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the cold stage of a febrile paroxysm, is the cause of all the subsequent phenomena. The doctrine assumed, in the second place, that this primary cause is to be found in the weakened energy of the brain, occasioned by the application and action upon it, of certain sedative influences or agents. Then it was further assumed, that this diminished energy of the brain, produces a state of debility in all the functions of the body, but especially in the heart and arteries, and in the extreme vessels; in consequence of which, it was again assumed, that these vessels become the seat of spasm. In consequence of the cold stage and of this spasm of the extreme vessels, it was finally assumed that the heart and arteries are excited to increased activity, and by this activity, the spasm of the vessels is overcome, the energy of the brain is restored, and the series of morbid actions thus entirely destroyed." Here are five gratuitous assumptions, according to our author, without a shadow of foundation. To us it appears that but one of the positions is assumed and unfounded; viz: that of the spasm of the extreme vessels. Of this, unquestionably there is no proof. Paleness of the skin can be observed, arising no doubt from retrocession of the blood to the internal parts of the body; but it is much more probable that this proceeds from weakness of the great propelling power, the heart, than from any increased resistance, caused by spasm of the extreme vessels. As to the other four positions, they not only were regarded as facts of every day occurrence, in Cullen's time, but they are still viewed in the same light by a large majority of our best medical writers. It is generally admitted, that the remote cause of a fever produces the feeling of debility and malaise, which precedes the chill, for a longer or shorter time; and that this feeling and the chill arise from the remote cause acting upon the nervous system, of which the brain is the common sensorium. This is the " progressis languore, lassitudine, et aliis debilitatis signis," of Cullen's nosology, quoted with approbation as an admitted fact by our best writers. It is not denied, that the remote cause of fever is a poison of some description, which acts as a sedative upon the nervous system, and depresses the vital energies; and although we cannot, in many instances, discover its presence, or lay hands upon it, and analyze it, we are, nevertheless, as confident of its existence as if we could subject it to experiment. We cannot perceive the effluvia of small pox when they pass into the air; but we have no doubt of their extensive circulation, in various ways, because we see their effects. That the feeling of debility proceeds from diminished energy of the brain, necessarily follows from the fact, that all impressions upon the nerves of sensation are transmitted to this central organ ; and it is granted by all pathologists. Then, that the accumulation of blood in the internal parts, increases the respiratory action, and also
stimulates the heart to augmented effort, by which the blood is again driven into the extreme vessels, dilating them and producing a feeling of heit on the surface, and next perspiration, is also an admitted fact. It is thus made manifest, that Dr. Cullen, according to the prevailing doctrines of our own times, so far based his theory of fever on facts, supposed then, as now, to be indisputable. What, then, becomes of our author's charge of " assumption." The unavoidable inference from this blundering criticism is, that he is incapable of distinguishing between facts and suppositions.
In his rage for using his critical scalping-knife, our author not only assails the above named great men, and professor Cooke, and Doctors Miller, and Gallup, and others of the regular profession, but he descends to animadvert upon the doctrines of Hahneman and Samuel Thompson, the two most notorious quacks of modern times. It is greatly to be regretted, that a gentleman of his respectability and standing in the profession, should have demeaned himself by noticing such miserable systems of imposture. Quackery has always existed, and will continue to flourish, until medicine becomes a perfect science; and the community become more enlightened respecting its true principles. But there is no better mode of assisting quacks in their devastations upon suffering humanity, than for physicians of character to show that they think them deserving of attention. It is immediately ascribed to envy and to jealousy of true merit. Although physicians know, that they do not deserve this imputation, it is impossible to convince the public that they are disinterested; and consequently, the better plan is, to leave quackery to pursue its course, and die a natural death.
Our author's first proposition is, that " all medical science consists in ascertained facts, or phenomena, or events; with their relations to other facts, or phenomena, or events; the whole classified and arranged." We have already shown that this proposition is absurd, when applied to physical science; and the same arguments prove its absurdity, in its application to medical science. He insists, that medical philosophers make this science to consist in the "inductive or reasoning process, superadded to the facts and their relations, more than in these latter themselves;" and he laments the evil effects which have resulted from this spurious philosophy, and these vicious or imperfect modes of investigation. Medicine, he thinks, has suffered to a vastly greater extent from these causes, than any other science.
In his second proposition, the author contends, "that each separate class of facts, can he ascertained only by observation, or experience, (experiment,) and that they cannot be deduced or inferred from any other class of facts, by any process of induction or reasoning independent of observation." He repeats, again and again, " usque and nauseam," that " the feeling has been almost universal, and it still continues so, that the scveeral classes of phenomena and relationships constituting medical science, are somehow so allied to each other, that a knowledge of one class may be, to a greater or less extent, deduced from a knowledge of the other classes. The prevalent idea is, that this connexion between the different branches of medical science is of such a character, that a knowledge of one branch may lead, by some deductive process, as it is called, to a knowledge of other branches. We are constantly told, for instance, that physiology is founded upon anatomy; that pathology is founded upon physiology; that therapeutics is to be deduced from pathology, and so on." He then proceeds to the details, which he supposes demonstrate the incorrectness of these views of medical science; and he first asserts, that "our knowledge of anatomy is not dependent upon our knowledge of other branches of medical science; and that our knowledge of one branch of anatomy does not include the knowledge of any other branch." Who is it controverts these positions T Who is it denies that our knowledge of anatomy is to be obtained in the dissecting-room, by the diligent use of the knife and forceps'! Not only so, but since the discovery and description of all that these instruments, directed by the naked eye, can show, the microscope has been brought to our aid, and in a short time we will be in possession of all the knowledge to be gained by this means. Again, who has affirmed that any amount "of knowledge of the conformation of the brain, will make us acquainted with the conformation of the liver V Such preposterous suppositions are idle and ridiculous. No such absurdity has been perpetrated by any anatomist.
In the next place, we are informed, that "our knowledge of physiology is not deducible from our knowledge of anatomy." It has never been held that all our knowledge of physiology is thus obtained; otherwise, the thousands of experiments upon living animals, of Magendie and others, would be altogether nugatory. But that a portion of it has been obtained, even our author is obliged to admit. He, however, attempts to explain away these cases, and says, " they can hardly be regarded as an exception to the doctrine which I wish to set forth." His mode of doing this, affords one of the best examples of superficial thinking and inconclusive reasoning, it has been our fortune to meet with. He refers these cases to the "doctrine of final causes, or the great principle of the adaptation of means to ends." He instances the circulation of the blood, which was deduced from the anatomy of the heart and blood-vessels. This, no doubt, is an admirable example of the adaptation of means to ends, and also of the physiology being derived from the anatomy. But does not this doctrine of final causes equally apply to all
the established facts of physiology, however great may have been the difficulty of their discovery! Look at the grand discovery of Sir Charles Bell, of two different sets of nerves, the one for motion, the other for sensation. A large number of experiments had to be performed, to make certain these important facts; and can there be a more beautiful illustration of the doctrine of final causes \ For ages, physicians were puzzled to explain the cases of paralysis of motion, without the sensibility of the parts being disturbed. Now we know that one set of nerves may be affected, while the integrity of the other is preserved. So of the brilliant discovery of Doctor Marshal Hall, of the reflex function of the excito-motory system of nerves. Why it was, that the function of respiration was continued during the unconscious state of sleep, while volition has so great a control over it in the waking state, was a problem which was not satisfactorily solved, until Doctor Hall proved that there is a set of nerves passing from the lungs to the medulla oblongata, and back to the muscles of respiration, the afferent branches of which are constantly stimulated by the venous blood in the lungs, and transmit impressions to the medulla oblongata; while the efferent, or those passing from that body to the muscles of respiration, supply them with motory power, and excite them to action. This is altogether independent of volition, which acts in the waking state, by means of its appropriate nerves; and this is the manner of supporting respiration, a function essential to life, which cannot be suspended for even a few minutes, without death being the consequence, during the insensibility of apoplexy and epilepsy, as well as in the unconsciousness of sleep. I might thus go over the whole of ascertained physiology, and show the application of the doctrine of final causes to each particular function of the bodv. How could it be otherwise, when Infinite Wisdom designed it all! It is, therefore, evident, that part of our physiology is deduced from anatomy; of which the course of the lymph in the lymphatic vessels presents another example; and it is equally plain, that our author's efforts to get over these cases of opposition to his dogma, serve only to involve him in greater absurdity.
The next statement of our author is, thafpa-thology is not founded upon physiology. The latter is not the basis of the former. The one does not flow from the other. Our knowledge tf the one, docs not presuppose our knowledge of the other." These assertions are so directly opposed to the common doctrine upon this subject, that it becomes necessary to show their truth and soundness, by a somewhat full development and illustration. "His function," he informs us, "is not only to speak the truth, but also, and especially, to make this truth felt and believed." Here again we inquire, who is it says that pathology is founded upon physiology ! We venture to assert, notwithstanding the air of originality and profundity with which this long chapter is imbued, that it consists entirely of the merest truisms; and that there is not a well educated physician to be found, who does not think precisely as the author says he ought to think and believe. No one asserts, that, from a knowledge of the normal action of the capillary arteries and veins, we would presuppose their liability to inflammation. No one asserts, that, by being aware of the readiness with which inflammation attacks one organ or tissue, we can infer the susceptibility of other organs or tissues to this morbid condition. Neither does any one assert, that an acquaintance with the progress and termination of inflammation in one organ or tissue, gives us information of the mode of progress and termination in others. All these, and numerous other monstrous suppositions, are the figments of a riotous imagination. If this charge was true, we could not instance the suffering and death of many of the most distinguished members of the profession, in their zealous prosecution of morbid anatomy and pathology. Can the author be acquainted with the labors of Louis and Andral, of Carswell and Bright, and scores of others, in nearly every part of Europe; to say nothing of our own countrymen, who have acquired celebrity in this field of inquiry? In order to investigate the pathological condition of the different parts of the organism, it is essential that we first know what is the healthful or physiological condition. Having ascertained this, we are prepared to observe deviations from it, and to decide upon the nature of the lesions which caused the morbid appearances. So a knowledge of normal anatomy is indispensable to qualify us for pointing out what is anormal. All this the author admits. But he, nevertheless, reiterates, time after time, that the common doctrine is, to infer the pathology from a knowledge of the physiology. This, we say, is a false charge brought against his brethren, for which he merits the sharpest rebuke. To expose all the weakness, common-place, and incorrect averments of this chapter, would require as many pages as the chapter itself contains. The seventh chapter is likewise devoted to proving what no one denies, as far as we know, viz : that "our knowledge of the causes of disease, is the exclusive result of observation."
The eighth chapter is more open to objections, than all which have preceded it. He here asserts, that " therapeutics are not deducible from pathology;" and avows himself as a member of the ancient school of the empirics, as contra-distinguished from that of the rationalists. He now quotes physicians of character, to show that the doctrine which he assails is held by them; and he proves that he is not, as is his habit, setting up a man of straw for the pleasure of demolishing him.
The empirical school bases its therapeutics, or
employment of remedies to cure diseases, solely upon experience. They try a medicine, and if it does not relieve the patient, or makes him worse, they try another; and repeat this process, either until they discover something which is beneficial, or the patient dies under the experiments. The rationalist school says, endeavor to ascertain the cause of the disease, and the mode of its action; and whether it affects the entire system equally, or some one organ more especially. If the latter, find out, by a post-mortem examination of those who die, what alteration from the normal structure, has been produced by the disease; and always adapt your remedies to the new action which has been superinduced.
To show the superiority of the method of the rationalists, over that revived and recommended by this author, let us examine a few diseases, and see what inference, as to their treatment, can be deduced from a knowledge of their pathology. Whatever .theory of inflammation we may adopt, as to the condition of the vessels of the inflamed part, whether that of increased or diminished action, it is manifest, that the febrile excitement of the heart is the morbid state, which chiefly demands our attention. If we can, in any manner, lessen the force with which it propels the blood into the inflamed part, we give immediate relief. Bloodletting and tartarised antimony, if nothing contraindicates, are the appropriate remedies for this purpose. Dysentery is now known to be an inflammation of the larger bowels. Aware of this, our remedies can easily be made to suit such a state of things. To cure tetanus, every possible variety of treatment has been tried; and the empirical plan of our author, has been fully carried out, in relation to this dreadful disease. Some recovered; a great many were killed. When the warm bath did not relieve and cure, the cold was prescribed, and the patient was taken out dead. Now that we know the seat of the disease to be the spinal marrow, and that it is irritation and inflammation, one or both, of that organ, we can direct our treatment to the seat and nature of the disease; and at least do no harm. Delirium tremens presents itself to our notice under two different aspects, viz: one from the discontinuance of the accustomed stimulus in the old drunkard; the other, from the drinking of a large quantity of liquor, in a short time, by those unused to it. Morbid anatomy and pathology point to the brain as the part chiefly affected, and teach us, that, in the former, we should stimulate the patient, and, in the latter, depress action, and allay irritation, by the employment of tartarised antimony and opium. It is not a valid argument against these views, although employed by our author, with his ordinary tact for confounding things essentially different, that a large number of mild cases recover, if left very much to the unassisted efforts of nature. Violent attacks, in the persons of old drunkards, and also of those who occasionally drink hard, will not be removed, without the use of the proper remedies. Acute laryngitis in the adult, and croup in the child, are diseases which, in their symptoms, bear a close resemblance; but morbid anatomy and pathology designate a material difference, which makes the employment of emetics highly pernicious in the former, and extremely beneficial in the latter.
We might thus go over the whole catalogue of diseases to which the human system is liable, and show that, in proportion as our pathology is certain, our therapeutics are precise and successful. Of the pathology of many diseases, we as yet know but little. The changes produced in the blood, during the progress of a fever, are, to a great extent, concealed from our view; and in consequence, our practice, as far as that fluid is concerned, is as empirical, as our author could desire. Doctor Stevens has endeavored to prove, that, in some cases, the loss of a considerable portion of the saline ingredients, is one of the prominent morbid conditions; and bi-carbonate of soda, and chlorate of potash, are thought, by him and others, to be indicated. Andral has made numerous observations on the state of the blood, in various diseases, and has obtained some valuable results. Much, however, remains to be discovered. When the time arrives, at which we shall have made out the diversified pathological changes of this important portion of the organism, not only in fever, but in all other diseases, we can prescribe for them with a rational prospect of doing good, instead of administering potent medicines, under the guidance of a blind empiricism.
The thought that this doctrine of the ancient empirics, is adopted and acted upon, by any physician having charge of the health and life of his fellow-creatures, is calculated to excite melancholy reflections; but it is still more lamentable to find, that such a dangerous principle is promulgated by a teacher of medicine in one of our most ancient schools; from which a number of young men go out annually, believing the doctrines inculcated by their instructors to be preferable to all others; and resolved to apply them in practice, without a doubt as to the successful issue.
We have already remarked, that mathematical demonstration has been applied with the most happy effects, by means of the infinitesimal analysis, to the higher astronomy. Medicine not being one of the exact sciences, never has been, and probably never will be benefitted by this method of proof. This is the source of much of the discrepancy observed in medical writings. When we remember, too, the infinitely diversified circumstances, in which disease is presented to our observation, and the difficulty of discriminating true facts from false ones, it is not at all surprising that
there is still room for vast improvement in medical science. This, however, we affirm, cannot justly be attributed to any want of industry and zeal, on the part of physicians; or to the adoption of a false method of philosophizing. It arises from obstacles, almost, or altogether, insuperable, in the science itself; and perhaps inseparable from it.
The reader, it is presumed, will now be able to form a sufficiently accurate opinion of the character of this " essay." A disposition to see nothing good or beautiful, over the wide domain of both physical and medical science—to show that he, the author, alone possesses the true secret of scientific investigation—and that, when he dies, wisdom will perish with him;—in a word, to e«lt himself, at the expense of the whole scientific world, is manifest throughout the work. Nothing can be more reprehensible, than the spirit in which the book has been composed. Instead of furnishing us with new facts, the result of his own diligent inquiries and untiring industry; and with new principles, or theories, founded on them, by a cautious induction, he does nothing but find fault with the labors of other men; and attempts to prove them all barren and unprofitable. It is a safe rule of conduct, and we commend it to the notice of our author, that if we accomplish but little ourselves, let us not undervalue the efforts of others.
SAMUEL ANNAN, M. D. Professor of General Pathology, and of the Special Pathology and Treatment of Diseases of the Chest, in the Washington University of Baltimore.
THE OLD OAK TREE.
Yon Old Oak Tree, that to the sky Flingeth his crooked branches high, Hath blasted been by the lightning's stroke, And withered now is that brave Old Oak: Nor might ye dream of the fate he met, For all alive seems the old Tree yet. The robe he wears he hath worn before, When his arms were stout and mailed o'er; And velvet leaves of the vine are seen Wrapping him 'round, with a mantle green. The Blue-birds whistle right merrily Around their nests, in that aged tree; And often do maidens young and fair Mingle in many a pastime there;— While he proudly stands as once he stood, Braving the storm as a warrior should, Daring the winds with a stubborn will— S haltered and scarred, but unconquered still'
Oh, long may'st thou stand, old riven tree That I played beneath in infancy!
I have slumbered oft in the grateful shade
Thv waving branches at noontide made;
And I've dreampt, as the low wind murmured there,
That some spirit was whispering in. the air,
While peacefully I sank to rest,
Cradled on my mother's breast.
My sisters have brought sweet flowers there,
And playfully wreathed them in their hair;
And I've listen'd there to the soft low tone
Of whispered love from a winning one,
Till my heart, like thy leaves by zephyrs stirred,
Was trembling with joy at every word.
Long may'at thou stand, in the garb of green,
That hiding thy blackened trunk is seen!
E'en tho' thou'rt like a face that*s clad
In wreathed smiles, when the heart is sad;
Yet, long may'st thou stand, old riven Tree,
That I played beneath in infancy!
Lino. Memphis, Tennessee.
REMINISCENCES OF ITALY.
"What a delightful day for roving!" I exclaimed, on opening mine eyes, one brilliant morning, and beholding the golden sun-beams illuminating our pleasant room. "Awake, awake, Ismelda, my sweet companion, and let's be going." We were quickly dressed and on our way, with a party of friends, to the Villa, Doria-Pamphili. Oh, the exhilarating month of October! how we enjoyed our walk and greeted with lightsome hearts the flowers and breezes, which regaled us at every step. (Breezes which re-galed us—a tolerable pun—but really I did not intend to make one.) We soon reached the Villa, for it is but three-fourths of a mile from Rome. Its grounds are extensive and magnificent, and peculiarly interesting from the numbers of ancient tombs, inscriptions and statues scattered about—above all, from some excavated catacombs within its precincts. Surrounding every apartment of these catacombs, are rows of small arches, each of which encloses a cinerary urn in a perfect state, although centuries have elapsed since it was deposited in its sombre niche. As we surveyed these memorial antiquities, that solemn fiat— "Dust thou art, and to dust thou shalt return," came forcibly to mind, for here the Good, the Biave, the Beautiful, the Proud, the Wicked, redoced to heaps of earth, painfully illustrate its power and truth. I thought, too, of the probable struggles of many of them, for that alluring and deceiving meteor, worldly Fame! What availed their efforts 1 Here, unknown, repose their ashes, *'hile their virtues, or their crimes, their very names, like their frail bodies, are buried in oblivion. Happy those, whose wishes soared beyond these
mortal scenes, and sought a surer friend in Heaven! My ruminations were interrupted by a summons to share the rural breakfast of fruit, milk and biscuit, with which we had provided ourselves. On this luxurious domain are artificial cascades and grottoes, fountains of every description, an Amphitheatre and a superb lake. Seated on its borders, we partook of our repast, and in defiance of sentiment and romance, did it ample justice,—thanks to our early promenade and Italian zephyrs! Vegetation prospers long in so bland a climate; and on that 9th of October, 1827, we rambled through verdant thickets and tripped over turf enamelled with flowers! While we were in the Amphitheatre, an old man, who acted as cicerone, slipped unperceived by us into a closet behind a marble figure, representing a shepherd blowing his flute, and turned a wheel; immediately, (as if the statue of Memnon had been transported from Egypt,) dulcet sounds issued from that before us, accompanied by the murmur of a hundred little water-spouts which. sprung from the ground like magic, played while the music continued, and with it, gradually melted away. Among the various inhabitants of the poultry yard were snow-white pea-fowls. They were not comparable in beauty of plumage to those of the usual colors, but they strutted about with quite as much vanity. Two buildings, in the form of a miniature temple and tower, afford shelter to them and their feathery companions when necessary. The interior of the Villa does not correspond with the decorations without. We were surprised at its plainness; its coarse brick floors and faded, ordinary furniture. Some ancient chandeliers, however, were remarkable ; and we admired several of its numerous old paintings and mutilated statues. From the roof, we enjoyed a fine view of Rome and its environs, and quite feasted our eyes upon an adjoining grove of stately pines :—they told of "dear native home." The Villa occupies the site of the Emperor Galba's gardens, and was constructed in the lfith century, for Prince Pamphili, by Alexander Algardi, a distinguished architect and sculptor of Bologna.
The present princess, Doria, is a beautiful creature, of majestic mien, and noted for her charity and religious zeal. During the celebration of the Holy week, we witnessed the washing of the pilgrims in the establishment appropriated to the females, and there we saw her bending over a pail of water and bathing the feet of an aged crone, with the humility of a Magdalen. She is exceedingly popular, and proves how lovely piety is in woman. It is carried to superstitious excess by both sexes in Italy. Shrines dedicated to the Virgin Mary adorn every road-side, and are seldom destitute of votaries kneeling before them, •' telling their beads" and imploring her protection and favor, to conciliate which and to evince their devotion, even the poverty-stricken will spend their