
natural vigour, or even in increased quantity, it is thrown
so rapidly out of the little tubes which carry it from the
glands to the surface, that the ordinary process of endosmose, by which it is gradually diffused, is insufficient for
the purpose, from the imperfect state of the upper tier
of epidermic cells, and what they cannot transmit they
retain, and hence are raised into little blisters the size of
millet seeds. This explanation, which we believe was
first fully given by V. Barensprung, agrees with the
analysis made by Vogel and others, of the fluid contained
in the vesicles, which in no important particular differs
from healthy perspiration.
Scabies is the next on the list.  The history of Itch



360


THE SKIN


is so curious and interesting as to deserve to be given in
detail.  It is now  630 years ago since Abenzohr, an
Arabian physician, described a cutaneous eruption attended with so remarkable a peculiarity that it seems odd
how it could ever again be confounded with any other
affection of the skin.  Nor does he ascribe to himself
the merit of discovering this strange characteristic, but
merely registers the popular belief upon the subject.
" Syrones," he says, "called (by the Arabs) assoalat and
assyab, are lice which creep under the skin of the hands,
legs, and feet, and there excite pustules full of water."
[We translate literally.]  So small are the animalculam
that they can hardly be distinctly seen. There were no
microscopes then. Although this distinction was copied
by the most distinguished writers, and the belief in the
existence of these little insects was universal over large
regions in Europe, from Greenland to Italy and Portugal;
and in Germany the people were in the habit of picking
them out of the skin under the name of sauren (probably
from syrones), and had a special name for the operation,
sdiuren-graben; and H-auptmann, of Leipzic, gave a drawing of them in 1650; yet it was not till the end of the
17th century that scientific men became fairly interested
in the matter, through a letter of an Italian called
Bonomo, intitled ' Osservazioni interno ai pellicelli del
corpo umano, dal G. Cor. Bonomo,' published in 1683.
And a century afterwards, in 1786, Dr. Wichmann, a
German, wrote an exhaustive treatise on the subject
under the title of '(Etiologie der KrIitze.' It seems
almost incredible that after all this, and after Moufet, in
his 'Theatrum   Insectorum,' had, in 1634, given a description and delineation of the insect, that owing, ac



AND ITS DISEASES.


861 -


cording  to  Hebra1 who     has written   an   admirable
paper upon    the subject, to   the   prevalence of the
humoral pathology and the influence of Autenrieth
and Hahnemann, the whole notion of the itch insect
fell into neglect and disrepute, and came to be looked
upon   as fabulous; so that even      as late as 1812
we find that Rayer and Biett, who were supposed
to be among the best dermatologists of the day, were
against the opinion. At this time, an apothecary of the
name of Gales played a memorable hoax upon the
learned world. He gave out that he had at length discovered the insect, and went the length of sending a lot
of them, which he asserted he had picked out of the
skin, to the French Academy. All the philosophic eyes
were directed to scrutinize the long sought and at last
found tormentors of our race, and Gales for a time
was hailed as a discoverer. Soon, however, it was observed that there was a marvellous similarity between
these insects and meal-mites, the hoax was admitted,
and the learned world relapsed into more secure incredulity than before.  At length, a student from the island
of Corsica, who had been in the habit of seeing the
insects taken out of the skin at home, came to Paris
and instructed the great Dr. Rayer, of La Charit6, in
the simple and popular mode of digging out the acarus
from its lair.  After this time, the little insect may be
said to have been promoted to a scientific degree, as the
learned men owned its existence and gave accurate delineations of its appearance. The best account we have
seen, of the progress of the disease from the first appli.
cation of the insect, is that given by Dr. Adams in his
1 ' Medicinische Zabrbiicher,' 1844.




362


THE SKIN


work on 'Morbid Poisons,' first published in 1801, at a
time when the connection between the itch and the insect
was not generallybelieved, in. Whenin Madeira, he says'
"C In July, 1801, I procured two oug6es (the Portuguese name for the itch-insect) from the young woman
whose aunt consulted me for the cure of her niece. The
old woman, without spectacles, which she always used
when working with her needle, but not without much
diligence and nicety-extracted them from the girl by
means of a pin, and placed them between the fingers of
my left hand, the skin of which, and I believe of my
whole body, was entire. They remained without any
disposition to move as long as I watched them, but on
examination two hours after, nothing was to be discovered but a small desquamation of the cuticle.
" For more than three weeks little or no inconvenience
was felt. From   that time began frequent itching in
different parts of my body, but no eruption could be
discovered. In less than a fortnight afterwards, my
arms and belly were covered with a general efflorescence
but few vesicles appeared. I applied to my old woman,
who readily drew two ougois from my arm, but not
from  the vesicles, indeed  on this and on all other
occasions I could not help remarking that although I
could not discover what the marks were by which she
was directed, yet she constantly passed over the vesicles
without suspecting them to be the nidus of the insect.
At length, I perceived it was a small, slightly discoloured
elevation of the cuticle, which appeared as if soon to be


1 Adams on 'Morbid Poisons,' p. 295.




AND ITS DISEASES.


363


vesicular, that the woman always attacked, but not
always with success. However, she constantly answered
to our inquiries, that where the bladder was formed the
ougao had left the spot.
" No remedies being used, nor any alteration in diet
or my usual habits, the weather also being warmer than
common, even for this season of the year, the disease
continued to spread rapidly, so that by the end of
August my whole body, arms, and thighs, were covered
with the efflorescence. As, however, the Vesicles were
few, I was willing to believe the eruption might be the
prickly heat. On this subject I applied to the old woman, who confirmed my suspicions, but there is reason
to believe I was not sufficiently cautious,in leaving my
teacher to form her own opinion before she had discovered mine. In the mean time, my health suffered exceedingly, not only from the inconvenience produced by
the itching; but about noon a quotidian fever began, with
a slight shivering, and was succeeded with headache, dry
heat, great thirst, loss of appetite, and considerable exacerbation of the itching.  The consequent perspiration
was not greater than what the season, might have produced.
cc So little was I prepared to expect such effects to
arise from such causes, or so determined to ascertain the
cause, that to allay the itching I used an ointment of
pomatum and saccharum saturni, from which some relief
seemed to follow. It was, however, for a short time,
and the paroxysm of fever being as regular, though
much slighter than in common ague, I had recourse to
the bark. If this produced relief it was very temporary.
"By the middle of October the efflorescence was uni



364


THE SKIN


versal over my abdomen, and very general over my arms,
breast, and thighs; my hands were only slightly affected,
but sufficiently to be detected by the natives. The character was indeed here more strongly marked, for the
white shining cuticular elevations were such as I should
not have scrupled in England to call the itch.
"About this time, one of my family became slightly
infected with the eruption; but her fever was very considerable.  It seemed, therefore, reasonable to attribute
all my own symptoms to ouc6es, or at least it was time
to try whether by ridding the skin of them, the other
symptoms would cease. The ointment I had invariably
found successful in all other cases was composed of a
drachm of white precipitate of mercury and an ounce of
soft pomatum.   The effect of this on us both was almost
incredible. In three days time the itching nearly ceased
and the fever entirely.  However, it was found necessary to have recourse to the ointment occasionally for
nearly a month afterwards; little cuticular elevations
and some vesicles arose at different times during that
period, and when they arose were constantly attended
with symptoms of fever. From that time we felt no
further occasion for any remedies.
" In the mean time, my friend Banger had began a
similar experiment upon himself. He borrowed a single
ou09en of me, and its multiplication soon showed itself.
The first parts in which he discovered either itching or
eruption, were the inside of his left arm, near the axilla,
and part of the chest which comes in contact with it.
This he imputed to his habit of sleeping with his right
hand in that position. At first, he used no means of
cure but warm bathing.   He next tried dry friction of




AND ITS DISEASES.


365


brimstone over such parts only as showed the eruption,
or gave the sensation of itching, and gained some assistance from  them, but was not cured without a sulphur
ointment; and the efficacy of this was slower than I
have usually found from the white precipitate ointment.
" My friend Mr. Banger brought a child to his house
much covered with the disease, that he might learn to
extract the insect himself.  He was so diligent in the
lessons he received daily from  an old domestic, that in
about six weeks the child afforded no more oug9es,
though all remedies were carefully avoided."
Dr. Adams gives a very accurate description of the
exact spot where acarus is to be found. He concludes
his paper by a series of reasons against the identity of
the disease engendered by these insects and true itch,
but refutes himself unconsciously by giving an excellent
delineation of the insect, which, on examination, turns
out to be the true acarus scabiei. Rayer, a competent
authority, says of them, " Adams has given two good
figures of the acarus."                 I
There is now no longer any doubt of the existence of
this little beetle called acarus scabiei, and that it has been
burrowing under the skin of our race for centuries; nor
is it doubted that wherever this insect is, there is true
itch. Whether itch may exist without the acarus is
another  question.   The   experiments of Adams and
others seem  to establish that the acarus is of itself sufficient to produce the itch in a healthy individual; but
it by no means follows that the itch would subside if all
the acari were removed, or that there can be no itch
without an acarus.   At the same time, it is highly pro



366


THE SKIN


bable that in all cases of true itch the acarus has been
present at some stage of the disease.    Hitherto, they
have been found chiefly, if not solely, upon the hands,
forearm, feet, and scrotum, thorax, and knee; and they
are always at the very end of their tortuous passage.
They are truly progressive, always going forwards and
never returning by the way they came, which may account for their affinity with the inhabitants of Scotland.
When taken out of their hiding-hole they leap like a
flea, and give the same sensation as that insect when
crushed between the thumb nails.
The itch, then, seems to have a truly local origin; at
its commencement it is always vesicular; it is never developed spontaneously, but always by infection; it takes
from two to five days to form in children, and from ten
to twelve days to form in adults, and it advances more
rapidly in the young, vigorous, and sanguine, in whom
alone it becomes complicated with impetigo and ecthyma,
than in weak, ill-nourished people. This we state on the
authority of Biett, whose position at the Hospital of
St. Louis, gave him the best opportunities of investigating
the disease.
These facts are greatly in favour of the opinion that
the insect is the true cause of itch, for if the disease
were inoculated by the insect merely-that is to say, if
there were a true itch virus, which when brought into
contact with the circulation produced a vesicular eruption which afterwards spread-then we should expect to
find that the same length of time was required for its
development in all individuals; at all events, it is against
all analogy that there should be so great a difference as
two to twelve days. We have besides numerous direct




AND ITS DISEASES.


367


experiments made by Hebra and others, the uniform
result of which was that the inoculation with the fluid
of the itch-pustule in no case gave rise to more than one
single vesicle, and often not even to this; while the
insect to the skin in the great majority of cases produced the disease.
Itch is a disease to which both sexes, all ages and
ranks, in all climates, are liable; but it prefers youth to
old age,'spring and summer to winter and autumn, the
temperate to the other zones, and the male sex is more
liable to it than the female. It never subsides spontaneously; and, although limited to a small part on its
first appearance, soon spreads over a large surface of the
body, and ultimately may cover the whole of it. At
first vesicular, it may become pustular, and from first to
last it is attended with intolerable itching, and is altogether a very filthy and loathsome disease.
Varicella, although strictly speaking a vesicular affection, has so many relations with smallpox as to be classed
along with it generally, and by many to be considered
merely that disease arrested in its development. It begins
with small red papular spots, on which vesicles about as
large as a barleycorn rise; these are filled with fluid, at
first clear, afterwards turbid, but never fully purulent.
At the end of a few days, four or five, the vesicles dry
up into brownish scabs, which fall off in a few more
days; and neither during its invasion, progress, or decline, is the disease attended with serious constitutional
symptoms. The strong fact against its being a form of
smallpox is, that the contents of the vesicles when introduced into the skin of another person never cause small



368


THE SKIN


pox, rarely any regular action, and, if any, vesicles
similar to those of varicella.1
The transition from the vesicular to the pustular diseases is very natural, for all pustules begin in vesicles,
and all vesicles tend to assume some amount of purulent
transformation of their contents.    The most important
pustular diseases are Variola, Ignpetigo, and EctJiyma.
We omit vaccinia, as not being, properly speaking, a
disease incidental to man, but only artificially produced for
a specific purpose, and therefore not requiring treatment.
Variola or small-pox is, in a dermatological point of
view, an acute inflammation of circumscribed portions of
the skin, the inflammation beginning at innumerable
points all over the surface; these points are at first red,
then they rise into pimples on which flattened and
umbilicated vesicles form, and then transform themselves
into pustules, and end in hard brown scabs.      The pustules sometimes unite, and the disease then       becomes
confluent smallpox. The cause of the umbilicated appearance of the vesicles, which is characteristic of the
disease, and appears on the third or fourth day, has
been a subject of much discussion, and there is as yet
no satisfactory result attained. On the whole, the most
probable opinion seems to be that on the summit of the
pimple an exudation either of plastic lymph capable of
forming a false membrane, or simply glutinous serum
entangling epidermic scales is formed, this secretion
spreads from the highest point of the pimple over the
surface, and binds the cuticle to the cutis, when the
I Naumann, ' Hanbuch der Med, Klinik,' Berlin, 1831, Bd. 3, 1 Abth.,
~ 649.




AND ITS DISEASES.


369


serum which forms the contents of the vesicle is forced
out by the skin, it meets with greater resistance at this
point than at any other, and when the whole lid of the
pimple, so to speak, is raised, the centre is for a time
detained by bands of the deposit and prevented rising
so quickly or so high. This layer which coated the
skin and cuticle, afterwards forms a transverse partition
of the pustule, broken at the edges so that the two
chambers comiilunicate.   In some instances, no doubt
the depression is caused by the centre of the vesicle
being anchored to the skin by a hair-tube, but this is
not always the case, as some writers assert.
The suppuration begins on the sixth day of the eruption, and is complete on the eighth; on the eleventh the
pustule bursts, and some of its contents escape.  After
the escape of the pus from  the pustule the desiccation
begins, and crusts of hardened secretion form over the
little ulcers left behind by the destructive inflammation.
The ulcers heal by cicatrization, and in severe cases the
true skin gives place to a multitude of scars, which remain a deformity for life. For scars are a sorry substitute for the natural envelopment of the body, and hence
the vast importance of preventing a disease whose cure
at the best is often so imperfect.
A  similar step which leads from viaricella to variola
conducts from eczema to impetigo.  Inpetzio (ab impetu,
according to Pliny) is a subacute inflanimation of the
skin, characterised by an eruption of small hemispheroidal
or flattened pustules on a slightly inflamed base, which
burst in the course of three or four days, and are succeeded by a rough yellowish transparent crust of considerable thickness. The pustules may be either sprinkled
24




370


THE SKIN


(/. sparsa) over the surface without any definite arrangement, or may be of a circular or other well-defined figure
(I. figurata.)  In the affected part the cuticle is absent,
the vessels of the true skin injected, but the hair and
glandular apparatus is generally quite healthy.1
The most important variety of the disease from   the
frequency of its occurrence and the annoyance it produces is lipetigo capitis, called also Crusta lactea, or
the milk-crust of young children.   It is attended with
severe itching, and the scratching thereby provoked
breaks the crusts and fissures the surface of the skin,
over which a viscid seropurulent discharge exudes.  On
the removal of the crusts the red and shining skin below
is gradually invested with its natural epidermic covering,
and no permanent injury is sustained, for the baldness
which this disease produces, as it does not arise from the
destruction of the hair-bulbs or glandular apparatus, is
merely temporary. Like other eruptions on the scalp,
it is sometimes vicarious, and its sudden stoppage is
dangerous.
-Eciymaa (,KOdEv, to burst forth) consists of an eruption
of round prominent pustules of considerable size, upon
any part of the body, attended with sharp pain, and is
either acute or chronic.  It begins, according to Rayer,2
in a conical elevation of the coriumn  at the apex of the
cone serumn and pus are effused, which gradually extend
over the whole surface of the tumour, and then a membranous deposit takes place in the centre; after the
pustule bursts a small ulcer remains, surrounded by hard,
thick, puffed edges, and this ends in a cicatrix whose
'Simon.
SOp. cit., 530.




AND ITS DISEASES.


371


centre corresponds to the point where the deposit took
place. It may be artificially produced by Tartrate of
Antimony,1 and is so often caused by bad food that one
variety is called Ectymna cachecticum.  In the well-known
experiments of Dr. Stark, who lived for some time on
nothing but sugar, an eruption like Ecthyma made its
appearance. The pustules produced by Tartar emetic
have sometimes the umbilicated appearance of those of
smallpox, probably from the same cause.
The morbid affections of the skin hitherto described
have been confined to its surface, those which follow
involve the deeper structures of that organ.    And first
may be taken boils and carbuncles.
i1zrunculm  and Anttrax are essentially the same, they
both cbnsist of an inflammation of the corium and subcutaneous cellular tissue, which terminates in the formation of a deposit, called in German, Pfropf  This deposit
is composed chiefly of the matter identical with the fibrine
of the blood.2 Round this as a centre, suppuration takes
place, and if there be but one pfropf the result is a
furuncle or boil; but if there be several, then a carbuncle
or anthrax is formed.   In the course of the suppuration
these pfropfs become separated, and not unfrequently the
whole of the tissues become involved in gangrenous
destruction.8
The hairs and glandular apparatus still remain to be
described. The hairs are planted obliquelyin their sheaths;
these sheaths are pouches of about a tenth or twentieth of
an inch in length, somewhat larger at the shut than at the
1 Simon and Helbert, de exanthematibus arte factis.
2 Ascherson, in Casper's ' Wochenschrift,' 1837, s. 729.
3 Rokitansky, ' Handbuch der Pathol. Anatomic,' 2 bd., s. 89.




3729


THE SKIN


open end. They are formed of three layers; the most external consists of cellular tissue, that next the hair of a clear
membrane, and between these there lie muscular fibres;
the bottom of the pouch is spreadwith minute granules and
cells which afford nourishment to the hair.  The hair itself
is composed of three structures, the outermost consists of
epidermic cells arranged so that the lower overlap the
upper, like the tiles on a house; the next is composed of
two sets of fibres, one like ribbon, the other like threads;
they form the bulk of the hair, and extend downwards
from the point to the root, which bulges out, and there
the fibres are more separated, like the sporules of a plant.
The central part consists of medulla or pith, which is
composed of a cellular structure containing fluid or air.
According to the most recent investigation of Griffith
and Steinlin, it is upon the presence of these little airbladders that the colour of the hair depends.' The sides
of the hair are not in immediate contact with its pouch,
but a membrane, of the nature of which there is still
some difference of opinion, lies between them and unites
them.   In each hair-pouch or bulb there ends the duct
of a sebiparous gland, so that the hair is continually
lubricated from this little oil-vessel. These glands are
lobulated and imbedded in the substance of the skin,
the several ducts from the different lobuli unite into a
main trunk, which terminates generally in the hair-pouch,
sometimes on the surface of the skin.     Thus it will be
seen that the ducts of these glands and the hair-pouch
form a common cavity, and hence it is sometimes difficult
to determine which of these organs is at fault in the
1 'Zeitschr;ft fur ration. Med.' von Henle and Pfeufer, ix, ii, s. 320.




AND ITS DISEASES.


373


morbid alteration of the part.      The number of these
glands is very great, according to a calculation of
Chevalier's, there are 120 millions of them on the surface
of the body,' and this fact alone, independently of the
diseases we shall presently see to be occasioned by any
obstruction in their ducts, is sufficient to impress us with
the importance of employing efficient means, by washing
and rubbing, to maintain this vast apparatus in a healthy
state. It may suggest the inquiry, whether we have
done wisely in giving up entirely the use of oil, which
the ancients employed so largely upon the skin, since the
soapg which has superseded it is valued rather for its
detergent properties in cleansing the exposed parts of the
body than for any unctuous qualities by which the skin
might be lubricated. It would be well for those who
devote attention to the restoration of health by the use of
water, exercise, and such like methods, to be familiar
with the means by which the Greeks attained to such
perfection of manly vigour and beauty.
The chief diseases of the sebiparous glands and the
ducts common to them        and the hairs, depend on an
increase of their secretion, or the obstruction of the outlet in some way. Of the diseases of the chief are
IckJityosis, Comeclo, 2Mfollzuscum, Acne, and Sycosis.
Ickhtyosis or fish-skin disease consists of an excessive
secretion of sebaceous substance upon the surface, it takes
the polygonal form marked out by the lines of the skin,
and forms raised crusts of considerable thickness; they
adhere to the epidermic scales, and become discoloured
from the impurities of the atmosphere, which naturally
1 ' Lectures on the General Structure of the Human Body,' &c., 1823.




374


TIHE SKIN


imbed   themselves in   so convenient a retreat.   The
affection may occur on any part of the body, but is most
frequently on the forehead and nose, the joints and
abdomen.    It is attended with little or no constitutional
disturbance, and may last for months, or even years.
Instead of this increased secretion being general over the
surface, it may be confined to one duct, and thus a horn
is formed.  The most remarkable case of this kind on
record is that of Paul Rodriguez whose horn, situated on
the upper part of the side of the head, measured fourteen
inches in circumference at its shaft, and divided into three
branches.'
Comedo is an enlargement of the duct of the sebiparous
gland, which leads to an increase in the tube common to
it and the hair; at least this is Krause's view, and a
prolable cause of this is atony of the muscular fibres,
which K6lliker has described as surrounding the canal;
this atony prevents the expulsion of the contents, these
accumulate and distend first the duct of the gland itself,
and then the hair pouch, with a tallow-like substance,
whlich shows itself at length on the surface.  A small
animal, called by its discoverer, Simon, Acarus folliculorum, is very frequently present, also in the ducts, so
often indeed that it can hardly be reckoned a morbid
appearance. It is of an elongated form, on the thorax
are four pairs of legs, and the abdomen three times as
long as the thorax, tapers slightly away and ends in a
blunt point; the head consists of two palpi and a proboscis between them.    Its entire length is -Tath of an
inch. The subjoined representation is taken from Mr.
' ' New York Medical Repository,' for 1820.


(
~,




AND ITS DISEASES.


375


E. Wilson's work, who corroborates Simon's description,
but objects to the name, and proposes to call the intruder
Steatozoon folliculorum.
Molluscumn is a tumour having the appearance and
being about the size of a ripe currant; it consists of an
enlargement of the sebiparous gland, or of the branches
of the duct nearest to the gland, so that when cut into it is
found to be composed of compartments corresponding to
these divisions. According to D)r. Henderson, who has
given the best description and delineation of the disease,1
the tumour has the appearance of a conglomerate gland;
its substance is impacted with sebaceous matter similar
to that found in Comnedones.  The cells of which it consists vary much, both in form and size, but seem to be
of a healthy and not a morbid character; the disease in
fact appears -to be an hypertrophy of the sebiparous
glands. By some it is considered contagious, this however is doubtful. It is not attended with danger, and
terminates either by the bursting of the tumours and
discharge of their contents, or by the sloughing out of the
whole mass; when this takes place an ugly scar remains.
Acne (from acqn,, as it occurs in the acme of life) is an
inflammation of the sebiparous glands and ducts and
hair-follicles, or of the latter alone.  It is characterised


1 'Edin. Med. and Surg. Journal,' vol. lvi, 1841.




376


THE SKIN


by an eruption of hard conical tumours of moderate size
dispersed over the body, especially on those parts where
the skin is thick.  It often happens that in the centre of
each of these little cones a round blackish spot is perceptible (acne punctata), which is the opening of the hairfollicle distended with inspissated sebaceous matter,
which may be pressed out. The other variety, acne
rosacea, is recognised by the redness of the tumours,
which is not unfrequently accompanied with a varicose
state of the neighbouring veins. The disease, as the
name implies, generally attends particular periods of
growth, and is dependent upon constitutional causes.
One form is a well known exponent of intemperate habits.
and vulgularly called grog-blossom.
Sycosis or Mentaara differs little from acne, except in
its situation being confined to those parts of the face
which are covered with hair.   It consists of conical elevations, at first red, then yellow, from suppuration at
their apex, each of which is traversed by a hair; the
little tumours on bursting form a yellow crust. The
disease probably begins in the sebiparous glands, and
gradually involves the hair-follicles. It is tedious, and
gives a very unsightly appearance to the face. Gruby,
of Vienna, describes a vegetable parasite as having its
abode in the eruption of sycosis, and calls the disease
iJentlarophyte.'  It is doubtful, however, whether these
cryptogamic plants have any etiological relation to the
disease, at the utmost their only pratical interest may be
their diagnostic value, nor can this be very great when
Mr. E. Wilson failed to discover them.


" Coniptes Rendus,' 1842.




AND ITS DISEASES.


377


The morbid alterations incident to the hair itself are
not numerous, but it shows its participation in various
affections both physical and moral, by the sudden and
marked changes it undergoes. The unhappy queens of
Scotland and France, Mary Stuart and Marie Antoinette,
both became gray before their execution, and one night
is said to have blanched Sir Thomas More, who might
well have said,"0 nox! quam longa es qume facis una senem!"
We have seen a remarkable example of the opposite
kind in a young lady subject to tic douloureux, whose
hair naturally of a light brown colour always changes to
a dark colour, approaching perfect black, after an attack
of that complaint.
Of the diseases proper to the hair itself the most important are, Tinia, Plica polonica, and Favus.
Tinia, trickonosis furfuracea (O9pL, capellus et voaoe
morbus), or common ringworm, is recognised by circular
or oval patches of skin in a dry furfuraceous state, on
which the hairs that grow are whitish, twisted or bent,
shrivelled and brittle, some broken off near their roots,
others matted into bundles and mixed with yellowishgray crusts. When the part is clean the patches look
parched and the hairs dried up.     Later, the spots become bald or nearly so. At the beginning of the attack
a thin layer of scurf may be perceived in patches here
and there, which are slightly itchy; the skin under
these patches is reddish, and then the papille appear as
in cutis anserina.  These pyramidal eminences are the
swollen mouths of the hair-follicles, which look as if
they had been drawn up by the growth of the hair.




378


THE SKIN


The hairs themselves are like tow bent and broken off,
so as to have a moth-eaten appearance, whence the name
tinia is derived. The grayish or yellowish crusts are
composed of furfuraceous scales and diseased hairs glued
together by the moisture which exudes from the diseased
surface. The disease consists in a morbid alteration of
the hair and hair-follicle. The hair instead of being only
1-400th of an inch in diameter is sometimes only 1-150th.
This enlargement of size depends upon a change in the
fibrous portion of the hair. The fibres of this layer
which we have already described are made up of
granules; the disease seems seated in these granules;
they are more numerous than in health, and, instead
of being   in  regular rows, are undulating, and new
granules  of a nucleated    character are mixed    with
them either singly or in long rows. Hence the disease
is very well called by Mr. E. Wilson granular degeneration of the hair.  This excellent observer is opposed to
the theory of Gruby and others, who ascribe tinia to a
vegetable parasite; he also denies that it is contagious,
and supports this opinion by some very strong arguments,
which seem to us satisfactory.  As the question of contagion of this disease is one of great practical importance, we should be somewhat shy in adopting the negative view, for the opposite, if an error, is comparatively
harmless, but this if wrong is dangerous.
Plica polonica, a disease fortunately unknown in this
country, seems to be essentially of the same nature as
tinia, and to consist of granular degeneration of the
hairs, which are swollen with blood and adhere into a
matted mass, painful to the touch, offensive to the smell,
full of lice, and altogether disgusting.   The disease




AND ITS DISEASES.39


379


sometimes begins not at the root but about an inch
above it, and aff-ects only the upper part of the
hair.'
Pavus is unlike all other scalp affections in that its
seat is below not above the epidermis, so that it presents a perfectly dry and very slightly raised   cupped
appearance of a bright yellow colour. Owing to the
depression of the centre of these bright crusts it gets its
name favii8 or honeycomb. Erichsen 2 describes the
disease as the formation of tuberculous matter in the
hair-follicle, the first effect of this is to cement the
root to its bed; as the formation of more tuberculous
matter goes_ on the whole capsule in which the hair
grows becomes filled. Mr. E. Wilson regards the af.
fection as degeneration. of the epidermic cells at the
period when they are in the process of formation, from the
primitive granules derived from the blood. These minute
bodies, instead of developing themselves by aggregation
into healthy epidermic cells, become transformed into
others resembling pus-cells, and present the appearance'
of the stems _and branches of a plant. This change
takes place at the- root of the hair, and these cells
linked together fill the little vessel in which the hairs
grow, and also enter like a chain into the hair itself,
running up through its substance and destroying its
texture as in tinia: the hair, in fact, adopts these
spurious bodies into it instead of the properly growing
cells it ought to receive, so it may be said to pith
itself with a- spike of what may be figuratively called a
plant, but what is in reality only a structure of diseased
SBidder, 'MUler, A~rchiv,' 1840.
O p. cit.




380                    THE SKIN
cells. This explanation seems to us more satisfactory
than either Erichsen's or Gruby's. On the contagiousness of this disease the opinions are diverse, and the
same amount of doubt, suggesting a similar degree of
caution, hangs over this as over 1Tnia. Both these
diseases undoubtedly are due to constitutional causes.
Favus is one of the worst diseases which affect the scalp,
for the bald spot it leaves behind after its cure is permanent and defies all kalydors: the reason of this is
that the hair-follicle or matrix is destroyed, and no
new growth can take place in it.
All that remains now is to describe the sudoriferous
glands, which are small oblong bodies composed of one
or more convoluted tubes, or of a congeries of sacs which
open into a common duct, from which the perspiration
which continually sensibly or insensibly moistens or bedews the surface is pressed out. The entire length of
each little tube, including the gland which is situated in
the deepest and middle layer of the corium, is about a
quarter of an inch. The duct and tubes are lined by
an inflection of the epidermis, thicker and funnel-shaped
at the orifice, and delicately fine in the interior. The
number of these tubes and glands is very great, no less
than 3528 having been counted in a square inch on the
palm of the hand. The total length of all the tubes in
an ordinary sized person if added together, so as to make
one line, would be twenty-eight miles. From this fact
we may form some estimate of the immense value of
their function in preserving the health of the body, and
of the importance of those curative methods which rely
chiefly upon their power of regulating this machinery,
which is so extensive and is so closely allied by sym



AND ITS DISEASES.


381


pathy with all the other secreting apparatus in the
system.
Although we propose to adhere to the same pathological order when speaking of the treatment proper for the
individual maladies, yet before doing so it may be well
to direct our attention to the different points of view
from which this important class of diseases may be regarded, in order to arrive at the principles applicable to
their successful management. These present four aspects.  First, the purely local lesions of the integument;
as, for example, those which arise from the chafing of the
surface, or the action of some chemical irritant on a particular part, or from  the bites or stings of insects, or
from the presence of insects keeping up a continual irritation. - In all such cases, the removal of the cause of
offence may be sufficient to restore the injured part to its
natural healthfulness.
The second class consists of those diseases which affect
the skin secondarily, their primary effect being upon the
system at large; as, for example, smallpox.  The amount
and degree of cutaneous affection in this disease is a most
important element, both as regards its prognosis and
treatment. In fact, we may look upon the extensive
pustular eruption as in some respects, independent of
the original constitutional cause, depending on the special
state of the skin for the conditions of its development,
and itself causing a new disturbance of the system.
One of the best illustrations which could be given of the
power topical influences exert, in modifying the development of the eruption of a constitutional disease, is afforded
by the following case related by Dr. W. Budd, in an interesting paper on the Symmetry of Disease, published in




382


THE SKIN


the 25th volume of the 'London Medico-Chirurgical
Transactions.'-" A sailor was admitted into the Dreadnought on account of a bruise inflicted on one side of
his breech by a fall into the hold of a ship. In the
course of some days he left the hospital, having recovered from the injury, but still showing a bruise-mark
on the breech. A short time afterwards he was again
admitted with severe febrile symptoms, which terminated
in the eruption of smallpox. The pustules were discrete
and very few in number all over the body, excect in the
exact seat of the former bruise, and there they were extremely numerous, and for the most part confluent."  We
have quoted the case at length because we look upon it
as full of instruction.  It puts beyond a doubt the importance of studying the progress of the pustules per se;
showing that their number and size are not always at
least an index of the general severity of the disease, but
depend upon some peculiarity of the skin; and it may
be of great importance in mitigating the affection of the
system to adopt local measures for moderating the cutaneous eruption. What the special means are which best
subserve this purpose we shall discuss in full when speaking of smallpox; at present, we adduce it as an example
of the importance of paying the strictest attention t6
the state of the skin in all diseases, which although involving the whole constitution, tend to excite a specific
morbid alteration in that organ.
The third class of these diseases are those in which
the skin assumes a sympathetic or vicarious action, holding direct relation with some morbid condition of an internal organ.  In some cases the external affection is
vicarious, that is, on its appearance the other malady




AND ITS DISEASES.


383


suddenly subsides, to reappear as suddenly on the disappearance of this.   Speaking of the trifling complaint
stroplulus intertinctus, Willan says " the papular eruption
is in many cases connected with a weak, irritable state
of the alimentary canal and consequent indigestion; for
if it be by any means suddenly repelled from the surface,
diarrhoea, vomiting, spasmodic affection of the bowels,
and of the general disturbance of the constitution succeed."'   Willan supports this statement, made on his
own observation, by the authority of other accurate observers.  In this instance the cutaneous affection is not
merely sympathetic but vicarious, or, in other words,
there has been a transference of the morbid action from
the bowels to the skin.    The subject of vicarious diseases is one of immense importance in a therapeutic
point of view, as well as extremely interesting in itself,
but it would be out of place to do more here than direct
attention to it as one of the sources of erroneous treatment; for, as in smallpox there may be danger of our
using too few local measures, there is as much danger of
our using too many in this and similar eruptions.      At
Sthe same time, we must draw a distinction between vicarious and sympathetic affections, for while the former
ought not to be hastily attacked, it may be proper to
direct vigorous treatment against the latter.   The distinction between the two classes is this: in the onethe vicarious-the morbid action leaves a dangerous
seat of operation, such as the intestines, and takes up its
abode on a part it cannot materially injure: in the
other-the merely sympathetic-the disease does not


I Willan, 'On Diseases of the Skin,' p. 22.




3814


THE SKIN


quit its original place of settlement, but establishes besides a dependency in some other part, and the two may
act not alternately to the relief, but simultaneously to
the distress of the system.   In such cases, of which
prurigo may be taken as an example, curing the secondary disease is like crushing the colony of a hostile
power. One source of mischief is quelled, and the other
is abated.
The remaining class consists of those diseases which
depend upon the presence of some constant constitutional
taint, and as they are the most numerous so they are
also the most difficult to cure.  A.s an illustration of
this division we may take lepra, by much the most common chronic affection of the skin, and generally looked
upon as quite incurable by the old therapeutic methods.
The most important fact connected with this complaint
for us at present is, that however inveterate or extensive
the eruption may be it is easily removed for a time by
medicine, which has a specific action on the skin, whether
this be administered in palpable or infinitesimal doses,
and thus a delusive cure effected, for after the abandonment of the specific the disease soon returns. We have
long had an opportunity of watching a patient who has
been subject to this disorder for about thirty years, and
in him it is always cured by Arsenic, whether he take
the 15th dilution or five drops of Fowler's solution three
times a day; and it is remarkable that after continuing
this medicine for a couple of weeks, let the quantity be
ever so minute, it is apt to produce unpleasant constitutional effects.  This is a good example of a homoeopathic
palliative; and it was the occurrence of cases of this
kind suggested to Hahnemann the important practical




AND ITS DISEASES.


385


division of medicines into those which were antisporic,
and those which were not. It may be that this distinction is rather confined to individual cases than fitted to
express the universal relations of a drug, that is, that in
one kind of disease and constitution a medicine may act
deeply and so permanently as to destroy the tendency to
the disease as well as its manifestation, while in other
constitutions or in other conditions of the system it
merely removes the     phenomenal expression without
eradicating the culpable element from the body. For
example, we look upon Mercurius as sometimes radically
curative and sometimes palliative. The palliation of an
inveterate disease by its specific antidote in minute doses,
and therefore acting through the system without permanently altering the constitution, is one of many arguments which might be adduced to justify the administration of medicines in alternation or succession, with the
view of effecting different spheres of morbid action; for
it is obvious, that if a particular substance has the power
of arresting one without exerting aly influence upon
the other, some other medicine may have an affinity towards that which, its predecessor did not reach, and an
indifference towards that which it cured.    Hence we
consider ourselves fully warranted both theoretically and
practically to advise the use of two distinct series of
homoeopathic remedies in the treatment of diseases which
arise from a constitutional taint, the one to be selected
for its specific power in curing the symptoms of the
disorder, and the other for gradually emancipating
the  system   from  the influence of its   predisposing
cause.
There is another point of view in which this power of
25




386


THE SKIN


palliation in what we may call local cures, ought to be
regarded, and it is this: There are some cutaneous eruptions which are neither vicarious nor sympathetic, nor
are they merely a part of the general disturbance of
some peculiar taint, but they seem to hold the same
relation to scrofulous constitutions which measles and
some other eruptions may be supposed to hold good.
They are what we might call the critical processes
through which the system is passed, and the future
health of the individual depends upon their proper
management. It must have been often observed by all
practitioners, that every member of certain families
at some particular age, often about six or seven years
old, begins quite unexpectedly, often during the fullest
health and apparently without any exciting cause, to
display symptoms of general delicacy; in one it may
be swelling of the cervical glands, in another thickening
of the upper lip or redness and swelling of the eyelids;
now, if at this critical period an eruption of an innocuous kind, eczema let us suppose, appears, the chances are
that it is the most favorable manifestation of the working out of the poison hidden in the frame, and the injudicious cure of this by employing the recognised antidotes to this peculiar morbid affection of the skin, may
be followed by baneful consequences to the future development of the individual. We cannot but fear that
this warning is not altogether unnecessary, for certainly
those who prescribe according to the manuals most in
repute will be almost certain to fall into the error, and
it is one which may not disclose its full fruits for long
afterwards, and then in some deadly and unmanageable
attack of an acute disease, the cure of which is rendered




AND ITS DISEASES;


387


imperfect from the disturbing force of this uneradicated
morbific cause.
After these preliminary observatiohs on the general
principles applicable to the management of affections of
the skin, we shall proceed to speak      of the special
treatment of the individual diseases in the order previoutsly adopted.
Cloasma or Pityriasis versicolor is easily recognised by
consisting as it does of brown irregular patches, distributed in a sort of geographical fashion over the body,
especially the chest and abdomen, so as to present the
appearance of continents and islands, with promontories
and peninsulas.   The only disease with which there is
the smallest danger of confounding it, are the coppercoloured syphilitic or mercurial spots, but slight attention
to the colour and the constitutional symptoms which
distinguish the latter will prevent the practitioner committing the awkward mistake that such a confusion would
be.  In itself, it is a perfectly harmless blemish of the
surface, the causes of which are unknown, and the
only general indications for its treatment are that it is
certainly aggravated, and perhaps sometimes induced by
the use of flannel next the skin, especially in persons
who perspire copiously.
Of the long list of medicines given by Jahr as available in this affection, the only ones which bear any resemblance to it in their symptoms, or are accredited as
having been useful in curing similar states of the skin,
are the following: Antimonium:-" Brown spots or dots,
like small hepatic spots here and there."   Cocculus:" Red irregularly shaped spots on the skin, on the whole
chest, and on the sides of the neck behind fhe ears, as if




388


THE SKIN


coloured with red wine, without heat or sensation."
Conitum:-" Chronic brown or frequently recurring red
itching spots on the body." Lachesis:-" Small reddish
spots on the face, neck, and arms, increase in number,
become scurfy and then disappear."   Ledurm:-" Bluish
spots on the body, like petechia."      Phosphorus:" Blotces and blotch-like spots, brownish and bueish red,
as in leprous patients." Phosphorus is recommended
by Noack and Trincks for the cure of brown spots on
the body and yellow spots on the abdomen and chest.
In one case of very extensive cloasma over the chest and
abdomen of some months' standing, I found in Phosphorus a speedy cure.   Sepia:-" Claret-coloured spots
on the neck and under the chin, without sensation."
" Brown-red hepatic spots on the skin."
Erythema is diffused redness of the skin, and is sometimes a symptom of some general disorder, especially
dyspepsia, hysteria and gravel; at other times it is a
purely local affection depending upon irritation either of
friction or of an acrid discharge.  It is stated by Hippocrates to be frequently the precursor of death when it
occurs in the hands and feet in any acute disease, and
also in pneumonia when it appears on the chest.1 It is,
however, only the second form of the complaint, known
as intertrijo, that falls to be treated of at present.
The parts most subject to this troublesome affection,
are the axillae, the mammm on their lower surface, and
the parts in contact with them, and especially the inside
of the thighs, from which it extends to the scrotum, and
by impeding walking    is extremely annoying.    It is
1 'Epidem.' lib. 1st, 89, 14.


i




AND ITS DISEASES.


389


often attended with a glairy secretion, with a faint sickening smell. In infants at the breast, when not well
cleansed, it is frequently met with about the nates and
scrotum.
The first indication for treatment is obviously the removal of the exciting cause. This may be wholly effected
when the mammae are the seat of the complaint by the
employment of suspensory bandages, while at the same
time the abraded or irritated surfaces may be dusted
with starch powder or coated with arnicated Collodion.
In other places, where it is impossible to avoid friction,
Calendula cerate will be found a useful application.
I generally employ glycerine in such cases now. Of
course, the greatest attention to the thorough washing
and drying of the affected parts should be enjoined. In
chapping of the hands it is recommended to rub them
with honey after washing and then to wipe them with a
towel; this is found to be the best outward application.
Warm baths, with a few Chamomile flowers in them, have
an excellent effect upon that form of the disease which
is met with in infants and young children. In addition to
these general measures for alleviation, from among the
following medicines the specific antidote for the cure may
be selected.
Belladonna   produces   "redness, inflammation, and
swelling of the whole skin."
Chamomilla:-" Redness of     one cheek, recurring   by
starts without shuddering or internal heat."  This is very
like one of the varieties of erethyma. Besides, Chamomilla has been found especially useful in the " rash of
infants and nursing females," it has also been known to
cure cc sore places on the skin, especially in children."




390


THE SKIN


Graplites has been recommended by Dr. Gross to be
given to the nurse while Chamomilla was administered
either as an external application or internally to the
infant.
IHepar svphulris is very effectual in curing "chapped
skin and rhagades on the hands and feet," which often
arise from erythema, and also in causing a beneficial
change in that unhealthy state of the skin which inclines
it to ulcerate on slight injuries.
Oleander:-" The skin of the body very sensitive all
over; it becomes sore, red and painful merely by the
friction of the clothes; for example, the skin of the neck
becomes so from the rubbing of the cravat, that of the
thighs from the rubbing of loose trowsers when walking.
Roseola:-This name has been somewhat vaguely
used by writers on cutaneous affections. Rayer considers its proper place to lie between erythema and urticaria,
while Willan ranks it with the exanthemata, and expresses
a doubt whether it can be properly called an idiopathic
disease of the skin. However this may be, all authorities agree as to the fact of the occasional appearance of
an eruption, at first red, then of a rose colour, and finally
becoming purple, attended with slight fever lasting about
five days from its appearance, and generally accompanied
with faint redness of the fauces.    It generally affects
children with delicate skins, especially in summer or
autumn, and in some it reappears annually, which is
much against Willan's opinion of its relation to the true
exanthemata.   Its chief interest consists of its resemblance to scarlet fever and measles; from the former it
may be distinguished by its colour approaching nearly to
purple, and by the mildness of the constitutional symp



AND ITS DISEASES.


391


toms, for it is only in the worst forms of scarlet fever that
this hue appears; and from measles by the evenness of
the surface, which does not rise into papular elevations.
Although a week or two would remove the trifling malady
without any aid of art, yet the administration of some of
the following medicines will probably assist, and certainly
not impede this consummation.
Aconite has been found useful in " measles and purple
rash."  Roseola is the only purple rash, properly speaking.
Belladonna, besides its proved utility " in measles and
purple rash," has also a specific action on the fauces,
which are generally affected in this disorder.
Sulphuric acid, although not among the list of homceopathic medicines, being highly spoken of by Willan, may
be included in this brief catalogue, along with Pulsatilla
and Nux vomica, which seem to be recommended by
homoeopathic writers entirely on empirical grounds.
Urticaria, or nettle-rash, may be ranked among the
sympathetic or vicarious diseases, as it is generally produced by some derangement of the system, generally of
the digestive apparatus, and not unfrequently relief is
experienced on the appearance of the eruption. The
affection of the skin, usually preceded by moderate
fever, manifests itself in the form of an elevation of portions of the skin, irregular in size and shape, and varying
in colour, being either bright red or pale, and attended
with intolerable itching or tingling.  The symptoms are
much worse at night. The more common form of the
complaint lasts for about eight days, but it sometimes
becomes chronic, and continues for years.   It is most
frequently met with in the young, and during autumn.




392


THE SKIN


The predisposing cause of this disease is evidently a
peculiarly sensitive condition of the skin, for those who
are liable to it can induce it at any time by pinching or
irritating the surface. The exciting cause may be either
of a general or specific character.  Of the general causes
the most frequent one is, some affection of the stomach
or intestines; but instances are on record where this
eruption appeared in connexion with pneumonia and
pleurisy,1 and Clark met with some cases where it was
associated with cancer of the uterus. Besides these very
serious causes it may be excited by others of a purely
nervous kind, such as mental agitation; and Dr. E.
Wilson had a patient in whom he could evoke it at
pleasure, by engaging her in conversation. "I have
watched the red wheals," he says, "appear and creep
along the skin, and disappear, while I purposely engaged
her in conversation on indifferent subjects.  A word, a
look, the slightest excitement, would immediately bring
out a copious eruption."'   This case affords conclusive
evidence that the notion which seems now gaining ground
among the young school of pathology, of this and most
similar diseases being the result of chemical change in
the constituents of the blood, is erroneous. At all events,
that precisely the same affections may be produced
without the possibility of this presumed cause coming
into operation.
The specific causes are certain vegetable and animal
substances which always excite the eruption; the former
in a few individuals alone, the latter very generally.
Among the former are sweet almonds.     After eating of
' Rayer, op. cit, p. 198.
" Op. cit., p. 157.




AND ITS DISEASES.


393,ms fruit both Dr. Winterbottom and Dr. Gregory were
attacked  with   urticaria.1  But the most remarkable
source of this disorder, is certainl shell-fish, particularly
mussels.   It was a prevalent opinion that these animals
became poisonous from the kind of food they lived on at
certain seasons, but this is now denied by the best
authorities, and the symptoms they produce are ascribed
to the peculiar susceptibility of individuals.  So great is
this sensibility in some persons that one instance is
recorded of a man who was always affected by nettle-rash
if he were exposed even to the vapour of soup in which
crabs had been    boiled.2   However, that mussels are
sometimes poisonous, from some cause or other, seems to
be established by the narrative of Burrows and others,
who describe cases in which death took place apparently
from no other cause than eating mussels, and with all
the symptoms of some violent poison.3
In the treatment of this complaint, of course if there
is any suspicion of its being of poisonous origin, the first
indication is to remove the cause, either by an emetic or
by tickling the fauces with a feather, and giving a copious
draught of warm water. However, this is very rarely
necessary, for the cases of this kind are very uncommon.
By much the more common varieties of urticaria depend
upon a general disorder, manifesting its presence on the
skin, on account of some peculiar liability of that organ
to be thus impressed.
1 Willan, op. cit., p. 404.
S' Med. Facts and Observations,' vol. v, p. 59.
3 I have a patient, a lady of middle age, who, if she take any exercise
after eating, is attacked with vertigo, insensibility, and convulsions, which
are relieved in the course of an hour or less, by an eruption of nettle-rash
on the face.




394


THE SKIN


The application of cold water to the affected parts,
either by sponging or by the shower bath, by which
means the   intolerable itching is greatly relieved, is
strongly recommended; at the same time we should be
cautious not to induce a sudden retrocession of the affection from the skin, when its appearance has been followed
by the subsidence of any internal disorder.
In the febrile stage of urticaria aconite is recommended; besides its suitability to the general symptoms
it produces " stinging, with feeling of soreness in various
parts of the body;" also " spots like flea-bites, especially
on the hands and face."
Bryonia produces a train of symptoms which are the
accurate counterpart of the disease: "Prickings over the
whole body; a slight emotion (laughter) excites a sudden
stinging itching over the whole body, as if he had been
whipped with nettles, or as if he had nettle-rash, although
nothing could be seen on the skin, afterwards he felt this
burning when merely thinking of it, or when becoming
heated; burning, itching, and stinging in different parts
of the body, in the evening after lying down in bed."
"Eruption on the whole body, especially on the back,
extending to the upper side of the neck, itching so
violently that he would like to scratch the parts to
pieces."
Cocculus:-"A sort of hard blotches, containing no
fluid, surrounded with a red border, burning and itching
the whole day, on the limbs, the wrist, and the back of
the fingers."
Dulcamara is strongly recommended and has been
proved useful in acute iu'ticaria.  It produces "buining
itching, resembling the rapid crawling of insects in diffe



AND ITS DISEASES.


395


rent parts of the body; he is obliged to scratch violently;
in the beginning the symptom increases after scratching,
afterwards it is diminished; there is little of it in the day,
generally only at night, and mostly from twelve to three
o'clock, after a short sleep the itching wakes him; also
red elevated spots as if caused by nettles; and "red
spots  on   the body; large and red blotches itching
violently  over the   whole   body, and    on  the neck:
nettle-rash after violent exercise, itching for an hour."
1?hus toxicodendron produces " red spots the size of
lentils, with small vesicles in the middle," and " nettlerash."
Datura stramonium, although not generally recommended, may be useful, as in a case of poisoning by this
substance, recorded by Dr. Meigs of Philadelphia, the
face of the patient became of a deeper scarlet colour than
he had ever seen it in scarlet-fever, and the neck and
breast as well as the face were covered with a multitude
of small spots of a brilliant red colour, many of which
were star-shaped.1
Urtica urens and Cancer fluviatilis are said to be
useful, but as yet there seems no very decisive evidence
in their favour, and my own experience of their value
from the occasional trials I have made of them, although
the number of experiments was not sufficient to test the
point, gives a purely negative result.
When the complaint assumes a chronic form, the
remedies most relied on areArsenicum, which produces " white blotches of the size
1 ' North American Medical and Surgical Journal,' January, 1827.




396                    THE SKIN
of lentils and having the colour of the skin, with a biting
sensation particularly at night."
Calcaria carbonica, among the symptoms of which we
find " nettle-rash, which goes off in the cool air."
Carbo vegetabilis, recommended in alternation of arsenicum, and which produces " burning in the skin, as of
sinapisms in different places, the back, the sides, the side
of the abdomen, &c.," as well as distinct " nettle-rash for
some weeks."    And
Hepar sulphuris, and S&dphur, which although they do
not present the symptoms of the precise eruption are
useful in curing the general morbid condition of the
system which engenders the complaint.
The next disease on our list is Erysipelas, which is
easily recognised by presenting all the usual characters
of inflammation of the skin, attended with the constitutional symptoms of inflammatory fever, such as rigours,
pains in the back and limbs, headache, lassitude, loss of
appetite, nausea, sometimes vomiting, pain at the epigastrium and constipation of the bowels. When the
attack is severe, especially when it affects the head and
face, it is usually attended with considerable delirium.
The duration of simple erysipelas, as contradistinguished
from phlegmonous, has hitherto been from twelve to sixteen days, of which three or four days were occupied in
the gradual rise of the symptoms, in an equal number
they remained stationary and took the same time to
decline.  Even in the slighter cases, blisters of greater
or smaller size appear upon the affected parts. An
attack terminates in more or less complete desquamation
of the cuticle. In a patient of Mr. Wilson's who was
subject to an annual attack of erysipelas, the cuticle of




AND ITS DISEASES.


397


the hands used to come off entire like a glove, and that
of the feet like a bag or loose stocking.'
Erysipelas prevails periodically in most large hospitals
and lunatic asylums, so that all operations even of the
most trifling kind are at such times followed by a severe
and often fatal attack of the disease.  In the opinion of
some it becomes contagious in these circumstances, but it
seems very doubtful if it be so in a strict sense of the term.
It has been observed to occur periodically as a vicarious
affection in some cases of amenorrhoea.2
There are few diseases in which the enormous superiority of the homoeopathic over the common empirical
method of treatment is more marked than in this, so
much so indeed, that our best surgeons, as the late Mr.
Liston, have adopted the specific treatment recommended
by Hahnemann, in addition to innocuous measures of
palliation, which perhaps it might not be amiss in the
present ascendancy of free trade principles that we in our
turn should borrow from them.     Of these, the most in
vogue are the dusting of the surface with flour, or rubbing it over with lard, or lastly, painting it with Collodium, to which 1-15th part of Castor oil has been added.
This last is strongly recommended by Dr. E. Wilson,
who bears testimony to its practical efficacy, ascribing
this to the perfect exclusion of the air, by which the
generation of heat at the surface is checked and at the
same time a gentle uniform pressure exerted upon the
enlarged and weakened cutaneous vessels. It has also
been the practice of the most celebrated surgeons to
1 Chevalier's 'Lectures on the General Structure of the Human Body,'
p. 122.
2 Rayet, op. cit.




398


THE SKIN


puncture the affected parts with the point of a lancet,
and there is no doubt that this affords great relief, nor
do we see any serious objection to the practice if it is
found necessary.
In the treatment of simple erysipelas it is usual to give
Aconite and Belladonna in alternation, and nothing can
be more satisfactory than the result of this practice. We
are in the habit of employing the first, second, or third
dilution of both, and of repeating the dose every two or
three hours.
Although the symptoms produced on the skin by
Aconite do not present a striking similarity to erysipelas,
yet the general febrile state is certainly mitigated by its
administration, and so far from  the action of the Belladonna being hindered it seems positively increased by
that of Aconite.   Among the symptoms of Belladonna
we find " Erysipelatous inflammation, with swelling or
even mortification of the parts, inflammation and swelling
of the whole skin, red hot swelling of the affected parts."
Rhus toxicodendron is recommended in what is called
vesicular erysipelas, but as the presence or absence of
vesicles does not indicate any specific change in the
morbid action, and as the eruptions produced by Rhus
seem essentially different in respect of the accompanying
constitutional symptoms, we do not see any ground for
seconding this recommendation.      In fact, we believe
Aconite and Belladonna sufficient for the cure of all cases
of simple erysipelas.  When it tends to become gangrenous other remedies are required.
Phlegmonous erysipelas is recognised by the hot pulsating pain, the thickening and great redness of the skin,
and the severity of the general symptoms.      In severe




AND ITS DISEASES.


399


cases there is gangrenous ulceration of the subcutaneous
and inter-muscular cellular tissues, and the sphacelated
portions escape by sinuses formed by the pus to the
surface.  It is generally found beneficial to enlarge these
openings or to make fresh incisions, so as to allow of the
removal of the dead and destructive accumulation beneath
the surface.   The medicines on which we place most
reliance in this dangerous disease are arsenicum and
lackesis.  Carbo vegetabilis is also recommended, but
rather upon general than special grounds, and we must
confess to have been disappointed with the action of this
remedy in almost all the acute diseases for the treatment
of which some writers prize it so highly. Besides the
medicines mentioned, we should add mercurius and hepar
sullpuris to the list, and with the aid of these remedies
we have seen apparently hopeless cases of this disease
ultimately rescued.
The scaly diseases, pityriasis, psoriasis, and lepra, are so
closely allied in their pathological characters, and the lines
of demarcation between the two latter at least, are so fine
that it would involve much repetition if we were to give
a separate enumeration of the medicines suitable for each
group; so that after noting the diagnostic peculiarities of
the principal diseases which are ranged under these heads
and the general treatment recommended for them, we
shall include the specific medicines useful for them all in
one list.
One of the most common forms of the first of the
group is pityriasis capitis, or dandrif. It is easily recognised by the increased scurf on the scalp, which is also
slightly painful and red. We have frequently found this
disappear if the head is well washed with cold water




400


THE SKIN


every morning and thoroughly dried with a coarse
towel.
The other local varieties are those which affect the
lips, the palms of the hands and the soles of the feet, also
a very troublesome form of the disease, attended with
considerable itching, is met with in the prepuce and
vulva.
Lepra is distinguished from  psoriasis by the more
circular form of its large patches, by its preference for
particular localities, especially the bend of the elbow and
wrist and of the knee and ankle joints, also by the greater
thickening of the skin and lighter colour of the central
part of the patch.
There can be no doubt that the occurrence of either of
these cutaneous affections indicates a peculiar diathesis,
probably closely allied if not identical with gout and some
forms of rheumatism.   They are frequently hereditary,
and when of long standing are found so intractable as to
be considered quite incurable by the old school of physic.
The directly exciting causes are often simple irritation of
the skin from any continued cause, such as working with
flour which induces psoriasis of the hands in bakers, and
a similar affection is apt to occur in shoemakers from the
continual handling of waxed thread. It has been observed by Willan and subsequent writers, that when
psoriasis appears on one side of the body, for example, on
one leg, it is very apt to appear also on the corresponding
part of the opposite side, and to present here the exact
counterpart of the shape and size of the original eruption,
however irregular that may be. This curious fact is
much dwelt on in the essay of Dr. Budd, to which we
previously referred.  It seems to belong to the general




AND ITS DISEASES.


401


law of the system, according to which the corresponding
parts on the opposite sides of the body are endowed with
vital properties so accurately analogous that all general
influences traversing the system produce identical impressions on them, and thus maintain that symmetry
which is essential to co-operative voluntary movement,
and therefore pervades the spino-cerebral system of nerves
and distinguishes it from  the ganglionic which presides
over the organic life, within whose sphere such combinations are not required. Besides this similarity of endowment and structure of corresponding parts, which induces
the one to assume the morbid action of the other, there
is probably an active reciprocal influence continually
interchanging between them, so that each may be said to
be in some degree responsible for the liabilities of its
correspondent.   We should hardly have dwelt so long
upon this had it not been for the whimsical explanation
given of it by one of so high and deserved a reputation
as Dr. Budd.
The extremely obstinate and troublesome character of
psoriasis and lepra has naturally evoked an endless variety
of expedients and experiments for their cure, and there
is one which, although not homceopathic so far as we
know, yet may be borne in mind, from the positive assurance we have had of its efficacy in a very inveterate
case of the formner complaint. We allude to a soap
composed of common juniper-spirit, dissolved in fixed
oil and mixed with soda ley. It is now in high repute
at Aix-la-Chapelle, and on it the virtue of another
fashionable remedy of this disease, "Huile de Cade," is
said to depend, or at least if it is not the common juniper
which is used in the preparation of this oil, it is the allied
species " Juniperus oxicidrus."
26




402


THE SKIN


Dr. Gully recommends the wet sheet packing as generally applicable to these as well as to most other diseases
of the skin, combined in this instance with an occasional
sweating, and he mentions that he has thus cured some
cases of inveterate psoriasis.'
Arsenic, according to the experience both of the old
and new school of physic, is the most eficacious remedy
in the scaly diseases.  "The effect of Arsenic," says Dr.
Wilson," " on the leprous patches is, in the first instance,
to increase their redness, activity, and heat, and subsequently to diminish those symptoms and render them
brownish and dull." Among the primitive effects of
Arsenic we find that " the skin of the body peels off in
large scales, painfulness of the skin all over the body,
prickings in the skin, itching particularly of the thighs
and arms, &c."    Our own experience confirms the power
of this medicine as a certain specific in modifying the
morbid condition of the skin when affected with lepra, so as
to give at least temporary relief, and of permanently curing
milder cases which do not depend upon a psoric taint in
the constitution.  The immense advantage of the minute
doses is well seen in the treatment of such complaints,
for there are many patients who are so susceptible to the
poisonous action of Arsenic that they cannot take the
quantity usually prescribed by allopathic physicians without the most disagreeable and even dangerous consequences, so that having only the alternative of being
poisoned or suffering from a leprous skin they naturally
prefer the latter as the lesser evil.
Dulcamara was at one time much in vogue for the
' The Water Cure in Chronic Diseases,' by Dr. Gully, p. 402, et seq.
Op. cit., p. 2S0.




AND ITS DISEASES.


403


treatment of lepra.  It was introduced to the notice of
the medical world by Professors Althorff and Gattengen
last century, and Dr. Crichton of the Westminster
Hospital, writing to Willan, says "he has found it very
effectual in lepra, psoriasis and pityriasis." 1 Rayer also
speaks favorably of it. None of the symptoms produced
by this substance correspond with those of developed
lepra, but it produces very marked "cdryness, heat, and
burning of the skin," which resembles the incipient stage
of the diseases under consideration, and although we
bannot expect a cure from Dulcamara, it may be well to
administer it as an intercurrent or palliative remedy
in a complaint which exhausts all the means in our
arsenal to effect its expulsion; and often exhausts them
in vain.
Calntarides is also recommended by Rayer, who says
he has found it more powerful than any other remedy,
although in the doses usually prescribed its administration is attended with serious danger.
Hepaar sulpiuris, we have been in the habit of prescribing in lepra, and have frequently seen unequivocal
benefit derived from  it, although in this as in most of
the other medicines generally employed, there is no decided correspondence between its primitive symptoms
and those of the disease.
Pkosphorus produces symptoms more like some forms
of lepra than any of the former medicines, and has been
found an efficacious remedy in the disease. Among its
symptoms are " round herpetic spots over the whole body,
furfuraceous dry herpes (curative) scaling off of the epi

SWillan, op. cit., p. 147.




404


'THE SKIN


dermis."   We must acknowledge that there remains
yet much to be done before we can undertake the cure
of this common and troublesome class of diseases, with
that confident anticipation of success which we are
enabled to entertain in reference to the treatment of
complaints, which, from their nature and duration, ought
to be as unmanageable as this one; and we must hope
that if we vigorously prosecute the proving of medicines,
we shall find some of more avail in the eradication of the
scaly diseases than those we have now to rely on.
The first of the papular eruptions is stroplulus, or red
gown or gum,1 hardly deserves the name of a disease in
its ordinary and simple form, occurring within the first
two months of infant life.   There is no other papular
eruption unattended with fever with which this can be
confounded, and its chief importance is derived from its
frequent alliance with gastric or intestinal disorder. It
is dangerous to employ the cold bath when there is
much of this eruption over the body, as there is a risk
of the transference of the irritation from   the external
cutaneous tissue to the internal mucous membrane.
Rayer recommends a decoction of Althmea-root to be
added to the warm water in which the infant is bathed.
This addition is said to have a powerful effect in allaying
the uneasy irritation and to be unattended by any bad
consequences.
Chamomilla is almost the only homoeopathic medicine
which it is necessary to administer. Besides being well
adapted to cure the slight disturbances of infant life geGum seems a corruption of gown. It was called red gown from its
resemblance to a printed cotton, and the name is still retained in certain
counties of England.




AND ITS DISEASES.


I405,


nerally, some of the symptoms it produces present a
marked resemblance to those of strophulus, viz.: "Red
rash on cheeks.and forehead, without heat; small red
spots on the skin, the spots being covered with rash
pimples; thick clusters of red pimples on a red spot on
the skin, itching, especially at night, and somewhat
smarting, in the region of the lumbar vertebrm and the
side of the abdomen. Rash of infants and nursing
females." It is usual and probably advisable to give
also a few doses of Sulphur either after the Chamomilla
or in alternation with it.
-Lichen is the sb'opiulus of adult life. Consisting of
a red papular eruption, attended with more or less
itching, terminating in a scurfy exfoliation of the cuticle,
sometimes becoming pustular, and not unfrequently
passing into a chronic form of scaly disease of the skin.
It is always connected with some general disorder of the
system, which generally shows itself by feverish symptoms, headache and nausea, a day or two before the outbreak of the cutaneous affection. Summer and autumn
are the periods of the year it prefers, and how much is
due to season is shown by the occurrence of the "prickly
heat"-a form of lichen-in almost all Europeans on
their first sojourn in a hot climate. While an unusually
hot temperature is undoubtedly one of the predisposing
causes of this troublesome malady, some internal irritation is as certainly one of the most frequent of the exciting causes. And it often appears as a vicarious morbid
action relieving the internal organs, and therefore it is
not safe to use measures for its repulsion.  "CThis accident," says Willan,1 "'is constantly succeeded by a
I Op. cit., p. 47.




406


THE SKIN


violent disorder of the constitution.  I have observed in
one or two cases where it was produced from imprudent
exposure to cold, that an acute disease ensued, with great
quickness of the pulse, heat, thirst, pains of the bowels,
frequent vomiting, headache, and delirium." Another
exciting cause of this complaint is some mental emotion.
A case is related by the same author1 of a little girl who
had been some time subject to an attack of lichen, which
would appear if she were scolded: and it is more frequently met with in persons of a nervous than in those
of a lymphatic temperament.      It seems also in some
way connected with a gouty diathesis. The two indications for treatment are to subdue the irritation of the
surface and to eradicate the internal cause.  To fulfil the
former cold applications, either of pure water or vinegar
and water, are recommended; and in chronic cases, the
vapour bath is said to be very useful, although it is not
free of danger in the acute form of the complaint. There
is no doubt that all affections of the skin attended with
itching are relieved by inunction, and the best unctuous
substance for the various forms of lichen is Glycerine.
It keeps the surface moist, and is not so disagreeable as
greasy applications.
Of the specific remedies, those which present most
correspondence in    their symptoms to lichen are the
following:
Aconite-besides the feverish symptoms which often
accompany lichen-produces " stinging, and feeling of
soreness in various parts of the body; spots like fleabites, especially on the hands and face; large red and


' Op. cit., p. 258.




AND ITS DISEASES.


407


itching pimples; reddish pimples filled with an acrid
fluid."
Ammoziuwr rnurialicum.-" Erratic itching and biting
over the whole skin, in the evening mostly, before lying
down; after lying down, the symptom passes off sometimes.; violent itching over the whole body, in the
evening before lying down, especially on the chest and
forearms, with little pimples after scratching; violent
itching around the *hips, at night and early in the
morning, also of the thighs, legs, and round the bend of
the knee, with rash-pimples, fine rash over the whole body
for two weeks."
Bryonia.-" Eruption of rash on the arms, on the
forepart of the chest, and above the knee, becoming red
in the evening, itching and burning previous to his going
to bed, but when in bed and getting warm, rash and
itching disappear. Pimples make their appearance on
abdomen   and  hips with  a burning itching, when
scratching the parts they feel sore; eruption on the
whole body, especially on the back, extending to the
upper side of the neck, itching so violently that -he would
like to scratch the parts to pieces."
calmnomilla produces this characteristic symptomn"thick clusters of red  pimples on   a red spot on
the skin, itching, especially at night, and somewhat
smarting-in the region of the lumbar vertebre and
the side of the abdomen, occasionally a shuddering is felt
all around, especially in the evening."
Cocculus.-" Red miliary pimples on the face, back
and chest, itching. in warmth."
Coniiun.-" Fine, scarcely visible, eruption  on the


*




408


THE SKIN


face, back, and remainder of the body, itching like a
tingling creeping under the skin."
Graphites.-" At night   the whole body becomes
covered with small pimples without sensation, they go
off again in the morning; small red itching pimples,
and with their tips full of pus, appear frequently on
the skin, they burn when scratched, and disappear on
the following day; spots like flea-bites on different
parts of the body; a number of red itching spots
on the whole body, especially the calves, for seven
days."
Mercurius produces-" Intolerable stinging itching as
from flea-bites, in the evening; round stigmata (on the
thighs and legs), gradually changing to round ulcerated
spots, and  becoming finally covered with   a scurf;
small itching pimples, afterwards changing to ulcers,
during the healing of which the surrounding skin peels
off."
Natrum muriaticum presents some striking resemblances
to lichen in the symptoms ascribed to it, viz.: "Red
spots, the size of a pin's head, over the whole body, preceded by a feeling of heat in the face, on the abdomen,
arms, and lower limbs, the spots itch, and when rubbing
them the whole body becomes red for half an hour;
small pimples on the abdomen and lower limbs; rash
over the whole body, with stinging sensation in the skin;
miliary eruption over the whole body, in the neck and
throat, on the abdomen, nates and thighs, the eruption
was at first felt only, afterwards it became visible in the
shape of small millet-seed, scratching made it redder and
harder, the itching prevented sleep."
Phosphoric acid produces red, smooth pimples on the




AND ITS DISEASES.


409


forearm  and neck, with red areolze, feeling sore when
touched; rash over the whole body, more burning than
itching.
To the homceopathic action of Sulphur in the cure of
lichen Rayer bears the following important testimony:
" Sulphureous baths so generally and    indiscriminately
recommended in the treatment of cutaneous affections
are constantly hurtful in acute lichen, and very seldom
serviceable in the chronic form of the disease.   These
baths may even cause a lichenous eruption; it is by no
means an unfrequent circumstance to see lichen agrius
appearing among individuals under treatment for scabies
by means of sulphureous water bathing. Nevertheless I
have obtained the cure of several cases of obstinate hereditary lichen, apt to return at frequent intervals, by
effecting  a material modification  of the constitution
by the use of artificial sulphureous water baths prolonged during several hours every day.    Results of a
similar description have been observed from the natural
baths of Louesche and Schinznach."'
Prurigo, resembling lichen in its general character, is
distinguished from it by the papular eruption of which it
consists being of the same colour as the surrounding
skin, by the little brown spots of effused blood that
besprinkle the affected parts, leaving evidence of the
violent scratching with which the sufferer has attempted
to relieve the intolerable itching from which the disease
receives its name. The severity of the symptoms differ
according to the period of life at which they appear,
being milder in infancy, so that the term mitis is applied


1 Op. cit., p. 585.




410


THE SKIN


to this variety; more severe in adult life, when the sensation is compared to the biting or crawling of countless
ants below the surface of the skin, and hence called
formicans; and most severe when it affects the aged, so
that in the melancholy words of Willan " those who are
affected with it in a high degree have little more comfort
to expect during life, being incessantly tormented with a
violent and inveterate itching."   Besides being in its
own nature a most intolerable irritation, it is sometimes
accompanied by the production of numerous parasitic
insects, which naturally increase the annoyance.   The
number of these is often incredible.  In one case quoted
by Willan, without any expression      of distrust, two
servants were employed in removing them in pailfuls
from their master and throwing them into the sea. Distressing as the irritation is when it merely affects the
external skin, still more dreadful are the consequences of
the disease when it attacks the genital organs, especially
the vulva and orifice of the vagina of the female.  The
following description of it, given by Professor Lorry, is
so striking that we shall quote it entire:  " Morbus ille
adultos ut plurimum     et primum    pubertatis florem
agressos adoritur, eosque qui, caste  viventos, urgenti
tamen impetu ad venerem ferrentur; mulieres etiam sed
maturius adoritur.  Ejus ortus primo metior est et pruritui totus continetur. At pruritui illi tum in maribus
tum  in feminis jungitur ardor in venerem inexplibilis.
Mores et precepta repugnant, coercet virtus vivax, at
manus indocilis ad has partes fertur, scalpendoque malum
irritatur, et animus ipse in partem operis venit cum
artuum tremore et palpitatione.  Sedatur vulgo per plurinas horas malun, tuncque omnia tranquilla apparent,




AND ITS DISEASES.


411


at recrudescit per paroxysmos noctu potissimum afficiens.
Sevit autem eo vehementius, quo aut familiariter magis
aut proximus cum freminis mares aut cum maribus
foemine vixerint.  Nec miinores accepit vires a vino,
piperatis, spirituosis, acribus alimentis potu coffeae, oleosorum  spirituorum ita ut noverim  viros qui nunquam
similibus pruritibus, nisi una ex hisce causis accesserit,
quas edocti experientia vetabunt sedulius. Progrediente
malo partes ad aspectum maculosee, maculis flavis vix
supra cutem extantibus distinctae sunt, scrotum omnino
rugosum- est, ut et labia pudendorum in foeminis, et ternpore paroxismi prorsus retractunm. Erectio penis et
libidinis ardens cupido mentem  incendunt.  Partes Mae
non eruptione lichenibus simili afficiuntur, sed epidermis
rugosa olit, et alluitur liquore unctuoso, non lentea maculente, non digitis adherente, sed ad sensum lubrico.  Increscente malo pruritus enormes fiunt per paroxysmos et
summe violentos, et frequenter redevivos, eta ut nec
pudor nec reveretia regum a scalpendo divertant, et scope
per interyalla etiam  paroxysmorum puncture acerrime
acubus inflammatis per cutem transactis morsu similes,
in clamorum adigunt: hinc partes illI rhagadibus atque
fissuris manu factis undeque hiant.    Ardor semper
inest, et ad   quemvis levissimum   incessum  exhalet
humor olentissimus, fervente interea oestro vinereo."I
Although in general this disease cannot be traced to
derangement of any.internal organs, yet it seems sometimes to be of a vicarious nature, for there is an instance
of sudden death from the repulsion of this eruption.
Dr. Lettsom, who reports the case, says " another patient


I Lorry de moirbis cutan., 4to, p. 449.




412


THE SKIN


was relieved in the same manner (by the occurrence of
prurigo) after having been much debilitated by frequent
fits of the gout; he imprudently, however, endeavoured
to allay the troublesome sensation of itching by a strong
saturnine solution, and after using this application for a
few days he suddenly expired in his chair."'
For mitigating the irritation of prurigo, cold baths
are generally employed, and the douche bath of cold
water is said to be useful in prurigo pudendi. Instead
of the   plain   water-douche the    gelatino-sulphureous
douche is strongly recommended by Rayer,2 and he relates a case which affords striking evidence of its efficacy. " A lady, aged 26 years, was attacked with the
disease in February, 1823, on the upper and inner parts
of the thighs near the greater labia, and upon these
parts themselves were detected a number of distinct
papille nearly of the same colour as the skin. During
the day the parts affected were the seat of an incessant
pruritus, which grew more severe in the course of the
evening, completely interrupted sleep, and lasted through
most of the night. A variety of severe measures were
had recourse to but without any permanent benefit, and
at the end of two months and a half, after consulting
with Dupuytren, it was resolved to try the gelatino-sulphureous douche bath; after the first few days the application had a wonderful effect in allaying the irritation.
The patient at once recovered her tranquillity and her
sleep, and after using the remedy twenty-five times at
the temperature of 250 R., for ten or fifteen minutes each
time, she obtained a complete cure."
' (Memoirs of the Medical Society,' vol. iii, p. 348.
SOp. cit., p. 61].




AND ITS DISEASES.


413


We are fortunate in having a large collection of
homoeopathic  medicines, whose   symptoms resemble
prurigo, from which to select the appropriate remedy for
each individual case.
Alumina.-Violent stinging and corrosive itching of
the whole body; of single parts; of the face, back, side
of the abdomen; particularly in the evening after getting
warm in bed; sometimes obliging one to scratch until
the parts bleed, occasioning pain.
Ambra grisea.-Itching and burning of many places
of the skin, as if from itch.
Ammonium carbonicum.-A good deal of itching of
the skin of the whole body; itching over the whole body
early in the morning for three hours; itching of many
places of the body, erratic, passing off after scratching
or painfully burning; erratic itching over the whole body;
the scratching is followed by burning vesicles and pimples
or hard blotches.
Baryta carbonica.-Tingling and burning prickings
here and there, not relieved by scratching or rubbing,
which become necessary; intolerable tingling over the
whole body, especially in the back, hips, legs, (malleoli)
the soles of the feet and fingers, waking him at night
and forcing him to scratch continually; burning itching
here and there; itching on the hands when in bed,
sometimes -in the face, sometimes on the back of the
hand; itching here and there, the parts becoming very
painful when scratched.
Calcarea carbonica.-" Itching of the whole body;
violent itching of those parts which sweat, especially
between the scapulae; in the evening when in bed violent
itching of the back, of the pit of the stomach, neck,




4.14


THE SKIN


chin, left eye, the hairy scalp, the mons verieris, and the
scrotum; itching of the mouth, nose, and nates; itching
of a dry, hot skin, as if it was covered with salt and
ashes; burning in the skin, with itching of the nates
and the posterior surface of the thighs."'
Carbo vegetabilis.--" Itching of the whole body, day
and night; violent itching of the arms, hands, and between the fingers, so that he was unable to fall asleep at
night, but without eruption; itching stitches on the side
on which he is lying in the evening when in bed; itching
of several parts of the body like flea-bites; fine slight
stinging over the whole body when getting warm in
bed; burning in different places in the skin, at night in
bed."
Caitsticum.--" Itching of the whole body at night,
with dry heat, especially of the head and face, back and
calves; stinging itching of the skin, particularly the
back, shoulders, arms, thighs, and the backs of the
fingers; formication  of the skin; pimples in many
places of the skin, with corrosive itching, and a burning
sensation after scratching."
Cocculus. -" Burning itching, stitches like flea-bites
in various parts of the skin; itching of the skin of the
body, especially in the evening when taking off the
clothes; violent smarting itching of the skin of the
whole body, as after copious sweat, when undressing;
itching and burning of the skin, especially the inner side
of the thighs, as of nettles, that part is also covered with
pimples, with a stinging pain when touched; itching of
various parts in the night, painful after scratching;
itching during the night, partly of the chest, from the
precordial region to the throat., partly of the integuments




AND ITS DISEASES.


415


of the tibia and in the axilla, after scratching bloody
lymph oozes from the pores."
Conizm macztlatum.-" Itching of the limbs, thighs,
and arms; erratic and evanescent itching of all parts of
the body; corrosive itching, commencing with a stitch,
in the evening when in bed, only on the right half of
the body, especially when lying on it, with uneasiness in
all the limbs, easily relieved by scratching, but constantly re-appearing in some other place; stinging sensation, as of flea-bites, closely succeeding each other in
different places of the whole body, but single bites, never
two at the same time, slow itching, smarting, burning
stitches in different parts of the body."
Graphites.-" Itching of the back and arms by day;
the itching becomes general and violent also in the face
and about the genital organs; momentary corrosive
itching in various places, obliging one to scratch."
Natrum muriatic'uzm.-" Itching over the whole body;
fine itching pricking of the skin in the evening when in
bed; itching stinging of various parts of the skin, with
flashes of internal heat without redness of the face:
small pimples on the abdomen and lower limbs."
Nux vomica.- " Burning itching over the whole body,
also in the evening when in bed; burning itching of the
upper arms, thighs, abdomen, and back, early in the
morning when dressing, in the evening when undressing,
even at night; burning stinging in various parts of the
body; burning pricking in various parts of the skin,
resembling flea-bites, in the evening after lying down;
burning itching pricking in various parts of the body;
itching or itching burning eruptions."
Opium.-" Burning pain and sometimes itching of




416


THE SKIN


the skin; stinging itching of the skin here and there;
itching, especially of the upper parts of the body, conmmencing at the chest and extending over the face, especially the nose; troublesome itching; itching of the
whole body, after scratching red blotches make their appearance, itching a good deal, but soon disappearing
again. Violent itching of the skin is said to be a constant symptom in poisoning with Morphia, attended
with small round colourless elevations of the skin."
This particular effect of Morphia is now known to be
due to the admixture of Codeine, which produces the
most intolerable itching, and may be found a very
serviceable remedy in this complaint."
Pulsatilla.-" Biting itching here and there, also like
formication; itching of the sole of the foot and between
the breasts, early in the morning in bed; itching stinging sensation in the skin, resembling flea-bites; burning
itching over the whole body, before midnight when
getting warm in bed, becoming more violent by scratching, this prevents his night sleep,-not much in the daytime, but only after having become heated by a walk, or
when rubbing the skin,-no eruption is visible."
Rhus toxicodendron.- " Itching of the whole body, particularly of the hairy parts, hairy scalp, and genital
organs; burning itching here and there."
Sulphur.-" Fornication   of the skin of the whole
body; pricking in the skin of the whole body, in the
evening after getting warm in bed; stinging itching,
especially when walking in the bpen air; the itching
place is painful after scratching; biting as from fleas, in
the evening after lying down, when removed by scratching in one place it immediately reappears in another;




AND ITS DISEASES.


4,17


disagreeable creeping itching, with pain when scratching
the part, the itching place bleeds and smarts after
scratching it; itching worse at night, and in the morning after waking."
The vesicular diseases pempkigus and pemploly,are
so nearly allied that no practical end is served by their
separation. They are easily recognised by presenting
the appearance of large blisters, which look exactly like
the effects of a burn or scald.  Pemphigus may be either
acute or chronic, the former variety is much rarer than
the latter. The affection seems to depend generally upon
imperfect nutrition, giving rise to an enfeebled condition
of the nervous system. Dr. Duchesne Duparc relates a
case which occurred in the hospital of St. Louis, of a girl
of eighteen years of age, who had never menstruated, and
who had been affected with chronic pemphigus from the
time she was five years old. It is said also sometimes to
depend upon the presence of a specific poison. Mr. E.
Wilson describes how a surgeon punctured himself when
opening a thecal abscess, upon which accident the arm
swelled as high as the armpit, and was three weeks in
this condition: some three or four weeks after it got well
a crop of pemphigus appeared on the leg, and had lasted
with occasional intermissions for eighteen months.
There are two important general directions given in
regard to the treatment of this disease; the first is, that
the patient should be allowed full diet, to impart vigour
to the system, as deficiency of vital force seems to be one
of the chief predisposing causes of the complaint; the
other is that it is of great consequence to support the
blisters, and thus to prevent the premature discharge of
their contents, for they possess irritating properties, and
27




418


THE SKIN


tend to aggravate and extend the disease if allowed to
flow over the skin; besides, too early rupture of the cuticle
exposes the raw skin beneath to the injurious effects of
friction.  Indeed it is better when the blisters do not
burst at all, but dry up. Rayer strongly recommends
the use of a perforated patch of rag, spread with simple
ointment, to afford support to the margin of the vesicle
where it is most likely to give way, and to diminish its
elevation above the surrounding skin, so as to lessen the
risk of the upper part being rubbed off by the unavoidable friction to which it must be exposed.
The specific medicines suitable for the treatment of
pemphigus are the following:
Bellaclonna-" Watery vesicles (on the palm     of the
hand and tibia), so painful that he would like to scream."
Causticiumn -" Large vesicles on the chest and back,
with anguish in the chest (orthopnoea), and fever, consisting of chilliness, heat and sweat; large painful blisters
on the left side of the chest and back, which burst; these
symptoms are accompanied by great feverish heat, sweat,
and anxiety."
Phosphorus-" Painful hard blisters in various parts,
not itching; blisters, bursting with moisture."
Rh us toxicodendron-" Confluent vesicles, most of
them containing a milky or watery fluid, with peeling off
of the skin, in three days." This is the medicine most
relied on in the cure of pemphigus, whether acute or
chronic, and the result of our experience in the disease
fully warrants the utmost confidence in the efficacy of the
remedy. We suspect that it was from its observed power
over pemphigoid eruptions that it was supposed useful in
vesicular  (so-called) erysipelas.  The two    affections,




AND ITS DISEASES.


419


however, are essentially unlike, and the action of Rhus
corresponds much more with the general symptoms
which attend pemphygus than with those which attend
erysipelas.
]Rupia differs from the vesicular diseases just described,
in its contents becoming very rapidly of a sero-purulent
character, and thus forming crusts thicker in the centre
than at the circumference, so as to resemble an oystershell; which, when removed, leave behind a small illconditioned ulcer.   It always occurs in    persons of a
weakened or depraved constitution of body.
4 In the treatment of this eruption, it is of importance
to puncture the bullae of which it is composed, at an
early period of their development, before the serum has
been transformed into pus; this prevents the formation
of the thick scab, and the confinement of the injurious
matter upon the surface of the denuded skin. Besides
allowing the escape of the contents of the vesicle, it is
well to apply a light bandage or water dressing to the
sores; and the diet should, be generous, or at least
nourishing and abundant, as the disease is often the
consequence of insufficient or pernicious food. Warm
baths are also recommended.
The medicines best suited to the treatment are the
following:
Arsenicum-" Black blisters, burning and very painful." Although there is nothing in this description very
distinctive of rupia, yet there is enough, taken in connection with the general action of the medicine, to induce
us to recommend it; particularly as in the few cases of
the disease we have seen, it appeared to act beneficially.
Kali bichromicumn-" In seven days vesicular eruption




420


THE SKIN


on a red and elevated base (itching and burning much,
especially when exposed to steam), in a few days becoming pustular, and presenting a dark point in the centre;
invading hands, arms, face, back and belly. On the
belly near the umbilicus, some spots, evidently of abraded
vesicles, presenting a deep hollow appearance, which
remains after they are healed." In a few days, an eruption of red round spots broke out on the back, arms and
belly; the spots then formed pustules the size of a pea,
covered with a scab, which came off in a few days, and
left a small dry ulcer, which partly healed up in about a
fortnight, leaving a colourless depressed cicatrix." These
symptoms were produced by the local action of the salt;
but taken in connection with the other symptoms of this
medicine, we believe it may be useful in some forms of
Rupia.
Mliercurius -" Herpetic spots and suppurating pustules, which either run into one another, forming at times
dry and scaly spots, at times discharging an acrid humour,
or which remain sore, become hollow, and afterwards
raised and cicatrised; new pustules springing up in the
neighbourhood." This is marked as a curative effect of
mercury, not a pathogenetic. Plumbe in his treatise on
skin-diseases, however, describes a case of rupia in which
the administration of Murcury was at first attended with
manifest aggravation of the disease.
Rhus toxicodendron--" Black pustules with inflammation and itching, rapidly spreading over the body."
These so-called "black pustules" are probably vesicles
filled with serum, deeply tinged with the colouring matter
of the blood, and therefore resembling rupia, which may
be called an intense vesicle.




AND ITS DISEASES.


4,21


Secale cornutumn.-" Bloody blisters on the extremities,
becoming gangrenous."     This medicine presents considerable resemblance in its action with the symptoms of
rupia escharotica, described by Dr. Whitby Stokes.
This author mentions that the popular remedy for the
disease was scroplularia  nodosa, and   from  personal
experience recommends its administration in the form
of a decoction.
Herpes admits of a good practical division into herpes
phlyctenoides, and herpes circinatus; the former is distinguished by the irregular distribution of the vesicles of
which it consists; the latter by the regularity of the form
the eruption assumes. The phlyctenoid variety affects
various parts of the body, especially the lips, where it
gets the name of labialis, and the prepuce (preputialis).
The little blisters run their course in about eight
days, and then dry up and form scabs. The disease
is of a purely local origin for the most part, and
attended with little or no general constitutional disturbance.
Of the circinate herpes, the most important, both in
point of frequency and severity, is zona. This remarkable
affection of the skin is recognised by its forming a red
semicircular belt of variable breadth round the body, on
which pearly white vesicular elevations are disseminated.
This disease, unlike the phlyctenoid, is essentially connected with some derangement expressing itself generally through the nervous system. When treating of its
pathology we mentioned Simon's opinion, that it depended upon an affection of the nerves; and this is
corroborated by the following case, which occurred to
Recamier:   "Two females were attacked with sciatic




422


THE SKIN


neuralgia; groups of vesicles, resembling those of herpes
zoster appeared here and there upon the thighs and legs
of the affected sides; but instead of increasing in size,
attaining maturity, in a word, of running the usual
course of zona, they became flaccid almost immediately
after being thrown out, and soon dried up; so that after
the fourth or fifth day, no further traces of the eruption
were visible."'  In fact, zona is sometimes little more
than a symptom of neuralgia; as the neuralgic affection
precedes the eruption by some days, and frequently
remains long after this has disappeared.   Besides its
connection with neuralgia, it is said to be indicative of
predisposition to disease of the part over which it is
situated; and Mr. E. Wilson has recorded the following
interesting case: "As an illustration of the occurrence of
this affection in a symptomatic form, I have preserved
the notes of a case of partial herpes zoster, in which
the eruption appeared upon the left shoulder, over the
infra-spinata fossa, in a young lady sixteen years of age,
in the spring of 1840. Upon examining her chest I
found it to be small and contracted, and her respiration
weakly, but she had no cough; I explained to her mother
that the eruption was of little consequence, otherwise
than an indication of susceptible lungs; that she must
use the greatest precaution in protecting her from the
influence of cold; and I gave her such hygienic instructions as I deemed best for the purpose of carrying out
that object, ordering  the  frequent application of a
counter-irritant to the chest and trunk, and the use
of flannels nest the skin.  I heard no more of this


S' Revue MiNedic.,' t. xxv, p. 435, quoted by Rayer, p. 258.




AND ITS DISEASES.


423


young lady till the January following, when I visited
her on her death bed, at her particular request.   She
had fallen a victim to phthisis, and died a few days
after my visit."'   Of course the connection between
the fatal disease and the previous eruption may have
been entirely accidental, but whether it is so or not,
can only be proved by the careful collection of similar
cases.
Herpes zoster and herpes circinatus, in which the
group of vesicles assume a circular form, are seldom  or
never chronic, and generally terminate favorably within
three weeks.   In old people, however, there is considerable danger of gangrene of the subjacent integument,
which has sometimes proved fatal.
In the treatment of herpes labialis it is advisable to
prevent the formation of the disfiguring scabs which
form the natural reliques of the vesicles by puncturing
them with a needle.
The following medicines are the most suitable for the
cure of this complaint:
Arsenicumn -" Red herpetic skin round the mouth;
eruption along the margin of the vermilion border."
Belladonna -" Small pimples on the lips, covered
with a scurf, and smarting as if they had been touched
by saltish water; pimple on the upper lip, tingling
when not touched, contact excites a stinging itching
in it."
Calcarea carbonica-" Eruption of pimples around the
mouth, and    in  the  corners of the   mouth; scurfy
pimple on the margin of the vermilion border of the
lower lip."
Op. cit., p. 208.




424 -

THE SKIN


Cicuta viro.a-" Burning itching vesicles on the upper
lip, near the vermilion border."
Dudcamara -" Pimples and little ulcers round the
mouth, with tearing pains when moving the parts."
Graphites-" Eruption near the corner of the mouth:
eruptions on the lip; small white blotches on the upper
lip; thick-set, whitish pimples on a red base, and somewhat itching, near both corners of the mouth under
the lips; a vesicle on the upper lip, with cutting
pain."
Ilepar sulp/iuris -" Eruption in the corner of the
mouth, with a sensation of heat in that part; red
itching spot below the lower lip, which was soon
covered with a number of yellowish vesicles, forming a
scurf."
MLercurius-" Yellow crusts on the upper lip near the
margin, with smarting and burning pain."
Silica-" Eruption on the lips, vesicles on the margin
of the upper lip, stinging, when touched causing a
smarting pain; pimple on the margin of the vermilion
border of the upper lip, first itching, afterwards, when
converted into a scab, merely smarting."
In herpes preputialis the following medicines may be
administered:
Aurum--" Itching of the scrotum."
Dzdcamara-" Heat and itching of the genital organs;
herpetic eruption on the labia majora."
Hlepar sulphuris-" Itching of the penis, and the frenulum preputiale; itching of the glans; humid soreness
in the fold between the thigh and the scrotum, with
smarting pain, as if the parts were excoriated; itching of
the scrotum."




AND ITS DISEASES.


4,25


Aferzcurius-" Voluptuous itching in the surface and
the interior of the prepuce; swelling of the prepuce, with
burning smarting and redness, with cracks and rhagades on the internal surface, and a red fine eruption
on the surface; vesicles on the forepart and sides of the
glans, penetrating into the part and spreading,-they
discharge a fluid, and soon disappear; burning round
the glans in the evening, afterwards vesicles on the
inner surface of the foreskin, which soon form little
ulcers, healing rapidly; a number of small red vesicles at
the termination of the glans behind the prepuce, changing
to ulcers, which burn and discharge a yellowish-white
staining, strong smelling matter."
Phosploric  acid-" Itching   creeping in the fraenulumn; vesicle near the frenuluy, itching when pressing
on it; humid itching vesicles. on the frenulu2, preceded
by creeping."
Sepia-" The glans is hot and itching, with soreness
of the prepuce; hot glans, with a pale red sometimes
itching eruption; red tips on the glans."
Silica-" Itching under the prepuce; redness of the
prepuce near the corona, as if excoriated, with frequent
itching; swelling of the prepuce, with itching humid
pimples on the outside; itching and humid spot on the
scrotum."
Sulphur-r-" Troublesome itching of the pudendum,
with pimples all round; painless vesicles on the outer
parts -of the pudendum."
To Aerpes phlyctenoides, not confined to any special
locality, such as the lips or genital organs, but spread
indiscriminately over various parts of the surface, the
following medicines are the most suitable:




426


THE SKIN


dconitum -" Large red and itching pimples; reddish
pimples filled with an acrid fluid; isolated pimples of
the size of a pin's head, and filled with a serous fluid,
make their appearance on various parts of the skin, especially on the forehead, nape of the neck, and on the
face, after a while the pimples dry up and peel off; vesicular eruption on both temples."
Arsenicumc-" Herpes, having a red unwholesome appearance, with vesicles and violent burning, particularly
at night (in the pit of the stomach and back)."
Bovista-" Goose-flesh, with violent itching; herpes
after an itching over the whole body, in the evening;
moist scurfy herpes-like red pimples."
Calcarea carbonica-" Itching vesicular eruption over
the whole body, especially the hips."
Cantlaris.-" Small itching vesicles between the chin
and the lips, on the forehead and cheek, on the palm of
the hand."
Clematis erecta-" Vesicular eruptions on the body;
herpatic eruptions; scaly herpes, with yellowish corrosive
ichor; chronic red humid herpes, with intolerable itching
in the warmth of the bed, and after washing; itching
humid eruption, with corrosive ichor, heat, redness and
swelling of the skin."
Mercurius -" Herpetic spots and suppurating pustules, which either run into one another, forming at times
dry and   scaly spots, at times  discharging an acrid
humour, or which remain sore, become hollow, afterwards raised and cicatrized,-new pustules springing up
in  the neighbourhood; herpes, with burning      when
touched; dry, raised, burning, itching herpes on the
lower and upper limbs, wrist-joints, hands, and between




AND ITS DISEASES.


427


the fingers; herpes, surrounded by a border of large
scabs, on the forearm and knee, discharging a good deal
of moisture; impetiginous   herpes on the abdomen,
thighs, and knees."
Pkosphorus -" Itching, large vesicles over the whole
body, also on the face; round herpetic spots over the
whole body."
Ranunculus sceleratus -" Vesicles upon the skin,
emitting a thin, acrid, yellowish ichor."
-Jhus tocicodendron -" Small burning vesicles, with
redness of the skin, on the whole body except on the
hairy scalp, the palms of the hands, and soles of the
feet; burning, itching eruptions, particularly on the
scrotum, prepuce, eyelids, and eyes, (arms and loins,)
with swelling of the parts and small yellowish vesicles
which run into each other and become moist, the larger
ones terminating in suppuration with red areolae, the
smaller ones drying up more rapidly, and scaling off in
a few days; confluent vesicles, most of them containing
a milky or watery fluid, with peeling off of the skin in
three days; pustules on the hands and forearms, which
burst and emit a clear moisture; herpetic eruptions,
alternating with pains in the chest and dysenteric
stools."
Sili'ca-" Eruption over the whole body, resembling
varicella, accompanied, preceded, and followed by violent
itching."
Sulpkur -" A scaly herpetic eruption, which had
been repelled by external means, appears again, itching
violently and burning after scratching."
The medicines most useful in zona are:-Rhus toxicodendron, graphites, mercurius, and pulsatilla.  Rhus is




428


THE SKIN


generally sufficient in itself to effect the cure, and even
we believe to prevent the appearance of the eruption by
curing the state of the nerves, which we may look upon
as the incipient stage of the disease. Nor do we believe
that the severe neuralgic pain, which so frequently follows
this affection when treated according to the old system,
which is in fact negative treatment, will often occur in
cases treated by rhus from the beginning of the attack.
We lately had a patient under our charge who exhibited
all the premonitory symptoms of zona, which were entirely relieved in about a week by the use of this medicine. When Rhus is not sufficient to accomplish the
cure, and when there is much burning, insupportable
pain, graphites is of great value, mercurius is recommended if there is much itching and a great tendency
to suppuration, and pulsatilla after or alternately with
mercurius when there is severe lancinating pain.'
If there remain neuralgic pains after the disappearance of the eruption zincum metallicum may be administered, but if the cure is not speedily effected it will be
found a most troublesome affection, requiring much patience both on the part of the sufferer and the physician, and requiring the latter to put forth all his skill
often without ultimate success.
Eczema in its simplest form consists of an eruption of
small vesicles, generally flat and not so globular as those
of herpes, spread over a greater or less extent of the sur.
face; they are filled with limpid serum which exudes
when they are mature, and after exfoliation of the cuticle
the whole affection terminates. When the inflammatory
I Jahr, 'Du Traitement Homoeopathique des Maladies de la Peau.'




AND ITS DISEASES.


429


action on which this vesication of the skin depends is
more severe, the surrounding parts are red, and this variety is called eczema rubrum.  When th3 serum of the
vesicles becomes converted into a bloody and semi-purulent fluid, and the vesicles themselves break down and
unite, then it is called eczema impetigenoides.  Besides
these varieties depending on the nature of the eruption,
the disease has received different names from the seat of
its occupation; of these the most practically important
are capitis, faciei, auriculare and perineale.  Instead of
being acute in its course it may be chronic, and so called
chronicum.
That it is often caused by some purely local irritation is shown by the fact of it so frequently appearing
on the hands of grocers, from handling sugar and other
dry and hard powders, as to have got the name of
grocer's-itch; it is also very common among bricklayers,
and Bateman met with a very bad case in a file-maker,
occasioned by the particles of metal producing a constant
irritation of the skin on the hands. Besides these local
causes, it sometimes originates in constitutional disturbance, and when this is the case its effects are salutary.
It was observed by M. Billard, at the Foundling Hospital at Paris, that infants who were affected with eczema
capitis generally thrive remarkably well, and Rayer
speaks of their exemption from convulsions and diarrhoeas of dentition.  This form of the disease is most
frequent among fair-haired and scrofulous children, while,
on the other hand, according to Rayer, consumptive
persons are rarely affected by eczema in any of its forms.
From the vicarious relation it holds with various internal
morbid actions, its sudden disappearance, either by na



430


THE SKIN


tural effort of the constitution or by the use of local
remedies, is considered highly dangerous. Alibert mentions a case of insanity produced by its retrocession, and
Rayer had a patient who had long suffered from eczema
of the fundament, and was attacked with a violent and
long-continued inflammation of the mucous membrane
of the intestines and pulmonary organs, which occurred
with the disappearance of his chronic eruption, lasted all
the time of its absence, and went off as soon as it was
re-established in its old position.  Rayer makes the general observation, that in  childhood eczema is more
prone to affect the head and face and upper part of the
body, in middle age the trunk, and in old age the lower
extremities and fundament.    The milder forms of this
disease are not dangerous, and are speedily cured; but
when chronic it is an obstinate and difficult complaint to
manage, and in the aged, unless very troublesome, it is
better to let it alone, as its cure is attended with danger
to their life.  Its worst form  is that which affects the
perinaeum and scrotum in the male, and the vulva of
the female, from the excessive itching and irritation it
produces, which, bad as they are in any part of the body,
become worse from the difficulty of obtaining relief, and
from the erotic excitement produced by the endeavour, a
source of dreadful present suffering, and not unfrequently
inducing practices destructive both of the physical and
moral well-being of the sufferer.
For the treatment of eczema simplex and rubruzm, the
following medicines are suitable:
Aconitumc-" Vesicular eruption on both temples."
Conium -" White transparent pimples, filled with
an acrid humour, which form     scabs resembling those




AND ITS DISEASES.


431


of the   itch, accompanied by    local, fetid, smarting
sweat."
]ulcamara-" Violent itching eruption of red spots,
with vesicles; eruption of white blotches, with red
areolee, stinging, itching and burning when rubbed, on
arms and thighs."
Mercurius produces an affection of the skin so like
natural eczema as to have got the name of eczema mercuriale.  It is thus described by Mr. E. Wilson:-" Eczema mercuriale is characterised by a red efflorescence,
occurring in patches of variable size, and surmounted by
transparent vesicles of extreme minuteness.  In the mild
form of the eruption the vesicles are not perceived until
the surface is examined with care, but in the more severe
degrees the vesicles increase in size, and their transparent
contents become opaque and purulent. In some instances, particularly when febrile symptoms are present,
the efflorescence occupies a large extent of surface, sometimes the entire body, and assumes the appearance of
rubeola; at a later period the small semilunar spots
coalesce, and form patches of larger size. The more
usual seat of the eruption is the trunk of the body, or
the thin skin of the pudendal region; sometimes it
appears first on the backs of the hands, and more
rarely on the face. The eruption is preceded by heat
and smarting of the skin, and its progress is remarkable
for excessive heat, with smarting and pruritus. When
the vesicles  are very minute they dry      up   without
giving rise to secondary inconvenience; but when they
occur in folds of the skin, or are larger in size, they are
usually broken, and the abraded derma pours out an
acrid and offensive ichor in considerable quantity."




432


THE SKIN


Among the symptoms in the proving the following
correspond to those of eczema:
" Eruption on both thighs in the evening (preceded by
heat in the head and dorsum of the foot), itching; a
burning water oozing out after scratching, as when one
pours brandy into a wound.     Itch-like eruption  on
abdomen and thighs, with itching; eruption resembling
greasy itch on the lower limbs, sexual organs, bends of
the knees, neck and abdomen considerably raised, red as
if sore, humid and itching."
There is no medicine to compare with mercury in the
treatment of this disease.  I generally give it in the form
of ointment, as well as internally.
Oleander I have known of great use in chronic eczema
of the lower part of the body; this too was given as
an ointment.
Phoslgphorus -" Painful hard  blisters  in  various
parts, not itching; blisters bursting with moisture;
itching vesicles between the fingers and in the bend of
the knee."
Rus ltoxicodendron -" Small burning vesicles, with
redness of the skin of the whole body, except on the
hairy scalp, the palms of the hands, and the soles of the
feet; burning, itching eruptions, particularly on the
scrotum, prepuce, eyelids and eyes, (arms and loins,)
with swelling of the parts, and small yellowish vesicles
which run into each other and become moist, the larger
ones terminating in suppuration with red areolae, the
smaller ones drying up more rapidly, and scaling off in a
few days; confluent vesicles, most of them containing a
milky or watery fluid, with peeling off of the skin in three
days."'




AND ITS DISEASES.


433


In eczema impetigenodes, besides some of the medicines  whose   symptoms we     have quoted, especially
mercurius and r4us, Iali bichrom. may be found useful
from its having produced a " vesicular eruption on a red
and   elevated  base,   itching  and    burning    much
(especially when exposed to steam), in a few days
becoming pustular, arid in some presenting a dark
point in the centre,-invading hands, arms, face, back,
and belly."
Sulphur is often useful: the symptoms indicating it
have already been quoted.
The medicines adapted for eczema capitis are these:
Arsenicum-" Corrosive burning itching of the scalp,
as if ulcerated; pimples covered with scurf and painful,
as if ecchymosed, when touched; pimples filled with a
bloody water, on the forehead and temples, with painful
soreness after friction."
MJercurius-" Humid eruption      on  the hairy scalp,
eating away the hair, with painful pressure, especially at
the sore places."
BAus toxicodendron-" Corrosive itching of the hairy
scalp, of the forehead, face, and round the mouth."
Staphisaqria-" A    number of itching scabs on the
hairy scalp; scabs on the hairy scalp, violently itching;
humid scabs, also with bad smell."
A5ulphur--" Itching pimples on the hairy scalp (the
first fourteen days); itching pimples on the forehead,
with pricking in the pimples when rubbed. Tinea capitis,
dry or fetid and humid, with thick pus, yellow crust,
and itching."
In eczema of the ears the following medicines are
useful:




434


THE SKIN


Grapkites-" Itching behind the ears; itching of the
lobule and cheek; after scratching the part lymph oozes
out, and soon hardens. The herpetic formations behind
the ears scale off and improve."
Ilepar sulphuris--" Heat, redness and itching of the
external ears; scurfs on and behind the ears."
Oleander-" Humid fetid spots behind the ears, with
rough herpetic spots in front."
In eczema perineale and preputiale the following medicines are recommended."
Arsenicum-" Itching of the anus, with      a feeling
of roughness and of soreness, as if the parts were excoriated."
Aurum--" Itching of the scrotum."
Dulcamara-" Herpetic eruption on the labia majora."
Mercurius--" Swelling of the prepuce, with burning,
smarting and redness, with cracks and rhagades on the
internal surface, and a red fine eruption on the surface;
vesicles on  the  forepart and   sides of  the  glans,
penetrating  into  the   part  and   spreading;-they
discharge a fluid and soon disappear    itching of the
labia."
Petroleum-" Itching and moisture of the scrotum;
redness and humid soreness of one side of the scrotum;
herpes between the scrotum and thigh."
Sulphur-" Prickings in the scrotum; burning in
the scrotum; soreness and dampness of the scrotum."
iMiliaria is an eruption of minute pearly vesicles, just
discernible, owing to their diminutive size, over the surface of the body. As it is always caused by excessive
sweating, for therapeutic purposes it is most convenient




AND ITS DISEASES.


435


to consider idrosis along with it.  Idrosis, or sweating
disease, may affect the body either partially or entirely,
and may be sporadic or epidemic. When confined to
one part of the body it most commonly affects the feet,
and may continue for years; in these instances, the
perspiration, besides being excessive in quantity, is
usually of a fetid smell, and attended with sharp stings
of pain in the heel. Its sudden cessation     is often
followed by dangerous internal disease of the bowels or
respiratory organs.  General idrosis, whether contagious
or epidemic, or sporadic, seems to depend upon the temperature and electric condition of the atmosphere, as it
generally occurs when there is an unusual amount of heat
and moisture in the air, and the localities in France,
where it has been most frequent, present these conditions in a high degree.  The most celebrated epidemics
of this disease have occurred in this country, and hence
it has acquired the name of sudor Anglicus.   It seems
to have been more rapidly fatal than even cholera, and it
naturally produces the utmost terror during its devastation.  The following extract from the account given by
Dr. John Kaye or Caius, presents so striking a picture
of the disease, that although somewhat out of place we
venture to insert it here:-   Quosdam enim in via cum
iter facerent sistulit; quosdam domi ostia et fenestras
reserando interemit; quosdam    per lusum  atque jocus
parum   joculariter jugulavit; per jejunia   quosdam;
quosdam   per saturitatem  abripuit; in somno aliquos,
nonnullos vigiles interfecit, usque adeo ut ex multis
ejusdem  familime paucae a febre incolumes perstiterint;
ex pausis nulli plerumque, intacti evaserint.   Ex his
alios brevi momento, alios unius, duarum aut trium, alios




436


THE SKIN


quatuor aut eo amplius horarum spatio post quam
sudare coeperant de vita sustulet. Sepissime qui in
prandio hilares erant sub coenam mortui fuerunt.  *  *
*   *   Itaque ex talibus initiis in dies ingravescentibus
ubi acerbiora incrementa longius latiusque se fundente
malo subsecuta sunt, vix credas quis pavor, quantus
metus omnes Britannos invasit; presertim     cum  ejus
conditionis miseranda quae tur   urgebat, contemplatio
funestaque mortis imago nullis spem vitse (cujus usura
omnibus solet esse carissima) non ademeret.     Neque
enim morbo ulla clementia fuit nec ullum miseris mortalibus securum refugium.   Etenim nusquam non populabatur nusquam non seviebat malum."' We cannot help
suspecting that the statement continually repeated in
treatises upon homoeopathy about this disease having
been cured by sudorifics, rests upon insufficient evidence,
or at least is of more limited application than the way in
which it is generally made conveys to the reader's mind.
It is of great consequence in the treatment or prevention
of idrosis to maintain a cool temperature by proper
ventilation of the apartment and light clothing, and the
neglect of these obvious measures was the cause of the
great frequency of the complaint in former times. The
following medicines are those best indicated and most
frequently successful:
Aconitum--" Peculiar sensation over the whole body,
as when the vapour is suddenly descending upon the skin
in a vapour-bath, and drops are felt upon the skin;
constant sweat, especially in the covered parts."  In a
case of idiopathic general idrosis which had affected a


S' Joannis Caii Britanni de Ephemera Brit.,' 1721.




AND ITS DISEASES.


437


woman for six years, the complaint was cured by Dupont
with extract of Aconite, after it had resisted all former
medication.'
Agaricus-" Sweat after very little bodily exertion
when walking; at night when sleeping." The white
Agaric is recommended in the profuse sweat of phthisis.2
Antimonium   crudum--" General sweat, without smell,
which made the tips of the fingers soft and wrinkled;
sweat during sleep; early in the morning when waking
a gentle sweat covers the whole body; general warm
sweat in bed every morning; sweat returning at the same
hour for three days in succession."
Arsenicum-" The sweat sets in at the close of the
fever, generally at night; in the evening when in bed at
the commencement of sleep, sometimes the sweat is seen
only on the hands and thighs; debilitating sweats, sometimes the debility increases to syncope; cold, clammy
sweats: sour fetid sweats; sweats tinging the skin and
eyes yellow, nightly, particularly about the thighs and
knees, or in the back, with itching early in the morning
when waking, sometimes only in the face and legs."
Belladonna-" Sweat during or after the heat, from
the least movement, over the whole body, especially on
the face and on the nose; cold sweat on the forehead;
sudden evanescent sweat; sweat having an empyreumatic
smell, imparting a dark tinge to the linen: sweat every
night, during the sleep, or only in the daytime; morning
sweats; sweats with enuresis."
1 Dupont, -Iist. d'une sueur chronique, &c., ' Journal G6n. de M6d.,'
1807, t. xxx, p. 33.
2 Bisson, 'De l'emploi de l'agaric blanc contre les sueurs dans la Phthisie
pulmonaire,' Paris, 1832, quoted by Rayer, p. 920.




438


THE SKIN


Bryonia-" Sweat breaking out readily after making
the least exertion, even during a walk in the cold air;
sweat during a meal; profuse sweat, particularly in the
morning or at night; oily sweat day and night; warm
sweat in the palms of the hands, or also over the whole
body, even about the head; cold sweat on the forehead
and head; sour sweat at night, also preceded by thirst,
oppressive drawing in the head, when the sweat is about
to terminate, and succeeded by a muddled condition of
the head.  Vaporous exhalation from the skin from evening until morning, or from 3 o'clock in the morning, with
lying on the back, light slumber, and dryness of the
mouth."
Rayer, describing the epidemic malaria which raged in
the department of Oise in 1821, says: " Many individuals who have gone to bed well, awoke labouring under
the disease, their bodies bathed in sweat, which never
disappeared till their death or convalescence.  Occasionally an almost imperceptible degree of fever, a burning heat, or a feeling as if a vapour were passing over
the limbs, and still more frequently a sense of constriction about the epigastric region precedes by some hours,
or by some minutes or seconds only, the appearance of
the sweat or rather the hot vapour, which, steaming from
a few places at first, is soon exhaled from the entire
surface."'
Carbo vegetabilis-"Great disposition to sweat; copious
and frequent sweat on the face (of a child); sweat, with
a sour smell; morning sweats; warm, night sweats, with
putrid smell; profuse sweats before midnight, even about
the head."
SOp. cit., p. 350.




AND ITS DISEASES.


439


C6amomilla-" General morning sweat, with smarting
sensation of the skin during or after the heat, with sour
sweat; general night sweat, without sleep; sweat in the
face, on the neck and hands; sweat during sleep, especially about the head; frequent transitory sweats on the
face and palms of the hands." Chamomilla is very
useful in checking the excessive sweat of women after
confinement.
C/ina-" Copious sweat; sweat when walking in the
open air; also profuse sweat; general profuse sweat;
readily excited sweat during sleep and motion; sweat
early in the morning, also during sleep; greasy sweat;
cold sweat all over the body, or only on the face, with
thirst; sweat after the febrile heat, particularly at night,
only on the back and forehead, with thirst or general and
exhausting sweat; sweat at night on waking or when
covering oneself ever so little; exhausting night sweats."
Coffea-" Vaporous exhalation from the skin in the
morning."
Dulcamara-" Sweat five days and more; general
sweat, especially on the back; sweat at night over the
whole body, in the daytime the sweat appears in the
axillm and on the palms of the hands: profuse morning
sweat all over, most however about the head; badly
smelling sweat, accompanied with profuse discharge of
transparent urine."
Ipecacuanlia-" Night sweat; sweat for some hours;
sour smelling sweat, with turbid urine."  Rayer mentions
that this medicine was much given in Paris during the
last miliary epidemic, but he speaks slightingly of its
utility.
Lachesis-" Profuse sweat accompanying other comr




440


THE SKIN


plaints. Profuse sweat, with increased, full, hard pulse
in the evening after moderate exercise, with bodily languor, in the morning preceding and following. Night
sweats; cold sweats accompanyiug the most violent
symptoms occasioned by a bite; sweat, tinging the
parts yellow; sweats which afford relief; profuse sweats
without relief in rheumatism."
]-Lizon palu8sre-" Sudden sweat when walking in
the open air, mixed with chilliness; fetid sweat over the
whole body, even the hair of the head sweats; he sweats
and cannot bear being covered; sweat during the whole
night, from evening till morning; slight sweat all over
on waking, with itching of the whole body, obliging one
to scratch."
Mercurims-" Sweat occasioning a burning sensation
in the skin; great disposition to sweat, especially at
night; profuse sweat when walking or moving; sweat
in the daytime, with nausea and languor; fetid sweat
for many nights; profuse night sweat, also of an oily and
greasy nature, tinging the linen yellowish and imparting
to it a feeling of stiffness; profuse fetid sweats, as if the
mattress and cover of the bed had been soaked in water;
profuse sweat on various parts of the body during the
night; excessive sweat having a sour and offensive smell,
and making the fingers feel soaked, spongy and shrivelled,
like the fingers of a washerwoman; sour smelling sweat;
sweat every evening an hour and a half after lying down;
profuse morning sweat."
Pulscatilla-" Disposition to sweat in the daytime;
disposition to sweat early in the morning; sweat the
whole night, accompanied by stupifying slumber full of
talk, &c.; sweat during the morning sleep, going off after




AND ITS DISEASES.


411


waking; slight general sweat; copious morning sweat;
sweat on the right side of the face; sweat only on the
right side of the body; sweat only on the left side of the
body."
Sulphzr-c" In the morning when        sleeping, sweat
going  off on waking; profuse sweat during         slight
exercise; sweat of the hands and feet in the morning;
copious morning sweat, setting in after waking; sweat
at night only on the nape of the neck; night sweat when
waking; night sweat having a sour, pungent smell;
sweat before bed-time, especially about the hands."
The next vesicular eruption we come to is scabies, or
itch.  It is of great consequence to be quite sure of the
diagnosis of this disagreeable disease. The only unequivocal symptom is the detection of the acarus, which if
present is always to be found at the extremity of the
hole it has burrowed under the skin, or if absent, the
furrows it has left may be easily recognised by a magnifying glass. Besides, the vesicles of itch are sharply
pointed cones, while those of eczema are round at their
summits and there is a peculiar scaliness of the surrounding skin.  The itching sensation is of rather a pleasant
kind, not sharp and burning like that of prurigo and
eczema, and the gratification of scratching is so great
that James the Sixth is reported to have said, it was a
pleasure fit only for kings. This, however, may have
been a witty libel upon his native land. As there is no
sort of doubt that the insect propagates the disease,
however else it may arise, it is manifest that th6 primary
indication of cure is to kill this parasite, and any unctuous substance applied abundantly to its habitation in the
skin is sufficient to effect this object.  The plan we




442


THE SKIN


generally adopt, is to order the patient to rub the affected
part with simple lard, and at the same time we give two
drops of the mother tincture of Sulphur three times a
day. Jahr recommends washing the surface with diluted
Sulphuric Acid, and administering the 300th or 400th
dilution of Sulphur internally. Whether these very high
dilutions are ever superior to lower ones may be a question, but we can hardly imagine that any one who has
had much experience in the treatment of itch, unless
misled and blinded by a theory, could seriously advise their use in that disease in preference to the
lowest.
Besides Sulphur various other remedies have been employed apparently with success. M. Bazin, who has had
large opportunities of observation at the Hospital of St.
Louis, at Paris, recommends an ointment of lard and
Chamomile flowers, prepared by heating equal parts of
those two with one of olive oil in a sand-bath and using
it by inunction. The advantages he ascribes to it, are
the instant relief it affords to the itching and the absence
of all secondary eruptions which frequently follow the
use of Sulphur ointment. We should think the plan
well worth a trial. In the Allgem. Hor. Zeitung, for
May, 1849,.Dr. Bosch recommends, from personal experience, the use of Peruvian balsam for this disease. He
says he has found it effectual in cases which had baffled
the ordinary curative processes. He gives night and
morning two drops of the first dilution of the Balsamum
Peruvianum nigrum, and rubs the balsam into all parts
affected with the disease night and morning.
Varicella or chicken-pox consists of an eruption of
small red slightly raised spots, on which vesicles appear




AND ITS DISEASES.


443


on the second day; these increase till the fourth day,
when they begin to shrivel, and on the two succeeding
days dry up into brownish scaly scabs, which fall off on
the eighth or ninth day and end the whole affair. Except being attended with considerable itching and sometimes smart feverish symptoms, there is little in this mild
and transient affection to call for the physician's aid.
However, the following medicines are recommended.
Aconite-" Isolated pimples of the size of a pin's
head, filled with serous liquid, make their appearance on
various parts of the skin, especially on the forehead, nape
of the neck and in the face: after a while the pimples
dry up and peel off." It also corresponds with the
feverish symptoms, and in general, according to our experience, no other remedy is required to effect a cure, or
(to speak more accurately) to be attended with recovery.
Antimonium   crudium--" Pimples at night; itching
when getting warm in bed and preventing sleep; red
vesicular pimples like varicella, with stinging pain when
pressed upon."
Pulsatilla-" Eruption resembling varicella after eating pork or fat things."
Tart. emet.-" Single vesicles or blotches, not very
much inflamed and resembling chicken-pox, gradually
increasing in size and number, filling with pus and then
surrounded with red inflamed areolae."
Variola or smallpox is divided into five stages: incubation, invasion, eruption, suppuration, and desiccation.
The period of incubation includes the time between exposure to infection and the manifestation of disorder in
the system, and ranges from five to twenty days. The




444


THE SKIN


invasion, occupying three or four days, is characterised
by the ordinary symptoms of fever, attended with pain
in the loins, the origin of which Chomel refers to the
kidneys and believes to be pathognomonic; and Heberden
remarks, that its intensity corresponds to the severity of
the subsequent course of the disease. The eruption
consists of small red elevated conical points disseminated
more or less thickly over the surface, especially on the
face and lips, and these papular elevations are gradually
transformed into umbilicated vesicles surrounded by a
red areola. This transformation is completed by the
fourth or fifth day. On the sixth day the lymph of the
vesicles is converted into pus, giving a yellow colour to
the eruption, which now loses its central depression and
assumes a flattened spheroidal shape. The process requires two days for its completion, and terminates in the
bursting of the pustule, the discharge of its contents,
and the establishment of the secondary fever. After
this, the desiccation begins, all the parts where the eruption existed are covered with a thick scab, consisting of
indurated pus and epidermis, which comes off about the
fourteenth day, and leaves the skin red and frequently
marked with fissures and pits.
When smallpox prevails, we are frequently asked by
our patients whether it is advisable to be re-vaccinated,
and it is well to have some positive data to rest our
opinion upon. Some years ago this operation was performed upon the Prussian army: 42,000 of them had
been previously vaccinated; of these, 33,000 had distinct marks, in 5645 it was indistinct, and 2577 had
none at all; when all were re-vaccinated, in 19,117 it
ran its ordinary course, in 14,000 it produced no effect,




AND ITS DISEASES.


445


and in 8672 it was irregular.1 When smallpox raged
in this army, the only fatal cases, seven in number,
which occurred, were among those who had not been
re-vaccinated, in all of whom it was very mild.     These
facts are enough to make us concur with the managers
of the vaccine establishment at Vienna, who recommend
that when " smallpox rages, it is well to re-vaccinate all
who are exposed to the infection." 2
In the treatment of smallpox, it is most important to
prevent the pustule from bursting, if that be possible,"for
there is more danger in this disease from the result of
the local mischief, than the constitutional derangement.
Of the plans most in vogue, perhaps the best is the old
Arabian one, of puncturing the matured pustule with
the point of a lancet, and gently pressing out its contents, which may be removed by a wet sponge. It is
maintained that the exclusion of light prevents the mischievous suppuration; and Dr. Picton, of New Orleans,
states that no instance of pitting after smallpox occurred in his practice, to patients who had been kept in
the dark.3
The subject was investigated experimentally by M.
Serres, who had found unusual success attend the treatment of patients kept in a dark ill-ventilated cellar, at
the time La Pitie Hospital was too full to hold them;
he covered some pustules with capsules of glass, so as to
exclude both light and air, and the result was, that they
shrivelled and dried up. It seems advisable, then, that
1 Kleinert's ' Repertorium,' 1840.
2 'Die Anomalien der Schutzpocken,' von M. Viszanik und A. F.
Zohner.
3 American Journal of Medical Science,' quoted by Wilson.




446


THE SKIN


the apartment should be kept as dark as possible: this
cannot be attended with any serious evil, and may be
productive of important benefit.
The following medicines are suitable for the treatment
of smallpox.
Aconitum--" In the eruptive stage of smallpox."
Arsenicum--" Should be exhibited in smallpox, when
hoarseness, angina faucium, and diarrhoea supervene."
Mercurius-" A few days after rubbing himself with
mercurial ointment, the patient experiences a troublesome
itching at the place where the ointment had been applied; gradually the skin becomes rose-coloured; this
redness is traversed by a few red streaks, which on inspection, prove to be the sound skin; the redness arises
from an assemblage of larger or smaller spots; the reddened cutaneous surface imparts a sensation of burning
heat to the finger; the redness disappears when pressing
on it, but returns immediately after the pressure ceases
the patient's general health remains perfect, the secretions are uninterrupted, and the pulse is not affected.
Ten or twelve hours after, slight elevations are discovered
by the finger on the reddened cutaneous surface, and on
looking at it through the microscope, these elevations
prove to be vesicles crowded together.   On the second
day the vesicles become more elevated, and are perceptible to the naked eye on looking at them obliquely;
they are filled with a yellowish lymph; the itching abates
somewhat immediately after the appearance of the vesicles.  On the third day the vesicles become depressed,
on the fourth day they desiccate, on the fifth the skin
scales off.  If the mercurial friction be continued, or if
some other dyscrasia be lurking in the system, the above



AND ITS DISEASES.


447


mentioned phenomena become more violent; the skin
assumes a dark red tinge, the vesicles increase to the
size of pustules, and the patient is attacked with feverish
chills which 'he experiences even before the vesicles make
their appearance; the eyes are slightly reddened, watery,
the nose is stopped, mouth and pharynx are dry, the
stool is retained, the urine scanty, red, the pulse rather
hard, quick, and almost small."' So much for the effects
of mercury in producing an affection similar to smallpox.
Mr. E. Wilson makes the following statements:1 " Mercury administered internally, has long been known to
possess remarkable powers in modifying the influence of
variola upon the system, but it was left to modern times
to prove that this agent has also the property of neutralizing the variolus virus when applied externally." After
mentioning that M. Serres and M. Briquet made use of
a plaster consisting of 95 parts of Mercury, 312 of
common plaster, and 16 of wax of resin and of turpentine, besides a slight addition of balsamus, he goes on to
say, "in the first experiment, a strip of this plaster was
placed on the arm  of a patient attacked with variola,
while a similar strip of diachylon plaster was applied to
the opposite arm; under the mercurial plaster, the development of the eruption was arrested; under the other
plaster, no modification took place."  In the second case
the face of the patient was " covered with the plaster, a
part of -which he tore off during the night which followed
its application; the denuded surface was the seat of suppurating pustules, whilst on that portion which continued
subjacent to the plaster, their abortion was effected."


SOp. cit., p. 97.




4,48


THE SKIN


In a third case-a man affected with "violent confluent
variola, the pimples were small, scarcely raised above the
level of the epiderma, and surrounded with a brilliant
red areola, the vigo plaster was applied, and allowed to
remain seven days; on its removal, it was found that no
suppuration had been established, with the exception of
four pustules, and these were situated near the mouth,
and had not been in contact with the plaster; this patient
was radically and rapidly cured, and no scars were manifested."  Dr. Oliffe recommends that "the whole face
should be covered with a mask of the vigo plaster, merely
leaving a space for the mouth, nostrils, and eyes, and a
little mercurial ointment should be applied to the eyelids.
The plaster is allowed to remain for three days in simple
smallpox, and four in confluent." Instead of this plaster,
mercurial ointment consisting of an ounce of Ungt. hydr.
fort. mixed with a drachm of starch-powder, has been
successfully employed by Dr. H. Bennet of Edinburgh.
Of course, the use either of the ointment or the plaster,
should not supersede the internal administration of
Mercurius.   It seems that unless the Mercury be applied
before the pustular stage of the eruption, it does no
good; it should be used upon the second or third day of
the eruption.  " It exercises," according to M. Briquet,
" a specific action on the cause, whatever that may be,
which produces the variolous pustule, or acts as an antiphlogistic, &c."
The immense importance of the subject seemed to require the production of the evidence in favour of the
utility of Mercury in the treatment of smallpox, instead
of giving merely the reported result of the plan; and
we shall follow the same course in respect to the only




AND ITS DISEASES.


449


other remedy which seems to us to have established its
claims to confidence, we mean Varioline.
In a paper which first appeared in the Horn. Vierteljahrschrift, Surgeon Schnappauf, of Dresden, relates his
experience with smallpox matter.  In a case of natural
smallpox, he says: " opening a group of pustules, on one of
the extremities, I succeeded in obtaining a clear watery
lymph, which I drew off and mixed in a glass of aqua
distil, pretty nearly in the proportion of the first dilution; after it was well shaken together, I added some
drops of alcohol to prevent it becoming putrid; of this
preparation I administered two drops every two hours
on sugar of milk-the effects were quite wonderful, in
so much that after the third dose, the greatest part of
the painful and unendurable symptoms were abated, and
the patient fell into a tranquil sleep, which lasted several
hours. The most surprising effect, however, was the
appearance of the pocks themselves, on the parts which
were least exposed to the air, and where, as is always the
case; the pocks had come out later than on the trunk
and lower extremities; the pocks, instead of having
increased ini size, were fallen  in  and shrunken like
withered fruit; those that were still in the stage of
lymph, did not go on to suppuration at all, but dried up
very soon. The remaining symptoms, such as the stretching and burning pain of the skin, the swelling and fever,
abated so rapidly, that the patient was relieved of most
of her distressing symptoms in about sixteen hours.". " I
have treated," he says, a little further on, " upwards of
twenty cases, of every age, both of natural smallpox and
varioloid, with Varioline, and in no one instance have I
found it to fail in producing its quick and remarkable
29




450


THE SKIN


effects."  Dr. Trinks, of Dresden, says: "I can confirm
the facts related in these observations of Surgeon Schhappauf.  In the winter of 1848-9, there raged here the
most wide-spread epidemic of smallpox which I ever remember; people of all ages and both sexes died of it;
it seized vaccinated and unvaccinated alike with the same
intensity; 4he eruption was preceded by violent affections
of the brain and spinal marrow, which disappeared when
it came out. Belladonna and Bryonia were of great service in that stage; in the septic state which frequently
followed on that, Arsenic wag, as usual, of much benefit;
against the salivation, Opium was administered with
great success; Magn. had no effect whatever; nor Tart.
Stib., nor indeed any homoeopathic remedy. On the
other hand, the varioline exercised an alterative, shortening and curative power on the exanthema itself--a fact
which must forcibly urge us to further trials of it." The
difficulty of procuring this remedy fresh, unless smallpox be epidemic, may be a hinderance to its practical usefulness; for there is good reason to believe, from the
experiments of Von Wenzel and others, that the virus
on which its power depends, is easily destroyed by
many chemical agents, as well as by spontaneous decomposition.
Imnpetigo is recognised by its consisting of a number
of small elevations of the skin, which terminate in a
pustular apex. On the rupture of the pustule the contents are effused and concrete into a honeycomb mass;
sometimes conical and depending like stalactitic formations. The eruption may be either disseminated irregularly over the surface (sparsa)-most frequently upon
the trunk, legs, and feet, or it may assume a circular or




AND ITS DISEASES.


451


other regular form (figurata), when it usually affects the
face, particularly the cheek and upper lip. One of the
most common seats of the disease is the scalp (iTpetigo
capitis); here it is known as crusta lactea, as it usually
affects infants at the breast.   In the acute form    the
crusts produced by the indurated muco-purulent secretion dry up and drop off, and so the disease terminates.
In the chronic form, however, no sooner is one crop of
pustules thus converted into exfoliating scabs than another crop springs up to take the place of those which
preceded them, and discharges its contents among the
spongy scales. When this happens on the scalp the
mass gets matted together with the hairs, the secretion
corrupting from its confinement becomes more and more
offensive, and the loathsomeness of the disease is aggravated by the swarms of lice which breed and lodge in
this congenial filth. The want of cleanliness being one
of the most common causes of this affection, simple and
abundant ablution is sometimes a sufficient remedy.
After the crusts are formed, the vapour douche is strongly
recommended as the most effectual appliance for their
removal, and it affords a wholesome stimulation to the
skin. Of course, at an earlier period the use of hot
baths or vapour is not desirable. The hair should be
cut' out with a pair of curved blunt-pointed scissors,
rather than shaved, this is equally effectual and less aitnoying, and if ample washing be not sufficient to remove
the crusts, a poultice may be applied. If after thoroughly
cleansing the head the crusts still continue to be reproduced, and the health of the child is either unimpaired
or even improved, it is better to avoid all medication
directed to the local grievance, for the chances are that




452


TIE SKIN


the eruption is a salutary effort of the constitution which,
if checked, would take some dangerous form.
Among the following medicines the appropriate one
for the cure of any special case will probably be found.
Arsenicum--" Pustular eruption on the head, the
temples, and between the eyebrows, causing painful itching, as if from  a sore; eruptions principally about the
lips and nose; pustules on various parts of the body,
which cause burning pain and great anxiety."
Calcarea carbonica-" Eruption on the hairy scalp,
with glandular swellings at the neck."  Such swellings
frequently attend inmetigo capitis.  " Thin moist porrigo
on the hairy scalp." We have great confidence in Calcarea in the treatment of this disease when it affects the
heads of scrofulous children.
Cicuta virosa-" Extensive (suppurating) eruptions
on the hairy scalp; suppurating eruptions (in the face),
with yellow scurfs and burning pain."
Clematis erecta-" Scaly herpes, with yellowish corrosive ichor."
Graphites-" Humid eruption at the top of the head;
it is painful to the touch; small pustules on the chin and
chest."
Hepar sulphuris-" Humid scald head."
Kali bichromicum-" During the first week a profuse
yellow scabby eruption formed over the upper lip."
Mercurius-" Humid eruption on the hairy scalp,
eating away the hair, with painful pressure, especially
at the sore places; pustules on the upper and lower
limbs, the tips of which are filled with pus, and
itching; impetiginous herpes on the abdomen, thighs and
knees."




AND ITS DISEASES.


453


Nitric acid-" Scurfy, humid, itchy eruption on the
hairy scalp."  Rayer says: "I have treated very obstinate impetigos successfully by the Nitric acid, in doses
of half a drachm    daily in  a pint of barley-water
sweetened to the taste.  It very seldom  happens that
this medicine is continued for a month or six weeks
without accomplishing a cure."
B]uzs toxicodendron-" Burning, itching   eruptions,
particularly on the scrotum, prepuce, eyelids and eyes,
(arms and loins), with swelling of the parts, and small
yellowish vesicles which run into each other and become
moist, the larger ones terminating in suppuration, with
red areolae, the smaller ones drying up more rapidly and
scaling off in a few days."  This is another medicine in
which we have great confidence in the treatment of
impetigo capitis, especially  when  the  discharge is
copious.
Sepia-" Small itching pustules on     the  occiput,
towards the nape of the neck, forming into ulcers the
size of an inch, with rough crusts, under which the
secretion continued for a long time."
Silicea-" Itching, humid porrigo."
Stapkisagria-" A number of itchy scabs on the hairy
scalp; humid scabs, also with bad smell."
Sulphur-" T'inea capitis, dry or fetid and humid,
with  thick  pus, yellow  crust and itching; crusta
lactea,"
Viola tricolor  is usually  recommended    in  this
complaint, but there is nothing in the proving to warrant
its administration, and we do not know on what authority
its reputation rests, beyond Jahr's italics, which arc
certainly somewhat capriciously employed.




454


THE SKIN


Ectyma is easily recognised from inmpetigo and other
pustular eruptions by the large size of the pustules of
which it consists; they are frequently as big as a split
pea; sometimes there is so much induration of the
surrounding skin that they resemble small boils, and
leave an ulcer behind them, after they disappear with
the rupture of the pustule and escape of its contents.
It is rarely an acute, generally a chronic disease, and its
favorite situation is the upper part of the trunk of the
body, which it sometimes encircles.    It almost never
affects the scalp.
The following medicines seem to correspond best to the
symptoms it presents:
Arsenicum-" Pulse 110; white pustules, some isolated,  the  greater  part confluent, appear   on   the
forehead, round the eyes, the cheeks, the arms, and
shoulders, and upper part of the chest; they terminate in thick crusts, and leave well-marked cicatrices."
Kali bichromicum-" In a few days an eruption of
red, round spots broke out on the back, arms and
belly; the spots then formed pustules the size of a pea,
covered with a scab, which came off in a few days, and
left a small dry ulcer, which mostly healed up in about
a fortnight, leaving a colourless depressed cicatrix."
iMercurius-" Visibly   spreading  herpes, afterwards
several ulcers discharging a corrosive ichor; herpetic
spots and suppurating pustules, which either run into
one another, forming at times dry and scaly spots, at
times discharging an acrid humour, or which remain
sore, become hollow, and afterwards raised and cicatrized; new pustules springing up in the neighbourhood."




AND ITS DISEASES.


455


R/ius-" Black    pustules, with   inflammation   and
itching, rapidly spreading over the whole body."
Tartarus stibiatus--" Large, round, full, burning
pustules, with red areolae, forming in two days and
leaving deep cicatrices; furunculous, pustulous eruption,
-occasioning a violent, painful itching, generally suppurating from  the size of a pin's head to that of a pea;
pustulous eruption, the pustules filling with pus, drying
up in a few days, and sometimes leaving deeply penetrating malignant ulcers."
Prumnculus-boils-is so familiar a complaint, and so
perfectly recognised even by popular observation, that
there is no need of saying anything about its diagnosis,
and -we may pass at once to the enumeration of the specific medicines likely to be useful in its treatment.
Arnica-'' Itdhing pimple between the thumb and
the index finger, as if a splinter were lodged in it." This
medicine is generally recommended to be given for boils,
and certainly seems useful, although there is no very
well-marked indication in the proving by which its suitability can be shown.
Belladonna-" Boils."
Kali bichromicum-" Without being aware of any
scratch, the arm swelled as high as the axilla, then
a boil-like elevation formed, which turned into a large
ulcer, with dark centre and over-hanging edges."
Hepar sulphuris-" Pimples, the size of a pea."
This medicine is recommended in indolent boils, and
may be used externally in the form of ointment with
advantage.
Lycopodium-" Large boil on      the left lower arm,
making the whole arm stiff, and another boil on




456


THE SKIN


the left shoulder (in   a few   days); boils    returning
periodically."
Pkosp/horus-" Small boils on the nape of the neck,
chest, and thighs; large boils on the thighs, chest and
forehead."
Pulsatilla-" Boils here and there." It is particularly suited to cure styes, which are one of the symptoms
it produces.
-  Staphisagria-" Frequent boils."
Sulpkur--" Boils."
Anthrax-consisting of fibrinous deposits, surrounded
by suppuration, which require to be expelled before a
cure is possible-is generally treated      by a   crucial
incision; this allows the pus to escape, and permits the
evacuation of the firm central masses, and seems the
most rational and least painful plan of treatment of a
purely mechanical kind, and therefore by no means
opposed to the administration of specific medicines at
the same time, in fact tending rather to favour than prevent their salutary operation.   Cold dressings may also
be employed, which should press firmly upon the part,
and the pressure should be gradually increased from day
to day till the cure is effected.
The medicines recommended to be given          in this
painful and tedious complaint are arsenicumn, belladonna,
and silicea; the recommendation seems to rest upon
clinical experience chiefly, for there is no very striking
similarity between the symptoms which they produce and
Anthrax.
Mlolluscum is a rare and curious disease, consisting of
pouches formed by the enlarged and distended ducts of
the sebiparous gland; they look like red currants or.




AND ITS DISEASES.


457


small gooseberries, studded all over the surface of the
body, and are so peculiar that after having once seen a
case of the disease, it is impossible not to recognise it
afterwards.  The only example of its successful treatment by homoeopathic medicine is recorded by Dr.
Dudgeon in the article " Kal. bich." (Hahn. Mat. Med.)
It was cured by Lycopodium and Silicea. The individual
tumours or tubercles, which varied in size from a large
pin's head to a pea, inflamed, suppurated and dropped
off as a scab, leaving bluish red cicatrices, which gradually died away.
Acne is known by the conical form of the elevations
of which it consists, the suppuration of those at the apex,
and the firm tubercle which they leave behind after the
discharge of their contents. In its treatment the following
medicines may be used:
Calcarea  carbonica--" Steatoma,. reappearing   and
suppurating every four weeks."
Kali bichromicum--" The face is covered with a profuse eruption like acne."
Kreosotum--" Eruption: pimples on    the forehead,
also as on the forehead of drunkards, or miliary pimples,
sometimes stinging, and always remaining dry; greasy
sort of pimples on the right cheek and on the chin,
covered with yellow, honey-like crusts."
Ledum    palustre-" Red   tubercles, also   on  the
forehead (as in drunkards), with stinging when touched."
Nuwxjuglans-" Little pimples (acne pustulosa) on the
face, chiefly about the mouth; small red pimples on the
neck, in the face, on the shoulders and the back, some of
which grow larger and contain a thick fluid."
Sulphur-" Red (itching) pimples on the nose, upper




458


THE SKIN


lip, around the chin, and on the forearms; they sometimes burn after scratching."
Out of the long catalogue of medicines useful in acne
these are the only ones whose symptoms at all correspond
with those of the disease, and the following are recommended upon empirical grounds alone: belladonna, carbo
vey., nux vomica, pulsatilla and natrum mnuriaticum: for
the acne of drunkards; carbo veg., ledum, arsen., num
vom.,pulsatilla, sulphur and belladonna, are the favorite
remedies.
In the closely  allied  affection montagra or sycosis
menli, the following medicines may be administered:
Antimronium  crudum.---"Red, burning, suppurating
eruptions on the face; eruption on the left cheek towards
the chin, with a yellow crust, painful to the touch, and
which may be easily knocked off."
Cicuta virosa.-" Thick, honey-coloured scurf on the
chin, upper lip, and the lower portion of the cheek, with
burning soreness and oozing of the skin, accompanied
with swelling of the submaxillary glands, and scurfs in
the nose, and insatiable appetite."
Graphites.-" The chin is covered with eruptions, also
scurfy round the mouth and the cheek."
Hepar sulphuris. -" On the chin, above and below the
lips, and on the neck, pimples resembling blotches, sore
when touched, but not otherwise."
Oleander.-" Suppurating pimple on the left and right
sides of the chin."
Sepia.-" Pimples on the chin, with ulcerative pain
when touched; itching pimples on the chin; long lasting
scabs upon the chin."
Tinea capitis, or common ringworm, is easily recog



AND ITS DISEASES.


459


nised by spots of nearly perfect baldness on the head;
upon minute inspection the hairs are seen to be there,
but stunted and shrivelled so as to resemble tow. The
affected parts are at first quite dry and covered with
small shining scales like mica; if the head be not kept
clean an exudation generally takes place from the surface,
and produces a matting of the hairs in which the scabs
are imbedded. The general indications for treatment
are to cut off the hair, but not to shave the head, and to
wash it every morning with common brown soap and
water.  Change of air, especially to the sea-side, and
a generous animal diet, are also advantageous.
The following are the specific medicines best suited
for its treatment:
Alumnina-" Falling off and excessive dryness of the
hair; soreness to the touch."
Arsenicum-" Bruised pain of the scalp, increased by
touch, the hairs are painful when touched; creeping of
the skin of the occiput as if the hairs moved."  These
symptoms of Arsenic, although they present no proper
resemblance to tinea, yet perhaps indicate an action of
some kind upon the seat of the disease, which is the hairbulb.
Calcarea carbonica-" Scaling off of the scalp in the
region of the vertex."
Grap/ites-" Scurfy spot on the top of the head,
with violent sore pain when touching it."  This is the
most favorite medicine in tinea, and is often used in
the form of ointment.
Sulphur-" Pain of the roots of the hair, especially
when touching the hair."
We must confess that our experience of the homoeo



460


THE SKIN


pathic treatment of this disease has been far from encouraging, and we have been not unfrequently somewhat
mortified by the rapid cure effected after all our efforts
had proved unavailing by some quack preparations applied to the part. Perhaps we do not pay sufficient attention to the local application of our'specific remedies.
We know that our discomfiture in our operations against
tinea has been shared by some experienced homceopathic
physicians, and it excites some surprise to observe the
confident tone assumed by others who seem to obtain
results so very different from ours by identical means.
We think this is a subject well worth the attention of
those who have extensive opportunities of observation,
and we trust they will give the medical world the benefit
of their experience in a minute detail of cases of tinea
which come under their care. What we have said of
tinea is still more true of favus, the last remaining disease on our catalogue. Of the pathology we have
spoken in the former paper, and to be able to say anything satisfactory about its treatment we must wait till
we have the materials afforded by a sufficient number of
cases successfully treated by homoeopathic remedies, for
there is nothing in the symptoms recorded in the provings
hitherto published to warrant our recommending one
medicine more than another with any degree of confidence.   In the therapeutic part of this paper we have
left the question of the dose entirely in abeyance; those
in the habit of using high dilutions prefer them in diseases of the skin as well as in other morbid affections;
those who usually give low dilutions in their turn prefer
the low.  As yet there is neither a sufficient accumulation of accurate observations to enable us to decide upon




AND ITS DISEASES.               461
the ground of empirical statistics, nor has. there been any
successful attempt to ascertain the laws by which the
enormous differences in the amount given by different
practitioners with nearly the same success, are to be accounted for. Till one or other of these grounds of comparative certainty be attained all dogmatism  on this
subject would be presumptuous in the highest degree,
*and would reveal not only ignorance, but worst 'of allignorance of our ignorance.




CHAPTER IX.


ON AFFECTIONS OF THE NERVOUIS S"YSTEM.
ALTHOUGH some of the conclusions arrived at by Sir
Charles Bell, are controverted by the most recent investigators of the -nervous system, and even the very important one of the posterior columns of the spinal cord
being the sole medium by which sensitive impressions
are transmitted from the circuimfercnce to the centre, is
denied by Dr. Brown- Sequard, yet the fundamental principle insisted on by that great discoverer of the distinction between those nerves which convey an impression
from without inwards, to give rise either to a sensation
by being transmitted to the brain, or to some action in
the body by its transmission directly fr-om the spinal
cord to the more external parts, and the nerves which
convey an impression from within outwards', has been
amply confirmed, and ig assumed by writers on this
subject as an axiom of the science of neurology, along
with its corollary, that impressions can only travel along
one line of a nervous fibre, and cannot be transferred to
another fibre although in the closest proximity, but
must invariably either pass outwards to the extremity,
or inwards to the centre. This principle is of constant
application in practice when we meet with some abnormal
condition of external parts, such as insensibility or




AFFECTIONS OF THE N}RVOUS SYSTEM.


463


numbness, and seek its cause in some affection of either
the spinal cord or brain. But there is a practical difficulty in applying it, from the fact that local influences
acting upon the remote branches of a nerve, may produce all the symptoms that would arise from an injury
of its root.  Sir Charles Bell gives an interesting illustration of this in the following narrative.  "When we
see a person alarmed without a cause, and there is no
danger in the case, there is something approaching to
the ludicrous in the scene. A physician paid me a visit
who had come up from the country in the mail, and had
fallen asleep in the night time with his cheek exposed at
the open window to the east wind. On the morning of
his arrival when preparing, to go abroad, he found upon
looking into his glass that his face was all twisted.  His
alarm gave more expression to one side of his face and
produced more horrible distortion. Both laughing and
crying you know depend on the function of the portia
dura, but when he came to me he considered it no
laughing matter: I never saw distortion more complete.
It was difficult to comfort him.  I am  happy to add
that the paralysis gradually left him, as I told him it
would." *
The following case related by Dr. Graves in his clinical
lectures t is even more remarkable from  the paralysis
affecting not the nerve which suffered the lesion, but
one organically rather than anatomically connected with
it.  "A  medical student travelling through Wales on
the outside of the mail, was exposed for many hours to
a keen north-easterly wind blowing directly on his face.
When he arrived at the end of his journey, he found
" Bell on the Nerves, p. 283.  t p. 398.




464


AFFECTIONS OF


that his vision was impaired, and that everything seemed
as if he were looking through a gauze veil. There was
no headache, no symptom of indigestion to account for
this evidently slight degree of amaurosis, and yet he was
recommended to use cupping to the nape of the neck,
and strong purgatives.   When he consulted me, which
he did in the course of a few days afterwards, I at once
saw there was something unusual in the case; and after
a careful examination I at length elicited from him the
fact of his having been exposed to the influence of cold
Wind.   It was now apparent that the retina suffered in
consequence of an impression made on the facial branches
of the fifth pair. The cure was effected not by a treatment directed to relieve cerebral congestion, but by
stimulation of the skin of the face, forehead, temples,
&c., &c."
A case presentiing a difficulty of this kind occurred iti
my own practice last autumn. About three years ago, a
lady of about 70 years of age came under my care. At
that time she was suffering from palpitation and irregular
action of the heart. I found on examining the chest
that there was some hypertrophy, and a faint murmui
along with extreme irregularity of rhythm. The pauses
were long and frequent, and occurred at uncertain intervals.  With the exception of a few symptoms, such as a
tendency to urticaria, which seemed to indicate gout in
the constitution, her health was very good, and she
had not been confined to bed for one day for many years.
At the end of last autumn she went to Malvern, and on
her arrival there complained of numbness of the left
hand and cheek, and partial insensibility of one side of
the tongue, along with unusual deafness anid some pain




THI, NERVOUS SYSTEM.


465


and confusion of head. On visiting her there the following evening, I found that she had come from the
railway station to her house in a carriage only partially
closed, and that the left side had been exposed to cold.
There was not positive insensibility of the affected parts,
but distressing numbness, and the pulse was quick and
even for her extremely irregular. The numbness was
over the cheek generally, extending to the lip on the
affected side, and she complained much of one side of
her tongue having lost its proper sensitiveness, so that it
annoyed her when she masticated her food. There was
no loss of the power of voluntary motion in any part,
nor was there any numbness of the legs.   I felt great
difficulty in giving an opinion as to the nature of the
case, which her friends looked upon as a paralytic attack.
The age and old heart-complaint, along with the pain
and confusion of head and increased deafness, seemed to
point to a central cause, while the limitation of the
numbness to those parts which had been exposed to cold
made one hope that it was merely an affection of the
external nerves. I left her Arnica and Nux vomica to
be taken alternately, and recommended her immediate
return home. On her arrival at Leamington in the
course of a couple of days, I found a very slight change
in the state of affairs, but that change was for the
better: this confirmed me in the favorable opinion I
had formed. In the course of a fortnight she was attacked with bronchitis, and was so ill that for some time
her life was dispaired of..However, she eventually recovered, and on her recovery still complained of the
numbness although in a lesser degree, and a constant
noise in the head.  Her health is now on the whole veiy
30




466


AFFECTIONS OF


good, with the exception of not being able to sleep except for a very short time at night, and being annoyed,
but not so much, by the sound in her ears. I confess
myself still to be in doubt as to the exact nature of that
Malvern attack, whether or not any central part of the
nervous system were compromised by it.
A much more satisfactory case of peripheral affection
of the nerves of the legs both as illustrating cutaneous
anmsthesia, and as an example of its successful homceopathic treatment occurred the folllwong winter. A gentle.
man of 46 years of age, florid in complexion, and of a
somewhat stout person, of active habits and temperate in
his diet, consulted me on the 4th of last March, and thus
described his case. Ie has all his life been in the enjoyment of perfect health; but fifteen months ago he began to
perceive a feeling of numbness on the outside of the
right leg, extending from the hip to the knee. This
numbness always came on at night and continued for an
uncertain time, and he also felt it in the morning; of
late it had increased to actual insensibility, so that he
could run a pin into the skin without pain. The skin
and parts below it felt hard. It was confined to the
outside of the thigh, and came on frequently after walking about his room of a morning, so that it did not
seem dependent upon his posture during sleep or his
dress in the day-time. It had been steadily increasing,
and he got alarmed at the idea that it might be the precursor of palsy. I gave him Plumb. carb. 4th dil. a
dose 3 times a day. In the course of a week he returned and reported himself better.  The same medicine
was continued, and after other two weeks he found himself almost quite well, and has remained so ever since.




TIHE NERVOUS SYSTEM.


467


I should mention that there was no appearance of any
disturbance of the digestion except slight costiveness,
which was removed by the medicines, In fact, but for
this one symptom his health was perfect.
I may here mention another somewhat similar case.
A woman of 30 years of age consulted me at the dispensary, and gave the following statement of her case.
She had had several children, and except not being very
strong was in good health.  Since the birth of her last
child about two months ago, the catamenia had naturally
been absent. She was I presume nursing an infant.
For a month she had been attacked every night about 11
o'clock with numbness of both hands and arms, attended
with such acute pain as to keep her awake. She described it as numbness followed by pain. I ordered her
the 2d dilution of Aconite: a dose 3 times a day. This
was upon the 17th of January.   She did not return till
the 11th of June, and then for some slight derangement,
and on asking her about her former complaint, she said
that after taking the Aconite for 2 or 3 days, she got
perfectly well.
Of the individual nerves there are none so often
affected as those of the face, especially the fifth pair,
and this being a nerve of sensation the expression of its
morbid condition is pain. There are two affections to
which this nerve is liable, simple neuralgia and tic
douloureux, and it is of great importance to distinguish
accurately between these, for an error in diagnosis may
give rise to serious disappointment.  Nor is this distinction an easy task. We find in the records of clinical
medicine many examples of ordinary neuralgia being
mistaken for true tic. Dr. Graves in his lectures makes




468


AFFI(CTIONS OF


the following observations, which are worthy of our
attention:-" I have seen many cases in which a painful
or carious tooth, or an injury done to the gum or jaw,
has been followed by violent darting pain in the nerves
of the face, simulating in many particulars tic douloureux.
I remember being sent for to Middleton, near Cork, some
time since, to see a -lady of delicate constitution, whose
health was materially deranged from what was said to be
an attack of tic douloureux. She had been under the
care of many practitioners, and had used very large doses
of the carbonate of iron and sulphate of Quinine, and at
the time I visited her was taking Arsenic.   The first
thing I did on my arrival was to examine her teeth. On
close examination I observed that on the crown of one
of the upper molar teeth there was a spot which appeared
to be decayed, and I found on inquiry that she frequently suffered from pain in this spot when she drank
any cold liquid. I had the tooth drawn and soon afterwards the pain completely ceased.  Yet in this case the
pain was not only of an intense character, preventing
sleep and wearing out her strength, but it had its intermissions, and wag aggravated at particular hours of the day."
He gives another similar case, but he does not inform us
how we are to distinguish the one disease from the other.
Nor can we find in Romberg, although he treats in his
usual scornful way the errors of practitioners in confounding  true  facial neuralgia  with  other painful
affections, any symptoms which afford unequivocal signs
by which a differential diagnosis can be established. He
gives five rules:-1st. "It is confined to certain distributions of nerves, and occurs in paroxysms separated by
' Graves's 'Lectures on Clinical Medicine,' p. 650.




THE NERVOUS SYSTEM.


469


a free interval."-So does toothache.-2d. " The peculiarity of the exciting cause."   This is generally unknown, and so wont help us much.-3d. " The sensitiveness of the affected surface of the face to unexpected
and slight contact."    This is certainly more to    the
point.--4th. "The preference shown by neuralgia of the
fifth pair for mature age, as it occurs only after the
thirty-fifth year."  This I am  certain is a mistake.   I
have seen it in a person below thirty years of age.1-5th.
"The rarity of the disease, which must increase our
scepticism  in forming a diagnosis."  There is anything
but help in this observation.2 It seems to me that this is
one of the cases where the difficulty is rather in the description than in the recognition of a distinction. To any
one who has watched cases of tic douloureux, there is no
danger, at least not much, of his confounding with this
dreadful disease ordinary facial neuralgia.  Perhaps the
most marked distinctions between them are the general
appearance and character of the patients, and the results
of our treatment.
As far as my observation goes, the subjects of ordinary
neuralgic pains of the face, of so severe and long continued a kind as to make it possible to mistake them for
true tic, are of a languid, exhausted, pain-worn appearance, and generally females; whereas the sufferers from
tic douloureux are usually the very reverse.  They have
a look of unusual vigour and vitality, and an expression
of a certain active despair in their countenance, presenting a great contrast to the passive expression of the
1 Dr. Quin, Dr. Madden, and Mr. Cameron all confirm this remark from
their own experience.
2 Romberg 'On the Nervous Sytcm,' vol. i, p. 48, 49.




470


AFFECTIONS OF


suffering of the others.  The health too of these sufferers
is often wonderfully little affected, and unless we see the
patient in an attack we can hardly believe the pain is so
dreadful as it is described, for we naturally but erroneously suppose that so great a pain must exhaust the
patient. This is not the case, however, and after an
attack is over and sleep has restored the nervous system
to its ordinary state, the appetite returns, and all the
functions go on with more than ordinary vigour and
regularity. For the sake of illustration I shall give the
particulars of two cases, the first being one of simple
neuralgia, the other one of true tic, which have lately come
under my notice, and I do so partly in evidence of the
second diagnostic test I adverted to, viz., the curability
of the one and the obstinacy of the other.
I was consulted, on the 30th of July, 1855, by a lady
of about 40 years of age, who looked the picture of a
person exhausted by suffering and general ill health.
She had a slow, languid, weighted gait, her voice was
feeble, and she spoke with an effort.  For two years she
said she had been suffering almost constant pain, which
occasionally become excessively violent, extending from a
point in the upper jaw corresponding to the root of the
eye-tooth upwards overt he cheek, nose, and temple. The
pain was aggravated by eating or speaking, but for some
time back it had been constant and severe.  The whole
of the face was tender to the touch, as was also the scalp.
The tongue was dry and white, the bowels very costive.
The catamnenia were too copious and frequent.   There
was leucorrhcea.  The pulse was small and rapid.  She
complained of aching in the limbs and general weakness.




THE NERVOUS SYSTEM.


471


I ordered her a drop of the second dilution of Chamomilla, three times a day for a week.
On the 6th of August she called on me again. Her
report was, that after the first dose of the Chamomilla
the pain began to abate, and that now it has nearly gone.
She got Nux v., second dilution, for a week, then Tr. of
Sulphur, and after that China, and by the middle of
September she was almost entirely restored to health.
She described her feelings on waking of a morning as a
sense of overwhelming gratitude, when she found that
the long-accustomed pain was gone, and that life which
had been a burden was now a pleasure. She continued
in the enjoyment of her new health till the following
winter, when the pain in the face returned, and was
cured in about a week by Mercurius solubilis and Chamomilla. This must be acknowledged to be a most
satisfactory case, but even had there been any doubt in
my mind as to its not being one of tic, the very rapid
cure would have removed this doubt.
Here is the contrast. A lady of about 60 years of
age, who had been under my care for headaches and
trifling ailments, and who was of a nervous and vigorous
habit of mind and body, consulted me, upon the 28th of
December, for the following symptoms. For a week she
had been subject to sudden violent pain, darting from the
internal canthus of left eye, up and down the side of the
nose, and into the brow. It comes on without any
warning, is very intense, and feels like a knitting-needle
run into the side of the nose. In other respects she is
quite well. Such was her description, and on comparing
this case with the last, one would naturally suppose that




472


AFFECTIONS OF


it was much the milder of the two. It had lasted only a
week, and had in no way impaired her health. However
I had my misgivings, and although she got apparently
well after a few doses of Mercurius solubilis I was not
surprised to see her return on the 10th of March.    She
complained of a return of the pain, but that it was more
severe.  It was like an electric shock running along the
nerves and into all their twigs, and again like very small
red hot wires thrust into the nose, eyes and brows.  She
had an alarmed look, very characteristic of sufferers from
tic, and she had the greatest dread of the slightest contact. She dared not blow her nose, for the merest touch
sometimes brought on this horrible pain, which made her
writhe about in agony. The intervals of the attacks were
quite uncertain.   I gave her Arnica and Arsenic.    She
reported herself on the 24th of March as having been
better while taking the medicine, but from that time to
this the attacks have returned, and each time more severe.
There is no change in their character; they are always
described as sudden, electric, burning, darting, shooting
along the twigs of the nerves, and hitherto they have
been always relieved by the medicines Ignatia, Mere.,
and Arsen., but she is not cured, nor I fear will be well
for many a long day.
Now what is the difference between these two cases?
It is evident that in both there was a morbid affection of
the fifth pair, in the first secondary to a general derangement of health, in the last, idiopathic, depending upon
some inscrutable alteration in the nerve itself. The
curious thing, however, is that in the first case this very
painfll secondary affection should have been almost in



T'HE NERVOUS SYSTEM.


473


stantaneously cured, before there was any time for an
improvement of the general health, so that we must look
upon it as a specific cure of a neuralgic affection. And
why can we not effect with equal ease and rapidity a
similar cure in a case of apparently much slighter kind?
Before we can reply to this we must know more of the
pathology of the disease. But I believe my opinion of
the difficulty of curing tic douloureux is borne out by all
who have had much experience in this rare and dreadful
disease; certainly it is so by Dr. Quin, who probably has
had more opportunities of observing the complaint and
who has been, I believe, more successful than any physician now alive.
The portio dura of the seventh pair of nerves being a
nerve chiefly if not exclusively subservient to motion, its
morbid conditions result either in spasms or paralysis of
the muscles of the face.  One form of spasm has received
the name of tic convulsif, and histrionic spasm of the
face. This affection is characterised by spasmodic jerking of one side of the face, giving the effect of a series of
grimaces.  It is seldom  painful, and seems generally to
arise from some sympathetic action communicated to the
portio dura from some internal organ. It was an old
belief that wounds of the diaphragm produced a peculiar
muscular affection of the face, known as risus sardonicus,
and as the origin of the phrenic and portio dura are not
far apart it is quite possible that the notion may have
had a foundation in fact.  The ancients ascribed to the
Ranunculus sceleratus the property of producing a somewhat similar affection, known as apium risus.  It might
be well to bear this in mind in the treatment of such
troublesome cases as the following.




474


AFFECTIONS OF


A woman of 44 years of age, pale, thin, and of a dark
complexion consulted me on the 22nd of August, 1855.
She stated that two years ago, without known cause, she
began to be affected with convulsive movements of one
side of the face, attended with numbness of the hands
and arms, and flushing of the face. When the attack
was on it affected the tongue so that she dare not speak
for fear of biting it, for it was drawn about in her mouth
against her exertions to keep it still or regulate its
movements. The attacks came on at uncertain intervals,
but were always more frequent and severe during the
catamenia, which were regular but scanty. The spasms
lasted for more than an hour at a time. After they were
over she felt very tired. She complained of being very
low in spirits, and nervous. The appetite was indifferent, the tongue clean, and the pulse natural.
I ordered her a drop of the second dilution of Ignatia,
to be taken three times a day. She continued this till
the 19th of September, when she reported herself as
having been quite free of spasms during the interval.
She complained of pain in the back of her neck and over
the eyes. For this she got Naja tripudians, the third
dilution, for a fortnight-that was to the 3d of October.
She then complained of nothing but depression of spirits,
and again she got Ignatia second dilution. She remained
well till the 17th of October, that was seven weeks, when
she had one of her old attacks. The attacks have continued from that time to this, although at longer intervals
and less severe. The medicines she has had are Cuprum,
Aconite, Stramonium, Hyoscyamus and Moschus, but I
am not satisfied that any of them exerted a specific action
upon the complaint. Ignatia certainly seems to have




THE NERVOUS SYSTEM.


475


done so, but it had the advantage of being the first, a
great thing in a. nervous case, where the patient comes
with high hopes from a new system of treatment. I
remember a somewhat similar case in a young lady of
nineteen years of age, which was rapidly cured by Pulsatilla and Sulphur.  However it was not so severe nor of
such long standing, and was probably connected with the
period of development.
Cases of paralysis of the portia dura are met with frequently in practice. They depend either upon some accidental exposure to cold, as in the instance already quoted
from Sir Charles Bell's work, or upon some pressure on
the nerve before its distribution to the muscles of the
face.  I lately met with rather an interesting case of
this kind, interesting at least from the speedy benefit of
treatment.  A little boy of two years and a half old,
well grown and healthy looking, was brought to me upon
the 5th of September, 1855, with distortion of the features when he laughed or cried. In these operations of
the features the right side took almost no part.  On examining the affected cheek a tumour was perceived a
little below and to the front of the condyle of the jaw.
It was about the size of a large almond, and slightly
painful to the touch. It was firm, inelastic, and there
was no fluctuation perceptible. The account given of
this tumour was, that the child had been delivered by
instruments, and that soon after its birth a small swell.
ing was noticed at the angle of the jaw, which afterwards
descended into its present position and increased in
size.  The features had been observed to exhibit this inequality of expression for a long time.  I ordered the




476


AFFECTIONS OF


4th  dilution of Silica, without, I confess, any great
hopes of doing good, and was almost as much surprised
as the parents when on the child's return in ten days I
found the tumour decidedly less. I heard nothing of
the case till the 9th of November, when the boy's
mother called for some more medicine, reporting that
the tumour was almost gone, and that she would bring
him over to see me again. I have heard no more of the
case, but as the parents live about forty miles off it is
not wonderful that they should not return if the boy is
well, but it is a reasonable inference that unless the case
had done well his parents would have come back.       I
take it for granted that in the course of time the portia
dura will regain its proper control after the cause of its
partial palsy is removed.
It is comparatively easy to infer a morbid condition of
particular nerves, which minister to voluntary motion
and ordinary sensation, from the symptoms presented by
the affected parts of pain or insensibility on one hand,
or of spasms or palsy on the other. It is, however,
much more difficult to distinguish with accuracy the
lesions of the par vapym, which possesses very complicated and peculiar endowments.   It may be well to refer
briefly to the anatomy and physiology of this nerve
before adverting to the effects of some of its morbid
affections.  The pneumogastric nerves arise behind the
olivary and close to the restiform  bodies: immediately
after leaving the skull, which they do by the foramen
lacerum posterius, they are intimately connected with the
hypoglossal, spinal   accessory, and  glosso-pharyngeal
nerves.  On arriving at the lower part of the neck, on
the right side, the nerve passes before the subclavian




THE NERVOUS SYSTEM.


477


artery, and on the left before the arch of the aorta.  In
its course it gives off first, the pharyngeal twig, which,
with branches of the glosso-pharyngeal, upper laryngeal,
and   first cervical nerves, constitute  the  pharyngeal
plexus.  Second, it gives off the superior laryngeal
which divides into the external laryngeal and the internal
laryngeal. The external laryngeal is distributed upon the
sterno-thyroid, hyothyroid, constrictor pharyngis inferior,
and crico-thyroid muscles.   The internal laryngeal divides into an upper and lower set of filaments; the upper
ascend to the glottis and membrane of the pharynx, the
lower are distributed upon the mucous membrane of the
larynx and pharynx and aritenoid gland and muscle.
One of them descends between the thyroid cartilage and
-crico-arytenoid muscles, and is distributed entirely upon
the crico-arytenoid muscle.    After giving off cardiac
twigs, the next important branch is the inferior or recurrent laryngeal.   This nerve,' on the right side, loops
round the subclavian artery, ascends between the trachea
and oesophagus, and after giving off branches in its
course supplies the posterior and lateral crico arytenoid
and thyro-arytenoid muscles. It gives branches to no
other muscles of the larynx.   The left differs from  the
right in describing a much larger curve round the arch of
the aorta.  Its distribution in the larynx, however, is the
same as the other.   After giving off these branches the
nerves increase in volume, form the pulmonary plexus,
and lose themselves in the subdivisions of the bronchial
tubes.
The functions of the pneumogastric nerve are as numerous as its distribution is extensive.  In the pharynx
it is a nerve of sensation -endowing the parts it there




478


AFFECTIONS OF


supplies with its peculiar sensibility by which the mechanism of deglutition is set in motion, and when morbidly affected, giving rise to a sensation of nausea, and
according to Romberg, to the peculiar sensation known
as the globus hystericus.
It is probable that the nervous sore throats we frequently meet with in practice, chiefly in females, characterised by a sense of heat, dryness, and pain, and sometimes redness of the fauces, but without swelling and
not interfering with the swallowing of food, are owing to
a state of hyperaTsthesia of this branch of the   par
vagum. We may take the following case as an illustration.
I was consulted on the 3d of August, 1855, by a
woman of 35 years of age, dark in complexion, and of
a nervous temperament, She complained of having for
six months suffered from a constant stinging pain in the
fauces, with an unpleasant sensation round the throat.
The pain was relieved by swallowing either solid or liquid
food. There was no swelling or redness discernible. It
was accompanied by a painful sense of weight between
the shoulders referred to the spine. For a week she had
also been affected with hoarseness, slight cough, and
some dyspncea. In other respects her health was good.
I ordered her a drop of the 3d dilution of Naja tripudians three times a day.  She returned on the 10th of
August, and reported her throat better, as also her voice
and cough, and complained chiefly of the pain between
the shoulders. The same medicine was repeated.     On
the 17th, she said her throat was now almost quite
well, the cough and hoarseness gone. She complained




THE NERVOUS SYSTEM.


479


of pain round the eyes, dazzling of sight, and much pain
in the upper part of the spine.    The Naja was continued. On the 24th, she was on the whole much better,
but a papular itchy stinging eruption had come out upon
the neck and shoulders, and small vesicles upon the
tongue.   She got Mercurius solubilis 4th dilution.  On
the 31st, the tongue was better, but the old sensation
had returned to a lesser degree in the throat. She again
got Naja as before. On the 6th of September she came
to say she had caught cold, which produced hoarseness
and beating pain at the vertex. She was ordered the
2d dilution of Belladonna.  She did not return till the
17th of October, an interval of about five weeks, and
then it was on account of pyrosis. In other respects
she had been   quite well. She had entirely lost the
uneasy feeling in the throat, from    which   she  had
suffered constantly for six months, and she felt altogether
a different person. She was ordered Mercurius solubilis,
and did not again return.
If this was, as I think, an affection of the pharyngeal
branch of the par vagum, it is rather curious to observe that as it got better, the morbid action seemed
transferred in some measure to the gastric branch of that
nerve.   " In the gastric distribution of the vagus," says
Romberg, "the neuralgia is ordinarily met with in three
forms; as a sense of constriction of the pharynx, of
burning in the oesophagus, and of tenderness in the
stomach.   The   first is known  as globus hystericus,
the second is included under the head of pyrosis,
and the last I term gastrodynia neuralgica."1 As to the
1 Vol. i, p. 104.




480


AFFECTIONS OF


treatment I attribute the cure to the Naja, the action
of which upon the nerves of the throat is remarkable.
While the gastric branches of the vagus are probably purely sensory, those which supply the larynx are
both sensory and motory; in virtue of the former
function endowing the larynx with its discrimination of
noxious and harmless air, and communicating to it the
sensibility which  sets in motion the mechanism    of
coughing; and as nerves of voluntary or semi-voluntary
motion presiding over the vocal apparatus. Thus it is
that hyperaesthesia of these nerves gives rise to spasmodic
coughs, (Romberg says even to hooping cough,) while
paralysis of some of the branches is one -of the causes of
aphonia.
The following case I consider an example of hyperaesthcsia of some of the laryngeal branches of the vagus,
probably the recurrent.  A  gentleman of 47 years of
age consulted me on the 28th July, 1855. He was thin
and sallow, and of a dark complexion. For many years
he had been subject to a sense of painful constriction
about the trachea, immediately above the sternum; he
could not draw a full breath, the inspiration felt arrested,
and resulted in a short cough.  On pressing the part he
said it gave him  an uneasy sensation.   I-Ie had had
occasional attacks of heemoptysis. There was no cough
in general, but every morning he expectorated a considerable quantity of sweet mucus. The pulse was small
and weak. lie had tried various climates, and been put
through the regular course of blisters, blue pills, &c.,
but hitherto he had got no permanent benefit.  On examining the chest I found that except unusual absence of




THE NERVOUS SYSTEM.


481


fat there was no symptom of disease. There was a
little irregularity in the heart's action, but not enough
to come under that name. The respiration was free over
the whole thorax. I fancied from the haemoptysis and
the obstinacy of the derangement of the respiratory
sensations, that there must be some tumour pressing
upon the par vagum, possibly an aneurism of the arch of
the aorta, and so I gave a very dubious prognosis as to
the result of the treatment. I ordered three powders of
the 3d trituratiuL-of Natrum  muriaticum, a dose three
times a day. He     returned in a week, and   to my
astonishment told me that after the first dose he felt
relief, and that now the uneasiness was entirely gone.
He could take a deep inspiration without either cough
or discomfort. The sputa were diminished to one third.
The pulse was fuller and stronger.   In fact he was
almost well. IH  continued quite well till this spring,
when he had a sharp attack of bronchitis, which yielded
to the ordinary remedies. I have seen him going about
within the last week or two apparently in perfect health.
Had this recovery occurred to a nervous woman, I should
have been inclined to impute it to some psychical action
on hysterical symptoms; but the person thus cured was
a remarkably sober-minded intelligent man, devoted to,the cultivation of a branch of science, who came at the
solicitation of his friends, and without almost any expectation of deriving much benefit from the treatment; so I
can ascribe the cure to nothing but the specific effect of
Natrum muriaticum.
I met with another case somewhat similar, of hypertesthesia of the pulmonary branch of the par vagum. As
the peculiar sensibility of the lungs which informs us
31




482


AFFECTIONS OF


whether we require to breathe or not, depends upon this
nerve, the exaggeration of this sensibility gives rise to
an unnatural craving for air, and produces the symptoms
known as nervous asthma.      Upon the 26th of last
February, I was consulted by a gentleman who was in
great alarm  about himself, as he had the impression
he was suffering from some disease of the heart. He
was abut 45 years of age, in the enjoyment of perfect
health, of most temperate habits, dining early, and taking
almost no stimulants and no supper; but for about a
fortnight he had been awakened every night after being
about an hour asleep, by an intolerable sense of suffocation; he was forced to sit up in the bed, and for about
half an hour or an hour, he felt as if the room, which was
a very large and airy one, was an exhausted receiver; he
felt as if he must die. This attack had occurred every
night and with increased intensity and duration each
successive time. After it was gone he was all right. I
gave him the 2d dilution of Nux vomica in pilules,
one to be taken three times a day.  He took one the
same evening, and had no attack. He took no more of
the medicine, and has continued perfectly free up to this
time with the exception of a slight threatening one night,
which was at once relieved by a pilule of the Nux. Nochange had been made in his diet nor in his habits in
any way.
While hypermesthesia of the laryngeal nerve produces
a tendency to spasms, their palsy or feebleness gives rise
to changes in the voice, ranging from slight hoarseness
to perfect aphonia. In order to understand how this
takes place, it will be necessary to advert briefly to the
vocal mechanism. The human voice is formed at the




THE NERVOUS SYSTEM.


483


opening of the glottis. During ordinary respiration this
aperture has a triangular form, and permits the free
passage of the air upwards and downwards. During
vocalization the base of this triangle almost disappears,
and the two sides approximate, and become parallel.
This has been observed in patients who have had an
opening in the throat, generally produced by an attempt
at suicide.   This change in the form of the glottis is
effected by the contraction of the lateral crico-arytenoid,
and the transverse and oblique arytenoid muscles. These
muscles receive nerves from the recurrent branch of the
vagus, so that palsy of the recurrent, we may assume
will prevent the change in the aperture, and be attended
with true aphonia.1 While the generation of voice seems
to depend upon the passage of a column of air through
a narrow slit, its pitch is modulated by the greater or
lesser tension of the reflection of mucous membrane
called the vocal ligaments.   This tension is due to the
contraction of the crico-thyroid muscles.     This muscle
as we have seen is supplied by the internal laryngeal
twig of the vagus. We may then fairly conclude that
when patients present themselves affected with complete
aphonia without any destruction or alteration in the
mechanical vocal apparatus, such as ulceration of the
cartilages, that the cause of this absence of voice is more
or less palsy of the internal laryngeal, while persons
whose voice has become simply deep and hoarse, and
who cannot emit the higher notes, are probably affected
SThis description is taken from Mayo's 'Physiology,' who follows Mr.
Willis's account published in the ' Cambridge Phil. Transactions' for 1832.
This description of the nerves is taken from Cloquet's ' Anatomy.' See
also Bell 'On the Voice.'




484


AFFECTIONS OF


with some degree of palsy of the branches of the recurrent which supplies the crico-thoroid muscles. This
may seem too great a refinement, and if it were advanced
speculatively from a study of the physiology of the parts,
I could hardly expect it to command attention. But the
fact is that from meeting many puzzling cases of aphonia
of various kinds, I have been forced to try and explain
them  by a reference to the distribution of the nerves,
whether successfully or not is another question.
For example, I was consulted on the' 26th of last
October, by a clergyman of 46 years of age.    He was
in perfect health, and enjoyed an unusual flow of high
spirits.  He told me that he had not the slightest faith
in homoeopathy, but having failed to obtain any relief
from the old system and from a two months' ramble in
Switzerland, he was induced to submit himself as a victim
to homoeopathy.   He spoke in a husky voice, and this
was his complaint. The voice was perfectly distinct and
loud, but sounded rough, as if he had a cold.  He said
he had been in this state for a year, and it was very
annoying to him in the performance of his clerical duties,
for it increased with prolonged speaking, and towards
the end of the service he found himself or fancied himself
almost inaudible from hoarseness. He was naturally
fatigued with the effort, and much disappointed to find
on his return from a complete rest and an invigorating
period of relaxation, he was just where he had been
before setting out, as far as the voice was concerned,
with his winter work before him.    I advised him    if
possible to get or take leave of absence for a few months,
for I hardly expected he would derive much benefit while




THE NERVOUS SYSTEM.


485


the cause of the malady was in operation. This however
he could not do. Besides the hoarseness he complained
of a frequent pain at the epigastrium, which seemed in
some way connected with the vocal infirmity, for he felt
it always worse after long speaking. I ordered him a
drop of the- first dilution of Conium, three times a day,
for a week.  He returned on the 2d of November, and
said the pain at the epigastrium was better or gone, but
there was no improvement in the voice. I then gave him
Belladonna the second dilution. He took this daily for
nearly a month, and his voice was muclh improved. He
then complained of a fungous state of the gums which it
seems he had long suffered from, and for this he got
Nitric acid. He took this medicine for nearly two
months, and I did not see him till the 25th of January,
when the voice was not so hoarse, and he said he had
been able to go through all his duties, consisting of two
whole services every Sunday, quite comfortably. I then
gave him the third dilution of Naja tripudians, and did
not see him again till the 6th of March, when he was so
well he did not want any more medicine. I attribute
the cure in this case chiefly to the Belladonna. It would
be interesting to know whether the hoarseness so frequent
among the English clergy, is due to the monotony of their
mode of delivery. It must be a great strain upon the
nervous apparatus to maintain the precise degree of
tension of the vocal chord required to produce this effect
for so long a time. I am not aware whether this affection is met with less frequently among speakers, whether
preachers or barristers, who exercise a much larger scale
of modulation in their ordinary delivery. My impression




486                AFFECTIONS OF
however is that it occurs with undue frequency in the
clergy of the English Church.
The next case I met with was very different. On the
the 10th of last December I was consulted by a strong
robust butcher, who was the very personification of rude
health. He might have sat for a picture of John Bull.
He was about 40 years of age, and there was something
perfectly ludicrous to hear him speak, for instead of the
great manly voice which one expected from so lusty a
man, he could only emit a faint whisper with the greatest effort. There was no tenderness about the larynx,
nor any cough, and in all other respects he was quite
well. For several years during the whole of the winter,
he had been subject to this loss of voice. It began by
huskiness, and went on to such complete aphonia as to
render him quite inaudible. This I suppose was from
an affection of the recurrent, for it was more than the
mere hoarseness which we might ascribe to the insufficient tension of the vocal ligaments. The cause he
suggested to be his exposure to cold in his open shop,
and being obliged in the exercise of his trade to talk a
good deal, in making bargains I suppose.  He was of
temperate habits.  I gave him the second dilution of
Belladonna, a drop to be taken three times a day for a
fortnight.  He returned at the expiration of that time
greatly improved, and the medicine was repeated. I
heard from him afterwards in about a month that he was
perfectly well, and his voice as strong as it was in
summer. He lived at some distance from me, and I have
had no opportunity of satisfying myself as to the correctness of this report, which however I have no reason to
doubt.




THE NERVOUS SYSTEM.


487


The following case presents some interesting points of
contrast to that of the lusty butcher.
A married woman of 44 years of age consulted me on
the 19th of May, 1854, and complained of dry husky
feeling in the throat, and great sense of weakness.  She
spoke in a whisper and could not speak louder.   She
stated that she had suffered from this loss of voice for
eight months, and that she was subject to it from any
depressing emotion. She was feeble and languid, the
pulse weak, and she had little appetite. I gave her Naja,
and on the 29th she said the unpleasant husky feeling
was gone, but there was no improvement of the voice.
I then gave her the first dilution of China; and after
taking this for a month, she got quite well. In this
instance the aphonia was evidently dependent upon the
general condition of the system, and not merely a local
affection of the vocal organs. This accounts for the
benefit produced by the China, a.medicine from which I
have frequently seen similar good effect in such cases.
Under the head of hyperaesthesia of the cutaneous
nerves, Romberg makes the following observations. " The
expression of this variety of hyperoesthesia consists in a
sense of pain, itching, formication, and heat; pain is the
most frequent symptom, and for this reason the term
neuralgia has been used to designate it. These sensations come on in paroxysms, and are confined to the
distribution of one or more of the cutaneous nerves, of
one or occasionally of both sides of the body.  Injuries
of the nerves may serve as types of this affection; because they may, as surgical operations generally are, be




488


AFFECTIONS OF


looked upon in the light of experiments which afford a
more distinct interpretation of natural conditions. Neuralgia from injury of a nerve may be known by a pain
commencing at a definite point in the course of a nerve,
by its distribution to the peripheral terminations of the
nerve, by excitement or exaltation of the pain by the
slightest touch of the injured part, and by cessation
of the pain when compression is applied above the seat
of the injury.  Sooner or later sympathies in other nerves
not only in the vicinity but also at a distance from the
original seat show themselves, and if the pain continues
for a long time, a constitutional disease is developed.
Punctured wounds, cuts, bruises, and foreign bodies are
the most frequent causes. The pain occurs in paroxysms,
and is produced or increased by change of weather,
affections of the mind, and errors in diet.  The purest
form of neuralgia is when the injury affects any sensitive
nerve, such as the subcutaneous nerves; it becomes
blended with symptoms of a motor character, when those
causes are seated in a nerve containing sensitive and
motor fibres."
CASES.
"A young lady, aged 16 years, while engaged in acquiring the art of cooking, pricked the middle finger of
the right hand, on the radial side between the second
and third phalanx. Violent pains ensued at once, and
inflammation set in some days afterwards with an eruption of phlyctenae accompanied by a dusky redness of the
hand and forearm. Suitable remedies removed the inflammation, but a painful sensation remained in the
finger, which was increased by contact, or spontaneously




THE NERVOUS SYSTEM.


489


and frequently induced sympathetic sensations in the
hand, arm, neck, and leg of the same side. Whenever
the patient becomes otherwise indisposed, the finger is
the most painful part.   The repeated use of the seabaths, at Norderney, has effected a remission but no cure.
At a later period, spasms in the distributions of the
facial and accessory nerve of the same side supervened."'
The following case I am inclined to consider an illustration of this affection.  On the 8th of October, 1855,
I was consulted by a lady who lives in a town at about
twenty miles' distance. She was about forty years of age,
looked very infirm, and had a peculiar puffy expression
of countenance. She stated that she had always been
delicate. She had had a large family, and ascribed her
present exhaustion to the copious haemorrhage which
attended her confinements. She had long been subject
to cough and pain under the right infra-clavicular region.
She was in her usual state of health in May, 1854,
when she pricked her fore finger with a sewing needle;
the wound was utterly insignificant, but very soon after
she was attacked with violent pain going up the arm as far
as the neck. After the pain had lasted for a week, the
arm became red and swelled. These symptoms continued for a fortnight and then gradually subsided. She
remained pretty well till the following September, when
she had a similar attack of pain and swelling without
any known exciting cause. Then in December both
hands and arms became affected, first with pain, then
with swelling, redness, and blisters. Since that time she


1 Romberg, op. cit., vol. i, p. 18.




490


AFFECTIONS OF


has been subject to such an attack about every three
weeks, and this corresponds with the appearance of the
catamenia. The attack is ushered in by intense headache, and a loss of appetite, and general sense of illness.
I found the pulse full, quick, and jerking, the tongue
coated.   She complained of loss of taste as well as appetite. She has been taking tonics of all kinds, but is
so weak that she is hardly able to walk even about the
house. I gave her Aconite 2d dilution, and Graphites
4th dilution. The first to be taken for two days, the
other for a fortnight.  On the 20th she was better, and
Graphites was repeated. I saw her again on the 14th of
November, she came with her hand bound up. She had
hurt the finger again with a piece of glass, and there was
a return of the pain and swelling of the hand and arm.
I gave her the 3d dilution of Naja tripudians, a dose
three times a day for a fortnight. On the 28th of November, she reported herself as much better every way,
and she went on with this medicine till the 23d of
February. The change in her appearance at this time
was most striking; she had lost her languid look, was
strong and more robust, she could walk several miles a
day, her appetite was good, her taste had returned, and
she had had no attack of her old complaint for four
months. The only medicines she has had since are
Sulphur and China, and she now considers herself as
quite well.
Cases of this kind throw light upon such diseases as
herpes zona, which seem to arise from some general derangement of the system, producing a neuralgia which
localises itself in the subcutaneous nerves of the side,




THE NERVOUS SYSTEM.


491


and gives rise to a vesicular eruption. It was from the
benefits I have seen from Graphites in this affection,
that I was led to begin the treatment of the foregoing
case with it. To the Naja, however, I consider the chief
credit of the cure to be due.
ON SOME LESIONS OF THE NERVOUS CENTRES.
IN the preceding section I related some cases illustrating morbid affections of certain nerves: I propose
now to direct attention to some affections of the brain
and spinal cord.
The first member of this class, in point both of importance and frequency, is undoubtedly epilepsy. I do
not intend, however, to enter upon a general discussion
of this dreadful malady, but I mention it that I may
have an opportunity of repeating, that hitherto my experience has been more in favour of Belladonna than of
any other medicine in the treatment of epilepsy, and
that I have found benefit in many cases of long duration and great severity by persevering for years in the daily
use of Belladonna; and I wish also to mention a curious
case that is now under my observation, as illustrating
the pathology of the disease.  Dr. Brown-Sequard states
that he found he could produce true epileptic attacks in
certain animals by wounds of the spinal cord-at least a
series of general convulsions returning at regular or irregular intervals. From this he argues that epilepsy is
in some cases owing to a morbid condition of the cord,
a state of preternatural irritability, and he agrees with
Dr. Marshall Hall in supposing that the immediate cause
of a fit is the closing of the larynx and the suffocation




492


SOME LESIONS OF


of the epileptic person, that this prevents the entrance of
air into the lungs, that the blood is no longer arterialised,
and that venous blood acts as a direct irritant poison to
the spinal cord.  This theory represents the conditions
of epilepsy to be a chronic state of preternatural irritability of the spinal cord, which gives a tendency to spasmodic closure of the larynx, that the suffocation thus
induced converts the chronic into an acute condition, and
the paroxysm is owing to the venous blood permeating
the cord, which is morbidly sensitive to this poison. Now
I have under my care a case of cyanosis, and the unfortunate subject of this congenital malformation, besides
the ordinary symptoms of the disease, is subject to
attacks of general convulsions of his whole body, on any
exposure to an unexpected excitement, such as a sudden
noise, intelligence of a painful or pleasurable character,
in short everything which excites the nervous system
either morally or by sensation, produces an attack of
general convulsions which lasts from    ten to   twenty
minutes, and resembles true epilepsy in every respect
but one, and that is he never loses his consciousness,
but gets excited.  Is the cause of these pseudo-epileptic
fits the presence of semi-venous blood in the arterial
vessels of the spinal cord P1
I cannot resist the observation that the action of Belladonna both on the brain, the spinal cord, and the nerves
of the larynx, has a marked affinity with this view of the
pathology of epilepsy.  Dr. Marshall Hall classes epilepsy with hydrophobia, as in both the spasms of the
larynx are of the greatest importance, and Dr. Brown1 I asked Dr. Marshall Hall his opinion of this case, and he replied he
would ascribe the symptoms to the cause suggested in the text.




THE NERVOUS CENTRES.


493


Sequard represents epilepsy as curable by cauterizing
the larynx so as to prevent its being thus affected by
spasm. Of the power of Belladonna over spasms of
the larynx there is no doubt, and thus this remedy may
act beneficially by at once modifying the preternatural
susceptibility of the cerebro-spinal centres, the predisposing cause of a paroxysm, and arresting in its incipient
stage the spasm of the larynx through which the smouldering disposition to a fit is roused into active reality.
I once had another very interesting case under my
charge, the history of which presents the following outline: a young man, of perfectly temperate habits, addicted to athletic sports and to no vicious indulgences
of any kind, and usually in the enjoyment of excellent
health, mounted his horse for a ride. Before he had the
reins in his hand, his horse bolted off at full gallop and
made for a low open stable-door.  Seeing that if he allowed himself to be carried into it he would be killed,
he threw himself off, and fell upon his head. He was
picked up and put upon the horse again.     He rode a
little way with a friend, who observing his manner strange
took him back to his house. On arriving at home, he
was lifted from his horse and laid upon a sofa; it was
then found that his skull was fractured. He remained
unconscious for some time, and then had a brain fever.
He has been an invalid ever since, a period of above
twenty years. He now states, that from the time of his
fall to the time of his recovering his senses after the
fever, he remembers nothing; that he must have acted
automatically, or, as Dr. Marshall Hall would say, by the
reflex action of the spinal cord alone, without any cere



494


SOME LESIONS OF


bral activity, and in this condition he rode some lalf
mile, and spoke, although incoherently.
At present he is rather thin, and his countenance has
an anxious expression, otherwise to the casual observer
he seems to be perfectly well. But he complains of
feebleness of his limbs, and is exhausted by a short
walk or by any excitement.  There is a mark upon the
right posterior and inferior part of his head, about three
inches in diameter, with two eminences where the skull
was fractured, and there is constant numbness there and
sometimes pain. Besides, he complains of pain rising
from a sensation of weariness to considerable severity on
any fatigue, at the lower dorsal and upper lumbar vertebrae.  This he has had since his fall.  He also is much
distressed by a dragging sensation in the testes, and
seminal emissions produced by any mechanical irritation,
as riding, with total absence of all erotic feeling, and
entire impotence.   His dreams are very peculiar; he
fancies that he is swinging to an immense height in the
air, head foremost, the swing is across the dome of St.
Paul's. This is a frequent dream, and has been for
years.  His nights are very restless.  His appetite and
digestion are good, but when he first consulted me he
suffered much from   constipation.  His pulse is rather
feeble; he gets soon chilled.
Such are the most striking features of a case which
presents many interesting traits. We may assume a
serious lesion of the posterior part of the brain, and
possibly of the cerebellum, as certain, but whence comes
the pain of the back? There are three possible causes.
He may have fallen upon his back after striking his
head; or it might be a contre-coup, the shock of the




THE NERVOUS CENTRES.


495


spinal cord resulting from the pitch on the head; or, lastly,
it may be that the cerebral and cerebellar lesion has excited a preternatural sensitiveness of the genital organs,
which act by their nerves upon the spinal cord, and that
this has induced a permanent weakness of the part.
The peculiar dream of swinging upwards is very interesting. We know that injury to certain parts of the
brain induce a tendency to turn or to roll, while cutting
other parts makes a bird try to soar.  Now, doubtless,
'this dream of ascent is in consequence of an injury to
the same parts of the brain in this patient as corresponds
with that part of the pigeon's brain the injury to which
prompts the bird to mount.  The reason of the sensation
only occurring in sleep and giving rise to a dream, and
not a movement, is obviously that the attention is too
occupied in the waking condition with external impressions or internal perceptions and emotions to be alive to
this dull, dumb, excited, animal instinct.  It is satisfactory to be able to say that this patient improved by
treatment. He got much stronger, he sleeps better, and
has fewer uneasy sensations. The medicines which did
it were Naja, Silica, and Arnica.
The next case was also the result of an accident.  I
was consulted last March by a remarkably large, robust,
and powerful man, 40 years of age, who stated that
four years ago he fell from the top bf a house, a height of
forty feet; he lighted upon a flat surface and quite prostrate, so that his abdomen was the first part of his body
to come in contact with the ground. From that day he
became the victim of constant pain felt in all parts
of the body. The moment he awakes in the morning he




496


SOME LESIONS OF


is sensible of severe pain in his back and loins, which
extends to the shoulders and arms and down the legs.
He has never been without this since the accident, but it
varies much in degree and is aggravated by exertion.
There is no headache or numbness, no wasting of the
muscles, the appetite is good, the urine natural, and the
sleep sound.   The bowels are sometimes bound and
sometimes relaxed. There is no pain on pressure either
of the abdomen or back. The treatment in this case
was followed by speedy and complete cure. For a fortnight he got Naja, but reported himself no better; he
then got Belladonna, and returned on the following week
free of all pain.  I saw him  last on the 11th of this
month (May, 1857), and he was still perfectly relieved
of the sufferings which he had endured without intermission for four years. The pathology of this case I
take to be a shock to the spinal cord, either direct or indirect; in the latter case it must have been transmitted
by the nerves of sensation to the posterior column, and
given rise to a morbid action which displayed itself by
a general hypermesthesia.  The rapidity of the cure in
this case was quite unexpected, and is a proof on how
slight an organic derangement a constant and severe
perversion of function may depend.   I think the case is
interesting, as throwing light upon the possible cause of
disordered action in what is called spinal irritation.
There are three distinct classes of spinal affections,
presenting certain common features, and sometimes
difficult to discriminate from one another, but radically
different in their nature, and, consequently, in the treatment they require.  Under the first head may be classed




THE NERVOUS CENTRES.


497


those serious cases of structural disease of the spinal
cord which go on from bad to worse and terminate in
permanent contraction or palsy of the limbs, or slowly
improve and eventually recover. Under the second head
we may class all cases of idiopathic spinal irritation, and
under the.last head cases of sympathetic spinal irritation.
The following case, reported by Abercrombie, is a good
illustration of the first class: "A  medical gentleman,
aged 30, who had been for several years in the navy,
returned home in perfect health, and was living in
Edinburgh, when he was observed by his friends to drag
his legs awkwardly in walking. He was not himself at
first sensible of it, but soon perceived a weakness and
want of command over both his legs, which gradually
increased to nearly perfect paraplegia.  Some time after
the affection of the legs took place he began also to lose
the power of his arms, and this also increased till he retained in them only a very feeble and unsteady power of
motion. They were also frequently seized with convulsive startings, so that an article which he attempted to
hold was thrown from him with violence. The legs
often started in the same manner, and were thrown about
with considerable violence, especially when he attempted
to move them while he was sitting up;   No disease could
be discovered in the bones of the spine, and he was otherwise in good health, until about two years after the commencement of the complaint, when he was seized with
phthisis, of which he died, in September, 1822. I examined
the body with the utmost care, and could not discover a
vestige of disease, either in the brain or the spinal cord."
That in this case there was some inscrutable structural
32




498


SOME LESIONS OV


disease will hardly be doubted, and most probably the
patient would have been incurable under any treatment.
I have had several such under my care, and the result
has been most unsatisfactory. But it is impossible at
the outset to distinguish between a curable and an incurable case of this sort.
For example, I was consulted, in September, 1855, by
a man who walked with great effort, supported by a
stick in each hand. He stated that seven months before he had been exposed to cold and wet, and soon afterwards he began to suffer from pain in the lumbar region of
the spine,which gradually extended upwards, and that soon
afterwards he felt a numbness and stiffness in his legs.
These symptoms had increased up to the time of my seeing
him.   He complained then chiefly of weakness in his
legs and back, and it was with the utmost difficulty he
rose from his seat, and shuffled along with the assistance
of his sticks. In other respects he was quite well,
except that his legs were always cold, and his urine too
copious. He had been for six months in a hospital
before he applied to me. This man got quite well.
Secale was the first medicine he got, and it seemed to do
him good; the other medicines which apparently were
most useful were, Sulphur, Arnica, Silicea, Rhus, and
Naja. The cure occupied about six months, and he was
then able to resume his work.
I had another striking case of a woman 60 years of
age, who for two years had suffered constant pain in the
back, with numbness of the legs, and almost total inability
to use them.    She gradually improved, and    almost
wholvl recovered under the use of Secale, which she took
steadily for about three months.




THE NERVOUS CENTRES.


499


Although the term spinal irritation has been vaguely
applied, surely Romberg goes too far when he says: " If
we substract the spinal pain which accompanies the
diseases of various organs, for instance, the stomach or
the liver, and which is increased by internal pressure,
and often associated with pain at the epigastrium, the
doctrine of spinal irritation is deprived of its entire
foundation, and takes its place among the fictions which
have always found their way into pathology when physiology was undergoing a revolution, and hence for a time
have been admitted as matters of fact."'
Abercrombie, more philosophical, and as cautious as
Romberg, always on his guard against admitting speculations in place of facts into pathology, contents himself
with observing: " When we find, along with the complaints now mentioned (what we should term spinal irritation), symptoms distinctly referable to the spine, as
pain or tenderness on a particular spot, it is fair to consider this as directing our attention to an important seat
of disease: but there is no doubt that these affections
often appear without any symptom that can be referred
to the spine, and in many cases with sources of irritation
distinctly referable to other organs."  The difficulty of
recognising a morbid condition with certainty, and of
describing it with such exactness as to secure its recognition by all competent observers, is no reason for denying its existence. No doubt spinal irritation is often
complicated with hysteria, generally with uterine derangement, still we not unfrequently meet with it as so well pronounced an individuality as to be unmistakeable and


SRomberg, vol. i, p. 155.




500


SOME LESIONS OF


unquestionably worthy of a name.    Here is a case in
point:
I was consulted, in March, 1856, by a lady about 30
years of age, who gave the following account of herself.
She said she had been delicate from her childhood, had
gone through both scarlet and typhus fever, and suffered
from suppuration of the ear in early youth; that about
four years ago she was attacked with cough, attended
with tightness of the chest and slight hamoptysis, for
which she was sent to the Isle of Wight, where she soon
recovered from all her chest-ailments, but was from that
time affected as at present.  The affection I found to be
excessive tenderness of the spine at the third and fourth
dorsal vertebrae; this was so great that she almost fainted
when I made the necessary examination; and I was
sent for early the following day to try and relieve her of
the extreme pain she had endured ever since I had
examined her. She had not slept during the whole
night, and could hardly help moaning. Besides this
extraordinary tenderness of the spine, she complained of
a short nervous cough; frequent shooting pain in the
head, brought on by fatigue, relieved by going to bed;
occasional swelling of the throat; neuralgic pain in the
face; general languor and insufficient sleep. The catamenia were quite regular; there was constipation of the
bowels.
Here was a case in which it was impossible to mistake
the focus of the malady. There was manifest affection
of the spinal cord, for no other morbid condition could
have produced such long-continued pain in the spine




THE NERVOUS CENTRES.


501


aggravated by pressure. This morbid condition was not
derived from the uterus, the functions of which were unimpaired, nor from any other viscus. It was an idiopathic
affection of the cord; and what Dr. Romberg would
have called it I don't know; but for all practical purposes
the term " spinal irritation " is good enough.  It is true,
had the patient died a post-mortem    examination would
have revealed as little as in the case reported by Abercrombie, already quoted; but he did not on that account
hesitate to refer the symptoms to some morbid change in
the spinal cord, although he was unable to discern any
such change.    We are equally entitled to affirm     the
existence of a disease of the cord in this instance, although
we cannot form any conjecture even what the precise
nature of that change is. There was no opportunity in
this patient for such a scrutiny as Romberg requires, for
under the use of Arnica, Belladonna, Naja, and Sulphur,
she got quite well in about eight months, and when I
last heard of her, she was in the enjoyment of so much
health and strength as to be able to nurse an invalid sister.
In cases like this one, of pure spinal irritation, I have
great confidence in Arnica, Belladonna, and Naja.
Although the severity of the pain, and general sensitiveness of the system seems to indicate excess of vitality,
at least of nervous irritability, yet the experiments of
Brown-Sequard rather point to an opposite conclusion.
He found that a transverse section of the posterior
columns of the spinal cord, instead of destroying or
diminishing sensibility, was followed by a notable increase
of sensibility of almost all the parts of the body behind
or below the section.7
1 ' Medical Times and Gazette,' April 26th, 1856.




502


SOME LESIONS OF


We frequently meet with another variety of spinal
irritation  where there  is also great   pain, but not
attended with the languor and general hyperzesthesia;
rather a sort of neuralgia of the spine. For this I have
found Veratrum very useful.  I look upon the distinction
of the varieties of spinal irritation as very important, as
probably the dissimilarity of the sets of symptoms
depends upon some radical difference in the morbid
change in the spinal cord.  Neuralgic affections, although
sometimes associated with spinal irritation, are a class of
themselves; and Romberg observes that " Vaillez and
others have made valuable contributions to our knowledge of cervical and intercostal neuralgia, and that alone
has withdrawn a large class of affections from the sphere
of spinal irritation, which its advocates are peculiarly fond
of appropriating." The following case of intercostal
neuralgia affords a good illustration of its entire dissimilarity from spinal irritation.
A woman of 50 years of age, consulted me, on the 8th
of November, 1854.     She stated that for ten years she
had suffered constant severe pain in the chest under the
left mamma.    For the last two months it had been very
violent.  She had vomited blood.   The affected side felt
either too cold or too hot, generally the latter.   The
appetite was good and the digestion healthy. She got
Ranunculus bulbosus, and came back in a week to report
herself better.  The same medicine was continued with
good effect, and, along with a few doses of Nux vomica,
entirely removed the pain.
There remains for our consideration the third class,




THE NERVOUS CENTRES.


503


which we have called sympathetic spinal irritation.  The
term is objectionable, but may answer provisionally, to
distinguish all those affections of the spinal cord which
depend upon excessive or irregular action in the other
organs, from those which have their origin in the cord
itself. The first peculiarity that strikes one about this
last class is, that it is almost exclusively confined to the
female sex.  The pains in the back which we meet with
in men are chiefly rheumatic, unless they be from kidney
disease, and they are comparatively rare. Among women
they are almost universal, and differ chiefly in degree.
The reason of this is manifestly the heavy periodic
demands upon the centre of the nervous system to enable
the catamenial discharge to take place.  This regularly
recurring effort at reproduction is attended with more or
less of excitement and exhaustion. It involves in a slight
degree what its completion, so to speak, conception and
parturition, involve to a very great amount, a sacrifice of
the individual vitality to the maintenance of the race.
This is Nature's interdict against the insane attempts to
assimilate the sexes in regard to their work. A woman
for some thirty years of her life is subject to a periodic
weakness, which should be more or less indulged by a
certain degree of repose from toil, otherwise her constitution suffers. This is probably the reason why needlewomen come in such crouds to consult us for pain and
weakness of the back; while, for my part, I do not
remember to have had a single shoemaker or male tailor
suffering from this cause.  Now, although needlewomen
may sit somewhat longer than shoemakers, still the lonig
twelve hours' seat of the shoemaker would undoubtedly
break down a great number of women.




504


SOME LESIONS OF


That the spinal cord is exhausted by these efforts,
especially the parturient one, is too certain. I once had
under my charge a most melancholy illustration of this.
The case is as follows:
A lady of about 40 years of age had been in the enjoyment of good health till after the birth of her last
S   child, which is three years old.  She had eight children
in thirteen years. Soon after her confinement she began
to experience a difficulty in walking: she could not lift
her feet well. She then felt numbness in her hands and
arms, and occasional severe pain. These symptoms
gradually increased till she became so powerless in her
legs as to require to be lifted on all occasions.  Besides
the inability of voluntary movement, she was subject to
violent pain at particular parts of the limbs-one spot
never free from pain was the insertion of the biceps
muscle of the left arm-and to various muscular spasms:
her legs, for example, would be suddenly and strongly
extended and grow quite stiff, and at other times one
or both would shake violently without her being able to
check it. Her sight was dim, and for some time she
complained of stiffness of the muscles of the face and
tongue.    These and various other unequivocal evidences of some central lesion of the nervous system,
went    on  steadily  and   latterly rapidly increasing,
notwithstanding the most careful treatment in every
respect, and the administration of all our most potent
remedies.
The medicines certainly seemed to do good for a
time, but the benefit was very temporary.      I thought
Plumbum carbonicum was one of the most useful.




THE NERVOUS CENTRES.


505


In this instance there can be little doubt that the
mother's life was thus compromised for the sake of her
offspring, and that if, instead of having had eight, she had
had only three children in the thirteen years, she would
now be alive and well. Such cases prove the heavy
draught upon the spinal cord of the process of uterogestation and parturition; and it seems to. me that they
stand in opposition to an axiom of Dr. Marshall Hall,
that involuntary reflex actions are not attended with exhaustion of the spinal cord, and that this organ does
not require for itself the refreshment of sleep.       In
proof of this view, Dr. M. Hall refers to the long flight
of certain birds, which he believes to be carried on
without any wear and tear of the nervous functions, by
their reflex action alone. But are not all the relations
of the uterus and other genital organs to the spinal cord
of the reflex character, that is independent of volition?
Yet, as we see, there is nothing which so exhausts the
nervous system.
The whole subject of the relation of the spinal cord
to the organs of secretion and involuntary muscular
action is one of great difficulty, and we must wait for
fresh light from the researches of physiologists.  In the
mean time, although we occasionally meet with a disheartening case such as the one I have just referred to,
yet it is consoling to observe that the large majority of
cases of sympathetic spinal irritation, whether those
depending upon exhaustion of the spine or of transferred
irritation from irregular action, are remarkably under the
control of homoeopathy.
For example: A woman, 45 years of age, consulted




506   SOME LESIONS OF THE NERVOUS CENTRES.
me, on the 11 th of February, 1857, and thus stated her
case. The catamenia had ceased the previous August,
and from that time she had never been free of pain in
one side of the head, coming on in paroxysms of great
severity.  She is also daily subject to pain in the right
arm, which, when it comes on, causes contraction of the
muscles, and makes the arm quite useless; the muscles
of the orbit are also affected, and the eyeball misdirected.
There is little appetite, but in other respects she is in
good health. I gave her the 3d dilution of Naja, a dose
three times a day for a week. She returned at the expiration of that period and reported that she had not been
so free from pain for three months.  She could use her
hand and arm to cut her meat, which she had not
done for that length of time. The niedicine was continued, and in another week she reported herself as free of
all pain, except in the back. This pain in the back remained, notwithstanding various medicines, for three
months, when, after a course of Sepia, the catamenia
reappeared, and she got well-at least, she ceased to
come, and I have every reason to presume she was and. is
well.
The case is curious as illustrating the transference of
an irritation of the spinal cord, produced by want of
uterine action, to the nerves of the head and the muscles
of the arm, its return to the spinal cord, and eventual
cure by the restoration of the function.




507


ON EPILEPSY.
There are few diseases, if any, more interesting to the
practitioner, and especially to the homoeopathist, than
epilepsy.  It is one of very frequent occurrence: out of
3636   patients treated   at the  London    Homceopathic
Hospital, 191 were epileptic.   It is one not less mysterious in its nature than uncertain. For example, we
find that out of the 191 cases which were treated at the
London Homceopathic Hospital, 38 were reported as
cured; out of 16 cases treated at the Leipzig Dispensary in 1854, 6 were cured; while at the same institution during the following year, out of 10 cases there
was only one cure.1     Out of 51 cases treated at the
Hahnemann Hospital there are no cures recorded, nor of
the 3 cases reported as having occurred in the Manchester Hospital.    This enormous diversity    of result
suggests a corresponding difference in the character of
the cases, for the treatment was doubtless much the
same in all, and, indeed, the results of two years in the
same institution present almost as great a contrast as we
meet with in the series.    On what, then, does this difference depend? This question implies a previous one.
What is epilepsy? It is briefly described by Dr. Watson
as " a temporary suspension of consciousness with clonic
spasm, recurring at intervals."'  If we accept this definition, we exclude from    the title of epilepsy all cases of
1 ' -om. Vierteljahrschrift,' 185-1-55.
2 'Lectures on the Principles and Practice of Phyic,' by Thomas
Watson, M.D., third edition, vol. i, p. 621.




508


EPILEPSY.


convulsions which consist of one single attack, and this
is by no means an inconsiderable class.    For example,
many children have what is called a teething-fit, and in
most treatises on the subject such fits are represented as
being of a true epileptic character.  The same may be
said of the fits which not unusually attend intestinal
irritation and child-bearing.   In  short, this definition
limits the use of the term   to cases where the disease
presents itself as one of a periodic kind, and suggests
the suspicion of its origin being in the centre of the
nervous system, the brain or spinal cord, and not in any
irritation of the peripheral nerves. Perhaps this is the
juster view to take, but it is opposed to the uniform
practice of all writers from Hippocrates downwards, not
excluding Dr. Watson himself, who in this matter falls
into a self-contradiction.  That epileptic attacks begin,
in some cases, by an irritation at the circumference, is an
indisputable  fact.   Romberg'     relates the  following
case, which came under his own observation, in proof of
this.
" A labouring man of robust constitution, who applied
for relief in the Policlinique, had fallen, three years previously, upon his right knee, in consequence of which
the joint had become disorganized.     The patient had
from this period suffered from epileptic attacks. The
aura epileptica commenced as a creeping sensation in the
large toe of the right foot; from here it mounted upwards along the inner surface of the leg and thigh, and
ended in the epileptic seizure.  In this case the aura did
not proceed from the seat of the injury, the knee-joint;


1 ' Diseases of the Nervous System,' vol. ii, p. 210.




EPILEPSY.


509


but when we consider the sensibility of the integuments
at the inner side of the knee-joint, as well as those of
the large toe, is derived from the same nerve, the saphenus
major, the connection between the aura and the cause of
disease seems undeniable."     This is a very instructive
case, for it seems to prove two things: first, that epileptic
convulsions may really be caused by some injury to the
peripheral nerves, and this is confirmed by many similar
cases on record; and, secondly, that the aura which is
referred by patients to the extremity of the nerves, may
be caused by some morbid action at some point nearer
the centre. In Romberg's patient the knee was the
" fons mali," but when there is no obvious injury, it is
impossible to tell whether this curious sensation be really
of central or peripheral origin. The whole subject of
this aura epileptica seems to require further observation.
It has been probably too hastily adopted as a pretty constant feature in epilepsy upon conjectural grounds. That
an impression made at the surface should be conducted
like an electric current up the nerves till it reached the
brain, where it exploded the accumulated nervous irritability, and produced a convulsion, seems a sort of notion
tacitly conveyed, both by popular and medical writings.
And yet when we investigate this mysterious aura, we
find that its very existence as a precursor of epilepsy
is denied by some of the best observers, while its explanation, on the other hand, is probably quite different
from that commonly received. Dr. Pritchard,' a very
accurate writer, says of this so-called " aura:"   " This
symptom is usually termed by medical authors.the aura


' On Diseases of the Nervous System,' p. 88.




510


EPILEPSY.


epileptica, and it is described by them as a sensation of
a cold vapour affecting the part and rising upwards.  I
have met with a great number of patients who have perceived the affection alluded to, but I never once heard it
described in this way, though I have been very minute
in my inquiries. It is generally represented as a convulsive tremor commencing in a limb."    Although Dr.
Pritchard rejects the term aura, yet he fully concurs with
other observers that some peripheral agitation precedes
the fit. The question that next occurs is, whether these
muscular tremors arise from    an irritation propagated
from  the brain and forewarning   the attack, like the
rustle of the leaves before the tree is bent and shaken
by the tempest, or whether this symptom is the first link
in the series of actions, which, if repressed, would terminate the whole. In certain instances, the latter inference seems the just one.      " Sometimes,"   says Dr.
Pritchard, " there is even a perceptible convulsion of the
large muscles of the limb, as in the case to be adduced
below, in which the patient averred, that by grasping
firmly the muscles of the leg in which the agitation
began, she could prevent the attack of coma."    There
may indeed be a doubt whether the cause of the arrest,
supposing the woman's statement be true, may not have
been owing to a powerful effort of volition acting consciously towards the leg, and unconsciously towards the
brain; for, in a case related by Dr. Seymour, an epileptic
boy was in the habit of arresting a paroxysm by biting
his tongue. We may safely conclude that if the so-called
aura ever do arise from the circumference, it is at best
a very rare occurrence.
There is no doubt, that in the vast majority of in



EPILEPSY.


511


stances, the perturbation of sensibility at the extremities
of the nerves is from a morbid action at their origin,
vwhich, on its transmission along the branches, produces
at the same time a muscular convulsion and a peculiar
sensation.  And it is certainly most unaccountable,
that if this excitement be prevented from reascending to
its original point of departure, the fit is sometimes cut
short. A case of this kind is recorded by Odier,1 of a
soldier, who, in consequence of a sabre-cut across the
left side of the head, became subject to convulsions,
which always began in the little finger of the right
hand, and gradually extending up the arm to the
shoulder, ended in a true epileptic seizure; he found
the epileptic attacks prevented by tying a cord tightly
round the arm in two places. By this simple expedient he staved them  off for three years, but, mLfortunately, being attacked on one occasion when intoxicated,
he was unable to employ his accustomed preventive, and
a fit came on which ended fatally. The post-mzortemn
examination disclosed a tumour on the surface of the
brain, connected with a depressed lamella of bone, where
the wound had been received. Had the history of this case
not been so fully known, it is one which might naturally
have been cited as an example of epilepsy commencing
at the circumference, from its first manifestations being
there, and from its being cut short by the arrest of
the peripheral agitation. This teaches us caution how
we accept such explanation in cases where the state of
the brain is not ascertained.
Romberg mentions a very curious fact, on the autho

'1 Medecine Pratique,' p. 181.




512


EPILEPSY.


rity of Dr. Sch6nbein, " that in several patients who were
blistered, he observed that immediately before the fit the
serum  assumed an acrid character, as in Humboldt's
galvanic experiment."  The inference Romberg draws
from this is, that as yet we have not paid sufficient attention to the changes induced in the sphere of nutrition
by that disordered condition of the nervous system on
which epilepsy depends.   This seems a very important
remark, and one which has a directly practical bearing,
for if the derangement of the digestive organs be the
consequence and not the cause of the epileptic condition,
it is pretty evident that the remedies suitable to cure
gastro-intestinal irritation of an idiopathic kind may have
little effect in correcting the morbid state of the nervous
system on which epileptic dyspepsia, if such a term may
be used, must be supposed to depend; and that a practitioner who follows a superficial symptomatic course of
treatment, instead of a deeper pathological one, will
probably be disappointed in its results. For example, in
Dr. Laurie's '.Practice of Physic,' almost the only systematic work we have upon our therapeutic principle, we
find the following headings, each succeeded by an enumeration of its appropriate remedies.  Epilepsy "from
plethora, with determination of blood to the head;"
" from debility, caused by loss of hiumours," "from the
irritation of worms," " from teething," " from hysterical
affections," "from the retropulsion of an eruption," "from
the abuse of intoxicating drinks or narcotics," "from
Mercury," "from checked perspiration," " from exposure
to the fumes of Arsenic and copper," "from moral
causes, such as fear, &c.,"   "from   crudities of the
stomach," and " from an injury of the head."    Under




EPILEPSY.


513


every one of these headings we find Nux vomica, and in
the following page we have the special indications of Nux
v. thus recorded: " Shrieks; throwing back of the head;
trembling or convulsive jerks of the limbs or muscles;
renewal of the fits after contradiction or an angry emotion; unnoticed evacuation of faeces and urine; sensation
of torpor and znubness in the limbs; vomiting; profuse
perspiration; constipation; ill humour and irascibility
between the attacks."  Now it is quite true that these
symptoms are common to Nux v. and to epilepsy, but a
moment's observation will satisfy anyone that there exists
a cardinal distinction between the effects of Nux v. and
the pathological cause of epilepsy, and this is, that Nux
v. is confined in its sphere of action to the spinal cord,
whereas epilepsy depends upon some affection of the
brain. A morbid action at the highest point involves all
the lower parts, and produces symptoms common to all
cases where they are affected; but a remedy to do good
must reach the height of the source, and in this instance,
be able to induce unconsciousness, otherwise it is inconceivable it should be of any use. " The weakest convulsion,"  says Hufeland, "with    unconsciousness, is
epilepsy; the most violent convulsions, consciousness
existing, are not epileptic."'  A stream from a poisoned
fountain cannot be purified by any     chemical works
half way down its course. It is not with the object
of captious criticism that this quotation is given, it is
simply in illustration of a prevailing practice, peculiar to
no school, of being led away in the treatment of this
and similar diseases from what seems the only true road


' Enchiridion Medicum,' p. 210.


33




514


EPILEPSY.


to cure- the application of a remedy to the seat of a
disease.
Although beyond all doubt epilepsy depends in almost
all instances upon some morbid condition of the brain, yet
what that condition is has not yet been ascertained. That
organic alteration of some part of the brain is a very
frequent attendant upon epilepsy has been amply demonstrated; but all attempts to determine the special part
of the brain have hitherto failed. J. Wenzel ascribed it
to changes in the pituitary body along with a morbid
state of its surrounding bony cavity; but the researches
of Engel and others have entirely failed to confirm this
opinion, which, however, rested upon a series of careful
dissections.  Indeed, there seems ground for believing,
that, even where organic changes in the brain are manifest after death, they may be the consequence, and not
the cause of the disease: for we know, as a certain fact,
that true epilepsy is suddenly produced by what may be
called  essentially  functional causes.  For example,
Maisonneuve relates two cases of confirmed epilepsy
being produced by gazing at the sun. The one was that
of a girl of five years old, who amused herself one
summer day by looking for some minutes at the sun, and
was immediately attacked with epilepsy, to which she
remained subject for nine years; the other, after having
gazed at the sun in the same way, was alarmed at seeing
a large black head, and in the evening she too was
attacked by epileptic convulsions, which returned at tolerably regular intervals.  Pritchard mentions a case produced in a woman by witnessing an execution. Now, in
such instances, and they might easily be multiplied,
there seems great improbability that there should take




EPILEPSY.


515


place a sudden organic change in the brain. And it is
very remarkable that even in cases where the patient had
suffered from the severest forms of epilepsy for many
years, no perceptible cerebral lesion has been discovered
after death. As this point is very important, and the
statement is rather opposed to the testimony of many
high authorities, it may be worth while to quote the
following striking illustration of it from Dr. Graves." Mr. A. B., the subject of the following case, was visited
during his long illness by a great many medical men,
among the rest by Mr.. Colles, Sir P. Crampton, Mr.
Singly, Dr. C. Lees, and myself.    He died on the 27th
of December, 1839, aged 30 years.    He had been a very
fine, robust, and intelligent boy until he was nine years
old, when he unfortunately got hold of five or six hard,
unripe pears, and devoured them greedily; in a few hours
he became thirsty, and drank a large quantity of buttermilk; in the course of the evening he fell into a state of
insensibility, during which he was convulsed. A physician of great experience and judgment from Kilkenny
was called inl, who opened the temporal artery immediately on seeing the patient, and employed the usual
means resorted to on such occasions.    Notwithstanding
this, the insensibility continued, and in about seven hours
it was observed that a hard tumour could be distinctly
felt in the epigastric region. This induced the suspicion
of some undigested substance, and a strong purgative
enema was given; its effect was satisfactory,-after a
copious evacuation, the tumour disappeared, and the boy
recovered his senses.   From that time, however, he be

1 ' Clinical Lectures,' p. 489.




516


EPILEPSY.


came subject to epileptic attacks. They annually became
more frequent and severe, and after six years the intellect
began to be impaired, and gradually lapsed into almost
total idiotcy.  He now remained almost entirely in the
house, and for many years had several epileptic fits daily;
the convulsive stage did not usually last more than three
or four minutes, but the coma often continued nearly an
hour. The disorder generally exhibited a manifestly increased severity twice a year, when the fits would return
about ten times daily, and with more than ordinary violence; after such a paroxysm had lasted about a week, it
invariably terminated in outrageous madness, the appearance of which was a sure sign that the paroxysm, so far
as the fits were concerned, was over; this madness was
of the most violent and noisy description, and required
restraint; when it had subsided, which it usually did in
about three days, he relapsed into his ordinary state, with
a few and comparatively slight fits daily. Such was the
course of the disease for sixteen years, during which he
was most tenderly and assiduously nursed. I ought to
have mentioned that a sudden and copious bleeding
fr-om  the nose often took place when the fits came on;
the breathing was invariably violent, irregular and heaving,
for eight or ten minutes after the convulsion had ceased,
but then gradually became tranquil, and so continued for
the remainder of the comatose stage. During the last
five years of this gentleman's life the fits became gradually less violent, but never ceased; for several years
before his death he remained free from attacks of madness.  The post mortem     examination was conducted
under the most favorable circumstances by Very skilful
and experienced anatomists. The result, so far as the




EPILEPSY.


517


head was concerned, was that the scalp, cranium, dura
mater, arachnoid, pia mater, together with the cortical
and medullary substance of both the cerebrum and cerebellum were all perfectly healthy; a very small quantity
of transparent serum was found in the ventricles; there
was no notable subarachnoid effusion; the spinal marrow
and its investments were quite normal." The farther
details of this case would be foreign to our present purpose, but we may adduce Dr. Graves's concluding observation, that he had known a gentleman who for nearly
thirty years was subject to frequent attacks of epilepsy,
and who yet was quite free from the disease for the last
twenty-five years of his life.
Such facts, although they can hardly be said to warrant
our holding out to epileptic patients a prospect of cure if
the disease has lasted a long time, should at least prevent
our condemning any to utter hopelessness.
In our ignorance of the proximate cause of epilepsy, it
is natural that we should direct our attention in a more
special degree to the exciting causes, as they sometimes
afford important indications for treatment, and among
these the repulsion of old eruptions undoubtedly deserves
a place. Hahnemann, in his introduction to his work on
" Chronic Diseases,' has collected a good many examples
of this effect of the sudden cure of cutaneous diseases;
and Dr. Pritchard states that attacks of epilepsy are by
no means rare as consequences of the disappearance of
the chronic or non-febrile disorders of the skin. Dr.
Ferriar has mentioned the case of a gentleman who
became subject to epileptic fits in consequence of the
disappearance of scabies after the use of some external
application, and who was suddenly cured of them, after




518


EPILEPSY.


a variety of remedies had been tried, by reproduction of
itch.'  It is refreshing to meet with such confirmation of
the statements of Hahnemann in the works of his opponents, and it may induce us to give more weight to his
opinions in regard to psora than at present it seems the
fashion to do.
Among the predisposing causes there is none       to
compare in importance with hereditary influences.   It
appears from  statistical inquiries made by Cazauvieilh
and Bouchet, that out of 110 epileptic patients there were
31, or nearly one third, who had epileptic parents or
relations; and that 14 epileptic mothers gave birth to
58 children, of whom 37 had died, the eldest at the age
of 14, the remainder at a very early age, and almost all
in convulsions.  These facts should be borne in mind if
we are consulted as to the propriety of a person subject
to epilepsy contracting a marriage. When we consider
the danger, not only of transmitting epilepsy, but of
engendering insanity by such a wedlock, it may raise the
question as to whether there should not be a legal bar to
marriages fraught with such certain and serious danger
to the community. For it is not merely the chance
epileptics, or lunatics, so to speak, that are the mischief,
but it is the infusion of bad blood, every drop of which
does harm, and retards the elevation of the race.
The age at which epilepsy is most likely to occur has
been carefully investigated.  Out of 66 cases compared
by Cazauvieilh, 50 occurred before the 20th year of the
patient's age; of the remaining 16, 5 began before the
25th year, and only 1 after the 50th.   It is generally


1 Op. cit., p. 218.




EPILEPSY.


519


believed that epilepsy never begins after 50 years of age:
there ate, however, cases on record where it made its
first appearance in a man in his 69th year, and in a woman
in  her 72d.   How    far the age at which it appears
modifies the chance of recovery or cure is not so easily
decided.   Dr. Laurie says "when the disease occurs
before the age ofpuberty, or when purely sympathetic, it
is generally curable without much difficulty by means of
homoeopathic remedies."' If this statement is really the
result of, observation and experience, it is extremely
encouraging, for nearly half of all epileptic cases commence at this favorable period. Without questioning
that the amount of individual success may have warranted
this opinion, one cannot help fearing that it rests upon
too insufficient data to be accepted as a general proposition. Pritchard, a most accurate observer, says, "epilepsy
often appears for the first time about the eighth or from
that to the twelfth year; and it is under these circumstances that the greatest danger exists of its becoming an
habitual disease. There is still a prospect of its subsiding in males at the age of puberty, and in females at the
establishment of the catamenia; but if these periods pass
over and the disease subsists through the changes which
the habits of the constitution then undergoes, there is
great danger of its continuing through life. But if the
appearance of the catamenia sometimes assists the constitution to get rid of this disorder, it much more frequently
gives rise to it; or, rather, the laws of the animal economy require a new set of operations to be set up in the
system at this time, in the place of which, when they are


I Op. cit., p. 355.




520


EPILEPSY.


not regularly performed, a variety of tumultuous efforts
ensue, and among phenomena of this class none is more
frequent than epilepsy. In fact there is no time of life
in females at which it so frequently makes its appearance." 1
Perhaps if Dr. Pritchard had practised homceopathy,
he might have changed his opinion as to the great risk of
epilepsy in the young becoming permanent; or it may be
that if Dr. Laurie had had the same amount of experience
as Dr. Pritchard, he would have qualified his statement.
As far as my own observation goes, it is opposed to that
of Dr. Laurie; for certainly by far the worst cases of
epilepsy that I ever met with have been in boys under
twelve years of age. It would, however, be wrong to
make an inference from this, as the number of cases is
too few; and when we consider the great power of our
medication in regulating and tranquillising the system
during the period of puberty, and how rapidly hysterical
and spasmodic affections frequently yield to the influence
of homceopathic remedies, it may not be unreasonable to
expect that those forms of epilepsy which are excited by
the purtubations spoken of by Dr. Pritchard may be
averted, if "the tumultuous efforts " are calmed and the
stormy latitude passed over under favorable circum.;
stances. For the more we examine the subject, the more
clear it appears, that epilepsy depends upon two concurrent causes; the one, a permanent morbid condition of
the brain, which gives a tendency to the production of
unconsciousness and convulsions, making epilepsy possible; the other, some exciting cause within or without


SOp. cit., p. 95.




EPILEPSY.


521


the body, which, if sufficiently intense, makes along with
the other epilepsy actual. Now medicine to be specific
must both tend to cure the morbid state of the brain
and to restrain the exciting causes within the system.
The worst of it is that epilepsy is connected in some
inscrutable way with general and cosmical influences,
and seems especially subject to certain laws of periodicity,
the nature and range of which are among the most
mysterious problems of vital phenomena. Sir H. Holland
indeed attempts to account for the periodic appearance
of epileptic fits by the conjecture of a gradual accumulation of nervous power, which, when it reaches a certain
amount, expends its force in the violent convulsions
which characterise the disease.' The objections to this
notion seem insuperable. That such accumulation ever
takes place is not proved; and if it were, we should
require to have explained how it produced unconsciousness
as well as spasms. Again: Epilepsy sometimes occurs
instantaneously from a powerful emotion before there has
been time for this conjectured supply to gather; and, to
conclude a list which might be almost infinitely prolonged, there is no relation between the duration of the
intervals and the severity of the fits; at least, if such
relation exist, it is one of inverse ratio,-not direct, as
this hypothesis would require. It will be more fruitful
to inquire into causes known to excite epilepsy, than to
indulge the fancy in framing conjectures.
The connection of epilepsy with sleep is an important
and curious fact.    Henle 2 observes that the occurrence
of a fit at night during sleep should be looked upon as
1 Holland's 'Medical Notes and Reflections,' 3rd edition, p. 283.
S'Path. Untersuchungen ueber Verlauf und Periodicit-it dc Krankeit,'




522


EPILEPSY.


a bad sign, for it shows that the brain must be the
origin of the attack, as all external excitements are at
that time absent.  It certainly does prove this; but the
inference of such cases being at all worse than those
which take place in the day-time does not seem to be
confirmed by the observation of their course, which,
after all, is the only sure test of the comparative severity
of the two classes. And we know too little about sleep
to form even the remotest conjecture of the nature of its
positive effect upon the cerebral function. We are
obliged to recognise merely its negative aspect-the attendant unconsciousness; but we cannot penetrate this
shroud, which conceals its phenomena as well from the
cognizance of the sleeper as from the investigations of
the spectators. We receive only obscure hints of an
active sleeping mental state through dreams, and by the
morbid disturbances to which it is subject. Of these,
one of the most remarkable is somnambulism, and this
condition is a frequent occurrence with persons subject
to epilepsy. Indeed, the relations between sleep and
epilepsy seems to be of a very radical character, and not
merely accidental. It is powerfully affected by mesmerism; and there is a minor degree of the epileptic
state which bears a close resemblance to that kind of
imperfect artificial somnambulism known by the absurd
name of electro-biology.   I have recently treated  a
female epileptic patient, who presented a singular example of these milder attacks, called by French writers
lepetit eval, interposed between the more severe one of
le grand vnal.  She was subject to fits of falling down
in unconsciousness, attended with convulsions; but besides these, shc would suddenly appear in a sort of




EPILEPSY.


523


vacant condition, in which she walked about, although
with an unsteady gait, and answered questions coherently, but she had no recollection of what had passed
in the period.  She once had one of these attacks in my
house: she was sitting in the waiting-room, and when
there dropped a piece of money; when she came into
the room where I was she looked like a person walking
in sleep, but she sat down and replied to my questions;
she gradually seemed to recover full consciousness, and
then felt uneasily for her money; on opening her purse,
she said she was sure she had dropped some, for the last
thing she recollected was taking it out whilst sitting in
the adjoining apartment, and that there was now less in
her purse than there should have been. Of what passed
between the time of her taking her purse out and the
moment she became conscious of her loss (which turned
out to be real) she had not the slightest remembrance,
and yet she had behaved in such a way that I had not
the least idea she was unconscious.  It was, in fact, a
brief attack of somnambulism. In some way or other
epilepsy is allied to sleep; and it might almost be said,
without an exaggeration, to be a disease of sleep, for a
large majority of attacks take place in sleep, and it is
therefore no wonder that we cannot comprehend the
morbid changes of a condition which in its most normal
phenomena is an impenetrable mystery.
It may be from this relation to sleep, the great periodic
phenomenon of all sentient life, that the periodicity of
epilepsy is derived, or perhaps both are in some way or
other connected with the alternations of the cosmical influences to which all the inhabitants of our revolving
abode are subject.  That epilepsy is affected in some




524


EPILEPSY.


way or other by the position of the moon, is more than
a popular belief. Romberg, who is certainly a cautious
and critical writer, thus speaks of it. "CThe planetary
influence of the moon (especially of the new and full
moon) was known to the ancients, and although here
and there doubts have been raised against this view, the
accurate observations of others have established its correctness."  I have at present under treatment two cases
of epilepsy, in which the patients, both females, represented their attacks as always occurring at the time of
the full moon and at no other.    The following very remarkable case is related by Dr. Mead,' and quoted by
Dr. Pritchard. " A girl of five years old, of plethoric
habits, was seized with violent and frequent convulsions,
from which she was with difficulty saved by evacuants
and other measures. After a short interval she was
again, at tIe full moon, seized with a violent fit, after
which the disease kept its periods constant and regular
with the tides. Ste alwacys lay s2eec7hless during tthe
wohole time of tlhe flood, and recovered upon the ebb!!
The father, who lived by the Thames side, and did business upon the river, observed these returns to be so
punctual, that, not only upon coming home, he knew
how the child was before he saw it, but in the night has
risen to his employ, being warned by her cries when
coming out of the fit of the turning of the water!!
The chance of recovery from epilepsy, according to
Hufeland, is one to twenty, (of course this refers to the
older systems of practice, not to ours,) and the history of
Mead's Works, p. 180.
2 The italics and marks of admiration are in the original, at least in
Pritchard.




EPILEPSY.


525


the remainder is of the saddest character.  Death occasionally occurs, but much more frequently the victim of
" this possession," as it used to be considered, continues
to live on, but gradually loses his intellect, and generally
ends by becoming insane or idiotic. To this rule there
are, however, a sufficient number of exceptions to warrant us in encouraging our patients with the hope that
the attacks may not affect the mind.  Cheyne 1 says he
has known individuals subject to epilepsy preserve their
intellect unimpaired in old age.  "A very dear friend,"
he adds, "who was liable to epilepsy, died a few months
ago in the seventy-fourth year of his age, whose comprehensive, well stored and active mind, remained unclouded
till within a few weeks of his death."
Among the examples usually adduced to illustrate the
continuance of perfect sanity along with epilepsy, are
Julius Caesar, Mahomet, and the great Napoleon. Cwesar
was not affected with this disease till near the close of
his life, and whether he displayed any change of temper
and intelligence that might have ripened into mental
weakness, is, perhaps, not known to scholars. But that
Mahomet was subject to epilepsy is a singular fact in
reference to his psychological character, and may account
for some of his ecstacies and supposed revelations; and,
perhaps, the infatuation of the great Napoleon, towards
the latter part of his career, may be in some slight degree accounted for by an incipient disease of the brain,
which would have developed itself in that organ, had it
not taken another form when enforced rest transferred to
the lower organs the activity natural to the higher. For


' Cyclop. of Pract. Med.,' art. " Epilepsy."




526


EPILEPSY.


the localization of morbid action when there is a general
dyscrasia (as there always is when cancer is present) is
determined by causes which we may call accidental, and
had Napoleon's brain continued to be exposed to the excitements of his consular and imperial career, his fate
might have been even a more melancholy subject for the
contemplation of the moralist.
The practical inferences which we may deduce from
this collection of observations, and bring to bear upon
individual cases of epilepsy that present themselves for
treatment, so as to enable us to form a plausible conjecture as to their nature and the greater or less difficulty
of affording relief are so obvious, that it is unnecessary
to point them out, and we may now direct our attention
to the therapeutics of the disease.
In a review of "Nervous Diseases," which appeared
in the twelfth volume of the British Journal of Homnzopatly, and which was written by an experienced and
skilful practitioner, the following passage occurs: "Few
if any of our medicines have as yet produced anything
precisely corresponding to epileptic attacks, consequently
the great majority of the indications recorded by Jahr (and
his copyists) are from clinical use only. As this must
always be at best a doubtful source of therapeutic indications, at least, until repeated observations shall have
firmly established the value of the various medicines for
different forms of epilepsy, our treatment of the disease
must necessarily be at present very empirical. Jahr
gives little more than descriptions of attacks that have
been cured under this or that medicine, but we should
rather like to know what guided the practitioner to the
selection of his successful remedy."  This is a very just




EPILEPSY.


527


observation: but what is to be done? Are we to wait till
we discover medicineswhich produce epilepsy? It is rather
disheartening to observe that one of the few substances
known to have this effect is comparatively seldom given
for the cure of disease by homceopathists. "Among the
older writers," says ]Romberg, " Stoll has already pointed
out that epilepsy is the result of lead-poisonin1/; among
moderns, Laennec and Andral have drawn attention to the
fact, but the subject has been most comprehensively
treated by Tanquerel des Planches, who has observed
thirty-seven cases himself." Doubtless, we may hope
that future investigations may enable us to apply to more
effect our law of cure in these cases, but in the mean
time as the reviewer truly observes, we are compelled to
submit to a more empirical method, and to be guided
more by our clinical experience than by our study of the
Materia Medica pura.   While admitting that this is an
imperfect, and while hoping it is only a temporary plan,
yet in the immediate urgency of practice it is one we are
compelled to adopt, and it is well we should make the
best of it. To do so it is essential that we should have
a clear notion of what are the important points to register
in reference to the attacks.  Of these, the age of the
patient, the period of the day or night when the attack
occurs, the duration of the unconsciousness, and the
subsequent effect of a fit upon the memory, are all of
cardinal importance, while, on the other hand, the peculiar cry, the way in which the fingers or thumbs are
drawn, or the eyes roll, are really of no consequence
whatever: and yet it will be found that the indications
in Jahr and Laurie have more reference to the useless
and accidental individual adversities than to the funda



528


EPILEPSY.


mental distinctions.  In fact, the way in which these indications have been arrived at is radically false.  A case
of epilepsy is reported in full, that is to say, the exact
character of the fits, whether there was grinding of the
teeth, clenching of the hands, wildness of the eyes, &c.,
and it is also recorded that Cuprum had been given and
the fits subsided.    Straightway, the    book-compilers
extract the symptoms as described, and publish to their
credulous readers that in the event of their meeting with
a case in which there is grinding of the teeth, clenching
of the hands, &c., they are to. give Cuprum!     It does
not seem to occur to our teachers that the indications
they record as discriminative are really common to almost
all convulsions, and while they dwell upon the common
they omit the peculiar.   It is not enough in drawing up
a " hue and cry" to describe the thief as a biped, without
feathers, or even supposing the document published in
England that he presented the most undoubted features
of being of the Caucasian type, in fact he might be
summarily described as looking like an Englishman. It
is not a bit more to the purpose when we ask in what cases
of epilepsywe are to give Belladonna, and in what Cuprum,
to tell us that the former is of use when there is a " sensation of crawling and torpor in the upper extremities,"
the latter when the paroxysm begins " in the fingers or
toes, or in the arms." 1 It must be admitted, however,
that it is much easier to say " how not to do it" than
how to do it, and the utmost we can hope for at present
is, that each practitioner will record simply the result of
his experience in epilepsy, and state fully the history of


1 Laurie, p. 356.




EPILEPSY.


529


his cases, and in this we may gradually methodize our
treatment, and if we do not rise to the height of being
guided by a sure law, at least have the satisfaction of
following a rational empirical rule.
I am well aware that the following cases are very defective in the requisite details, but they were never meant
for publication, and they are now given with the hope of
calling forth from others their experience in this common
and dreadful malady.
CASE I.-G. A-, a well-grown and intelligent lad,
seventeen years old, had his first epileptic attack at fourteen years of age, that is three years ago. About three
months after had two fits: he was free from them for
four months, after which period they returned, and ever
since that has had one or two at intervals of three or four
months. I saw him first on the 24th of August, 1855,
and he had had six attacks the previous day, and one
that morning. The fits begin with convulsions of the
muscles of the face, which extend to the arms and legs.
He is generally unconscious for twenty minutes. He got
the second dilution of Belladonna, and was to be taken
three times a day.   He continued this medicine, repeated from week to week, and had no attack till the
11th of January, whei he had one fit at night. This
was a longer interval than had yet elapsed since the first
fit, and there was only one fit this time, so Belladonna
was continued up to the 14th of July, when he got
Mercurius for a cold, and up to the present time he has
been quite well. I consider that he is cured, and by
Belladonna. This medicine, it will be observed, he took
daily for nearly eleven months, and as the fits first made
34




530


EPILEPSY.


their appearance about the age of puberty, and increased
gradually in severity up to the commencement of the
treatment, the chances of so sudden a spontaneous a
recovery are very inconsiderable.
CASE II.-H. J-, also a fine intelligent boy 14 years
of age, came under my care upon the 17th of December,
1855. His parents stated that he had been subject to
convulsions as an infant, and that from  that time he
had suffered from strabismus. His present malady began a year ago, and consists in an unpleasant sensation
coming over the head and hands several times a day,
and a regular epileptic fit once or twice daily.  His
memory is not affected, and his health is otherwise
good. He got the third dilution of Naja, a drop three
times a day. On the 24th of December, he returned and
said he had only had two fits the previous week. The
Naja was repeated. On the 31st of December he reported having had two fits the previous week, and complained of pain at the forehead at night. He then got
Belladonna, second dilution, a dose three times a day,
from that time to the end of April, when he discontinued
his attendance, he remained free from fits. This is certainly a very striking cure, also due I conceive to Belladonna.   He took the medicine for four months. I
have heard of him since, and he is reported to be quite
well.
CASE III.-S. E-, a female of 33years of age, unmarried, of a depressed and stolid, I may say epileptic
countenance, was first seen by me upon the 10th of
September, 1855. At the age of thirteen years she got




EPILEPSY.


531


a fright, and soon afterwards had one epileptic fit. The
fits have continued ever since; they always precede and
follow the catamenial period, and generally last for a
quarter of an hour; she is stupefied for a time after the
convulsions are over, and for some time back her memory has been weakening.     She has a sensation of
" something in her left side," but no regular aura as a
precursor of the fit. The catamenia are regular and too
copious; she is subject to relaxation of bowels after an
attack.  She got the 2d dilution of Belladonna, to be
taken three times a day for a week.   She returned on
the 17th of September, and said she had had one attack
during the interval. Althoughher epilectic attacks have
come on invariably for the last twenty years at the catamenial period, yet she has them frequently at other times,
and without any observable periodicity. The Belladonna
was continued till the 19th of November; she then reported that the last period had passed without a fit, but
there was an abortive attempt at one, consisting in what
she called " a shuddering," a sort of general tremor with
a peculiar sensation. The Belladonna was continued.
On the 19th of December she returned and reported
having had one very slight fit the previous week. She
again got Belladonna.   On the 31st of December she
complained of excessive depression of spirits, and got
Naja; on the 7th of January she got Carb. veg.; on
the 14th, Ignatia; on the 11th of February she reported
that the catamenia had not appeared at their usual time,
and she got Sepia.   On the 25th, she complained of
weakness, trembling, and depression, and again got
Ignatia till the 31st of March.  She stated that during
the interval she had only had one very slight fit, and up




532


EPILEPSY.


to the end of May she had continued free from them.
Having discontinued her attendance, I do not know the
final result. This case is not so satisfactory as the previous one, still, that attacks which for thirty years had
occurred with the most accurate punctuality every month,
should be so rapidly modified in their character after the
administration of homoeopathic medicines, is a striking
fact in itself.
CASE IV.-M. P-, a big lad, 19 years of age, of a very
dull expression of face, and an almost idiotic gait and
demeanour, was brought to me on the 6th of March,
1856.   He had been suffering from     epilepsy for six
years.   The fits occurred two or three times a day, but
not every day. He got Belladonna 2d dilution, a dose
to be taken three times a day.  He returned on the 2d
of April, and his mother reported that he had had two
bad fits the last week. The medicine was continued.
From that time to the 14th of May he remained free of
all attacks; on that day he had one fit.  He had nothing
but Belladonna up to the 23d of July, and his mother
affirms very confidently that his mind is improved, he is
more intelligent, and that the fits are far less frequent
and severe.  He is still under treatment.  The improvement in this case is remarkable, for the patient presented
the worst appearance, having the heavy vacant look peculiar to old epileptics.
CASE V.-E. M-, a young woman 21 years of age,
came to see me upon the 4th of December, 1853.     She
had been subject to epileptic fits for ten years.  The convulsions affected only one side of the body, which was




EPILEPSY.


533


represented to become black; they were said to be very
violent, and attended with complete unconsciousness;
they returned every two or three weeks.   She had never
passed more than five weeks without a fit since her first
attack, which took place when she was eleven years old.
She was subject to violent pain at the top of her head,
otherwise her health was good.   She got the 3d dilution
of Cuprum, a dose of it three times a day, and returned
on the 25th of January to state that she had had convulsive jerkings and tremors of the hand and arm, but no
fit.  She got the 2d dilution of Belladonna to be taken
in the same way.    February 1st, the report is, " not so
well; " complains of pain in side and head, especially at
the vertex.   Cocculus, 2d dil., as before.    February
11th, jerking of arm and leg, but no fit for nine weeks.
Repeat the Cocculus.     March   1st, no fits.   Repeat.
March 8th, had jerking in hands and arm, but no fit.
Repeat Cocculus.     March 21st, no fits, and jerking
better.  April 12th, no fits; more jerking of arm.  Cuprum, 3d dilution.   September 11th; she returned this
day, and stated that for nine months she had been quite
free from fits and tremors, but they had returned the
previous week.   She again got Cuprum, and on the 18th,
reported that she had had another fit, and again another
occurred on the 25th, when she got Belladonna, 2d dilution.   She remained free till the end of a month, when
she had a fit, and got Cocculus.    She returned on the
20th of November, and stated that she had had three
fits the previous week; she complained of sore throat,
and got Belladonna. From this time to the middle of
January, 1854, she remained free from fits, and then discontinued her attendance.   This case illustrates the inse



534


EPILEPSY.


curity of apparent cures, and the capricious character
of the malady.    For ten years she never passed five
weeks without at least one fit; after a little less than
four months' treatment she passed nine months in perfect
health, and one might have supposed the disease cured,
and yet it was only alleviated, the exciting cause was
probably removed, but not the morbid condition of
the  brain; so it returned   again with considerable
severity.
CASE VI.-L. P-, aged 14, a pale girl, healthy looking,
four years ago had her first epileptic fit. It was very bad;
there was no cause assigned for it. They have returned
at irregular intervals until a year ago, when they began to
occur once a month. They last for a quarter of an hour,
and go off in a sleep.  She had one three weeks ago, and
considered one was nearly due when she applied to me,
on the 20th of March, 1857.  She got the 2d dilution of
Belladonna, and had no fit till the 22d of June, and none
between that and the 12th of November.
These are all the cases of sufficient general interest, as
illustrating either the action of particular medicines,
or the character of the disease, that I find worth reporting, and I may conclude with this observation, that
on the whole I have more confidence in Belladonna than
in  any other medicine, in   ordinary cases  of true
epilepsy, and I think it is of consequence to continue its administration for a long time after the fits
have ceased.   I have often given it in the 2d dilution, for months, and I never saw the slightest harm
from it.




EPILEPSY.55


535


The following case, although not one of epilepsy, is
so far allied that it may -not be out of place here:
The-subject of it, W. F'-~-, was a fine hearty-looking
man, 49 years of age, a gardener, who had been in the
enjoyment of good health till three years before, when he
fell from a height of thirty feet upon the top of his head,
a~nd was after that unconscious for -five weeks. Ever
since that time he suffered constant pain at the vertex,
attended with such extreme mental dejection, that he has
been unfit for work, and would sit and weep the whole
day long.   He complains of constant thirst, and no
appetite; the ton-gue was coated, and the bowels torpid.
I saw him first on the 19th of December, and he then
got Nux, v., 2d dilution. He returned on the 3 1 st, and
said his appetite and bowels were better. He then
got Sulphuric acid, 3d dilution, a drop three times a
day. From that time he began to improve rapidly; the
pain in the head went off, his spirits returned, and in
the course of a month he was able to go to work, and
on the 10Oth of April he sent me -a message that
he was perfectly well, and at his work ' as before his
accident.




CHAPTER X.


ON MESMERISM.
IT is impossible for any sane mind to be brought in
contact with the world of mesmierism without being dismayed- at the dismal disorder which reigns over the whole
region; one feels as if quitting the familiar earth for
Tartarus, and exchanging the diffused light of day by
which we recognise the colour, form, and distance of objects, for the fitful corruscations of the aurora borealis or
gleams of vivid lightning, that dazzle the sight rather
than reveal the things around us. We feel that all our
conscious experience is opposed to the phenomena we
seem to witness or of which we are told; and while we
dare -not refuse the evidence of our senses or the testimony of trustworthy witnesses, we are equally unwilling
to receive as truths appearances or statements utterly- at
variance with all probability. A little reflection, however,
will convince us that this discrepancy is apparent rather
than real. The experience by which we try mesmeric
phenomena is all derived from our waking state. Mesmerism is a state of sleep. Our sleeping experiences are
not recollected, and we cannot bring them to bear upon
the subject. If we could remember all that passed in
sleep we might find nothing extraordinary in the acts
of a person in a mesmeric condition. The neglect of




MESMERISM.


537


this fundamental distinction seems to lie at the root of
the confusion of the matter; and the only hopeful method
of advancing into the labyrinth is by starting from the
most obvious and familiar of the phenomena of sleep. To
enable us to do this at all successfully, we must first disentangle sleep from certain other states into which it is
often confounded.
Sleep is frequently spoken of as a state of negation,and as such related to stupor or fainting; but a little
careful attention will dispel this error.  A  faint is an
arrest of all the animal functions: the heart ceases to
beat, the lips grow pale, there is total insensibility, there
is, in short, temporary, at least apparent, death. In stupor, although the heart continues to beat, it does so
languidly and laboriously, there is no sensibility as in
sleep-to any stimulus that can be applied to the system,
there are no dreams, and there is no sense of refreshment on recovering from it.   It is a dead, unnatural, unwholesome calm, not a living, natural, sanative repose.
Stupor and faint are morbid states, sleep is essentially a
healthy one.
"Sleep, Death's twin brother, knows not death."
Hence it is a misnomer, and one which has done much
mischief from the erroneous idea it involves, to call those
poisonous substances which produce stupor, Aypnotics.
Narcotics or soporifics they are, but sopor and narcosis
S   are not synonymous with sominus.
Sleep, then, we believe, along with some of the best
physiologists who have written on this subject,' to be a
positive condition of the system, beginning in all proSSee Burdacl's 'Physiologic,' vol. v, p. 185.




538


MESMERISM.


bability before birth, and continuing till death. For there
is great likelihood that the foetus in utero floats in its
little ocean fast asleep, and only slowly after birth enters
the full state of wakefulness.1 Its position is that of
sleep. Many animals when they fall asleep resume their
prenatal attitude by instinct; some seem scarcely to wake,
as those born blind, till some days. Infancy is a prolonged sleep: and in our progress to second childhood,
which too is little else than sleep, it is necessary for the
preservation of our faculties that we should nightly return
as it were to Nature's womb, to be quickened for the returning morning of a fresh birth.        That there is a living
mystery in these long years which we spend in sleep can
scarcely admit of a doubt; and perhaps when the " soul,
the body's guest," shall go into other regions of existence, the resurrection which is to reunite our separated
elements will combine the double experience of all that
we have learned in our waking hours, and all that may
have been taught us when asleep.
1 It may be somewhat too fanciful for a scientific paper to suggest that
if the child be asleep before its birth, it may in that sleep be visited by
dreams, and those dreams may take their character from the emotions of
the parent: and one might even imagine that some very vivid dream might
be remembered in after life. Perhaps this idea lies in these verses of
In Memoriam:"How fares it with the happy dead?
For here the man is more and more;
But he forgets the days before
God shut the doorways of his head.
"The days have vanished tone and tint:
And yet, perhaps, the hoarding sense
Gives out at times (he knows not whence)
A little flash, a mystic hint."




MESMERISM.


539


The more we ponder upon sleep (the great recurrent
movement in the epic march of life), the more does its
importance as well as its mystery grow upon us.. It is
an aspect of the law which governs not only all sentient
but also all material existence,-the mighty law of alternation: the succession of day and night, of summer and
winter, the perpetual repetition of the modified past,
which constitutes the present, and involves the future.
And hence it can hardly be matter of surprise that the
infraction of this great law should be attended with most
direful consequences.  Abstinence from  food enfeebles
and reduces the frame, but want of sleep disturbs all its
functions.  It is partial death,-death of our sleeping
life.  In sleep we return into the great telluric life from
which we sprung, for out of the dust of the earth were
we created.  Not to sleep is to array this life against us;
hence sleeplessness is attended with visions of all that is
unnatural.  It is not because ghosts are invisible by day
that they are only seen at night, it is because they can
only be seen by the eyes of the sleepless.
Sleep viewed from the negative point may be defined
a healthy condition, in which the conscious will of the
sleeper ceases to control the mental and bodily operations.
Both mind and body may continue active, and may and
probably do act in obedience to laws as distinct and ab..
solute as those which govern the waking state; but the
initiative impulse may be given by external forces instead
of by the will of the individual. The will of a waking
person may regulate the actions of a sleeping one.  If
the ear of a sleeper be tickled with a feather his hand
will rise to remove the annoyance: if into his ear be
whispered words of obvious meaning it frequently excites




540                    MESMERISM.
a corresponding dream. This seems the simple explanation of the amusing actions to which the very silly name
of electro-biology has been given. To induce these acts
a person is but asleep, and dreams are suggested to him;
he sees and hears and walks as if awake, but in reality
he is asleep, his will is dormant: he is told that a chair is
a horse, he dreams it and acts a dream. There is nothing
wonderful in this.   It is not so uncommon for persons
when fatigued to fall asleep while walking and to continue
their walk.   Innumerable examples of this are on record,
nor is it unusual for them to hear and to see with sufficient distinctness as to avoid obstacles.  This happens
even in ordinary sleep, to say nothing of somnambulism.
The mesmeriser puts a person to sleep, and by so doing
acquires the control of his thoughts and voluntary motions
as long as he is asleep. The only remarkable thing is
the power of putting to sleep, and this peculiar sleep.
The cataleptic phenomena produced by mesmerism belong
to a different category, and are beyond the present scope
of our inquiry.
If we define mesmerism to be the power of inducing
sleep in its various modifications and of communicating
with the sleeper, so that while on the one hand the
waking operator can influence directly his thoughts and
actions, and on the other can receive from him in return
an account or description of his perceptions, we exhaust
all the higher phenomena of this state, including clairvoyance. For clairvoyance is neither more nor less than
the admission of a waking person into the consciousness
of a sleeping one. What this kind of consciousness is,
whence it comes, by what laws it is regulated, we know
absolutely nothing; nor can we expect to know anything




MESMERISM.


541


except by examining it for itself. We know how we
perceive the external world when we are awake, or rather
we only know that certain mechanical contrivances are
used to enable us to do so.  We know that in sleep if
there be perceptions of the external they are not produced by the apparatus of the senses that supply the
corresponding waking ones.  More than this we do not
know. Ordinary vision is as great a mystery as clear
sight. But it is an obvious contravention of all the laws
of induction to attempt to explain the one by the other:
we might as well try to estimate the effects of a piece of
music or poetry by a mathematical formula, or to speculate on the probable longevity of an angel. And we
consider all the theories which have been invented to
facilitate the belief in clairvoyance (for we cannot suppose that even their authors could for a moment imagine
they explained the phenomena) as falling under the
rebuke of Lord Bacon, when he says: "The art and
mind of man if it work upon matter which is the contemplation of the creatures of God, worketh according
to the stuff, and is limited thereby; but if it work upon
itself, as the spider worketh his web, then it is endless,
and brings forth indeed cobwebs of learning, admirable
for the fineness of thread and work, but of no substance
or profit."'
It is no part of our design to enter into a disquisition
as to what mesmerism is; whether it be a form of terrestrial magnetism, or have a diabolic origin we must
leave to the decision of natural philosophers and divines,
and whenever they are all agreed we shall humbly bow
to their decision.  However, it does appear to us a reSC Advancement of Learning,' p. 41.




542


MESMERISM.


trograde step in philosophy to expend time in attempting
to ascertain the nature of any force: all we can hope to
determine is the conditions under which it is manifested,
and the laws which regulate its phenomena.     Hence,
with all deference to Baron Reichenbach and with all
respect to Professor Gregory, we greatly prefer the old
term  of mesmerism to the new    title of odyle.  It is
enough for us as physicians to try and discover what
mesmerism does, not what it is: and it seems to us that
mesmerism, however produced, is the hypnoticpar excellence.
We have already indicated the immense value of sleep,
and if mesmerism really be a sleep-producing agent over
which we have certain control, its value must be immense.
It is asserted to have another value, in making us acquainted with phenomena of disease by means of clairvoyance; into this, too, we shall briefly inquire.
In the first place, however, we shall consider it in its
direct therapeutic bearing, as enabling us to afford that
exquisite repose to patients, the want of which we know
gives rise to many positive diseases, as well as being in
itself a source of indescribable suffering and distress:
and in the following observations we shall speak entirely
from personal experience which we have had of its efficacy in a few cases, and which has convinced us that
mesmerism is quite indispensable for the successful treatment of a certain limited class of diseases.  We do not
mean to deny to it a larger sphere of usefulness, but in
the wider range to which its professed advocates promote
it, we believe it may merely rank as one of many useful
appliances, whereas in the more limited sphere it stands
entirely alone, as the only curative agent.




MESMERISM.


543


Of course, by calling it a hypnotic we remove it from
the category of strictly homoeopathic remedies; we do
not consider its action in the cases we are about to speak
of as homoeopathic.  But as we never meant by adopting the homoeopathic law as our guide to deprive ourselves of our moral liberty as physicians, we need hardly
observe that we consider ourselves perfectly justified in
employing this or any other adjuvant which does not interfere with the administration of the minute doses we
are in the habit of using, and we cannot but regret the
tendency of the profession at present to cut itself into
fragments, each   representing  a fractional truth.  It
seems to us just as rational that physicians should be
called respectively, cathartic, diaphoretic, or emmenagogue, as water-cure or mesmeric doctors.
I shall now briefly detail my own experience.
The first case I shall relate is that of a lady about
thirty years of age, of nervous lymphatic temperament,
of a firm frame, vigorous in mind and body. This patient was formerly under the charge of a physician,
by whom she had been successfully mesmerised. Before
coming under his treatment, she had been for years
delicate, and had suffered much from a short cough and
pain in the lower part of the back. For this she had
been bled, by an allopathic practitioner of considerable
reputation, every week for many months without any advantage. When she first consulted me she complained
of violent pain on one side of the head about the temporal region, almost incessant nausea, occasional vomiting, total sleeplessness, and a sense of restless uneasiness
which made her quite miserable. I found the homceo



544


MESMERISM.


pathic remedies usually beneficial in such cases of no
avail, and at her own request I put her asleep by making
passes slowly over the head and face. It required only
a few minutes to induce the most profound slumber. I
allowed her to sleep for about half an hour, and then
waked her by blowing gently in the face. For some
weeks afterwards she was perfectly free of all pain, both
in head and back, her appetite was good, she had slept
soundly every night, and in fact felt perfectly well. From
time to time she had a return of her distressing symptoms, and they were always relieved for a period of at
least four or five weeks by a repetition of this simple
operation. I tried on one occasion making her gaze intently on a small object in the manner similar to Mr.
Braid's method, and the result was equally satisfactory.
In a few minutes she was fast asleep, and on awaking
had the same sense of relief, repose, and restoration as
when she had been put asleep by passes. It is now
many months since she was mesmerised, and she reports
herself to be in the enjoyment of perfect health.
This simple case may be sufficient to correct an erroneous notion we find prevalent, that mesmerism if once
used requires to be continually repeated, and that a
patient becomes dependent upon it. A patient is dependent upon sleep, but the function once restored may
continue normal without the repetition of the means first
used for its induction.
The next case is a very complicated and curious one.
The patient is a lady of about thirty-four years of age,
dark, of a pale complexion, great sensibility, and a very
vigorous mind. Till she was eight years old she was a




MESMERISM.


545


healthy, ruddy, firm-fleshed, active, good-tempered child.
But soon after that age, without any appreciable reason,
she began to grow pale, thin, and nervous; she was occasionally affected with weakness of memory and stiffness
of the limbs, and entirely lost her appetite; the bowels
were excessively confined, and she took great quantities
of aperient medicines.  She continued in this declining
state for five years; at the age of thirteen she went to
Harrowgate, drank plentifully of the water, and was relieved from all her lessons which she had been vigorously
prosecuting before notwithstanding her delicacy. The
water and exercise together had a salutary influence:
she passed a quantity of ascarides, and was restored to
perfect health at the age of fourteen. The catamenia
then appeared without any inconvenience. She again
became fat and rosy, and seemed to have regained all
the plumpness and    health of her childhood.   This
agreeable state, however, did not last very long, for again
in two years, that is, at the age of sixteen, she became
sleepless and languid, lost her appetite, and had pain at
the catamenial period. All the symptoms got worse.
What she did eat was immediately rejected; and for
some weeks her life was sustained by injections.  She
was subject to alternate attacks of mild delirium  and
exhaustion; the latter so great that she was on  one
occasion believed to be dead.  She recovered and continued well till the age of nineteen. At this time she
was exposed to a good deal of excitement and fatigue
owing to the death of a sister, and after that she began
to suffer from tic douloureux, and to see spectral illusions. The spectral illusions generally took the appearance of persons, sometimes living, more frequently dead;
35




546


MESMERISM.


they were seen by day as well as by night, and were
always of a very distressing kind.      From   this time
until my attendance began she was ill of some form
of hysterical   disorders, with   intervals  of tolerable
health.
In the middle of June, 1847, she heard suddenly of
the last dangerous illness of a relative to whom she was
much attached; the catamenia were present at the time
and suddenly stopped. From that time until I saw her
in the middle of August, nearly two months afterwards,
she had never slept except for about an hour each morning. At the catamenial periods she was subject to a
strange species of delirium; she used to start up at one
o'clock in the morning, tried to rise out of bed, although
very weak, and to bite persons or objects within her
reach; she would struggle for an hour so that it was with
great difficulty she was restrained. During the attack
she saw dead persons and all sorts of frightful apparitions
which seemed to approach her, and was all the time
quite unconscious of what she said or did. At the same
time it was curious to observe that her speech was
coherent, and she answered questions put to her quite
naturally, although often in an amusing and witty
manner. She had no recollection on coming out of this
state, which often lasted for two hours, of anything that
had passed. The fits usually returned nightly for eight
days, gradually subsiding towards the end.
Besides these strange attacks she suffered almost constantly from general neuralgia, which very frequently
passed into the most frightful attacks of tic I ever witnessed; causing her to spring out of bed and roll about
in screaming agony, and leaving her utterly exhausted




MESMERISM.


547


so as to be quite unable to speak. Besides she would
frequently faint and lie as one dead for hours.
Such is a general view of her condition during the
autumn and winter of 1848.
Having been formerly relieved of pain by mesmerism
she requested me to try it, and the first effect was very
remarkable: it did not induce sleep, but it gave a sense
of rest, and there was an appearance of the catamenia
which had been long absent.   She described the sensation produced by the mesmerism as of oil poured over
the nerves soothing and quieting them. The improvement in the general health of the patient was slow but
steady, and mainly ascribable to the continued use of
mesmerism. The sleep which had been wholly absent
began to return, and was the unmistakable presage of
further improvement. Her strength, which was sunk to
the lowest ebb from want of sleep, and appetite improved
wonderfully, so that she could walk miles.   She still
remained subject to attacks of tic at long intervals, and
the spectral illusions continued for a time, but they too
gradually disappeared, and she ultimately became perfectly strong and well.  I may mention a simple experiment I made upon one occasion to satisfy myself and her
that they were figments from within, and had no external
reality. On one occasion she described a figure standing
at the distance of about three yards from her in the
broad daylight.  I took a mirror and placed it behind
the spot the intruder was represented as occupying, in
such a way that had he been of veritable flesh and blood
she must have seen his back.  I then told her to look in
the mirror and tell what she saw; she replied she saw
the face repeated.  Thus by a simple optical manoeuvre
the unreality of her visitor was demonstrated.




548


M5ESMERISM.


The next case is a very interesting one from the spontaneous appearance of some of the higher phenomena
in mesmerism.
The patient is a lady of about thirty years of age, of
lymphatic temperament, large head, pale hair and eyes,
and very short-sighted. She had been delicate from her
childhood, and consulted me first about five years ago.
At that time she suffered much from constipation and
general weakness, but was able to walk about, although
she frequently complained of pain in her back.  At first
she was much improved by homceopathic treatment,
but afterwards on her return from the country her
general health failed, and when she again came into
town, about four years ago, she was almost constantly
confined to bed or a sofa.  She was subject to frequent
attacks of retching, sometimes vomiting blood; she had
little or no appetite.   She frequently suffered from
very violent spasms in the bowels and strangury, and
complained much of pain at the lower part of the spine,
aggravated by pressure or motion.  She slept very little,
and did not feel refreshed by the sleep she got. The
catamenia were never regular.
I was sent for late one night, and found her coughing incessantly.  The cough was hard, hoarse, and
croupy. She complained of pain about the larynx and
trachea; the pulse was so rapid as almost to be uncountable. She was extremely hot, restless, and uneasy.
She once had a similar attack, for which she was leeched
and blistered, and did not recover from it for six weeks.
Thinking it was not purely inflammatory I tried the effect
of making passes over the face and throat, and in about




MESMERISM.


549


fifteen minutes she was better and inclined to sleep.  I
gave her Aconite and left the house, but was re-summoned about three o'clock in the morning.  This time I
persevered more steadily in mesmerism, and had the
gratification of seeing her fall fast asleep in about twenty
minutes.  I left her with injunctions to continue the
Aconite should she awake.  On calling about ten o'clock
that day I found her much improved. She had slept for
some hours, felt refreshed, and the cough although not
gone was much abated. In the course of a few days she
was restored to her usual state of health.  The manifest
benefit afforded by mesmerism induced me to repeat it
regularly about twice a week, and she always slept
soundly the night after it was done, and somewhat the
following night. This in itself was an improvement.
At this time the weakness in the back had increased to
such an extent that she was constantly confined to bed,
and unable to rise or even to turn herself without assistance. She had no power in her legs, and could not even
move them. Being compelled to be absent from town
for about six weeks, on my return I found her a very
great deal worse. She had not known sleep during my
absence; she was scarcely able to taste food, and the
little she took she vomited; her pulse was small and
quick; and she was so alarmingly weak that her friends
expected her death. On re-commencing mesmerism the
sleep was restored, and gradually the sickness subsided,
and her appetite returned. By steadily persevering in it
her general health gradually improved.   She lost the
excessive irritability which had been before most distressing, and as she herself expressed felt restored to a new
life.  hi the course of about fifteen months she was able




550


MESMERISM.


to walk a little with assistance, and felt much more
vigorous than for years. The severe spasms when they
occurred could always be checked by mesmeric passes,
and in short all the sudden dangerous attacks were under
control, and there was steady progress towards a certain
measure of health.
One day while asleep she began to speak of something that was going on in the adjoining room, and upon
my asking her a question she replied sensibly, although
in a low and peculiarly modified tone of voice. Having
thus discovered that she was in a state of clairvoyance,
at each visit I put a series of questions to her about the
state of her health, and what she saw in her body, and
I shall now transcribe from notes taken on the spot some
of these conversations.
Are you asleep?  Yes.
How long will you sleep?  Five minutes.
Do you see your back?   Yes.
What is it like P It is white.
Is it all white? No; at one spot it is reddish.
Is it purple?  Purply.
Where is that spot? An inch and a half from the
bottom.
Is it the same colour as yesterday?  Yes; how  curious!-it is so smooth and full of little grayish spots.
Do you see my hands?   Yes.
What do I hold?   A book.
What is in the other?    A  little stick--(it was a
pencil).




MESMERISM.


551


SECOND EXAMINATiON.
Are you asleep?  Yes.
Will you sleep for ten minutes?  Yes.
Is your back better? Yes; a little better.
Do you see it?  Yes.
What is it like?  White and smooth.
Is it all white?  No; when I see it close it is not:
it is reddish at one spot.
Is it purple? Reddish-purple. I see little spots.
Where?    Further up.  Gray.
Do you see.the blood moving in it?  Yes.
What like? Reddish-white. Oh! I see little things!
I must see close-threads like hairs from the side coming
from the bone. Oh! what a number!
Do you see the brain? Yes;-big bone; curious
fibre things.
Does the brain look different when awake or asleep?
I think it does.
Patient awoke at expiry of ten minutes.
THIRD EXAMINATION.
Are you asleep?  Yes.
Will you sleep for ten minutes?  Yes.
Do you see your back?   Yes.
What is it like? Smooth, white, quite white; reddish
low down, nearly at the bottom.
Is it hot?  Yes, hot.
Do you see what I have in my hand?   A board with
coloured lines on it.
Do you see the colour of the lines? Yes, I must look
close-close.




1552


MESMERISM.


Can you count them?    One, two, three-no, I can't.
Are there five?  Yes.
Are any like your back? Yes.
She pointed out one of the colours on the board; and
expressed herself over and over again that this was the
one like her back. The board contained all the shades
of purple, from red to blue.
FOURTH EXAMINATION.
Are you asleep? Yes.
Will you sleep for ten minutes?  Yes.
Will you look at your back?  Yes.
What do you see? The same, just the same; reddish
purple down low; not better.
Do you see the blood in it? Yes.
Do you see the blood in other parts?    Yes; little
vessels.
Do you see the blood in the little vessels? Yes, little
threads, red and white.
Has the blood the same appearance in the red part as
in the other? It is redder.
Does it go faster or slower?  Faster.
How broad is the red spot?  A little bit.
Half an inch? Longer, it rises from the back, lumpy.
Do you see all the way up the back? Yes.
Do you see the brain?  I see a bone.
A large bone?  Yes; curious, oh, curious!
Do you see anything on the outside of the bone?
Blood.
Do you see anything quite outside?-Do you see your
hair? Yes.




MESMERISM.53


553


FIFTH EXAMINATION.
Are you asleep? Yes.
Will you look at your back? Yes.
How is your back? Better.
Do you see it? Yes.
Do you see the red part? Yes.
Do you see a paper in my handsP Yes.
Do you see the strokes? Yes.
Do you see the colours? Yes.
Are any of them like your back?.-She pointed out
onie.,
S IXTH EXAMINATION.
Are you asleep? Yes.
Will you sleep for five minutes? Yes.
How is your back? Very well.
Do you see it? Yes.
Is it less red? Yes., it is paler.
She pointed out the colour it resembled most.
During an attendance of many months I repeated
my examinations at each visit., and I shall now give
the general conclusions I have arrived at on the matter.,
after a long series of careful observations, and after
reading the current literature on the subject.
When Coleridge says, " Seeing is not believing, but
believing is seeing," he meant something better than a
philosophical paradox. And the more we reflect upon
-vision, the more we shall be convinced that both memory




554


MESMERISM.


and imagination have more to do with the process than we
at first suppose. Ordinary vision implies two conditions,
an external visible object and an internal seeing and
conceiving faculty. So that it is well said we see what
we bring with us the faculty of seeing.    The perception of an uneducated person on looking at some
wholly new sight is quite different from that of one
used to examine the object seen.   Sight affords the
materials, but the mind constructs the picture; and the
picture varies with the mind.
The same holds good in clairvoyance. The person
describes as he conceives he sees, but his conception
depends upon many conditions. In the walking state
the errors of sight may be corrected by the other senses
or by changing the point of view. This is not possible
in clairvoyance.  So that at the outset we must expect
great fallacies, and our observation has fully confirmed
this anticipation. Of one thing, however, we are certain: that the images described by the clairvoyant are
not derived from the waking person who puts the questions. Any one used to observe his own mind knows
that there is a wide distinction between the active imaginative state and the passive recipient one.  In the former it is full of images; in the latter there is none.
Now I am quite sure that in the case I have just detailed the images described by the patient were not in
my mind. Her mode of perception I do not even attempt to guess at, but I know that it was not derived
from me, for I never had conceived, in her fashion, of
the things she described.
In trying to settle for ourselves the important question
of how far these descriptions are trustworthy, we be



MESMERISM.


555


come aware of certain important sources of fallacy. The
most important is this: there may exist some kind of
emotional sympathy between the mesmeriser and the
person who is mesmerised.       The emotions of hope or
fear or anxiety which affect the waking person may be
communicated to the sleeper. These emotions seem to
act upon the imagination, and to mould to a great extent
the sleeping vision. Hence I am inclined to disbelieve
all descriptions which relate to subjects strongly affecting
the feelings of the mesmeriser. Besides, there is the
constant effort of imagination eking out what is seen,
like a person peering through a mist at a dim object he
is anxious to recognise.
After 'these enormous deductions we find a residue of
pure observation, but we have no means of ascertaining
how far even this is to be depended on unless we have
independent means of verifying it, which of course supposes the subject to be one patent to our waking faculties, and this narrows still more the possible utility of
the revelations of clairvoyance.
The practical conclusion I am    inclined to come to is
that mesmerism as a hypnotic agent is very valuable,
that in certain rare cases the revelations of a clairvoyant
may be of value in ascertaining the precise pathological
condition of patients, but that it must be employed with
extreme caution and reserve, as it is just as likely to mislead as to guide aright.
On the moral aspects of the subject it would be out
of place to enter, but I cannot refrain from making one
observation, and it is this: that the relation of a physician to his patient is the most sacred, the most delicate,
and -the most responsible which can unite two persons




556                  MESMERISM*-.
in a professional point of view, and that any person fitted
to discharge the high duties implied by this. connection
is worthy of the trust which must be reposed in one who
is made the depository of the sleeping confidence of
another.   And let me. add that I consider that the
employment of mesmerism for the purpose of amusement
is utterly disgraceful to all connected with such exhibitions.




CHAPTER XI.


ON SIR H. HOLLAND'S " MEDICAL NOTES AND
REFLECTIONS.
THE table of contents of this interesting volume is as
follows: "Effects of Mental Attention on Bodily Organs,"
" On Mental Consciousness in its relation to Time and
Succession," "On Time as an element in Mental Functions," " On Sleep," " On the relation of Dreaming to
Insanity, &c.," "On the Memory, as affected by Age or
Disease," "On the Brain as a Double Organ," "On
Phrenology," "On Instincts and Habits," and lastly,
" On the present state of Inquiry into the Nervous
System."
We should certainly have inverted the order of this
enumeration, for all the topics relate to some of the
functions of the nervous system, and it seems natural
to precede any consideration of the obscure points involved in discussing these mysteries of our frame, by an
accurate survey of the exact amount of our knowledge
of their seat.
There are two distinct methods of investigating the
functions of the cerebral and nervous systems-the one
from within, the other from without. We may begin
with the fact of consciousness, and pursue its relation to
such physiological conditions, as sleep, time, as an elc



558


SIR H. HOLLAND'S


ment in natural functions, &c.; or we may begin with
observations on the outlying portions of the nervous
system, and by experimental investigation of the nerves
of sensation and voluntary motion, advance towards the
centre till we arrive at the confines of consciousness,
where all such observations are arrested. To attempt to
give any summary of the results of physiological researches, would be at once absurd and presumptuous;
nor do we find anything of the kind in this volume.
All we meet with is an allusion to certain well-ascertained
facts, and many vague conjectures as to what future
observers may discover. Most of the problems suggested are of a kind which rather invite the other
method of investigation, and so by it we shall chiefly
allow ourselves to be guided in the labyrinth into which
our author leads us.
The two facts, from one or other of which all reasoning must start, are the perceptions of our own minds,
our impulses, our moods, our memory, &c., and our
perception of objects outside of us. Beyond these two
is no point de depart conceivable; and hence it is that
we must be brought to a standstill at once, when we attempt to speculate upon the phenomena of sleep. We
cannot observe the dreams of another person, we cannot
investigate our own; so that anything like a satisfactory
elucidation of dreams is impossible;-still, the subject
of sleep and dreaming is so important, that we would
fain push a little way into it, and the hints we meet with
in the chapter on that subject are worthy of attention.
Sleep may be either general or partial, perfect or imperfect. If the human frame be likened to a republic,
consisting of numerous states, independent of one an



MEDICAL NOTES AND REFLECTIONS.


554


other in so far as local government is concerned, but capable of general or congressional action in regard to
other countries, we may represent sleep in its ordinary
degree as the cessation of all such activity.  The sleeper
is dead to the world; he no longer acts upon it, but it
acts upon him. The changes required to sustain his life
and energy go on with unimpaired or increased force and
regularity; and as these changes depend on the integrity
and wakefulness of some parts of the nervous system,
it is manifest that they, at least, cannot submit to the
influence of sleep. To prove the rule by the exception,
we may quote a case where sleep seems to have invaded
the nerves of respiration.  It is thus reported in Sir C.
Bell's work:1
"Mr. --, surgeon, called on me to hold some conversation on his own case. He attributed his unhappy
condition to a malignant fever, with erysipelas, during
which there had been exhibited a great deal of calomel, as
much as 30 grains at one dose, which cured him; but he
thought it left him subject to a gastric affection with
chronic inflammation. However that may be, this is
his present condition.  On falling asleep, just at the
moment when volition and sensibility cease, the involuntary motions also stop, with a sensation of death, under
which he wakes generally convulsed. His medical friends
have sat by him and watched him, and they have found
that when sleep is overpowering him, the breathing becomes slower and weaker; the heart and pulse also fall
low, and cease to beat as sleep comes on; and after a
short time he awakes in terror."
1 'Bell on the Nerves,' p. 425.




960


SIR H. HOLLAND'S


Such would be our nightly condition if sleep overwhelmed the nerves of respiration as it does the brain.
We may, then, safely assume that some part of the nervous system is always awake.   It is a very difficult and
important inquiry to determine what these perpetual
sentinels of life are. Do the nerves of voluntary motion,
and do the parts of the spinal cord whence they arise
partake of sleep? or is this function confined to the
brain? The former view is supported by many analogies,
and will, perhaps, explain a fact familiar to all physicians-that many patients, although apparently in a
profound sleep, as far as utter unconsciousness of an
external world is concerned, never have the feeling of
repose, but complain of a sense of restless uneasiness of
the spine, which haunts them like a dream the whole of
the night. It may be, that the normal state of sleep is
a lessened degree of consciousness in all the parts of the
nervous system under the influence of volition. That
many reflex actions, besides the purely involuntary, go
on in this state is certain. The partial contraction of
the muscles of voluntary motion, the steady action of
the sphincters, which is arrested by death and some
powerful narcotics, is evidence of this, in what we may
call every night life; while we have abundance of examples of a much higher degree of combined muscular
efforts during sleep; as when a coachman drives his
stage dozing the whole way-an occurrence now, perhaps, uncommon, but frequent enough in the old days
of the night mail. Then we have somnambulism in all
its degrees. If the opinion which is now most fashionable among physiologists be correct, that the cerebellum
is the organ of associated muscular movements, it might




MEDICAL NOTES AND REFIECTIONS.


561


offer a very simple explanation of sleep-walking to suppose this part of the brain to be awake while all the
rest is asleep.  Be this as it may, it is of importance to
recognise the facts, that sleep is never universal, and that
we cannot yet define the limits of its influence upon the
nervous system.
It is never universal-is it ever perfect? Does it ever
annihilate for the time all intercourse in both directions
between the sleeper and the world? There are strong
facts against the affirmative position-facts which seem
to compel the belief that even in the deepest stupor there
are channels by which the external world produces its
impressions on the consciousness of the person who seems
utterly insensible.
If we agree with our author in considering the stupor
induced by pressure on the brain as differing from ordinary sleep only in degree, and to the eye of the observer
there is no appreciable difference between the sleep of
over-tired nature and that of apoplexy, and if we can
establish the persistence of the capacity of receiving
impressions -even in the deepest stupor, we must admit
that there is no evidence for sleep ever being so absolute
as to destroy all consciousness.  The case we put in as
proof rests  upon   the  unimpeachable   testimony  of
Abercromby, and is thus related by himself:"A child of four years of age underwent the operation
of trepanning, while in a state of profound stupor from a
fracture of the skull. After his recovery he retained no
recollection either of the operation or the accident; yet
at the age of fifteen, during the delirium of a fever he gave
his mother an exact description of the operation, of the
36




562


SIR H. HOLLAND'S


persons present, their dress, and many other minute
particulars."
If, then, in a sleep of morbid intensity it is proved that
impressions took place which were afterwards remembered, we may safely conclude that in ordinary sleep the
mind is supplied by hidden rills of sensation which
become the source of an infinite variety of emotions and
cogitations, mostly beyond the power of recall, but
mingled in the texture of the mind as it is woven on the
loom of time.
Where there is memory there must have been attention
-at least, to such a degree as to enable the mind to
perceive an impression; and we may conclude, that even
in the profoundest sleep, attention is never wholly absent.
This accounts for the consciousness during sleep of the
lapse of time, and also for the very singular fact that the
slightest noise of a kind requiring the attention, will
waken a sleeper who withstands the loudest uproar, if it
does not affect him personally. We know of an officer
whose duty required him to be on the alert against a
surprise during the last seige, who was awakened by the
first discharge of a rifle, while sleeping through the roar
of all the batteries of cannon, in utter unconsciousness.
With the large artillery he had no business, but he had
with the musketry. Such axamples might be indefinitely multiplied. It is enough if we recognise the fact
that in sleep we do not part with either attention or
memory.
This, then, is "the stuff that dreams are made of."
They are the lines drawn on the sensitive surface of the
mind by impressions made upon the body. Most fre.




MEDICAL NOTES AND REFLECTIONS.


563


quently these lines arrange themselves into figures purely
fantastic, one figure breaking in upon another like an
unsuccessful photographic picture; at other times, under
the influence of causes which affect the nervous system,
such as opiates, the images assume more distinct arrangement, and are impressed more permanently, so as not
only to become objects of waking recollection, but to
remain so vivid as to confuse the mind, and to defy all
efforts to adjust them to their proper significance. Thus
we perceive how readily the indulgence in drugs which
produce intense and pleasant dreams, such as opium and
cannabis indica, become the fertile cause of insanity; for
it is impossible to conceive a more perfect realisation of
universal madness than would be presented by the world
of sleepers rising, and acting each his own particular
dream.   Such is the state of the victim  of delirium
tremens: he is possessed literally by horrible dreams.
Fortunately, we can avoid the causes we know to install
dreams in the place of reason;-for the most part, they
are poisons in the blood, perturbing the brain and
nervous system.
But far short of any such intense disturbances as to
constitute permanent illusions after sleep, we may recognise as a cause of disagreeable dreams any alteration in the
state of the blood which prevents it supplying the proper
materials for the nightly regeneration of the nervous
system. Hence the unrefreshing sleep in many fevers;
probably from the retention of secretions which the
emunctories are disqualified for removing. And another
frequent cause of imperfect sleep and distressing dreams,
is the insufficient quantity as well as the impaired quality of
the vital fluid.  Many a restless night is caused by going




56-1


STR B. HOLLAND'S


supperless to bed, and in the present day, when out of
opposition to late dinners, the delicate members of a
family are regulated by their abstinence-enforcing medical
attendant to a meagre early meal, it is very doubtful
whether the advantages of an easier digestion are not
countervailed by the starving of the nervous system
deprived of its food during its time of repose.   We can
testify from frequent experience to the advantage of a
moderate but substantial supper, in procuring sound and
refreshing sleep for persons who out of respect to some
code of health, have been in the habit of religiously
abstaining from tasting food for some hours before going
to bed.
Besides the confused shadows left upon the mind by
ordinary dreams, and the intense ones imprinted there by
morbid states of the blood, there is another class which
has given rise to much interest and speculation, but
which would lead us, if the subject were pursued, into
the wide wastes of mesmerism.      We allude to dreams
which have a distinct relation to the external world, presenting to the sleeper pictures      of  distant  objects.
Whether it be possible ever to include this subject in any
purely scientific treatise, will depend very much on the
spirit with which it is pursued by those who take a
special interest in it.  Mesmerism may be said to have
advanced to such a point as to demand recognition by all
writers of physiology as well as psychology, and the more
recent and celebrated of the latter have frankly acknowledged this,' and have not hesitated to declare that we
receive impressions from the external world by other
SFor example, Sir William Hamilton, late Professor of Logic and Metaphysics in Edinburgh. See his ' Dissertations.'




MEDICAL NOTES AND REFLECTIONS.


565'


channels than the senses. This is a great step, and one
which opens the door to endless speculation and inquiry,
and this is closely connected with the subject of sleep
and dreams. It is notorious how much influence, for
example, atmospheric causes have upon the entire phenomena of sleep. Now if the only essential difference,
viewed from  the pyschological point, between sleeping
and waking, be that in the former we cannot control the
impressions made by external causes, but must permit.
them to scrawl their signatures on the mind at random,
while when awake we can repress the emotions and
thoughts the same ever-acting influences would tend to
evoke, it is manifest that these impressions may still be
made, and enter unconsciously into the whole fabric of
the mind's growth and structure.  It is in this way we
may probably explain the national differences of the
modes of thought observable over the globe.      How
large a portion of the solar light goes to form the mind
as well as the body of " the children of the sun " in
eastern and southern latitudes, is a question fertile of
speculation, and one which, when satisfactorily resolved,
may account for many perplexing perversities in oriental
philosophy and religion. It is along this line of inquiry,
where, every now and then, physiology and psychology
intersect, that Mesmer's temple stands, and we can only
express an earnest hope that his votaries may strive after
a philosophical method of pursuing their investigations;
and we cannot here refrain from expressing our regret
that a subject of such deep interest to all thoughtful
minds, especially to those engaged in medical persuits,
should have been degraded to such base purposes as to
have become a scandal and reproach, instead of an




566


SIR H. HOLLAND'S


honorable ally. The extravagancies and follies perpetrated by men calling themselves physicians, especially
in America, is enough to make one blush for his profession.  How any sane man can for a single hour give
himself up to the delusion of spirit-rapping, is only
explicable by presuming on his part a total ignorance of
the fundamental laws both of psychology and physiology,
but that physicians should patronise instead of explaining
the fallacies, seems almost incredible. What are the
alleged facts? simply these, that certain persons hear
certain sounds, and that they cannot detect a physical
cause for them. Well, what of that?  If these noises
have an objective reality, if they are caused by vibrations
of air from an impulse given to a piece of wood, the thing
that gives this impulse, must be a thing, that is, must
possess the first attribute of matter, impenetrability;
otherwise it could not act upon matter; if it be impenetrable it must have extension and form, and therefore it
is not spirit, which is defined as being without material
qualities. If a spirit be assumed, and we may freely
admit the presence of spirits to any amount, the objection
to their turbulent activity is simply the fact that hitherto
the whole course of observation has more and more unequivocally demonstrated the position, that the spirit, the
only one we know about, the human spirit, active enough,
and mischevious enough, in all conscience, is quite powerless to act upon any form of matter without the intervention of a nervous system. To prove the connexion of
the noise with a spirit, those who believe in it must first
prove the presence of a spirit on other grounds, and then
how being there without a nerve, muscle, or bone, it taps.
But how much simpler the explanation of the phenomena




MEDICAL NOTES AND REFLECTIONS.


567


if we assume the whole affair to be a subjective illusion
of the sense of hearing. That it should happen to several
persons at once, is no argument against it.  We know
how contagious tremors of the nervous system are-we
know, for example, that on one occasion at a factory, a
girl was seized with convulsions from the fright given by
a mouse put into her bosom, and that in a few days no
less than twenty-three women and a man were labouring
under similar convulsions, and if such perturbutions of
one portion of the nervous system propagate themselves
to those around so rapidly, why may not a similar
extension take place in perturbations of a nerve of sensation? Once admit this, and all mystery vanishes.
The transition from the subject of sleep to that of
habit and instinct seems natural, for by habit sleep is
much controlled and modified; and in our observations
we shall include what we have to say upon hereditary
disease, although this is treated by the author in another volume by itself. But the disjunction seems unnatural, especially when we meet at the outset with the
remark, that hereditary peculiarities are much more
frequently met with in the organs of animal, than of
organic life.
The origin of all habits is probably due to the simple
fact, that we naturally employ that plan of attaining a
desired end, which is resisted by the weakest obstacles.
We grope from infancy to old age along the barrier
which limits our activities, and where we discover an
opening in this restraining obstruction, we push through
it, and press onwards till we encounter the next wall of
R omberg 'On Diseases of the Nervous System,' vol. ii, p. 179..




568


SIR H. HOLLAND'S


circumvallation.  On our return to our starting point
we recollect the road we have taken, and the next time
we set out on the same journey, we follow the same.path.
If this road be dangerous to ourselves or injurious to
others, we are driven out of it by our instructors, whether in kindness to us or out of fear for themselves interposing some new and greater obstacle, so that we have
again to discover afresh the point of least resistance.
Thus are habits formed and educated.      Hence their
enormous power for good and evil. For the road we
know we come to walk with such ease and so full a sense
of security and satisfaction, that in a short time all effort
is at an end, and what was at first accomplished by
anxious trial and constant exercise of will, becomes subject to laws which regulate involuntary actions. The
exact method by which this takes place is not known.
That walking is a most difficult achievement for an infant, and its first successful pursuit of knowledge under
difficulties, is well known to all mothers and nurses, but
what the change in the nervous system is, by which an
act thus laboriously learned becomes one of utter unconsciousness-becomes transferred we may say from
the brain presided over by the will, to the spinal chord
which associates muscular efforts of a purely involuntary
character, remains as yet an unsolved riddle.   Habits
may be said to represent for the individual the maximum
of attainment with the minimum of effort.  Can we then
wonder that all novelties, such for example an entirely
new method of medical practice, should be absolutely rejected by the mass of those who have formed themselves
upon an old one?   Can we be surprised that when they
see a barricade in every street, they should raise an




MEDICAL NOTES AND REFLECTIONS.


569


alarm, and call upon the government to order out the
troops and clear the city?  This is an illustration of the
power of habit not given by Sir H. Holland.
That the habits once acquired become not only permanent features of an individual, but are also transmitted
to his descendants, is a supposition supported by strong
analogies. Thus it is quite notorious that the progeny
of a well-bred pointer requires hardly any training. A
pointer puppy may be seen standing at a hen or a duck
in the stable yard, without ever having "set his puppy
brains to work to comprehend the case." Here we have
an example of the transmission of a purely artificial
habit. That special talents may be cultivated so as to
affect the character, and then transmitted, if not susceptible of proof in the instance of man, is at least probable; and, perhaps, the curious fact noticed by our
author and differently explained by him, that the right
hand and arm are as a rule from birth stronger than the
left, may be accounted for by tracing to the remotest
times the universal occupation of men to be engaged in
fight. The authentic records of our race are little else
than a succession of wars. At the present day all savage
nations are always fighting, and seldom do anything else.
Their life, indeed, is a process of self-extermination.
Now it must have very soon been observed, that wounds
on the left side were more dangerous than those on the
right, and so it would naturally happen that an attempt
would be made to withdraw the left and expose the
right; but the exposed side must be the armed one,
hence the spear would be grasped by the right hand, and
the shield held over the left breast. Thus may we suppowe that our race became right-handed, and ill- natured




570


SIR H. HOLLAND)S


politicians may find in this an excuse for ascribing a
certain sinister aspect to the efforts of the peace party in
this country.
How far habits injurious to health and full development of all the organs may be the origin of positive disease and malformation, and thus the source of monstrosity, is a most important question for all who have any
charge of the public health, but the subject has not
been investigated in a wide range, or with sufficient
exactness to warrant any satisfactory conclusions.  It is
certain that many diseases of the nervous system, such
as epilepsy and insanity, which arise from individual
excesses or vices, are prone to assume a hereditary character. At the same time, there seems a much stronger
tendency in congenital than in acquired deviations from
the normal type to be perpetuated by transmission.
Sir H. Holland gives some curious examples of this kind
in the following passages:
"' An instance is known to me of hydrocele occurring
in three out of four successive generations in one family
-the omission adding to the singularity of the fact,
from its depending on a female, being a third in the
series, in whose sons it reappeared.
"c I am acquainted with a family in which there are
three examples, the father and two children, of inability
to distinguish red as a colour.   Another example resembling the last is known to me, where three brothers
and two or three children of their families have the
inability to  distinguish between blue and pink.   Instances of hereditary defects of this kind are far from
unfrequent.  I have known squinting to occur in every
one of five children, where both parents had this pe



MEDICAL NOTES-AND REFLECTIONS.


571


culiarity. An example has recently occurred to me of
that remarkable affection, the suffusio dimidians, existing
in a father and his daughter, and brought on in each by
circumstances singularly alike. The frequency of blindness as an hereditary affection is well known, whether
occurring from cataract or other disease of the parts concerned in vision. The most remarkable of the many
examples known to me, is that of a family, where four
out of five children, otherwise healthy, become totally
blind from amaurosis, about the age of twelve, the vision
having been gradually impaired up to this time. What
adds much to the singularity of this case, is the existence
of a family monument, long prior in date, where a family
ancestor is represented with several children around
him, the inscription recording that all the number were
blind.
"The repetition of cases of deaf and dumb children
in the same family is familiar to those who are concerned
in institutions for the relief of this congenital defect, and
will be afterwards noticed in reference to another singular
modification of this fact.
" In one family I have known four or five cases of the
peculiar tremor tendinum of the hands and arms, which
is sometimes called the shaking palsy, and which here
occurred in young persons of 16 or 18, as well as in
those more advanced in life. In this case, too, as well
as in another of the same affection, I had proof of the
peculiarity having gone through at least three generations.
"Defects or peculiarites in the form and setting of
the teeth, as well as in the hair or nails, are often hereditary; and lefthandedness, from whatever cause it pro



572


SiR H. HOLLAND'S


ceeds, I have more than    once observed to take the
character of a family peculiarity. In a family where the
father had a singular elongation of the upper eyelid,
seven or eight children were born with the same deformity,
two or three other children having it not. I have known
another family in which five daughters resembled the
mother in having a large growth of hair on the lip and
chin.  In like manner I have seen enlarged tonsils occurring in almost every individual of a large family,
without other cause by which to explain it. A case is
recently known to me, where the patella was wanting
both in father and son."
" I find many examples among my notes of what must
be deemed hereditary tendency to heart-disease; and
such in truth are familiar to all observers.  In one of
these, four brothers died between 60 and 65, of organic
disease of the heart, with prior cases of the same kind
in their family. In another case, which I note here as
having most recently occurred to me, I find three cases,
including one of the morbus ceruleus, in three successive
generations.  It is unnecessary to add others.
" Of hereditary obesity I have seen some very curious
examples-the most recent that of a family in which out
of two generations four individuals died of the results
of excessive accumulation of fat, producing diseased
action of the internal organs, and dropsical effusions, two
other cases of the same tendency existing in the family,
under distressing though less urgent forms.     Several
cutaneous disorders evidently tend to become hereditary,
whether from peculiarity in the texture of the skin, or
depending on the general temperament and state of the
circulating  fluids.  I have lately seen  three cases of




MEDICAL NOTES AND REFLECTIONS.


573


Psoriasis in the children of a family where there is strong
predisposition to gout, a conjunction I have observed in
many other instances.   Certain impetiginous eruptions
belong also to a family constitution, such as is often
termed scorbutic, and are obviously transmitted from
parents to children.
"Icthyosis is occasionally seen as an hereditary disorder. I may notice here another singular disease, the
pellagra of Lombardy, in which, together with the peculiarity of a local limitation, there occurs a very singular
succession of symptoms, beginning with a cutaneous
affection of leprous character, passing through various
stages of cachectic disorder, and ending generally after
the lapse of a few years, in fatuity or death. I have had
much opportunity of observing this curious disease in all
its forms. There can be no doubt of its hereditary
nature, though there is difficulty in tracing it back, in
Lombardy, for much more than a century, and equal
difficulty in assigning the causes which give it existence
in this district alone. The peculiar form of leprosy prevailing in certain parts of Norway, comes under the
same description of hereditary disease, and is further
analogous to the pellagra in the fatuity it often produces.
In the hospital at Bergen I have seen this singular disorder in all its forms and stages.   Diabetes, from my
observation (and Dr. Prout states the same fact,) has
sometimes an hereditary character. Enuresis in children,
from whatever source arising, occurs sometimes in so
many individuals of the same family, as to make it
almost certain that it has a common congenital origin.
What is not less remarkable, as an instance of similar
speciality, emphysema of the lungs has been ascertained




574


SIR H. HOLLAND'S


to depend in a great number of cases, on hereditary influence, independently of any disposition to tuberculous
pulmonary disease.
"Another instance which may be termed special,
though belonging to a part of structure diffused over
the whole body, is the hmemorrhagic diathesis. Though
I do not find in my notes any very marked examples of its
hereditary nature, except where confined to the lungs,
and connected with a phthisical constitution, yet some
are recorded so explicit as scarcely to leave the fact in
doubt; and remarkable further, from the seeming limitation of these instances to the male sex. Nor is there
greater difficulty of explanation here, than when a more
limited portion of structure is concerned. The points of
question are the same in each case; and the solution, if
ever obtained, must be common to both.
" Other diseases might be mentioned, offering questions of the same kind as those stated above. Asthma,
for example, sometimes shows an hereditary character.
I have known the complaint to occur in three successive
generations, and often so numerously in the same family
as to make it certain that a common cause was concerned. This cause is probably one of structure. Yet
it would be difficult to affirm it to be so, or to state in
what part the peculiarity is likely to exist. It may be
that some normal state of the nervous system is chiefly
concerned; there being nothing to disprove the possibility that such state of certain parts of this system may
be transmitted by descent, so as to become a source of
the disordered actions of asthma.  Or the cause may,
perhaps, be sought for in connection with the gouty




MEDICAL NOTES AND REFLECTIONS.         57


575


diathesis, to which I cannot doubt from experience that
some forms of asthma are closely related.
"C Every physician will recognise the general tendency
to hereditary character in disorders of the brain and
nervous system. This is a remarkable part of the subject, involving, as it does, every variety and degree of
morbid affection, from simple headache to the worst
forms of epilepsy, apoplexy, and palsy. I shall hereafter
notice in relation to another part of the subject, some
singular examples in its illustration. The topic is further
one of deep interest, as including the various conditions
of hereditary insanity, instanced not merely in particular
families, but even in. districts and communities, where,
from local circumstances, there has been little intermixture with the rest of the world. From these facts well
attested to us, we gather the important conclusion that
some deviation in physical structure, whether obvious or
not, is the cause of the aberrations it presents.  In no
other way can we conceive the transmission of the tendency from one generation to another. It m-ay be that
a part of the fabric of the brain is concerned, far too
miniute for the most subtle research to follow; and this,
indeed, might be presumed, looking at the nature of the
functions affected. But still, whenever the transmissions
occur, we are bound by all analogy to infer the presence
of a morbid, material cause, upon which the phenomena
primarily depend.
"CCThere is much that is curious in the tendency to
headaches thus transmitted by descent, and often going
through whole families with similar character. The
cause here presumable varies in different instances. Sometimes, and especially, perhaps, where they are periodical,




576


SIR H. HOLLAND'S


the affection may belong to the gouty habit, and to the
matter of gout in the circulation. In other cases, abnormal
structure of the vessels of the head may be concerned.
In others, again, some peculiarity in the nervous substance itself.
" In hereditary affections of the nerves, as in those of
other parts, it is extraordinary in what minute peculiarities
the tendency often shows itself.  It is difficult, indeed, in
some of these cases to distinguish what is due to imitation
alone; but in other instances where this is excluded by
circumstances, we find, nevertheless, nervous habits and
disorders of the parents reappearing in the offspring to
a singular extent.
"These entailed disorders are certainly more numerous than is generally supposed; and, probably, the
source of many morbid states, apparently remote in kind.
As respects their origin, they may all be referred to the
general principles we have already laid down.
" There are some examples of abnormal structure, or
disease, which, though frequently occurring in detached
instances, yet are so especially numerous in certain localities, as to afford suspicion in the absence of other sufficient causes that hereditary tendency is much concerned.
Such is the goitre of particular districts, no consistent
explanation of which has yet been given, founded on
local circumstances of climate, or mode of life. The
plica polonica prevailing almost exclusively along the
course of the Vistula, is another instance to the same
effect. I might apply the same remark, though with
greater doubt, to that curious affection, the trismus
nascentium, prevalent in particular localities, and these
widely different in   all physical circumstances.   The




MEDICAL NOTES AND REFLECTIONS.


577


great frequency of urinary calculi in certain districts
where there is no obvious peculiarity of air, food or
water, as a probable cause; and the common tendency
to lithic acid deposit in particular families, may admit
of like explanation.  And this is further sanctioned by
the certain connection of the calculous with the gouty
diathesis."
A question has been mooted which has given rise to
much acrimonious discussion, as to whether acquiredhabits by becoming hereditary may not gradually affect
the distinction of animals into different species. The fact,
however, seems to be decided by the pretty general consent of all physiologists, that the range of deviation is
confined to what may be called the limits of the type of
the species; and that there is not the shadow of evidence
for a progression of the kind on which the theory of
'The Vestiges of Creation' rests, in fact, the evidence
is entirely opposed to it.  Our author expresses himself
in rather a vague and unsatisfactory style upon this
matter, and we greatly prefer the following passage of
Mr. Kingsley:
"Let us, therefore, say boldly that there has been a
'progress of the species,' and that there may be again,
in the true sense of that term; but say as boldly, that
the transmutation theory is not one of a progress of
species at all, which would be a change in the idea of
the species taking place in the Divine mind-in plain
words, the creation of a new species. What the transmutationists really mean, if they would express themselves clearly, or carefully analyse their own notions, is a
physical and actual change, not of species, but of individuals, of already existing living beings, created accord37




578


STR H. HOLLAND'S


ing to one idea, into other living beings created according to another idea. And of this in spite of the apparent change of species in the marvellous metamorphoses
of lower animals, nature has as yet given us no instance
among all the facts which have been observed; and there
is, therefore, an almost infinite inductive probability
against it.  As far as we know yet, though all the dreams
of the transmutationists are outdone by the transformations of many a polype, yet the species remain as
permanent and strongly marked as in the highest
mammal."
It is not easy to trace the origin or to define the conditions of instinct. To those who take pleasure in contemplating the universe with all its created inhabitants
as the expressions of a divine and ever-acting Power,
whose thoughts so far resemble those of the human
intellect as to follow a regular sequence moving along a
course of unerring logic, although ages intervene between
his footsteps (to borrow the language of Guizot), there
is nothing either strange or repulsive in regarding the
class of instinctive actions as mental operations unconsciously subject to unknown laws; this seems to be the
notion which Laplace intended to convey by the phrase
of there being animal affinities analogous to those which
cause the molecules of a crystal to approach one another,
and assume definite arrangement.    But to those who
delight to dwell upon the triumph of the human will in
subjecting to its own purposes of good or evil the whole
machinery, whether sentient or material of the outer
world, there is something humiliating in tracing from the
proud pre-eminence, where some Titan of his age lords
over all, the roots of his existence, so to speak, beneath




MEDICAL NOTES AND REFLECTIONS.


579


the surface, where they become subject to the same laws
which control and regulate those of the most insignificant
insect.  It is this contrast in man between a domineering
will and intellect, and a subjected bodily nature, that
gives such interest to the subject of instinct. And yet,
perhaps, in the highest forms of human existence, the
two may be brought into unison with mutual advantage.
For, after all, if we consider instincts narrowly, we shall
find. that they imply either peculiar sensitiveness to
noxious influences, or special impulses towards actions of
a character beneficial either to the individual, or the
species of which it is a member. The animal perception
of noxious influences is exemplified in the retreat of
birds friom pestilential districts, in the general rejection
by animals of poisonous food, and in the general avoidance of what would be dangerous to their well-being,
while their active instincts induce them to go through
many actions in a state which Cuvier likens to somnambulism, from its unconsciousness on the part of the individual of any benefit to be derived from it.
The difficulties that are chiefly dwelt on by Sir H.
Holland, seem to arise for the most part from a sort of
tacit demand that every action shall have the accomplishment of a preconceived object for its motive. Now,
doubtless, this is true in regard to ourselves in a great
measure, when we have reached maturity, and becomecapable of analysing our inducements to change our
habits of action, but it is not true of us in infancy, nor
is it at all necessary to suppose any such process of
mental anticipation in the mind of an animal. There is
in fact no more real difficulty in conceiving a series of
impulses compelling a succession of corresponding acts




580


SIR H. HOLLAND'S


in a beaver and a bee, than there is in comprehending
the growth of an embryo. What makes the various parts
assume each its own proper form, and what gathers
them all into a complete and separable being in foetal
life?  We answer, the laws of their growth. Then if
we only advance the idea of growth from an individual
to a species, we shall strike upon no new difficulty. The
same impulses which prepare by anticipation all the requisite defences, the thick skin and sharp teeth for the
beaver, while still in the womb of its parent, where no
such defences are of any use, impel the full-grown
beaver to undergo all the labour which excites our
wonder, before it knows from experience that the work
will be of any personal advantage to it.
Admitting as we must do, that the continuance of our
individual and social existence rests upon the instinctive
impulses of our nature, as opposed to the actions suggested by reason, the question how far, or in what way
the former ought to become subordinated to the latter,
would lead us into considerations more proper to the
writers on ethics and political economy, than to those on
physiology. Perhaps we may express a doubt whether
there is not. too great a tendency in the present direction
of education and civilization to undervalue the importance of the primitive and instinctive emotions out of
regard to certain formulae of conduct. Virtue is good
but innocence is better; and if it were possible to
harmonize the strong natural impulses so as to allow
them their full effect in giving energy to life, without
interfering with the eternal laws of purity, we should
gain immense power without sacrificing any of the social
proprieties. But if our efforts are directed to the sup



MEDICAL NOTES AND REFLECTIONS.


581


pression rather than the regulation of instincts, nature
may avenge itself "by stopping the supplies," and so
paralysing the constitution.  If we were to follow this
reflection to its natural consequences, it would lead to
the consideration of some of the most embarrassing
questions submitted to us in our capacity of medical advisers, by persons who have to suffer from a conflict between what we may almost call individual and social
morality, whose health is destroyed by submission to
laws absolutely necessary for the general welfare of
society. Any attempt to adjudicate in such distressing
cases is beyond the scope of the physician's office; all
we can do is to state the consequences and leave the
decision to the individual. It may be that duty shall
require the sacrifice of health: this does not entitle us
to advise an evasion of the duty, but merely to state the
facts.
As to the seat of the instinctive appetites and emotions, although probably always in some part of the
nervous system, it would seem to be various in different
species of animals. For example, a decapitated butterfly will exhibit as much animation in the presence of one
of an opposite sex, as when in possession of its head,
with all the organs of the senses there concentrated,
while the destruction of even portions of the brain, will
annihilate in animals higher in the scale, all the perceptions and emotions represented by the insect's excitement.   An inquiry into the seat of the emotions, naturally conducts us to phrenology, a subject treated by
our author in rather a superficial manner.    It is one
which admits of two distinct points of view, which have
not, perhaps, been sufficiently discriminated.  Accepting




582


SIR H. HOLLAND'S


as an established fact that the brain is the organ on
whose integrity all mental operations depend, it is an
obvious suggestion that as, on the one hand, we have a
complicated series of very dissimilar mental attributes,
and on the other a no less complex organization, we may
infer that each of the various primitive emotions and
faculties will have a corresponding cerebral locality.
" Eminent men in all ages have acknowledged this dependence of the faculty of thought upon the body: of
these, I need only mention (we are now quoting
Prochaska)' Hippocrates, Galen, Descartes, Abraham,
Kaw Boerhaave, and Gaubius.    The force of truth made
Tralles also subscribe to this opinion, for, although he
carried the doctrine, that the mind is independent of
the body too far, yet he observes, it is, indeed, certain
that experience teaches us that so long as the soul is
connected with the body, a well-established brain is
absolutely necessary for it to think, imagine, reproduce
ideas, and judge concerning them." Ernest Platner,
also, in his elegant essay, de vi corporis in memoria, observes, "since such are the facts, it is manifest from the
observations already made, as to the mode of perception,
that every one of our senses is put in action by the
common agency of the body and mind, so that no
sensation or thought can be produced by the mind
without the body, nor by the body without the mind.
And this doctrine that the soul so long as it is connected
with the body, can neither think, nor have self-consciousness, without a properly constituted brain, derogates
certainly in no degree from the immateriality and


3 Unzer and Prochaska, on ' The Nervous System,' p. 445.




MEDICAL NOTES AND REFLECTIONS.


583


immortality of the soul, which God by special favour
can endow with an eternal consciousness of itself, and
of things external to it, although the body it had
inhabited be destroyed-a doctrine we are taught to
believe by religion, which also in every age has been
desired by mankind, and which great philosophers have
approved by their assent."  So much, then, we may
take as an acknowledged fact in physiology, and it is a
perfectly legitimate advance from this broad basis, to
attempt to ascertain by an examination of the brains of
those who when alive exhibited well-marked peculiarities
of character, whether certain portions of that organ do
not correspond with certain faculties. The difficulties
of pursuing in a rigidly scientific method this investigation, are obvious  enough, and exemplified   by the
obstacles which required so much time and genius to
overcome them, before the much simpler facts of the
relation of nerves to different senses and other functions
were finally established.
The other point of view from which phrenology may
be regarded is that of an attempt at an accurate physiognomy of the head. Every part of the body is indicative
of the character of the whole individual in a greater or
less degree; the hand may be called a hieroglyphic,
legible perhaps to a mind of angelic power, of the perceptions of all the relations involved in every part; and
how much more may we expect from the head, the
capital of the human fabric, the grand distinctive feature
of man?  It is surely no mean task to endeavour to fix
with precision the meaning of every curve and line, and
a task which, if pursued with the clear idea of the knowledge we may thence derive, is likely to be attended with




584


SIR H. HOLLAND'S


success.  But it would perhaps have fared better with
phrenology if its cultivators had kept to this idea instead
of confusing a question in itself sufficiently perplexed by
the introduction of another element altogether, that is,
the relation of the form of the head, not to character
only, but to the brain also. It may be perfectly true
that a head broad behind, with a corresponding broad
and a thick-set neck, is an indication of a large endowment of the faculty, which the phrenologists out of
respect to the race of novelists designate as No. 1, and
it may be equally true that this function of the cerebellum  is to preside over complicated movements.  Why,
should the one set of observations be held to clash with
the other? At the least we may suspect premature generalisation on the part of the phrenologists in this direction. It would be out of place here to enter upon the
objections raised against the system from the psychological
side, as giving an imperfect analysis of the mind, and
overlooking some of the most essential difficulties which
lie upon the very threshold of all attempts to catalogue
the mental faculties of man.  Perhaps it is oxving to such
omissions that M. Comte, whose sympathies should
incline him to a favorable judgment of the labours of
phrenologists, pronounces against them the severe sentence, "that they do not seem to have even perceived
the difficulties that must be overcome before their system
is accepted by philosophers." However this may be,
there is one thing quite certain, that until the system is
universally accepted, or at least much more generally than.
at present, it is a great error on the part of those who
describe the localities of the symptoms of the head, to
adopt a phrenological nomenclature.  Descriptive ana



MEDICAL NOTES AND REFLECTIONS.


585


tomy is a science, like physical geography, altogether
independent of hypotheses. Where should we be now
if instead of describing symptoms as affecting specified
regions of the body, they had been allotted to the supposed functions which such regions covered? What
could we make of a pain in the region of melancholy, or
envy, or anger?   And yet at one time the liver and the
heart were as firmly and generally believed to be the
actual seats of emotion, as the different portions of the
brain are now.
To those who are interested in the development of this
subject, we might suggest the importance of not too
rigidly circumscribing mental capacity to cerebral development, but embracing in their inquiry the whole of
the nervous system, with many parts of which, as the
ganglionic, we are as yet but imperfectly acquainted.
We know that in the lower tribes it is the seat of most
of their impulses, and it may be that the impulsive character of mind which enables genius to leap from height
to height, while talent, however great, has to ascend and
descend with painful effort the intervening space, may
be dependent upon a more liberal supply of ganglionic
nerves, which imbibe with unquenchable avidity all the
influences of external nature, and thus feed with extraordinary bounty the faculties of emotion and conception,
so as to give rise to a creative energy by which they
summon into the world of matter and observation truths
which till then had been held unrevealed by the ocean
of possible realities which surrounds our little island of
achieved knowledge.
The only remaining topics in this volumc about which




586


SIR H. HOLLAND'S


our limits permit us to linger, are, " the effects of mental
attention upon bodily organs," and "memory as affected
by age and disease."
The effect of directing our observation upon our own
organs is a subject of much importance in reference to
the proving of medicines, and one which has of late
attracted the attention of physiologists by the interest
excited by Dr. Mayo's observations and the magnetescope.  It is yet involved in great obscurity.  All we
positively know is, that if any particular organ of whose
existence we are conscious by sensation, such as the
heart or the stomach, be made the subject of thought or
attention, this mental attitude or exertion may induce
certain changes in that organ which     becomes the
subject of consciousness. We thus have a self-deranging
power within us. How this is effected is difficult to
say.   We   must suppose that there is constantly
present a dim perception of the existence of these organs,
derived from certain nerves of sensation, and when we
are in perfect health the accumulated impression is one
of well-being,  or what    has been   recently  called
euphoria. We may here remark that this state of
euphoria in excess is sometimes the precursor of some
serious attack of disease, and in such a case we may
suppose that the exciting cause of the paroxysm is the
excessive development of nervous power in the organs of
organic life. The diseases in which this has hitherto, been
chiefly observed are of a spasmodic and nervous character.
We have noticed it mother cases, however, and have
had under treatment a lady affected with a singular
kind of bilious diarrhoea. The prominent features of her




MEDICAL NOTES AND REFLECTIONS.


587


case are, that chiefly after eating she is subject to become
affected with a sudden sense of cold, and a pain first in
the right then in the left hypochoncdrium, and immediately
afterwards she has an urgent call to stool, and an evacuation of a large quantity of frothy yellow discharge. The
whole.paroxysm occupies only a few minutes, and it is
quite uncertain in its return, being sometimes absent for
many days and again taking place repeatedly in the
course of the same day. She always knows when an
attack is at hand, by a peculiar elevation of spirits, and
general sense of unusually vigorous health. We adduce
this in illustration of the fact that we derive a constant
stream of impressions from the organs of organic life, and
we must suppose that there is a reciprocal action kept up
between them and the organs of mental emotion. This
indeed we know to be the case, as testified by the rapid
and intense disturbance produced by emotion upon all
the vital parts, so intense as sometimes to be instantly
fatal.
That the muscular system is also in constant communication with the cerebral, we learn from the facts of the
muscular sense, and that this system is also acted on
powerfully by the brain without volition, is proved by
the convulsive movements of the body which have often
been  observed in  paralytic persons. Yawning, for
example, takes place when the voluntary power of opening the jaws is absent. If then we put all these facts
together, we shall see that the only remarkable thing in
the new series of observations to which attention has
been directed is, that the impulse to an unusual degree
of active intercommunication between the sensorium and
the distant organs is given by the will, and that the




588


SIR H. HOLLAND'S


derangements of these organs so produced is carefully
observed by the mind. We may go even a step further
in simplifying the problem, by suggesting that the will
does not act directly upon the organs affected, but indirectly, by inducing in the mind an attitude of anticipation analogous to the emotion of anxiety, so that the
whole circle is represented by the following acts;--first
an act of attention directed to either, let us say, thestomach or the fingers; second the prolonged attention
excites an emotion of longing anxiety; third, this emotion
acts through the nerves proper for its conduction, either
upon the sensitive surface of the stomach, or upon the
muscles of the fingers; and fourth and lastly, we take
cognizance of the sensations produced in the one directly,
and in the other indirectly, by observing the muscular
tremors magnified by mechanical contrivances, such as
the divining rod, or magnetescope.  Such seems to us
the rationale of the whole mystery.
In regard to its relation to homoeopathy all we have
to say is, forewarned forearmed.  So obvious a source
of fallacy is to be carefully guarded against. And when
Sir H. Holland says, speaking of the effects of minute
doses of apparently inert substances, in deranging the
health, " We find the proofs (even as they come from
the founder of the doctrine) to consist principally in the
simple assertion of the subject of the experiment, unchecked, as far as we can see, by any regard to the
phenomena now before us, though so absolutely essential to the truth of all conclusions thus obtained," we
say in reply that it is quite plain our learned author,
however well he may be acquainted with Aristotle and
Hippocrates, did not take any pains to investigate this




MEDICAL NOTES AND REFLECTIONS.


589


matter. Had he done so, he would have learned that
the greater number of Hahnemann's provings, and
those most relied on in practice, were made at Leipzic
by students under his direction, and that he subjected
each observer to a close and critical cross-examination
before he admitted his statements of the experience of
sensations from any drug under investigation into his
catalogue of the effects of the medicine.  That Hahnemann's later works were less carefully prepared, is
acknowledged by all acquainted with the subject; but
to include in a sweeping censure all the results of so
much patient and learned labour, on account of partial
inaccuracies, would be to throw away the only chart we
possess of a sea we must navigate, because we discover
certain currents which had escaped the observation
of the first daring mariner who had surveyed it for our
advantage.
Such is our reply to Sir H. Holland; but fas est ab
toste, &c., so we take his suggestion as really of mportance,
and, in future, in proving medicines, we trust that great
attention will be paid to the morbid sensations which
arise in the body simply when we set ourselves to look
for them. These are spirits which do come when they
are summoned, and we quite agree with some of our
American critics in recognising the distinction between
such morbid sensations and symptoms in the true sense
of the word.. On the subject of memory as affected by age and
disease, we find many curious observations. Our author
very properly points out the fact, that in estimating any
supposed defect of memory, we must be careful to
-measure the power, not by any abstract standard, but




590


SIR H. HOLLAND'S


by that of the individual, and to be alive to the distinction of memory and recollection. Memory may be defined as the accumulation of mental impressions.. We
are obliged to restrict it to mental, for the impressions
made upon the senses, such, for example, as those of
sound, or light, or smell, are not properly the subject of
memory, for they cannot be recalled either by an act of
the will, or by association. This is a striking fact, which
touches the confines of sensations as separated from
ideas.  Properly, we have no control of our sensations;
they are the handwriting of nature upon us. The
characters we cannot alter. If we could, the integrity
of the senses would be at an end, as they are when the
mind recalls sensations in its morbid state, and becomes
subject to illusions of the senses;--a subject of extreme
interest as a phenomenon of disease, but from its rarity,
and manifestly morbid character, testifying to the truth
of the proposition, that as a rule, sensations are not
within the province of memory.
The difference between memory and recollection may
be compared to that between the possession of property
and a supply of ready money. The proprietor of a
gold or diamond mine of incalculable value, might starve
in London from the want of a penny; and the loss of
the power of recollection, produced by some accidental
and purely bodily cause, may give the appearance of an
entire failure of memory. We find in this chapter some
curious examples of this. " A. case of slight paralytic
affection," says Sir Henry, " is at this time before me,
where the perceptions from the senses are unimpaired;
the memory of persons and events seemingly correct;
the intelligence only slightly affected; the bodily fune



MEDICAL NOTES AND REFLECTIONS.


591


tions, though feeble in power, not otherwise disordered;
but where the memory of words for speech is so nearly
gone that only the single monosyllable 'yes' remains as
the sole utterance of all that the patient desires to express; even when a simple negative is obviously intended,
no other word is used. In another case of recent occurrence, where, in sequel to a paralytic attack two years
before, the memory of words had been greatly confused
and impaired, I found them  all regained and brought
into right use, except the pronouns, which were almost
invariably substituted  one for another.  In  a third
case, where the patient, affected with hemiplegia, at
a very advanced   age  passed into   a  state of low
rambling delirium, a few days before his death, all that
he spoke, whether in answer or otherwise, was in
French-a language he had not been known to speak
at any time for thirty years before. This continued
until his utterance  ceased  to  be intelligible  altogether."
To this form of imperfect recollection Sir Henry
suggests the designation of dislocation of the memory.
The dislocation of words while the train of thought is
unbroken, is sometimes curiously exhibited. It is related
in Sir Walter Scott's life, that while dictating some of
his novels-which he only did. when he was prevented
by illness from  writing himself-the amanuensis was
sorely puzzled by the utterance of a word having no
conceivable relation with the immediate context; but
after he had proceeded some lines in the composition,
this same word then again appeared, and this time in
its right place. It would seem that the thinking had
gone so far ahead of the expression, and that there was




592


SIR H. HOLLAND S


going  on   simultaneously a process   of  continuous
thought, and the delivery of that product to the keeping of the memory, which gave it forth in a purely
mechanical fashion.
This suggests the important distinction between the
memory from association of propinquity, and the memory
of analogy. By the former, we recall objects and events
in the order in which they were presented to the senses;
by the latter, they return in connection with other facts,
to which the mind finds them to be like. Learning a
catalogue, or a page of a dictionary by rote, is an effort
of the memory of propinquity; the composition of a
theme, in which all the known facts are arranged in reference to the subject of the composition, is an illustration of the memory of analogy. The first is necessary
for excellence in all technical knowledge; and having it
in abundance gives great readiness, and the power of
rapid decision; while the other is required for all efforts
which demand the combination of invention along with
recollection. When this distinction is not recognised, it
is apt to induce an entirely false inference in regard to
questions of veracity. There- are men-of whom     we
may take Coleridge as a type--who, with an enormous
power of acquisition, seem to have little consciousness of
the difference between what they have acquired, and
what they have created. The memory of propinquity is
overborne by the memory of analogy. The fruits of
other minds are stored unlabelled in their own, and reproduced without acknowledgment; and then the critics
"cc cry havoc, and let slip the dogs of war."  This is no
barren subject of investigation even to the physician, who
must be aware of all such distinctions in giving an




MEDICAL NOTES AND REFLECTIONS.


593


opinion upon points relating to insanity, and the enfeeblement of the mental powers by age and disease.
The effect of bodily weakness in paralysing the recollection, is well attested; and we meet with a curious
illustration of it in this chapter. The author, who
among his other accomplishments, seems to speak
German with ease, descended a mine in Germany, and
having fasted all day, and undergone much fatigue,
found to his dismay, when at the bottom, that all remembrance of that language had fled as entirely as
'Nebuchadnezzar's dream was forgotten by that monarch.
Whether he was fortunate enough to meet with a Daniel
'who  recalled the  language, and the interpretation
thereof, we are not informed.  We are also told that
the recent influenzas have been characterised by a certain
enfeebled power of memory, even at their commence-.ment; and we call special attention to this fact, as it
may give an important indication in the selection of the
specific remedy for this epidemic.
While, on the one hand, we thus observe as a frequent
occurrence the loss of recollection without that of
memory, on the other hand we occasionally meet with
the converse, where the whole mental action is due to
what may be considered an almost mechanical reproduction of the image presented to the mind by the senses.
The most striking example of this is in the phenomenon
which Romberg calls " the echo."  In certain states of
cerebral paralysis, the patient repeats the words spoken,
and this is the only symptom of intelligence afforded.
Thus, in one case he relates of a girl affected with some
cerebral disorder, when he said " Put out the tongue,
raise the arm," the patient repeated his words, but
38




CIA


94SIR HI. HOLLAND )5


made no movement. W~e have observed this in certain
forms of deliquidum in a hysterical patient. The exact
words, and even tones, are reproduced without the
slightest consciousness at the time, or the faintest remembrance afterwards.
After all, this phenomenon is only strange from its
intensity; for the reception of a set form of words may
be grone through with as entire absence of consciousness
as the echo betrays *in the illustrations we have cited.
Such exercises evince no more mental activity than the
movements of an old soldier at drill or the fluttering of
the wings of a decapitated goose. They are simply the
reflex actions of the brain.  Hence the necessity for
securing progress, that not only we should have m-inds
endowed with the capacity of evoking the hidden powers
of matter- scientific discoverers; but also that we should
have a continual succession of men gifted with that prerogative of genius which consists in feeling with unusual
intensity the meaning of old forms of speech, 'and of
passing these coins effaced by long use through the mint
of their own personality, if such an expression may be
allowed, so as to restore to them a fresh image and
superscription; so that they may stimulate the same
feelingsn they were designed originally to arouse, and by
renewing  the type renew   the print.  Thus literature
and science mutually react on one another, and can
never be as they -never have been antagonistic, the one
giving hife, the other the means of living.
We find we have exhausted our space, and we fear
our reader's patience, just as we reach the threshold of
the volume of medical notes and reflections., so that we
are constrained to sum up all we have to say upon it in




MEDICAL NOTES AND REFLECTIONS.


595


a few sentences.  An enumeration of some of the subjects we have already given, and under each head will
be found many curious observations. 'On the whole, it
is written in a spirit of fairness, and contains much good
advice to the profession at large upon the abuse of the
implements of torture (such as the lancet and the purgative appliances) which a too confiding public has put into
their hands. He bears honest testimony in the following
passage to the progress of homoeopathy, and the misstatements he makes we may charitably ascribe to ignorance, not to malice. In speaking of the improvement
in the regimen of patients, he says-" I cannot doubt
that to this cause in great part may be attributed the
growth and continued prevalence of homoeopathy in England."  He tells us a little farther on that it has passed
into neglect in Germany, but we prefer taking our evidence upon that point from the Hollands of that country,
who state exactly the reverse; and when he says that
homceopathy is ineffcient in all acute diseases, we only
regret that beside travelling from Iceland to Greece,
he had not also made a journey from   Saville Row to
Golden Square, and after he had exhausted the writings
of all the Greek physicians, he had not taken the
trouble to read an essay on pneumonia by Professor
Henderson, written in plain English; for if he had done
so, he would have had a glorious opportunity of affording a splendid example of the triumph of truth over the
trammels of prejudice, as he, doubtless, in obedience to
the precepts of medical morality and philosophy he so
strenuously inculcates, would have been forced to declare
that the true remedy for all the abuses of medicines
which form the subject of the latter part of this volume,




596


SIR II. HOLLAND S


were to be found in the writings of one Samuel Hahnemann.    But the open secret, the true talisman of success,
that only requires candour and courage to be known, is
passed by, and the secrets of no practical value buried
in the vestiges of former ages or remote countries, are
diligently hunted   after as being   more worthy of a
member of the College of Physicians and 'the Royal
Society of London.
We cannot conclude without adverting to the chapter
entitled, " On points where a patient may judge for himself," for we fully expected to find among the first, as by
far the most important, a patient's right to select his own
medical adviser.   This indefeasible right of a free-born
Englishmen is not sufficiently recognised, and yet surely
it is involved in the " Habeas Corpus" act! We trust
that before there is any rash legislation touching this
liberty, the opinions of constitutional lawyers will be
asked, and that the descendants of men whose ancestors
won from kings immunity from arrest, and from being
carried off to prison, will not tamely submit to the
usurpation of colleges, and the risk of incarceration in
their own domiciles, guarded by sentries armed with
lancets.
This primary right of every sick man, Sir Henry does
not advert to, but expatiates on the prospects of consoling all who seek our aid by assuming as encouraging
and pleasant an aspect as we can, and indeed suggests
the picture of a most amiable and courtly physician, one
well qualified to gain public respect, and well deserving
of the honours he has attained, although, perhaps, not
quite rising to such an ideal as is represented by Leigh
Hunt in the following passages, with which we shall




MEDICAL NOTES AND REFLECTIONS.


597


take leave of Sir H. Holland--" We know not, indeed,
who is calculated to excite a liberal enthusiasm, if a
liberal physician is not. There is not a fine corner of
the mind and heart to which he does not appeal; and in
relieving the frame he is too often the only means of
making virtue itself comfortable. The physician is well
educated, well-bred, has been   accustomed to the infirmities of his fellow-creatures, therefore understands
how much there is in them   to be excused as well as relieved; his manners are rendered soft by the gentleness
required in sick rooms; he learns a Shakesperian value
for a smile and a jest, by knowing how grateful to suffering is the smallest drop of balm; the whole circle of
his feelings and his knowledge (generally of his success
too, but that is not necessary) gives him a sort of divine
superiority to the mercenary disgraces of his profession.
"* * * The ordinary jests on the profession are never
echoed with greater good-will than by those who do
not deserve them; and to complete the merit of the
true physician-of the man whose heart and behaviour
do good as well as his prescriptions-he possesses that
humility in his knowledge which candidly owns the limit
of it, and which is at once the proudest, most modest,
and most engaging proof of his attainments, because it
shows that what he does know he knows truly, and that
he holds brotherhood with the least instructed of his
fellow-creatures."1  Of this representation we may say
-" Se non 6 vero e ben trovato."
1 'Men, Women, and Books,' &c., by Leigh Hunt, vol. ii, p. 43.


0




CHAPTER XII.


ON CHOLERA.1
"My experience of this department, brief as it has
been, strongly impressed me with a sense of the great
want that is now felt of some systematic record of cases
of Choleraic disease, their treatment and results, with a
view to determine, in so far as may be possible, the best
mode of meeting this formidable epidemic. Hitherto,
no'successful attempt has been made to collect such a
record; and as I find that my feeling of the want is
very generally shared by the medical profession, I have
obtained the sanction of Her Majesty's Government to
the nomination of a Medical Council representing all
branches of the profession. ** * *        By means of a
return in the accompanying forms, the observations of
all qualified practitioners on the cases that come under
their care, may be collected and made available for determining the laws which regulate choleraic disease, and the
effects of the different systems of treatment now in use."
Thus wrote the President of the Board of Health to the
medical profession, addressing to them this general invitation, and nominating a medical council having the
1 'Report of the Committee for Scientific Inquiries in relation to
Cholera Epidemic of 1854,' presented to both Houses of Parliament by
command of Her Majesty.                                  i




CHOLERA.


599


highest national sanction, and intrusted with the greatest
national responsibility. Let us see how the gentlemen
selected for so high a trust discharged the duties it involved.-" Soon, after your having constituted a medical
council to advise the Board of Health on matters relative
to the then prevailing epidemic of cholera, this council
thought it convenient for the despatch of business that
subjects referred to them should be distributed among
certain committees of their number; and on this plan
we, the undersigned, were requested to become a committee for the scientific purposes of this council.
" Two special duties accordingly devolved upon us:
first, to suggest the institution of particular scientific
inquiries which we thought likely, by bettering medical
knowledge of the disease, to strengthen the public resources for its prevention and cure; secondly, to review,
as laid before us, the various points of this investigation,
and to submit to you our judgment of its results. * *
Our principal aims and the methods by which their
attainment was sought, have been as follows:
1st. With a view to the descriptive history of cholera,
we have examined the larger statistics of this invasion
as to the places wherein the disease chiefly prevailed; as
to the influence of age, sex, and employment in favouring
its attack; and as to its own pathological stages and
periods;"2d. In the hope to gain more precise knowledge of
the causes of the disease, we thought it of primary importance that the air and water of the metropolis during
the epidemic period should be studiously observed;
and that special inquiries should, as far as possible, be




600'


CHOLERA.


made into the state of these universal influences in districts
actually infected with cholera;-and
" 3d. With the object for increasing for our profession
the present insufficient resources of medical treatment,
we have endeavoured to procure comparative records of
various therapeutical experience successful or unsuccessful, and have invited from persons versed in such inquiry,
an elucidation of those questions in the practical pathology of cholera which appeared to us most urgent for
solution."
"When persons, not accustomed to accurate investigation," observes the writer of this report, "attempt to
compare together the results of various treatment, as
tested by death or recovery, they are seldom sufficiently
on their guard against the immense fallacy of leaving
unexpressed the degrees of the disease, against which this
or that medicine has prevailed." Admitting to the fullest
extent the truth of this maxim, we shall now attempt to
determine from  the data afforded by the information
given in the tables before us, what we should anticipate
to be the mortality of 33 cases of cholera, 22 of which
passed into collapse in Golden-square between the 10th
August to the 8th of Oct., 1854. The three questions
to be answered, in order to obtain this result, are-first,
whether the number of collapse-cases was under or above
the average, for this is one of the most certain tests of
the severity or leniency of the disease;-second, how far
the locality was likely to operate as a favorable or
unfavorable element in the course and result of the
cases;-and third, whether the time involved a mild or
malignant period of the epidemic's continuance. In




CHOLERA.


601'


reply to the first question we learn, at p. 17, that out of
3596 cases 2431 passed into collapse, so that by the
simple rule of three we know that, to afford an average
mortality, 22 out of the 33 should have done so in the
Golden Square Hospital. This is exactly the number
stated in the tables, so that we may be confident that
the cases treated there were a fair sample of those treated
over London.    The mortality (omitting fractions) of
these 2431 cases was 66 per cent. or 1627 persons.  In
short, the number died that a person acquainted with the
average mortality of this class of cases would have
expected to die. So much for the first question: let us
now ascertain the reply to the second. What was the
condition of Golden Square?  Was it healthy or otherwise?  Again we quote our book, p. 49.  "In the three
registration sub-districts of St. Ann's, Golden Sqmuare,
and Berwick Street, together comprising a population of
42,000 persons, it appears that there occurred 537 deaths
from cholera, being at the rate of 128 to every 10,000
inhabitants, while the general chorera-rate was only 60
to the same nmnber." " A striking feature of the outbreak was its extreme suddenness as measured by the
large number of persons simultaneously attacked. Its
greatest local diffusion appears to have been reached on
the second if ilot on the first day from its commencement; it remained of equal prevalence for two days, and
on each of the two following underwent a decline of 50
per cent."
We find, our sample of cholera to have been taken
from the part in all London where the disease was most
intense and destructive. Nay, we are wrong in saying
taken from  it, but treated in it-a most important




602


CHOLERA.


difference. The experiment was made in the veiy focus
of the disease, where, in addition to the poisoned well of
air in which the patients lived, they had also to contend
with the depressing moral influences of an awful and
overwhelming mortality suddenly falling   upon  them
without warning, and terrifying them by the appalling
rapidity of its execution.
The only remaining condition we must ascertain is,
how far the period from the 10th of August to the 8th
of October was likely to embrace the epidemic in its
mature or its incipient and declining malignity. To this
question we receive, at p. 72, of Dr. Sutherland's supplementary report, the following satisfactory reply:-The
number of deaths from cholera in the week ending the
12th of August, was 644, in the week ending the 19th,
729, and the ascent of the mortality throughout September, the month in which almost the whole of the 31
patients were admitted into the Golden Square Hospital,
is represented by a mortality on the first week of 1277;
on the second, 2050; on the third, 1549; on the fourth,
1284; and on the fifth, of 740.  Thus we see that the
conditions of the experiment fulfil the most stringent
requirements of the writers of this report. The cases
were treated at the height of the epidemic in the locality
where the disease was most mortal, and they presented
the average number of collapses. The only objection to
which the inference from the success is open is, that the
number treated was too small to establish so important,
and to the medical world so improbable, a fact. But
whose fault is this?  Certainly not ours. Surely if the
Board or Medical Council have thought it worth while
to record that out of 11 cases treated with Calomel in




CHOLERA.


603


small doses 7 died, that out of 8 cases treated with larger
doses of Calomel 8 died, that out of 8 cases treated by
Salines 7 died, and many more equally consolatory facts
derived from the returns of hospitals and private practice,
it might have been worth while to place on record that
out of 22 collapse cases treated by Camphor, Veratrum,
Arsenicum, and other remedies, 20 did not die but only
7.  Surely this fact may be supposed to be of interest to
the public, for whose benefit they were appointed to
their office, and at whose expense these tables are published. When pressed for a reason for their strange
omission, they said the remedies we used were unknown.
However, this is not true, almost all the medicines used
by us in cholera are to be found in Dr. Paris's therapeutic
work. That he was ignorant of their real value is certain,
but still he had what may be called a bowing acquaintance with them, so that he could not plead medical
decorum   as a reason   for ignoring them.    The absurdity of the conduct of Dr. Paris and his coadjutors
has been already so fully exposed, that here we shall
only add, before passing on to other parts of the report,
that there is so transparent an uneasiness and distressing equivocation in his reply to the demand of the
President of the Board of what have you done with the
homceopathic statistics? that he and his fellows present
the hopeful spectacle of what the old divines call sensible
sinners, and we trust that the next time we have the
pleasure of encountering them, they may have advanced
into states of more secure conversion.
As soon as we leave that portion of the field of investigation where professional prejudices interfered and enter
the ground of pure science, we find a great improvement




604


CHOLERA.


in the character of the work, and recognise that this
report is greatly superior to any previous one, both in
adding to our positive knowledge of the conditions which
favour the development of epidemic cholera, and in the
caution evinced in avoiding dogmatic statements not
warranted by careful induction.    Indeed, it is very
remarkable that only now after this strange and deadly
epidemic has made its third appearance among us, and
after all that has been written and spoken about it, our
select pioneers in medicine should adopt throughout the interrogative formula of infant science and dwell more emphatically upon the questions which can only be solved by
future observers than upon the fruits of all their statistics
gathered with so much machinery from a large body of
practitioners, and arranged with such pedantic particularity with the assistance of arithmetical and algebraical
formulas. They tell us to a nicety the chances of a
patient dying at each hour after his attack, and are
evidently much more familiar with the notions natural to
an actuary of an insurance office, whose only recognised
facts are that men are now alive and that they must all
die, than with the feelings proper to a true physician,
that the fundamental idea of his business is to frustrate
the designs of death, and perplex to the utmost by the
success of his efforts the calculations of a mortality of an
epidemic founded upon its natiral course and termination. The profound scepticism betrayed in this report of
the utility of any treatment and the extravagant expectations of future immunity by improved drainage is a
characteristic feature of the age, and seems almost incredible in the face of a.compulsory vaccination act of
parliament.




CHOLERA.


605


The universal but vague observation of some unusual
state of the atmosphere being a constant attendant of
cholera, has here, for almost the first time, been submitted
to accurate scientific observation, with what success we
shall presently see. The observations were made by
Mr. Glashier at the Royal Observatory, Greenwich, and
embraced the state of the atmosphere in reference to its
pressure, as indicated by the barometer, its moisture, its
density, its movements, its chemical and electrical conditions, and its haze, fog, mist, and rainfall.
In regard to its pressure we are informed that " the
corrected weekly means of the observed readings of
the barometer had been considerably in excess of their
average during February, March, and April, but in the
three months next following they presented no important
deviation, and only became remarkable towards the end
of August.   The atmospheric pressure had then risen
much above its normal amount; and, during the worst
period of the epidemic, was more continuously great
than at any other time.  From  the 25th of August to
the 10th of September, the reading was above 30
inches, and on three days in this period as high
as 30-. The mean reading for the two months exceeds the corresponding amount in any year of Mr.
Glashier's series; and it is the more noticeable since
(as will presently appear) less than the usual effect was
due to watery vapour."
We cannot question the accuracy of Mr. Glashier's
observations; and if they are corroborated by similar
ones in other parts of the country, they may tend to
establish a most important fact in regard to one of the
most essential conditions of this epidemic. Unfortu



606


CHOLERA.


nately, we find a total discrepancy between these observations and those made during the former invasion of
the disease at Edinburgh. There the cholera made its
appearance with extreme fatality about the middle of
October, and the number of cases reached its maximum
on the first week of November, there being 49 attacks
on the 6th of that month. Yet the observations of Mr.
Adie, a highly scientific and accurate observer, who for
many years kept a register of the weather, altogether
failed to show any important deviation from the usual
standard, or with the corresponding days in the previous
year. The readings of the two were as follows:
BAROMETER.                 BAROMETER.
1847.   Morn.    Even.     1848.   Morn.   Even.
Nov. 1. 2974. 29-70      Nov. 1. 29-37. 29-39,2. 29-89. 30-10,,  2. 2943. 29-32
S3. 30-10. 30-00,,  3. 2936. 29-48,, 4. 2984. 2924,, 4. 2948. 29-50,, 5. 29-34. 2934,,  5. 29-23. 29-21,, 6. 2950. 2946,,  6. 29-15. 2849, 7. 20-30. 28-92,,   7. 29-35. 2961
This table shows that the barometer was actually
rather lower instead of being decidedly higher at the
period when the cholera prevailed than at a similar period
of the preceding year when there was no cholera. It is of
much importance to observe that Edinburgh being the
first place where it made a decided impression, leads to
the inference that it was, so to speak, constitutionally
weak; and we should, therefore, expect that if in any
degree the weakness of a place or its liability to a mor



CHOLERA.


607


bific influence depended upon the undue amount of
atmospheric pressure, here, if anywhere, it should have
shown itself.  In other words, if undue pressure is a
requisite for the active and energetic propagation of
choleraic poison, how comes it that the disease should
have selected as peculiarly favorable a place where this
supposed requisite for its vigorous existence and propagation was not only absent but even reversed? This
counter observation ought to be taken into account by
our scientific inquirers, for it is not by ignoring observations of perfectly qualified observers that they will
satisfactorily reconcile conflicting evidence, and elicit
solid truth on which successful theories may eventually
arise.
That cholera is an exotic requiring for its development in this country, an unusually high range of temperature is a prevailing opinion, supported bythe following
statements of Mr. Glashier: "During the early part of
1854, the mean daily temperature of the air had been
higher than normal; its excess for the first 101 days of
the year averaging 3"4. There had then set in a very
cold period, injuring vegetation, and killing many hardy
plants, and for the 97 days, terminating July 19th,
there had been a daily defect of temperature, averaging
3-3. The next few days showed a sudden increase of
heat; the 25th of July was the hottest day of the year,
its temperature rising nearly to 90, and exceeding the
normal by 11. Three weeks of cooler weather followed,
but from the 19th of August to the 1ltli of October
(within which there were the worst ravages of disease)
there  was an   excess  of heat, averaging   2-6 per
cent. of the 54 days; and during one week of this




608


CHOLERA.


period, that ending the 2d of September, the excess
amounted to 6-.    After the week   ending the 14th
of November, the temperature was below its average
till December." Although we believe that this has
generally been observed, yet there was an important
exception in Edinburgh which we shall exhibit in a
tabular form rather with the view of limiting the importance given to the generalization than of disproving
its accuracy. It will be seen by the following tables,'
that during the greatest prevalence of cholera the temperature was much lower than it was in the same period
of the preceding year.


When there was no cliolera.
1847. Morn. Even..Min. Max.
Nov. 1. 58 54.4 46 60
S2. 52 55. 44 58
S3. 46 43. 32 56
S4. 49 47. 37 54,,5. 52 49.43 57
S6. 54 52 43 59,,7. 55 57.43 57


During the extreme prevalence
of the disease.
1848. Morn. Even. Miln. Max.
Nov. 1. 42    43. 38  43
2. 41 38. 35    48
3. 37    30. 34   48,  4. 34  28. 27   37
5. 39   42.27 46
6. 44   34. 38 49,,  7. 42 35. 32    44


On Mr. Glashier's observations upon this head the
committee make the     following  remarks:-" Despite
some exceptions probably less real than apparent, it
seems that Asiatic cholera, and, indeed, bowel poisons
generally, are favoured by high temperature; and in
comparing together our two last epidemics with a
parallel comparison of their seasons, we are struck wvith
the fact that in 1854, when the summer temperature
began later than in 1849, and quite abruptly rose to its




CHOLERA.60


609


maximumn, so too the course of mortality in that epidemic
was peculiar, seeming to imitate the summer temperature
in its deferred commencement and sudden rise." What
a strange confusion of ideas inl the brain of the scientific
committee this paragraph exhibits! Tfhe cholera is no
longer a disease, but a poison-not only a poison, but a
bowel poison! The whole question of the pathology
which professes to be treated afterwards., and is afterwards settled by an unsettling mark of interrogation, is
here dogmatically decided by an inference! We are
taught to speak of cholera as a bowel poison. By an
ingenious abuse of purely hypothetical language in
framing a statement upon the amount of heat in the air,
an attempt is made to win belief for a notion, the grounds
of which have not yet been even stated, and which, when
they are brought forward afterwards by the same writers,
are by themselves admitted to be insufficient. After so
glaring an illustration of setting at defiance the fundamental principles of induction, one of which is the
avoidance of conjecture in the statement of observed
phenomena, what confidence can we repose in this
national committee for scientific inquiries?
One of the most curious and interesting observations
made with regard to the state of the atmosphere was its
increased weight during the prevalence of cholera. This
fact was noted during the last epidemic by Dr. Prout,
and it has since been confirmed by Mr. Glashier. Thle
explanation given of it is, that it depended upon the
diffusion of some gaseous matter in the air; and in
connection with this the remarkable absence of ozone at
all the stations where the air was examined in the cholera
districts, seems to indicate the presence of some poison39




610)


CHOLERA.


ous gas; for this ozone is held to be the sort of vital
principle of our atmosphere, representing by its presence
in abundance an invigorating condition favorable to life,
and incompatible with any destructive power, and by its
diminution or entire absence, a state favorable to the development of noxious influences. What ozone is and
how produced is yet a mystery; all that is known of its
production, however, points to active electrical agency as
its probable cause. The deficiency of ozone daring the
recent epidemic corresponds with the unusual absence of
electrical disturbance at that period, there having been
no thunder-storms from  July to the end of the year.
There was a deficiency in the tension of the common
positive electricity during the whole period of the epidemic.  If this observation may be taken as representing
a general fact, we may by it account for the peculiar
sensations experienced at places where the cholera was
very bad, as at Petersburg, where, according to Dr.
Muller, all experienced "a feeling of discomfort, uneasiness, pressure at the pit of the stomach, and tearing
pains in the lower limhnbs;" but Dr. Muiller makes no
mention of any unusual sensation in the bowels.
We may conclude our observations on the state of the
atmosphere by giving Mr. Glashier's summary in his own
words:-" The three epidemics were attended with a
particular state of atmosphere, characterised by a prevalent mist, thin in high places, dense in low [the choleracloud of Indian writers?]. During the height of the
epidemic, in all cases, the reading of the barometer was
remarkably high, the atmosphere thick; and in 1849
and 185,1, the temperature above its average. A total
absence of rain and a stillness of the air, amounting




CHOLERIA.


611


almost to calm, accompanied the progress of the disease
on each occasion.  In places near the river the nighttemperatures were high, with a small diurnal range, but
a dense, torpid mist and air, charged with the many impurities arising from the exhalations of the Thames and
adjoining marshes, a deficiency of electricity, and, as
shown in 1854, a total absence of ozone most probably
destroyed by the decomposition of the organic matter
with which the air in those situations is so strongly
charged.
"In both 1849 and 1854 the first decline of the
disease was marked by a decrease in the reading of the
barometer and in the temperature of air and water; the
air, which previously had for a long time continued calm,
was succeeded by a stormy south west wind, which
soon dissipated  the former stagnant and poisonous
atmosphere.   In both periods at the end of September
the temperature of the Thames fell below sixty, but in
1854 the barometer again increased, the air became
again stagnant, and the decline of the disease was considerably checked.  It continued, however, gradually to
subside, although the months of November and December
were nearly as misty as that of September.  By the close
of the year diarrhoea and cholera had subsided, but a
high rate of mortality still continued."
Without at all wishing to undervalue the importance
of these observations, we must again express our dissent
from assuming them to be at all essential to the production of the epidemic, until it be shown how far they
coincide with the outbreak of the disease in a part of
the fleet on the Black Sea, in 1855, where it is obvious
that many of the causes prominently specified could not




612


612            CH OLERA.


have been in operation, and where it is doubtful if even
any of them wvere in existence.   It is our proud boast
that the sun never sets upon the British flag, and it
would be well if the extent of our territories were put'
to the profitable use of instituting a series of accurate
investigations of the local conditions which attended the
appearance of an epidemic whose circuit has now embraced the whole of the British dominions.     Thus we
might arrive at a knowledge of what is essential and what
is merely accidental in the phenomena not only of this
but of all epidemics. Indeed it is impossilble -not to be
struck with the undue importance attached to causes of a
purely local kind, such as an unwholesome supply of
water or too dense population, in dealing with so broad
a question as the cause of a pestilence as deadly at sea as
on land, confined to no latitude, restrained by -no peculiarity of national habits, strewing the desert with corpses
as well as overwhelming the densely populated cities with
destruction.
One of the best-established facts in regard to cholera
is the effect of local elevation.  This has been generally
observed in previous epidemics, and now we find it stated
with scientific precision. "The distribution of the
choleraic attacks (although in widely different degrees of
frequency, and perhaps also of severity) throughout the
whole metropolitan area, seems to establish that the
cholera leaven, be it what it may, was scarcely less diffused in the districts that suffered the lowest mortality
than it was in the districts where the disease was tenfold
more fatal. But while the presence of this leaven seems
to have, been universal throughout the districts of the
mectropolis, the consequences' excited by its presence have*




CHOLERA.


613


greatly varied in different localities; and independent of
any hypothesis, it may now be stated, as the experience
of two epidemics in London, that such local varieties of
effect, grouped into masses for comparison, have been
more nearly inverse to the elevation of soil in the affected
districts than proportionate to any other general influence
that we could measure.    Thus, approaching London
along the roads from   the surrounding country, and
descending through the successive regions succeeding
each other in circles down to the waters of the polluted
Thames, we see in the epidemic the people fall upon the
right hand and upon the left, in numbers that increase in
every circle, and express arithmetically the growing force
of those physical influences on which the poison of cholera
apparently depends for its powers of existence and development."
In accepting this proposition we must qualify it by
inserting the word relative before elevation.  It is not
the elevation above the sea level which conditions the
affinity of a place to cholera, but its rise above the
nearest water level. For example, it never was more
deadly than upon the high table land at the source of
the Euphrates, in 1822,1 when it destroyed a Persian
army, killing 300 men out of a batallion of 1000,
so that the rear of the line of march was strewn with
dead bodies, as if the army had been all the way in
action.
The admission that the poison was pretty equally diffused over the plain of London, and only more fixed at
different spots by local causes, throws great doubt upon


1 'Travels of Mr. Baillie Fraser.




614


CHOLERA.


the assurances we frequently hear made by sanitary reformers, and which Dr. Southwood Smith is reported
recently to have indulged in before a popular audience,
that we shall be able eventually to avert these terrible
scourges by a more careful attention to drainage.   That
something may be done to lessen the stay of the plague
by removing the fostering impurities we admit; but so
long as men select the banks of rivers to build cities
upon-those natural highways of the world,-and so long
as the sea shores-those margins of " creation's common"
-are preferred to inland situations, so long must we
expect that, in obedience to a law whose existence we
cannot deny, but which to us is a mystery, this epidemic will return again and again, by its old road, to its
old haunts, and at each recurrence mock all the efforts of
all sanitary commissions, and only be restrained when
the true prophylactic and specific remedies fortify all exposed to it against its malignant influence. We may
perhaps hazard the observation, before leaving the question of the effects of elevation, that the greater salubrity
of high elevations, in giving strength to nerve and muscle
and immunity to many chronic diseases, as well as most
epidemics, is a fact of greater importance now than formerly, for the substitution of artificial roads of iron for
the natural water-courses will make us more and more
independent of these dangerous places, and give to intercourse and commerce full sway, without taxing the health
and longevity of all in any way dependent (and who is not?)
upon their successful promotion.
Reviewing all the committee has made out on the
aetiology of cholera, we are struck by its extreme meagreness, and were little prepared for the concluding remark




CHOLERA.


615


they quote from  Mr. Glashier's report, that "were the
meteorology of our towns carefully ascertained and collated
with that of the metropolis, and both together with that
of the country generally, of which last I have a foundation of many years' continuous observations, that in a
short tinme we should be in a condition to elaborate a
clear insight. into the meteorological causes of cholera,
influenza, and many phases of disease which now burst
upon us with the suddenness and devastating power of
a Divine and wratlfid visitation."  The problem which
Mr. Glashier speaks thus confidently of solving is one
that has baffled the human intellect flrom the earliest ages,
and the reason that almost no progress has been made
towards its solution is that the causes which produce
almost every one phenomenon are many and mixed, not
reducible to simple calculable elements.  It might be
possible to determine the effect of heat, or of electricity,
or of moisture, if each could be isolated; but when they
are not only constantly reacting on one another, but are
all diffused through an ocean of air in a state of constant
motion, and when, in addition to the complexity of the
agencies in perpetual operation, varying only in degree,
we reflect that the thing acted on, the human organism,
is also, itself in a state of as ceaseless a course of rapid
changes, and that these atmospheric influences are only
one of many groups of causes which modify its nature
and render it liable, or the reverse, to morbid action, we
are utterly at a loss to conceive the grounds of the confidence here expressed, and feel inclined rather to regard
it as a rhetorical flourish, not to be literally interpreted.
This is the more charitable interpretation, for the concluding clause expresses the astonishing declaration that




616


CI-OLERA.


the Divine character ascribed to the operation is due to
our ignorance of its laws, a proposition, if it has any
meaning, necessarily implying that the discovery of
material laws leads to the rejection of the belief in the
Divine causation of the universe.
Failing to lay hold of the evil in the air, our philosophers applied themselves to an examination of the water,
and we must all remember what a flourish of trumpets
there was some time ago in the 'Times' and other organs
of popular delusion, when the microscopists detected the
imp of mischief in the form of vibriones swarming both
in the water imbibed and in the choleraic discharges from
the bowels. The discovery is thus quietly let down by the
committee:-" With respect to the living animal and
vegetable forms traced by Dr. Hassall through the whole
series of waters, there seems no evidence that they, by
their own action on the human body, could be productive
of choleraic symptoms."   At the same time there is
ample evidence to prove that one of the most favorable
conditions for encouraging the disease is the employment
of water, contaminated with the filthy impurities of
London, for domestic purposes. And if the fabulous
importance once ascribed to this lead to an improved
supply, it may find a place in history beside that other
fable, which relates how a father told his sons that if they
trenched the land he left them they would discover a
treasure. They did so, and found, not gold, but improved fertility which was the treasure their provident
but apparently lazy progenitor contemplated.
There is no question agitated by the committee of
greater importance, both theoretical and practical, than
the connexion, if any, between cholera and diarrhoea, and




- CHOLERA.


617


there is none left in a more unsatisfactory condition. At
page 62 the question is thus put and answered:" When diarrhoea and cholera prevail together epidemically, are they (with difference of degree) the same
disease? This question must now doubtless be answered
in the affirmative."  And yet at page 59 we read:" Does cholera begin as a morbid process of the gastrointestinal mucous membrane, or is this state preceded by
some state of general poisoning, which requires the
gastro-intestinal membrane to act as an emunctuary?"
Of course, if cholera be only an intense diarrhoea, as is
positively asserted in the passage above, there can be no
doubt that it must begin in the intestines. And yet,
strange to say, instead of answering this simply in the
affirmative the reply is:-" The flux from the gastrointestinal mucous membrane is doubtless the f-irst of the
more obvious phenomena of the disease, and         may
perhaps be, in every sense, its beginning; but, on the
other hand, it may be that the cause of cholera affects
primarily some other part of the economy, as the blood
or the nervous system, and acts only through them upon
the mucous membrane of the stomach and intestines;
and it may be that the affection of this membrane is
essentially the process by which some poison is eliminated
from the body." Now, if cholera be diarrhoea, and if
this diarrhoea be the elimination of a poison from the
body, it follows, as an unavoidable inference, that so far
from our efforts being directed to check this escape of
poison by its natural outlet, we should employ all means
in our power to promote its exit; and yet, we are told,
almost in the same breath, that if we can only stop the
initiatory diarrhoea we shall prevent the cholera!  Is it




618


CHOLE1RA.


possible to conceive a more absolute contradiction?
Diarrhoea in an exaggerated form is cholera; and is also
a highly salutary critical discharge! But this beneficial
discharge must be arrested the moment it is discovered,
for, like other allopathic remedies, it is very apt to kill
the patient!   Can we imagine a more bitter satire on
the old school? Here we have a revival of the most
mischievous doctrines of the old pathologists. Every
practitioner is placed in the dilemma of making his own
decision whether the diarrhoea is to be looked upon as
useful or injurious, and in the imminence of a deadly
plague he is told it is a toss up whether he will be assisting in curing or killing the patient, as he adopts the one
or the other view of the question. And this is the
practical result attained by our scientific committee, who
are so overwhelmed with scrupulosity of conscience that
they will not admit a numerical statement of facts,
attested by their own witness, of the results obtained by
homoeopathic treatment, because by so doing "they would
give an unjustifiable sanction to an empirical practice,
alike opposed to the maintenance of truth and to the
progress of science."!!!
Fortunately for the profession at large, their deeds are
not so bad as we should expect from their creed. There
is so little difference in the average mortality of their
various modes of treatment, that it is plain, if they did
not do any good they did not do much harm, and they
have the comforting assurance of their scrupulous and
conscientious president that, "as to the advanced stages
of cholera, nearly all resources of medicine seemed equally
powerless for good: that practitionlers summoned to the
relief of this dreadful disease [what an apt expression,




CHOLERA.


619


allopathy relieving cholera when nature and the patient
were too strong for it!] could scarcely decide between
any two lines of treatment, except for an occasional
certainty that one of them    would   positively harm."
Harm   the assault of the cholera or the resistance of the
patient?
This then   is the ex-cathedra   deliverance of our
national teachers in the reign of Queen Victoria in
reply to a requisition of the state, that " tiey should
determine the best mode of meeting this formidable
epidemic."
To us it has always seemed to be one of the most
surprising confusion of ideas that the question of whether
diarrhoea or cholera were identical should have ever been
mooted.   We can hardly conceive two diseases more
radically dissimilar, and we feel confident, that if instead
of limiting the investigation of the cholera to the appearance it assumed in London, the committee were to collect
a full history of all the phenomena of the disease in the
various parts of the globe, where it has been most deadly,
this notion of its connection with diarrhoea would vanish
without a refutation being required. As this, however,
is too much to expect, we shall state shortly why we
disbelieve that cholera and diarrhoea are identical.
We disbelieve it because diarrhoea and cholera are
wholly unlike in their origin, their course, and their
termination. Diarrhoea is a flux from   the bowels produced by a thousand different causes, by unripe fruit, by
neutral salts, by purgative medicines, by damp weather,
&c., common in all ages, in all latitudes, presenting no
one special peculiarity, except the simple fact of an excessive discharge from the intestines. Its course is like its




620


CHOLERA.


origin, of most uncertain duration, from hours to weeks,
or even years, and its termination equally accidental, ending in complete or partial recovery, or going on to death
by simple exhaustion.  And what is cholera? A disease
produced by no known substance, by no amount of exposure to cold or damp, always and invariably by some
hitherto unexplained morbific influence in the atmosphere; a disease always sudden in its invasion, invariably
attended with the most characteristic peculiarities, of
which perhaps the most striking is the entire absence of
all symptoms in its most intense degree; a disease confined
within certain limited ranges of locality at one time, and
altogether unknown in Europe thirty years ago; a disease
rapid in its course, never chronic, always ending in a few
days, either in death, fever, or recovery.  That the state
of the atmosphere and locality which favours the development of cholera is also in this country favorable to diar.
rhoea is not to be wondered at, when we find that
diarrhoea is caused by so many causes, and that this
epidemic should settle by choice upon every diarrhoea
establishment is most natural, but we might as well
identify cholera and poverty as cholera and diarrhoea, for
every point of similarity between the two former is
equally true of the latter. As to the question of whether
diarrhoea always precedes cholera or not, we do not
think it is of so very great importance as most writers
affirm. The presence of diarrhcea undoubtedly shows a
predisposition to the action of cholera poison, but whether
the removal of the diarrhoea prevents the attack of cholera
is a very different question. For it is not the diarrhoea
which is dangerous, but the conditions which engender
this diarrhoea, and so long as they continue to operate, we




CHOLERA.


621


greatly doubt if the stopping of the intestinal discharge
gives real security against the plague.
That the amount of discharge from the bowels holds a
direct proportion to the intensity and danger of cholera
is utterly false. By the consent of all observers, the most
rapidly fatal cases present this feature in the lowest degree.  But, observes our committee, possibly the discharge may take place into, but not out of the bowels
like internal uterine haemorrhage.  Supposing a spasmodic closure of the sphincter ani-supposing a vast
effusion into the bowels, supposing, supposing, &c. Was
the committee appointed for scientific investigation, or
for framing conjectures? We meet no end of suspicions,
they suspect this and they suspect that-or in the
phraseology of some of our American friends, they are
always expecting.  Perhaps this is as it should be, for an
expecting committee is the true exponent of a " Medecine
expectante."  To us who are of another school it seems
that, before assigning this cause to account for the absence of external discharge, it would have been right to
have ascertained its existence, and to have put the question: in cases where no such discharge took place was
there observed any fulness of the bowels, or any indication of such a complete closure of the anus as would
account for its absence?   We have positive facts to
show this was not the case, for although in such cases
the discharge was small, it was not absent, and the
entire collapse that attended them made any such spasmodic action impossible. Moreover, in the numerous
dissections of these cases, in no one instance were the
bowels found full of fluid. So much for the only hypothesis by which the ingenuity of the committee can




622


CHOLERA.


account for the notorious observation so entirely destructive of their theory of the disease being an intense
diarrhoea, that in its most intense and characteristic form
there was no diarrhoea at all!
The explanation of the numerous, extraordinary, and
in some respects contradictory symptoms of cholera now
generally adopted abroad, and which seems at all adequate to account for all the phenomena is, that the specific poison acts primarily on the nervous system, probably directly on the ganglionic portion of it, but involving also at the outset the respiratory nerves.  Hence
the sense of death so characteristic of the disease;
hence the oppression of the heart compelling the sufferer
to exclaim, oh my heart! hence the oppression at the
chest and the hollow whispering voice. This is worthy
of special attention, for it is never observed except in
cases of paralysis of the branches of the pneumogastric
nerve which supply the vocal apparatus; and Romberg
observes that he has frequently met with instances of
this aphonic condition in cholera temporarily suspended
by a strong emotion; proving it to be a true imperfect
palsy of those nerves.  Was such a system ever observed
in the whole history of all the varieties of diarrhoea?
This palsy of the respiratory nerves leads as a direct
result to the imperfect regeneration of the blood. There
is no true respiration; the air returns from the lungs as
cold as it entered, and chills the hand held over the patient's mouth. The blood passes through the pulmonary
capillaries as through tubes of glass, altogether unchanged, and instead of being reborn there as it should,
it dies, and as a dead fluid flows through the frame,
separating into its chemical constituents as if it were




CHOLERA.


623


withdrawn from the body. What can we expect from
this dead blood? Certainly no secretions.   Hence the
suppression of the urine, and of the bile, and of all
frecal matter, and hence, too, as a dead fluid it permeates
the surfaces, both internal and external, in the former in
profuse watery discharges from the bowels, in the latter
as cold perspiration from the pasty skin. In the worst
cases even the blood-globules are broken up, and then
we find coloured sanguineous discharges from the bowels,
erroneously looked upon as dysenteric, but wholly different, and the most fatal of all appearances as indicating
the greatest decomposition of the blood. And this dead
blood we believe also to be the cause of the cramps and
the pains, by acting as an irritant poison on the nerves
of motion and sensation. For the severity of the cramps
is another index of the intensity of the attack.    No
wonder that the physician's art should so often prove
unavailing in dealing with so frightful, intense, and rapid
a poison, one more rapid and more intense than the
venom of the most poisonous reptile! But how wonderful
it is that we should have a remedy at all for the first
stage of this terrible disease, and how marvellous that
Hahnemann should have recognised at one glance the
real nature of the malady, and directed us with confidence to the only remedy! And this, too, without
having ever seen a single case of the disease, which he
so thoroughly appreciated. What a contrast do his clear
words of assurance and promise present to the confused
mutterings of the present leaders of the medical hosts in
the wilderness of doubt. And yet we are told by a
writer in the Medical Timnes, who has of late been exercising his ingenuity in making mountains out of mole



624


CHOLERA.


hills, that Hahnemann was all wrong in this, that Camphor is not homceopathic to cholera.  If our modest
teacher wishes to see his likeness in political life, we
advise him to study the writings and speeches of a certain
very pugnacious advocate of peace, who, after explaining
that he considered the late war to be an infamous outrage against humanity, a sin and a crime in its origin
and in its continuance, instead of insisting on its being
given up, treated his audience to his views of the most
effectual way of carrying on this flagrant wickedness.
Thus our hostile instructor, after proving that homoeopathy
is nonsense, objects to us for not being consequential in
our nonsensical course of action. With all due deference
to our anonymous adviser, as we preferred to leave the
conduct of the war in the hands of those who believed
in its justice, to making it over to the direction of a
quaker meeting, so we shall continue to practise homoeopathy as recommended by Hahnemann, rather than
follow the advice of one who sees only a lion in the way
and rejects with the utmost contempt the aid of those
who seek to prove to him that the lion he so dreads is
nothing but an ass in the royal robe.
All that now remains for us to do is to glance at the
results of the different methods of treatment which
occupy a separate report. A more complete burlesque
upon the so-called numerical method of arriving at
positive data in medicine, it has never been our lot to
meet with. After the committee has told us " that the
choleraic pestilence varies in the severity of the individual attacks from the degree of a trifling indisposition
to that of a most deadly and intractable disease; that in
one form it is fatal to 6, in another to 669 in every 1000,




CHOLTERA.


625


and that, therefore, any alleged specific requires that its
effects should be investigated with the greatest care."
What do we find? A series of tables giving the bare
numbers of cases treated with various drugs without the
slightest specification of the character of the individual
cases so treated, without the date of the period of the
experiment, and without the dose of the remedy.  Thus
we have twelve cases treated with Calomel in small doses,
but what a small dose is we are not told, giving 63 per
cent. of deaths in collapse cases; but then we are informed that only in five out of the twelve so tabulated
was Calomel given alone, in all the others it was combined either with Opium    or with Salines--(what are
Salines?)-or with emetics, or with some other remedial
or destructive agent, and yet they are to serve as the
results of Calomel treatment! Then we have Calomel
given in larger does, but how much larger we are not
told, and the result is highly reassuring, for out of eight
cases there were eight deaths. Indeed, the only conceivable purpose of this report is to show what we must
avoid, if we do not wish to destroy all our patients, and
the only sagacious remark we find is the following, made
in reference to the Calomel and Opium treatment as
possibly productive of fever.  "In examining the remarkable proportion of consecutive fever in Scotland, it
appears that in one district, Paisley, 103 cases of consecutive fever have occurred in 110 cases of cholera; 50
of these only had collapse; 60 cases of cholera, therefore, went into consecutive fever without having had
collapse. In all these cases Calomel and Opium were
used as the prominent treatment in the previous stages.
There is no evidence in the returns on this most interest40




626


CHOLERA.


ing topic, whether the Opium was given in any unusually
large doses. Fever is reported to have been prevalent in
Paisley during the outbreak of cholera: but allowing
certain weight to this latter cause for the large number
of cases which passed from cholera into consecutive
fever, it is still a question, as they were all treated with
Calomel and Opium, whether the Opium was given in
large doses. In the latter case, the result would seem to
correspond with the large proportion of cases of consecutive fever in the metropolitan hospitals, in which the
use of Opium combined with chalk appears to have
been attended with like results."
The meaning of this, stript of verbiage, is that Opium
tends to produce consecutive fever. This inference of
the committee is one we arrived at long ago, from observing the very small proportion of cholera cases treated
homoeopathically in Edinburgh which passed into consecutive fever, in comparison to the large number with
which such a termination in cases treated according to
the directions of the Board of Health, then called the
Sanitary Commission, which advised " twenty grains of
opiate confection, for example, repeated every hour until
the relaxation of the bowels ceased."
We are disappointed at not finding more details of
the effect of the Saline treatment recommended by Dr.
Stevens.  More fatal than 100 per cent. it could not be,
and although we may suspect that the enthusiasm of the
veteran pathologist has misled his judgment and induced him   to over-colour the success of this mode of
treatment, yet, making all such allowance, we cannot but
wish to see a fair and extensive trial given to the
use of the Salts he advises in cases of pronounced




CHOLERA.


627


collapse, where all our efforts are so often unavailing.
And we feel curious to know what was the result in
Sweden of the following directions issued by the Board
of Health of that country, and which seem to be certainly less dangerous than the Opium and brandy treatment patronised by the predecessors of the present committee:
"General directions for the treatment of cholera
founded on the experience of later times.
"When an indisposition that gives warning of the new
disease shows itself by weakness, giddiness, heaviness of
the head, loss of appetite, swelling, or distentioni of the
abdomen, nausea, and frequent diarrhoea, the patient
ought without delay to place himself in a warm and soft
bed, and cover himself well. He ought then immediately to take from two to three, at the most four, drops of
the spirit ofcamphor diffused in a teaspoonful of sugared
water, or on a bit of sugar, every five minutes.  If after
a few doses the patient falls into a perspiration, or if in
this way the symptoms become milder, the doses are to
be taken at longer intervals. If the symptoms become
worse, or the drops be rejected as soon as taken, they
must be given more frequently.     If within two hours
no important improvement takes place, and the wellknown symptoms of true cholera appear, then melt three
good tablespoonfuls of common salt in a quart of warm
water, and let the half of this be taken immediately till
vomiting take place. After the stomach is emptied, a
large mustard or horseradish poultice is to be applied to
the pit of the stomach. This should be kept there till
there arises a strong perspiration, and then a moderate




628


CHOLERA.


teaspoonful of the carbonate of soda and a good tablespoonful of equal parts of vinegar and water is-to be
given in a state of effervescence every twenty minutes.
After three or four doses of the above effervescing medicines, whether the tendency-to vomiting be diminished
or not, there must be given regularly each half hour, a
Stevens' Saline Powder, in two or three tablespoonfuls of
beef tea or oatmeal gruel. One of these powders is to
be given every half hour, until the cholera symptoms
have wholly and entirely disappeared, and even then the
Saline powders are to be gradually discontinued, with
more and more increased intervals."
Afte some judicious observations upon the general
management of the patient, the document concludes with
the signatures of P. V. Afzelius, L. Hwasser, C. H. Berostrund, W. H. Romansson, G. C. Schultz, and P. J.
Liedbeck.
What were the results in Sweden of this plan of treating cholera?




CHAPTER XIII.


MEDICAL NOVELS.1
THE only feature common to these various and very
dissimilar works of fiction is the one which brings them
within the limits of our critical jurisdiction. They have
each of them a Doctor for the hero of the piece. This
is so new an honour for us that it naturally suggests the
inquiry of whether there has been any change in the relation of medicine to fiction by which the two have been
brought into a state of greater rapprochement than formerly, or whether it is a mere accidental drift upon the
hat of the doctor of medicine of that incessant fall of
novels which cease not summer or winter to descend
upon the earth, tending to accumulate about the porches
of the church, especially if of mediaeval architecture, and
to overwhelm   gentlemen who ride at sunset with a military air, but which hitherto has been rather dispersed
than attracted by the sharp rattle of the doctor's carriage
or the canter of the country surgeon's bony nag. To
enable us to reply at all satisfactorily to this question,
we must consider what the various kinds of fiction are,
and we shall then perceive that while some of the multifarious productions will naturally eschew others will as
naturally adopt, medicine as the appropriate magazine
1 'Doctor Antonio,' by the author of 'Lorenzo Beuoni' (G. Ruffini).'Two Years Ago,' by C. Kingsley.-' Fair Oaks,' by Max Lyle.-' Lucian
Playfair,' by J. Mackern.




630


6MEDICAL NOVELS.


from  whence to derive materials "to point a moral or
adorn a tale."
Works of fiction may be divided into three orders,narrative, speculative, and dramatic.  The first is the
primitive tale or story of which we may take the Oriental
fictions, for example, those of the "Arabian Nights," as
a perfect type. The interest of this class depends almost solely upon the incidents narrated.  The amusement they afford is but one degree removed from     a
purely sensuous one. In fact in the original manner of
its construction and delivery it appeals much more to the
senses than to the intellect.  The appropriate scene is
the shade of a tamarind tree, the time the setting of the
sun, or the after-glow that suffuses like a bright dream
the face of the desert; warmth, stillness, all combining
with the influence of the plant that " soothes but not inebriates," to give full effect to the charmed story of
what befel "in the golden prime of good Haroun Alraschid."  To derive gratification from this requires a
degree of passivity on the part of the hearer almost approaching sleep, and, in fact, he gives himself up to the
gratification of a waking dream.   In this blustering
climate of ours we cannot accumulate all the accessaries
of the Eastern reveller in stories; the nearest approach
perhaps is to " lie under a cherry-tree, in a fine day in
June, and read Quentin Durward," an occupation which
a celebrated divine and orator used to speak of as his
greatest conceivable enjoyment.
The act of reading implies a certain amount of effort,
and so far it is inferior to the passive entrance of the
imagery by the ear.   However, long practice and the
modern perfection of type and paper reduce this once




MEDICAL NOVELS.


631


laborious operation to an exceedingly small impediment,
so that a person lying on a sofa in a well-lighted, wellwarmed room, with a well-printed convenient volume, is
in almost as favorable a position for being given up
to the purely sensuous enjoyments of a story as if he
were in a desert of Arabia. Let us suppose a novel is
ordered for such circumstances, how would the writer
who undertook the task set about it?     He would naturally say to himself " my object is to give the greatest
possible amusement with the smallest conceivable effort
on the part of the reader. The reader is like a person
lolling at a window watching the passers by, I must
give him his procession, and contrive that the persons
who compose it shall be as picturesque as I can make
them. Now if I watch the passengers of any thoroughfare I find my eye is attracted by a few to the exclusion
of the others, and most of all by the scarlet uniform of
a soldier. While the colour arrests the eye the fancy is
at once roused into a pleasing reverie as to the possible
adventures of his life.    He could tell us of strange
scenes of excitement, exactly what my readers want."
The soldier, then, as an adventurer, as a warrior, as a
bright figure, attractive to the senses, and above all as
representative of the manly in contradistinction to the
feminine on the one hand and to the angelic on the
other, and for this reason instinctively the favourite of a
large class of women, the soldier will be generally selected as the hero of the narrative novel; the doctor
never.   Because he personally makes no appeal to the
senses, his dress is traditionally sombre, his manners not
self-asserting, but, on the contrary, of the most unobtrusive character, gliding as he is supposed to do like a




MEDICAL NOVELS.


ghost between the living and the dead, and so far from
being of an essentially manly formation, the more he
approaches the ideal the more will he recede from the
distinctively manly and approach the feminine, or combine in finely adjusted proportions the masculine and
feminine elements. " More compassionate than woman,
lordly more than man."-Such a character may be infinitely superior to the military, representing the empire
of love, while that represents the love of empire, but it
will never do for a narrative novel.
The distinctive character of the second order, or speculative novel, is, that the fiction is subordinate to the
inculcation of some peculiar notions that the writer wishes
to introduce into the public mind. It might be called
the didactic instead of the speculative, for it generally
aims at teaching; however, we prefer calling it speculative, for it is now so often employed to give currency to
novel ideas or speculations. It may be considered as
taking the place in modern literature that "the moralities"
occupied in the fifteenth and sixteenth centuries.  These
were plays whose object was to bring before the public
some peculiar truth, or what their author regarded as
such; they dealt mainly with religious belief, as that was
almost the only subject which occupied the popular mind
of that period, but they were not exclusively devoted to
that, for there is one of the moralities of the time of
Henry the Seventh written with the view of enforcing
upon the people of England the study of philosophy, and
in it the discovery of America is referred to. Now that
the influence of the stage has been superseded by that of
the press, we naturally find the agency of the latter used
for similar purposes as the former once so powerfully




MEDICAL NOVELS.


633


served; and a large number of modern novels, indeed
probably the majority, are the moralities revived. While
the special form of the morality-novel must depend on
the genius or lack of genius of the writer, the subject will
naturally be chosen in accordance with the requirements
of the period.  At one time it will be religious, if the
public mind is interested in any ecclesiastical controversy,
as it was some years ago; at another time it will be political like Coningsby: but at present neither church nor
state politics are in the ascendant; on the contrary, had
it not been for the large feeder from India the Tiimes
was in risk of perishing of inanition, owing to the extraordinary apathy of the public about its own affairs. There
is not at present a single political question which excites
even the most moderate enthusiasm in the public mind,
at least no question of internal policy.  But sailors tell
us that there is no time when more work is done than
during a run across the Pacific Ocean, when, for weeks
together, not a sail requires to be touched, for that then
the men are all busy in putting the ship and all its tackle
into order.  So with the ship of state during this profound repose of the political elements, questions of social
interest have for the first time risen to command public
attention, and Young England has chosen for his motto
" education and health."
The consequences of this change are very curious. In
the first place it annihilates political parties, for who can
possibly deny the importance of either health or education?
In the second place it advances into a new position the
ministers of health and the body of teachers.  This seems
to be the reason of the appearance of the doctor as a
hero.  Had the moralities existed as plays instead of




634


MEDICAL NOVELS.


as novels we should have had the president of the College
of Physicians on the stage instead of Dr. Luther and his
Frau, and he would have lectured his audience upon the
folly and criminality of sleeping twelve in a closet and
the other abominations that are practised in all our large
towns. But we may even go a step farther and observe
that not only will medicine in the abstract naturally
occupy the attention of this class of novelists, but that
the reformed medicine of Hahnemann is specially fitted
for the fiction pulpit, because it professes to achieve far
more positive good, and therefore is more calculated to
stir the imagination; it has the advantage of an affirmation against a negation; it has also the charm of novelty
and of popularity, for, from its freedom from all the revolting appliances of external torture and disgusting
potions, it gives no offence to the most delicate, and might
be practised, as indeed it largely is, by the most refined
ladies in the land. All these are powerful recommendations to the novelist, and the only reason that a homceopathist has not hitherto figured as he should in fiction
is the dread of ridicule so fatal to this class of literature.
For unless a novel of the speculative kind is successful
it is nothing; it is a sermon without an audience, and
a writer will naturally be keenly alive to ridicule knowing
how entirely it would defeat his aim. For the doctor
has of old played a ridiculous part in fiction, and this was
the inevitable consequence of his secondary and incongruous position so long as the military hero prevailed.
Now that a change is advancing it is a great trial to a
novel to convert this traditionary laughing-stock into a
hero, and when we add to this inherent difficulty in
exalting a doctor, the additional disqualification presented




MEDICAL NOVELS.


635


by a doctor who is laughed at by all other doctors and
the vast majority of their patients, it is obvious that it
would require no ordinary courage, indeed nothing less
than great genius or great prestige, to write a novel with
a homceopathic doctor as its hero, which should command
public attention and attract public sympathy; yet the
thing must come in the course of nature.
The remaining class, the dramatic, includes all tales of
fiction, the interest of which depends upon the representation of character. In many respects this may be considered the highest order, for it implies in the author the
possession of true creative faculty, and its influence is
much more permanent than that of either of the other
two.   Mere narrative of curious incidents, however cunningly conceived and set forth, cannot exceed in interest
the actual narrations of adventurous travellers; and the
speculations introduced into a novel, let them be urged
with ever so great eloquence, must be antiquated either
by their reception or rejection.  But the vitality of a
well-conceived character endures for all time-even
although the type is not the highest. Who has not come
under the influence of Defoe while reading the 'Adventures of Robinson Crusoe?' At first sight one might
suppose that the fascination of this work lay in the
incidents it related, but a more careful examination
of Defoe's writings, and a comparison of 'Robinson
Crusoe' with all other books of sea-faring adventure,
whether real or fictitious, teach us that it is the intensely
human element which pervades the work that gives it so
strange an influence; it is because when we read it we
are for the time actually converted into so many ' Robinson Crusoes,' each of us has made his goat-skin coat and




636


MEDICAL NOVELS.


shaggy trousers, and been startled by the print of the
cannibal's foot. The fictionist who possesses this faculty
may use it for effecting indirectly the objects aimed at
by the two other orders of writers. He may produce a
tale of wonders of surpassing interest, or he may make
his characters represent his peculiar opinions, speculations, or beliefs, or he may employ his power of delineation in one particular direction so as to exhibit the vices
and follies of his time. He will then be the satirist,
and the satirist is the preacher in disguise, and so well
disguised is he that one of our most popular and powerful writers of fiction has had to defend himself seriously
from the charge of being immoral because all his characters were specimens of selfish, mean, and despicable
human beings, whatever their social rank! As if it
were possible for the mind to conceive of vice as vice
without being in possession of the idea of virtue! and
as if it were possible to depict meanness so that it gave
rise to dislike or indignation in the mind of the beholder
without stimulating into active exercise the nobler feelings on which this resentment depends.
For the purposes of this highest class of novels, we
consider the materials afforded by medical experience
well suited.  Either as actor or spectator the physician
might be the central point of a most interesting and
instructive fiction.  If taken as an actor, he might be
accepted as a type of a mind exposed to the most peculiar training, the results of which might be exhibited.
He is placed in the most neutral, and, at the same time,
the most instructed position of any class of men.' He
1 Sir T. Brown says, "I am of a constitution so general, that it consents
and sympathises with all things. I have no antipathy, or rather no idio



MEDICAL NOVELS.


637


must know everything and be nothing.       He cannot be
a politician, for he passes from the bed of the dullest
obstructive to the chamber of the most effervescent
radical, and in each he sees only a sick man, for disease
is the heir-apparent of the great leveller death, and
carries much of its successor's authority.  He cannot be
a dogmatic theologian, for he has to see and hear in one
ward the dying petitions of a dozen different creeds, all
delivered with equal earnestness, and which it would be
inhuman to interrupt by question or doubt. He can
hardly even be a patriot, for he has to bend over the
wounds of his country's foes, and to administer in sympathy all the attention in his power to those he denounces
in his litany.  In short, the physician must be human
in the largest acceptation of the word, feeling for man
as man, for woman as woman, and even for the infant
as an infant. To the psychologist it can hardly fail to
be a most interesting problem how far it is possible for
a mind to become so general in its sympathies and in its
acquisitions without losing for itself a hold of all positive belief. The danger at all times common to medicine,
which we might call the art of defeat, where he is best
who makes the fewest blunders, is greatly increased at
those times in the history of the art when scepticism of
its value breaks over it like a flood, as it is now doing.
The medical sceptic is well sketched in 'Fair Oaks.'
"Paul did not get on as a doctor.     His cast of mind
was metaphysical rather than practical; and he was
utterly deficient in that steady self-reliant hardihood of
syncrasy in anything. These natioual repugnancies do not touch me, nor
do I behold with prejudice the French, Italian, Spaniard, or Dutch."
(' Religio Medici.')




638


MEDICAL NOVELS.


speech and action, which the medical man who intends
to rise in practice must feel or assume. The 'rough and
ready' doctor, like the rough and ready soldier, is often
the one most distinguished by fortune. Paul Glyn was
not such. With his keen and delicate perceptions, he
dared not practise the 'hit or miss' system of treatment;
he saw too vividly all the remote possible consequences
of the slightest error to risk anything willingly; he was
not prepared to take many a random shot on the chance
of one hitting the mark. And when he failed he could
not carry off his failure with due professional imperturbability. Paul certainly was not born to be a doctor!
He soon found he could not satisfy either his patients or
himself; he had not their confidence, for he had not his
own. He became more and more irresolute and selfmistrustful. Each failure prepared the way for others;
with his character this was inevitable, for at each failure
his high ideal and exaggerated self-reproach bore him
down, and paralysed fresh exertion. And Paul began to
dislike a profession which brought him into daily perplexities of judgment, into daily contact with problems
he could not solve, and suffering he could not relieve.
He began to experience that deep distaste of his circumstances-that weary restlessness, which assails a
man who feels himself intellectually superior to his position, while practically, or in the opinion of others, he is
unequal to it."
This looks a picture from life. We at once recognise
the quiet, unobtrusive, thoughtful, man of learning, who
has been elbowed aside by the vulgar, loud, bustling,
pushing practitioner, and who, settling in some eddy,
watches the stream bearing others towards the prizes of




MEDICAL NOVELS.


639


life, of which he is infinitely more worthy than they who
rush on, but which he must for ever fail to achieve, because he is deficient in    the  coarse  hempen fibre
that bears the jar and tug of the clumsy galley of fortune. The poet complained to Jupiter that he had forgotten to leave a place for him when he portioned the
earth among soldiers, lawyers, &c. Jove replied, True,
there is no place left for you there, so must you come up
here beside me, that is your place.   This is Schiller's
consolation to minds of the high order of Paul Glyn.
"Fair Oaks' is the only one of the fictions enumerated at the beginning of our article in which the medical mind, as such, is made the subject of scrutiny and
speculation. That this analysis displays great penetration is beyond a question. From the extract we have
given, our readers can form their own opinion. How
far the construction of the plot is well qualified to bring
into play the most important elements of the medical
mind, supposing that to be the purpose for which the
book is written, may be fairly doubted. It seems to
have been written by one more experienced in medical
failures than in medical success. The hero gives no indication of possessing medical intuition, as special a gift
as military intuition-an endowment which enables the
born doctor to appreciate at a glance the realities of a
case through all its adventitious coverings-something
wholly different from the scientific diagnostic faculty,
with which it may or not be combined. The medical
hero should be    represented as having   this peculiar
medical faculty in   great abundance whatever other
qualifications he may have.
There is more of this quick perception of the state of




641.0


MEDICAL NOVELS.


matters and ready tact in devising expedients for putting
wrong right in Dr. Thurnall, the hero of ' Two Years
Ago,' by Mr. Kingsley. There is also a much richer
field of incidents invented for the display of this medical
faculty.
But Mr. Kingsley in this, as in most of his other
novels, uses his characters too manifestly as masks through
which to utter his own sentiments. The voice is still the
voice of Jacob, however hairy his hands may be. So
that, although, with the instinct of genius he has represented  a good    deal of the ready-handed doctor in
Thurnall, yet the character, as a whole, is altogether an
unfit representation of the true medical man, and indeed
Mr. Kingsley seems quite aware of it, for reserving the
prize-a lord's sister-for a long-skirted, young, lilyhanded, intoning, clergyman, who comes out on the high
church side and is converted to the opposite by the
cholera in the course of a few pages, he marries his
medical hero to a mad Methodist teacher,-and it is a
very suitable match.
The admirable story of' Dr. Antonio' derives its
interest from the excellence of its portraiture of character.
The hero is a doctor, because it suited the purpose of the
author to represent him     in the variety of situations
natural to such a calling at the period and country in
which the scene is laid.  But he is not a medical hero;
he is a chivalrous Italian gentleman who moves with
native grace, power, and dignity through a variety of events
of domestic and political interest.  He is in his nature a
genuine hero, but the doctorship is entirely adventitious.
His profession is made subservient first to love, and then
to politics.




MEDICAL NOVELS.


641


The same observation is true of 'Lucian Playfair.'
He, too, is put through an immense number of situations,
such as only members of the medical profession are
likely to be acquainted with, and not many even of them.
For example, we have the horrors of the worst of madhouses revealed, and a story which, from its extreme
improbability, we presume to be true, of an Irish medical
student, who carried his passion for the object of his
affections not beyond but into the grave, and, with the
assistance of an expert resurrectionist, dug up the body
of his mistress (the process of disencoffining is accurately
described and really curious) carried it off for the purpose
of a quiet private dissection, which was unfortunately
frustrated by the revival of his victim, and arrival of her
brother.  This work is an example of what might be
produced by a physician, if he were to give an account
of his experience of actual life, but to win a large amount
of confidence implies such devotion to a profession as for
the most part disqualifies from the task of writing fiction,
and of course it would be out of the question for one so
trusted to violate the sanctities of the medical confessional, and reveal, for the gratification of an idle curiosity,
the strange, tragic, or comic incidents which daily come
before his notice.  His vast experience of naked life may
make him a most wise and entertaining companion, but
not a novelist. This seems to be perceived by the lynx-eye
of our most popular of living authors. The part which
( Physician " plays in Little Dorrit as contradistinguished
from "Bar," and the mercantile hero of the piece is
eminently characteristic.
'Fair Oaks' is the only one of our list which we can
regard as a medical novel in the sense of dramatising the
41




612


MEDICAL NOVELS.


physician's vocation; and this novel, although written
with great beauty of expression, is interesting and instructive chiefly for the stray thoughts which lie imbedded
in its texture, rich in   suggestiveness; and from    the
piquancy of its satire, than from  the specific merits we
demand in a work devoted to the representation of the
art of healing. Its exposure of the hollow pretentiousness of fashionable old physic is extremely clever, and we
are sorry to say that one of the best scenes in the book,
"the Consultation," is not an overdrawn picture, nor
confined to the old school altogether, and justifies the
new reading given of the old proverb, " in the multitude
of councillors there is safety"-yes, to the councillors,
but Heaven pity the object of aggregate medical attention.  A  consulting congregation is about as irresponsible as a corporation; both are equally destitute of the
fundamental elements upon which punishment naturally
falls.
But literature is rich in good satires of our profession,
and what we long to see is something more really true to
nature.   The power displayed by the writer of 'Fair
Oaks,' and the evident selection of this field for his
speciality, make us hope that we shall have other works
from  the same pen, which shall give a fuller and fairer
delineation of what the true hero of medicine is or ought
to be, combining as he should so much of the teacher
with the doer of good, and re-establishing the primitive
Christian identity of the healer of the body and the
saviour of the soul.




CHAPTER XIV.


SAMUEL BROWN.
THosE who knew him, and those who did not, wvill be
equally disappointed by every biography, be it full or be
it brief, of Samuel Brown.  No description can justify to
the one, or explain to the other, the admiration he excited.  The reason is not far to seek. Biography is a
branch of history, and history occupies itself with
actualities and not with possibilities: it is the chronicle
of success: it leaves to the orator and the poet to build
a shrine to the nameless demigods, out of whose fall the
hero rises to glory and a deathless name. While the
intellect bows submissive to this inexorable decree of fate,
and concedes that history must follow the career of deeds
without pausing to tell of efforts, yet there is a craving
in the depths of our being to have some memento of
those who have exercised a powerful influence upon us:
some record of the talisman that bound by its spell so
many and such various characters. That Samuel Brown
possessed this talisman, will appear from the merest
outline of the story of his life.
He was born at Haddington, the 23d February, 18 17.
His father was a small merchant, the son of a dissenting
minister, John Brown, the author of a well known commentary on the Bible which bears his name.   He was




644


SAMUEL BROWN.


educated at the grammar-school of his native borough,
and studied medicine at Edinburgh, where, in the year
1833, he attended Dr. Hope's lectures on chemistry,
" and (to use his own words) from that (to me) memorable session I was sworn a chemist."  In 1837 he read
a paper before the Society-of Arts on the mucilage of
the fuci: this was published in the Edinburgh Philosophical Journal; he was then only twenty years old.
In 1839 he read before the British Association a paper
on the crystallization of insoluble and infusible carburets,
and obtained for this the annual medal of the Hunterian
Society; in the same year he obtained the gold medal of
the Medical Faculty of the University for his thesis on
the coagulation of albumen and catalysis; in 1841 he
read before the Royal Society a paper on the preparation
of paracyanogen in large quantities, and on the isomerism
of cyanogen and paracyanogen; and finally, in the same
year, before the Royal Society, he read his celebrated essay
entitled, " Experimental researches on the production of
silicon from paracyanogen," in which the process was
described of transmuting, as he alleged, carbon into
silicon.  I-ad this announcement been made by a mere
speculator upon chemistry, or a novice, it would hardly
have been deemed worthy of refutation, but Samuel
Brown was no such man. Even in 1839, Dr. Traill,
Professor of Medical Jurisprudence, had from personal
acquaintance, borne evidence to his intimate knowledge
of the higher branches of chemical science. Dr. George
Wilson, the accomplished Professor of Technology in
Edinburgh University-himself recognised as a firstrate chemist-writing, in 1843, of Samuel Brown, says,
" for the last eight or ten years he has devoted his atten.




SAMUEL BROWN.


645


tion almost entirely to the study of chemistry.     He
brought great natural gifts to the task, had leisure to
apply them to advantage, and neglected I believe no
source of information... The greater part of the
last four years has been spent by him in his laboratory
in the prosecution of experimental researches, and he has
acquired, in the course of these, great experience and dexterity as a  manipulator."   Can we wonder that an
ambassador so accredited coming from regions altogether
unknown to us, but familiar to him, and insisting with
all the fervour of a sort of scientific inspiration, not only
on the actuality of the facts, but on their theoretical
necessity, should obtain belief?  All agreed that if any
youth of his day was to win his way to the secrets of
nature, none was so qualified as Samuel Brown; and when
we saw him retire into seclusion and live like a hermit,
sleeping in a hammock in his laboratory, living on the
most meagre food, stinting himself of everything; this
bright youth, caressed by all who knew him, whom all
were glad to entice from his lonely and miserable dormitory to the best of cheer and society, when we saw him
thus wrapt in his discoveries, was there any credulity on
our part in giving him our fullest faith? Of his province,
chemistry, we knew nothing compared to his knowledge.
Of himself what did we know? Why we knew that in
1843 he delivered a course of four lectures on the atomic.
theory, and that the opinion of his audience was thus
expressed in a memorial written by the late Sir William
Hamilton, who was certainly a most competent judge of
the intellect displayed in them.  " We would record our
admiration of the genius, eloquence, and learning which
pervaded the exposition of your large and philosophical




646


SAMUEL BROWN.


views of the principles of chemistry, as well as your
elegant, simple, and precise experimental illustrations of
isomerism.    We are aware that not having ourselves
made a careful repetition of your experiments, we are not
entitled to offer any opinion with regard to their accuracy; but from the simplicity of the processes you
described as well as from the rigid and critical character
of your reasonings, we cannot but indulge a confident
hope that future investigations will end in the confirmation  of your discoveries.   These discoveries appear to
us to be not only most important in themselves, but to
possess. an especial claim to attention, from having been
made under the guidance of an original and comprehensive view of atomics, on which you have bestowed much
thought and laborious investigation, and which if established as a general principle, must tend materially to
change the whole aspect of chemistry."       This address
was signed by Sir William Hamilton, professor of logic,
Dr. Chalmers, the great divine, Mr. Goodsir, now professor of anatomy, Dr. A. Thompson, professor of physiology, Dr. Davy, the well-known chemist, brother of
Sir Humphrey, and many other names of celebrity in
various departments of high       intellectual attainment.'
This happened in May, 1843. The following September
he offered himself ats a candidate for the chair of chemistry in the university, vacant by the death of Dr.
Hope. He founded his claims almost entirely upon his
great discoveries, but at the same time presented testimonials of his scientific attainments and his general
1 These lectures have been lately published along with various interesting essays by the same author. The title of the book is 'Lectures on the
Atomic Theory; and Essays Scientific and Literary,' by Samuel Brown,
T. Constable, 1858.




SAMUEL BROWN.


647


talents.  To the latter some of the most eminent men
of the day bore emphatic testimony. Archdeacon Hare,
the  author of 'The Victory of Faith,' 'Guesses at
Truth,' &c., thus writes to him.   "There is a philosophical power of looking into the heart of things and
discerning their inmost relations, which is the highest
faculty for all speculation, whether its object be the outer
world, or the moral and spiritual nature of man...  The writings of yours with which I am acquainted,
have seemed to me to betoken that you do possess the
power of philosophic intuition in a degree in which it is
possessed by very few Britons of our age." Thomas
Carlyle writes, "I can at all times with great readiness
testify that I have found in him a man of vivid penetrating, high aiming, hopeful nature; full of ardour, of
discernment, and veracity; a singular acuteness as well
as vigour of intelligence, prompt invention, clearness,
swift precision, nay, brilliancy and general felicity of
utterance,-the elements in short of a truly gifted man,
to whom scientific or other triumphs, if circumstances
proved not too unfavorable, were very possible, were
very probable."  Thus backed by Carlyle, Hare, Jeffrey,
Hamilton, Chalmers, and many more celebrities, Samuel
Brown had very nearly got the chair, and it was the opinion
of his friends that if he had rested his title on his general
and scientific capabilities, and not upon his discoveries,
he would have succeeded. The contest was keen, and
he retired, although beaten, with high honours.
The following May, 1844, he thus wrote of it to a
friend.  " My thoughts and feelings about Chalmers
noble letter, and Macdougall's1 noble exertions, I shall
SProfessor of Moral Philosophy in the University of Edinburgh.




648


SAMUEL BROWN.


tell you better than I could put them down on paper. I
tell you I would not this poor day give that letter of our
Scottish hero of 1800-50; that other of Carlyle's, the
British chief of the same period; that of Emerson, the
prophet of young America; the unsought enthusiasm of
Macdougall, the man of Edinbro' of this year; the
indignation of Sir William Hamilton; the erudition of
Edinburgh and Oxford in one extravagant, magnificent
head; the approving hope of Hare, the apostle of faith,
illustrated by understanding, in the majestic church of
England; the life of love given me without reserve by
Archibald Craig, the acute and fervid angel of my studious toils; the kindly admiration of your well-beloved
self, Drysdale, Ross, Simpson, Giraud, and a few more,
with Ruffini, the still centre figure of the blessed group;
and last, far from least, the judicious smile of our keen
and graceful Jeffrey', for an earldom and broad acres to
boot, not to say a paltry chair even in the alma mater
of my yearning youth."   This was a proud moment;
by sheer talent he had, at the age of 26 years, won for
himself the interest and admiration of the foremost men
of his day.  We look upon it as the culminating point
of his career. Up to this time he was the heir apparent
of the crown of science; he claimed the throne as his
due; had his claims been allowed he would have reigned
right royally, for he was of a glorious nature; but his
claims were not admitted, they were protested against by
the whole hierarchy of chemistry, he was looked upon by
them as a pretender, and his life was wasted away in one
long miserable effort to vindicate what he to the last
maintained to be his legitimate position.
SOf the 'Edinburgh Review.'




SAMUEL BROWN.6


6-i9


This most gifted and most sensitive of men who
seemed made to conquer, to whom all things were possible, had he not pledged his life to the impossible, was
doomed to endure, from 1843 to 1856, all the mortifications that envelope the career of a pretender. What he
must have suffered no mortal can tell, and whether to
the last he was sustained by confidence in his discoveries,
or whether he adhered to them out of a dogged resolution and a fixed belief that for him there was no choice
but to succeed or die, it is hard to say. Those most in
his confidence, and who ought to know best, maintain
his entire faith in himself to the last; but long before
he was released by death, his frame had been wasted
away by a painful disease of the intestines, which for the
last ten years of his life had impaired his health to such
a degree. as to make all work difficult and uncertain for
him. This sad fact we must not forget in estimating his
achievements. He was wounded early in his day of
battle, but for this, who shall say what he might not
have accomplished?
It was at the time of his fullest vigour, in 1843, that
he wrote the article entitled " A Theory of Small Doses,"
which first appeared in the third number of the 'British
Journal of Homoeopathy,' afterwards in the ' Introduction
to the Study of Homoeopathy," and which has been reprinted in his collected writings. His interest in homoeopathytook its rise in Dr. Black's conversion to it. Dr. Black
and Samuel Brown were fellow students, and presidents
the same year of the Hunterian Society. Dr. Black
had distinguished himself during his academical career
by his zeal and talents, and when it was announced
among his old friends that he had fallen into the deln



650


SAMUEL BROWN.


sion of homoeopathy, there was a wild wail of despair
over the fallen star. A common friend wrote Samuel
Brown a chapter of lamentations upon the occasion. It
was not his way, however, to take part in clamour, and
so he got Hahnemann's ' Organon' and read it through
before replying to this friend. He then wrote, that so
far from  seeing anything absurd in homceopathy, it appeared to him a method of great beauty and probable
truth, and that he found in the 'Organon' of its discoverer,
the indications of a profound genius, and ended by
strongly urging upon his friend the duty of mastering
the system he thus unphilosophically denounced. From
that time Samuel Brown never ceased to take a lively
interest in homoeopathy; he was familiar with most of
the English treatises upon it, and did great service to
the cause by his eloquent orations at medical societies,
and by popular and scientific articles, which appeared
in various periodicals, and to the last he submitted himself and his family to the treatment of homoeopathic
physicians with unwavering faith.
We would gladly linger over this exulting and abounding period of his career; but the world's pitiless sentence vm victis had been pronounced, and he began to
die. His doom took long to execute, but it was fixed
from the first; he was often reprieved, but the law of
failure took its course. Those who knew him well can
recall the fatal changes which had then commenced to
develop the deadly malady under which he finally sank.
He grew restless: he went to Glasgow for two years, and
lived in his laboratory there, then he returned to Edinburgh, then he went to Haddington, again he came back to
Edinburgh, and married, and settled at Portobello. To the




SAMUEL BROWN.


651


casual observer, or those who only knew him in society,
there was nothing to excite suspicion of unhappiness or
disappointment about him.   He entered like a beam of
light, there was a glowing ardour in his looks, his words,
his movements, that seemed to spring from excess of
life. On every topic that was named in his presence,
whether grave or gay, scientific, literary, or artistic, he
seemed equally at home; he did not sink to the level of
a petty theme, nor did he let it go by as beneath his notice, he laid hold of it in his own wonderful way, and
bore it up to his region of beautiful speculation, and
there he transfigured it into a glorious apparition. No
wonder he believed in transmutation, he had himself the
gift, he could transmute the basest lead into the finest
gold by the subtle fire of his intellect and the magic of
his tongue! Perhaps in his power of exquisite talk,
which for variety, fluency, freshness, and depth, excelled
the improvised scientific talk of any man we ever heard
of, not to say listened to, there lurked the snare that
worked his final failure.  He could set all things to
rights; the most chaotic materials grew into a kosmos
in his hands; he perceived with such rapidity the points
of approximation between the most dissimilar appearances, that all he had to do was to arrange them, and
pass lightly over the intervals, and behold there was a
chain of endless extension! The links were wanting
here and there, but still we saw where they ought to be,
and when this chain was electrified by his fervid manner,
who could coldly handle it, detect, and demonstrate the
gaps? Thus unconsciously he may have answered for
nature instead of questioning her; did he mistake the
echo of his own voice for her reply? By and bye was




652                  SAMUEL BROWN.
he not somewhat decoyed from      crucibles, weights, and
measures, and all the weary work of unsuccessful experimentation, to the world of imagination, where instead of himself transmuting he was transmuted? He
seemed to lose the primary essential hold upon facts,
and left the pursuit to which he had vowed his life,
neither willingly nor altogether consciously, but by a dire
necessity, because he could not go back nor get forward,
and dallied with literature.  Here, too, he failed,) not
because he had not greater talents and knowledge than
those who outstripped him in the race, but because he
was half-hearted in it.    It was only his by-play, he
scorned it, and scorned himself for doing it;-it was
not meet that the heir-apparent should keep a huckster's
shop; he resented the indignity that he conceived he
submitted to; thus, like a man on double business bent,
unable to decide for either, he half did both.  Yet some
of his writings are very beautiful, but they appear absolute failures to those who had heard him speak; the
glow-worm   by day-light is not more inferior to the exquisite phosphorescence as seen at night, than are Samuel
Brown's best literary efforts as compared to his brilliant
talk. This appears to us the saddest part of the whole
affair. He has passed away, he, the gifted, the wise, the
learned, the eloquent, has passed and left nothing;nothing but a life-long influence upon those who knew
him, an influence for which, doubtless, they will be held
accountable, as for one of their highest privileges.
SWe suspect the readers of his collected essays will demur at this
sentence. However, all we mean by failure is, that he did not come up to
the enormous expectations he had given rise to by the excellence of his
speech. He was dwarfed by himself, not by his associates.




SAMUEL BROWN.


653


"We shall seldom meet," he wrote to a friend, cc"one
another now. Let each see that the other has grown
when we do meet. To be stronger and freer, in a word,
to be manlier! and manlier every year be now the common object of our unenvious emulation. I challenge
you to the generous combat."
Let us accept the noble challenge, and expect the
meeting, humbly committing the time and place to Him
who is the beginning and end of the career of all His
creatures. To Him, too, let us commend the faithful
partner of poor Samuel Brown, who did all that woman
could to mitigate the unutterable sorrows and sufferings
of his long, long death.


TH E END.




PRINTED  BY 3.IE. ADL&RD,
BARTHOLOMEW CLOSE.




W~orks by the Author.


A TREATISE
ON
EPIDEMIC CHOLERA.
Opinions, of the Press.
"Tis work is by a gentleman who has embraced the homoeopathic doctrine, and if all books designed to render popular the
teaching of Hahnemann had been written equally well and in the
same temperate spirit, the truth probably had never been involved in a wrangle. The founder of the creed was persecuted,
and illiberality naturally gave rise to violence of exclamation, but
those'who have adopted his convictions are not also bound to
imitate his personality. This last is what Dr. Russell does not
attempt. He writes like a gentleman, and all he says is read
with profit and entertainment. He does not attack those who
differ from him in opinion, but he depends entirely upon his
ability to make his case intelligible. We read with pleasure,
and our entertainment is not impaired by the presence of scurrility. Sincerely do we hope that other advocates of homceopathic
principles will imitate the example thus prominently illustrated
by one who is not the least among the order to which he belongs.
The practice is no longer a novelty, but after the years during
which it has been pursued, it may be fairly regarded as established,
and the time has surely arrived when its advantages, merits, or
defects, may be investigated with temper. We desire the question should be discussed, and the public care little for the professional squabbling with which it has been injudiciously mixed up.




"Dr. Russell avoids everything like dispute; and instead of
seeking to undervalue the labours of those opposed to him, he
appeals to their works to show the soundness of his own belief,
or to enforce the facts on which it is based. Throughout the
volume we meet with quotations from the writings of authors
who are not favorable to homceopathy, but fronm these authorities
much is adduced which serves to illustrate the pathology of the
disease, about the peculiarity of which the writer descants.
"The information scattered throughout the- vomlL~ well repays
the reader.
"The display of scientific knowledge is not indulged; neither
is a fitting appeal to professional authorities ostentatiously rejected. There is no writing up or writing down to be encountered, but in an easy style, to which earnestness of purpose gives
dignity, the author is content to state his case.
" We heartily recommend our readers to obtain this work and
to study it. Whether he who peruses it is disposed to place
faith or laugh at Homieopathy will hardly influence the pleasure
or instruction to be derived from the volume. It takes large
views of large subjects, and the smallness of the doses it occasionally recommends does not affect the many important topics
on which Dr. Russell eloquently dilates."-2Morning Post.
" A book well worth attention, apart from Dr. Russell's hommoopathic opinions and arguments." -Examiner.
Preparing for Publication.
LIFE
OF
SAMUEL HAHNEMANN.


By the same Author.












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