fit
,TT.
\
THE ASCLEPIAD.
aiBoofcof flDriginai iResearcb anD Dbgertmtion
SCIENCE, ART, AND LITERATURE OF MEDICINE,
PREVENTIVE AND CURATIVE.
1887.
IBenjamm fcfflarn iRicfmr&son,
VOLUME IV.
TEEAR DUM PEOSIM.
\
liontion :
LONGMANS, GREEN, AND COMPANY,
PATERNOSTEJR ROW.
P. BLAKISTON, SON, & CO., PHILADELPHIA, U.S.A.
CUPPLES, UPHAM, & CO., BOSTON, U.S.A.
Printed by Hazell, Watson, & Viney, Ld., London and Ayteabury
IN SINCEREST ADMIRATION
OF THE GREATEST LIVING SCHOLAR OF VICTORIAN MEDICINE,
AND OF A PHYSICIAN
WHOSE VIRTUES EQUAL HIS LEARNING,
WILLIAM ALEXANDER GREENHILL, M.D. OXON.,
(OF HASTINGS, SUSSEX,)
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS,
HOMO MULTARUM LITERARUM,
THIS FOURTH VOLUME OF THE ASCLEPIAD
IS INSCRIBED.
PREFACE
TO THE FOURTH VOLUME OF" THE ASCLEPIAD."
TN this volume of THE ASCLEPIAD, published during
an exceptional year, an exceptional variation has
been introduced in one part, that, namely, which has
been devoted to a review of medicine in the Victorian
era. The numerous congratulations received in regard
to this innovation may tempt me, on fitting occasions
in the future, again to devote one whole number to
some one particular subject.
BENJAMIN WARD EICHAEDSON.
25, MANCHESTER SQUARE, LONDON, W.
October 3l$t, 1887.
CONTENTS.
PAGE
ON PURPURA ILEMORRHAGICA AND THE SCORBUTIC DIATHESIS,
INCLUDING STIGMATA. DIAGNOSIS AND TREATMENT . . 1
NATURAL SELECTION FOR SCIENCE AND ART ..... 22
OPUSCULA PRACTICA 46, 132, 349
MAYOW, JOHN, M.D., LL.D., A NEGLECTED GENIUS (with
Portrait) .......... 55
ON OXYGEN IN VITAL PHENOMENA . . . . . . 71
PRACTICAL BIOMETRY, OR THE MEASUREMENT OF LIFE IN HEALTH
AND DISEASE ......... 80
ARBUTHNOTT, JOHN, M.D., F.R.S., THE MEDICAL SCHOLAR (with
Portrait) 142
COTEMPORARY PRACTICE AND LITERATURE ... 94, 194, 391
ON THE PHENOMENA OF PALPITATION WITH OR WITHOUT INTER-
MITTENCY OF THE HEART AND CIRCULATION. . . .101
ON WINTER PALACES OF HEALTH AND CAMPS OF HEALTH AT
HOME. A PRACTICAL IDEAL . . . . . .120
VITALISING AND DEVITALISING OXYGENS . . . . .172
PRACTICAL BIOMETRY, OR THE MEASUREMENT OF LIFE IN HEALTH
AND DISEASE. PART II 186-
MEDICINE UNDER QUEEN VICTORIA. AN EPITOME OF THE GREAT
ADVANCEMENTS IN PRACTICAL MEDICINE, PREVENTIVE AND
CURATIVE, BY THE VICTORIAN FACULTY OF PHYSIC THROUGH-
OUT THE EMPIRE . 201
Vlll ILLUSTKATIONS.
PA&K
SNOW, JOHN, M.D., A REPRESENTATIVE OF MEDICAL SCIENCE AND
ART OF THE VICTORIAN ERA (with Portrait] . . . 274
CLINICAL HISTORY OF SCARLET FEVER 339
THE PHYSIOLOGY OF GOOD AND EVIL . . . . . .341
BROWN, JOHN, M.D., AND THE BRUNONIAN SYSTEM (with Portrait] 357
ON ACTIVE OXYGEN IN VITAL PHENOMENA
ILLUSTRATIONS.
PAGE
MAYOW, JOHN, M.D., LL.D Portrait facing 55
ARBUTHNOTT, JOHN, M.D., F.R.S. . 142
SPHYGMOGRAPHIC READINGS 104 to 111
GARTH, POPE, AND HOGARTH . . . Portraits facing 156
OXYGEN RESERVOIRS ....... Facing 179
SNOW, JOHN, M.D Portrait facing 274
BROWN, JOHN ,,357
OXYGEN RESERVOIRS Facing 179
NORRIS, WILLIAM, AN INSANE AMERICAN . . . 205
ON PUEPURA H^MORRHAGICA AND THE
SCORE UTIC DIA THESIS, INCL UDING
STIGMATA. DIAGNOSIS AND TREAT-
MENT.
the course of the development of medical
science it has naturally happened, in many
instances, that certain allied diseases, differing
in some degree as to pathological condition,
have become classified under one term. Measles and
scarlet fever were for centuries considered as one and the
same disease ; nor was the error detected until Morton,
the contemporary of Sydenham, drew the distinction
between the two maladies, and gave to them distinct
names. In the study of scarlet fever itself, the non-
contagious malady rosalia idiopatJiica was classified, even
to our own time, with the true contagious scarlet fever.
And, again, typhus and typhoid fevers were confounded
together until, also in our time, they were shown to be
two perfectly distinct affections.
In the practical discourse I am about to offer, my
object will be to show that, under the head " Purpura
Hcemorrhagica" which the people commonly place under
the general term " Scurvy or Scorbutic Disease" we may
include what may fairly be considered three very different
pathological states, and, in a word, different diseases ;
VOL. iv. 1
2 ON PUBPUBA H.EMORRHAGICA
all of them presenting, it is true, allied phenomena, but
each one definitively distinct when it is known: each
having a distinct pathology, etiology, diagnosis, and
prognosis ; and, each requiring a distinct treatment.
TYPES OF PTJRPURA.
So far it has been the prevailing idea that a fluid condi-
tion of the blood is the one distinguishing character of the
maladies under consideration. Hence, when we have seen
purpuric spots on the body of the patient, our first care
has been to provide, both by local and general measures,
against haemorrhage ; and our fear has been that from
some local external injury, or from some internal break of
continuity of structure, there may be escape of blood, and
death from persistent flow.
For many years past I have had before me cases of
disease thus identified, and commonly recognised as one
typical form of disease. My present object is to show
that under such identification there are three perfectly
distinct types of disease. I designate these types as :
(1) The Aqueous ; (2) The Saline ; (3) The Vascular.
AQUEOUS PURPURA.
The pathological character of this type is special. The
blood of the patients who are subject to it is in a state of
extreme fluidity, the fluidity being due to an excess of
water, so that the colloidal parts of the blood, and also the
saline parts, are diluted to an unnatural degree. I do not
know of any proof that in these cases there is an actual
deficiency of fibrine. If there were, the muscular struc-
ture of the patient would probably undergo some modifi-
cation a condition by no means necessary, since the
disease may be seen in persons whose muscular develop-
ment and muscular power is good, if not actually perfect.
AND THE SCORBUTIC DIATHESIS. 6
But in the blood the relative natural proportion of water
to the colloided matter is disturbed; the water is in excess,
the cohesive attraction between the particles of the colloid
is reduced, and the blood, imperfectly protected by the
plastic fibrine, is ready at any weak point to escape, to run
from the vessels in fine stream, or to diffuse, in the form
of purpuric blot, into the peripheral surfaces of vascular
organs or on the surfaces of membranes.
In some experiments I once conducted on the produc-
tion of artificial dropsy by the injection of water into the
peritoneal cavity of an animal, such fluidity of blood, by
mere dilution of water, was induced in every case ; the
addition of water to the amount of one-fifth of the weight
of the animal causing a fatal dilution. The blood in these
instances was rendered feebly coagulable, or even non-
coagulable ; it flowed with rapidity and continuance from
a wound, and it was easily effused under the skin.
In the human subject suffering from aqueous purpura
the same condition obtains. In one instance, in which
the purpuric state was connected with serous dropsy,
I caught a few ounces of blood flowing from a vein
of the patient. The blood had a specific gravity of
1,035, or only 25 above the specific gravity of the
urinary secretion of the same patient. The blood yielded
no clots on agitation ; the corpuscles were large, pale,
and globular ; the amount of water was increased to 860
parts in 1,000, while the fibrine was reduced, relatively, to
1 part in 2,000.
The eruption which accompanies most cases of aqueous
purpura is in some cases not developed at all, although
the conditions for its manifestation are strongly present.
The patient knows that his blood will flow with dangerous
freedom if he prick or cut himself, and he will tell you of
members of his family who are scorbutic and bleed in a
4 ON PURPUBA H.EMOBBHAGICA
similar way ; but he may not have any eruption, and may
pass through life suffering only what is called the scorbutic
diathesis. The reason of this is that the colouring matter
of the blood is retained by the red corpuscles, and that
the fibrine is equally diffused through the volume of blood.
The blood consequently makes its course freely until some
other factor intervenes. A prick, a slight blow, may be
all-sufficient for this purpose, or even pressure induced by
the dress. I had one patient in whom a sudden exposure
to cold would bring out the characteristic purpuric erup-
tion. In these cases, if the skin be frozen in a small point
by ether spray, the purpuric spot will follow ; and I have
found this a valuable mode of diagnosis in the obscurer
forms of the disease.
The eruption is easily developed by other causes in
those who, from the condition of their blood, are prepared
for it. Excess of alcohol or excessive mental or physical
fatigue will induce it. The character of the eruption
when it occurs is distinctive it is diffuse, irregular, and
faint. It partakes of the character of a superficial bruise,
and it passes through the phases of colour presented by
an ordinary bruise, but is unattended by swelling.
What has struck me often is the immunity with which
persons affected by aqueous purpura go through life.
They sometimes carry with them exceeding good looks ;
they are fairly strong; and, they are usually well nourished.
If they suffer from great loss of blood, they recover rapidly
when the bleeding has been checked, and even regain
colour. I doubt, however, whether, in true examples of
this disease, the blood ever becomes of natural quality.
The remote origin of this example of purpura from
extreme fluidity of the blood will, I believe, be ultimately
found to be central and nervous. It is among the most
marked diseases of the hereditary type, and the hereditary
AND THE SCORBUTIC DIATHESIS. 5
quality of the malady is generally diffused through a
number of members of a family to an extent specially
striking. I was called a few years since to arrest hemor-
rhage after a tooth-extraction in one of these subjects,
and I found that four members of the family had suffered
from aqueous purpura. One had died from loss of blood
from a leech-bite ; another had marked purpuric erup-
tion ; two had suffered haemorrhage from the gums, and
had shown purpuric spots ; and my patient all but died from
the escape of blood which was practically uncoagulable,
until syncope, from actual loss of blood, supervened. In
two cases which have come before me in which no decided
hereditary tendency could be discovered, the patients in
both cases adults attributed their disease to mental
causes, that is, to causes acting intensely on the mind.
One attributed the disease to a severe fright occurring
during childhood ; the other to sudden and excessive
grief. I believe both were correct in their surmise,
because they based it on clear and reasonable evidence
of facts. But how the blood can be physically modified
by mental shock I do not assume to know.
SALINE PURPUBA.
The second form of purpura to which I would direct
attention I designate as Saline Purpura. In this type of
the disease there is no deficiency of fibrine in the blood,
but as a colloidal substance it is held in a state of undue
solution by an excess of soluble saline material. The
synthesis of this disease was well brought out in some of
my early experiments, in which the blood was rendered
preternaturally fluid by the administration of alkaline
salts. The distinguished Huxham observed a similar
condition in the human subject, in the case of a man
who habituated himself to the taking of bicarbonate of
6 ON PURPURA H.EMOBEHAGICA
ammonia until his blood became permanently fluid. The
same condition has, again, been observed on a large scale
in the scurvy produced by too long a subsistence on
foods preserved by salt, and especially when under such
foods the body has been exposed to extreme cold, as in
Arctic explorations. The same condition may be observed
in certain advanced stages of alcoholic disease. Very
soon after the introduction of chloral into medical prac-
tice and its use by the chloral habitues, I met with a case
of purpuric chloral eruption, a saline purpura caused, as
was easily foreseen, by the accumulation in the blood of
the sodium formate resulting from the decomposition of
the chloral in the body. I have now seen four instances
of saline purpura so induced.
In these cases the specific gravity of the blood is in-
creased, and the attraction of cohesion in the fibrine is
suspended by the presence of an agent which holds the
water in too close combination with colloidal matter. In
this condition the fibrine, the albumen, and the colouring
matter of the blood all diffuse through the membranes,
and the exudation of blood at feebly resistant surfaces is
easily effected ; hence the bleeding spongy gum in well-
marked illustrative forms of this malady. Persons suffer-
ing under saline purpura are the true scorbutics of the
older school of physic. They supplied the patients whose
blood, when our forefathers drew it, as they usually did,
was seen to separate, while it was flowing, into fibrine
and serum, as fibrine separates when we precipitate the
corpuscles by adding a saline solution to blood newly
drawn.
There is in this form of purpuric disease no necessary
evidence of hereditary tendency. On the contrary, the
malady is usually caused by error of diet or toxic habit.
The eruption when it occurs in saline purpura is
AND THE SCORBUTIC DIATHESIS. 7
more sharply defined as a spot, macula, than in aqueous
purpura. It is not induced by an injury, but breaks out
spontaneously. Often there is no eruption; but there is
always a tendency to exudation of blood from the gum,
from the throat, and, occasionally, from the lung.
VASCULAR PURPURA.
In the third form of purpura, which I have designated
vascular purpura, there is always either an eruption, or
so marked a disposition to eruption that the smallest
physical accident will induce the purpuric spot. The spot
in this instance is more than a mere discoloration, it is
a large blot; and with the discoloration, which is deep
coloured, there is swelling, and after a time firmness of
structure at the point of the swelling. The subjects of
vascular purpura are usually well nourished, and are not
necessarily disposed to the malady from hereditary pro-
clivity. They are commonly young persons, children in
their first years. They are disposed to be fat, and if they
are carefully inspected while undressed they are found to
present some deformity of body more or less marked. The
spine will show a slight curvature, or a lower limb will be
somewhat distorted, or the chest will be badly developed
and misshapen. The blood in these examples of purpuric
affection may be, as far as I can detect, perfectly natural.
There is no history that these subjects have suffered from
haemorrhage of any kind, although they are held to 'be
in perpetual danger of this occurrence. If a little blood
be drawn from them for examination it is found to
coagulate quickly and firmly. The colour of the blood
is natural, and the corpuscles are of natural size and
outline ; in fact, the very character of the purpuric blotch
is proof of the plasticity of the blood. The effused blood
thrown out into the subcutaneous tissue undergoes
8 ON PURPURA H2EMORRHAGICA
coagulation there, whence the cause of the hardness and
swelling of the eruptive blotch. There is, in fact, no
definable disease of the blood.
The origin of this form of purpura I attribute to some
change in the vessels of the minute circulation. Either
the minute vessels are paralysed, or there is some de-
generation of structure in them, so that under slight
mechanical pressure they permit the blood to flow through
them into the surrounding tissue. In an essay published
in 1874, I suggested that the failure of the minute
vessels to retain their blood under slight mechanical
blow or quick pressure, is due to structural change
rather than to nervous deficiency. But I spoke sub
fudice, and rather as proposing a new and very interest-
ing subject for future observation, than as offering any
decided opinion of my own on this particular point. The
reasons I had for the view were that in the subjects of the
type of purpuric disease now being described there was
no necessary attendant symptom of vascular paralysis,
while the paralysing effects of extreme cold, from the
action of ether spray, did not lead to the eruption from
effusion of blood. I looked upon it, therefore, that when
the effusion actually did take place there was mechanical
rupture of the minute vessels, and that the subcutaneous
haemorrhage lasted until, by the process of coagulation of
the blood, the exudation was arrested.
Some experimental researches on the influence of the
prolonged action of Amyl Nitrite which I conducted in the
year 1870-1, and reported to the British Association for
the Advancement of Science at its Edinburgh meeting in
1871, have on re-perusal suggested some very important
reflections leading to a modification of my original idea.
I shall refer to these experiments in a future number
of the ASCLEPIAD, but I notice them now in order to
AND THE SCOEBUTIC DIATHESIS. 9
state, in a few lines, that I found it possible to modify
the pulmonary circulation at will, by modifying the
nervous tension, through inhalation of the vapour of the
nitrite, with such nicety as to produce : (a) pallor of
the pulmonary structures ; (6) congestion ; or (c) haemor-
rhage into the parenchyma, so distinctly, as to charge the
lung tissue throughout with what might fairly be called
purpuric or hasmorrhagic blotches.
These researches help, it may be, to elucidate most
usefully the early stages of pulmonary disease from nervous
failure. They throw, indeed, a powerful and guiding light
on the first stages of what is, perhaps, the most ordinary
type of phthisis pulmonalis. But they bear also on this
subject of vascular purpura. They show that when the
nervous control over the extreme arterial circulation is
reduced, the exudation of blood or local haemorrhage is
one of the most marked succeeding phenomena.
It may, therefore, be the fact that in vascular purpura
the local haemorrhage is the result of local arterial in-
nervation. At the same time, I am still obliged to repeat
what I said twelve years ago, because all succeeding
observation has sustained the statement, that in the
history of vascular purpura there is no necessary history
of hsemorrhage, no necessary history of hereditary dis-
position. The subjects of the disease are usually young,
and, well nourished ; they have a tendency to grow fat ;
and they have, usually, some marked sign of imperfect
development of the skeleton. Their blood is plastic, but,
owing to inherent weakness of its containing vessels at
their peripheral extremities, it escapes on slight cause.
The blood is healthy : it coagulates naturally, and its cor-
puscles are of correct size and form. The eruption of blood
is like an ordinary bruise ; it is prominent, is attended
with swelling, and becomes hard as the serum is
10 ON PURPUEA H2EMOERHAGICA
absorbed from the coagulated fibrine. Extreme cold does
not bring out the eruption, nor, indeed, anything save a
mechanical injury; and a small open wound, though it
may bleed longer than is natural, ceases to bleed owing
to the coagulation of the blood.
ON COMBINATIONS OF TYPES, AND ON STIGMATA.
In the above descriptions I have related what seem to
me to be the three pure distinctive types of purpuric
disease. I have, however, seen combinations of types ;
and one of these combinations, namely, the first or aqueous
.with the third or vascular, calls for special notice. I
believe the combination to be very rare, but when it
does happen it gives rise to a series of most significant
phenomena. Two well-marked instances have occurred in
my practice.
A middle-aged lady was the subject of this form of the
malady. She had from her early life been liable to
haemorrhage from slight wounds, and to frequent attacks
of epistaxis. At the time of her visit to me she exhibited
a few purpuric spots of that diffuse and simple bruise-like
character which I have mentioned as belonging to aqueous
purpura. She had venous murmur, and the specific
gravity of the urine was low 1010. These symptoms
were all very characteristic, but there was added to them
another viz., that of exudation of thin blood, at different
periods, from some part of the skin, without any visible
wound or cause. She would wake in the morning to find
pale spots of blood on her pillow, or on the sheet ; and
one day, just before she visited me, she had found her
dinner napkin spotted with blood. The phenomenon, for
which she could not herself account, produced a serious
and painful impression on her mind, an impression of
surprises and intense fears. I was able to assure her that
AND THE SCORBUTIC DIATHESIS. 11
there was nothing mysterious or inexplainable in her case ;
and, from the description she gave me of the last escape
of blood, I was certain that the fluid had exuded from one
of her fingers. I examined carefully the tips of the
fingers without discovering the point. Then, with success,
I placed her hand before an opening in a screen upon
which was directed the light focussed from a magnesium
lamp. The light passed readily through the structure
of the fingers and hand, the parts being thin and delicate,
and on the inner side of the fourth finger of the right
hand I detected, near to the palm, a round and exceed-
ingly dark spot, about the size of a hemp-seed, and looking
like an enlarged vein. When this spot was examined
with a glass by ordinary light a minute opening was
detected, from which, under pressure, fluid blood exuded,
with tingling, produced by the pressure, along the limb up
to the elbow, in the course of the ulnar nerve. I touched
this point with styptic colloid, and put over it a compress
of cotton-wool and a tape bandage. On the following
visit the patient told me, with infinite satisfaction, that she
had noticed no more blood-stains, but that the tingling
from the pressure was acute. I thereupon removed the
compress, and found the cotton-wool stained with dry
blood. To effect a radical cure I froze the part with
ether spray, made a lancet puncture through the small
subcutaneous tumour, and plugged with cotton-wool
saturated with iodised colloid, reapplying the compress.
The result was all I could desire. The wound, from
which a little cheesy -like matter escaped, healed well ;
and under return of composure of mind and the
influence of medical treatment of which more shortly
a good recovery took place. The last I heard of this
lady was that the symptoms had not returned, and that
she was in good health.
12 ON PUBPUBA H^MOBBHAGICA
Throughout the history of medicine details of cases such
as this are scattered, often with wonder attached to
them. The illustrations that have been left to us of
bleeding from stigmata, and of so-called bloody sweat, are
of this nature. The patient is suffering from an unnatural
blood, and there is set up a local disease of the blood-
vessels at some small point in the peripheral surface.
What may be called a capillary or arteriole aneurism is
thus induced, which after a time opens by a minute aper-
ture through the skin. Then follows, under a little extra
pressure of blood, the sanguineous exudation. In patients
of this class, persons usually of excitable and nervous
character, the mere palpitation of the heart under a
mental impulse is sufficient to produce the transudation
of blood. Thus, in certain cases, the bleeding can be
brought under the influence of the will, and even by
trained mental action may be rendered automatic and
regular in respect to time. In the very patient whose
history I have given these events were to a large extent
realised. The haemorrhage would sometimes be induced
after a meal, but during sleep, at which time it was
expected, it came on with regularity. It occurred almost
immediately after going to sleep.
In another case in which I was called in for con-
sultation by a most excellent practitioner, Mr. Lord, of
Hampstead, a great number of purpuric spots were dis-
tributed over the body of the patient, also a woman of
middle age. The spots were of the size of millet seeds,
and they gave out very thin fluid blood under very
slight provocation. Whenever this patient, who was
extremely excitable and nervous, was exposed to any
cause that produced flushing of the skin followed by
perspiration, her body linen was stained of a rusty
reddish colour, evidently from some escape of colouring
AND THE SCORBUTIC DIATHESIS. 13
matter of the blood, with the exuded water from the skin.
The friends of the patient called this "bloody sweat,"
and it was the nearest approach to that phenomenon that
has come within my experience.
DIAGNOSIS, GENERAL AND DIFFERENTIAL.
Diagnosis of Aqueous Purpura.
In aqueous purpura there is a history of haemorrhage
of fluid blood, restrained with difficulty, and caused by
very slight wounds. There is a history either of here-
ditary disposition to the disease or of its induction by
some nervous shock or injury. The blood is very fluid
when taken from the body, and does not coagulate.
The corpuscles of the blood are large, and deficient in
central depression. The specific gravity of the blood is
low, and the specific gravity of the urine is low. The
eruption on the skin is not a persistent symptom, and
when it appears it consists of a diffused blotch resembling
a bruise, with neither swelling nor hardness. The erup-
tion is brought out by any cause that for a moment
paralyses the vascular tension. It is brought out readily
by extreme cold. The patients themselves are not, as a
result of the disease, in an emaciated or enfeebled con-
dition, and they do not bleed from open surfaces, except
when the vessels are divided. In other words, their blood
does not exude through closed vessels, but it easily flows
from a wounded point, as from a prick, or the suction of
a leech.
Venous murmur as a diagnostic sign. In these cases
the phenomenon of venous murmur, first observed and
explained by the late Dr. Ogier Ward, is a most valuable
diagnostic sign, and is strikingly differential of this type
of purpura from the third or vascular type.
14 ON PUBPURA H.EMORKHAGICA
The murmur is best detected over the external jugular
vein, on either side, and is easily known from subclavian
or other arterial murmur by its continuous character.
As Ward originally described it, it is like the " hum of a
bee." It is easily modified by the pressure of the stetho-
scope over the vein, and it can be stopped altogether by
so increasing the pressure as to stop the current. I have
met with no case of true aqueous purpura in which,
venous murmur has been absent, and the subsidence of
t is always the best indication of recovery. I doubt,
indeed, whether the blood can be in the fluid condition
which constitutes the aqueous purpuric state without the
presence of venous murmur.
In some instances a faint ansemic cardiac murmur may
accompany the purpuric state. But just as there may be
a loud anaemic cardiac murmur with no accompanying
venous murmur, so there may be a loud purpuric venous
murmur without a cardiac murmur. I have no explana-
tion to offer respecting the cause of this difference, and
until the whole subject of murmurs from and under
varying conditions of blood is experimentally tested, no
explanation worth anything is at hand. Fortunately the
practical fact is not impaired by this deficiency, and the
practical fact, generally, is : Venous murmur from pur-
puric ; Cardiac murmur from ancemic blood.
Diagnosis of Saline Purpura.
In saline purpura there is no necessary history of
hemorrhage of fluid blood, nor yet of hereditary dis-
position to such haemorrhage ; but there is always a
history of an induced morbid condition from error in
diet, exposure to some noxious agent, or disintegration
of blood from disease. The blood is fluid when taken
from the body, but from it fibrine separates, and the
AND THE SCORBUTIC DIATHESIS. 15
corpuscles are shrunken and crenated at their edge. The
specific gravity of the blood is high, and the specific
gravity of the urine follows the same rule. The tendency
of the blood in these cases is to exude from the soft spongy
surfaces, as from the gums ; and if an eruption present
itself, it is in the form of maculae or petechise. Trans-
udation of blood by the mucous secretions is not
an uncommon diagnostic fact of this type of purpura.
Venous murmur is also not uncommon as another point
of diagnosis.
Diagnosis of Vascular Purpura,
Vascular purpura is known from the other varieties
by the circumstance, specially, that the blood forms a
firm clot when it escapes by an open wound, and that
haemorrhage is thereby checked in the natural way. The
blotch produced by effusion of blood beneath the skin,
from a bruise, is raised, and is firm in its character.
There are no indications of venous murmur as in
aqueous purpura, nor any of sponginess of or bleed-
ing from the gums, as in the saline type of the
disease. The subjects of vascular purpura may be "ner-
vous people," so called ; may often be affected with
erythema fugax, suilden blushing and suffusion of the
face, with other signs of relaxed peripheral circulation
and neurasthenia ; but they may be otherwise fairly
conditioned, and, if not equal to any very severe bodily
or physical labour, may pass for persons of moderate
health and strength. They have commonly some chronic
defect in the osseous system, developed in early life.
TREATMENT.
I turn now to the consideration of a subject which,
of all others, is most important to us who are actively
16 ON PUKPUEA HJSMOBEHAGICA
engaged in the practice of healing ; I mean the treatment
of the different types of purpura to which attention has
been drawn. What I have gradually learned as to the
distinctive types of the disease has influenced me in
the most marked degree, and has, I believe, led to suc-
cessful results of treatment which I did not realize when
I was less clear as to the precise nature of the phenomena
which, in the different groups, came before me.
Treatment of Aqueous Purpura.
In aqueous purpura the treatment generally consists in
supplying the patients with a fair amount of fresh animal
food, in reducing to the smallest degree the amount of
water and watery fluids, in avoiding all alcoholic liquids,
and in keeping the fluid secretions in active operation.
A rather frequent purgation is of undoubted service,
and with this a ferruginous mixture may be happily
combined. I believe the best ferruginous medicine is a
combination of superphosphate of iron with peroxide
of hydrogen, as follows :
Syrup of Iron Superphosphate, 5188.
Solution of Hydrogen Peroxide (10 vols.), siss.
Pure Glycerine, ^iss.
Distilled water to 3yj.
Mix. To make a mixture of six ounces, of which let a twelfth part be
taken three times a day in a wine-glassful of water.
With this treatment plenty of out-door life should be
enjoined, and moderate exercise. All violent exercises,
such as football, fencing, boxing, and other pastimes,
which expose the body to physical blows and accidents,
should be forbidden.
When in this class of case haemorrhage occurs from a
wound, it is of first importance, while using local means
to arrest the flow of blood, to be sure to remember the
AND THE SCOKBUTIC DIATHESIS. 17
general condition and to connect general with local
measures. In the course of the last twenty years I have
been called in many cases to arrest what it was feared
would prove fatal haemorrhage coming on after the
extraction of a tooth, or an accidental cut on the skin,
and once after a leech bite. The uniform result of success
which has been obtained in these examples has been
largely due, I am conscious, to the circumstances that I
have kept the patients, even while the bleeding was
imperfectly staunched, well supplied with food, and have
administered dilute sulphuric acid in ten minim doses,
with water, frequently, as if treating for haemoptysis.
In the way of local treatment to the bleeding wound,
my experience is not in favour of the repeated applica-
tion of caustic styptics ; neither is it strongly in favour
of the actual cautery. The most troublesome and anxious
case I ever had, in fact, was one in which the per-
chloride of iron had been used, and had produced, not
a styptic, but a destructive action, with intense soreness
and unsoundness of tissue. It is to be remembered that
in these cases the blood is not coagulable, and that to
attempt to cure by causing coagulation is all but hopeless.
It is best, therefore, to trust to systematic pressure with
a plastic styptic, and I have found styptic colloid, on the
whole, by far the best application.
Treatment of Saline Purpura.
The treatment of saline purpura requires to be quite
different, in many details, from that for the aqueous
variety. In this purpuric or scorbutic state, water, which
had better be distilled, may be given freely ; animal
food may be supplied moderately, but salted foods must
be withheld altogether. Fresh fruits may be allowed, and
VOL. iv. 2
18 ON PURPUEA ILEMOKRHAGICA
lemon juice may be added to water as a daily drink,
unless the stomach should become deranged by either
of them. In my early days what was called Silvester's
anti-scorbutic drink was often ordered in cases of saline
purpura with good effect, and I sometimes still prescribe
it. The formula for it is :
Potasea Bitartrate, 5J SS -
Juniper berries, ^ij-
Powdered ginger, 5j-
Moist sugar, 5xxxij.
Pure water, C iij.
Mix. Boil gently for half an hour, then let cool and strain.
Of this solution in the fresh state, before it undergoes
active fermentation, half a pint to a pint may be taken
daily with food : it does away with the necessity of lime
or lemon juice, and when iron is required it carries well
the syrup of the superphospate of iron in drachm doses,
or the citrate of ammonia and iron, or the citrate of
quinine and iron, in doses of three to five grains.
Medicinally, dilute hydrochloric acid with hydrogen
peroxide is most useful. I prescribe it as follows :
Dilute Hydrochloric Acid, 5\j
Solution of Hydrogen Peroxide (10 vols.), ^iss.
Distilled water, to ^vj.
Mix. To make six fluid ounces, of which let a twelfth part be taken
two or three times a day in a wine-glassful of water.
To the spongy and bleeding surfaces of these patients,
caustic styptics, though they are often used, are, according
to my experience, injurious. They destroy structure,
create irritation, and do not, except for the briefest
possible time, arrest the exudation of blood. A tannin
styptic, with some deodorising substance added to it, and
nothing beats iodine, forms the surest and safest local
remedy. The annexed is a good formula :
AND THE SCORBUTIC DIATHESIS. 19
Pure Tannin, gr. xxx.
Distilled water, Ijiv.
Dissolve and filter. Then add :
Simple Tincture of Iodine, 5j.
Tincture of Myrrh, Jd'ss.
Mix. To be used as a wash for the mouth every night and morning
with water, and to be repeated when there is exudation of blood from
the gums.
In the saline purpura out-door exercise should also be
recommended, with the same precautions as above given
in respect to the treatment of the aqueous variety of the
disease.
Treatment of Vascular Purpura.
The treatment of the last or vascular type of purpura,
in which the diseased condition is in the vessels, and not
in the blood, introduces another and different series of
remedial measures. In these cases the idea of special
styptic applications is unnecessary, and attention has
mainly to be paid to such conditions as shall promise
either to give better tone to the nervous vascular supply,
or to be curative, if that be possible, of organic lesion of
the vessels of the minute circulation.
The patient in these cases must be well sustained with
plain wholesome mixed foods, less all alcoholic stimulants;
he must have plenty of fresh air, and must be subjected
as little as possible to undue fatigue.
It is in these cases that the administration of turpentine,
medicinally, is often of such signal service. In what
manner turpentine influences, physiologically, we have no
very correct knowledge ; but an inquiry which has, for
some time past, been most ably pursued by Dr. Crocker
will, I trust, before long explain its precise action. As a
remedy, however, I know it to be all but specific for
20 ON PUBPUEA H^IMOBRHAGICA
the particular type of purpura which is now under
consideration. With a little care in prescribing it, using
glycerine or common alcohol as a vehicle, it may be
combined with iron ; or it may be given in capsule. On
the whole, I think that for children glycerine carries it
best, and it is far better to administer it in small and
frequently repeated doses, such as three to five drops
three or four times a day, than in larger and more
nauseous doses at longer intervals.
In a few cases where there has been considerable feeble-
ness of body, and where the turpentine has interfered with
digestion, I have administered, with advantage, the syrup
of the superphosphate of quinine and iron. But I incline
most to the terebinthinate remedy, and should specially
welcome any pharmaceutical improvement that would
make so excellent a medicine more acceptable to those
who are benefited by it.
Twice in the course of my observations I have seen the
eruption of the vascular type of purpura coupled with
an outbreak of psoriasis. In these examples there is
probably some diseased condition of the minute vessels ;
and when the two eruptions occur together the admini-
stration of arsenic may be resorted to with advantage.
I have, however, not found arsenic of any specific value
in the simpler, I mean the uncomplicated purpuric
affection in any of its varieties.
I have already sketched out, incidentally, the local
treatment I should follow in cases where the aqueous
and the vascular types of purpura are combined. In
the first case that came under my care, where there
was external bleeding from stigmata, in addition to the
local plan of dividing the vascular bleeding spot and
plugging with iodised colloid, I treated generally by the
administration of the superphosphate of quinine, iron, and
AND THE SCOBBUTIC DIATHESIS. 21
strychnia, adding to that, for a few nights, an opiate, the
sleep having been much disturbed. This treatment, with
a frequent alterative, acted well, and I should see no
reason, in another and similar example, for instituting any
modification of it.
In the study thus presented it would have been easy to
have introduced many other facts and observations bear-
ing on the subject of purpura as a symptom of other
diseases. In such cases purpura assumes, probably, the
same varieties of types as have been described above, and
is indicative of one or other of the morbid states of blood
that have been under consideration. But I have pre-
ferred, in this essay, to take up the disease as it appears
before us in the form of a distinct malady uncomplicated
with any other disease, and called simply purpura, pur-
pura hsemorrhagica, or scorbutic affection, up to the
present era of medical and common nomenclature.
NATURAL SELECTION FOB SCIENCE
AND FOE ART*
HEEE is a prevailing idea that between science
and art a great gulf is fixed ; that the man
of science can never be an artist, that an
artist can never be a man of science.
I ask myself the question, Is there any ground for this
belief? I ask myself the question, shall I, called to this
most honourable task, for which I cannot be too appre-
ciative, of presiding here to-night, shall I, addressing
students of science and art, tell them they are students
between whom there is a wide gulf fixed ; or that they are
all one in work, intention of work, and ultimate result ?
The questions, both of them, are practical to the fullest
degree. If there are in these highest spheres of human
labour two distinct spheres, then there are two distinct
sets of men for the habitation of the spheres ; and every
man, aiming for the highest, should ask of himself, and
for himself, to which sphere do I belong ? Moreover,
every teacher of youth, who is anxious for the completest
development of those whom he has in charge, should
observe the bent of his scholars in their early days, and
* Address delivered before the Liverpool Institute, at the Distri-
bution of Prizes, on Friday, December 17th, 1886.
NATURAL SELECTION FOE SCIENCE AND FOE ART. 23
should discover, if they are gifted for the higher places
of learning, on which side to place those who are destined
to possible greatness of work, in either department, in
science or in art.
Before we come to a conclusion on a subject so momen-
tous, touching as it does the fate of students every-
where, let us glance at the evidences on which a safe
conclusion may rest.
IS COMBINED GREATNESS POSSIBLE ?
In the first place, in this line of contemplation, let us
go back to actual experiences of mankind relating to
what has been possible. A little child, standing by my
side in a sailing boat on an uncertain sea, looks in my
face and inquires of me : " Did you ever see a boat go so
much on its side and right itself again, and can it sail on its
side as well a son its keel ? " " Yes, my child," I answer,
" it can ; " and he is therewith brave and confident. So I,
at sea on the question before me, ask of the older guide,
Biography : Can you tell me whether any man has ever
sailed on science and on art with equal facility according
to the fate that impelled him and the necessity that
guided him?
By this biographical method of arriving at evidence I
get proof that there have been rare men who have been
equally representative, in themselves, of science and art.
You stand before a great picture of the Last Supper.
You see the faultlessness of the pure artistic spirit. The
groups of three ; the similar dissimilitude of the group-
ings ; the expression of every one in each group so
characteristic, according as each one should be ; so subtle
where subtlety is called for ; so demonstrative where
demonstration is required ; so trusting where truth is the
trait described ; so affectionate where love is the one
24 NATUEAL SELECTION
attribute ; all and every group, all and every individual,
so completely alive and moving, that the very surface
lives.
You stand in the Louvre before a picture called the
" Madonna with the Kocks." Your eyes rest on four
exquisite figures, the colouring of which is the painting
of light itself, while the flowers in the foreground are so
natural that the statement made respecting them, to the
effect that a botanist might classify them, botanically, as
easily as if the originals were before him, is literally
true. You are filled with wonder at what manner of
man the master must have been who depicted life in so
perfect and lasting a fashion.
You are riding through Lombardy ; you see a vast
plain, levelled for the laying out of canals in such grand
and regular form that the idea of the most refined and
comprehensive engineering skill forces itself on your
attention. You inquire what genius laid out these wonder-
ful plans and completed these wonderful works.
You take up some plates of anatomy and the text
in which the plates are described. You are yourself an
anatomist, and can judge of the effect. There is an out-
line of the eyeball ; there is a sketch of muscular powers ;
there is the plan of a limb at rest, or of a limb in motion.
What anatomist can have wrought out all this clear,
precise, concise, and delightful study? What industry
can have put so much into so little ?
You are out on the highways or the fields, and you hear
a shout or a noise. Your eyes are directed upwards, and
you see, far above you, but descending to the earth, a
huge umbrella under which a man or a woman sits, and
gradually descends to the earth. Ah, you say, a parachute!
What a clever mode of descent ; what style of man
could have invented a thing like that?
FOE SCIENCE AND FOB AET. 25
You are by the seaside during your seaside holiday.
There is built out on land, at a little distance from the
sea, a kind of small temple. You enter it in darkness,
but in time your eyes get accustomed to some sight on a
table which is below and before you. You perceive there
passing along, in miniature, the outer world which you
have just left. You notice waves of the sea in motion ;
the sails of a windmill in revolution ; a tennis court with
the players in earnest pursuit of their game, and their
ball flying about right merrily ; a kite sailing in the space
of sky ; some recognisable friends coming along the pier.
What a charming treat, and what a marvellous con-
densation ! Who could have thought of it, or made it
possible ?
You listen to some grave men who are discussing
together the great earth on which we move. They explain
what they call its annual circuit ; they show you from
a model how the seasons fall, and how by the rotation of
the earth on its own axis day and night are proclaimed in
regular order. Who unfolded this order to his comrades
of the earth ; who unrolled the secret of the seasons, and
expounded day and night ?
You want to know, by reading from a master, what is
the order of the human senses in respect to their value
for the appreciation of nature. You find one who tells
you that sight holds the foremost rank, because it receives
its impressions immediately and the place of action is
apparent ; that sculpture and painting, consequently, as
they make the nearest approach to reality, should take
higher rank amongst the fine arts than music, which
appeals to a lower sense, and is only transient in effect,
although her harmonious effects are no less pure than
those of painting ; and, that both painting and music take
a higher rank than poetry, which is at its best a mere
26 NATUEAL SELECTION
verbal reflex of words and deeds of men, with, mere power
to speak the actual and the real.
You ask for a poet, notwithstanding, to breathe to you
some " verbal reflex " that shall appeal to the desires
and wishes of your soul. You find one of sage experience,
who tells you that he
"Who cannot do as he desires, must do
What lies within his power. It is in vain
To wish what cannot be. The wise man feels
That from such trammels he must free himself.
Our joy and grief alike, on this depend,
On knowing what to will and how to act.
But he alone whose judgment never strays
Beyond the line of right, this lesson learns.
Nor is it always good to have one's wish :
What seemeth sweet full oft to bitter turns ;
Fulfilled desire hath made mine own eyes weep.
Therefore, reader of these lines, if thou
Wouldst virtuous be, and be beloved of men,
Will ever for the power to do the right."
You think that each of these bright paintings, inven-
tions, and words must have had many projectors and
unfolders and inventors ; and so indeed they had long
before the time for the complete illumination of them all.
But they waited nevertheless for one man and one mind
to illumine them, and they found that man in one
who was a prince of both domains, domain of science,
domain of art, Leonardo da Vinci.
If we could transfer ourselves back to the earliest
days of this same strange genius, we should find also
that to his other gifts he added the gift of music ;
that he could play the lute and sing divinely, improvising
both words and melody.
So you see that it is possible for one man to be a master
in art and a master in science ; and some of you of ambi-
FOE SCIENCE AND FOE AET. 27
tious turn may feel that what one man can be, another
man can be, if sufficient industry be put into his efforts.
I would not deny that there are those who are born to
such greatness, for there are, no doubt, as good Leonardos
on the earth as ever were found in the Academy; but
the number is not large. Genius of the simplest kind
is exceptional ; and comprehensive genius, the excep-
tional of the exceptional is so mighty that when it
appears as it did in Leonardo, it cannot help but pro-
claim itself. I leave such genius, therefore, to take care
of itself, and I apply myself to the commoner types of
human excellences, and to the development of them for
every-day usefulness.
NATURAL TYPES OF GIFTED MEN.
Ordinarily, and according to what seems to be the
natural rule, there are two distinctive types of mind
born, not made. We may call these types of mind the
synthetical and the analytical, or the constructive and the
separative ; the mind that builds, and the mind that
finds and collects the materials for the process of building.
By these qualities the human mind, always admitting the
great exceptions, divides itself into science and art.
Ths scientific is the analytical, separating, finding mind.
The artistic is the synthetical, constructive mind.
Both discover or reveal to the world : but the scientific
mind discovers and reveals what is in existence and what
can be found by diligent search. The artistic mind
reveals what was not previously in existence.
Newton, with great research, picked up gravitation as
an existent phenomenon. Cervantes produced " Don
Quixote," and made one who never existed as living a
man as any man who ever did exist.
28 NATUEAL SELECTION
Aristotle, Kepler, Newton, Linnaeus, Charles Darwin,
are grand types of the analytical school.
Plato, Shakespeare, Michael Angelo, Milton, Cervantes,
Dante, Eaphael, Bunyan, De Foe, Moliere, are grand
types of the synthetical school.
Leonardo includes both, followed, to a certain extent,
by our own Christopher Wren ; and, in a minor but still
striking degree, by John Martin, whose paintings of
Belshazzar's Feast and the Last Judgment are equalled
by his original and noble designs for giving health as well
as beauty, to London delivered from ugliness and pesti-
lential disease.
In youth, and very early in youth, the endowment of
one or other of the two great types is, I think, always and
easily detectable when either exists in a marked degree.
But it is true that neither may be detectable in any
marked degree, and I am not intending, in the least, to
offend when I observe that in the large majority of all
classes it is not detectable in any such degree as to indi-
cate a striking character. Perhaps, in every person, there
is a preponderating balance on one side or the other.
Perhaps always the boy who is good at arithmetic shows
a plus of the scientific faculty. Perhaps always the boy
who is good at imitation from nature shows a plus of
the artistic quality ; and it might be well, therefore, in
every instance, to endeavour to discover what is the
tendency, so that the simplest may find their natural
place in their after-lives.
The rule, however, I wish most to impress is, that
in cases where the quality stands out clearly as its own,
there every effort should be made to let that quality
have its fullest play. The mind should be permitted to
follow its own bent towards the position of master in its
own sphere ; while it should be so directed as to be led
FOR SCIENCE AND FOE ART. 29
toward scholarship in the other sphere. Then, in the
same person, the science and the art will inter-relate.
The man of science, hard as his science may be, will have
some taste or art in the development of the most difficult
portion of the subject in which he is master. The man of
art will, in like manner, have some scientific accuracy in
the most original and exquisite design in which he may
have superlative skill and fertility of invention.
If you students whom I see before me, and to whom
prizes of merit have this night passed, if you have not
sought advice, or received advice, as to your particular
cast of mind for or towards greatness, try for yourselves
what you are. There is not one who may not, by thought-
ful study and self-examination, come to a knowledge of
his own strongest capacity. If in anything you excel your
comrades, according to your judgment, exalted into con-
science and conscientious belief, there and in that direction
your strength lies. Try.
No doubt in early trials you may feel that your efforts
are feeble because they are few. But there is soon a
response to this test. If you are putting your hand to the
pencil, and find that, do what you will, you cannot, like
some of your fellows, draw a straight line or a curve, draw
firmly an outline, see the heights and depths of shadows,
calculate distance, distinguish colour, or construct a
design, you need not tarry long in order to divine that
the artistic mind does not belong to you.
If in science you discover that you cannot master the
arithmetic, the mathematical problems, the chemical sym-
bols, the mechanical theorems, the classification of natural
laws and natural phenomena, as others can, you may be
sure that you are not destined to be a master in science,
except at a cost of labour which would not be needed,
and would not be thrown away on a more congenial
30 NATUEAL SELECTION
vocation. Perhaps in one or other of the developments
of art you are an artist. Try.
DIVISIONS OF HUMAN FACULTIES.
Physiologically the faculties of man may be divided
into three, the animal, the emotional, and the intellectual
or reasoning. We may say of these faculties that each has
its seat in the nervous organisation, the animal faculties
in the nervous networks of the glands and expanded
membranous surfaces of the body ; the emotional faculties
in the nervous centres and ends which lie in proximity
to the great vital organs, the liver, the stomach, the
heart, the lungs, and the arterial vessels, to their
extremest terminations ; the intellectual faculties in those
great centres of nervous matter, the brain and spinal
cord.
The grand evolution of the life of all lives, the mental
life, has, probably, proceeded upwards from the expanses
to the centres of organic being, and thence to the centres
of intellectual being ; animals pure and simple ; animals
endowed with emotion, feeling, sympathy; animals en-
dowed with emotion, feeling, sympathy, and, finally,
with intellect, by which they learn to know right from
wrong, the perfect from the imperfect, the accurate from
the inaccurate, and to hold all that the expanses and
organic centres have collected from the outer world, as
phenomena retained in the treasuries of what is called
memory.
The changes of mental quality which man, in his uni-
versality, presents, are made on these three bases of
existence. If we take the mass of human kind it is as yet,
even up to this enlightened day, in the animal phase of
its development, the first phase, the lowest, the strongest,
FOE SCIENCE AND FOE AET. 31
the most enduring ; that on which the higher faculties rest
and which would remain, even though the higher faculties,
rising to the highest pitch of excellence, as they did in
the period of Hellenic glory, should fall back into the
lowest barbarism, degradation, and all but death.
For, in truth, all men, whether men of art or men of
science, have this in common: they are animals sharing
that quality with the whole plane of animal life, and
rising only to the higher and diviner life by the faculties
o / O t/
that are implanted in, and rest upon, that common centre.
You inquire of me, What inference do you draw from
this anatomy of reasoning, or reasoning by anatomy ?
The inference I draw is, that the student of art, or the
student of science, is one or the other, or none or the
other, according to the type of his organisation. For
greatness either in science or art the animal basis requires
to be sound and health} T ; there is evidence that it need
not always be robust, but it must always be sound.
Some men of grand artistic faculty have worn out, in
early years, the animal basis of their lives, and so have
been accounted feeble ; but the original strength of their
animal organisation must have been prodigious, and by
the work it produced, in a short time, must have been
of the very highest class. This type has obtained more
amongst the greatest musicians than any other artists ;
and we can easily see how in them the wear from nervous
vibration must have told on their animal mechanism.
The animal basis sound and maintained so, the student
of art or of science who has marked qualities for either
branch must in the end win, if he follow that which is in
accordance with his nature. He will, on the other hand,
according to my view, never win greatness, if he and his
work are not in accord. Under reverse of faculty he will
sink into mediocrity.
32 NATUEAL SELECTION
HARMONY OF MIND AND WORK.
My own profession, medicine, taken in its widest
acceptation, offers, I think, the best field for students
of science and students of art in combination of talent.
It is true that medicine belongs mostly to the domain of
science, but it admits of some openings for even fine art.
The skilful oculist is an artist, and other portions of
mechanical skill connect themselves with pure artistic
gift. Medicine, therefore, is favourable to men who,
devoting themselves to science, are gifted with art. Yet
with fullest admission of this fact, medicine is not a field
for the pure artistic worker. Get above the mediocrity,
get amongst those who have genius for art rather than for
science, and the failure of pure artistic genius in medicine
is as clear as the day. In medicine at this moment, three
men, at least, who might have been artists of the century
have been lost in the vocation they have followed, to
which vocation, beyond their high personal character and
beautiful lives, they have added not a jot, not a jot,
because they were not born to yield any addition to the
science they were led to pursue. One man in medicine
stands out historically as a great man of science, and an
accomplished but not a great artist in one form of art ;
I mean Baron Haller. Another man stands out as a
great artist and an accomplished but not a great man
of science ; I mean Albinus. But these are exceptions,
and are both inferior to the typical Leonardo.
There was once a man in medicine very original, very
illustrious, who stood just below the highest rank in either
department of knowledge, because falling short of being
a Leonardo ; he was neither an Aristotle, a Sydenham, nor
a Shakespeare. This man was Erasmus Darwin, natu-
ralist, physician, and poet, the founder of the theory of
FOB SCIENCE AND FOB ABT. 33
progress by natural selection, the author of some of the
ablest essays on disease, the writer of poems which show
fancy without fervour, and rhythm without either gaiety
or splendour. This man fitted well into medicine in proof
of its possible universality, but neither medicine, science,
nor art claim him exclusively as their son.
In other departments the attempt at combined great-
ness has been ignoble compared with what has occurred
in medicine. I cannot see that there has been or is any
success at all ; but failures appear on every hand where,
by accident or intention, the man of science has been
forced into an artist, the artist into a man of science. It
seems, indeed, to me that the block which has been put in
the way of human progress by the ignorant transposition
of living science into living art, and the reverse, can never
be known until the folly of the transposition is seen in the
astounding results that will follow upon the reformation
of the false and blind system which now exists of letting
expediency instead of fitness decide the fate of the
student in his early days, and of allowing the sharpness
of competitive examinations to drive the student, hope-
lessly, into a career for which there has been no test
whatsoever either of aptitude or affection.
THE COMPETITIVE CROSS.
I must take the brunt of the offence, if offence be taken,
for dwelling at this opportune moment on the subject of
competition, to which I have just referred. I want my
countrymen in calm and sober judgment to put to them-
selves the common-sense question : Can we ever expect
to have the same class of great men as those who have
graced the history of the past, if we fail to allow greatness
that natural selection and freedom which have permitted
genius to find its own sphere and live and labour therein ?
VOL. iv. 3
34 NATURAL SELECTION
The crowds of students that are now going in for art,
what does it mean? Not a crowd of artistic talent,
most certainly. Then why the crowd ? Art can only live
by progression, and progression can only belong to the
few who are endowed with particular faculty. The crowd,
therefore, can but trample art into ruins, and die itself
in the debris. The same in regard to science and the
crowd which, helter-skelter, flocks to it for occupation
and bread.
Surely this is physiologically wrong. Science, and
science alone, should be provocative of science ; art, and
art alone, provocative of art.
I repeat, therefore, to you students, try yourselves, and
see what you are fitted for. If you find that out, I
believe there is no eminence to which you may not
aspire, no usefulness to which you may not add some-
thing useful, no possible happiness to which you may not
attain.
To labour for the achievement of true eminence, to
cherish the idea of adding the useful to usefulness, is
most commendable ; but above all things precious is the
work and scope of work that brings happiness to the
worker.
Happiness in work is the proof of the fitness of the
called to the vocation in which he moves. When a
man is happy in his work, he has found his work.
But how few there are who are so far fortunate, none
but one who is in practice as a physician can form a
complete idea. In my professional life, cast much in the
ebbs and tides of the intellectual classes, there is nothing
that gives me such frequent pain as the tale of life at
work at a grindstone, which would have no grind in it
if the right man were at it. Perfunctorv work done
CJ v
under necessity, how common. I really think that to
FOR SCIENCE AND FOE ART. 35
one person who tells me, " I love my vocation," two tell
me, " I hate my vocation," and follow it only because
needs must when the devil drives.
And in this matter the devil drives merrily on the
wings of the wind, while his victim dries up and withers
away.
I charge you again, student of science, student of art,
who would aspire to be eminent, useful, and happy in
your work, try your own faculties, and choose your
natural bent. Cast aside boldly all that may beset you,
trust to the soundest of safe promise for success, the
only natural evolution, natural selection in work and
vocation.
MASTERSHIP AND SCHOLARSHIP.
I am now going to take another and qualifying, but
not contradictory view.
I want to beg of you when you have found your
natural selection not, thereupon, to slight and ignore the
studies which you have felt to be inappropriate to you,
because they are not the studies to which you would
have linked yourself for all your career. Great mistakes
are often made in this respect, mistakes second only to
the mistakes incident to a false selection.
You hear very often a pedant declare, " I know nothing
except my own business, or, my own profession ; I am a
practical man ; every man ought to stick to his own last ; "
and so on. This is Mr. Conceit talking ignorant nonsense
and vulgarity. Have nothing, I pray you, to do with
him ; above all things do not copy from him.
In your own department be a master ; but in all useful
departments other than yours that lie in your way, be,
at the same time, a scholar.
Observe the distinction, master, scholar. However
36 NATURAL SELECTION
high you may try to reach in science, the more easily you
will advance if you are a scholar in art. However exalted
you may strive to be in art, the more easily you will rise
if you let yourself become a scholar in science. You
must live to my age and know this truth in its most acute
presentation, before you can fully grasp it ; but, believe
me, it is a truth of the purest kind.
In the domain of physiology, I, for one, have been
accustomed to teach. I have taught some thousands in
this part of science. But as a student I had no oppor-
tunity of learning the art of drawing ; and what I have
lost by that omission is such a loss that the black board
has become a veritable black cloud to my pleasure as
a teacher. If I could but go to that board and sketch
out, as an artist could, the diagrams, the figures, the
structures, I want to describe, what a lecture I could
give !
George Cruikshank, in dying moments, resting on my
shoulder, puts out his right hand, and, showing me the
fingers and thumb, as if they were holding the magic
pencil which for threescore years and ten he handled
so marvellously, asks me with the simplicity of a child,
" Will nothing go out from them again ? " Alas ! nothing.
If I could only, in the most elementary way, have learned
such skill as those ever-industrious fingers had acquired,
what lectures I could have delivered ! If I had known
as much of art as he knew of science related to art, how
much better had it been for me !
I do not say this regrettingly, but instructingly. Choose
for your vocation that province in which you shall or may
become a master. But in the rejected province be also a
scholar.
Shakespeare was the embodiment of his vocation in art.
His mastership was there ; but his scholarship was as wide
FOB SCIENCE AND FOB ABT. 37
as his art was concentrated, and by that combination his
artistic perfection was realized.
In fact, as a model for students generally, Shakespeare
is better than the singular and exceptional Leonardo,
because he is a model, to whom every student may
turn with advantage and instruction, of mastership and
scholarship produced without any unnatural grind, or
cram, or other abnormal effort. Shakespeare found
his work in art, his pleasure in scholarship. He
let science, history, metaphysics, interest him, while he
kept to himself that artistic labour which sprang from
his own natural reading of human thought and passion
as his own particular intellectual study and glory.
After Shakespeare, as a similar model, comes the German
Goethe, who was wont indeed to claim in the world of art
and science this second position. Goethe was essentially in
the first place an artist, a truly constructive genius. But,
subservient to his most subtle mastery of artistic details
and idealistic conceptions, he entered the domain of
science so far as almost to discover the homologies of
the skeleton.
By every master of art and scholar of science William
Shakespeare may, however, be taken as the type of an
artist without effort ; one of those whom Dr. Walshe has
so admirably defined as possessing "the spontaneously
active intellectual attribute, which supersedes the necessity
for labour, genius" One of those, also, who let the
environments of learning, from which scholarship is de-
rived, supplement and feed his genius.
I might go through all the realms of biography, and
never find a model so correct in every light as this one
man ; and the reason why his name is perhaps of all
names most frequently repeated, depends more than on
aught else that can be offered in explanation of the
38 NATURAL SELECTION
phenomenon, on his combinations of mastership and
scholarship in their natural order.
UNION OF SCIENCE AND ART.
Let us come now a little way down to every-day life,
and having made up our minds towards mastership in the
line of natural selection that may belong to any one of
us, let us look at the effect of omitting and of adding
scholarship to our selection, whatever that may be.
I have shown from one failure how bad it is in science
not to have some skill in art ; but that illustration 'may be
largely and profitably extended. Turn to the origins of
many scientific inventions and discoveries, and see how
often they have been, and, for the matter of that, still are,
rendered objectionable and difficult, in consequence of
the inferior art with which they are explained and illus-
trated ; or in consequence of the fact, that subjects which
can only be made clear by good artistic illustrations, are
not made clear because the author had not the skill or the
will to execute the very part which would have made him
intelligible.
On the other side, see how common it is to find a great
D
artistic conception and execution spoiled by the perversion
of some false representation of some natural object. I
have seen a most artistic picture, including a constellation
of the heavenly bodies, ruined, because the artist would
not be scholar enough to go out in the starlight and look
at the mode in which the constellation is formed. I have
seen in figures exquisitely painted anatomical mistakes,
which a few days' study of anatomy would certainly have
rendered impossible. On the stage I have observed refined
actors give representations of states of body of a pheno-
menal kind, which, in regard to fact, show no truth what-
ever, and, therefore, produce no true natural effect. I have
FOE SCIENCE AND FOB ART. 39
known an accomplished Juliet snatch up the sleeping
draught of mandragora, gulp it off, and fall down dead,
as if she had been shot, instead of sinking slowly, peace-
fully, and gracefully into the sleep which would have
come over her if the narcotic had really passed her lips.
Again returning to science, and to science of a distin-
guished kind as such, we detect constantly in the
exposition of it an entire disregard of artistic skill in the
matter of writing or speaking it. I could show you pages
upon pages of the highest class volumes in science, so
shamefully composed that the subject-matter is not even
now intelligible, and in fifty years will be as an unknowr
tongue. About this, indeed, there is, I fear, a silly senti-
ment, that for a man of science to write so plainly that he
who runs may read him, is for such a man of science to be
designated a popular writer, and thereupon to be classed
as one who is not strictly a man of science at all. What
stuff this is M. Guizot has well described by a happy use
of the following argumentum ad absurdum : " Every
essay ought to be readable. Firstly, because it is written
to be read ; secondly, because if it be not readable it
cannot be read ; thirdly, because if it cannot be read it
will not be read."
The same error in science extends to oral teaching.
It is an absurd fashion of common application, to treat
any attempt at true artistic arrangement in scientific oral
teaching as unscientific. The desk, the manuscript, the
diagram however badly executed, the black board, the
duster, the piece of chalk, and the tumbler of water, with
such apparatus as may be required for experiment, these
are the things making up the orthodox stock of the man
of science who would rank as a true scientific expositor.
Give him these, together with the immortal pointing-rod,
on which he may rest as a bear rests on his pole, and he
40 NATURAL SELECTION
may hesitate and stammer and arrange and re-arrange his
notes and their delivery to his heart's content. If a poor
player were to venture on the stage so forlorn and so
unprepared, he would be hissed off without the slightest
mercy. Yet this inartistic method of lecturing, considered
as the right and natural method, goes on from day to day,
and year to year, and no one raises a word against it,
although all admit that science lectures do not pay, and
that the man or woman who goes to such lectures for
enjoyment, is a person of peculiar serenity and exceptional
taste.
I notice, however, that whenever a scientific lecture is
perfectly illustrated, as, for instance, with the oxy-
hydrogen lantern and screen, and with such assistance is
respectably delivered, people go to it readily enough.
But here art has now been brought into requisition, and
therein lies the attractive charm.
Yet I remember the time when the lantern was scouted
in science, and I know eminent men who would still rather
describe an intricate structure from the most inartistic,
inaccurate, second-hand copy from nature, drawn on
paper, than from the most exquisite photograph, taken
direct from nature, and thrown upon the screen.
All this shows a want of artistic scholarship in science,
which is quite as faulty as the want of scientific scholar-
ship in art.
Pray understand that I do not wish to urge the absolute
rule that every man of genius, in science or in art, must
be a master in one and a scholar in the other. This
would be false to history. Newton was the greatest
man of science who ever lived. Turner was the greatest
painter of his kind who ever lived. But Newton probably
knew as much of art as Turner knew of science, and that
is saying very little. Neither of them made time to learn
FOB SCIENCE AND FOR ART. 41
much out of his own pursuits. Yes, it may be so.
There are some great lives too concentrate to be aught
but one life in labour. And yet I cannot but believe that
even these concentrate minds were more useful if, some-
times, they left their own labour to find rest by change
into another but kindred sphere.
Certainly, too, in many great works, the noblest results
have been obtained by the combination of science with art,
and art with science.
Architecture yields an eternal series of monuments
in proof of this view. In a magnificent cathedral there
is as much, and as laborious, and as refined science, as
there is in the construction of a tubular bridge over the
Menai Straits. Yet who would compare one work with
the other, a tube to a temple. The one is science clothed
and beautified by art, the other is science stark naked.
The men who built the temples were masters in science,
scholars in art, or masters in art and scholars in science,
and their works follow them for the delight as well as
service of mankind.
In the natural selection for science and art keep these
ideas in mind ; and even if you do not agree with them, the
study of the disagreement may be of value to you. I
venture to think you will agree, as you proceed with your
studies, and that the lines indicated may prove good
lines for every student to keep upon. You may, by follow-
ing the course suggested, influence a wider circle of people
than you otherwise might, and extend useful reforms
in directions which are, at present, closed against
progress.
Do not think me egotistical in a desire to be practical,
if I give you another personal illustration of my meaning.
I have told you of one sad failing of mine as a lecturer,
that I have no artistic skill with the pencil. Let me,
42 NATTJBAL SELECTION
on the other side, record a certain success by virtue of
one small artistic effort with the pen.
I began from the earliest part of my career to work at
the preventive as well as the curative side of medicine,
and while I was very young found myself extremely
active in the ranks of those who have been denominated
sanitarians. I started the first Journal of Public Health
and wrote more essays and papers on public health topics
than I can at this moment remember off-hand. To the
small circle in which my writings were acceptable, and
in which they excited a sympathetic response, they 'did
me credit ; but to the great world which I wanted to
reach, and in which no real good could be done until
it was reached, my most laboured works were so many
disjecta membra.
A lady friend of mine, a shrewd and critical person,
condensed her criticism of one of my works into this
stern and hard sentence, " It is a dry book." The saying
was too true, and it clung to me.
I went on over twenty years penning these " dry
books," not one of which passed out of my own sanitary
coterie.
At last a good opportunity occurring for the venture,
I thought I would try an address which should be scien-
tific in essence and artistic in construction. The idea
fructified, and in due course was presented to the world
under the now well-known allegory, " Hygeia, an Ideal
of a Model City."
I believe that no one was so surprised as myself at
the success of this little contribution to sanitary literature.
The general press was, for a time, full of it ; it was
translated into quite a number of foreign languages ;
it was read in all parts of the world ; houses, streets,
yachts, inventions, and articles of clothing were named
FOR SCIENCE AND FOB ART. 43
after it ; and from the time when it was published, eleven
years ago, until now, it has retained much of its popularity !
The favoured of fortune liked it, and those less favoured
by fortune liked it so much that I once had sent me a
published penny copy of Bunyan's " Pilgrim's Progress,"
with my essay in combination, the highest honour that,
perhaps, ever fell to my lot.
I hope the address had an effect beyond what was
pleasing and grateful to its author. I trust it led people
to think of the subject of the prevention of disease, of the
importance of making each home a centre of health, and
of encouraging the sentiment that national health is
national wealth. But my sole object in alluding to the
incident is to impress on students of science and of art,
that a subject cold and unpromising in the extremest
degree may be warmed into a genial picture by a little
artistic care, and may therewith find its way into regions
which before were inaccessible to its most earnest and
laboured intentions.
I would I had time to show another picture, in which
science could be equally well represented as assisting art to
make its way. But the few moments still at my command
must be devoted to what may be called the psychological
qualities which, under the selection for science or for
art, are most likely to lead to successful issues.
BASES OF SUCCESS.
In the previous part of this address reference was made
to the three faculties of our nature which form our
physical and mental organisation. Each of these faculties,
animal, emotional, intellectual, must be kept in health, if
the work pursued, be it ever so well selected, is to be
successful in its results. The animal nature must be kept
in health first and foremost, for it is the foundation on
44 NATURAL SELECTION.
which all else rests ; and, having the health of that founda-
tion in my thoughts, I would say to every student, whether
of science or of art, begin from the first in a simple mode
of life. Make frugality the basis of your success, for luxury
will interfere with labour and defile produce. You cannot
be too temperate ; you cannot be too careful in letting
the physical body be the sound temple for the healthy and
active mind. Combine with this sufficiency of sleep, with
early hours for sleep and for the awakening from it. Make
the sun your fellow-workman, and soon, with practice,
you will find ample time to conjoin original work with
the ordinary work which the ablest men must undergo.
To this healthy physical training add healthy mental
training of the emotional faculties. Keep in control too
eager a desire to excel in all things ; subdue that curse
of the human mind, the curse of jealousy. Do not over-
strain in labour. Eemember the curious and significant
fact that, when you are looking for something, like a book
in a library, there is no surer way of not finding it than of
looking for it too eagerly. Strive, but do not strain. As
far as possible avoid controversy. On mere speculative
questions, on matters of public policy, controversy may
be of service ; but in dealing with nature, whether by
finding out her ways or by constructing after her plans,
it is far better to learn and to do, than to wrangle either
about methods or men.
In doing understand what you yourselves have done ;
then every one will understand also, and you will be the
faithful expositors of your own achievements a great
advantage and accomplishment.
To the control of the animal and emotional faculties
add restraint of the intellectual.
If you progress into great fame, still press on, for the
choicest and most approved successes are soon forgotten.
FOE SCIENCE AND FOB ABT. 45
Nature enforces that rule in respect even to triumphs,
which at first sight are most surprising.
All knowledge newly-born is miracle ;
"Tis new to us, and, therefore, wonderful.
"When first our children learn to speak, and take
The inventories of their tiny worlds,
We wonder and admire. But when they come
To speak and act with a much finer sense,
We wonder not : the miracle has ceased.
And so it is with older children who startle the world
with their first efforts. Their miracle ceases, and they
must be born again for new enchantment.
I repeat, as I retire from you, the chief lesson I would
wish now to leave with you. Try your own faculties,
and select your natural vocation. To borrow an old and
splendid saying, obey your call, and abide the result.
In science, in art, many are called, few are chosen ; but
whether you be of the chosen or not, obey your call.
So shall you assist to your own soul's content, though
the world know it not, in forwarding that happy day when
disease, pain, deformity, and sin shall be replaced by health,
happiness, beauty, and purity, for evermore.
OPUSCULA PEACTICA.
" There are mites in science as well as in charity."
BENJAMIN RUSH.
METHYL AL.
>T the meeting of the British Association for the
Advancement of Science, held at Norwich, in
1868, I brought out for the first time the
chemical fluid called Metliylal as an anaesthetic
and hypnotic, and at a meeting of the same Association at
Exeter in 1869, I again drew attention to it in order to
make it useful in practice.*
Methylal is a colourless fluid of specific gravity O855 ;
its vapour density is 38, taking hydrogen as unity ; and
boiling-point of 42 Cent., 107'6 Fahr. Its solubility in
blood is one part in three ; its composition is C 3 H 8 2 .
It is made by distilling methylic alcohol with sulphuric
acid in the presence of peroxide of manganese, but it
requires several re-distillations before it can be obtained
in the pure state, for which reason it is at present a very
expensive compound. The first specimens with which I
experimented were made in my own laboratory ; later
specimens have been made for me, with much care, by my
friend Mr. Williams, the well-known operative chemist.
When methylal is quite pure it is almost tasteless,
but bites the tongue, and owing to its low boiling-point
* Reports of the British Association for the Advancement of Science,
vol. xxviii., pp. 183-4, Norwich meeting ; and vol. xxix., p. 406, Exeter
meeting.
OPUSCULA PRACTICA. 47
quickly evaporates. The odour of it is fragrant, and not
very powerful. The pure vapour creates no irritation on
being breathed.
After long exposure to the vapour of methylal, in an
atmosphere containing not less than 35 per cent, of the
vapour, warm-blooded animals may be made to pass into
a sleep which, once established, is deep and prolonged.
In my first researches the sleep so induced lasted for
ntervals of two and even three hours, but I believe now
that this long narcotism was due to the presence of
acetone, from the methylal not having been sufficiently
purified. Last year with a perfectly pure specimen,
made by Mr. Williams specially for my work, I en-
deavoured to anaesthetize two dogs with methylal in
order to enable Mr. Mavor, the veterinary surgeon, to
operate upon them painlessly. After half an hour's
nhalation of the vapour narcotism was not produced.
The fluid was then injected hypodermlcally in one animal
to the extent of an ounce dose, upon which a gentle sleep,
or rather intoxication, followed, but with no sufficient
anaesthesia to allow of painless operating.
In my report of 1869 I showed that methylal, which
is very soluble in water, could be administered by the
mouth when diluted with water, or by hypodermic injec-
tion, and I have prescribed it occasionally, as a mixture
several times. I usually begin with a fluid drachm dose,
mixed either with glycerine or syrup of orange flowers
and distilled water. Example :
Methylal, pure, 5vj.
Syrup of orange flowers, 5^'-
Distilled water, 5vj.
Mix. To make a solution of six ounces ; of which let one to two
fluid ounces be taken in a wine-glassful of water as directed. The dose
may gradually be increased to twice the above quantity or more.
48 OPUSCULA PEACTICA.
In action, as a medicine, methylal lies between alcohol
and anhydrous ether. It quickens the action of the heart
with reduction of arterial pressure ; it makes the respira-
tions slow and deep ; it induces a tendency to sleep ; and,
it is a sedative to pain, but not to a very deep degree.
On the whole it would be best to keep it in the group of
anodyne antispasmodics, in which I originally put it. It
causes very little muscular excitement and no vomiting,
but after long inhalation of its vapour it produces a free
flow of saliva. As it mixes well with alcohol and with
ether it might be administered with either of these agents ;
and it might also be given with amyl nitrite for the relief
of colic, asthma, angina pectoris or tetanus ; but before
it can come into general use it must be reduced in price.
Signor Personali, who has recently been experimenting
with methylal, seems to have arrived at results similar to
my own ; but he adds that it may be used as an ointment
or liniment for external application. It is true that it
mixes fairly with oil and with lard ; but as it boils at 107
Fahr. I cannot see how it can be of any service for
external use, except in causing a slight local anesthesia
by cold, from evaporation.
EPILEPT1FORM SEIZURES FROM POST-NASAL POLYPUS.
PATIENT was brought to me who was supposed
to be suffering from epileptic or epilepti-
form seizures. She was a lady thirty-four
years of age, married, and in all respects,
the seizures excepted, in robust health. She had no
hereditary history of epilepsy, and medical opinions
had been divided as to the exact nature of the seizures.
One practitioner had expressed that to his mind the
attacks were of hysterical rather than epileptic form ; but
OPUSCULA PBACTICA. 49
his view was not sustained by two other practitioners
whom she had consulted, and who had both distinctly
affirmed that the affection was of epileptic character.
At her first visit to me, I could only come to the same
conclusion. The patient was not in the least hysterical,
and her description of the seizures was clearly the
description of epilepsy. I prescribed for epilepsy, but
the results of the treatment were nil. At last my
attention was specially drawn to one particular state-
ment, which she said she had held from the first, namely,
that the cause of the attack always seemed to her to be
in the back of the throat, and to be produced by some-
thing that dropped into the larynx in the same manner as
when in swallowing " something goes the wrong way."
She explained that several times seizures had occurred
while she was singing, that one of them had come on
while she was singing in church, and that she had, on that
occasion, been carried out of church insensible.
The persistency of the patient in this view of the cause
of her symptoms led me to make a spectroscopic examina-
tion of the throat. I found nothing in the larynx that was
unnatural, but while the mirror was in the throat, a large
drop of fluid fell from the post-nasal cavity. I was led,
thereupon, to examine that cavity, and detected a polypus
of which no previous indication had been given. With a
pair of curved, broad-bladed forceps I had no difficulty in
seizing the polypus and bringing it away entire. It was a
large fluid gelatinous mass of the size of a large walnut.
When it was lifted up and gently pressed, drops of
gelatinous fluid easily exuded from it. There has been no
return of the growth, although eight years have passed
since its removal, and there has not been one epileptiform
seizure since, nor even an approach to one.
There are two lessons of much practical importance in
VOL. iv. 4
50 OPUSCULA PKACTICA.
this case, (a) That so large a mass should have been con-
cealed in the post-nasal cavity, without being discovered by
the usual signs of obstruction, (b) That such a simple
cause should have led to seizures which were so distinctly
epileptiform in type.
I have no doubt whatever that the seizure was in every
instance due, as the patient herself diagnosed, to the
escape of a portion of the fluid from the polypus into
the larynx, and to spasm and asphyxia from the foreign
intrusion.
In my experience the case was novel altogether, and
since it came before me I have invariably examined the
throat in every example of epilepsy I have seen ; but no
similar illustration of cause has been detected. To
Marshall Hall the fact would have been invaluable as a
demonstration of the correctness of his view of the reflex
laryngeal origin of epileptic convulsions.
i
NATURAL PERIODS FOR MENTAL LABOUR.
reading recently one of the essays of Mr. Edwin
Chadwick, I find an argument on the question
of limitation of mental labour. Mr. Chadwick
is of opinion that for children at school three
hours of mental work daily is as much as can be borne.
Students at the universities may take more, but. should
not exceed from four to five hours. Men of letters, at their
best, should never exceed from five to six hours. To me,
as a physician particularly well-acquainted with the literary
fraternity, the question, how many hours a day may
mental work be carried on with safety, is often put ; and
I have come to the conclusion, from objective as well as
subjective experience, that Mr. Chadwick is correct, viz.,
that from five to six hours is the natural limit, even for
OPUSCULA PEACTICA. 51
the healthiest writer, and, that this amount of labour is
still more healthily tolerated if it be taken in spells of two
or three hours, with an interval of rest between.
I am quite convinced that in the long run more work
can be done by the limitation of study to five, or, at most,
six hours a day than by any excess over that period, while
the quality of the work is in every respect better.
How far physical may be carried on with mental
exercise is another question, which often comes before
me. In my own case, physical work of almost extreme
kind seems to help mental work, for the five or six
appointed hours devoted to it. When, therefore, I am
on a tour, which is my choicest pastime, cycling, riding on
horseback, or walking, I make no difference. I take work
for study with me, to which I devote from two to three
hours in the morning before commencing a journey ; and,
at the close of a cycling journey of fifteen or twenty miles,
I find, after a short rest, a repetition of the same amount
of study rather a pleasure than a labour. Medical practice,
which involves a considerable amount of physical activity,
rather favours than hinders mental activity, so that I really
work better when I am moderately busy in practice than in
periods when I am what is called " slack."
This, however, is not the universal experience. I know
many persons whose mental powers are very easily reduced
by severe exercise, and for them I usually advise that the
mental facility should be the measure of the physical ; that
the capacity for mental labour should be measured by the
powers of physical endurance ; and that when it is found
that a certain amount of physical labour begins to encroach
on mental activity, it is well to make a stop within the
boundary. There is no one who cannot measure out for
himself this record, which may vary in respect to physical
exertion from three miles a day of walking exercise to
52 OPUSCULA PRACTICA.
six ; or from ten miles of cycling to fifteen or more, and
the same for horse riding. But to make the measurement
exact it must be conducted fairly. Seven hours of sleep
in the twenty-four must be secured, and mind and body
must be kept quite free from the influence of stimulants.
Alcohol is such a fierce and merciless destroyer of both
mental and physical power, that any quantity of it sufficient
to induce a sensible effect is fatal to all measurement,
since it alone makes work which is not detected, and not
accounted for.
The best proof that the mind is exhausted from mental
work is, I believe, omission of words in the construction of
sentences, although this error may also occur from haste in
composition, and must be differentiated accordingly.
IODIDE OF SODIUM.
LONG experience in the use of iodide of sodium
leads me to call attention to the practical
value of this salt as an adjunct to, or substitute
for, the fellow and much more commonly used
substance iodide of potassium. Iodide of sodium has
nearly the same properties as the iodide of potassium, but
it must be given in much larger doses. I often prescribe
it in combination with common salt in the proportion of
one part of it to three parts of the common salt, and
instruct the patient to take three to four drachms of the
combined salts at meals with food, in the same way as
common salt is usually taken. In this manner a hundred
grains of sodium iodide may be administered daily with
good effect. In chronic eczema, in chronic and painful
rheumatic affections, in chronic syphilis, including under
these heads the conditions in which the iodide of potassium
OPUSCULA PEACTICA. 63
is of service, the iodide of sodium often comes in admirably
when the potassium salt does not agree with digestion.
The late Mr. Thomas Hunt, at my suggestion, took to
prescribing the iodide of sodium in chronic eczema, and
became so satisfied with it that in the latter part of his life
he substituted it for iodide of potassium altogether. He
also prescribed it largely in combination with arsenic in
lepra and psoriasis, a practice I have followed with great
advantage.
Iodide of sodium forms also a good antiseptic for out-
ward application in cases of indolent ulcer, chronic syphi-
litic sores, and offensive discharges from the nostrils. The
formula for it in such instances is :
Sodium Iodide, 5ss.
Tincture of Myrrh, 5j.
Rectified Spirit, 3ij.
Distilled Water, 5vj.
To make a solution of eight ounces.
I found this solution, in form of a fine spray from
Seigle's steam spray inhaler, of the greatest service in a
troublesome case of chronic syphilitic ulceration of the
fauces.
PEROXIDE OF HYDROGEN IN HOOPING-COUGH.
HAVE treated nine cases of hooping-cough with
peroxide of hydrogen exclusively, in six males
and three females, all children. The solution
was given in doses of a fluid drachm five or six
times a day. The remedy in this affection has a decided
value. Commencing with it in the acute stages of the
disease, and trusting to it alone, I have never seen per-
tussis cut short so quickly and determinately by any mode
of treatment except change of air. I had previously used
54 OPUSCULA PEAOTICA.
dilute nitric acid in hooping-cough, as advised by the late
Dr. Gibb, and with satisfactory results. The peroxide
appears to me to act in a manner very similar, but I
think with more effect. It subdues the spasmodic
paroxysm, checks the secretion in the throat, and shortens
the period of the malady, lessening, thereby, the dangers
of after-effects. The mode of prescribing it is :
Hydrogen Peroxide (10 vols. strength), 5vj.
Glycerine Pure, 5iv.
Water distilled to 3iij.
Mix. To make a solution of three fluid ounces, of which let half a
fluid ounce be taken in a wine-glassful of water as directed.
When there is stridulous spasm with the cough I sub-
stitute ozonic ether 31] for the solution of the peroxide,
or add it to the mixture.
ETHEREAL OXYGEN.
THEEEAL oxygen is a compound I have recently
invented for inhalation. I place in a Wolffs
bottle, with an inhaling mouthpiece attached to
one neck, two ounces or more of ozonic ether,
the ethereal solution of peroxide of hydrogen. To this I
add, gradually, solution of permanganate of potassa
8 grains to 1 oz. of water by the other neck of the
bottle, and then cork that neck. As the fluids commingle,
oxygen gas and ether vapour are given off freely, and can
be inhaled from the mouthpiece. The compound of gas
and vapour, anaesthetic, antispasmodic, and respirating, is
applicable to a large class of cases of disease, such as
pertussis, asthma and phthisis. I doubt if I have ever
added anything more useful to practical therapeutics than
ethereal oxygen.
(Jliutotvpe from (Portrait in t: ^ractat'.is
Oxford. ^(7)LXXIV. . TV -%.).
JOHN MAYOW, M.D., LL.D. A NEGLECTED
GENIUS.
'HE saying of Dr. Walshe, quoted in a previous
article, on the possession by some men of " the
spontaneously active intellectual attribute,
which supersedes the necessity for labour,
genius" was never better exemplified than in the person
of the illustrious medical scholar and experimentalist
whose life is now before us, John Mayow.
In my student days I had heard this man incidentally
spoken of both in the chemical and in the physiological
classes. Dr. Eobert Willis had also directed my attention
to his work, and had told me in what high esteem he was
held by the learned Bostock, the author of the renowned
and ever-useful book on Physiology, a priceless book for
classical study.
But it was not until I chanced to come face to face with
Mayow, in the portrait of him published in the present
ASCLEPIAD, that I was sufficiently interested in him to look
up carefully the details of his life and work. These
completed, I found that in Mayow medicine had a son of
sons, a genius, although, as Beddoes calls him, " a neglected
genius ; " one so great, and at his death so young, that we
may compare him, almost, with the poet Chatterton as an
illustration of what youthful genius of the highest order
56 JOHN MAYOW, M.D., LL.D.
may accomplish against time. I am not quite sure,
indeed, whether we might not compare him also with
Chatterton in another respect ; but as this is a speculative
point I will not dwell on it. Like Chatterton, he was
certainly of poetic mind, although he wrote in crabbed
Anglo-Latin prose instead of exquisite English verse.
Of the life of Mayow but little is known. In writing
the medical history of Bath for the Medical Times and
Gazette in 1864, I found in a local history of the famous
old city that he practised there, and biographer Wood
(Athense, Oxon.), recording what he learned long after the
death of Mayow, tells us a little about him, but so little
that the Biographies generally seem to consider him
unworthy of notice. Even the " Biographical Dictionary "
of last century, so careful not to omit the name of any
famous Briton, omits Mayow; and as this work is the
basis of all later biographies they follow with the same
omission.
What is known of his birth and early career is that he
was descended from a respectable, or, as Wood says,
" genteel " family living at Bree, in Cornwall. His parents
came to London, and in London John was born, some time
in the year 1645, in the parish of St. Dunstan-in-the-West,
in Fleet Street. The day of his birth is not known,
neither is it known where he received his preliminary
education; but on September 27th, 1661, the year after
the restoration of Charles II., at the age of sixteen years,
he was admitted a scholar of Wadham College, Oxford.
He had not been a very long time a scholar at Wadham
College before he became a probationary Fellow of All
Souls'. This appointment he obtained through the influence
of Henry Coventry, Esq., one of the Secretaries of State,
entering amongst the legists, and taking the degree of
civil law. He may therefore have intended to follow the
A NEGLECTED GENIUS. 57
legal profession, but it is more probable that he took up
the LL.D. as a necessary step to the fellowship, there
being no arrangement for the fellowship through medicine.
Whatever his original intentions might have been,
Mayow studied physic, graduated in it, and very early
in life came to London to practise as a physician. He
did not join the Eoyal College of Physicians, and would,
therefore, be an outsider ; which would not be favourable
to his advancement. In the winter time he seems to
have remained in town ; in the summer he took up his
residence in Bath, and without any doubt carried on
medical practice there. While he was in the first years
of his practical life, probably before he attained his
majority, he began to investigate by the process of
experiment, then a new and open field in medical
progress, which Harvey had started and one or two had
followed, but which had not yet become the accepted and
acceptable method. The publication of this experimental
work was, nevertheless, well received, if we may accredit
Wood, who in his quaint style says he was noted for his
practice, especially at Bath, but better by his books,
which show " the pregnancy of his parts."
In 1668, when he could not have been more than
twenty-three, or at most twenty-four years of age, Mayow
published his first treatise, " De Respiratione" at Oxford.
The following year he published from the same place
another treatise, " De EJiachidite ; " and in 1673 he
published a complete edition of all his works in an
octavo of one hundred and fifty-two pages, with four
plates, each containing several well-executed figures ; an
"Elenchus Eerum," or abstract; a dedicatory poem signed
" C. T. Coll. Omn. An. Soc. ; " a dedication from the
author, " Illustrissimo Viro D. Henrico Coventry,
Serenissimo Principi Carolo II., Mag. Brit.., Franc, et
58 JOHN MAYOW, M.D., LL.D.
Hib. Regi, A Secretioribus Consiliis & Primario
Status Secretario." The whole work is entitled " Trac-
tatus quinque MEDICO-PHYSICI, Quorum primus agit
DE SAL-NITRO et Spiritu Nitro-Aereo. Secundus DE
KESPIRATIONE. Tertius DE KESPIRATIONE FCETUS in utero et
ovo. Quartus DE MOTO MUSCULARI. Ultimus DE BACHI-
DITE. Studio JOH. MAYOW, LL.D., d Medici; Nec-
non Coll. Omn. Anim. in Univ. Oxon. Socii. OXOKEI, E
Theatro Sheldoniano, An. Dom. MDCLXXIV." The per-
mission to publish the book was given by Peter, Bishop
of Bath and Wells, Vice-Chancellor of the University.
" IMPRIMATUR PETRUS BATHON. & WELLEX. Episc., Vice
Cancellarius. Oxon., Jul. 17, 1673."
On this volume all the fame of Mayow rests, and by the
way in which he has arranged his title page we see upon
what part of the work he himself chiefly depended for future
recognition. He has arranged the five subjects according
to his own idea of the order of their merit, and he has put
De Sal-Nitro first, and in bolder type than all the rest.
The design is as fair as it is modest. It is as if he were
speaking from afar to those of us who were to speak of
him, to Thomas Beddoes and to me, yes, even to me :
" See, my friend, what I conceive to be my most original
and enduring thought. I have put it first, for your eye
first to fall upon, and I have underlined it thrice, for your
mind to study it most carefully."
That Mayow himself had a knowledge of his own
greatness to be carried down to posterity in his volume of
five essays there can be no doubt, for his dedication to Henry
Coventry conveys that thought, although, in the language
of his time, he gives all the credit to his patron. But
even he, perhaps, no more supposed that he should ever
be compared, as he has been, to Francis Bacon, or to his
contemporary, Isaac Newton, who was three years his
A NEGLECTED GENIUS. 59
senior, than that he should be as altogether forgotten for
long periods, as if he had never been born. Yet both
these fates have fallen to his lot.
THE WORKS OF MAYOW.
Leaving for a moment all debate on the value of these
essays, it will be most instructive to look at the essays as
a whole, and see by what work and quality of work their
title to fame survives.
Of the five essays the four first are physiological, the
last, on rickets, practical ; and, as a broad fact, we may
accept, at once, that the four first are all or nearly all
that need be mentioned ; indeed, but for one deliverance
to which I shall in due course refer, the essay on rickets
might be left out of the record for good.
Of the four essays of mark, the second in order of place
is the one on respiration, which was published separately
in the year 1668. The position this essay holds in the
volume is significant, as indicating the line of study which
its young author had followed. It is a fair inference that
he began his original studies with the subject of respira-
tion, and being led from them to the investigation of the
invisible air which is taken in by respiration, he made,
through his experiments, what he believed to be a dis-
covery so great and lasting that it claimed priority over
all else that he had accomplished.
" DE SAL-NITRO."
In the first essay, " De Sal-Nitro," Mayow divides his
subject into fifteen chapters. He supposes that the air is
universally charged with a vital substance, " Spiritu Sc
Vitali" and that this substance is essential for all acts of
combustion or burning. The same principle or substance
exists in nitre, by this proof, that if the experiment be
60 JOHN MAYOW, M.D., LL.D.
tried of burning charcoal in a vacuum or under water it
will be found that the charcoal will not burn, but if the
charcoal be mixed, intimately, with nitre it will burn
either in a vacuum or under water. Gunpowder contains
sulphur and charcoal ; neither of these substances will
burn under water, but united with nitre, as gunpowder,
the compound will explode if it be dry, or will burn slowly
away if it be moistened with water. The reason of this is
that the nitre contains the same spirit as that which exists
in the air, and which is always necessary in order that
combustible things may burn. To this something the
name may be given of nitro-aerial spirit, or of saline
vital air, because it exists in the salt nitre ; or it may be
called fire air spirit, because it exists in the air. It is
neither acid nor alkaline.
All heat seems, he thinks, to spring from the action of
this spirit, from the motion of its particles, motion being
produced by an impulse. We must, therefore, assume the
existence of a refined or subtle constantly moving matter.
The fiery or vital particles of the air are not the air itself
altogether, but only its subtler part ; and nitre does not
contain the air altogether, but only this same subtler part,
confined as it were in it. Combustion is due to this spirit
in contact with other substances, like charcoal and sulphur.
Fermentation is another phase of the same contact, and is
attended with heat. Combustion itself is fermentation in
its most violent form. The rust of iron is produced by
the action of the particles of the spirit of the air acting
upon the " metallic sulphur " of the iron, and in effect is
the same as if the iron had been acted on by an acid.
In these observations we see that Mayow had a clear
idea of the presence in the air of something which was
a part of the atmosphere and which combined with other
substances, producing, according to combination, heat,
A NEGLECTED GENIUS. 61
active combustion, fermentation, rust. We, knowing
more than he, call this something oxygen gas ; he, seeing
as we see, that the same substance is in nitre and in the
air, called it, naturally enough, nitro-aerial spirit.
This was his preliminary work ; he proceeded next to
curious and important results by the experimental method.
He had observed when a cupping-glass is placed on the
surface of the body that soon after the lamp is withdrawn
from the glass the glass adheres firmly to the skin, and
the skin rises up to fill a vacant space. In this experi-
ment he assumed that a portion of the nitro-aerial spirit
in the cupping-glass before it is applied is used up in the
combustion from the lamp. In this way a vacuum is
formed; the skin rises to occupy the space, and the suction
makes the glass adhere firmly to the skin. The observa-
tion led to a new experiment.
By means of a drawing to make quite clear the details
stated in his report of the experiment, he shows to us that
he placed a lighted candle in a basin or trough, and sur-
rounded it with water up to a point a little below the
lighted wick. He next inserted a syphon tube in the
water in such a way that the two limbs of the tube stood
upright above the water, while its lower rounded part
rested on the floor of the basin. He then covered the
burning candle with an inverted cucurbit a pear-shaped
bell-jar, letting one limb of the syphon stand outside it,
and letting the mouth of the jar descend gently below the
level of the water. The syphon tube permitted the air to
escape as the jar descended, and the candle was left
burning in the confined air of the. jar. Here was an
imitation of the cupping-glass, and here was a test of his
theory. If the candle by burning would extract nitro-
aerial spirit from the enclosed air, the water would rise in
the cucurbit to fill the space. The water did rise, and
62 JOHN MAYOW, M.D., LL.D.
the space was occupied. In a later stage he measured
how much space was lessened by combustion in a closed
jar, and calculated it was one-thirtieth part of the
whole ; not by any means a bad measurement, considering
that he had no knowledge about the carbon-binoxide that
was formed, or how to absorb and fix it.
In another experiment he repeated what he had done in
a different way. so as to avoid expansion by the sudden
application of heat from the flame of the candle. Instead
of putting a candle into the bell-jar under water he
suspended in the jar a plate on which he had laid some
easily-combustible substance. This substance he fired in
the bell-jar by means of a burning glass a most ingenious
device ; and again he observed that from the combustion
there was loss of the nitre-aerial spirit, with an ascent of
water into the jar to fill up the space which the spirit had
previously occupied.
In a third experiment in this series he enquired if
air would feed combustion after the nitro-aerial spirit had
been withdrawn from it. He seems to have placed, as
before, some combustible substance on the plate in the
bell-jar suspended above a burning candle; to have
suffered the candle to exhaust the spirit, and then 'to
have attempted to fire the combustible substance with his
burning glass ; but without avail, because in the absence
of the spirit there could be no combustion. No spirit, no
fire !
VITAL AERIAL SPIRIT.
So much for the combustion of flame. What about
animal combustion, the color vitalis, the heat of life ?
Does the animal combustion submit itself to the same test
as the candle ? For the purpose of putting this point to
experimental proof, Mayow filled a jar with water and
A NEGLECTED GENIUS. DO
tied over the mouth of the jar a sheet of bladder. He
next placed a live mouse in another and smaller glass jar
containing common air, arid inverted the jar so as to let
its open mouth fit closely upon the moist surface of the
bladder, the mouse itself resting on the same membraneous
surface. If now the mouse used up an} 7 of the nitro-
aerial spirit in the upper bell-jar, the bladder ought to rise
in the upper jar just as the skin rises in the cupping-glass,
and at the same time the vital fire of the mouse ought to
go out. Both events did occur. The mouse was soon
raised upon a rounded elevation of bladder and its
animal fire was extinguished. It ceased to live.
In a second experiment of the same nature he varied
the details by placing a mouse in an inner chamber sur-
rounded by water and covered with a bell-jar. He now
saw the water rise in the outer jar as the part of the air
absorbed by the mouse was extracted ; and, measuring the
absorption by the lost space, he concluded that one -four-
teenth part was taken up by the breathing animal before
the extinction of its vital fire.
Again, he compared the attraction, if I may so say, of
the animal fire for the vital air by the attraction of the
common fire for the same air, and found what I, by
another form of research, have also found independently
that an animal will, for a short time, live in an air exhausted
so far that the combustion of a taper or candle will not
take place in it. In other words, that an animal will live
longer than a candle in the same volume of common
air in a closed receiver.
Once more, he discovered that if two animals be placed
in a closed receiver filled with air, the one animal in the
lower, the other in the upper part of the receiver, the
animal fire will go out soonest in the animal in the upper
part.
64 JOHN MAYOW, M.D., LL.D.
Putting together all these facts, so familiar to us of this
day, so startling and novel in his day, Mayow concluded
that animals live in air by the process of constantly
extracting from it a vital part or spirit, which, being
absorbed by them, feeds the animal flame and sustains the
animal heat. The conclusion thus arrived at led him
easily enough to study the mode of the absorption. How
was the vital aerial spirit taken up ?
The ideas prevailing in his day that the inspired air is
wanted to keep open the air passages, to cool the heart,
to sustain a fermentation in the heart, or to impart an acid
vapour to the blood in order to excite the motion of the
heart a view which Sir Isaac Newton appears to have
held were not satisfactory to Mayow, because insects
cannot live without air. He saw that air enters the
lungs, primarily, by its own weight, and is expelled
by an act of the body, the act of expiration. He
inferred that in the lungs the air loses some part of
itself, its nitro-aerial spirit ; and he came to the bold but
correct view that the part lost was absorbed by the
blood, and was carried round the body with the blood
to keep up the animal fire. With the microscope he
essayed to see the tubes in the structure of the lungs
by which the air might be directly conveyed. He saw
very fine tubes, but without affirming that these were the
conducting channels, he still affirmed that the part of the
air which is absorbed or lost enters the blood. A dog
that lay panting and struggling to breathe ceased to pant
when blood charged with nitro-aerial spirit was driven by
a syringe over the lung from the right into the left side of
the heart.
The office of the lungs is to separate the nitro-aerial
spirit from the air and convey it to the blood, and the
vital air so conveyed by the blood to the heart stimulates
A NEGLECTED GENIUS. 65
the heart to motion. It also changes the colour of the
blood, making the venous blood of bright red hue.
In further support of his argument Mayow contended
that the gills of fishes were the lungs of fishes ; that the
water in which fishes float contains, in its pores, the vital
air in sufficient quantity to support the breathing of
fishes ; and that the vital air passing over the gills is
absorbed by them, and conveyed from them to the
blood. He showed, moreover, that when water is
deprived of the vital air it will not support the life of
the fish.
One step more. The placenta plays, he believed, a
similar aerating part to the foetus in utero, and air passes
with the blood of the mother to the foetus. He was,
therefore, as Bostock expresses it, "the first who enter-
tained a correct opinion respecting the use of the placenta
as an organ supplementary to the lungs ; " and who
" also extended his views to the chick in ovo, although
he had not a very clear conception of the manner in
which the nitro-aerial particles were obtained by the
blood of .the foetus or by the fluids of the egg."
MECHANISM OF RESPIRATION. MUSCULAR MOTION. FERMENTS.
Engaged in observations on the respiratory function, it
was natural enough for Mayow to study the mechanism of
respiration. He was singularly happy in this research.
He described most carefully the two layers of the
intercostal muscles ; argued that both sets by their con-
traction elevate the ribs and increase the capacity of the
thorax ; and that the diaphragm, by its contraction and
relaxation, regulates the capacity, increases the thoracic
space by descending into the abdomen, and reduces the
space by arching into the thorax. His illustrative drawings
on these points are excellent. In the fourth of his essays,
VOL. iv. 5
66 JOHN MAYOW, M.D., LL.D.
" De Motu Musculari," Mayow displays a good know-
ledge, for the time in which he lived, of the structure
of muscle. He considered that the transverse fibrils
inserted in the greater fibres perform the chief office
in contraction of muscle, but that the nitro-aerial spirit is
again necessary for the production of motion.
In this part of the work he has a special chapter on
the ferments of the stomach, the pancreas, and the
kidneys ; with an hypothesis that all the secretions are
due to fermentative changes, each special according to
its kind. He treats also fully on what he calls the
animal or vital spirits, and brings into this division a free
notice of the vital function of the nitro-aerial particles
or subtle portion of the air.
RICKETS.
The last essay, on rickets, is, as before stated, the one
practical essay, testifying to the physician rather than
to the physiologist. It opens with a tribute to Glisson,
better known to us in these days as the anatomist who
described the capsule which bears his name, " Clarissimus
Glissonius." Then he gives the diagnosis of the disease,
the symptoms, the cause, the cure. In treating of cause
or causes one good suggestion is made. The cause of the
disease is, he thinks, nervous exhaustion. The nerves, not
less than the blood, contribute to nutrition " Nervi ad
nutritionem conducunt" and the failure in rickets is
not from the brain but from the spinal cord. The history
of the disease and its causation forms a striking contrast
to the " Methodus Medendi" which, directed to remove
the obstruction of the medulla spinalis, is beyond measure
perplexing and complicate, one prescription alone being
made up of eleven ingredients. I leave this part of
Mayow's labours to fate, with this one further observation,
A NEGLECTED GENIUS. 67
that he seems to look upon rickets as a comparatively
new disease in the western counties of England, a disease
of forty years previous to his time.
PHYSICAL SCIENCE.
Engaged principally in pursuit of physiological discovery,
Mayow had his time well occupied and filled by that work
alone. Still, by keeping his mind open to receive every
kind of friendly hint from nature, although outside his
own dominion of conquest, he added not a few new and
important facts and theories to physical science. His
drawings as well as his text, for example, clearly tell us
that he invented and used a pneumatic trough and collected
and retained gases. He filled a globular glass bottle with
water ; he inverted the bottle, with the mouth of it open
under water in a trough ; he passed portions of iron into
the neck of the bottle ; he acidulated the water with
spirit of nitre, and filled the bottle with the air or gas
generated, in bubbles, by the contact of the acidulated
water with the iron. In short, he decomposed water and
collected hydrogen. He supplies also a drawing in which
two bottles were used, one for the generation, another for
the collection of the gas that was evolved. Unfor-
tunately for his fame in the field of pneumatic chemistry,
he did not examine the gases which he collected in order
to test their physical qualities. He showed that they
could be collected and removed from place to place, but
he left what remained of the inquiry .to the independent
genius and industry of the true founder of the pneumatic
method, Joseph Priestley.
In speculative science Mayow also took a prominent
part. He held that motion is the result of an impulse
communicated to the rigid subtle particles of the nitro-
68 JOHN MAYOW, M.D., LL.D.
aerial spirit. The particles would never move of
themselves, but they are moved; and by that movement,
in mass, we get what may be called the phenomena of
motion, and of heat which is exalted motion. Such, it
seems to me, is the idea he conveys, and by it tries to
describe that condition of rigid bodies called elasticity.
The particles of air, he contends, are compound and rigid.
Light is not an effusion but an impulse through the nitro-
aerial particles, or an impulse through a medium ; a step
further and he would have forecast the vibratory hypo-
thesis of light and of the ether of space.
Eespecting the heavenly space, however, he had another
view. To his mind the sun is an immense chaos of nitro-
aerial particles, agitated by a rapid and incessant motion.
The air or spirit from the sun becomes cooler and cooler
as it approaches the earth, so that in the middle region,
between the earth and the moon, the emanations consti-
tute the region of absolute cold. But from the earth the
air rises to the utmost region of the element of heat, then
descends and is deflected to the north pole by the motion
of air from the equator ; and, sweeping back over the
surface of the earth from the pole towards the equator,
gives us the north wind.
One step more, and out of the half true ideas which
floated in his brilliant mind, with a little knowledge about
the southern hemisphere, Mayow had discovered the cause
of the trade- winds. How near he was to this induction is
shown by the observation he makes that, in the manner
above described, a circulation of air, essential to life, is
maintained on the earth.
Not less interesting than this hypothesis of the trade
winds is another respecting the cause of water-spouts,
which he attributes to a vertical motion of the air, and
which he illustrates by a plate, showing two figures, in
A NEGLECTED GENIUS. 69
which the vertical lines of motion in spiral form are well
depicted.
One last speculation and I bring the physical sugges-
tions of Mayow to a close. He assumes that the firmament
is of blue colour, because we look above us into a space
or region where motion of particles is most slackened.
All faint flames, he tells us, are of blue colour, because of
the slower motion of the particles in the combustion.
ESTIMATES OF MAYOW AS A SCIENTIFIC DISCOVERER.
To many modern readers the name of John Mayow will
be a new name ; and it is very curious in looking at the
comments which have been passed on him, that while he
has never retained a permanent rank as a discoverer he
has appeared in the most remarkable manner by fits and
starts, like a variable star in the great firmament of
science. In the last year of the last and in the first year
of the present century the pages of the admirable Medico-
Physical Journal held communications from Dr. Lubbock
of Norwich, Dr. Yeats of Bedford, and Dr. Stokes of
Chesterfield, in which the claims of Mayow, called forth
by the writings of Beddoes, were very freely handled.
From these and from other sources I could fill the
whole of an ASCLEPIAD with controversial details, in
which Mayow would be presented on one side as standing
on the same level with Newton, and, on the other side, as
being a mere copyist from a preceding writer named
Bathurst, or from his contemporaries Lower, Hooke,
Thurston, and Boyle. A paper in the Transactions of the
Royal Society depreciates him to uplift Boyle ; and
Scheele speaks of him sneeringly as one giving " obscure
hints " on the composition of atmospheric air.
But no unprejudiced mind that is familiar with
experimental pursuits, can for a moment doubt the
70 JOHN MAYOW, M.D., LL.D. A NEGLECTED GENIUS.
originality, the truthfulness, the genius of this man. The
train of experiment which he invented and carried out,
the correctness of the results, the faithfulness of the
pictorial illustrations, as well as of the text, the startling
and brilliant inductions which nothing except experiment
could have suggested, all go to prove that John Mayow
stood alone in his greatness, a master, young in science,
but so old in skill and accomplishment that whatever he
touched was illuminated with new light.
I can have no doubt that he foresaw oxygen gas and
some of its most important uses. He did not call it
oxygen, he calkd it sal-nitro ; by which he meant some-
thing in finely-divided particles or atoms. He did not
call it a gas, but he caUed it a spirit, which is the same
thing ; for gas comes from geist, geist is ghost, and ghost
and spirit express, alike, any invisible something that pro-
duces a phenomenal and definable act.
THE DEBT TO NATURE.
John Mayow, Wood informs us, paid his last debt to
nature in an apothecary's house bearing the sign of the
" Anchor," in York Street, near Covent Garden, in the
liberty of the city of Westminster, in the month of Septem-
ber 1679, in his thirty-fourth year. He had been married
a little before, not altogether to his content. He was
buried in the Church of St. Pauls, Covent Garden.
The portrait of Mayow speaks of gentleness, honesty,
intelligence, sadness, genius. Dr. Yeats, in 1799, wished
for him that the laurel of merited reputation which the
fatigues of discovery wreathed about his brow might
continually flourish unfaded. To which I, eighty-eight
years later, heartily add : So may it be.
ON OXYGEN IN VITAL PHENOMENA.
AN ABSTRACT OF ORIGINAL RESEARCH.
great question, How far vital pJienomena
may be modified by modifying the condition
of vital air or oxygen, formed one of the first
experimental studies in which. I was engaged. I
have recently reviewed these early labours; and throwing
out all that seems to me, after a lapse of thirty years,
extraneous, I propose to present here, in abstract, so much
as I would like to leave as a permanent record of original
research. In order to carry out these inquiries, I fitted
up at Mortlake, where I first practised, a special room
with all required conveniences for the production of
oxygen, for its purification, and its storage ; for the trans-
mission of it through chambers of various sizes constructed
of wood and glass, and the means for testing it after it had
been used in experiment.*
EFFECTS OF ARTIFICIAL ATMOSPHERES CONTAINING VARYING
QUANTITIES OF OXYGEN AND OF NITROGEN, AT A MEDIUM
TEMPERATURE.
In the first set of researches the question was asked
by experiment : What would be the effect on life of a
modification of the proportions of the two elements, oxygen
* Many details of this research formed a portion of the Lettsomian
course of lectures delivered before the Medical Society of London in
1861, and were published in the Transactions of the Medical Society of
London, vol. i., part ii., 1861.
72 ON OXYGEN IN VITAL PHENOMENA.
and nitrogen, which make up the common atmosphere in
which we live, with the oxygen as one part, the nitrogen
as four ; or more correctly, by percentage, the oxygen as
21, the nitrogen as 79 per cent., the temperature being
in all cases the same, but moderate in degree.
In the first instance large warm-blooded animals were
made to breathe the factitious atmospheres ; but, as it soon
became clear that in animals of warm blood the results were
always the same under the same circumstances, healthy
mice of the same weight were the subjects of observation
in the major parts of the research. Mice were easily
introduced into the new atmospheres, and the quantities
of gases used being limited, were easily manageable. The
results obtained may be epitomised as follows :
In a given quantity of common air, i.e., four of
nitrogen and one of oxygen, enclosed in a glass chamber
at a temperature of 55 Fahr., an animal became narco-
tised and died asleep in one hour and fifty minutes. In
the same quantity of a factitious atmosphere, made by
mixing together three volumes of nitrogen with two of
oxygen, and enclosed in a glass chamber of the same size
at the same temperature, an animal of the same kind and
weight remained free from narcotism thirty minutes
longer than the one in common air, but finally, becom-
ing rapidly narcotised, died within two minutes of the
same time.
In the same quantity of a factitious atmosphere, having
two volumes of nitrogen and three of oxygen, all other
conditions being identical, the same results precisely were
observed as when the nitrogen was decreased one volume,
and the oxygen was increased one volume.
In the same quantity of a factitious atmosphere, having
one volume of nitrogen and four of oxygen, the propor-
tions of the gases of common air reversed, and all other
ON OXYGEN IN VITAL PHENOMENA. 73
conditions being the same, the animal did not become
narcotised until two hours had elapsed, and then con-
tinued in deep sleep for six hours, with invariable
recovery from the sleep if, within three hours and a half
from the commencement of the sleep, it were removed
out of the artificial into the natural atmosphere.
In a fourth atmosphere, in which oxygen pure and
simple was used, all nitrogen replaced by oxygen, the
phenomena were the same precisely as in the case where
one part of nitrogen was present, up to the moment of
complete narcotism. The sleep also continued in the
same deep form, but it ended in cessation of respiration,
circulation, and life, at the end of four instead of six
hours.
In a last observation of this series an animal of the same
kind was placed at 55 Fahr. in a jar of common atmo-
spheric air of so large a size that the same volume of oxygen
was present as in the jar of the pure oxygen, but diluted
with the natural four parts out of five of nitrogen. By this
means, it was asked, what is the vital value of nitrogen as
a diluting agent ? The result was that in this proportion
of oxygen and nitrogen the animal life was sustained for
eleven hours and a half, and for nine hours without
narcotism or any sign of variation from the natural.
As in these observations the whole series was in progress
together in the same room at one and the same time, there
was no difficulty in arriving at the conclusion that a
certain dilution of oxygen in nitrogen favours the
sustaining action of oxygen within the living organism.
How this was effected was to some extent determined by
examination of the atmosphere that was left in each
instance.
In the three first residual atmospheres the oxygen had
been utilised so fully that it failed to support flame.
74 ON OXYGEN IN VITAL PHENOMENA.
In the case where pure oxygen alone was employed,
the larger volume of the gas remained unchanged. Only
one-fifth of the expected proportion of carbon di-oxide
was now produced, and in the same jar vital combustion
was sustained for five similar observations before sufficient
carbonic di-oxide was evolved to cause an asphyxiating
atmosphere.
In the instance where by using the larger volume of
common air the same quantity of oxygen was employed
as when oxygen alone was used, the whole of the oxygen
was not taken up. Nearly one-fifth of the whole of the
residual atmosphere remained as free oxygen.
INFLUENCE OF COLD ON OXYGEN IN VITAL PHENOMENA.
In the next step of research the influence of oxygen on
life was tested at a low temperature. In these researches
a refrigerating bath was used for bringing down the oxygen
to 20 Fahr. The bath consisted of a series of metal tubes
immersed in a freezing mixture, and through the tubes the
oxygen was supplied in current, so that when inhaled it
should have the ordinary atmospheric pressure, but should
be reduced to and maintained at the temperature of 20
Fahr.
The results of these inquiries led to the discovery that
on pure oxygen the effect of cold is to reduce its vital
combining power to such an extent that it becomes,
practically, an anesthetic gas.
When two animals of the same size and weight were
placed in different atmospheres of the same volume, the
one atmosphere being that of the common air, the other
that of pure oxygen, but both at 20 Fahr., the animal in
the oxygen became narcotised within a few minutes, and
in thirty minutes was dead from the narcotism, the
cessation of life being as tranquil as if the most perfect
ON OXYGEN IN VITAL PHENOMENA. 75
anaesthetic vapour had been used. The animal in the
common air remained longer awake, and continued to
breathe, after narcotism, fifteen minutes longer. It lived
forty-five minutes, and the cessation of its life was marked
by convulsive movements as from the action of carbon
di-oxide formed by the animal from its own vital
chemistry. The atmosphere left in the jars showed, more-
over, that this was the fact. The pure oxygen sustained
flame, and yielded not more than 2 per cent, of carbon
di-oxide. The common-air atmosphere, on the other hand,
extinguished flame, and yielded 11 per cent, of the
di-oxide.
These results were followed by others obtained by
modifying the atmospheres at 20 Fahr. in respect to the
relative proportions of oxygen and nitrogen. In this way
it was discovered that the rule before observed in atmo-
spheres at 55 Fahr. held good, and that an atmosphere at
20 Fahr. composed of four parts oxygen and one part
nitrogen atmospheric air reversed in regard to proportion
of its gases, the vital properties of oxygen were better
sustained than in common air under the same conditions.
An animal in the reversed atmosphere, all other conditions
being the same, lived twenty minutes longer than in
common air, and thirty-five minutes longer than in pure
oxygen.
OXYGEN AS AN ANAESTHETIC.
In using oxygen in these low temperatures I had
no difficulty in making it applicable as a general an-
aesthetic. In one instance by the simple process of
varying the temperature of the oxygen, raising it gradu-
ally when the respiration became very low, and then
lowering it again, a large rat was kept in deep anaesthetic
sleep for thirteen hours, during any period of which it
76 ON OXYGEN IN VITAL PHENOMENA.
could have been submitted to any surgical operation
without suffering.
INFLUENCE OF WARMTH ON OXYGEN IN VITAL PHENOMENA.
On the same lines of observation recorded above, with
the difference that the atmospheres tested were warmed
up to 70 Fahr., an entirely new series of phenomena were
developed. The influence of the increased warmth enabled
pure oxygen to sustain life much longer than common air,
when it was used in the same quantities. In pure
oxygen at 70 Fahr., the same volume which at 55 caused
narcotism in two hours, and fatal narcotism in six hours,
the narcotism did not appear until the close of three
hours, and the fatal narcotism was delayed until twelve
hours.
The same results were caused by a still higher tempera-
ture, 90 Fahr. a temperature common in summer weather
in this country. But when the temperature was raised to
the extreme of summer heat, 12 5 Fahr., however gradually
it was effected, coma and death took place within fifteen
minutes. The bright red colour- of the tissues in trans-
parent parts became of a dark hue, coma set in, and
death was preceded by active convulsive seizure as in
asphyxia. In every particular death occurred, in fact, in
oxygen as in carbon di-oxide, as if it were due to the
development in the blood of the animal of an excessive
production of carbon di-oxide.
If the exposure to the oxygen at 125 Fahr. were sudden
the symptoms were also sudden. They were like a stroke,
and were apoplectic in character, resembling, in the insen-
sibility, the clonic convulsion, and the quickly-developed
rigor after death, the symptoms of sunstroke, as we see them
in man. In corresponding experiments with common air,
in lieu of pure oxygen, the same phenomena from sudden
ON OXYGEN IN VITAL PHENOMENA. 77
exposure to the same temperature also took place, but in
a slower degree.
INFLUENCE OF ELECTRICITY ON OXYGEN IN VITAL PHENOMENA.
The influence of the electric discharge on oxygen gas
in relation to the maintenance of the vital properties of
the gas formed another line of research, in which some
very curious and important phenomena were observed.
It was found that if two animals of the same kind were
placed in the same volume of pure oxygen at a medium
temperature of 55 Fahr., the results could be modified in
the most signal manner by varying the electrical condition
of the two atmospheres. If one of the animals in the
oxygen atmosphere were left in the jar in the same room
as the other at 55 Fahr., the phenomena were repetitions
of what has been stated already ; the animal became
comatose in two, and died four hours later on.
If the other animal, also in pure oxygen taken from the
same reservoir of oxygen as that of its fellow, were so
placed that its atmosphere received, by means of a fine
metal point, a small brush from the positive conductor
of a frictional electrical machine, the coma was not
developed in it as in the other animal, and the vital action
was maintained up to the time when it became interfered
with by the accumulation of carbon di-oxide.
In one of these observations a mouse in the electrified
oxygen was removed from the jar one hour and thirty
minutes after its fellow in the unelectrified gas was dead.
Upon removal, the drowsiness it had exhibited quickly
passed away, and it continued to live as if it had merely
risen from sleep.
The distinguished Schonbein, to whom is usually attri-
buted the discovery of those conditions of oxygen to
which he applied the names of ozone and antozone, held
78 ON OXYGEN IN VITAL PHENOMENA.
that oxygen may exist in three states : as active oxygen,
or ozone ; as negative oxygen, or antozone ; and as neutral
oxygen, or oxygen proper. Oxygen obtained from per-
oxide of manganese is ozone oxygen ; oxygen made from
peroxide of barium is antozone oxygen ; a mixture of
these two oxygens in equal volume and under the same
conditions is oxygen proper or neutral. The ozone might
be looked upon as a positive, the antozone as a negative,
the neutral as an equal condition in which one oxygen
has neutralised the other.
At the time when the researches now related were in
progress, the hypothesis of the three relative conditions
of oxygen was the accepted hypothesis. I therefore pro-
ceeded on that view, and I assume, I think justly, that
chancre of view as to the nature of the oxvgens does
O v O
not alter the facts which indicate the differences of their
action on vital phenomena.
In the researches on this question the same lines of
experiment as have already been cited in regard to
oxygen pure and simple were repeated, except that
oxygen in the states described above, namely, as ozone,
antozoue, and neutral oxygen, were the gases used.
Equal measures of these oxygens were collected in
separate glass vessels or chambers, and were used at the
same times, and under the same conditions of temperature,
for experiment. Mice of the same size and weight and
health were placed in the chambers charged with the
different oxygens. The results were very uniform and
very peculiar.
At a temperature of 60 Fahr. the animal in ozone
positive and active oxygen would fall into deep sleep in
one hour and twenty minutes, and, continuing to sleep,
would cease to breathe in from two hours to two hours and
twenty minutes after the commencement of the inhalation.
ON OXYGEN IN VITAL PHENOMENA. 79
The animal in negative oxygen, antozone, at 60 Fahr.,
would become comatose at the same time as the one in ozone,
and would cease to live in four hours and twenty minutes ;
that is to say, it would live one hour and forty minutes
longer than the animal in ozone.
The animal in neutral oxygen at 60 Fahr. would become
drowsy at the same time as the animal in ozone, but would
not fall into such deep coma, and would continue to
breathe four hours and forty minutes ; two hours longer
/ o
than the animal in the active oxygen, and twenty minutes
longer than the animal in neutral oxygen.
It followed in further research that the character of the
gas in the three chambers, in respect to its power for
supporting life, had changed. The residue of active oxy-
gen sustained the life of another animal of the same kind
a shorter time than the residue of negative oxygen ; and
the residue of negative oxygen supported life a shorter
time than the residue of neutral oxygen.
In another research the modifying effects of temperature
were put to the test. The experiments related immediately
above were repeated in precisely the same way, except
that the proceedings were carried out at 75 Fahr. instead
of 60 Fahr. This was sufficient to change the whole course
of the phenomena. At 75 Fahr. all the oxygens became
the same as to their influence on the vital action. The
animals passed into sleep at the same times, and died at
the same times, but continued to live four times longer
than they would have lived in the same volume of common
air at the same temperature.
PEACTICAL BIOMETRY OE THE MEASURE-
MENT OF LIFE IN HEALTH AND DISEASE.
the course of the past few years my attention
has been systematically and professionally
directed to the subject of the measurement
of life, especially in regard to life assurance.
Gradually the question has assumed a character of
singular and great importance. By bringing to bear all
the modern appliances required for the research, it is now
possible to measure the value of life, at various stages,
with as much accuracy as is attainable in any matter that
calls for forethought and estimate ; as the cost of working
so much land in order to get a profit out of it ; or the
duration of work that can be obtained from a steam-
engine, new or old, or of intermediate value between new
and old.
What is wanted is a method of applying the information
that is obtainable in a simple and systematic form, so that
all members of the profession of medicine may act on a plan
uniform in its details and uniform also in its results.
In the present volume of the ASCLEPIAD I propose to
bring into form some practical notes which I have drawn
up carefully for the purpose. I shall commence with points
relating almost exclusively to the measurement of life for
life insurance, and all through I shall keep this same
matter in view. But other points will also spring up, such
PRACTICAL BIOMETRY. 81
as value of life under various constitutional states, under
different kinds of heart disease, under severe mental or
physical strain and other organic affections, and under
exposure to occupations which modify vital endurance.
CHAPTER I.
NOTES ON MEDICAL REFERENCE IN LIFE ASSURANCE.
THEY who are engaged in the selection of lives for in-
surance are often much perplexed by the variance of
medical expression and opinion in the papers of reference.
In their printed rules and directions for inquiry Directors
try to introduce such questions as will, in their opinion,
cover the whole of the facts they want to know in regard
to each life that comes before them. They endeavour
at the same time to frame each question in such a manner
that it shall convey a fair and exact idea of the facts they
desire to obtain, the facts on which their own conclusions
may be soundly based.
From the care which has been bestowed on the con-
struction of these inquiries, from the experience which
has been gained in practically testing them, and from the
revisions which have been instituted from time to time, it
might, easily, be inferred that they were now reduced to
as close a compass and to as clear a quality as can be
reasonably attained. I believe this to be the case, and that
the list of questions is not open to any serious criticism
or comment. The fact that nearly all offices for life
insurance have established a series of inquiries which
are, on the whole, so uniform that the report of any one
would be pretty nearly applicable to the requirements of
all, is sufficiently clear evidence of itself to prove that the
practical questions set forth in these reports are as com-
plete as could be expected or demanded.
VOL. iv. 6
82 PEACTICAL BIOMETRY.
But when from the questions submitted we pass to the
answers attached to the questions, the results are not so
satisfactory. To the different questions, different values
are attached by different reporters, and it becomes a duty
for Directors to calculate the value of the answers sup-
plied, a duty often more difficult, or very often as difficult,
as that of supplying the answers by him who sent them.
In this task of computing the value of the answers sent,
Directors have, it is true, the important aid rendered to
them by their own staff of medical advisers, and without
that aid they would be in constant trouble. With it they
are still not unfrequently left to determine on certain
points presenting contradictions and difficulties which to
the unprofessional part of a Directors' Board are extremely
embarrassing.
Under these circumstances it has occurred very often to
Directors who are specially interested in the commercial
part of life assurance, that it were best to accept all lives
that present themselves, on a statement that should not
include any professed or professional report. It is urged
that, commercially, one life would correct another, and
that the larger number of persons who would come to
an office which called for no intricate medical inquiries
would create a business comprehensive enough to allow
an average of results that would be handsomely remune-
rative.
I am not myself in doubt as to the soundness of this
view if a business could be obtained that would be of the
extensive character suggested. But in the competition
now extant I do not believe such a business would be
obtainable. Directors are bound, therefore, to make
every effort to bring the reports which they receive to
the utmost simplicity and uniformity, and I shall treat
first on the salient points on which they wish specially to
MEASUEEMENT OF LIFE IN HEALTH AND DISEASE. 83
be advised, and on such mode of treatment of those points
as shall bring out their fullest value to the mind of every
one, whether he be or be not a member of the
medical fraternity.
Importance of Legibility and Simplicity in Reporting.
A preliminary observation is required on the subject of
writing and constructing a report independently of the
matter of it. Eeports are sometimes received written so
illegibly that it is with the utmost difficulty the Secre-
tary can construe them. He transfers them occasionally
to the Directors, who are as much puzzled as himself. By
continued practice in reading different hands a Secretary
learns in time, it is true, to read almost anything ; but the
facility with which a document is perused is always a
matter of very serious moment, as regards time, to the
most skilful reader. I have seen a Board delayed several
minutes over the understanding of a single line, and even
a single word. The effect of these difficulties is often
to convey, it may be quite incorrectly, an idea of hasty
observation or composition, which is not consistent with
the idea of thoughtful composition, and it does commonly
happen that when many particular words are obscurely
written the whole of the report partakes more or less of
obscurity or confusion. The words which are most likely
to be written in a form difficult to decipher are those in
which some technical remark is conveyed. The parts
of the body, stated under the anatomical names, are
persistent causes of embarrassment, and are sometimes a
trouble to those who may themselves be as conversant
with the term and the meaning of it, when they can get at
it, as the writer himself. I remember the word " endocar-
dium " being once written in such a way that at last it had
to be construed by a fortunate guess, derived not from the
84 PRACTICAL BIOMETKY.
word as it stood itself on the paper, but from the context
and by the process of excluding other words which it
might be from its appearance, but could not be from its
intention.
The words which are most difficult to read are those in
which a number of letters of a similar character appear,
especially such words as end in " urn " or " riurn," like
minimum, delirium, periosteum, endocardium, cerebrum ;
together with words like membrane, neuralgia, murmur,
aneurism, asthma. Difficulties arise again from the
employment of terms which are too strictly technical. It
would be a very great assistance if terms which every
person understands were invariably employed, such as
hooping-cough instead of pertussis, scarlet fever instead
of scarlatina, and so on.
Importance of Consistency in Method of Reporting.
The greatest difficulties, however, are met in the
attempt of a Board to arrive at a correct conclusion,
in every case which comes before it, as to the value of
the life proposed. It constantly happens, it happens
indeed nearly every Board day, that a life summed up
as being of the first class is disqualified from accept-
ance as such by some previous part of the report, in
which some detail prevents the Board from relying on
the general conclusion that is placed before it. The
irregularity thus mentioned is often singularly per-
plexing. The proposer knows, in all probability, from
the medical referee himself, that his life is returned as
belonging to the first class. He expects, thereupon, that
he shall be received by the Company as first class, and
then is surprised and vexed to hear that at the chief
office he has been accepted as not of first class, but as
bearing some addition upon his premium. The addi-
MEASUEEMENT OF LIFE IN HEALTH AND DISEASE. 85
tion to the premium may be small, but small as it may
be, it becomes a distinct annoyance. It puts the pro-
poser in an unsatisfactory state of mind with himself;
it makes him doubt ; it leads him to believe, implicitly,
that either the medical referee of the Company or his
own medical adviser has made a mistake ; or that the
medical officers who direct the Board have made a
mistake ; or that the Board is too particular or too
offhand in its selection from the reports that are
made to it.
Whichever of these views be taken, whichever is
naturally suggested, the result is unfortunate, and is a
most frequent source of misunderstanding or dispute.
I recommend, therefore, very earnestly, as a practical
suggestion in the filling up of returns, that the strictest
vigilance be paid to the mode in which the final state-
ment, regarding the class in which the life may be placed,
is filled up, so that the class selected may not, in any
respect, contradict the detailed statements which have
been given in the preceding part of the return.
Importance of avoiding Discrepancies between Details
and Summaries.
It sometimes occurs that the apparent discrepancy
between the summary and the detail is met by the
reporter in his explanation of reasons why he has
placed the life in a particular class. The reasons may
or may not be considered satisfactory by a Board, and
my experience is that they are not, as a rule, satis-
factory. In a considerable number of cases, they are
reasons, actually, of a disqualifying kind. They direct
attention to an objection, and then as it were explain
it away on the ground that other and favourable con-
ditions of health compensate for this one special dis-
86 PRACTICAL BIOMETRY.
qualification. To medical men discussing the refined
questions which arise out of these explanations, the
arguments set forth may be plain, reasonable, and prac-
tical. But to a lay Board they are rarely plain enough
or practical enough. To the mind of a Director who
is not learned in fine distinctions, the announcement of
one fault in respect to health and life is easily sufficient
to raise doubts as to the value of the life altogether.
He does not appreciate compensations. He shares in
the common, and on the whole sound, opinion that men
and women die around us every day from the simple
failure of one particular organ of the body ; that
every organ may be in perfect condition except one,
and yet that the whole may fail to live for no other
reason than that one organ fails to live. The Director
argues from this that the strength of the chain of
life, like that of a common mechanical chain, depends
on the perfection and resistance of each particular
link ; and if, therefore, there is pointed out to him a
faulty link in the chain of life, he, naturally enough,
doubts the chain, whatever may be said in favour of all
the other links of which it is made up.
It is also worthy of remembrance by those who
are dealing with special cases of lives proposed for
insurance, that the experience of men who week after
week are dealing with accumulated cases, leads them
to favour the correctness of the common view from
the evidence which is, on the large scale, presented
to them. They learn at the Board that a life enfeebled
in one organ is often less valuable than is a life in
which there is a general failure without any distinct
sign of special organic failure, because they see men who
are reported as good lives in every respect except in
regard to one particular failure, drop off unexpectedly,
MEASUREMENT OF LIFE IN HEALTH AND DISEASE. 87
and this so often as to lead to a more than ordi-
nary anxiety in respect to one organic fault or
failure.
On the whole, then, it is I think best for the medi-
cal referee who has detected any special failure in a
life before him to state that failure and its importance
without any defence, however skilful, derived from
other conditions of the body, in favour of the life. I
have known a murmur in the heart caused by valvular
obstruction, commented upon as compensated for by
the greater size and force of the heart, a size and force
which have been acquired by the very difficulty that lies
in the way of the blood, and which enable the heart to
overcome the difficulty. The argument is one which,
from a purely medical point of view, might be, to a
certain extent, sustainable ; but it is an argument which,
addressed to mere common-sense commercial men, is
out of the range of their experience, and is not con-
sidered as reliable enough to become the basis of a
commercial undertaking.
In the main, Directors leave decisions on those
points very largely to the judgment of one of their
medical advisers who is in immediate connection with
them, and the plan is attended with much practical
benefit. It is, in fact, the only plan that can be followed
when the report presents points which are purely
technical and professional in character. But even with
this form of precaution there is sometimes great diffi-
culty. The physician who has to report upon the
report of the medical referee has not the advantage,
or may not have had the advantage, of seeing the
proposer whose case is reported on, and, as a result, he
is unable to speak with the authority which he would
like to exercise. If he should speak authoritatively, and
88 PRACTICAL BIOMETRY.
at the same time adversely to the report, he is apt to
be considered as interfering with a document the state-
ments of which rest on evidence directly taken by the
reporter upon the case. The discussion which ensues
is liable to pass into a state which forces the Directors
to take on themselves the duty of acting as the final
judges of differing medical opinions, and of deciding on
the differences upon their own responsibility.
I repeat therefore, from the Directors' point of
view, as well as from the purely medical point of
view, the recommendation that in no report should any
stress be laid on compensating, or apparently compen-
sating, advantages for decided local defects in a pro-
posed life. It is best, in my judgment, for the referee
to state the facts as they are simply presented to him,
and to be content with pointing out, in as clear a
manner as possible, the precise nature of the local
mischief, and the precise conditions of all the other
organs of the body.
CHAPTER II.
DETAILED MEDICAL REFERENCES IN LIFE ASSURANCE.
IT will be seen by turning to the list of questions con-
fidentially addressed to the members of the medical
profession to whom the Directors refer, that the in-
quiries of a special scientific character on which they
seek for advice and guidance are, generally, the follow-
ing:
1. The appearance of the patient in regard to health,
bodily condition, and complexion. The height and the
weight of the person proposing ; and the appearance as
to age, that is to say, whether he or she looks to be
younger or older than is stated in the personal report.
2. The condition of the circulatory system. The
MEASUREMENT OF LIFE IN HEALTH AND DISEASE. 89
character of the pulse in respect to rhythm, volume,
regularity and force, the pulsations of the heart, and the
sounds of the heart. The condition of the veins, and
whether there is any chronic enlargement of them
varicose veins.
3. The configuration of the chest, and the state of
the lungs. The proportion and development of the
subclavian and cardiac regions of the chest ; the expan-
sion of the subclavian regions ; the rate and character of
the respiration ; the state of the lungs as determined by
percussion and auscultation.
4. The state of the tongue ; from which follows,
naturally, the inquiry and report on the condition of
the digestive system.
5. The condition of the kidneys and bladder in relation
to disease of the kidneys, the presence of calculus in the
bladder, the presence, in the male, of prostatic disease, the
existence of stricture.
6. The condition of the abdominal organs in reference,
specially, to diseases of the stomach, the liver, the spleen,
the pancreas, and the mesenteric glands.
7. The evidences as to the existence of constitutional
diseases, such as gout, rheumatism, scrofula, syphilis, and
cancer.
8. The inquiry on the question of rupture ; if rupture
be present the nature of it, the length of time it has been
present, and whether it is supported by a truss.
9. The evidences as to diseases of the nervous system,
cerebral or spinal, including observations as to any sign of
apoplexy, or danger of apoplectic seizure, and including,
also, any indications of mental derangement.
10. An inquiry, as determinate as can be made, in
respect to the habits of the person proposing to insure ;
whether the habits are regular, or irregular and in-
90 PRACTICAL BIOMETRY.
temperate. There is no answer that comes before a
Board of greater moment than the answer to this
inquiry.
11. The family history of the proposer, and the
hereditary dangers to which he or she may be fairly
considered subject.
12. The general impression and summary, in regard to
the health and life of the proposed insurer.
Without precisely following the order of inquiries as
given in the usual papers forwarded to the medical
referee, I have related the details that are specially
required at the Directors' Board. It will be seen that
they vary somewhat considerably in value, but with the
exception of that one inquiry which relates to the tongue,
they are all of such importance that an unfavourable
report upon any of them would be received, without
any general comment by the referee, as reducing or
invalidating the life.
Facts tliat most Impress a Board.
The facts that impress the Directors' Board most
unfavourably are the following :
1. A very decided variation from certain natural con-
ditions of height and weight of body, and of weight of
body in relation to age. Some particulars on this subject
will be supplied in a future page.
2. Decided indications of premature decline of life,
premature old age.
3. Spitting of blood, unless it be proved by the clearest
demonstration that the blood was derived from a purely
local source and was of trivial moment, such as bleeding
from an injury or accidental tear of the mucous membrane
of the mouth or throat, or from an inflamed, congested, or
MEASUREMENT OF LIFE IN HEALTH AND DISEASE. 91
ulcerated throat, if unattended by any symptoms of
chest affection.
4. All kinds of heart-disease that are decisively con-
nected with rheumatic affection ; valvular disease with
regurgitation ; structural degeneration ; permanent inter-
mittency of the heart ; arterial degeneration ; aneurism ;
persistent unnatural rapidity of pulse.
5. Contraction of the chest, with pointed or pigeon-
shaped projection of the sternum. Flattening under the
clavicles. Dulness of percussion in the subclavicular
region, with deficient expansion. Wavy respiration.
Feeble respiratory murmur. Crepitation in any part of
the lung ; or indications of emphysema, of bronchial
dilatation, or of bronchial spasm. Persistent unnatural
rapidity of respiration.
6. All conditions of the glandular organs that indicate
structural changes in the glands themselves or in the parts
connected with them, and especially in the kidneys and in
the urinary system. All the varieties of structural change
comprehended under the head of Bright's disease, and
attended with the passage of albumen in the urine, hold
an important place. Stone in the kidney or bladder, even
when the calculi are small and pass with the urine, is
considered as most important. Prostatic disease is always
understood as a serious disqualifying condition.
The other glandular organs, the liver, the spleen, the
mesenteric glands, the pancreas, and in the female subject
the breast, are well understood as seats of grave diseases,
and especially as seats of diseases of the malignant type.
Whatever is reported in respect to disease of these organs
is accepted as of special moment.
7. The diathetic conditions are well understood, and
the existence of family or constitutional taint never fails
to' attract attention and to be calculated upon according to
92 PRACTICAL BIOMETRY.
its natural meaning. The family history of tubercle and
of cancer is most considered. I shall show in a subse-
quent page that there are certain family histories of
these diseases which are held to disqualify the life
altogether for insurance.
8. All permanent nervous affections are regarded at
their full importance, but due care is bestowed in ob-
serving from the medical report whether the nervous
disease is functional or organic. Nervous affections, in-
cluding phenomena of a mental character and insanity,
are looked upon with much hesitation. Paralysis, in
every variety of it, is a formidable symptom, and usually
excludes, except it is local and the simple result of local
injury.
9. The report as to the habits of those who propose to
insure is held as of primary consideration, and seems to
be gaining more and more attention. Habits are well
understood in relation to their effects on the body and on
life by all intelligent men, and in summing up the results
of habits, no refined points of diagnosis are demanded.
The results are prominently proclaimed in the facts of
daily life. The habit which of all others is held of
moment is the drinking habit. What is commonly called
moderate drinking is now looked upon with extreme
care ; and what is called immoderate drinking, in-
temperance, even with qualifying clauses and distinc-
tions, is in these days accepted as one of the worst
introductions to the advantages of life insurance. Some
Boards reject those who are called intemperate in every
stage of the intemperate habit, and even prefer not to be
troubled with persons who, having been intemperate, are
reported as of entirely reformed character in that respect,
and as under the pledge of abstinence from all intoxicating
beverages. In a few Companies there is a special division
MEASUKEMENT OF LIFE IN HEALTH AND DISEASE. 93
of insurers who are pledged to total abstinence. These
are distinguished from moderate drinkers, so that they
may be able to realise the vital advantages belonging
to their mode of life.
10. All the forms of constitutional and chronic diseases
which depend upon organic changes and which are
described by symptoms indicative of persistent errors of
function are well understood, in respect to their vital
characters, by the Directors' Board. Such diseases as
diabetes, dropsies, piles, vertigo, faintness, insomnia,
angina, dysentery, dysuria, aphasia, are duly compre-
hended by their names, irrespectively of the medical
commentaries that may be made upon them. The mean-
ing also of some important local affections in regard to
the value of life, such affections, for instance, as arcus
senilis, glaucoma, cataract, labyrinthine vertigo, recurrent
eczema, and psoriasis, is now fairly understood by those
who sit regularly to receive and adjudicate on medical
reports.
COTEMPORARY PRACTICE AND
LITERATURE.
' Every physician will and ought to make observations from his own experience ;
but he will be able to make a better judgment and juster observations by
comparing what he reads and what he sees together." FEIEND.
PRA CTICAL BA CTERIOLOGY.
(BY EDGAR M. CROOKSHANK, M.B.)
T will remain for a future generation of men
of science to determine whether such a term
as " bacteriology " ought ever to have been
invented or applied. At best, the study con-
veyed by the term is a study of a branch of biology, and
whether it ought to be elevated to the full rank of the
department to which it belongs is indeed a doubtful
question. It is not likely that any of the masters in
science would have given it so unnatural a distinction ;
they would, for its own sake, have kept it in its true and
minor place, amongst the asteroids of the universe of
science, not the systems. Mr. Edgar Crookshank, whose
book published by H. K. Lewis, 1886 is now in hand, is,
however, not to blame for the term he has used in the
title of his work. If bacteriology be for a passing hour
admitted as a distinct science, whatever there is good in
it he has presented with industry, knowledge, ingenious
resource, and artistic skill of the highest order. He has
spared no time, no labour, no expense, to give to
medicine a book which will last as a mark of the present
time.
COTEMPOEAEY PEACTICE AND LITEEATUBE. 95
Presuming that any student shall desire to follow up
the branch of natural history here presented, he cannot
find a better groundwork on which to start than this
most clear and luminous guide ; and it adds to the value
of Mr. Crookshank's book, in no slight degree, that he is
cautious not to go too far in connecting bacterial forms
with disease, as producing and primary causes of disease.
He has gone quite far enough in this direction in treating
on what is called the Bacillus anthracis, where, probably,
he feels there is firmest ground for the etiologist to stand
upon. But, generally, he keeps to natural history, a most
commendable course, as saving him, conspicuously, from
the conceited dogmatism of a small and narrow school,
which would, if it were allowed to have its own way, trace
every accident leading to disease, from phthisis pul-
monalis to curvature of a limb, to a bacillus ; would
impose the belief that the coins of the realm, susceptible of
the pestiferous bacillus influence, may become the roots of
physical not less than moral evil ; would do its best to
turn the body medical into a grand army of inoculators
for the prevention of diseases that might not otherwise
exist ; and would be vain enough to attribute all the
successes of sanitation, achieved during the last half
century, to its own ephemeral clamour and utterly un-
reliable assumptions.
SPUTUM: ITS MICROSCOPY AND DIAGNOSTIC AND
PROGNOSTIC SIGNIFICATIONS.
(BY FRANCIS TROUP, M.D.)
HE reader of Mr. Crookshank's work noticed
above, should read with equal care Dr. Francis
Troup's volume on " Sputum," published by
Messrs. Oliver and Boyd, of Edinburgh, 1886.
Troup, who from his earliest student days has been one
96 COTEMPOBABY PRACTICE AND LITERATUBE.
of the most industrious and earnest men in the profession,
has opened his admirable volume with a list of thirty-
seven preceding authors on the subject before him
"Acta Eruditorum" but has produced, in fact, the first
real book upon it, and that in so complete a form as to
render it a permanent work for the medical library, and for
the student of advanced attainment. He begins by dividing
sputum into four classes or varieties (1) mucous, (2) muco-
puriform, (3) purulent, (4) serous. He next describes
the very simple instruments required for microscopically
observing and copying the grosser morphological ele-
ments of sputum, such as elastic tissue, spirals, and
crystals ; to which he adds a very useful table for
measurements of magnified objects. This he follows up
with a description of the photo-micrographic apparatus,
by which his volume has been copiously and wonderfully
illustrated from its beginning to its end, and with a diagram
showing the apparatus when it is ready for service.
Having prepared his readers to follow him by these
preliminary details, Troup proceeds to the demonstration
of all the varieties of sputum and the contents of it, dead
and living, met with in disease. On bacillus of tubercle,
chapter v., he devotes fifty-six pages, including four
beautifully-executed chromographs. On the topic of the
origin of tubercle in phthisical patients from bacillus
pure and simple, his argument is not convincing. It is
the argument of one wishing to believe and yet hesitating
over certain facts which make belief difficult. Why does
not the sputum of consumptives, expectorated everywhere,
rich in bacilli and spores which "have ample oppor-
tunities of drying up and pulverising, and of thus getting
wafted ubiquitously through the air and of reaching the
lungs, healthy or diseased, of mankind," why does it
not create universal phthisis ? Why do nine out of
COTEMPOBAEY PRACTICE AND LITERATURE. 97
ten of those who make up the general death-rate
escape phthisis after taking in the bacillus of tubercle ?
"Perhaps," he says, "healthy lungs with sound epi-
thelium deny power of ingress of the bacilli to their
tissues ; perhaps, if they do penetrate, they (the bacilli)
become encysted ; or the healthy cells or blood or tissue
juices are chemically so constituted as to destroy or starve
the intruders. There still reigns," he adds, " much that is
enigmatical in this struggle of cells and bacilli for exist-
ence, and no one has yet given an unexceptionable
explanation of the preponderating occurrence of cerebral
and intestinal tuberculosis in children and of pulmonary in
adult life." " I pray thee do not mock me, fellow-student ! "
No one will give an explanation to that very curious
question while the nervous system is left out of the
calculation, and the facts of heredity are laid at the feet
of the mushroom hypothesis. But your book, notwith-
standing, is one of the best books of modern physic.
VALVULAR DISEASE OF THE HEART.
(BY ARTHUR ERNEST SANSOM, M.D.)
>N a compact and useful little volume Dr.
Sansom brings out, through Messrs. A. and
J. Churchill, 1886, the second edition of his
Lettsomian. lectures on the treatment of some
forms of valvular disease of the heart.
In the first lecture he deals with endocarditis ; in the
second with mitral regurgitation ; and in the third with
mitral stenosis. The profession is so well informed on the
merits of Dr. Sansom's careful observations as a diagnos-
tician and pathologist, it is not necessary to review him in
detail on these points, but there are two rules bearing
on the treatment of mitral regurgitation which deserve
VOL. iv. 7
98 COTEMPORARY PRACTICE AND LITERATURE.
special attention. The first of these relates to the use of
caffeine in the treatment of cases of mitral regurgitation,
in which failure of compensation has occurred. Here
caffeine acts as a powerful diuretic, and is valuable when
dropsy has been manifested; it tends also to increase the
force of the heart, it calms the respiration, and reduces the
temperature. The second refers to a comparatively new
remedy in such cases, the Convallaria majalis, the lily
of the valley, administrable as an infusion of the flowers
and leaves. Sansom classes convallaria with digitalis as
a stimulant of the muscular fibre of the heart, but from
very careful observation as to its effects on the pulse, the
respiration, the temperature, and the renal secretion, he
comes to the conclusion that as compared with digitalis it
is inferior in therapeutical value ; that in cases manifesting
dropsy it should be accompanied with caffeine, and that it
should be continued for no longer than weekly periods
without interruption.
Like all advanced physicians, Dr. Sansom recognises
the value of general hygiene and dietary in the treatment
of cardiac affections, and his notes on this subject (pages
104-12), in which he brings to a close the lecture on
mitral regurgitation, are exceedingly valuable and common-
sense.
DIGITAL EXPLORATION OF THE (ESOPHAGUS.
(BY MAURICE H. RICHARDSON, M.D.)
>HE Boston Medical and Surgical Journal for
December 16th contains a paper by Dr.
Maurice H. Richardson, in which he describes
an operation performed by himself, that may
be considered as presenting one or two features entirely
novel in the art of surgery. In brief, a man thirty-seven
COTEMPORARY PRACTICE AND LITERATURE. 99
years of age, six feet one and a half inches high, came
to the Massachusetts General Hospital on September 26th,
1885, stating that three da}^s, previously, he had swallowed
his false teeth. A coin probang passed into the
oesophagus was caught under the plate of the teeth, and
the end broke off, but was passed by the bowels some
days later on. On December 3rd he left the hospital,
being able to swallow, but had not passed the teeth. On
July 3rd, 1886, he re-entered the hospital, the teeth still
lodged in the oesophagus, as nearly as could be estimated
about two inches above the line of the nipples. He was
now much emaciated, and as every effort failed for remov-
ing the teeth through the upper part of the oesophagus, he
gladly assented to the operation of gastrotomy.
On August 5th, 1886, the patient being carefully
etherised, Dr. Maurice Eichardson made an opening in the
left hypochondrium, three inches from the tip of the ensi-
form cartilage and extending outwards and downwards.
The peritoneum was opened, the stomach was raised and
opened, an incision made large enough to admit the hand
and forearm of the operator, the hand passing, seemingly,
a very great distance until the plate was felt, and, after a
second careful manipulation of the index finger, was with-
drawn from the stomach. The mucous membrane of the
stomach was united with a continuous silk suture, and
the peritoneal membrane with thirty-six fine silk sutures.
The stomach was dropped back into its natural place, the
external wound was closed with interrupted deep and
superficial silk sutures, after the peritoneal cavity had been
carefully sponged out, and iodoform and gauze dressings
were applied. On the 13th of August the patient began
to take liquid food by the mouth; on the 19th had scraped
beef for dinner ; on the 21st took solid food in quite large
quantities ; on the 2nd of September was walking about ;
100 POST SCRIPTA.
and on the 25th of October returned to his work as a
teamster. I congratulate my namesake on his success, and
commend his paper to all surgical readers, not only as an
historical record, but as containing a very useful epitome
of the various cases in which gastrotomy has been
performed by other chirurgeons.
POST SCRIPTA.
THE APPENDIX.
TJie Appendix of Acknowledy inent* of Books, Pamphlets, Magazines, Reports,
and Exchanges for this quarter will be j)ublis7ted in the next number of THE
ASCLEPIAD.
TO CORRESPONDENTS.
Books, Reports, and Pamphlet* intended for notice in THE ASCLEPIAD should be
addressed to the Author at his residence, 25. Mancliester Square, London, W.
Names of Subscribers and other Matters of Business should be forwarded to Messrs.
Longman*. Paternoster Run; London, E.G.
Advertisements, and all Communications respecting them, should be forwarded to
Mr. A. P. Watt, 34, Paternoster Row, London. E.C.
The Author icttl be greatly obliged if senders of Newsp<ipers and Magazines would
kindly ma,rk the passatjex to which they wish to direct attention.
3lanuarp
rafTfer^^^^
dmAalflfcaij
;
r^^F^?
ON THE PHENOMENA OF PALPITATION
WITH AND WITHOUT INTERMITTENCY
OF THE HEART AND CIRCULATION.
N the ASCLEPIAD for July 1884, Vol. I., pp. 193-
211, I treated upon the phenomena of inter-
mittency of the heart and circulation. In
the present essay I propose to treat on the
phenomena of palpitation.
Between the two series of phenomena there is some-
thing that is in common and something that is
distinctive.
I.
SYMPTOMS OF PALPITATION OF THE HEART.
I believe that all persons who suffer from intermittent
pulse have occasional attacks of palpitation, but some
persons have palpitation who are not liable to inter-
mittent action. The symptom of palpitation is not
always well denned, nor is it at all times denned in the
same terms. One person calls it a fluttering of the
heart ; another, a fluttering within the chest ; a third,
palpitation or throbbing. The symptom, moreover, is
not uniform in character. At first it is noticed as if
proceeding from the stomach and ascending to the
throat, giving a singularly unpleasant tickling sensa-
tion in the back of the throat, with fulness. Exertion
VOL. iv. 8
102 ON THE" PHENOMENA OF PALPITATION.
after meals is a common apparent cause of this palpita-
tion, which, though comparatively devoid of danger, is
still often a disagreeable and even alarming condition
to those who have to endure it. After a time other
symptoms occur, and are embarrassing. On lying
down to sleep there is disturbed action or movement
in the chest, with over-action of the heart, so that the
action can be heard loudly through the pillow, and this
is followed by frequent twitching of the muscles of the
limbs, of the lower limbs especially. In most instances
of this character the limbs actually move as if under the
influence of a galvanic shock, and with the movement,
or immediately preceding it, is a painless movement in
the chest, as if from a jerking action of the heart itself.
During this condition the motion of the heart may be
actually intermittent, but the jerk I speak of is dis-
tinct from intermittent action. All the time through
there is no pain, and I may add that all the time
through there is no spasm. In this point of view the
paroxysm of palpitation differs from a paroxysm of
cardiac apnoea. Physiologically, the motor tracts only
of the nervous organism are deranged. After a longer
or shorter period sleep comes on, at first perhaps a start-
ing and disturbed sleep, but anon quiet. With the
quiet, and with placid sleep, all the signs of palpitation
and of irregular muscular motion disappear.
In persons strongly disposed to the form of palpita-
tion now described, it is remarkable how small a matter
will excite a paroxysm in the latter part of the day ; late
hours, indulgence in strong tea, indulgence in tobacco,
too hearty a supper, these all tend to bring on the
irregular action and the sleepless disquiet. But that
which induces the nervous symptoms most readily is
emotion or continued mental exertion. Either of
ON THE PHENOMENA OF PALPITATION. 103
these, especially at the hour of rest, is peculiarly
provocative of the mischief of which I now speak.
Some amusements of the evening, even, lead to this
disturbance. Chess is a game very bad for a late
hour ; played earnestly and intelligently, it calls special
faculties into undue action at the expense of other
faculties; it leaves active faculties at work; it leaves,
that is to say, some of the cerebral centres still think-
ing, and these, like troublesome, noisy companions, are
fatal to repose. In a lesser degree, and with irritable
persons in as great a degree, late whist is bad. Nay, I
know of nothing worse than quarrelsome whist with the
stake high. A game of this kind may be ended, but
hours will pass before the dissatisfied and quarrelling
mental organs within the player will arrange terms and
settle down. Eeading late in the night and reading
or speaking aloud late are especially mischievous.
The worst mischief of all is the practice of carrying
to bed the anxieties and annoyances of the labours of
the day. I believe that more than half the cases of
palpitation of the heart occur from this one mistaken
and foolish practice. It is a practice from which success
can never follow, for the organ that must work must
rest, and if it do not rest diurnally its proper time, it
will rest annually in time to come i.e., it will die while
the rest of the organism lives, and then there will be
physical anarchy, disease of the kingdom of mind, one
of the great estates defunct, and the balance lost.
The condition of the heart when it palpitates is not
greatly different from what occurs during intermittent
action : that is to say, if the palpitating organ be sub-
mitted to auscultation there will be heard a quick
repetition of second sounds with an occasional first
sound. The sounds may run sharply thus : Lub diip 0.
104 ON THE PHENOMENA OF PALPITATION.
Ddp diip 0. Dup dup 0. Lub dup 0. Diip diip. Lub
dup dup. Lub diip. Diip dup 0. Lub dup 0. The
motion of the heart is at first extremely rapid, and the
first indication of recovery from the disturbance of
balance is slower action of the heart.
SPHTGMOGEAPHIC EEADINGS OP PALPITATION.
The readings of the pulse during palpitation of the
heart are very singular. It is not often that the
physician gets the opportunity of taking the readings,
because it is rare that he sees the patient while the
paroxysm is on. I myself, although in the course of the
year I am consulted by a great many persons who com-
plain of palpitation, have been obliged to wait a con-
siderable time before being able to obtain a set of
readings which should satisfactorily mark out the
pulse during the period of palpitating movement.
I have now obtained seven such tracings, and as each
of them tells a different history from a clinical point of
observation, I shall follow them, and the details con-
nected with them, in orderly review.
(a) Simple or Uncomplicated Palpitation.
The reading supplied in the annexed diagram (Fig. 1)
Fig. 1.
is derived from a case of what I may venture to call
simple or uncomplicated palpitation. In this patient
ON THE PHENOMENA OF PALPITATION. 105
there are no indications whatever of organic disease
of the heart, neither is there any indication of inter-
mittency of the heart. It is the case of a lady forty
years old, of active hahits and of strong will, who has
passed through many years of grief and trouble, who
has not broken down under her trouble, but has faced
it bravely, and who, taking everything into considera-
tion, has remained in good, if not robust, health, present-
ing no trace whatever of organic disease of any kind.
After some accession of mental trouble which had
led to sleepless nights, this patient came to consult me
respecting what she described as "waking up with
palpitation." She would lie awake in bed with her
mind too active, until at last, overpowered, she would
fall into a doze. Suddenly she would start up, awakened
by the most violent throbbing and palpitation of the
heart, a palpitation which she could not only feel, but,
at extreme stages, could hear and see. The attack, she
believed, was always relieved by getting out of bed and
standing up so as to hold or clutch the back of a chair,
the chimney-piece, or the foot of the bed. No flatulency
attended the paroxysm, no faintness, no dizziness, no
pain. Each attack lasted about the same time, from
seven to eleven minutes, and then almost suddenly sub-
sided, leaving behind it a sense of exhaustion, and some-
times an aching in the back and loins, which aching
might, however, be merely the result of the strained
position in which she sought relief. Sleep usually
followed each attack of palpitation in the early stages
of the affection, but later on it did not follow so readily,
and the paroxysms occasionally occurred in the day-
time. One morning after a very disturbed night a
seizure came on while the patient was in the consult-
ing room. It was " not one of her worst " attacks, and
106 ON THE PHENOMENA OF PALPITATION.
I was enabled to take the reading rendered above with-
out adding to her excitement or anxiety.
In order to observe the changes of the pulsation
which were in progress whilst the palpitation was
present, it will be instructive to compare the sphygmo-
graphic reading during palpitation with a standard
or natural pulse reading here subjoined (Fig. 2).
In making this comparison, the first thing noticeable
is that the square of the pulse reading is lost in the pal-
pitating pulse. In the natural pulse the straight up-
right stroke, marking the impulse, passes through four
and a-half degrees or nine millimetres of the standard
scale, and the distance from one stroke to another,
cceteris paribus, is precisely that of the length of the
impulse stroke, so that the whole of the series of events
as written by the pulse constitute a square. In the
palpitating pulse this is much changed ; the impulse
stroke passes in many cases through six degrees of the
scale, and the distance between the impulse strokes is
reduced to one-half the length of the impulse. Thus
there is increased impulse with quickened action ; and
this is what was observable without looking at the
reading of the sphygmograph, for the pulse was beating
doubly as fast as natural, namely, at 130 a minute, and
the impulse felt by the finger was strong.
Other variations are seen between the natural and the
palpitating pulse in the oblique descending line, with
its curves, which runs from the top of one impulse line
ON THE PHENOMENA OF PALPITATION. 107
to the base of the next. In the natural pulse the first
part of the oblique descending line is through three
degrees or six min. , followed by a rise of half a degree or
one mm. ; then by a second descent of one degree or
two mm. ; a third rise, of half a degree or one mm. ; and
a final descent of one degree and a-half or three mm. , to
reach the base of the next line of impulse.
In the palpitating pulse the impulse or ascending
line is unequal. It sometimes, as will be seen, passes
through six degrees, but now and then it falls short of
this by a full degree, and once rises a little above. The
first descent is prolonged by a full degree, the re-ascent
is prolonged.
But after all, what is shown by this tracing is simply
the motion of an over-speeded heart with a little irregu-
larity. It is a pure type of uncomplicated palpitation
of nervous origin.
(b) Palpitation witli Intermittency.
In the next diagram there is depicted a characteristic
tracing taken from a patient in whom occasional
intermittency of pulse, often extreme in character, is
sometimes combined with palpitation.
In this case the sufferer is a lady sixty-four years of
age, who also has led an anxious and wearing life.
She is still strong, and, when well, active ; is of light
build, and of sanguine temperament. She has consulted
me from time to time, during many years past, for an in-
termittency of the heart, the cause of which she traces
back to a great mental shock arising from the death of
her husband. She had become so accustomed to the
intermission of the pulse that she had lost the dread of
it, but one day, after sharp exercise, " while recovering
from a cold which had prostrated her," she was seized
108 ON THE PHENOMENA OF PALPITATION.
in the street with palpitation, and for many weeks had
recurrent attacks of the same kind, from which, for-
tunately, she has now recovered.
I commence the tracings of the pulse in this patient
with one which shows her ordinary pulse when she is
free both of intermittency and of palpitation. It will
be seen from this reading that the heart is fairly natural
in impulse and in order of work. It numbers seventy-
two to the minute (Fig. 3).
Under slight excitement or exhaustion, the pulse,
natural during the greater number of beats, presents a
peculiar intermission, as shown below, in which an
intermittency of two beats is broken by two minor im-
pulses. In this condition it will be observed that the
impulse stroke is greatly increased in length (Fig. 4).
Fig. 4.
In very bad states of depression this patient exhibits
the intermittency in extreme degree. Of the pulse
tracings then presented the reading next given is a fair
specimen (Fig. 5).
ON THE PHENOMENA OF PALPITATION.
109
In this tracing it is well shown how much the im-
pulse is increased when the intermittency is severe, and
how long is the interspace between the impulses even
when there is no distinct break of stroke.
The last reading from this same patient illustrates
the condition of palpitation in combination with slight
intermittency (Fig. 6). There is in this case, again, no
sign of cardiac disease. The symptoms of palpitation
and of intermittency both depend upon irregular
nervous supply.
(c) Palpitation witli Permanent Intermittency.
In some instances of chronic intermittency of the
heart the paroxysm of palpitation occurs between the
periods of intermission, and becomes then a most
agitating symptom.
The diagram next submitted (Fig. 7) is an example of
this kind from the pulse tracing of a gentleman seventy
years of age, who has been a sufferer from intermittent
circulation for over twenty-five years. In his case
110 ON THE PHENOMENA OF PALPITATION.
there is no cardiac murmur, neither is there any indi-
cation of cardiac obstruction. He moves about very
Fig. 7.
freely, goes out to business frequently, and, as a general
rule, retains a fair appetite and health. But at periods
there is added to the ordinary break in the pulse beat
a sharp attack of what he calls fluttering or palpitation,
which without being painful, in the acute sense of that
word, is both alarming and distressing. The paroxysms
last often for a period of an hour, and when they once
begin to appear are apt to recur two or three times in
a day. The tracing supplied was taken at 11 A.M., during
one of these periods cf frequent recurrence of palpitation.
In this state of the circulation some nervous excite-
ment stimulates the intermitting heart into ineffective
attempts to action during the prolonged breaks or
lapses of the full cardiac action.
(d) Palpitation ivith Organic Cardiac Disease.
Palpitation, according to my experience, is a com-
paratively rare accompaniment of chronic valvular or
other form of organic cardiac disease. It is so rare that
I have come to look upon it as phenomenal ; but if it
does present itself it is an unusually serious complica-
tion, and is, I suspect, in valvular affections, the cause,
occasionally, of fatal catastrophe. I have been able to
take one tracing, herewith subjoined (Fig. 8), in which
the palpitation was developed during the existence
ON THE PHENOMENA OF PALPITATION. Ill
of valvular disease, with aortic inefficiency, of long
standing.
Fig. 8.
Spliygmoplwnic Signs of Cardiac Palpitation.
The symptoms of palpitation are well expressed by
the sphygmograph, but they are also very well defined
by the sphygmophone, of which a description is given
in the ASCLEPIAD, Vol. III., pp. 357-8. During pal-
pitation the needle, whilst crossing the vibrating
screen, instead of translating the curves into three
distinct sounds yields one rapid sound only, delivered
with a "burr," something like a word that would
be spelt burtlir. It is a sound quite characteristic,
and is a good additional diagnostic to those which have
been previously described.
II.
EXTRA CARDIAC OR ARTERIAL PALPITATION.
Up to this point I have been treating, exclusively, of
palpitation of the heart ; but there remains yet for con-
sideration a form of palpitation, very obscure as to its
nature, and sometimes very troublesome, which, because
it does not seem to be connected with the heart, I have
called extra cardiac, and, because it is connected with
the arteries, arterial palpitation.
The most common seat of this symptom is in the
region of the stomach, and it has therefore been
112 ON THE PHENOMENA OF PALPITATION.
designated, I believe in the first instance by the
learned Cabanis, epigastric palpitation.
I had read of the symptom, but had not been forcibly
impressed with the lesson, until I met with a direct
observation from nature, which made me curious to
know more.
One of the most eminent of living men in physical
science first pointed out to me the fact that even severe
palpitation may not be cardiac, because he himself
constantly had palpitation in the epigastrium when his
pulse at the wrist was quite steady and slow. As I
seemed to doubt the correctness of his observation for
he was the subject of intermittent pulse he one day
drove up to me at my house. " Now," said he, "I have
unbearable palpitation ; you can see it through my
clothes, and it makes me feel faint, but it is distinct
from the intermittent action of my heart, and from the
actions of ray heart or pulse at the wrist, as you will
find." His observation was accurate. His heart was
beating seventy-four times a minute, with intermit-
tent action at every twenty-sixth stroke, but the motion
of the heart was tranquil, and was entirely distinct from
the rapid vehement palpitation which he felt. The
palpitation was from some pulsating action immediately
below the heart ; it was epigastric, and had no relation
in regard of stroke to the motion of the heart.
By being more careful in examination, I have,
since this case, found the same phenomenon viz.,
tumultuous action or fluttering felt as if beneath the
chest, without any actual disturbance in the motion of
the heart. This palpitation is usually accompanied
with a sense of fulness in the throat, and is relieved by
the eructation of flatus, or by the passage of gas along
the small intestines into the colon. The pulsation can
ON THE PHENOMENA OF PALPITATION. 113
be felt by the observer very distinctly, and it can also
be heard through the stethoscope, but not always in
exactly the same place. It is usually heard most dis-
tinctly in the epigastric region, centrally, a little below
the lower point of the sternum ; it consists of a series
of quick throbs, very full and bounding, sometimes with
a faint murmur. In my first communication on this
symptom I thought it was due to a tremulous rapid
movement in some of the fibres of the diaphragm, but
further experience has proved to me that the pulsation
is really vascular, and that it is due to motion in some
of the large vessels which proceed from the aorta to
feed the abdominal viscera, probably the coeliac axis. It
is as if the nervous supply to the vessel were rendered
in an irregular or disturbed manner, and the vessel
underwent a rapid series of contractile and dilating
movements, independently of the cardiac impulses.
Epigastric palpitation is rarely prolonged, and, although
it is painfully disagreeable, it is not often of serious
moment. It is less commonly connected with inter-
mittent action of the heart than is the true cardiac
palpitation.
Muscular Palpitation.
There are some peculiar movements or flutterings to
which the people sometimes apply the term palpitation.
One of these is a nervous symptom consisting of quick
involuntary movement in the body of the biceps or
triceps of the upper limb, or of one of the muscles of
the thigh or of the calf of the leg, by which the
muscle is not made to move the limb, but is felt to
flutter or palpitate. There is another kind of fluttering
in the chest occasionally spoken of, which is, I think,
114 ON THE PHENOMENA OF PALPITATION.
connected with the muscular columns of the diaphragm,
and which resembles that above described as felt in
the voluntary muscles. Once I have known these
flutterings to be connected with cardiac palpitation,
and that in a way which suggested some common
origin.
III.
ORIGIN AND CAUSE OF PALPITATION.
The origin of palpitation is obscure, but the seat of
it is clearly in the nervous system, and most probably
in the sympathetic nervous chain. With all emotion,
that is not vehemently extreme, there is quickened
movement of the heart, as when one says, in
common phrase, "the heart beats high," and in that
excess of action there is a first stage of palpitation.
Sometimes, indeed, the term is used in common
language when the heart palpitates with ordinary
excitement, of joy or trepidation. All these ordinary
and, as they may perhaps be called, natural palpita-
tions are no doubt derived from external impressions,
vibrations carried through the senses to the organic
nervous centres supplying the heart, and transmitted by
them to the pulsating organ itself, thereby increasing
the rapidity of its beat. The palpitation of disease
seems to be produced also by an excitation of those
centres, either from an undue degree of excitability
in them, or from some excess of vibration direct or
reflex conveyed to them.
The influence at work in producing cardiac palpita-
tion is akin to that which produces intermittent move-
ment, but the change is functional and temporary.
When the vapour of nitrite of amyl is inhaled for a few
seconds it has the effect, even in strong persons, of
ON THE PHENOMENA OF PALPITATION. 115
exciting the organic ganglia ; and quick, vehement,
and palpitating action of the heart is the immediate
result.
It is certain that there is no necessity for any organic
disease to exist in the heart itself in order that the
phenomena of palpitation may be developed. The
palpitating heart may be a diseased heart, but it need
not be so ; and because the heart is organically diseased
there is no more reason why it should be affected with
palpitation than if it were healthy. In other words,
there is no definite morbid anatomy known that
accounts for the phenomena of palpitation, and it can
scarcely be said that there is so much as a sound
theoretical explanation.
It may be observed, generally, that the subjects of
palpitation are, as a rule, of nervous temperament.
They are "impressionable" people, and they are also
people of active natures. In childhood they were
exceptionally sensitive, and they remain so. One of
them explained to me, in describing himself, that " in
moments of trial, when speech is wanted, words choke
utterance, and then palpitation is sure to come ; " an
excellent description.
IV.
TREATMENT OF PALPITATION.
The treatment of palpitation is moral, hygienic, and
medical, and the value of these stands in the order
in which I have placed them.
Moral Treatment.
In the moral treatment the grand point is to impress
the sufferer with the confidence that there is no instant
danger from the seizure ; for palpitation is fed by fear,
116 ON THE PHENOMENA OF PALPITATION.
and so little as an expression of fear by the looker-
on increases the intensity of the over-action. In like
manner all hurry and worry aggravates the symptom,
and so, during the attack, the utmost care should be
taken to avoid noise, haste, and fussiness. A gentle
persuasion towards quietness, a firm assurance that the
seizure will very soon pass away, and the best help of
an encouraging kind is supplied.
Hygienic Treatment.
The hygienic measures for the treatment of palpita-
tion have reference to the directions which should be
given for warding off the attacks and for removing
the unhealthy conditions of body which dispose
towards them. In these directions it is essential to
include, first and foremost, the removal of all possible
causes of excitement, worry, and exhaustion, mental
or physical. To this must be enjoined regular habits
of life. Early hours for bed are requisite, and a con-
tinuance in bed in the recumbent position for eight
hours out of the twenty-four at the least is very
important. During the day moderate outdoor exercise,
with avoidance of rapidity and of over-action from
climbing steep ascents, should be specially enforced.
To the moderate open-air exercise above suggested
should be added daily and free ablution in water just
sufficiently warm not to create a shock or to leave a
sense of chilliness of the skin. Brisk friction and use
of the flesh-brush may follow the bath with advantage.
I would, however, while on the subject of baths offer
a word of warning as to the Turkish or Eoman bath in
this class of case. Good as that bath is in cases of
disease properly selected for it, it is not good for
persons subject to acute and extreme palpitation. The
ON THE PHENOMENA OP PALPITATION. 117
stimulus of the heat has caused in two patients I
have known a severe and troublesome seizure.
Meals should he taken at regular times ; at no time
should a heavy meal he indulged in, and the simpler
the diet the better. Some articles of diet in ordinary
use should .be limited. Too much animal food is bad.
Light and easily digested foods, in moderate quantities,
and fresh fruits are always good. In one of my cases
a trial of a purely vegetarian system of diet had un-
questionably a very good result, but as different scales
of diet are suitable for different persons I cannot here
lay down any hard-and-fast rule. The plan I am
accustomed to follow in prescribing diet is to find out
from the patient's own report what articles of diet suit
best, and then to use my own judgment, at the time,
for advising the selection.
As regards drinks, there are three which, in my ex-
perience, are always unfavourable in cases of palpita-
tion. These are tea, coffee, and alcohol in every shape.
.1 know of no case of the kind in which tea has not
proved injurious. Coffee is not so bad as tea, alto-
gether, but there are very few instances in which coffee
can be readily tolerated. Alcohol is often much craved
after, but it is a most deceitful ally. A little excess of
it is prone of itself to excite the over-action without
any other spur, and soon after it has been removed
from the body it causes a depression which favours the
recurrence of palpitation, under any excitement, in
the most marked degree. The quantity of fluid taken
should be limited in amount, and as to quality, the
nearer it comes to water pure and simple the better.
Something requires to be said about mental as
well as physical food. Eeadings, amusements, and
pastimes which keenly affect the emotional faculties
VOL. iv. 9
118 ON THE PHENOMENA OF PALPITATION.
are to be avoided as much as any more plainly physical
forms of excitement. Whatever mental food keeps the
mind awake, whatever makes the sufferer hold his
breath with wooder or anxiety, is bad as bad can be.
Exciting novels, plays, exercises, games of chance,
should most surely be put aside. But good, steady,
pleasant mental work is not harmless merely, it is use-
ful ; it prevents the mind from brooding over the
bodily incapacity, and it becomes an element of cure.
Under this head of hygienic practice, there is one
habit, bearing chiefly on the male sex, to which I must
allude, and against which it is absolutely necessary to
protest. I refer to the habit of smoking tobacco, and to
the use of tobacco as a luxury in every way. Tobacco
is the worst of enemies to soundness of heart, and
steadiness of heart work. To those who are subject to
acute palpitation, tobacco is so mischievous that it is
hopeless to attempt to treat them until the habit is
abandoned. On this point there must be no mistake.
Medical Treatment.
During an attack of acute cardiac palpitation,
medical treatment of a direct kind can only be pallia-
tive. It is a common practice to place the patient in
the perfectly recumbent position, but as this position
leads, frequently, to breathlessness and much discom-
fort, I never enforce it unduly. The sufferers usually
find out the best position for themselves, and standing
up, and even gentle walking backwards and forwards,
commonly appear to bring relief, as if the general
muscular action equalised the local over-action.
For the actual palpitation, digitalis is the only
remedy I have found of any positive service, and it
combines well with remedies which have a tendency to
ON THE PHENOMENA OF PALPITATION. 119
promote, quickly, the cutaneous and renal excretions.
I usually prescribe the tincture of digitalis in five or
ten minim doses, with half a fluid drachm of nitric
ether, and two fluid drachms of the liquor ammoniaB
acetatis. In instances where there has been prolonged
sleeplessness with palpitation, I have combined morphia
in full doses with digitalis with good effect, adding the
narcotic dose to the formula just named.
In general treatment I am accustomed to follow,
whether the heart be organically sound or unsound,
the same methods as those described in my previous
essay on intermittency. The organic bromides of
iron, quinine, and morphia, and the mixture of iron
carbonate, ammonia, and morphia (ASCLEPIAD, Vol. I.,
p. 204), are excellent remedies. The only difference
in treatment, in fact, relates to the use of alcohol,
which, valuable in some cases of intermittency, is
less compatible in cases of palpitation.
Treatment of Epigastric Palpitation.
The rules already offered for the management of
cardiac apply equally to the epigastric palpitation.
There is, however, in cases of epigastric palpitation
more frequent necessity to meet dyspeptic symptoms,
including flatulency and constipation, by alterative
and mild aperient correctives.
ON WINTER PALACES OF HEALTH AND
CAMPS OF HEALTH AT HOME. A PRAC-
TICABLE IDEAL.
early return of many invalids who went
out lately to Italy and the southern part of
France, in order to spend their winter in a
more genial climate than our own, has led
me to recast a project which I hroached twenty-two
years ago for establishing in our own islands winter
palaces and homes for the sick.
At the time named above my friend Dr. Henry
Bennett had not made a Mentone abroad, and no
greater desideratum was wanted than the health resort
which he practically discovered and founded. We all
owe him a deep debt of gratitude, and I would not, on
my part, encourage for a moment any mere childish
fears respecting the late earthquake that should injure
his good and useful work.
But while the phenomenon of the great earthquake
lias the effect of directing the minds of people to the
subject of winter residences, the opportunity seems
wide open for asking the thoughtful to reconsider the
suggestion I would once more offer respecting home
residences for the winter season.
If we could in these islands of ours give our invalids
ON WINTEE PALACES OF HEALTH.
all the benefits of an Italian summer as a supple-
mentary means of health, and even as a change from
one pleasant scene to another, we should be render-
ing an important service. To thousands of invalids
who are anxious for a warm winter residence >
and who require such residence, there stands in the
way the absolute impossibility of going to it so long
as it is abroad. One cannot afford the expenses of
the journey. A second has an objection to cross the
sea. A third has friends whom it is not advisable or
not possible to leave. A fourth is really too ill to
undertake a journey to the south of France or other
spot equally distant. A fifth has been abroad and.
has not been benefited by the change, or has received
a doubtful advantage with so many discomforts or dis-
likes that return to the same is not palatable. A sixth
does not like to be removed from the care of friends to
whom he or she is accustomed, or from m'edical advisers
who have inspired particular confidence. Lastly, many
require to be at home in order to secure, as suitable for
their particular case, certain aids and appliances
which may not be continuously obtainable in a foreign
place.
Supposing a hundred Mentones or other similar
places were in existence, and were all well filled, there
would remain still an enormous population which would
be glad to avail itself of the advantages derivable from
residence in the ideal health-spots which I am about to
describe.
I am not speaking here from any imaginary experi-
ence, but from the actual experience which is known to
every physician who is in active practice. It is a
matter of consultation over and over again in my life
whether some invalid shall or shall not leave England
122 ON WINTER PALACES OF HEALTH
for winter residence abroad, or whether, all things con-
sidered, it is not best to advise home residence. Con-
stantly, when I press the advantages that would follow
the change to a warmer climate, I am met with the
direct intimation that what is urged cannot be carried
out. To the sick person the fact may be most dis-
tressing, but there it is. Then compromises have to
be considered, and some English place not as yet fully
adapted to the purpose, but the best that can be got
under the circumstances, has to be proposed.
Let me, in support of the project, add yet another
reason, national and may I not say patriotic. I base
the scheme I have to propose on the full assurance that
whatever Nature has done for man, that same thing man
can imitate. Man can and does effect what Nature does
not : he makes steam engines and telephones, which she
does not, and therefore he often works in a marvellous
manner quite independently of her. At the same time
he can imitate her, he can adapt her plans to his pur-
poses, and he can, if he pleases, build a town and endow
it with a climate which shall have all the advantages
any natural place may have. In plain words, he can, if
he will, compete with Nature in the matter of climate,
and in the matter of steadiness of climate can beat her.
My library in London, in which this paper is written,
has had a climate of 64 Fahr., with constantly changing
air, since the 1st of last November until this month of
April. To compare so very small a thing as this with a
great thing. If one room eighteen feet square can be
kept all through a very sharp and severe winter at mild
summer warmth, why cannot a court eighteen yards
square be kept in the same condition ; and if a court
eighteen yards square, why not a town eighteen hundred
yards square, if that were wanted ? It is, after all, no
AND CAMPS OP HEALTH AT HOME. 123
more than a question of degree measured by human
necessity and human demand.
WINTER PALACES OF HEALTH.
What then shall be said that is not in favour of this
demand ? The necessity is clear enough ; why shall it
not be gratified ? At this moment the one great cry in
England is honest work for honest labour. Here is the
grand opportunity. Here is work for a hundred thou-
sand hands at least, to build in Great Britain a hun-
dred winter towns that shall defy and beat Nature on
her own ground. With the forces of men now un-
employed, and ready for work, the whole change I
would suggest could be carried out in five years, and
then there would remain plenty more to be done in
continuation and elaboration of the original plan.
The idea of this, plan first suggested itself to me at
the city of Bath, when engaged there in writing the
medical history of that city, in the year 1865, for the
Medical Times and Gazette. I wrote then of Bath that
its climate and its site were equally advantageous for
invalids, and that few, if any, cities in England are so
favourably placed for supplying the essentials of health.
After describing the geological foundations of the city,
I ventured to express that the general advantages are
far superior to the value of its far-famed waters as mere
medicinal waters. And I added the suggestion, "If a
large winter palace of glass were erected in Bath, and
were warmed by the application of the heated water
which now flows from the springs into the Avon, Bath
would be made one of the grandest resorts in the
kingdom, perhaps in the world, for sufferers from
various affections of the chest. Up to this time Bath
has not been famous as a resort for consumptives,
124 ON WINTER PALACES OF HEALTH
simply because it seems to be an idea that the waters
are not specific in consumption. But Bath is, in fact,
the beau ideal of a winter residence for this class of
invalid." *
Eecalling the design I had at that time in my mind,
I retain the impression, unchanged, that there is a site
in Bath on which under glass the most perfect winter
residence in the world could be constructed ; that, with
a very little addition of heat, the lost water, already
heated half-way towards boiling point by natural means,
could be utilised to bring up the walks, gardens, and
lawns of the residency to equable temperature of from
60 to 70 Fahr. during the coldest season; that in
these gardens flowers and subtropical plants could be
cultivated in all their beauty, and with all their health-
giving properties ; and that in such grounds, leading
directly out of the residences, the sick could find every
enjoyment and every amusement, mental and physical,
that was best adapted to their condition, treatment,
and possible cure.
In respect to the method of construction, it occurred
to me at the time, and repeats itself to me now, that
the residences should consist of substantially built
houses of two stories, surrounding a square of gardens
covered with glass, with four grand entrances. Each
of these houses should be divided into an upper and
lower flat sixty feet deep from the front, twenty-five
feet wide, and fitted with every convenience for the
residence of an invalid, and with every room and part
at equable and adjustable temperature. The two sets of
flats, upper and lower, numbering say one hundred
altogether, would accommodate comfortably and luxu-
riously that number at least of sick people, with all
* Medical Times and Gazette, March 18th, 1865.
AND CAMPS OF HEALTH AT HOME. 125
necessary attendants and friends. On the roofs of
these flats would be four galleries or terraces, covered
in glass and laid out with flowers, each gallery twenty
yards wide and upwards of one hundred long, in all a
promenade round of nearly a quarter of a mile.
The square, covered at a grand height with an arch
of glass, like the Crystal Palace, would be the inner
garden, kept always at equable temperature. It would
be large enough for lawn tennis, bowls, billiards, lawn
billiards, croquet, and a variety of other games and
physical exercises of every description.
Add to this residency a library, a reading-room, a
lecture-room, a concert-room and theatre, a gymnasium,
all the most approved baths, including swimming baths,
and a pump-room at which the different artificial
medicinal waters could be obtained, and it must,
indeed, be a fastidious invalid who could not spend,
for health's sake, the months of December, January,
February, March, and April in such a palace of health.
In a palace of health of this kind there need be no
monotony nor one whit less of good exercise than is
obtainable at foreign resorts, while the immense
advantage would be secured of entire freedom from
treacherous winds and the other accidents of atmo-
spheric variability which the best climate within easy
reach of Great Britain fails altogether to secure.
For let it be observed that in our palaces of health
as they might be produced we could command climate.
In such a palace we could have our own suns, to shine if
we wished them, by night as well as by day. With the
electric light, under which the most perfect vegetation
can be fostered, under which seeds can be made to
hasten their blooming, we can flood all our palace with
light, setting at defiance fog and cloud and storm. By
126 ON WINTER PALACES OP HEALTH
the same means we could make the air what we pleased
in respect to its physical influence on the life of man as
well as on vegetation ; we could charge the air with
ozone, giving to it measured degrees of activity ; or we
could make it neutral, soft, and balmy.
We may, I feel sure, go even further. We may,
under the teaching derived from practical experience,
when our palaces of health are established, defy the
outer winds themselves. We may admit an east wind for
the sake of its supply, r io turn it into any quality of wind
we like so soon as it has entered our territory. We may
make it dry or moist, keen or soft, bracing or relaxing,
as we list. In our hands it is so much oxygen and
nitrogen in definite proportions, but of indifferent, or
accidentally different, qualities which we can rectify at
pleasure as we may consider best.
Into details of drainage, water supply, and ventilation
of this the winter palace of health I do not enter here.
They are details already mastered, and can be dealt
with by any one of our sanitary engineers with perfect
skill, and here I may leave them in all safety.
I have drawn out above a palace of health for one
hundred residences, not because I consider this number
sufficient, but simply because I consider it convenient
as a standard upon which to calculate. If one of these
palaces were started, there would, I doubt not, soon be
palace villages of four hundred houses or more, with
many additional advantages, such as cricket fields,
cycle courses, and horse exercise grounds, all under
genial summer life.
I have named Bath as the home of a winter palace
of health because that city seems to promise best for
the birthplace of the enterprise. I could, however,
name many other places in which, in sheltered spots,
AND CAMPS OF HEALTH AT HOME. 127
the same kind of palace could be erected with, every
chance of success. Two years ago, in Gloucestershire,
near to Stroud, I found a place well known as the
" Golden Yalley," which would be admirable for the site
of a winter palace. There are other valleys by the
score which are made, as it were, for this object which
call out from hill to hill to be domed with glass and
to be fitted up by the engineer's and architect's art,
so as to become, in all their natural beauty, gardens of
perpetual summer, with miles of park verdure and
pleasance.
CAMPS OP HEALTH ON HIGH LEVELS.
In the preceding section I have treated of palaces of
health in sheltered positions. But sometimes it is wise
to send the sick to places of an elevated position where
the air is light, bracing, and dry. These I should call
camps of health on high levels.
We send our invalids at present out of our own
islands in order to secure for them the benefits
accruing from residence in such situations.
To prevent this necessity I am now about to suggest
a new project.
In a great number of places in these islands there
exists on the highest ground, with the most magnificent
views, extending in some instances to sixty miles of the
surrounding country, what is called the Eoman camp,
i.e. the elevated site in which was the Castra Stativa,
or pitched camp of the Koinan legions during the
Eoman occupation of Britain.
Whether these camps were of Eoman construction,
or whether they existed before the Eoman conquest
and were merely seized upon and adapted by the
conquerors, does not call for notice here. I am dealing
128 ON WINTER PALACES OF HEALTH.
simply with the sites as they now are for the purpose
of indicating to what a grand use a few of them might
be applied.
These sites are centres of health. With excellent
judgment, in many of them a pine wood is planted at
the south-west point, by which the prevailing wind
of these islands is tempered from the camp, and
by which the odorous air from the pine trees is
wafted over it for more than two hundred days of each
year.
The encampment is a square more or less perfect,
including within its embankments eighty to a hundred
acres of land. In some which I have measured the
distance round, on the top of the embankment, is
two thousand yards, broken in two or four places by
the gateways or grand entrances. The centre of the
ground enclosed by the embankment is in some cases
raised ; in others, owing to the excavations which have
been made, the surface is irregular or even depressed in
the centre.
Outside the entrenchment there are commonly two
ramparts, broad and well laid ; and from the surrounding
country there is a road, more or less perfect, leading up
the ascent to one at least of the grand entrances. Few
men have climbed more of these ascents than I. I have
climbed them at all seasons, and I know no spots more
invigorating. The air at the summit is always so light,
so clear, so bracing even in warm weather, so dry and
bracing in cold weather, one is almost led to believe
that the great engineers who selected these elevations
had the health of the camp before them as the
prime consideration.
Some of these camps are placed by the sea, so as
to command a grand sea view, as at Cissbury camp,
AND CAMPS OF HEALTH AT HOME. 129
near Worthing, in Sussex, or at Cadbury camp, near
Clevedon, in Somerset. Others are on the high lands
inland, as in the Cotswold range.
Wherever they may he and this is the point I wish
to dwell upon they are sites for camps of health within
our own British territory. Utilised properly for health,
there would be no necessity to send our sick people, who
would be benefited by pure air at a considerable alti-
tude, from their native soil. In the strangest manner,
these camps are already constructed for the purpose we
require. They may remain just the historical mounds
they once were, and yet serve the purposes of health
as they once served the purposes of war, serving indeed
still for war : the war against disease and on behalf of
health.
Standing recently on one of these encampments, I saw
as clearly as if it were there the health camp stretched
out before me. Looking down the line of the encamp-
ment leading to the plain or valley below, I saw the
two ramparts repaired and relaid. Each one of these
formed a road twenty feet wide, level, hard, and smooth
as a Koman road ought to be, over which a carriage
could run almost noiselessly. I saw a very broad
road joining at right angles the higher rampart with
the road from the gateways of the camp, and another
road in continuation joining the higher with the lower
rampart. The upper rampart road was two miles
round, the lower three at least. From each gate
of the camp, the road descended into the valley, and
connected the camp with the highways and byeways
leading to the towns and villages of the surrounding
country. Outside the great mound the work of the
Roman engineers had been so well imitated and
matched, that Caesar himself might have said, " Well
130 ON WINTEB PALACES OF HEALTH
done." On the new ramparts my invalid friends were
taking their evening drives, or were sitting about on
the western side watching the sunset over the sea.
Turning from the outside to the central part of the
camp, I saw in the centre, where, perchance, once stood
the Eoman Pharos, a heacon or watch-tower still,
but of a newer order. In time, as darkness brings the
night, there will stream out from above that central
dome, not -the beacon-fire of the Caesars, but an electric
sun, which will fill the whole place with its light.
Below the dome I saw also, standing out ready for work,
the telescope of the observatory which shall watch
through the night the homes of those star-gods whom
the Eomans worshipped. Then, looking beneath the
watch-tower, I discovered the camp of health, pavilion
and pavilion spread out fan-shaped from the centre;
homes of the sick in gardens of beauty ; another palace
of health, provided, like the palace of the valley and
sheltered city, with every art that can tend to bring
conditions in which health shall be regained and death
defied.
In England alone I could find twenty of these now
useless encampments ready, under a few months of
preparation, to be applied so as to give, without a
touch of historical injury, this great want to our people,
mountain air in camps of health. In these camps, by
boring, water would be found in abundant quantity ;
from them all that is dangerous could be drained away
with a facility unexampled. In the valleys and on the
hill-sides around farms and industries would spring up
to minister to all wants, and what is practically now
a desert would soon become a centre of fruitful
vitality.
In these suggestions I have included England alone,
AND CAMPS OF HEALTH AT HOME. 131
but it would be as unfair as impolitic to leave out
of consideration the sister countries. Scotland,
especially on her western side, offers the most
magnificent scope for palaces and camps of health. It
is sinful, indeed, to think that such healthful beauty as
Scotland affords should remain unutilised. The same
applies with equal force to portions of Wales.
And Ireland too has her sites for palaces of health,
sites unique in excellence. I remember a valley in
Donegal which appeals to me as made for the very
purpose. It is like a basin of land, foliage, and pasture,
filled to the brim with purest light and brightest,
lightest air. Whilst, in that glorious south of Ireland
is Glengariffe, where, with little more of art than Nature
herself affords, a series of winter homes, unrivalled
in any part of the world, wait only for patriotic skill to
tempt visitors from all the world.
In such a time as this, when nothing but political
wrangle is heard high and low, when party is tearing
party to pieces, until the body politic is as bare,
uncomely, and savage as a moulting eagle, are there
none who will help to create a wholesome diversion by
inaugurating a new era of national progress, in palaces
and camps of health on native soil ?
OPU8CULA PEAGTICA.
" There are mites in science as well as in charity."
BENJAMIN RUSH.
THE RECENT EPIDEMIC OF DIARRHCEA.
epidemic of diarrhoea which has pre-
-
vailed in London and the provinces during
the past quarter has presented some clinical
characteristics which should not pass away
without notice. We have long known that during very
cold weather, the indigent poor, who are hadly fed and
badly clothed, are subject to diarrhosa. But, as a rule,
the affection is confined to them at the period of the
year named, and even amongst them it does not add
largely to the mortality. We have also known, from
the course of the disease in London and in New York,
that the prevalence of diarrhoea, as indicated by its
mortality, has its maximum in July and August, its
minimum in March and April. But the late epidemic
is peculiar in that it has not only proceeded against the
rule of season, but has been indiscriminate in the selec-
tion of the attacked. In the cases that have come
under my observation and they have been several
the affected were persons surrounded with every com-
fort, and in no case have I been able to recognise
any reasonable cause for the attack.
The symptoms themselves have been unusual. They
OPUSCULA PRACTICA. 133'
have come on suddenly, without much pain, without
spasm, without interference with the appetite, without
fever, and without indication of stomachic disorder.
The tongue has been clean, the primary digestion little
disturbed. In two cases only have I heard of actual
vomiting, and in them the sufferers complained merely
of the rising in the throat of acid fluid water brash.
In every instance I have seen there has been excessive
flatulency, with distention of the colon from flatus,
as a marked symptom.
The usual course of the affection has been as fol-
lows. The patient, in good health, has felt a sense
of depression and uneasiness, commencing in the
abdomen, with distention. This has suddenly been
succeeded by copious and brisk discharge of colourless
fluid from the bowels, with much flatus, without either
griping or spasm, but with immediate sense of relief
from the oppression. In the course of two or three
hours the purgation has returned, the fluid expelled being
white and yeast-like, with, perhaps, some little solid
or undigested substance. This condition has continued
for two or three days, the action of the bowels disturb-
ing the night's rest once or more. The taking of food
or drink has seemed always to favour the purgation,
and some fluids, beer and tea especially, have greatly
favoured it. The attack in the lightest cases has
commonly lasted from two to three days, the return
to the natural state being marked by the passage of
darkish green fluid, or what is called bilious evacuation.
After this the natural state has been resumed, without
return of the symptoms, although in one instance
I knew a relapse to occur several times, so that actual
recovery has not yet, one month after the commence-
ment, been completely pronounced.
VOL. iv. 10
134 OPUSCULA PRACTICA.
I have seen no fatal case myself, nor anything suffi-
ciently serious to keep the sick person confined long to
the house, nor have I seen jaundice or other compli-
cating phenomenon.
The treatment I have followed has been of the
simplest kind, and has answered efficiently. I have
enjoined warmth of hody, avoidance of mental and
physical fatigue, a very carefully regulated diet, and
early hours of rest, with a fire in the hedroom, so that
the temperature of the room should not fall below
60 Fahr. Medicinally, I have prescribed at first
a mild mercurial pill, followed by a warm aloetic
draught. Afterwards, twice daily, ten minims of dilute
nitric acid, with five minims of tincture of nux vomica
and a fluid drachm of liquid taraxacum, in a wineglass-
ful of water.
Of the cause of this epidemic of diarrhoea I have no
clear understanding, and Mr. A. Wynter Blyth, who
has made some excellent observations upon it, tells me
that the medical officers of health are much divided
in opinion on the point. I am inclined to think, with
Mr. Blyth, that the affection is due to some obscure
atmospherical peculiarity. I have not found a particle
of evidence that would connect it with impure water,
with diseased milk, with any article of diet, or with
drainage. The first physical derangement in those
who have suffered from the disorder has been hepatic
congestion, with deficient secretion of bile. But how
this is induced remains an open question. One final
fact deserves particular notice namely, that the epi-
demic has prevailed mostly amongst the adult members
of the population. Children have been remarkably
exempt from it.
OPUSCULA PEACTICA. 135
METHYLIC ETHER.
N the synopsis of anaesthe ics, ASCLEPIAD, vol.
ii., p. 270, there is a hrief notice of methylic
ether, which I would here supplement from
notes taken in 1867, when I tested this
ether with the ohject of ohtaining from it a per-
fectly safe anaesthetic that should narcotise very
rapidly, but with sufficient effect to allow the surgeon
to perform long or short operations painlessly. For
this purpose the ether acted remarkably well. In
twenty-seven instances sufficient insensibility was
induced to enable the operation of tooth extraction to
be performed without pain, and in all these instances
recovery to perfect consciousness occurred within a
minute. There was also observed another fact, namely,
that whilst the persons who were subjected to the
narcotic expressed and felt no suffering from the opera-
tion they underwent, they retained so much conscious-
ness as to respond to requests made of them, and often
to converse during the period they were under the
anaesthetic influence.
I have not pressed forward this method of annulling
pain, because methylic ether cannot be rendered suffi-
ciently stable for practical daily use. Being a gas, it is
necessary either to condense it by pressure, or to satu-
rate ethylic ether with it under the influence of cold.
The first of these methods is troublesome and expensive,
and the second is uncertain, because with elevation of
temperature the light methylic vapour is diffused and
lost, and common ether alone remains.
The physiological action of methylic ether deserves
nevertheless to be kept in mind : first, because of the
power it possesses of destroying sensibility before it
destroys the consciousness ; and, secondly, because of
136 OPUSCULA PEACTICA.
its safety. So safe is it that a rabbit put to sleep
with it into deep unconsciousness remained breathing
it for twelve minutes without dying, and, allowed,
apparently, to die, was recovered by artificial respira-
tion so long as seven minutes after the cessation of
respiration, i.e., after what appeared to be actual death.
As methylic ether is easily condensed, and as the
means of condensing vapours and gases are now much
improved, it may yet be possible to bring it into
useful service as an anaesthetic. It is made by heating
together one part of pure methylic alcohol with four
parts of concentrated sulphuric acid. It is usually
collected over mercury. It is a colourless gas, pleasant
to inhale, and of ethereal taste. Its vapour density is
23, taking hydrogen as unity. At 98 Fahr. blood
absorbs thirty volumes of the gas. For medicinal pur-
poses the gas might be collected over cold water, from
which all that is absorbed thirty-three volumes could
easily be liberated by the application of heat, and after-
wards condensed under pressure. The aqueous solution
of the gas is a narcotic and anaesthetic.
CONSCIOUSNESS AND COMMON SENSATION.
jHE metaphysicians, in treating of conscious
and unconscious states of mind, have taught
that there may be periods of consciousness
with an absence of common sensibility. I
have observed and reported on this fact from persons
under the influence of the vapour of amylene ; and,
as above stated, the same fact is observable in those
who are under the influence of methylic ether. One
patient, who sat for the extraction of two teeth
under methylic ether, selected the tooth to be first ex-
OPUSCULA PEACTICA. 137
tracted and afterwards rearranged her position for the
second operation. To the looker-on, it seemed, in
fact, as though no change in her life had occurred,
yet she affirmed that she was sensible of no pain
whatever ; and, several other less striking but hardly
less singular examples came before me. We may
then, I think, fairly assume that in course of time
we shah 1 discover manageable and certain anaesthetic
substances which will paralyze sensation only, leaving
the muscular power unaltered, and the mental little
disturbed. We may gather from this either that in the
cerebral hemisphere there is some distinct and simple
centre of common sensation which may be acted upon
by certain agents without involving all the cerebral
mass, or that the peripheral nervous matter may be
influenced without involving the other portions of the
nervous system. On the whole, I incline to the view
that the action of those agents which destroy pain
before they remove consciousness is primarily on the
peripheral system ; for we know, from the process of
local anaesthesia, that it is easy to destroy sensation at
the extremities without destroying or even interfering
with consciousness, while those who have inhaled the
vapours which destroy common sensation before inter-
fering with the mental condition, invariably describe
the experience of a numbness and insensibility in the
extreme parts of the body.
That which we most require is an agent that shall be
easily applied, and shall admit of being so applied
generally as to induce insensibility to pain with or
without destruction of consciousness, as the case before
us may demand. There are many minor surgical opera-
tions for which consciousness need not be destroyed,
although pain ought to be ; there are other operations
138 OPUSCULA PEACTICA.
in which the consciousness of the person operated npon
is of great service to the operator ; and there is a third
class of cases in which it is essential to suspend both
sensation and consciousness.
Those substances which first destroy common sen-
sation can always be pushed to the extent of destroying
consciousness, so that if we could get a perfect agent of
this kind we should have the full requirements in our
hand. Up to the present moment we have been content
with two classes of agents, one which destroys con-
sciousness and sensation at the same time, the other
which locally destroys sensation, and has no influence
on the consciousness. I look hopefully for a method in
which, by means of a single substance, we shall be able
at will to suspend common sensation alone, or to exalt
the process into suspension of consciousness. When
this object is attained with safety and facility, the
science of anaesthesia may be considered as perfected.
VOLTAIC NARCOTISM.
PEOPOSAL has been made to re-introduce
some researches of mine, on local ansesthesia,
which awakened a considerable interest when
they were first published in the Medical Times
and Gazette of February 5th (p. 140), February 18th
(pp. 156-7), and June 25th (pp. 647-9) for 1859. In those
researches I applied a solution of aconite or of atropine
in chloroform to the body, on a sponge covered with a thin
copper plate connected with the positive pole of a voltaic
battery. At a little distance from the same surface, I
placed another sponge, moistened with water, covered
also with a thin plate of copper, and connected with the
negative pole of the battery. By this means a con-
OPUSCULA PRACTICA. 139
tinuous current was set up between the two covered
surfaces of the body, and observation was made to
determine if under the current the narcotics could be
carried through the cutaneous surface so as to deprive
the part to which they were applied of its sensibility.
To the projected process I gave the name of voltaic
narcotism.
The research was carried on for over six months, and
excited a brisk and adverse controversy, in which the
late Dr. Augustus Waller, F.B.S., a man of marked
ability, took the leading part. The results were in
many instances remarkable. I applied voltaic narcotism
with success in many operations on lower animals and
in some on the human subject, namely, for tying a
nsevus, dividing a tendon subcutaneously, removal of a
large fatty tumour from the shoulder, cutting for hernia,
extraction of teeth, and puncture of a bursa. In the
end, however, I gave up the practice, because the process
was too slow in its action ; was sometimes painful in
application ; led, in one or two instances, to soreness
and .vesication around the wound, although it did not
interrupt healing by the first intention ; and, finally,
because it was uncertain in its operation. The late
Mr. Nuneley, of Leeds, a very shrewd observer, and
Dr. Waller, were of opinion that all the conditions of
anaesthesia which I obtained were brought about simply
by the absorption of the narcotic solution, less the
voltaic current. It is probable that they were right in
their conjecture, and such success as may have followed
the re-introduction of the voltaic method is, I doubt not,
due to the direct and simple local absorption which they
recognised. Such absorption has been demonstrated very
clearly in the late employment of cocaine as a local
anesthetic.
140 OPUSCULA PEACTICA.
SYRUP OF SUPERPHOSPHATE OF IRON AND OXYGEN
(S7RUPUS FERRI SUPERPHOSPHATIS OXYGENATE*).
last ASCLEPIAD the introduction of the
ahove-named syrup was recorded, and I now
describe it in a more perfected form as a
superoxygenated superphosphate of iron.
The best form is as follows :
Syrup of superphosphate of iron.
Solution of peroxide of hydrogen (ten-volume strength).
Pure glycerine.
Of each a fluid ounce. Mix. To make a mixture of three ounces.
Doses for an adult, from one to two fluid drachms two or three times a
day in three ounces of water.
Mr. Eobbins, who has made for me many trials in
the manufacture of this oxygenated syrup, observed
the curious fact that if the peroxide of hydrogen
solution were added in excess to the syrup of the
superphosphate of iron, and if the glycerine were not
employed, the colour of the resulting product became
of the most beautiful red. The colour of the prepara-
tion was so rich, and the taste so agreeable, I would
have liked to have prescribed the syrup in this state,
but, unfortunately, the colour was unstable, and it
was not wise therefore to adhere to the prescription.
Prepared by the formula given above, with glycerine,
the syrup is almost white, very stable, and of an agree-
able taste. It can be made to combine with tincture
of nux vomica, with strychnine, and morphine, codeine,
quinine, salicine, or any other agent which does not
by its presence disturb and liberate the oxygen from
the peroxide.
The syrup, as it is, is a most useful remedy in cases
OPUSCTJLA PEACTICA. 141
of a neurasthenic type, and especially when anaemia is
also present. In an instance of pure anaemia treated
with the syrup in combination with an occasional
saline purgative, I have seen more rapid results toward
recovery than from any ferruginous remedy I have
hitherto employed under similar circumstances.
ETHER SPRAY FOR REDUCTION OF HERNIA.
a case of strangulated hernia in which the
taxis, used in the ordinary way, had failed,
I thought it would be good practice to test
the reducing action of cold by ether spray.
I therefore froze the skin thoroughly over the whole of
the hernial tumour, under which, after a very short
time, the tumefaction began to decline, and, on making
very moderate pressure, the bowel returned to its place,
with the usual gurgling sound. Kecovery took place
without any untoward symptom. This was in the first
days of the use of ether spray, and although the plan
has since been repeated by other practitioners with
the same good results, it is, I think, not sufficiently
known. Hence this new note upon it.
JOHN AEBUTHNOTT, M.D., F.B.S.
TEE MEDICAL SCHOLAE.
?HE life-history of the world medical is as
peculiar for the variety of talent which it has
produced, as for the choiceness and vigour of
its mental qualities. There have been in
medicine men of every form of thought and expression :
poets, from the Apollo who was god of physic as of
song ; voyagers of Bass Straits immortality ; travellers
striking out alone into the heart of Africa to win that
mighty continent for civilisation ; historians of Smollett
type ; natural scientific inquirers of every possible cast :
botanists, naturalists, chemists, geologists, astronomers;
antiquaries, wits, novelists, mechanics, mathematicians,
philanthropists ; and political philosophers of all schools,
from Bernard de Mandeville to Joseph Hume.
But although medicine, in her Catholicism of intellect,
has fostered so many and varied types of learning and
character, she has generaUy had one special person for
the exhibition of one special gift ; while, as if to be
isolated more thoroughly from the world, many of her
greatest men have, in the study of the higher problems
of science or in the pursuit of noblest literature, sunk
their craftsmanship and left the guinea-fishing business
altogether to their smaller and more selfish kindred.
o
(JLutotype from Oil (Painting- by Jeruas in the pcsr.essicn cf th-
College of \P-iysiaijuns. Jiutograph facsimile fron~
of St. Andrews University, 11 Septem'bris, 1
JOHN ARBUTHNOTT, M.D., P.B.S. 143
In England, for one country at least, there has been
so strong a prejudice against the professional skill of
" learned " doctors, that the physician who has written
a clever poem or made a great discovery in science,
geography, or aught else, has too often written, there-
with, his last prescription. The shock administered
to the public by Charles Bell, whenever he announced
a new physiological argument, was so severe in its re-
action upon his practice, that he was obliged to admi-
nister quamprimum a "practical" restorative in the
shape of a clinical lecture ; and the fate of poor Gold-
smith, who was before the era of the clinical lecture
restorative, every one knows.
The most absurd rule has its exceptions, and this rule,
which regulates the estimate of medical skill, has once
or so had its course, for a moment, broken.
The most marked instance of this kind is met in the
life-history of the man now on the easel John Arbuth-
nott a man who during a long life spent in the exhi-
bition of mental traits as varied as they were powerful,
while tossing in the whirlpool of political debate,
while classic-serving, antiquarianising, science-seeking,
satire-writing, wit-making, and fun-distributing, man-
aged, by hook or by crook, to write prescriptions, the
physic of which the people and even royalty swallowed,
with all good breeding, and with infinitely more faith in
its efficacy than ever satisfied the conscience of the
renowned prescriber.
BIRTH AND PARENTAGE.
Arbuthnott, though a London physician, emigrate d
as many other eminent Esculapians, before and since his
time, have done, from Scotland. He was born at
Arbuthnott, near Berrie, a small town in Kincardine,
144 JOHN AEBUTHNOTT, M.D., F.E.S.
not far from Montrose, in the year 1667, in the month
of April, day of the month uncertain. I was deeply
indebted to the Rev. R. M. Spence, minister of Arbuth-
nott in the year 1856, for many of the particulars in this
part of my narrative, especially for the correction of a
mistake by the biographers regarding the father of
Arbuthnott, whom they have confounded with that
famous nonjuring Divine, Principal Alexander Arbuth-
nott, whom James the Sixth of Scotland and First of
England confined to his college for disobedience. Our
Arbuthnott's father was, it is true, named Alexander,
but was a different man. He was the minister of
Arbuthnott in his day, but whether he was related to
the noble family of Arbuthnott, the descendants of which
are still in our peerage, is not very certain. Mr. Spence,
inquiring for me on this point at Arbuthnott House,
was kindly assisted by the Hon. Captain Arbuth-
nott in ascertaining whether anything could be found
relating to the Doctor or the Rev. Alexander. The
inquiry was fruitless.
The father of John Arbuthnott, from whatever family
he sprang, was, as before said, a minister of the village
of his name. He, too, like his former namesake, was
rebellious ; he refused to comply with the Presbyterian
system, which was restored at the Revolution of 1688,
and was obliged, in 1690, to resign his charge. He retired
to the castle of Hallgreen, near Berrie, in the neigh-
bourhood of which he possessed, by inheritance, the
small estate of Kinghornie. John Arbuthnott was the
eldest son of his family, his mother being one Margaret
Lamy, of Muryton. He had one brother, at least,
whom we shall have before us a little later on.
The manse in which Dr. Arbuthnott was born is not
standing, but the present manse is built on its site. In
THE MEDICAL SCHOLAR. 145
the garden of the present manse are two yew trees, said
to be from four to five hundred years old, which must
have been in existence when Alexander Arbuthnott was
minister, and round the trunks of which his boys, per-
chance, often gambolled. The church, a very ancient
building, where the said father preached and the boys
listened, remains, a curious relic of Roman Catholic
times, but bearing in many mutilations the marks of
that hot-brained zeal of Knox, which led, as Mr. Spence
happily says, him and his associates, " while they re-
formed religion, to deform its temples." The church
and manse stand in a prettily wooded valley, through
which the little river Berrie runs.
Hallgreen Castle, to which Arbuthnott's father retired
with his sons after his ejection from his cure, still
stands. It is situated on the sea-shore in the neighbour-
ing parish of Berrie, and about three miles from the
Arbuthnott manse. At the time when the Arbuthnott
family retired to it, it belonged to a Mr. Ruitt. In
1856 it was the property of Mr. James Farquhar.
The estate belonging to Alexander Arbuthnott at
Kinghornie, which, no doubt, descended to him as the
younger son of the old Arbuthnott family, became part
of the property of the Baroness Keith.
MEDICAL GEADUATION.
According to an anonymous biographer who wrote
from Glasgow in 1751, and from whom most succeed-
ing writers have taken their cue, John Arbuthnott's
first step in life was to the University of Aberdeen,
where, as the story runs, he studied and graduated
in medicine. This statement is founded on error,
for to the University of St. Andrews is due the honour
of being the alma mater of our brilliant scholar. The
146 JOHN ABBUTHNOTT, M.D., F.B.S.
evidence for this statement is clear. In the British
Museum there is retained, among other of Arhuthnott's
works, the title-page and first text page of a gradua-
tion thesis on animal secretion, with an additional
dedicatory note, which I subjoin in perfect copy in the
footnote.*
It will be observed that this document does not bear
the date of the year, and is, therefore, in so far, im-
perfect. To obtain further facts, I wrote to my late
friend Dr. George Day, when he was Chandos Professor
at St. Andrews, and through him obtained the assistance
of the learned secretary to the University, the late Eev.
-' THESES MEDICO DE SECRETIONE ANIMALI
qua*
Fauente Deo Opt. Max.
Ex authoritate
D. D. Georgii Hamilton,
Principalis Coll. S. Leonardi
In Academia Andrea-politana,
Et ejusdem Academia; Rectoris magnifici
Nee non
Amplissimi Senatiis Academici Decreto,
Pro Gradu Doctoratus in Medicina Consequendo
Publico examini subjecit
Johannes Arbuthnolt Auct. et Resp.
In Scholis Marianis.
Ad diem 11 Septembris, 10 a.m.
Adolescenti ingenuo
Edivardo Jeffreys,
Collegii Universitatis
Apud
Oxonienses
Supenoris ordinis commensali
Theses hasce
D. D. Auctor.
THE MEDICAL SCHOLAB. 147
J. M'Bean, M.A., who, after a careful research in the
records of the University, found not only the registries
of the day when Arbuthnott graduated, but also his
autograph, which, with the registries, I present to
the reader as I received them :
" 11 mo., Septembris, 1696.
" Quo die generosus hie, cujus nomen infra subscribitur Gradum Doctor-
atus in Medicina (prestitis prcestandis) honorem hunc conferente E. D.
McAlexr. Monro D. pralecto, Coll. S. Salvatori nostri ac cjradum pro-
motor e"
" 11 mo., Septis., 1696.
" Quo die generosus hie cujus nomen infra subscribitur medicina studiosus
(prsstitis prastandis) in album Academies receptus est.
" Georg. Hamilton, Coll. Leonard, Principalis."
It thus comes out clearly that Arbuthnott graduated
on the llth of September, 1696 i.e., in his twenty-ninth
year and that the graduates of St. Andrews have
historical right to claim him as their brother.
SETTLEMENT IN LOMDON.
A few years after the ejection of their father from his
pastorate, the two brothers Arbuthnott left home to
carve their ways through the world. The younger one
went on the Continent. The elder, Dr. John, with
his new university honours fresh upon him, made
his way first to Doncaster, and then to all-absorbing
London. Both brothers embraced their father's poli-
tical principles.
On reaching London, the Doctor was received into the
house of a Mr. William Pate, a learned woollen draper,
and commenced to work for the bread and cheese of this
life by teaching mathematics, in which he was a pro-
148 JOHN AEBUTHNOTT, M.D., F.E.S.
ficient. At this period, 1695, Dr. William Woodward,
a physician and geologist, brought out a work on the
" Natural History of the Earth," which created in its
day almost as great a furore as " The Vestiges of Crea-
tion " has in ours, though of a somewhat different
character. Woodward was a remarkable man, and
after his death was satirised for his practice of ad-
ministering to his patients whey and oil in immense
quantities. He died in 1728, and left a valuable col-
lection of fossils to the University of Cambridge, with
an endowment for a chair of geology. Woodward, in
his work above-named, dwelt on the successive deposi-
tion of strata, and invented a theory about the forma-
tion or structure of the earth on this basis. In 1697,
Arbuthnott brought out his first literary work in
answer and in opposition to Woodward. The essay
was entitled " An Examination of Dr. Woodward's
Account of the Deluge." It is a scholastic treatise,
and written in good tone. The philosophy of Steno
is here compared by Arbuthnott with that of Wood-
ward, to the advantage of Steno, while an abstract is
added of a book by Angostina Scilla. Whichever
of these combatants might be right, Arbuthnott's work
did him immense service, and brought him early into
public notice. He looked out now for medical prac-
tice as an additional means of subsistence, and three
years later enriched literature by the publication of an
admirably argumentative work on the " Usefulness of
Mathematical Learning."
The essay on mathematics was written in the form
of a letter to a gentleman in Oxford. It bears date
November 26th, 1700. In it the author argued for the
application of mathematics, on the ground that the
study of this science accustoms the mind to attention,
THE MEDICAL SCHOLAR.
gives it a habit of close and demonstrative reasoning^
and frees it from prejudice, credulity, and superstition.
It praises Borrelli and Steno for their researches, and
says that the only organ of the animal body whose
structure and manner of operation are fully understood
has been the only one which the geometers have taken
to their share to consider. The organ he refers to is-
the eye, the use of which, in his opinion, Kepler first
found out solely by his geometrical labours.
Arbuthnott was now fairly before the world. He
had evidently been married some time, since his second
son, George, was born in 1703. Who Mrs. Arbuthnott
was is not recorded, but we gather from his letters
that she was an excellent wife, and that their wedded
life was as happy as it was distinguished. In 1704, on
St. Andrew's Day, the Fellowship of the Eoyal Society
was awarded to Arbuthnott. Soon afterwards an
accident threw him into the favour of royalty. Being
at Epsom, at a time when Prince George of Denmark
was also there, he was called to see the Prince, who
was taken ill unexpectedly. His skill, attention, and
learning, fascinated the Prince so much that in the
next year (October 30th, 1705), by special command,,
and in consideration of his good and successful services-
to Prince George, Arbuthnott was elected Physician
Extraordinary to the Queen, Anne. In this same year
1705 April 16th he was created Doctor of Medicine-
Cantab., and on December 12th, 1709, an Honorary
Fellow of the Eoyal College of Physicians of Edinburgh.
I find no record of moment concerning Arbuthnott
from this time until the year 1709, when, upon the
indisposition of Dr. Hannes, he was appointed, in
the month of November, Physician in Ordinary to
Her Majesty and went to reside in a house in St.
VOL. iv. 11
150 JOHN ABBUTHNOTT, M.D., F.B.S.
James's. In the next season April 27th, 1710 he
was made a Fellow of the Koyal College of Physicians ;
and in the same year he read an interesting paper at
the Eoyal Society. This paper will be found in
Vol. XXVII. of the " Transactions," p. 186. It seems
to have been read at an October meeting, and is en-
titled, "An Argument for Divine Providence, Taken
from the Constant Eegularity Observed in the Births of
Both Sexes." It occupies five pages. The argument
is, that upon the exact balance maintained between the
numbers of men and women, it is provided that the
species shall never fail nor perish, since every male
has his female of proportionable age. Taking, as a
line of demonstration, a mathematical view of his sub-
ject, the further conclusion of the author is, that the
equality of males and females is due to " art," not
" chance," there seeming to be no more probable cause
for the equality " than that in our first parents' seed
there were at first formed an equal number of both
sexes." There is, however, he admits, a slight differ-
ence in the numbers of the two sexes ; for inasmuch as
the mortality of males is greater than that of females,
so more males are born than females ; while the
equality of men and women is well nigh perfect. In
illustration of the regularity of the sexes, the paper in-
cluded a table of the births of the two sexes in London
from the year 1629 to 1710.
The practical and social result to which Arbuthnott
came was this : " That polygamy is contraiy to the law of
nature and justice, and to the propagation of the human
race ; for where males and females are in equal number,
if one man takes twenty wives nineteen must live in
celibacy, which is repugnant to the design of nature."
It will be seen that in this inquiry Arbuthnott
THE MEDICAL SCHOLAR. 151
anticipated a modern statistical disclosure. We shall
see in the sequel that he anticipated some other im-
portant scientific works, which are thought specially
to belong to our own time.
THE MAN OF LETTEES.
The Court physician, in his St. James's residence,
was now advanced to a position which he had scarcely
looked for in his most hopeful hours ; and the happiness
of his life was not a little increased by the many valued
friendships which he had the good fortune to secure.
His closest friends were Pope and Swift. They met
nightly, a glorious party. Arbuthnott led the witty
and classical vein, Swift the austere and heavy satirical,
Pope the sharp and sarcastic. Meantime, they were
all earnest friends. Swift says of Arbuthnott, " He has
more wit than we all have, and more humanity than
wit;" and referring to his professional skill, thus ex-
presses himself :
" Remove d from kind Arbutlmoti 1 s aid,
Who knows his art, but not his trade,
Preferring his regard to me
Before his crotchet or his fee."
The only reflection on his incapacities is, that he cannot
walk. " He is a man that can do everything but walk."
This is Swift again, in introducing the Doctor to Pope.
In those days an important political club existed, of
which Harley, Earl of Oxford and Lord High Treasurer,
Swift, and Arbuthnofct were members. They were
sixteen in number, dined weekly at each other's houses,
supported the Tory interests, and called themselves
brothers. Hence Arbuthnott, in writing to Swift, calls
him brother. Harley he styles as "the dragon."
152 JOHN AEBUTHNOTT, M.D., F.B.S.
The letters of Arbuthnott to Swift at this period are
very interesting. He tells how he attacked Lord
Bolingbroke for wine for Swift, how he will pay bills for
him on demand, and explains his own annoyances at
Court. Mrs. Arbuthnott, with a woman's usual
anxiety, wishes that Swift were married.
Thus these wits and critics went on gaily ; they got
up clubs which bore the name of the proprietor of
the house of meeting ; they laughed heartily at the
absurdities of the world in general, and of the literary
world in particular ; and they plotted a great work, a
satire, " On the Abuse of Human Learning in Every
Branch," The first part was drawn out under the title
of " Memoirs of Martinus Scriblerus ; " it was couched
in the Cervantes style, and was intended to be in no
way deficient in pepper.
In a letter from Arbuthnott to Swift, dated Kensing-
ton, June 26th, 1714, he says, referring to u Martinus
Scriblerus," "Pray remember Martin; he is an inno-
cent fellow. The ridicule of medicine is so copious a
subject that I must only here and there touch on it. I
have made him (Martin) study physic from the apothe-
caries' bills. Martin is made to determine the question
of the weight of ancient men by the doses of physic
that were given to them. There is a map of diseases
for the three cavities of the body and for the external
parts. Ratcliffe is made to rule this empire. Another
point of satire is taken from the Greek physicians who
set up a sensitive soul as first minister to the rational.
This is the Archaeus of Helmont and the Microcosmeter
of Dolans. These ruling powers have their genii under
them, who are made to fight."
In the same letter he made a weak attempt at poetical
witticism, got up on going to bed. Think of any other
THE MEDICAL SCHOLAE. 153
man than Arbuthnott writing such stuff to the violent
Dean !
POETRY ON DUST.
" The dust in smaller particles arose
Than those which jiuid bodies do compose ;
Contraries in extremes do often meet,
'Tivas not so dry that you may call it wet."
Only the first part of the " Memoirs of Scriblerus "
appeared, and this many years afterwards. But in the
project was embodied much of the subject matter of
Swift's <c Gulliver " and Pope's " Dunciad." Johnson,
commenting on the " Memoirs of Scriblerus " in his
" Life of Pope," expresses no regret that the design was
never completed. Speaking of the published part,
which even in his time was well nigh forgotten, he
says, " If the whole may be estimated by this specimen,
which seems to be the production of Arbuthnott, with
a few touches perhaps by Pope, the want of more will
not be much lamented, for the follies which the writer
ridicules are so little practised that they are not known;
nor can the satire be understood but by the learned ;
he raises phantoms of absurdity and then drives them
away. He cures diseases that were never felt. For
this reason, this joint production of three great writers
has never obtained any notice from mankind; it has
been little read, or when read has been forgotten, as no
man could be wiser, better, or merrier by remembering
it. The design cannot be of much originality, for,
besides its general resemblance to ' Don Quixote,' there
will be found in it particular imitations of the history of
Mr. Ouffle."
The design of the " Memoirs " was broken up, owing
to the altered position of matters on the death of Queen
Anne, August 12th, 1714. Arbuthnott had success-
154 JOHN ABBUTHNOTT, M.D., F.K.S.
fully treated the Queen soon after his appointment as
her physician, and had been complimented for his skill
by Gray in the prologue to the " Shepherd's Week."
He must also have won the favour of the Queen herself,
since he had received from her the post of physician
to the Chelsea Hospital (November 12th, 1713). He
attended her now through her last illness, and Mead
was called in consultation. His letter to Swift about
his " dear mistress's " death is most touching.
" Sleep," he says, " was never more welcome to a
weary traveller than death was to her." He writes
this letter "with tears in his eyes."
On the succession of George I., Arbuthnott lost his
Court appointment, and was obliged to remove from his
house in St. James's. Mead gained the royal favour,
and was made Court physician; but the friendship
between him and Arbuthnott was in no way changed
by the change of circumstances. Both were true men
and honourable.
Dispirited by his misfortune, Arbuthnott now paid a
visit to Paris to see his brother, who resided there. He
stayed six weeks in Paris and six in Kouen, leaving his
two girls in France with their uncle, " which was his
chief business." He returned to London and took
a house in Dover Street, "hoping still," he writes,
" to keep a little habitation warm in town, and to afford
half a pint of claret for his old friends."
Arbuthnott was not the man to be long dispirited ;
he resumed practice in his new house, and had the
confidence of the public and the profession freely
bestowed on him. There is no note whatever of the
amount of his income, but his practice seems to have
been chiefly among the upper classes. Lord Chester-
field prided himself on being not only his patient, but
THE MEDICAL SCHOLAE. 155
his friend. He retained the friendship of his old
acquaintances, Garth, Friend, Swift, Pope, while the
amiable poet Gay presented himself as an additional
comrade. Friends met at his house frequently, and
little country parties were got up, of which the Doctor
was always chosen as the captain, from his seniority.
He was very exacting in his orders on these occasions,
and poor Pope had a great deal to put up with ; even
his night-dress had to he smuggled, so that he might be
sure of having it with him.
No adventure of any moment ever occurred on which
Arbuthnott did not write a pleasant essay. These pro-
ductions w r ere all written in a great folio paper book
which he kept in the parlour. So little, however, did
he care for them after they were put together, that
often, when he was writing out the last sheets of his
folio, his children were tearing out the first, without
hindrance, for use in the manufacture of kites. Thus
what to us now might be most valuable historical docu-
ments were scattered literally to the winds.
In 1715, conjointly with Gay and Pope, Arbuthnott
brought out a comedy called Three Hours after
Marriage. The piece was brought on the stage in
1716, to prove a dead failure. The plot was bad, and
the sentiment not superexcellent. The next year
Captain Breval, a man who had done much service for
the Duke of Marlborough, wrote, under the cognomen
of Joseph Gay, a farce called the Confederation, with
a ridiculous caricature print of the authors of the
Three Hours after Marriage comedy. Pope, never
forgetting an attack, trounced poor Breval for this in
the "Dunciad," "Breval, Bond, Besaleel, the varlets
caught."
In 1717, the poet Prior got into political and
156 JOHN AEBUTHNOTT, M.D., F.B.S.
pecuniary difficulties. To assist Mm the kind hand of
Arbuthnott was foremost. In combination with Pope,
Gay, and Swift, he got up and earned out a subscription
for the publication of the poet's works.
About the year 1720 Hogarth, then a young man,
entering one evening into Button's coffee-house, fell
athwart a distinguished trio, Arbuthnott, Garth, and
Pope. Charging them at the point of his pencil, he
brought them before the world in inimitable caricature.
My friend the late Mr. Squibb, of Montague Place,
lent me from his valuable picture collection a copy of
this Hogarthian work. I am thus enabled to introduce
to my readers the hero of this piece and his immortal
coffee-house companions. The figure of Pope is to the
right of the sketch ; the seated figure is Arbuthnott ;
Garth stands to the left, holding his gold-headed cane.
Hogarth himself sits with his back to us, as grand
listener and draughtsman.
I have traced out the career of Arbuthnott to the
year 1720-21. His health being indifferent, and his
brother having come over from Paris, the two brothers
started off for Bath in the autumn of 1722. Pope here-
upon has a characteristic letter to his friend Digby :
" September 1st, 1722.
" Dr. Arbuthnott is going to Bath, and will stay there
for a fortnight or more. Perhaps you would be com-
forted to have a sight of him, whether you need him or
not. I think him as good a doctor as any man for one
that is well. He would do admirably for Mrs. Mary
Digby ; she need only to follow his hints to be in
eternal business and amusement of mind, and as active
as she could desire. But, indeed, I fear she would out-
walk him, for, as Dean Swift observed to me the very
THE MEDICAL SCHOLAE. 157
first time I saw the Doctor, lie is a man that can do
everything but walk. His brother, who is lately come
to England, goes also to the Bath, and is a more
extraordinary man than he, worth your going thither on
purpose to know him. The spirit of philanthropy, so
long dead to our world, is revived in him ; he is a
philosopher all of fire, so warmly, nay, so wildly in the
right, that he forces all others ahout him to be so too,
and draws them into his vortex. He is a star which
looks as if it were all fire, but is all benignity, all gentle
and beneficent influence. If there be other men in the
world that would serve a friend, yet he is the only one,
I believe, that could make an enemy serve a friend."
Excepting the fact that on the 30th of September,
1723, he was chosen Censor of the College of Phy-
sicians, we glean but little record of Arbuthnott
until 1727, when we find the same Collegiate body
numbering him among their "elect," on October 5th,
and listening in full conclave soon afterwards to a
Harveian oration, delivered in his classical style. The
oration, as a matter of course, was loud in its praises of
Harvey, whom the orator compared as a philosopher
with Newton, and whose actual labours he very clearly
comprehended and defined. Various points and facts
in the history of our science were also touched upon
with masterly care. The views of Michael Servetus,
of Eealdus Columbus, and of Cesalpinus, on the circu-
lation of the blood, were not forgotten, but were
represented as buried or as lost until the true man
came to announce his discovery, and to set the seal on
his mission in the Lecture Hall of the Eoyal College.
The oration is remarkable in that it contains a sugges-
tion for keeping a journal of the weather, and of the
prevailing diseases as influenced by meteorological
158 JOHN AKBUTHNOTT, M.D., F.E.S.
changes. This idea was carried out soon afterwards
by Professor Mussenburg, and by a society of learned
and ingenious gentlemen of the profession in Edin-
burgh, who met to discuss the history of acute
diseases as depending upon the constitution of the
seasons.
In this same year 1727, Arbuthnott brought before
the world the most classical, if not the most useful of
his works : " The Dissertation on Coins, Weights, and
Measures Explained and Exemplified." This work, as
its author states apologetically, is one of labour more
than of judgment. " He proposed to get no reputation
by it, and he hoped to lose none." The book was
dedicated to the King, in a poem written and signed by
Charles Arbuthnott, one of the sons of the Doctor,
then a student of Christ's College, Oxford, who after-
wards entered the Church, but with difficulty, because
he had fought a duel. Arbuthnott himself had no
love for the Georges, but the son might show his
loyalty with advantage, and without compromising the
father.
Eor a considerable period after this event our author
gave his name to no productions, but some of his
biographers say, on no very definite evidence, that for
three or four years he was busily engaged in the
composition of various political pamphlets. It is more
evident, however, that at this time he was in very
indifferent health ; for in a letter to Swift, dated June
9th, 1729, he says that " he is bad of a constant
convulsion in his heart, so that he is likely to
expire sometimes." A squib, called " A Brief Account
of Mr. John Ginglicutt's Treatise concerning the
Altercation or Scolding of the Ancients," published in
1731, is attributed to him. It is doubtful whether he
THE MEDICAL SCHOLAE. 159
wrote it ; but whether he did or did not is of no
moment, for it has little brilliancy or point, and its
meaning is dead. The " Art of Political Lying," also
brought out in this year (1731), is a more pointed
satire, and in all probability did come from his hand.
I pass it over, however, with the mere mention of
it, to refer at greater length to an essay on aliments,
entitled, "An Essay concerning the Nature of
Aliments and the Choice of them, according to the
Different Constitutions of Human Bodies, in which the
Different Effects, Advantages, and Disadvantages of
Animal and Vegetable Diet are Explained. By John
Arbuthnott, M.D. London : 1731."
This composition was done while the writer was
still in indifferent health, and, therefore, but ill-
prepared for the labour. The work went ultimately
through many editions, and to the third edition were
added " Practical Eules of Diet in the Various
Constitutions and Diseases of Human Bodies."
Somewhat inconsistent of Arbuthnott was the long
title of this work, since in earlier days he had been
first to laugh at long titles.
The reason assigned by the author for writing the
book on " Aliments " was, that Dr. Cheyne had,
some years before, written an essay on "Health and
Long Life." which had "produced even sects in the
dietetic philosophy." Arbuthnott was sometimes
appealed to in these " symposiac disputations "
amongst his friends ; and having remarked that the
dietetic part of the medicine depended as much as
any of the rest on scientific principles, he was called
to make good his assertion. He was from home,
" absent from his books at the time he composed this
treatise," and he apologises earnestly for its short-
160 JOHN AKBUTHNOTT, M.D., F.B.S.
comings. " I can say," he adds, "but little of the merit
of the performance, but a great deal of that of the
subject; for surely the choice and measure of the
materials of which the whole body is composed, and
what we take daily by pounds, is at least of as much
importance as of what we take seldom, and only by
grains and spoonfuls."
Throughout this essay there is a rude physiology,
far more advanced here and there than might be
supposed possible, erroneous oftentimes of necessity,
according to our present standard of knowledge, but
even in its ignorance common-sense, and in its
experimental part bordering on many great tmths.
He saw that in serum of blood there was a principle
identical to white of egg; but the serum was more
saline, and, under distillation, yielded a volatile alkaline
salt. In some diseases, as scurvy, an alkaline state
of the blood obtains. This alkaline acrimony indicates
the use of vinegar and of acid fruits, such as oranges
and lemon juice. " Heat, thirst, hot belchings, foulness
of the tongue and breath, a bitter and hot taste in the
mouth, sickness, loathing, bilious vomiting, stools
with a cadaverous smell, pains in the belly with heat,
are symptoms of an alkaline state of the humours in
the stomach and bowels.
" Such a state disposeth the humours of the body to
heat, inflammations, and putrefaction, hinders nutrition,
and often causes eruptions on the skin, dark, livid, lead-
coloured, and gangrenous, and what is commonly called
the hot scurvy."
Now and then, too, he adds a practical fact which
will bear reviving. I give one illustration : " If," he
says, " there be a specific in aliment for rheumatism,
it is whey. I knew a person, subject to this disease,
THE MEDICAL SCHOLAE. 161
who could never be cured by any other method but
a diet of whey and bread."
The ultimate fact at which he seemed to have
arrived in his contemplation of aliments was, " that
all the intentions pursued by medicines might be
obtained and enforced by diet." These are his own
words, as they were his thoughts. Had he lived in
these times, he would have seen to the bottom of the
homoeopathic success without spectacles. It was,
indeed, from ignoring such facts as he taught, that
Hahnemann succeeded in planting his name and
system on mankind. The treatise on aliments was
well received, and its author promised to take up
the subjects of air, rest, and motion, in the same
manner.
A note still remains for the year 1731. There died
at this time in Scotland, aged sixty-two, one Colonel
Charteres, a man reported as of most execrable
character. Upon him an epitaph was written, which
is said confidently to be from the pen of Arbuthnott.*
HIS GREATEST WOEK.
In 1732, Arbuthnott went to work tooth and nail in
endeavouring to reform certain abuses and tricks which
* The epitaph opens as follows and continues in similar strain :
" Here continueth to rot
The body of Francis Charteres,
Who, with an indefatigable constancy and inimitable
Uniformity of life,
Persisted,
In spite of age and infirmities,
In the practice of every human vice,
Excepting prodigality and hypocrisy,
His insatiable avarice exempting 1dm from the first,
His matchless impudence from the second"
162 JOHN AEBUTHNOTT, M.D., F.K.S.
were being carried on under the title of " Charitable
Corporations." This effort did not prevent him,
though he became the victim of asthma and had been
obliged to remove to Hampstead for change of air, from
bringing before the public, in accordance with his
promise, " An Essay concerning the Effects of Air on
Human Bodies. London : 1732." His greatest work.
It has been surmised that he was led to the study of
this work from being himself a sufferer from asthma.
This is mere invention, for he gives sufficiently valid
reasons for his undertaking. The subject had long
been in his thoughts, and there was no one else who
chose to consider it. The book was, however, written
at a period when the increasing bad health of its
master led to frequent interruptions. The preface is
loaded with apologies. In it he gives us an insight
into the character of his mind, which will have already
been detected by the critical reader. " That weari-
ness," he observes, " in thinking about the same subject,
incident to me, perhaps, with others of mankind, makes
me abandon several particulars too soon."
Arbuthuott, at least, knew his own peculiarities.
Brilliancy of thought depends often on shortness of
exertion, and the pungency of wit lies in the con-
centration of the greatest possible amount of mental
force into the smallest possible space of time. Your
true wit is a thinking rifle. You touch him on the
explosive part, and he goes off so sharply, and with
such effect, that you start back, and if you yourself
are not the target, your wonder, or your admiration,
or both, are carried out of bounds, electrically. But
here your wit ends his accomplishments. The sharp,
telling crack is his distinguishing trait ; he must have
time to reload.
THE MEDICAL SCHOLAR. 163
Arbuthnott, according to all Ms contemporaries, was
not without the peculiarities of his class. He was a
momentary philosopher ; so nature formed him. The
weariness of a long stretch of thought was more than
he could bear.
The essay on the "Effects of Air " is, notwith-
standing the peculiarities of the man, one of the most
remarkable books in the literature of medicine, and by
many odds the best scientific work of Arbuthnott.
There is genius in its every page, a true living soul
in every paragraph, an inseeing into things to him
almost indefinable, and a glance at facts that were to
come, which can only be appreciated by those who will
take the trouble to read the essay through with care,
and with an eye fixed on the knowledge of the present
as well as of Arbuthnott's day and generation. There
had been no Dutrochet or Graham to tell Arbuthnott
the secret of osmosis; no Priestley, Black, Lavoisier, or
Liebig to explain to him the nature and meaning of
respiration ; yet hear how this philosopher could reason
on these subjects. " The blood in the lungs is warmer
than on the surface of the skin ; the coats of the vessels
and the pulmonary artery are extremely thin, and of those
exposed to the outward air; and yet the perspiration
from the lungs is not half of that from the skin. What
is the reason of this small proportion ? Is the air
absorbed ? For the quantity of perspiration is the
difference between the air absorbed and the humour
prepared. There are several things which may be said
for and against the air's entering the blood-vessels of
the lungs in respiration.
"From the flaccid state of the lungs of animals that
die in vacua, it seems evident that the lungs do not
expand themselves upon the exsuction of the air ; con-
164 JOHN ARBUTHNOTT, M.D., F.E.S.
sequently, the air is sucked out or escapes through the
blood-vessels of the lungs ; else, if retained, it would
expand and swell them ; if the air has a free egress
through the coats of the vessels of the lungs, it may
have a free ingress. On the other hand, attempts to
force air into the hlood-vessels of the lungs by the
windpipe have proved unsuccessful, and the lungs of
animals that die in vacua afterwards swell in the air-
pump. Things may happen in a live animal which
will not succeed in a dead one. Air will pass through
any membrane when moist. The quick restoration of
the balance of the air within and without human
bodies shows that there is a free communication ; and
it is probable that it is so in the lungs as well as
in other parts of the body."
It is unnecessary to indicate how deep a knowledge
is here shown of facts which have required the space of
a hundred and fifty long years to be brought to a state
of demonstration and acknowledgment.
We might rest long in admiration of this wonderful
essay, but time presses. One word more. We have
seen that Arbuthnott's mind was of the acute, tense,
electric order. The fact is admirably shown in the
work now being pursued. In one sentence he gives
a definition of the physiological use of respiration.
The sentence is the man ; and if he had lived only to
emit this short saying, he would have sworn himself
great. " BESPIKATION is THE SECOND DIGESTION." Think
as we will, with Liebig and eremacausis right near,
and no profounder definition of the fact can be given.
Our ideas about details may change, and Liebig 's
definition of eremacausis may even be forgotten ; but
this immense generalisation, embraced in five words, is
an indelible utterance.
THE MEDICAL SCHOLAR. 165
MISCELLANEOUS WORKS.
In so far as I have traced out the career of Arbuth-
nott, I have referred to such only of his literary works
as are known positively to have been written by him.
There are, however, various tracts and small essays
rusting in old libraries, and bearing no author's name,
which have been fathered on him without much regard
to historical accuracy. At one time De Foe's immortal
" Eobinson Crusoe" was believed to have been written
by Arbuthnott an entire fallacy long since exploded.
Of other political productions classed as his works,
some bear internal evidence of having come from a
source quite different, and from minds of a stamp much
inferior to his. " Harmony in an Uproar ; " " The Con-
gress of Bees ; " " The Art of Selling Bargains ; " " The
Longitude Examined for Longitudinarians ; " " The
Petitions of the Cooks and Colliers ; " " The Life and
Adventures of Don Bilioso de 1'Estomac ; " " The Most
Wonderful Wonder ; " The Manifesto of Lord Peter; "
"The Devil to Pay at St. James's;" "The Mas-
querade," a poem (the author of which was certainly no
poet); " The State Quack ; " " < Gulliver' Deciphered"
(an indirect puff in favour of Arbuthnott) ; " A Learned
Dissertation on a Dumpling " all this trash of trash
I believe to consist of works in which Arbuthnott had
no part whatever.
Some other miscellaneous works attributed to Arbuth-
nott, though anonymously published, may, from their
style and argument, be fairly considered as his. " The
History of John Bull " is one of these, a very able
satire, and amusingly readable even now, although the
social changes that have intervened since its day have
taken off its point. In like manner I may speak of the
VOL. iv. 12
166 JOHN AKBUTHNOTT, M.D., F.B.S.
pamphlets : "It Never Kains but it Pours ; " " The
Political Art of Lying ; " " The Supplement of Swift's
'Miscellania; ' " " A Letter to the Students of Both Uni-
versities ; " " An Essay on an Apothecary ' ' a very hitter
satire; " An Account of a Surprising 'Apparition on
October 24th, 1732;" "A Sermon Preached at the
Market Cross, Edinburgh, on the Subject of the Union,
in 1706, from the Text, 'Better is he that laboureth
and aboundeth in all things, than he that boasteth him-
self and wanteth bread ' a shrewd and able discourse ;
" An Account of the State of Learning in the Empire of
Lilliput, together with the History and Character of
Bellum, the Emperor's Librarian " an amusing tale in
the " Gulliver " style ; " Critical Eemarks on c Gulliver's
Travels'" a facetious attempt to prove by classical
authorities that the notion of the Houyhnhams was
well known to the ancients of Greece, Italy, and Eng-
land ; and a poem, or reputed translation called " Know
Thyself," serious in tone but barren in poetry. " The
Hazards of Game ' ' (8vo, London, 1692) and " The Free-
holder's Political Catechism " (a political satire) are
attributed, the first safely, the second doubtfully, to
Arbuthnott. The catechism, which seems to have
appeared in 1733, was not fathered on him until after
his death.
I cannot pass over in silence two other snatches
which have been laid at the door of Arbuthnott, with
insufficient evidence, it is true, yet not without plausi-
bility. It will be remembered that, in his first days in
London, he opened a discussion on Dr. Woodward's
work on geology. In 1728, Woodward died. Soon
after this event there appeared " An Account of the
Sickness and Death of Dr. W dw d, and also what
Appeared on the Opening of his Body, by Dr. Tech-
THE MEDICAL SCHOLAE. 167
nicum." I hope and believe the critics are wrong who
say that Arbuthnott wrote this low and contemptible
satire, the only passable point of which, even satirically,
is, that Woodward administered, in the course of
his life, 20,473 vomits, 756 hogsheads 4 gaUons
and a pint of sack whey, and above 50 tons of oil.
In like manner, I hope that the critics are again
wrong in supposing that another tract (" The Memo-
randums of the Six Days preceding the Death of a Late
Eight Eeverend"), and dated March 18th, 1714, came
from the hand of our witty physician. Assuredly,
there is no wit or worth in this scribble ; and it is im-
possible to affix to it the name of its true author.
From Pope's own showing, in a letter to Warburton
dated November 27th, 1742, it is clear that some of
the notes to the first editions of the " Dunciad " were
by Arbuthnott, who, indeed, furnished the susceptible
poet with many witty points and satires, which were
easily interwoven into his melodious verse.
TOWARDS THE END.
Eeturning to the chronological order of our narrative,
we enter the year 1734. Arbuthnott was failing fast.
He had sped through sixty-seven summers, and his
work was well nigh done. He lived chiefly at Hamp-
stead at this time. Before the last scene his more
vigorous friend Pope crowned him with a final garland.
The immortal prologue to the " Satires " was done in the
form of an epistle to the " Friend of my Life." Dipped
in gall was the pen of the poet ; but in the midst of
bitterness, and with his teeth keenly on edge against
half mankind, he concentrated in the last lines the
whole of his living and loving sympathies on his dear
Esculapian.
168 JOHN AEBUTHNOTT, M.D., F.B.S.
" Oh, friend, may each domestic bliss be thine ;
Be no unpleasant melancholy mine.
Me let the tender office long engage
To rock the cradle of reposing age,
With lenient arts extend a mother's breath,
Make languor smile, and smooth the bed of death,
Explore the thought, explain the asking eye,
And keep a ii'hih one parent from the sky.
On cares like these if length of days attend,
May Heaven, to bless those days, preserve my friend !
Preserve him social, cheerful, and serene,
And just as rich as when he served a queen."
The poet's hope was unrealised. Arbuthnott wrote
this year his often-quoted farewell letter to Pope.
There is something enchanting in this last contribution
to letters which marks the man, and tells his life-story
in a few lines. He has, he says, the satisfaction to find
that he is as officiously served by his friends as he that
has thousands to leave in legacies, besides the assur-
ance of their sincerity. His bodily distress is as easy
as a thing of that kind can be. He has found relief
sometimes from the air of Hampstead. His nights are
bad, but many have worse. He then refers to his love
for Pope, whose talents were not the foundation of his
friendship. He urges the poet to continue that noble
disdain and abhorrence of vice which he seems naturally
endued with, and to study more to reform than to
chastise. Lord Bathurst he compliments, the venison
present will be acceptable to friends, but the writer's
venison stomach is gone. His recovery he feels hope-
less ; the kindest wish of his friends for him must be
" Euthanasia," a happy death. Living or dying, he is
the poet's friend.
Such is an outline of this famous letter; it was
written from Hampstead, on July 17th, 1734, and was
THE MEDICAL SCHOLAE.
replied to by Pope in happy strain : " You are fitter to
live or to die than any man I know." Enviable
Arbuthnott !
Before the year closed, a severe shock was given
to Arbuthnott by the death of his son Charles.
Writing to Swift from Hampstead, on October 4th,
1734, he foresees very plainly that his own end is near,
and at the same time shows that, whatever his practice
had been, he had laid by but little fortune. " I am not
in circumstances," he relates, " to live an idle country
life. I am in the case of a man that was almost in
harbour and then blown back to sea, who has a reason-
able hope of going to a good place, and an absolute-
certainty of leaving a very bad one. Not that I have
any particular disgust of the world ; for I have as great
comfort in my own family, and from the kindness of my
friends, as any man ; but the world, in the main, dis-
pleaseth me, and I have too true a presentiment of
calamities that are like to befall my country." It is to
him, at the same time, " a most sensible affliction to
bring his children to bear the loss of a father who loves
them and whom they love."
In the close of the year Arbuthnott returned to
London, not to Dover Street for he had left there
but to Cork Street, Burlington Gardens. Here he
lived on until February 27th, 1735, when he met the
euthanasia, and slept the sleep. Swift might never
have seen his friend again though he had lived, yet
it were a satisfaction even to know that he was
alive.
When Mrs. Arbuthnott died, I am not able to say ; but
at the time of Arbuthnott's death there were left two
children : one son, George, and one daughter, Anne.
George became first secretary in the Eemembrancer's.
170 JOHN AEBUTHNOTT, M.D., F.R.S.
Office in the Exchequer under Lord Masham. He
prospered in the world, and was made one of the
executors of Pope, with a legacy from the poet of ,200.
He died aged seventy-six, in 1779. Anne Arbuthnott,
who possessed much of her father's taste and wit, was
also remembered by Pope in a legacy of .200.
The political opinions of Arbuthnott are sufficiently
well known. He clung to the Stuart family and the
Tory party, but was too candid not to admit such
virtues as did exist in the first representative of the
House of Brunswick.
Of his professional bias we know little, except that
he had no great reverence for either the surgeons or
apothecaries of his day, and placed more faith in
general treatment than in the specific application of
particular remedies. He sometimes prescribed for
Swift by letter. Cinnabar of antimony and castor form
parts of one of these prescriptions (December llth,
1718) ; but he has not much faith in the " cinnabar."
Another time he advises " Geronster waters, which will
not carry from the spot," for vertigo (November 17th,
1723). In a third note Peruvian bark and iron rust
are the remedies (November, 1730).
By the kindness of the President, Treasurer, and
Registrar of the Eoyal College of Physicians, I supply
an autotype of an oil portrait of Arbuthnott, belonging
to the College, which portrait, according to the learned
Librarian, Dr. Munk, is ''presumed to be by Jervas.
It was formerly in the possession of Dr. Turton, Bishop
of Ely," at the sale of whose effects it was purchased
by the College in 1864. The portrait, not a very
powerful work of art, though good in details, presents
to us the genial rather than the brilliant character of
its original.
THE MEDICAL SCHOLAE. 171
As an historical character, Arbuthnott is a man who,
while he made himself, helped others ; who was broad
and far-seeing in philosophy; who practised his profes-
sion as a science, and ignored it as a trade; who, living
in the company of men to whom English literature
and poetry are ever indebted, infused into the minds of
these much of that brilliancy, point, and wit, for which
their books are so remarkable ; who in prose-writing
excelled pre-eminently, and who had sense enough
to give up the poet's vocation when he found such
vocation not to be his own ; who was esteemed by his
comrades as "having more wit than all of them, and
more humanity than wit ; " who abhorred vice, and,
for her own sake, loved virtue. On these claims, con-
sidered in their combined rather than in their individual
importance, the fame of Arbuthnott rests ; on them is
based the right to number him amongst the great men
of the Esculapian line.
ON VITALISING AND DEVITALISING
OXYGENS.
AN ABSTRACT OF ORIGINAL RESEARCH.
the last ASCLEPIAD I related some experi-
mental facts bearing upon the action of
alcohol on animal vitality under various
conditions of heat and cold. I shall now
proceed to present another series of facts having
reference to the vitalising and devitalising properties
of the same gas under different conditions of it and in
different classes of animals.
INFLUENCE OF OXYGEN IN CURRENT ON ANIMALS OF DIFFERENT
CLASSES.
The illustrious Thomas Beddoes considered, from his
experiments, that pure oxygen gas acts on the bodies
of men and animals as an excitant. Some years after
his time Mr. Broughton, an able observer, who worked
at the subject in connection with Sir Benjamin Collins
Brodie, came to the conclusion that oxygen in relation
to vital phenomena is a depressant and a narcotic.
In 1852 I studied carefully these very different
opinions. At that time Broughton's views, backed by
Brodie, were dominant, and in every text-book oxygen
was classified as a depressant and slowly acting nar-
ON VITALISING AND DEVITALISING OXYGENS. 173
cotic. My -own experimental observation seemed, on
the whole, to confirm this hypothesis, and yet there
was some counter-evidence which created a suspicion
that at medium temperatures the narcotic action was
not developed until such time as the presence of car-
bonic dioxide would account for the narcotism.
In Broughton's experiments the animals subjected to
pure oxygen were placed in closed chambers containing
the oxygen ; but provision was made for the absorption
of carbonic dioxide into potash water contained in
a reservoir placed below the floor of the chamber, and
freely open to the whole of the chamber by perforations
through the floor. It seemed to me to be doubtful
whether this provision for the absorption of the carbonic
dioxide was complete, and as I had noticed that so
small a proportion as five per cent, of the dioxide in
oxygen gas produced a narcotic effect, I began to
suspect that there might be a source of error in the
experiments which had been so generally relied on in
support of the accepted view.
I had an opportunity of speaking with Sir Benjamin
Brodie on the matter of the experiments in which
he had taken so active and important a part. He
entered very kindly and candidly into my doubts,
but assured me that no care whatever had been
wanting in obtaining proof that carbonic dioxide
and every other conceivable agent incident to animal
combustion in the oxygen had been excluded. He
informed me that the gas in the chambers was fre-
quently extracted and subjected to analytical investi-
gation, and that no less distinguished a chemist than
the late Professor Brande, to whom he was good
enough to refer me, had taken part in the investigation,
and had lent the weight of his observation to the
174 ON VITALISING AND DEVITALISING OXYGENS.
support of the observers who were most immediately
concerned in the inquiry.
Without presuming to doubt the correctness of the
observations which are here referred to, I still had
much difficulty in connecting them with the observa-
tions I had myself made in respect to the varying
effects of temperature on the vital properties of oxygen.
I therefore determined to carry out a new series of
inquiries, in which, by using the oxygen in current
in simple words, by ventilating a chamber steadily and
perfectly with pure oxygen instead of air the idea of
the interference of carbonic dioxide should be absolutely
excluded.
For this purpose I fitted up a large reservoir for con-
taining the oxygen gas, after the manner of a common
gas reservoir. I produced the oxygen as it was
wanted from chlorate of potassa; I washed the gas
freely before it entered the reservoir ; I tested it in
order to see that it was negative to iodide of starch
paper, that it was perfectly free of chlorine, free acid,
and all appreciable impurity. In order to determine
temperature, a self-regulating thermometer was placed
in the oxygen chamber, in which a mean temperature
of 60 Fahr. was at all times maintained. The regula-
tion of temperature was secured by passing the gas
through a series of coiled metallic tubes immersed in a
bath constructed also of metal, the water of which
was changed as required so as to regulate the tempera-
ture of the tubes with precision. A gas lamp placed a
little distance beneath the bath was sufficient to keep
the water in the bath up to the required heat ; while
by two taps an inlet and an outlet the water could
be instantly changed if any increase of temperature
were observed in the chamber.
ON VITALISING AND DEVITALISING OXYGENS. 175
The results of these inquiries were of singular
interest. They showed that freshly made, pure oxygen
used in current, and serving as an atmosphere minus
any trace of nitrogen produced different effects as a
vitaliser on different animals. Some were excited by
it and rendered feverish, just as Beddoes had observed,
the temperature rising 75 Fahr. above the natural.
In other animals no such effects were produced,
and in no instance in any animal was narcotism pro-
duced so long as the oxygen was freshly supplied in
steady current. The animals in which the febrile state
was excited were the cat, the dog, the guinea-pig,
and the pigeon. The animals that were not similarly
affected were the rabbit and the frog. The febrile
effects in all cases where they were developed were
induced in a period of eight hours.
In the first set of observations the effects of the
oxygen atmosphere were tested on the animals indi-
vidually ; that is to say, each one was placed in a large
chamber ventilated with the oxygen at 60 Fahr. and
provided with means for supplying food and drink with
complete readiness, while every care was taken to
sustain uniformity of procedure.
To remove all doubts, however, a still more certain
mode was followed. A chamber was constructed of
sufficient size to receive in separate compartments of it,
all communicating with each other by perforated par-
titions, one representative animal of each kind. In
this way every animal lived in the same oxygen just as
it might have lived in common air in an ordinary
dwelling or compartment.
The results were the same in every particular as
described above.
When it was clearly discovered that the rabbit was
176 ON VITALISING AND DEVITALISING OXYGENS.
practically unaffected by the oxygen at 60 Fahr. during
periods of exposure which were sufficient to induce
febrile disturbance of an acute kind in other animals,
the observation was directed to ascertain how long
the rabbit would live in pure oxygen in constant
current.
The answer to this question was that the time
was practically any time, so long as abundance of
food was regularly supplied. In one instance a rabbit
lived seven days in oxygen, with the only variation from
its natural state that although it ate per day its own
weight of green vegetable food, being always voracious
for food, it lost four ounces in weight. Another rabbit
lived twenty-one days in the pure oxygen, without any
indication of variation so long as the current of oxygen
was freely admitted. If the current were suspended by
any accident, as when making fresh gas, the breathing
would become a little quickened from some accumula-
tion of carbonic dioxide, but the symptom passed away
immediately the current was restored. The breathing
also became quickened when food was wanted. While
in the oxygen the ears of the animal were always of
bright vermilion tint so long as the gas was pure and
freely passing on ; but very slight impurity of the gas
caused the colour to become darker in tint, and with
that the respiratory action became rapid. On their
removal from the oxygen these animals showed some
loss of weight, but no other unnatural change was
manifested, and so little were they affected that, being
in the ordinary air, they would jump into the oxygen
chamber in order to get food that was placed in it if
they were permitted the entrance.
Although over thirty years have elapsed since these
observations were made, I have the same confidence in
ON VITALISING AND DEVITALISING OXYGENS. 177
their correctness as ever. They included many months
of most careful watching and attention, and I recall no
point that would lead me to suspect any source of
error. The results were themselves of importance, but
far less so than some other results to which they led,
and which are now to be recorded.
INFLUENCE OP OXYGEN ON VITAL PHENOMENA AFTEE ITS
DEVITALISATION, BY EXPOSUBE TO LIVING ANIMAL
BODIES.
The most important observation in these inquiries on
the vital qualities of oxygen gas and their modifica-
tion was elicited from a circumstance which occurred
in the course of the above-named research, and which
at the outset was totally unexpected.
In order to economise the oxygen gas, I constructed
for holding it two large reservoirs of equal size. One
of these reservoirs was filled with pure oxygen, the
other with pure water. The chamber for holding the
animals was placed, so to speak, between these two
reservoirs, as drawn in the annexed diagram. When the
animals were living in the chamber A, a tube from the
upper part of the oxygen reservoir B was connected with
the chamber, and the gas was driven by water pressure,
from a cistern above, through the chamber. The gas,
after passing through the chamber, was allowed to
escape to the upper part of the second reservoir c, which
was filled with water, and as it entered this second
reservoir it took the place of the water, which was per-
mitted to flow out by a tap at the lower part in exact
proportion to the entrance of the gas above. In this
manner all the oxygen in the first reservoir, less that
which was consumed by the animals, was collected and
178 ON VITALISING AND DEVITALISING OXYGENS.
ON VITALISING AND DEVITALISING OXYGENS. 179
retained in the second reservoir, to be returned to the
first when that was exhausted.
In its course from the one reservoir to the other, the
oxygon was perfectly purified of carbonic dioxide, of
ammonia, and of all appreciable foreign product ; it
was filtered by passing it through cotton, and it was in
this way also dried ; it was driven through the chamber
with such steady motion, that no accumulation of
carbonic dioxide could take place within the chamber ;
as it escaped from the chamber it never held more
carbonic acid than the common outside air ; and it was
maintained at the medium temperature of 60 Fahr.
The gas was made by the same method as that which
had been used in the previous experiments.
When the arrangements were quite complete, and
the animals that were to be placed in the oxygen, in
current, a cat, a dog, a rabbit, a pigeon, and two
frogs were introduced into the different rooms of the
chamber A, connected with the reservoirs, one of which
had been already filled with the pure gas, the gas
from the reservoir B was then drawn steadily through
the chamber, was tested as it passed from the chamber,
was entirely purified, and, less what had been con-
sumed, was received into reservoir c, which in six
hours was charged with what had come over from B.
During the passage of this first charge, the pheno-
mena produced were the same as those which had
previously been observed from the first oxygen in
current. But as the second charge passed through, a
change of the most striking character took place. The
animals all became drowsy. The current of gas was
quickened so that the first reservoir was recharged in
four hours; the gas from the chamber was tested, to
be found quite innocuous, and to exist still as pure
180 ON VITALISING AND DEVITALISING OXYGENS.
oxygen ; yet the drowsiness of the animals continued.
The symptoms were not those of asphyxia nor of
excitement of any kind, hut of the gentlest sleep.
The pigeon slept as birds usually sleep, with its
head under its wing. The four-footed animals extend-
ing out their fore-feet, their noses resting between
their feet, slept deeply and calmly, with their heads
gently nodding, and with their breathing easy, quiet,
and regular. If they were aroused and there was some
difficulty in arousing them they fell back again im-
mediately to sleep, their limbs giving way as if over-
come with sleep. The sleep became deeper, the
breathing slower; and by the time the third charge of
oxygen was three parts over, the pigeon had ceased
to breathe ; the cat had so nearly ceased, it was difficult
to detect any movement of the chest ; the dog just
breathed, easily and at long intervals ; and, the rabbit
was in the deepest sleep, from which it could not be
roused. The frogs alone were unaffected. It did
not seem that they had experienced any change in
their life, except that the webs of the feet were of
a brighter red than usual.
At this time some gas extracted from the chamber
was carefully tested. It contained less carbonic
dioxide than the common air of the large room in
which the chamber was placed, and a lighted taper
plunged into the chamber burned with the same
brilliancy as in pure oxygen, though, I thought, with
a faint yellowness of flame. The animals were re-
moved from the chamber. The pigeon was quite dead ;
the cat continued to sleep for a few minutes, and then
ceased to breathe ; the dog continued to breathe in the
common air, woke up after an hour, and recovered, but
remained inactive and listless for the greater part of a
ON VITALISING AND DEVITALISING OXYGENS. 181 1
day ; the rabbit woke up just as if it had rallied from
a long sleep under chloroform, and in two hours was
quite well.
The bodies of the pigeon and cat were carefully in-
spected after death. They presented no indication of
death by asphyxia. The lungs were inflated, and of a
red colour. The heart contained blood on both sides,.
and of the same colour on each side, not venous, not
arterial, but like venous and arterial bloods admixed.
The brain was bloodless. All the other organs of the
body were quite natural. The appearances were the-
same in both animals.
The research was next continued in the same way with
animals separately in smaller chambers. Without any
exception, the same results were obtained. During the-
second period of re-inhalation of the same gas, drowsi-
ness was induced, which during the third re-inhalation
passed into deep sleep, and easily extended into death
by sleep if the inhalation of the modified gas were
continued.
Lastly, Broughton and Brodie's researches, in their
original form, were re-tested with this new light
thrown upon them, and with entire confirmation of
the correctness of those distinguished observers.
The ultimate result of these inquiries was the
evidence that oxygen, inhaled at the same temperature
by some warm-blooded animals, can be made to produce-
fever and inflammatory local changes, as Beddoes said,
or can be made to induce coma and what may be called
deep narcotism, as Broughton and Brodie described.
Fresh oxygen was shown to be an excitant ; oxygen
breathed over and over again, although cleared of all
known products of animal combustion, was shown to be
an anesthetic or narcotic.
VOL. iv. 13
182 ON VITALISING AND DEVITALISING OXYGENS.
DEVITALISING OXYGEN EEVITALISED.
The research was now recast from the observations
which had been previously made. The method of
causing warm-blooded animals to become comatose by
the re-inhalation of oxygen was followed up to the
point when symptoms of narcotism were indicated.
At that point freshly made oxygen was introduced in
current instead of oxygen that had been inhaled,
purified, and restored. The fresh oxygen led to rapid
removal of the signs of narcotism, and, if continued,
caused the symptoms of excitement in the animals
susceptible to its influence.
Once more. The method of producing narcotism by
re-inhalation of oxygen was conducted as in previous
cases, but when the signs of narcotism were manifest,
the oxygen in the chamber was charged electrically by
a series of brushes from a metallic point connected with
the positive conductor of a frictional electrical machine.
Within a very short time the gas thus modified lost
its narcotising power, and resumed its character as
an excitant just as if freshly made oxygen had been
introduced.
But during all these changes caused by oxygen on
the warm-blooded animals, cold-blooded animals frogs
were not influenced ; they were not excited by the
active, they were not rendered drowsy by the negative
gas.
In the course of this research, one incidental note
was made which is of moment. It was observed that
the decomposition of dead animal substances, such as
portions of flesh, cooked and uncooked, was much
more rapidly developed in the devitalised than in the
fresh oxygen.
ON VITALISING AND DEVITALISING OXYGENS. 183
EEFLECTIONS.
The fact of deepest interest attaching to these re-
searches is that oxygen, on being breathed and re-
breathed by living animals, loses its power of main-
taining life, becomes a gentle but effective anaesthetic,
and induces a condition of oblivion or sleep which is
intensely profound, but which need not be fatal.
The question follows. How is this influence brought
about ?
To this question there can, I think, be but one of
the three following answers :
(A) During the course of the oxygen through the
living body there is generated, and afterwards thrown
off from the body, an unknown gaseous product, which
has not yet been isolated from the atmosphere into
which it is diffused.
(B) Oxygen is a compound substance, in the pro-
cess of its circulation through the body is decomposed,
and loses in the decomposition one of its component
parts, that is essential to life.
(c) During the contact of the oxygen with the blood
or the tissues of the animal, some quality of the gas
essential to its vitalising power is lost, so that the gas
becomes negative in its action.
The first and second of these answers seem inade-
quate, for the simple reason that if either a new com-
bination product were formed, or if the oxygen were
decomposed and a new product of decomposition were
formed, there would be some change in the remaining
gas within the chamber, which change would be easily
recognisable. Further, if the phenomena of sleep and
collapse were due to a new product or to the decomposi-
tion of the oxygen, it is not easy to explain why the gas
184 ON VITALISING AND DEVITALISING OXYGENS.
should continue to support flame, or why the passage
of electric brushes through it should renew its vitalising
powers.
Whatever view he taken as to cause, the phenomena
are equally important as physico- vital facts, for we see
in them an explanation of some common hut hitherto
unexplained experiences. The relaxation and depres-
sion which precede a thunderstorm when the air is
close and sultry and the brightness and lightness which
follow after the lightning has revivified the oxygen of
the air is one of these experiences.
The extreme relaxation and depression which is felt
when many persons are crowded together in a close
room, even though ventilation be provided for, and
the relief which is obtained on getting into a more
open space, is a second similar experience.
The difference between the air of the valley and
that of the raised plateau is a third illustration ; and the
difference on the body of a moist and of a dry air may
possibly receive its explanation from this knowledge of
the vital changeabilities of oxygen. It is most reason-
able to infer that the saturation of the air with water
may as distinctly deprive the oxygen of its vital activity
as that it should render some electrical phenomena,
notably the production of ozone by the electric dis-
charge, difficult of demonstration.
Lastly, and this is the most important fact of all to
us practising physicians the phenomena afford a light
which may guide us to the interpretation of many of the
obscurest symptoms of disease. Granting that there may
exist in the body, under abnormal conditions, substances
which reduce the vital properties of oxygen, then depres-
sion, inertia, drowsiness, and prolonged sleep, may be
natural and necessary results. Even so simple a thing
ON VITALISING AND DEVITALISING OXYGENS. 185
as an excess of water in the blood would be all-sufficient
to produce such a series of results, and this indeed is
what I found did occur in lower animals in the syn-
thesis of ascites by mtra-peritoneal injection of water.
I predict in conclusion, if it were ever to occur,
by natural or artificial means, that in a living body
the oxygen taken in by the lungs should pass, after its
oxygenation in the lungs, back to the right side of the
heart, the reverse of what occurs in cyanosis and
should so make its way a second time round the cir-
culation instead of being used up effectively in the
production of carbonic dioxide, then there would be
symptoms of depression, lassitude, relaxation, and
inactivity ; symptoms, in short, like those induced by
the gas after it had been deprived of its vital energy by
the process of re-inhalation, ut supra.
PRACTICAL BIOMETRY, OR THE MEASURE-
MENT OF LIFE IN HEALTH AND DISEASE.
CHAPTER III.
ON MEASUEEMENT OF LIFE IN RELATION TO THE GENERAL
CONDITION AND APPEARANCE OF THOSE PROPOSING TO INSURE.
GENERAL CHARACTERISTICS.
OEE importance than is commonly supposed is
attached by the Directors' Board to that
portion of the report of the medical referee
which treats on the general appearance of the
person proposing to be insured. It is such an everyday
occurrence to hear that a person is looking well or ill, or
that a person is looking younger or older than his years,
that we are apt to let the observation pass as of trifling
note. In life assurance the observation means much, and
as a preliminary notification, and if I may so say, intro-
duction of a proposer, it is of much service to those to
whom he is introduced.
The evidences on which the brief answer to the ques-
tion relating to personal appearance should be founded,
in order to render the answer quickly applicable, include
physiognomical readings of health and disease with which
the practitioner soon becomes familiar. They are the facts
derivable from the movement and gait of the person, as
PBACTICAL BIOMETRY. 187
betokening activity, strength, and life or, inactivity,
dulness, want of vitality, or premature age ; the facts
betokening elasticity of mind and freedom from care, or
oppression of mind, anxiety, and worry ; the facts betoken-
ing good or bad nutrition, the nutrition that is fairly
balanced and healthy, or the nutrition that is either too
pronounced or too little pronounced, the nutrition of
obesity or the failure called emaciation or wasting ; the
facts which bear on the complexion in relation to disease,
whether the cutaneous surface be of natural tint, or suffused,
or pale (anaemic), or waxy-looking, or yellow or pasty ; the
facts relating to expression, whether that be mobile and
happy, or dull, heavy, and firm-set ; the facts relating to
the changes of colour in the hair, whether the hair retains
its natural colour and quantity, or whether it be grey or
be falling off.
When, from the arrangement of observation of these
signs, it is possible to state the general conclusion that the
proposer looks younger or older than his age, or is of
natural appearance according to his age, an important
piece of evidence is obtained. When again, irrespective
of appearance of age, the indication of internal change
and of degeneration is presented, the evidence is still more
valuable.
PARTICULAR EXTERNAL CHARACTERISTICS.
There are certain external appearances which have of
late years been held as of special moment, and which
deserve a brief notice in this place. They are (a) the
atheromatous expression, (5) the alcoholic expression, and
(c) the arcus senilis.
(a) The atheromatous expression is that of a dull, waxy
paleness, in which the sclerotic or white of the eye
specially shares. The whole of the cutaneous surface is
188 PRACTICAL BIOMETRY.
pale, dry, cold. The features are dull, heavy, and drowsy,
and the eyelids and lips are large, but not swollen. The
veins often stand out prominently. The patient, generally,
is enfeebled, and although there may be no decisive physical
signs of disease of the lungs, he is rendered breathless on
slight over-exertion. The indications are those of athero-
xnatous disease of the arterial vessels, and of vital failure
from progressive degeneration.
(b) The alcoholic expression is essentially cyanotic in
character. The skin, especially of the face, is red or
reddish-dark, or actually dark in colour, and in cold
weather is often much darkened. The features are heavy,
and the eyelids and sclerotic coat of the eye are usually
injected. The vessels of the nose are large and injected.
^Sometimes on the nose there is the development of the
tubercular cutaneous disease, acne rosacea, a symptom
which is always of importance. The expression in the
alcoholic face is that of excitement and stare, or of depres-
sion and lack of apprehension, with lax or feeble look.
These conditions of expression may alternate in the same
individual, but either of them is very characteristic. The
.alcoholic expression is indicative, as a rule, of actual
-degenerative structural change.
(c) The arcus senilis, or white line surrounding the cornea,
has received various readings in relation to its value as a
sign of internal disease. In all times in the history of
medical science the arcus has been looked upon as a sign
of premature old age, and the fact that it is frequently
present in old age, as its name implies, has given an
almost universal credence to the view stated. When,
some thirty years ago,. the late Mr. Edwin Canton threw
out the brilliant theory, which for a time so enchanted his
compeers, that the arcus senilis was, so to speak, the
outward and visible sign of fatty degenerative change of
MEASUEEMENT OF LIFE IN HEALTH AND DISEASE. 189
internal organs ; when in support of this theory he
adduced that the arcus itself is due to fatty change ; and,
when he backed up this statement by a record of cases
in which the arcus was present in combination with fatty
degenerative conditions of the heart in the same persons,
the inter-relationships of the two conditions were accepted
as of grave account. For a time arcus senilis was
intimately connected in the mind of the physician with
fatty degeneration of the heart.
This view does not now hold its place. When it is
stated in a report on the life of a person who claims to
be insured that the arcus senilis is markedly present, and
when it is told that the said person is young, or has not
reached the meridian of life, the sign is accepted as of
certain value. But if it be not connected with other
manifest signs of -degeneration it is not considered as an
excluding sign. It ought not to be, for, occasionally,
even those who present it when they are young live on to
a full term of life. In my own experience this has been
signally the fact. A young man who consulted me in the
year 1854 because he was told that the arcus senilis,
which was marked in both his eyes, indicated disease of his
heart, is still living, and is and has been in the enjoyment
of the best health. This, I think, is not by any means
a rare experience.
The arcus senilis is, probably, hereditary as a pheno-
menon, like grey hair. Presented in a person who has a
good family history, a history of longevity, it need not, in
my opinion, be of itself a disqualifying sign at all. Taken
in connection with signs of degeneration it may and
should be carefully stated, but without the extreme im-
portance attached to it that was connected with it when
the mere fact of its presence was looked upon as a solemn
presage. After middle life it is less important than before.
190 PEACTICAL BIOMETRY.
CHAPTER IV.
ON TEMPERAMENTS IN RELATION TO THE MEASUREMENT OF LIFE
FOR INSURANCE.
It is an old observation in medicine, old as Hippocrates,
that men are widely divided by temperaments, and
that certain temperaments are better or worse than
others in respect to the life value of those in whom
they are discovered. At various periods different
observers have described the human temperaments in
different language and under different classifications,
but it shows how little man has changed in respect to
temperament when we learn, as we easily can, by
comparing the descriptions of the Father of Medicine
with the natural facts lying before us at this hour, that
the temperaments presented three thousand years ago
are presented practically unchanged in the present day.
THE BASIC TEMPERAMENTS.
There are four basic temperaments, all of which ought
to be recognised in measuring up life for insurance. It is
true they often commingle, two or more of them blending
in the same person, owing to blendings of different
temperaments through marriages ; but when the bases
are understood the blendings are easily read off. The
basic temperaments are (a) the sanguine ; (b) the nervous ;
(c) the bilious ; (d) the lymphatic.
The Sanguine Temperament. In persons of the pure
sanguine or sanguineous temperament the hair is red,
or of warm auburn colour ; the eyes are light blue
or hazel-grey ; the complexion is ruddy ; the skin is
usually freckled ; the body is strong, tall, lithe, active ;
the voice sharp and piercing ; the temper quick ; the
mind hasty, keen, perceptive ; the circulation quick,
MEASUREMENT OF LIFE IN HEALTH AND DISEASE. 191
steady, and firm. Persons of this temperament, if they
lead regular lives, are, as a rule, happy and long-lived.
If they are ill, they recover quickly when recovery
commences, although they are very liable to acute disease ;
and if they do not actually recover, they hold long and
tenaciously to life. They are reputed, and properly so,
as of " wiry constitution." They may generally be accepted
as good lives for assurance, and if they are in health,
they look younger than they really are. If they look
older than they really are, they may fairly be suspected of
organic deterioration in some vital part.
The Nervous Temperament. Persons of nervous tempera-
ment have light hair; blue, deep blue, or bluish-grey
eyes ; fair complexion, with often abundant freckles ; calm
and soft features ; and open expression. The representa-
tives of this type vary extremely in respect to build and
strength of body, for they are subject specially to the
strumous diathesis. In the most favoured specimens the
body is splendidly developed ; the skeleton is large and
strong, the muscles firm and strong ; the movements of
the body, slower than in those of the sanguine type, are
graceful and powerful ; the voice is full and resonant, the
temper even, the will resolute, the circulation firm. In
the least favoured specimens of the nervous temperament
the complexion is pale, the hair greyish white, the features
small, the expression feeble, the skeleton slight, the
muscles deficient in power, the gait and bodily movement
generally weak, the voice feeble, the temper irritable, the
will irresolute, the circulation feeble. In these representa-
tives of the nervous temperament the evidences of
strumous affection are usually to be detected, and the
history of the strumous diathesis is traceable in the line
of their family. For insurance the people of nervous tem-
perament who are of the first class are fairly recommendable,
192 PEACTICAL BIOMETEY.
though they are not so long-lived as persons of the san-
guine type. Those of them who come under the second
division I have named are bad representatives for insurance
even at their best.
The Bilious Temperament. Eepresentatives of the bilious
temperament have dark hair, dark eyes, swarthy skin,
large and often finely chiselled features, and staid ex-
pression. They have frequently the skeleton finely
developed, and have great muscular power. They are,
however, less lithe and active than those who are of
sanguine cast, but they possess much greater mental
capacity. Their voice is full and melodious, their temper
passive, their will firm, their circulation steady and slow.
They live to a full, if not to a ripe old age, when they are
not exposed to unusual wear and tear of life. Taken as
a whole, their vitality affords an excellent average.
They are good lives for assurance.
The Lymphatic Temperament. The representatives of
the lymphatic temperament have watery blue or grey
eyes, light brownish white, or ash-coloured hair, pale
complexion, heavy features, and dull expression. The
skeleton, if it be large, is not elegantly formed, and the
muscles, even though they be fully developed, are flaccid
and feeble. The movements of the limbs are clumsy, and
the gait heavy. In the matter of physical construction,
persons of pure lymphatic temperament are not favourably
placed for enjoying length of life, for they are easily
reduced in power during disease, and probably are open
to danger from overstrain and physical shock in a more
decided degree than others. But they have one remark-
able redeeming quality, namely, that they are of even mind
and take the events of life with more complacency
than any other class of their fellows. This ensures them
from much harm that would otherwise be apt to occur
MEASUREMENT OF LIFE IN HEALTH AND DISEASE. 193
to them. They are not usually long-lived, for their
tendency is to repose and inactivity, under which they
are prone to fatty degenerative changes ; but they live
commonly to a fair term of years and are moderately
favourable for insurance.
DIVISIONS OF IJFE AND TEMPERAMENTS.
If we take the full term of natural life on its anato-
mical valuation, as Fluorens has estimated it namely,
at one hundred and five years, we may divide it into
seven parts :
1 . From birth to fifteen years : completed childhood.
2. From fifteen years to thirty : completed adolescence.
3. From thirty years to forty-five : completed manhood.
4. From forty-five to sixty : ripened manhood.
5. From sixty to seventy-five : first decline.
6. From seventy-five to ninety : second decline.
7. From ninety to one hundred and five: senile
maturity.
We may then theoretically apportion the value of the
temperaments by a standard as follows, supposing the
representatives of each temperament to run their natural
course :
Sanguine. Life value to sixth stage, running into the
seventh.
Nervous. Life value to fifth stage, running into the
sixth.
Bilious. Life value to sixth stage.
Lymphatic. Life value to fifth stage.
MIXED TEMPERAMENTS.
I have described above the four basic temperaments
in their pure type or form. As, however, it is rare to
194 PEACTICAL BIOMETRY.
see them in this type, it becomes necessary to consider
the mixed temperaments in relation to value of life.
Favourable Admixtures.
The mixture of the sanguine and bilious.
The mixture of the sanguine and nervous.
The mixture of the sanguine and lymphatic.
The mixture of the nervous and bilious.
Unfavourable Admixtures.
The mixture of the nervous and lymphatic.
The mixture of the bilious and lymphatic.
The most favourable of these mixed temperaments is
probably the sanguine and bilious ; the most unfavourable
is, without doubt, the nervous and lymphatic.
In an excellent essay bearing on this subject, Dr.
Moreau Morris gives the colours of the iris a prominent
position as a test of measurement of life by temperament.
" The colours of the iris," he says, " are, strictly speaking,
either blue or brown, presenting every variety of shade,
whose perfect admixture produces the pure hazel. The
colour of the iris never changes in the individual, except
as to shades, and presents one of the strongest indications
of the original fundamental constitutions. Thus the two
temperaments bilious and sanguine are well represented,
the first by the brown, the second by the blue ; the
former venous, sluggish ; the latter arterial, quick. In
the pure hazel we find these two grand temperaments
well blended, nearly always associated with vigorous,
healthy, and long life." Morris is further of opinion, in
which I fully coincide, that, " as a rule, when the iris
looks watery and weak with the colour, whether brown
or blue, thin and transparent, there may be suspicion of
a defective constitution, while a pure, deep, bright colour
MEASUBEMENT OF LIFE IN HEALTH AND DISEASE. 195
is a strong indication of a vigorous life. Very dark hair
and beard, with light eyes and pale skin, show scrofulous
and consumptive tendencies."
In a further note, in which, in the main, I also concur,
he adds that " the colour of the hair, beard, and skin
compared presents good indications of health and disease,
as well as of personal and ancestral longevity. Dark red
hair and beard indicate nearly the same bilious tempera-
ment as dark brown or black hair with brown eyes.
When the eyes are of a reddish brown tint, easily lighted
up under excitement, caused by a more rapid circulation,
we have most decided indications of the tendency to
apoplexy, liability to sunstroke, or sudden cerebral
congestion ; and as in these temperaments there is
usually less muscular tenacity of vessels, it is with such
that the smaller blood-vessels give way under pressure
from undue excitement or continuous mental activity. It
has been remarked that comparatively few persons with
pure brown eyes can be found living above seventy years
of age. On the other hand, it is rare to find persons over
the age of seventy who have not pure hazel eyes."
To this description should be added, in my opinion, the
grey eye as pertaining to those who often attain great
age when the sanguine temperament predominates.
COTEMPORARY PRACTICE AND
LITERATURE.
" Every physician wul and ought to make observations from his own experience ;
but he witt be able to make a better judgment and juster observations by
comparing what he reads and what he sees together" FBIEND.
"JONES MEDICAL AND SURGICAL MEMOIRS,"
(BY JOSEPH JONES, M.D.)
MONGST the books of the quarter there can be no
hesitation In giving first place to the two new
volumes of " Medical and Surgical Memoirs,"
containing investigations on the geographical
distribution, causes, nature, relations, and treatment of
various diseases, by Joseph Jones, M.D., Professor of
Chemistry and Clinical Medicine in the University
of Louisiana. The work is peculiar in that it is not
only written, but published also, by its learned author,
who in this matter of business combined with author-
ship goes ahead of Mr. Euskin himself.
As a medical investigator and writer, Joseph Jones holds
a position which is singularly his own. He is at one and
the same time a professor of chemistry and of clinical
medicine, as Boerhaave was in last century. There are
many and obvious advantages in this arrangement, so
many that if a chair of the kind were to be instituted
here, it would be soon one of the most popular. There is
something most direct in the combination. Every sick
COTEMPORARY PRACTICE AND LITERATURE. 197
person presents some sign of deranged chemistry, and
whatever is given, medicinally, to cure the sick, has its'
own distinctive chemical quality. The practitioner of
medicine is forced, therefore, to become a chemist,
whether he will or not, and whether he be a good or a
bad chemical scholar. Professor Jones is equally good as
a chemist and as a clinical worker, to which excellent
qualities he adds an industry which probably constitutes
him the most industrious man living in the present world
of physic. In the two volumes under notice, he supplies
over thirteen hundred closely printed octavo pages of work y
dealing with more than two hundred and fifty different
subjects of a physiological, chemical, pathological, and
practical character. It is difficult to name preferentially
any of these subjects, but those which seem most deserving
of study relate to the blood, the cadaveric alkaloids,
malarial fever, hsemorrhagic fever, indigenous remedies of
the United States, intermittent fever, jaundice, filaria
in blood of animals and man, leprosy in America, albi-
nism in the negro race, direct action of malarial poison on
the nervous system, stagnant swamp water, and yaws in
relation to syphilis and yellow fever. If there be one
part of this work which I have myself perused with
more interest than another, it is that on the indigenous
remedies of the United States. During the recent war,
when the ports were blockaded, and all commercial
intercourse cut off from those countries and American
States from which the South had received her. supplies of
medicine, it was necessary that the indigenous remedies-
should be carefully examined. This led to the inquiries
by Professor Jones on which the facts of this memoir are
based, and a truly curious and valuable memoir it is.
The Georgia bark (Pinckneya pubens\ a rival of cin-
chona ; dogwood (cornus Florida) ; Virginia snake-root
VOL. IV. 14
198 POST SCBIPTA.
(aristolochia serpentarid] ; and quite a fair materia niedica
of other substances are here brought before us, with some
remarkably good commentaries on the value of salicin
and of the salicine compounds.
To pass a word of complaint on labours such as these
were indeed impossible, except when the author's own
interests are at stake ; and, because of these interests, it
may be admissible to suggest that it had been far more
convenient if each of the great memoirs had been brought
out in separate volumes of handy size, rather than in the
somewhat ponderous form in which they are here put
together. The illustrations, which are so excellent and
useful, would, in this way, have come well together in
each volume, and the study would be immensely facili-
tated of works so super-excellent that nothing ought to
stand in the way of their universal utility in medicine.
POST SCRIPTA.
" Gray* Anatomy," " Radcliffe's New Departure in Science" with other Reviews,
will appear in the next number.
TO CORRESPONDENTS.
Books, Reports, and Pamphlets intended for notice in THE ASCLEPIAD should be
addressed to the Author at his residence, 25, Manchester Square, London, W.
Names of Subscribers and other Matters of Business should be forwarded to Mesrs.
Longmans, Paternoster Row, London, E.G.
Advertisements, and all Communications respecting them, should be forwarded to
Mr. A. P. Watt, 2, Paternoster Square, London, E.G.
The Author will be greatly obliged if senders of Newspapers and Magazines would
kindly mark the j)assages to which they wi-sh to direct attention.
APPENDIX OF ACKNOWLEDGMENTS.
" Canadian Economies." Montreal: Dawson Brothers. 1885.
"The Medical Annual for 1887." Edited by PERCY WHITE. London: Hamilton,
Adams & Co.
" The Croonian Lectures." By P. W. LATHAM, M.D. London : G-. Bell & Co. 1887.
" National Temperance League Annual." Edited by ROBERT RAE. London : National
Temperance DepSt. 1887.
"Cancerous Affections of the Skin." By GEORGE THIN, M.D. London: J. & A.
Churchill. 1886.
" Paving of Private Streets." By WILLIAM SPINKS. London: E. & F. N. Spon. 1887.
" Thomson's Conspictus Adapted to the Pharmacopoeia of 1885." Edited by NESTOR
TIRARD, M.D. London : Longmans & Co. 1887.
" The Science of Dress." By ADA S. BALLIN. London : Sampson Low, Marston &
Co. 1885.
" Disease in Childhood." By G. A. WRIGHT, M.B. London : Longmans & Co. 1887.
" Disease and Sin." By A MEDICAL MUSER. London : Wyman & Sons. 1886.
" The Picture of Jesus." By H. R..HAWEIS, M.A. London : Charles Burnet & Co. 1886.
" On Fevers : their History, Etiology, Diagnosis, and Treatment." By ALEXANDER
COLLIE, M.D. London : H. K. Lewis. 1887.
" Suggestive Lessons in Practical Life." 4th Series. London : Smith, Elder & Co. 1887.
" Medical and Surgical Memoirs on the Geographical Distribution, Causes, Nature,
Relations, and Treatment of Various Diseases." By JOSEPH JONES, M.D. New
Orleans : J. Jones, M.D. 1887.
" Sixieme Congres International Pharmace utique. Compte Rendu." Par E. VAN DE
RYVERE. Bruxelles: 1886.
" Some Phases of Cerebral Syphilis, " and " On Tinnitus Aurium." By JULIUS ALTHAUS,
M.D. London : Longmans & Co. 1887.
"Harveian Oration." By F. W. PAVY, M.D., F.R.S. London : J. & A. Churchill. 1886.
"Inaugural Address at the Meath Hospital." By L. H. ORMSBY, M.D. Dublin: J.
Atkinson & Co. 188G.
" Researches into the Etiology of Disease." By J. W. MCLAUGHLIN, M.D. Chicago : 1886.
" Oxygen as a Remedial Agent." ByCHAS. J. SMITH. London : J. & A. Churchill. 1887.
" Good Health : is it worth Buying ? " By JOHN C. M'VAIL, M.D. Kilmarnock :
Dunlop. 1887.
" Temperance from a Medical, Social, and Religious Point of View." By WILLIAM
JEFFREY, LL.D., L.R.C.P. Edinburgh : Ogle & Murray. 1887.
"An Address on the Physical Training of Girls." By RAYNER W. BATTEN, M.D.,
M.R.C.P. Gloucester : Chance & Bland. 1887.
" Boston Monday Lectures." By JOSEPH COOK, D.D. Boston : Rand Avery Company.
1887.
" Die Alkoholfrage. " By VON G. BTJNGE, Professor of Chemistry au der Universitat
Basle. Leipsig : F. C. W. Vogel. 1887.
" The Water and Baths of Aix-les-Bains." By S. M. RENDALL, M.D. Edinburgh : E.
& S. Livingstone. 1887.
'The Neurotic." By J. MILNER FOTHERGILL, M.D. London : 1887.
" Eaten of Worms." By BRIGADE-SURGEON W. CURRAN. London : T. W. Danks. 1886.
" The Coming Reformation of the Twentieth Century." By Lrsus NATURAE. London :
Simpkin, Marshall & Co. 1887.
" Inaugural Address on Listerism." By G. BANTOCK, M.D., F.R.C.S. London: 1887.
" Cancer : its Origin and Prevention." By D. W. WILLIAMS, M.D., M.R.C.P.L. [London :
Hamilton, Adams & Co. 1887.
" M. Pasteur at Bay." By JOHN C. CLARKE, M.D. London : Victoria St. Society. 1887.
' ' Comparison of the Poisons in Diphtheria, Scarlet Fever, and Membranous Croup.' '
By CHARLES J. RENSHAW, M.D. Sale : Croft & Co.
" Witchcraft, Conjuration, Exorcism." By A. ELLEY FINCH. London : 1887.
" Inaugural Address at the Society of Engineers." By PROFESSOR HENRY ROBINSON.
London : E. & F. N. Spon. 1887.
" On Intrapulmonary Injections." By ARTHUR RANSOME, M.D., F.R.S. London : John
Heywood. 1887.
" Genesis of the Elements." By WILLIAM CROOKES, F.R.S., V.P.C.S. London: 1887.
"The Main Drainage of the Houses of Parliament." By THE ENGINEER. London:
Alexander & Shepheard. 1887.
" Cookery for our Sick and Invalid Poor." By THE AUTHOR OF "CHEAP DINNER
DISHES." London : Simpkin & Co.
"La Circulation des Forces." By DR. L. NATAUSON. Paris : 1886.
200 APPENDIX.
" Some Points on the Physiology of Attention, Belief, and Will." By JAMES CAPPIE,
M.D. London : William Clowes & Sons. 1886.
" State-and-rate-paid Education." By EARL FORTESCUE. Reprint from National
Review. 1887.
' ' The Geography of Malaria." By JOHN PARRISH, M.D. Newark : L. J. Hardham.,,1886.
' ' Further Remarks on Hepatic Phlebotomy and Puncturing the Liver Capsuli." By
GEORGE HARLEY, M.D., F.R.S. London : 1887.
" Inaugural Address at Congress at York, September, 1886." By SIR T. SPENCER
WELLS, Bart., F.R.C.S. 1886.
" Pneumato-Therapy." By SOLOMON SOLis-CoHEN, A.M., M.D. Detroit : George S. Davis.
" Speech on Cremation Bill." By THE HON. J. MILDRED CREED. Sydney : L. Brack. 1886.
" Rural Sanitation." By J. A. DAVENPORT, CJ3. Nantwich : 1887.
" An Address on Medical Education, Examinations, and Degrees." By JOHN S. BRIS-
TOWE, M J)., LL.D., F.R.S. London : 1887.
"Etiology of Constitutional Diseases of the Eye." By JOHN TWEEDY, F.R.C.S.
London : Ballantyne & Co. 1887.
" Intestinal Casts, with Report of a Case." By W. A. EDWARDS, M.D. Pennsylvania: 1887.
" Speech on Repeal of Contagious Diseases Acts." By C. BELL TAYLOR, M.D. London :
Effingham Wilson. 1883.
' ' Some Medico-legal Cases under State and National Laws." By B. JOY JEFFRIES,
A.M., M.D. Boston : 1886.
" Diseases of Potters." By JOHN T. ARLIDGE, M.D., A.B. Hanley : Allbert & Daniel.
1887.
" Causes of Small Average Fees among Doctors." By A COMMON SENSE DOCTOR.
EXCHANGES.
" The New York Medical Journal." '' Journal of Chemical Society." "Journal of
Society of Arts." "Chicago Med. Journal and Examiner." "New Orleans Med. and
Surg. Journal." " Sacramento Med. Times." " Monographia Syphilitica." " Illus-
trated Science Monthly." (> New England Med. Monthly." " Chemical News."
" Clergyman's Magazine." " College and Clinical Record." " Glasgow Med. Journal."
" Bristol Med. Chir. Journal." " Australasian Med. Gazette." " Journal of Mental
Science." "Quarterly Journal of Inebriety." "Sanitary Journal." "Hygiene
Pratique." "Med. Temperance Journal." ''The Polyclinic." "Asylum Journal."
" Journal of Microscopy." " Longmans' Magazine." " Gentleman's Magazine." " Bel-
gravia." "Chemist and Druggist." "Health." "Sanitary World." "Journal
d'Hygiene." "Malthusian." "Animal World. 1 ' "Scientific American." "Bollettina
della Societi Fiorentina d'Igiene." "Med. Record." "Bulletin de 1' Academic de
Medecine." "Liverpool Med. Chir. Journal." " Medico-legal Journal." "Hospital
Gazette." "Journal Scottish Meteorological Society." " International Journal of the
Med. Sciences." "Journal of Heredity." "The Health Journal." " Science Gossip."
"The Med. World." "The Photographic News." "Edinburgh Med. Journal."
" The Wayfarer." " South African Med. Journal." " Phrenological Magazine." "Med.
and Professional Review." " Technics."
REPORTS AND TRANSACTIONS.
" Special Report of the Bureau of Education." Part I. New Orleans : 1884-85.
Washington : 1886. " Bulletin of State Board of Health of New York." September and
December, 1886. " Report of East London Nursing Society for 1886." London : 1887.
" Report on Works Executed by the Hon. the Commissioners of Sewers during 1886." By
WILLIAM HAYWOOD. London : Mitton, Smith & Co. 1887. " Report of the State
Board of Health of the State of Michigan for the Fiscal Year ending Sept. 30th, 1885."
Lansing : 1886. " Report of Medical Officers of Health of Newcastle-on-Tyne during
1886." Newcastle-on-Tyne : A Reid. 1887." Annual Report of River Tyne Port
Sanitary Authority, Feb. 14th, 1887." " Transactions of the Sanitary Institute of Great
Britain." Vol. VII. 1886.'' Transactions of the Odontological Society of Great
Britain." London : Harrison & Sons. 1887. " Transactions of the Society of the
Medical Officers of Health. Session 1885-86." London : Shaw & Sons. 1886.
" Transactions of the Academy of Medicine of Ireland." Vol. IV. 1886. Dublin :
Fannin & Co. 1886. " Proceedings of the Medical Society of London." Vol. IX.
Harrison & Sons. 1886. '' Proceedings of the Society for the Study and Cure of In-
ebriety." London : H. K. Lewis. 1887. ; ' Circulars of Information of the Bureau of
Education." Nos. I., II., 1886. Washington : 1886. " Proceedings of the Physiological
Society." London : 1887." The Vital Statistics of the City of Glasgow." By J. B.
RUSSELL, M.D., LL.D. Glasgow: A. Macdougall. 1886. " Rusultati dell' Inchiesta
sulle Condizioni Igieniche e Sanitare nei Comuni del Regno." Roma : Reggiani e Soci.
1886." Report on London Water Supply." By W. CROOKES, F.R.S., W. ODLING, M.B.,
F.R.S., and C. MEYMOTT TIDY. London : 1887.
MEDICINE UNDER QUEEN VICTORIA.
AN EPITOME OF THE GREAT ADVANCEMENTS IN PRAC-
TICAL MEDICINE, PREVENTIVE AND CURATIVE, BY
THE VICTORIAN FACULTY OF PHYSIC THROUGHOUT
THE EMPIRE.
TO THE STUDENT OF THE FUTURE.
S the expectation now exceeds the hope on
which it was begotten, that THE ASCLEPIAD
will be retained as a book of reference when
the passing scenes, rivalries, and tempers
of the present time have ceased to be, I have thought
it useful in an eventful year, and immediately upon
the great event of the year', to devote one complete
number to a brief review of some of the fundamental
changes and advancements which have occurred in
the practical science and art of medicine within the
kingdoms under the rule of the Queen, since her
accession, fifty years ago.
It has been my happy fortune to have lived in the
whole period, and for full four-fifths of it to have been
actively engaged in the knowledge and practice of
medicine, as a student of the same, just as much a
student at this hour as when I sat in the lecture-room,
and all through, Deo favente, in unbroken health and
with opportunities for work and observation in the
heart of the Empire, which few have enjoyed.
This review, therefore, may be taken as almost
VOL. iv. 15
202 MEDICINE UNDER QUEEN VICTORIA.
exclusively from an eyewitness of what is told in it.
When, exceptionally, it is not so exclusive, it is, even
then, direct from another eyewitness who communi-
cated it to the author.
Owing to the circumstance of the directness of the
facts to be recorded, I shall let memory and experience
alone direct the pen ; and in order to reduce to neces-
sary dimensions and intentions the subject to be sub-
mitted, I shall confine observation strictly to those
practical advancements of medical art of the first
degree which have signalised the Victorian era thus
far, in the Victorian Kepublic of medical learning.
In order to steer quite clear of all personal con-
troversy, and to write what is to be told in abstract,
so to speak, towards living labourers in the field of
work, I shall omit all reference to every living name.
Of some of the distinguished dead it may be compatible,
and even necessary, to speak in brief terms ; but of
the living it is fairest and wisest to let their works
follow them, and to reserve all that is personal for
a more extended and detailed history of medicine of
the nineteenth century, to be written in a later period
of my life, should that be spared in a condition for
so great an undertaking and labour.
In the course of the Victorian reign of fifty years
the advancement of medical practice and art has
progressed on six great foundations, to each of which
I propose to devote a special chapter, with an
additional and biographical chapter relating to a man
who fell at his work in the middle of the reign, and
who, to my mind, taking him all in all, was one of
the most faithful representatives of his profession in his
day and generation.
CHAPTER I.
THE FIRST ADVANCEMENT : THE TREATMENT OF THE
INSANE.
'HE first great advancement in the science of
medicine commenced, practically, in the year
when the Queen ascended the throne, and
consisted in the adoption of the method of
treating the insane without violent physical restraint.
What the practice of medicine in the treatment of the
insane had been previously it is in this day almost
impossible to conceive. There was in it no science,
and certainly no humanity. I remember perfectly, as
a youth, climbing the wall of a barn in order to look
through a small grated window at a poor lunatic who,
for over twenty-five years, had been chained in one
corner of the place, and in that condition had been
retained and kept by his relatives as a dog or other
savage animal might have been. He was bedded down
in straw just as other animals were, and, except that it
was put for him on a wooden platter, his food was
given to him as it might have been given to a dog.
He took the food in his hands and tore it with his
teeth, the idea being that it was not safe to let him
have a knife or fork, or anything more than a wooden
spoon as a help for feeding. The people who had this
man in charge were not more cruel than the rest of
mankind. They laboured under the idea that it was
for the safety of themselves, and, on the whole, for the
204 MEDICINE UNDER QUEEN VICTORIA.
benefit of the insane man that he should be kept as he
was kept. Had he been set at large he would have
done some mischievous or dangerous thing for which
he would have been punished, and for which they
would have been responsible. It is true, they might
have sent him to a madhouse, but there he would
certainly not have been better cared for than at home.
He would have been under the rod of strangers, and
might have been exhibited as a show to those who
were curious for strange sights. He might also
have been irregularly fed, or improperly clothed to
meet the variations of seasons. As it was, he was
kept out of mischief; he did not complain, he gave
little trouble, and he was not merely safe himself, but
he was a safeguard to the lonely house or lodge
attached to the barn in which he was domiciled. For,
strangely enough, the poor, helpless creature was a
terror to the superstitiously wicked, to the prowling
vagrant, the thief, the burglar, and the incendiary.
When he howled or cried or laughed maniacally, the
wicked were alarmed into flight. The notion in these
days was also common that the insane, at particular
times, were under special influence, and that lunatics
were under the influence of the moon. That lunacy
was a lunar problem was, indeed, a belief as absolute
as that the moon herself appeared monthly in definite
quarters, and that she governed the tides. This belief
is not effaced yet, but so strong was it at the period I
have been speaking of the latter part of the last reign
that the brother of the lunatic, to whom reference
was made above, would make his calculations as to the
states of mind into which the lunatic would pass by
reckonings of the moon, and sometimes it really
seemed as if his predictions were correctly cast.
THE TREATMENT OF THE INSANE. 205
As an illustration of the barbarities which were
practised in these institutions, my late friend, the dis-
tinguished George Cruikshank, gave me this engraving
which he etched, in his time, from an original drawing
by G. Arnald, A.E.A., of a man named William N orris,
an insane American, who was riveted alive in iron,
and was for many years confined in that state, by
chains twelve inches long, to an upright massive bar in
206 MEDICINE UNDER QUEEN VICTORIA.
a cell in Bethlem Hospital. The drawing was exhibited
"to a select Committee of the House of Commons
on Madhouses 1815," during the delivery of Mr.
Haslam's evidence, and, as it is now extremely rare, I
give a copy of the Cruikshank etching, produced with
striking fidelity hy Mr. Charles Ferrier from the plate
which Cruikshank himself, who saw the original Norris,
gave to me.
I have no personal recollection of the state of
asylums at the first period of the present reign, but I
have heard from others much that excites the surprise
of the present generation when it is told. The asylums
were conducted on the worst and cruelest of systems.
All government, if such it may be called, was by
force and fear. The insane were looked upon as en-
dowed with supernatural strength and craft, as human
machines of great power, cunning, and viciousness,
uncontrolled by reason or any attribute of common
sense. It was best, therefore, to keep them at all
times under restraint, and to make, in some cases,
the form of restraint unchangeable, permanent, and
irresistible.
The system of pinioning the insane in so decisive
a manner as Norris was pinioned, was probably ex-
ceptional, but pinioning in a milder manner was the
rule rather than the exception. Manacles attached to
the limbs and secured by chains to the bunks or beds
in which the insane slept were in common use, and
what was called the strait-waistcoat, by which the
upper limbs were kept under bondage, was so universal,
th'at it remains, by name, a word of reproach towards
.the violent until the present hour. " He ought to be
put into a strait-waistcoat " is still a frequent vulgar
declaration.
THE TEEATMENT OF THE INSANE. 207
The centrifugal and the centripetal treatment on a
wheel were other methods followed out for the manage-
ment of the insane up to the latter part of the period
preceding the Victorian. It had been ingeniously sur-
mised that the amount of blood supplied to the brain
could be increased or lessened by placing a living
human body on a horizontal plane attached at a right
angle to its axis on a large revolving wheel. If the
head of the sufferer were placed on the circumference of
the wheel, then it was assumed that the blood in the
body would be forced into the brain as the wheel went
swiftly round; if, on the contrary, the sufferer were
placed with the head to the centre and the feet to the
circumference, the brain would be emptied of blood as
the wheel revolved. One of the medical friends of my
early days saw this machine in action, and made
inquiries as to the effect it produced. His record in
respect to it was, that, if the prayers of the sufferers
not to be put upon it, their screams on it, and their
giddiness and sickness when they came off it, were to
be accepted as signs of improvement, then the treat-
ment might be considered to have been of value ; but
that he could trace out no instance whatever in which
any insane person had been cured by the experiment.
The Rev. Dr. P., a very learned man, who in my first
days of practice, was a patient under my care, told
me that in a great asylum, of which he was for a time
a governor, the attendants were detected in the act of
dressing the insane under a system of the most astound-
ing kind called by them " the long stocking quietener."
When a patient was to be dressed in the morning, the
attendant went to the bed or bunk of the victim, passed
round his neck a long soft stocking, and gently but
firmly twisted the stocking until the throat was sufii-
208 MEDICINE UNDER QUEEN VICTORIA.
ciently compressed to produce a temporary asphyxia and
insensibility. Then another attendant came, and while
this rough anaesthesia was sustained, dressed the semi-
suffocated body for the day. The plan, on being exposed,
was not without its defenders, who urged that the pro-
cess gave no pain, that it was attended with no bad
results, that it saved hours of horrible suffering, and
that it was humane because it did away with all neces-
sity for chastisement, with strifes and struggles, and
with injuries to the dressers as well as to the dressed.
These various modes of government of the insane by
punishment were not confined to those of the insane
who were poor and, if it be fair to use the term, friend-
less. The rich were shut up in separate houses large
or small, and were subjected to the caprice which the
unwatched powerful almost of necessity extend to
the unprotected weak. Even royalty itself did not
escape. From the moment when the unfortunate
monarch George III. betrayed his insanity in his
speech at the opening of Parliament "My Lords and
Gentlemen, and Woodcocks cocking up your tails," he
shared with his subjects the servitude of the insane.
There are some pictures of him extant, showing him
during the period of his insanity, which are simply
appalling in the misery they betoken. They are
pictures of fear concentrated and abiding, as well as of
a mind aberrant and feeble. The story so often re-
peated that the king, while in confinement at Windsor,
was chastised into obedience, was largely accredited, and
was excused as a necessary part of the treatment of the
insane. The exhibition of the king by his keepers, for
gain, was not considered as at all a detestable measure ;
and that he received bad usage, is, I fear, but too
true. While visiting a large asylum in 1860, the
THE TREATMENT OF THE INSANE. 209
proprietors brought to me a man of advanced life, who
had been engaged in his youth as a younger or assistant-
keeper of the poor king during the pitiful and painful
Windsor period. And this man told us that he himself
had seen His Majesty knocked down for his obstinacy.
Such is the background of the picture of insanity
and its treatment previous to the present reign. I
should rather say, it is a portion of the background
only, for to fill it up entirely would indeed be a task
impossible.
For some time previous to the Victorian era there had
been a few good and humane efforts to relieve the
insane of a certain amount of the oppression to which
they were subjected. Three names in connection with
this effort deserve especial mention, Pinel, of the
Bicetre in Paris ; the elder Tuke, in the Retreat at
York ; and Dr. Charlesworth, in the City of Lincoln
Lunatic Hospital in which Institution the grand final
and triumphant experiment of entire freedom of the
insane was carried out.
The Lincoln Hospital, historical now in regard to the
introduction of the non-restraint system, was opened for
the reception of the insane in the year 1820. It stands
above the city, and commands a wide view of the sur-
rounding country. As an historical place I visited it
twenty-three years ago in order to look over its records
and to come to a safe conclusion in regard to its
claims as the centre from which the new treatment of
the insane, introduced in the Victorian era, had been
inaugurated. I found it to be an unpretending build-
ing from the outside, but light and cheerful within,
the construction being of the old architectural type,
a plain front with wings, and with galleries in the
interior.
210 MEDICINE UNDER QUEEN VICTORIA.
The idea of building this asylum started with a
gentleman by the name of Parnell. Parnell left a sum
of one hundred pounds on conditional terms, in order
to provide for the erection. A considerable time
elapsed before the work began, and at first the house
was not constructed for more than fifty inmates, and
those persons who had seen better days. But it soon
changed in character and received the poorer classes
also ; then it became enlarged, so that in the last two
or three years of the reign of William IV. it had in
it from sixty to seventy patients, who were classified
in three groups the orderly, the disorderly, and the
convalescent ; all of whom were under the general care
and superintendence of a resident medical officer.
My investigations, conducted on the spot at the time
I have named above that is to say, twenty-five years
after the original experiment about to be recorded was
tried led me to discover that from rather an early
time in the history of the institution the insane there
were treated in a manner more than usually thoughtful
and humane. The spirit of Pinel and that of the elder
Tuke had found its way into the asylum, and many
steps were advanced towards the final emancipation
that was to be one of the honours of Victorian civiliza-
tion. The patients of the first class who were con-
sidered orderly, and the patients who were considered
convalescent, were allowed the use of the best apart-
ments and of the grounds in the front of the house.
They were also freed of much of the more ex-
treme kinds of restraint, and were treated as if they
were not under need of government by fear or by the
exercise of cruelties that were as revolting as they
were useless. The disorderly patients remained, how-
ever, under the ban of the old system. They were
THE TREATMENT OF THE INSANE. 211
lodged in the back wards and galleries of the north
side of the house ; they had the courtyard as their only
out-door exercise ground ; and they were subjected to a
strict personal restraint, modified, to a certain extent,
on the instance of Dr. Charlesworth, but retaining
much of the objectionable system. These patients
were not allowed to intermingle one with another,
and were made to wear appliances which restrained
them from the free exercise of their limbs. The
strait-waistcoat had been abolished, because one of the
patients wearing a strait-waistcoat had been found
strangled by it ; and in place of it light iron handcuffs
had been introduced. The handcuffs were attached to
a strong girdle of leather, which went round the waist
by a light chain, and gave moderate freedom to the
arms and hands.
Another improvement introduced by Dr. Charles -
worth consisted of what was called " the boot hobbles."
The " boot hobbles " were a pair of boots made of
bed tick and of leather, the soles of which were
locked during the night to the foot of the bunk or bed
in which the disorderly insane person took his or her
repose. They were adopted in order to avoid the
chafing and soreness of the ankles caused by the iron
anklets with chains, which had previously been in use,
and which were common in most asylums for the insane
in the departments for the disorderly and dangerous
classes there. The idea was humane, but unsuccessful.
The boots did not hold the patients securely, and the
chafing was still severe. Handcuffs with light chains
were used for the upper limbs, and very troublesome
patients were bedded in straw.
These details are offered because they exhibit what
may be ca]led the best of the best treatment for the
212 MEDICINE UNDER QUEEN VICTORIA.
insane that could perhaps, with one or at most two
exceptions, have been found in the world previous to
the present reign. They indicated efforts towards the
radical change that was to follow, lessons admirable
as leading up to that change without being the thing
itself. They suggested amelioration of a system which
was still thought to be necessary.
The advocates of these modifications of procedure
were, like those of the present day, who in treating
of capital punishment consider the punishment neces-
sary, but urge that it should be made perfectly pain-
less, and as far as death can be made pleasant, the
pleasantest of all deaths, namely, by the gentle in-
ducement and sustainment of sleep, until by easy
transition the sleep becomes final.
I discovered from the books of the Lincoln Lunatic
Hospital that in 1829 there were a little over 54 per
cent, of the patients under restraint. The number
slowly diminished until 1834, when it stood a little
over 41, a diminution of 13 per cent. In 1835
there was a reduction from January to July of 4 per
cent, from the previous year ; and from July to
December of 15 per cent, from the previous six months
of the same year. In 1836 this reduction increased
over 10 per cent, beyond the reduction in 1835. In
1837, 9 per cent, of further reduction followed : and,
in 1838, the year of the Coronation, the table of the
restraints of the insane in the Lincoln Lunatic
Hospital was a white sheet. Not one patient, the
house surgeon, Mr. Gardiner Hill, reported to the
Board of Management, had been put under any re-
straint of a physical kind whatever. The disorderly
class had been conquered and ruled by the law of
human kindness. The strait-waistcoat, the handcuffs,
THE TEEATMENT OF THE INSANE. 213
the anklets and chains, the boot hobbles, had one and
all passed from the scene. Four dozen wrist locks,
ordered by the Board of Management from Birmingham
in 1835, remained as curiosities.
That white sheet of 1838 presented to the managers
of the Lincoln Asylum by their resident surgeon was
the finest emblem in all the world of that year of a
new civilization. There are many noble souls who
would rather have been the author of that blank sheet
than owner of the Crown of the Empire, and I doubt
not the day will come when the historian will visit
Lincoln to look at the unpresuming asylum of that fair
city as the Victorian temple of health in which the
liberty of the insane was first proclaimed.
Let me here do justice to one who can no longer
speak for himself, and who played the last and most
efficient part in the great work ; the man who really cut
the Gordian knot, and who, by his courage and pertina-
cious earnestness, transformed a beneficent desire into
a practical system. This man was the young house
surgeon of the asylum, Gardiner Hill. He, entering
on his duties in 1835, made short work of the experi-
mental trial. His argument was of the root and branch
kind : not to modify restraint, acknowledging it to be
a necessity, but to do away with it altogether, as
absolutely unnecessary. In the midst of the keenest
opposition, with a resolution of his superiors facing
him, that if any untoward event attended the experi-
ment the blame would be at his door, he carried the
experiment out unflinchingly and successfully.
I was with Gardiner Hill in his last hours, and told
him once again, as I had often told him aforetime, that
he had not lived in vain, and that some day the world
would recognise him as one of its greatest benefactors.
214 MEDICINE UNDER QUEEN VICTORIA.
He could not speak, for his speech was paralysed, but
his close grasp of my hand conveyed to me, with all the
eloquence of death, how the hope cheered him in the
valley of the shadow.
The system of complete withdrawal of restraint, once
established, went on its way rejoicingly. Dr. Pritchard,
of the Northampton Asylum, a man whom but to see
once is to remember for good, so earnest and gentle
was his nature, was first to visit Lincoln to learn the
new truth, and to act upon it. Then the learned and
splendid Conolly came forward. With unexampled
opportunities, equalled only by unexampled zeal and
industry, Conolly showed at Hanwell how grand an
advance was secured ; and, with his graceful pen made
both the history and the practice of world- wide fame.
There is nothing more striking in the course of
medical science than the improvement in the treatment
of the insane by the abolition of restraint. It may be
considered as a complete conversion extending through-
out all our wide Empire. It has placed us first amongst
all nations as physicians of mental disease, and has
yielded the best literature on insanity that has ever
been produced.
Strangest fact of all, we have obtained, as an outcome
of the system of treatment under the love that casteth
out fear, a literature of the insane by the insane, as
remarkable as it is curious. The Morningside Mirror,
written, edited, printed, I believe, and published by
the inmates of the Morningside Asylum in Edinburgh,
is one representation of this literature, which would
alone suffice to illustrate the success of the first in-
stalment of practical medicine in the history of the
people living under the sceptre of Victoria.
CHAPTEE II.
THE SECOND ADVANCEMENT: PREVENTIVE MEDICINE,
1HE second grand advancement of practical
medicine in the Victorian reign is that
preventive art which, founded on science,
aims to remove diseases altogether, and
to make life so comfortable and so perfect that men
shall die the natural death, the euthanasia, knowing no
more of the act of death than of the act of birth.
" Magnus ab integro seclorum nascitur ordo ;
Redeunt Saturnia regna."
Virgil, who prophesied so much, was himself a physi-
cian, and what he predicted of the Augustan age we
have lived to see begin in ours. For surely when
the order of prevention of disease began, the first
steps towards the golden age were taken.
Medicine, in her practical handiwork, never did any-
thing more noble than when she put her hand to pre-
vention. She tried herself then by the test of the
purgatorial fire. She did not ask, shall I be consumed
by this purifying fire ? She went to work without hesi-
tation, she never ceased at her labour, and she never
will cease at it until the work shall be fully accomplished.
I do not think it is to be doubted that the ultimate
fate of medicine, as a remunerated calling, will be sealed
by the preventive method. Without any doubt the in-
fluence of preventive measures has already commenced
216 MEDICINE UNDER QUEEN VICTORIA.
to tell on professional incomes all round. A few demi-
semi quacks may still nourish their crescendoes, but,
in proportion to the increase of the population, the
general income of medicine has fallen considerably
from what it was in less healthy and less health-pro-
moting times. Fees have risen, but incomes have fallen;
and as there is a limitation in regard to rise of fees, to
prevent them from becoming prohibitive, the prospects
of medicine, commercially speaking, are poor indeed.
The preventive system of medicine had long been
looked for, and hoped for. Hippocrates forecast it. The
Koman Asclepiades aided it. In the Arabian school of
medicine, it was one of the good things to come. At
Salerno it found a resting-place. In the revival of
Italian science and art it had an earnest advocate and
patron of genius in Kamazzini. In last century in
this country it had most distinguished pioneers in
John Arbuthnott, in Sir John Pringle, and, as Mr.
Lecky has lately told us, in a forgotten scholar of high
rank as an advanced sanitarian and author, Dr. Thomas
Short.
But the true advance was reserved for the Victorian
reign. It began in 1838, on a sound basis, with the
public and systematic registration of births and deaths,
and in the publication, week by week, of mortalities,
and of the causes or diseases by which mortalities
are produced.
It was not a member of the medical body who
proposed this important advancement, but it was a
member of our body, the late distinguished William
Farr, who took it in hand, and with an industry, skill,
and perseverance which made all difficulties disappear,
weaved the registration of mortalities together with
their causes, into a record of disease and death that
PBEVENTIVE MEDICINE. 217
has become the broadest, the most instructive, the most
established table of natural laws and sequences that has
ever been constructed in the whole of the domain of
natural knowledge. I do not hesitate to say that, in
the absence of this foundation, we could have arrived
at no true rule or advancement in sanitation, because
without such knowledge as it affords to rest upon, there
would have been speculation without data and endless
controversies, leading merely to complications and
guesses, which would have made confusion worse
confounded.
Two latter-day facts, and facts of common observa-
tion alone, attest to the soundness of this foundation of
knowledge. When now a man or woman wishes to go
to a place to live for a longer or a shorter time, the
mortality table of the place is consulted in order to
ascertain what is the salubrity of the locality, what are
the prevailing diseases of the place, and what its death-
rate. If the death-rate be high, and if the causes of
the high death-rate be found to be removable, such
causes as bring in and sustain the great plagues or
pestilences, then that town is a marked town ; it is
like the condemned places of old ; it is a place haunted
by the spirit of uncleanliness, and must be avoided by
the seekers of health and purity. This is the first
fact. The second is, that this foundation of preven-
tive medicine, laid first in England, is being laid in
other civilized communities with an imitative exacti-
tude which conveys the most satisfactory praise to
the original design.
Other great advancements of preventive science and
art are the official inquiries into the health of the
kingdom; the inquiry into the sanitary condition of the
labouring classes ; the closing of the densely-packed
VOL. iv. 16
218 MEDICINE UNDER QUEEN VICTORIA.
graveyards of great cities, and the institution, in their
stead, of the public cemeteries ; the various successful
attempts to supply great populations with pure water ;
the efforts to apply to useful agricultural or horticultural
purposes the sewage of towns ; the careful study of
ventilation; the construction of model schools and
factories ; the introduction of the half-time system of
education ; the opening of pleasure and recreation
grounds for the people ; the erection of model cottages,
in which the late Prince Consort played so distinguished
a part ; the erection of model lodging-houses ; the
remodelling of the whole system of temporary lodgings
for the poorer classes ; and, the construction throughout
the realm of model prisons. These works of the
Victorian period will form topics for future history,
which will redound to our honour probably beyond
all conquests of any kind previously accomplished
by human skill, courage, and resolution.
Out of these advancements, numerous as they are, it
is difficult to select any one which, more than another,
deserves our special observation. They are all momen-
tous when they are correctly appreciated. I have
looked back upon them as they have risen up before me
in the past, and they come up in such bold and natural
order as to almost defy competitive examination. Com-
pared by the results obtained, it would be fair to say
that the history of the preventive system in the gaols
of the country is the most striking feature. In the
previous reigns the gaols were the saddest pictures and
centres of human degradation, punishment, and misery
that could be imagined after the asylums for the insane.
In regard, indeed, to the amount of physical disease
which they enclosed they stood in badness beyond the
asylums. They were the common centres of fever, and the
PEEVENTIVE MEDICINE. 219
term " gaol fever " was the every- day language applied
to them to designate their deathly character. "Under
the new regime of preventive science and art all this
is completely changed. The new gaols which have
arisen, not as palaces, nor as structures of artistic
design, but as sanitary strongholds, have taken the first
place as centres of health. They, with all their lugu-
hrious and miserable surroundings and functions, have
solved the once hopelessly-involved question whether
it was possible by any human skill to suppress pestilence,
or keep it out of a place where many human beings,
brought together, are confined within four walls by day
as well as by night with but one outdoor court of
limited extent for daily exercise. They have proved
that this grand question may be safely answered
affirmatively. They have bidden good-bye to plague
and pestilence, and they have turned the unhealthiest
into the healthiest places.
Apart from any particular improvement indicated in
the history of the gaols, there are certain general
results springing from the combined action of all the
improvements, which show a combined advancement,
singularly historical and promising for the future. The
grandest attainment is that of the general reduction in
the death-rate throughout every part under English
rule in which preventive medicine has been brought
into operation. It may be stated in the most positive
manner that, wherever the preventive system has been
allowed fair play, there the death-rate has been reduced
in fair proportion to the extension of the sanitary effort.
Thus in towns in the United Kingdom where the death-
rate was at 26 and 28 in the thousand, there has been
a steady reduction down to 20, and in some instances
even to 19 in the thousand.
220 MEDICINE UNDER QUEEN VICTORIA.
This happy change has extended to other and less
favoured countries and to other parts of the British
dominions. It has been particularly well developed
in India. In the early days of the present reign
India was looked upon with actual dread as a place of
residence. To say that a person was about to take up his
abode there was to suggest, to nervous and sympathetic
minds, that the person was going, almost of necessity,
to an early grave. The anxiety thus felt was, I dare
say, somewhat exaggerated ; at the same time it was
based upon such serious evidence of a truthful character
that the very exaggeration of anxiety may be looked
upon with leniency, if not with absolute forgiveness.
The mortality in India was indeed so great that in an
article I took occasion to write, about the year 1855, on
the "British Juggernaut in India," I could only compare
a regiment of English soldiers there to the Irishman's
famous knife, which retained its continuity by the rapid
exchange of a new haft to a new blade, and then a new
blade to a new haft. In 1853 the startling fact was
elicited that the Honourable East India Company's
European regiments were absorbed and required to be
renewed every eight years, while in Her Majesty's
regiments the same absorption and renewal was required
every twelve years. One officer, Dr. F. S. Arnott,
reported that he had seen a regiment decimated by
disease in nine days, and reduced in the space of a year
at the rate of 215 per thousand, which would have
annihilated it in less than five years. This able officer
considered that the loss of a regiment at the rate of
47 in the thousand during a year of service was an
unusual success, and in this estimate he was certainly
well within the mark. A death-rate of 100 per thousand
of the mean force existed for a period considerably later
PEEVENTIVE MEDICINE. 221
than that above stated. But when the preventive
system got good hold, the rate became rapidly reduced,
so that between the years 1869 and 1878 it fell to 56'67
in the thousand, with a saving of sickness during that
period of over twenty-five thousand.
A corresponding saving has occurred under the pre-
ventive system in the home army. A death-rate of 18
per thousand was followed in the latest decade by a
reduction to 12*51, while a sick-rate of 50 per thousand
was brought down to 39 '38.
The same benefit was extended to the colonial armies.
A death-rate of 30 in the thousand was reduced to 10*7,
with a lowering of the sickness-rate from 70 per thousand
to 39-81.
Putting all these savings from prevention together
we have yielded the preservation of 40,000 active men
from actual death, with a larger numerical saving from
sickness and its subsequent evils.
With the information gathered from these various
sources carefully analysed, reasoned upon, and calculated,
the master who has the key to the preventive system
can now, in a fairly approximative degree, estimate the
sanitary condition of a place from the details that may
be supplied to him in respect to the number of the deaths
that have occurred in it during a period of years,
not less than ten, in combination with the list of the
diseases by and through which the deaths have been
induced.
By what may be called an inversion or inverse reading
of the same subject of study it would be equally easy for
the scholar in preventive science to formulate a town
which should yield a definite mortality springing from
the same kinds of disease. In other words, he could
predict what conditions of a locality would lead up to
222 MEDICINE UNDER QUEEN VICTORIA.
the development of particular diseases which would, in
their turn, in a given time, produce a definite death-rate
or mortality.
Again, taking another line of study from data similarly
furnished, the philosophic sanitarian could, without
seeing it, define the condition of a town or locality in
which an unusually good condition of health prevails if
he were supplied simply with the details of the death-
rate and with the character of the diseases through
which that death-rate was obtained. With like facility
he could construct a healthy town in which the disease
and the death-rate should be determined by the
construction.
These results of study, theoretical though they may
seem at first glance, are really practical outcomes of
perfectly sound rules of calculation, and are the most
distinctive proofs of solid progress. They are rapidly
bringing preventive science into a fixed science, the
master-stroke of human effort in its highest mani-
festations.
The course of inquiry, in the investigation of causes
of disease and death, has brought about another
research respecting the specific importance of those
causes themselves. This has led to the unravelling
of a skein of entanglement that has been a puzzle
for ages past. What part in the great role of disease
leading up to the final role of death did particular
causes play ? It was a suspicion favoured by Paracelsus,
by Thomas Willis, one of our great English geniuses
of a past age, by Van Helmont, and by many more,
that some diseases of an acute kind are due to a
ferment and to fermentation within the living body.
The hypothesis was for a time extinguished by the
famous Dr. Black, who first demonstrated the presence
PREVENTIVE MEDICINE. 223
of carbonic acid in the breath and the secret of the
animal combustion. He was followed by Lavoisier
and other experimentalists, who argued that the absence
of products of fermentation in disease, such as would
be present if the diseases that had been called fer-
mentative were so, disproved the hypothesis. The
advance of chemical and physiological science brought
back the old view, and soon so far re-established it,
that with the returns of the causes of death a class
of diseases called zymotic diseases, supposed to be
connected with zymosis or ferment, became classifiable,
and have remained a specific group, recognisable by
so many characteristics of resemblance in regard to
origin, incubation, distribution, and prevention, as to
be brought into order and largely under abeyance to
general laws and principles of prevention.
In like manner other forms of disease, arising from
other sets of causes, have been brought under classi-
fication, not perhaps as yet with sufficient nicety,
but in a manner temporarily workable and ready for
re-arrangement on a better plan, as increasing know-
ledge may direct the way.
From this same collection of facts many important
pieces of information have been revealed which
throw a strong Light on causation as distinguished
from cause. The most striking of these side ad-
vances or flank marches in the study of disease are
six in number.
(1) The regularity of the published records of diseases
and mortalities has enabled skilled observers to connect
together seasons and mortalities. Dr. Farr first
detected that waves of cold, of sufficient potency,
caused a rise in the death-rate, in an order which
varied according to the ages of the persons affected.
224 MEDICINE UNDER QUEEN VICTORIA.
He showed that cold killed, if we may so speak, by a
rule of proportion. If it killed one person who was
thirty-nine years of age, it would kill two who were
forty-eight, four who were fifty-seven, eight who
were sixty-six, sixteen who were seventy-five, and
thirty-two who were eighty-four ; the relative increase
of influence on those who were ready to succumb
from cold being doubled every nine years.
Mr. Milner, surgeon to the gaol at Wakefield, observed
that seasonal heat and cold exerted an invariable
influence on persons who, like prisoners confined in
one large prison, were living in all social respects
under the same conditions. He found that under
cold, feeding being the same, et cceteris paribus, the
weight of the human body undergoes reduction, and
that under warmth the weight shows an increase,
so that there is a period of natural loss of weight,
beginning with September and ending in March, and
a period of natural increase of weight, beginning with
April and ending with August. These facts have been
further and more elaborately added to by the observa-
tions on season in relation to disease. It has been
discovered that every registered disease has its own
season of maximum and of minimum intensity ; and
that the most unlikely diseases, as they would at
first sight appear, such diseases as delirium tremens
and the mental disturbance leading to suicide, have
each their recurring times of depression and activity.
We now mark these changes of disease, dependent on
season, in curves defining the maximum and minimum
intensities of all common diseases, by which, as by a
chart of disease, we may provide for periods of intensity,
may forewarn the people in regard to such periods,
or remove, under some circumstances, from the minds
PREVENTIVE MEDICINE. 225
of the people false fears originating from false state-
ments, or false and untrustworthy predictions.
(2) Still further service has been rendered by the
preventive method on the large scale, in the means
which have been afforded for arriving at truth on the
question of the geographical distribution of disease, and
mortality from particular diseases throughout the entire
kingdom. We know now that one of the most fatal
diseases of the land, pulmonary consumption, prevails
in given lines of localities with dampness as a factor of
the affection in those places ; that other diseases, such
as rheumatism, affect valleys and secluded places where
damp also is an evil ; that in some localities cancer is
a prevailing pathological sign of the place, and the
like. We might, in short, now, as sanitarians, mark
out dangerous places and particular dangers, as a cycling
society marks out dangerous roads and particular
dangers of those roads. We might put up, if it were
necessary, at the entrance into a town or locality, the
names of the prevailing diseases, and the special reasons
why the diseases do prevail.
An important further service, lying in this same
direction, is derived from the fact, which the preventive
system discloses, of the recurrence of certain well-
defined spreading diseases. We have learned that
diseases of dreaded character, such as malignant cholera,
when they break out in a locality, are wont to re-appear
in the same spots as those in which they have pre-
viously raged, and in which they have shown the
greatest virulence, whenever it has happened that those
spots have remained in their original states of impurity.
On the other hand, we have learned that, when the
spots favourable for the development of an outbreak
have been thoroughly purified, they have become
226 MEDICINE UNDER QUEEN VICTORIA.
thereby protected from renewal of the outbreak, the
.best of all evidences of the truth that prevention is
better than cure.
(3) Another advancement springing from the pre-
ventive system has relation to the discovery of special
causes which have hitherto remained largely or alto-
gether unsuspected. One illustration of this kind has
reference to alcohol as a cause of disease and mortality.
It is a piece of human knowledge, old as the Book of
Proverbs itself, that indulgence in wine is destructive
to the health of man, and many writers on medicine,
in all ages, have described the evils of excess in forcible
language. But under our new line of studies in
preventive science during the Victorian epoch, we have
arrived at the knowledge that the effect of alcoholic
beverages is to produce an entire family of diseased
conditions which have previously been supposed to be
of separate natures, varied in form, and each form
a distinct disease. We have now ascertained that
those persons who are most nearly connected with
alcohol as sellers and vendors of it, have the very
lowest vitality; and we have been able to define the
diseases which cause that low vitality so well, that
we can read off more than twenty different kinds
of disease, affecting different organs and parts of the
body, all having their root in alcoholic indulgence. By
following out the research in detail, we have also
arrived at the annual mortality in two parts of the
Kingdom England and Wales arising from alcohol,
and have detected that no single cause of fatal disease
is so deathly as this one cause, alcohol. We estimate
that in England and Wales nearly fifty thousand
persons a year die from it, a tenth of the whole who
die from all diseases put together.
PREVENTIVE MEDICINE. 227
Continuing inquiry on this new line, which hids fair
to be pursued for many years to come, the influence
of other individual causes of sickness is discovered.
We add to our knowledge that the cause, whatever it
may he, which is at work to produce pulmonary con-
sumption stands next in order as a single cause in fatal
action ; that the combined causes of the whole family
of the zymotic diseases double in their fatal effect that
of alcohol, producing about a fifth of the whole mortality;
and we expect, with every hope of success, to unravel,
with similar accuracy, the remaining causes of other
diseases, which still lie in obscurity.
(4) Proceeding somewhat in the same direction of work,
but using our estimates for a different purpose, we have
it in our power to determine how from decade to decade
the cause and intensity of different diseases vary and
tell on the life of the nation. In 1847, compared with
the whole mortality, the deaths in England and Wales
from zymotic diseases were 23' 26 per cent. ; in 1880
they were 20*09. In 1847 the deaths from pulmonary
consumption were 12'67 per cent. ; in 1880 they were
9*12. In 1847 the deaths from diseases of the respi-
ratory organs were 12' 14 per cent. ; in 1880 they were
17*78. In 1847 the deaths from diseases of the brain,
nerves, and senses were 11*54 per cent. ; in 1880 they
were 13*12. In 1847 the deaths from diseases of the
digestive organs were 5'82 per cent. ; in 1880 they
were 4*74. In 1847 the deaths from accident and other
forms of violence were 31*50 per cent.; in 1880 they
were 31*84.
Such data as these, though still requiring improve-
ment in mode of collection, are invaluable. They
exhibit at a glance the illness in the sick rooms, public
and private, of the kingdom. They show where pre-
228 MEDICINE UNDER QUEEN VICTORIA.
ventive science is strong, where it is weak ; where the
nation is advancing towards health, where it is going
back. Pulmonary consumption is slowly retreating ;
other diseases of the respiratory organs are rather
rapidly advancing. Diseases of the brain and nervous
system are advancing. Accidents and violent injuries
causing death remain almost as they were nearly forty
years ago.
(5) In extension of labours which had been commenced
by Thackrah and others in this country before the
Victorian era, the new methods of research developed
within that era have helped materially to facilitate the
study of occupation in relation to disease.
The mortality tables have been utilised in a singu-
larly useful manner in this direction, and have yielded
returns which are so accurate and precise that the
relative value of life in seventy of the chief occupations
of the manhood and womanhood of the country is
brought to all but commercial exactitude. The clergy of
the Established Church have won the palm of vitality ;
the publicans and other persons connected with the
sale of those toxical fluids commonly called intoxicating
drinks have, naturally enough, appeared at the opposite
or lowest place in the contest for life ; and between
these two extremes the different classes of our people
have been calculated up according to their vital values
in the trades, callings, or professions they are destined
to occupy. In these determinations it has been shown
how much depends on little things ; how life is never a
matter of chance, when knowledge holds the torch ; and
how almost entirely we are the arbiters of our fate, if we
choose to learn and to be guided by what we have
learned. Thus it is shown from our returns that the
grocer and the draper, tradesmen of similar social status
PREVENTIVE MEDICINE. 229
and living in the same localities, are by mere occupation,
as now carried on, so different in respect to the value
of their lives, that one hundred and eight drapers die
to seventy-six grocers.
Again, it has been illustrated from the same returns,
that the life of the grocer may be deteriorated by a
change in his line of business ; and that, when by the
sale of toxical substances he increases his trade, he
loses his vitality, and, in entrenching on the revenue of
the publican, accepts the publican's penalty of a shorter
existence.
These calculations have their economic as well as
their medical importance. They find their application
in the Insurance tables, and render the purchase of life
insurances and annuities a more certain transaction
than it ever has been in any previous period of its
history.
(6) In the course of the preventive system of medicine
in its later stages, we have been able to discover some
specific causes of disease proximate, if not primary.
The relation of impure water to the development and
spread, or at any rate to the spread, of some diseases
is an accomplished discovery not easily over-estimated.
For this line of inquiry we are indebted to the repre-
sentative man whose life appears in the close of this
number, Dr. John Snow. It was the good fortune of
Snow to observe that cholera, in its malignant type,
may be associated, as by origin, with the drinking
of impure water, water containing organic human ex-
creta; and his untold labours threw a marvellous light,
not merely on the spread of cholera, but on typhoid
and other allied diseases. The clue once given that the
causes of certain diseases may be received into the
body by the drinking of water, the effects of imbibing
230 MEDICINE UNDER QUEEN VICTORIA.
other impure fluids naturally followed, and the late
Dr. Murchison was led to inquire into the question of
milk as the bearer of the poison producing scarlet fever.
Later on, diphtheria has been discussed as coming from
a similar source; and later still there has appeared
another, but, perhaps, too hasty and too hypothetical a
generalisation, attributing all spreading diseases to an
organic substance carried into a susceptible body by
food, drink, or air. At the same time there has sprung
up a new edition of the old hypothesis of Willis and
Yan Helmont of the fermentative character of the whole
family of the contagious diseases, with the assignment
to each of them of a particular plant-like particle of
living aptitude, which by its growth and propagation
is the cause of these diseases.
Unfortunately, the enthusiasm lighted up by this last-
named line of thought has been too speculative in its
tendencies and too pronounced in its aspirations. If
what it has set forth had been an approach to the
truth, the whole family of the contagious diseases, with
some others which are not proved to be contagious,
like Phthisis pulmonalis, would by this time have
been prevented or cured by clear and absolute methods.
The result so much expected has not been realised; and
the outside world, waiting to see a miracle, and seeing
that the death-rates have not as yet been touched,
except by the slow but sure principles of the general
sanitary improvements which were extant before the
appearance of the new speculative philosophy, is dis-
trustful of so much promise and so blank a return.
The distrust, most natural and probable, is not likely,
in the long run, to be injurious. It will rather be useful
as unfolding and correcting the mistake which has
been committed of extending too indiscriminately the
PKEVENTIVE MEDICINE. 231
study of the parasitic origin of diseases, which, on a
thoughtful and observant plan, was beginning to be
recognised under exact and practical research.
The latest advances of preventive medicine have
been reflected with great benefit on curative medical
art, in the matter of the treatment and management of
wounded surfaces. To the surgeon the proverb that
cleanliness is next to godliness has come home with
irresistible force ; and although, like the followers of Sir
Kenelm Digby, who bound up wounds from the air,
and bade the wounded depend for certain cure on
polishing with sympathetic powder the weapon that
made the wound, the modern surgeon has not always
been content to believe in natural cure to the exclusion
of the supernatural, he has been wise in his generation,
and has met his reward. The surgeon has become
cleanly in his work, and, under the name of " aseptic
treatment " and such like terms, has achieved thereby
successes which preventive medicine perfectly care-
less whether she or some idol of the market-place
gets the credit always gives to those who either
mysteriously or inteUigently follow her methods of
cure.
On the whole, the instalment of medical progress in
the Victorian age made by and through the science
and art of prevention, is of itself an advancement
which in no known record of medical labour has been
approached or so much as conceived.
CHAPTEE III.
THE THIRD ADVANCEMENT: ANAESTHESIA.
'HE year 1846, the ninth year of the Queen's
reign, ranks memorably as the year of the
great revival of the medical art of performing
surgical operations on the living body without
the infliction of pain.
None excepting those who can remember what a
surgical operation was without anaethesia can fully ap-
preciate the beneficence of this advancement. The ear
is always more sensitive to sympathetic emotions tham
the eye ; and as a consequence the cries of the patient
who was under the knife of the surgeon were infinitely
more painful to bear than anything that was revealed
through the eye. I remember well how at the first
major operation I witnessed, an amputation at the
shoulder joint, by the late Professor Laurie of Glasgow,
I sought falsely for comfort in the feeling that if the
patient, a youth about twenty years of age, did not cry
out I should get through it fairly well. But the patient
did cry out, and then the bar of the bench before which
I stood, and which I clutched firmly, was indeed a sup-
port, while two of my fellow-freshmen, less fortunate,
had to withdraw. It required in fact a kind of special
training of considerable duration to get over the depres-
sion, not to say fear, excited by the demeanour and cries
of the sufferers brought to the operating table. Some
reached the spot and then refused to submit themselves
ANAESTHESIA. 233
to the terrible ordeal. Others were bold enough until
the pain commenced, and then screamed and struggled
so terribly it required the greatest force to hold them.
In short, every operation was a scene. The death of
the sufferer from the shock following operation, and
death actually on the operating table, from fear and
suffering combined, were not by any means very rare
occurrences.
In the year 1846 this scene underwent an entire
transformation. Operative surgery became a painless
art.
While we may connect this advancement with the
Yictorian era, we must not be vain enough to claim it as
a development of the British school of medicine. An-
aesthesia was a renaissance. As far back as the Greek
and Roman schools of medicine the narcotic substance
known as mandragora was used as an anaesthetic, in the
form of a wine, for the purpose of producing a sleep
under which operations could be painlessly performed.
This practice of administering a narcotic draught for the
abolition of pain in operation was, at times, employed
to a period as late as the latter part of last century,
when Augustus, King of Poland, had given to him,
surreptitiously, a narcotic draught which acted so well
that his foot was amputated without his knowledge by
Weiss, his surgeon-in-chief. The king was disturbed
by the proceeding, and asked what was being done,
but receiving a soothing answer fell again asleep, and
did not discover, until the following morning, that the
amputation had been performed.
There is some evidence also which lends favour to the
view that volatile narcotic substances were sometimes
used for the production of insensibility ; but we have
to come down to the present century in order to arrive
VOL. iv. 17
234 MEDICINE UNDER QUEEN VICTORIA.
at the first steps of that method of anaesthesia which is
now under our consideration.
In the first year of this century Humphry Davy
published his famous volume on " Eesearches Chemical
and Philosophical, chiefly concerning Nitrous Oxide or
Dephlogisticated Nitrous Air and its Respiration."
Davy was at that time superintendent of the Pneumatic
Institution founded by Dr. Beddoes, and in the course
of his work he observed that the inhalation of nitrous
oxide gas produced temporary sleep, under which the
body lost its sensibility. This led him to make the
important original observation that, " as nitrous oxide
in its extensive operation seems capable of destroying
physical pain, it may probably be used with advantage
during surgical operations in which no great effusion of
blood takes place."
About this same time, while what was called the
pneumatic treatment was under discussion, the inhala-
tion of the vapour of ether came into use for the treat-
ment of disease. Dr. Richard Pearson, of Birmingham,
introduced this practice by making his patients breathe
the vapour, either from an inverted funnel or from a
handkerchief, as a remedy for Phthisis pulmonalis. He
was followed by Dr. Thornton, a London practitioner,
and later on by Dr. Woolcombe, of Plymouth. In
1815 Nysten employed the vapour of ether for the relief
of pain, and invented an instrument for the administra-
tion, an ether inhaler, which seems to have been very
ingenious and successful.
In 1818 Faraday, in an article in the Quarterly
Journal of Science and Arts, compared the effects on
the body of nitrous oxide and of the vapour of ether,
and pointed out that the physiological action of each
was closely alike, if not identical. The observation
ANESTHESIA. 235
led to a curious experimental demonstration in the
lecture rooms of the chemists. When in their annual
courses of lecture nitrous oxide came under description,
it was customary for the lecturer to administer laughing
or nitrous oxide gas to one student, and the vapour
of ether to another, so that the analogy of action of
the two substances might be compared. This experi-
ment was carried on regularly each year in the
laboratory of the famous Professor Turner, of University
College, London.
Up to this time, it may be said that all or nearly
all that was known about nitrous oxide and ether was
confined to English science, and so it remained until
1844, when, in America, a new and most important
line of inquiry, ending in the discovery of modern
anaesthesia, began to be pursued.
This new discovery sprang out of the English labour.
Mr. G. J. Colston, a public lecturer in the United
States, made the administration of laughing gas a part
of the demonstrations of his discourses. He was not
alone as a public lecturer in this respect, for many
other public lecturers had followed Dr. Turner, and
the proceeding had become so popular that the effects
of nitrous oxide were made the subject of one of the
most amusing and striking stories in verse that has
ever been composed. But Colston was fortunate in
having an opportunity, on December llth, 1844, of
exhibiting the action of the gas at Hartford, Con-
necticut, on one of his audience in the presence of an
observant man, a dentist by profession, named Horace
Wells. After the lecture Wells asked Colston to
accompany him to his surgery, and administer to him
nitrous oxide gas, whilst another dentist, named Dr.
Riggs, extracted for him Wells a troublesome tooth.
236 MEDICINE UNDER QUEEN VICTORIA.
The operation was performed painlessly, and Wells, on
coming out of the anaesthetic sleep, exclaimed, "A new
era in tooth-pulling ! "
Horace Wells followed up this triumph by using
nitrous oxide several times for tooth extraction, and
soon afterwards he went to Boston, and repeated the
practice, but unsuccessfully.
In 1846, on the 30th of September, the vapour of
ether was used, in the place of nitrous oxide
for annulling the pain of tooth extraction, by Dr.
W. T. G-. Morton, a dentist of Boston, who had been
in partnership with Horace Wells. The anesthesia
was successful ; and from that day until the present
the vapour of ether has been used for the production
of insensibility to pain in all varieties of surgical
operations, major and minor, with marvellous success.
I have done my best for many years past to ascertain
by all obtainable and credible evidence whether Morton,
who seems to have been the first to administer ether
for operations, was original in the design. The question
remains in doubt, largely from Morton's mysterious
conduct in relation to it. He admitted that he took
into consultation a chemist, Dr. Charles Jackson, who
afterwards affirmed that he first suggested to Morton
the application of ether. In point of fact, the two took
out a patent for the discovery, and Morton concealed
the agent that was being used by calling it "letheon,"
until Dr. Bigelow, of Boston, discovered its nature by
its odour. On the whole, I believe that a writer in the
Dental Cosmos, in 1860, solved the difficulty most
satisfactorily by explaining that Horace Wells made
the suggestion both to Morton and Jackson, and that
they acted upon it. Poor Wells, disappointed and heart-
broken, ended his useful life, a few years later, by suicide.
ANESTHESIA. 237
To Morton the credit may be given of having first
administered the vapour of ether for surgical operations ;
first for tooth extraction, and afterwards for operations
by the knife performed by Dr. J. C. Warren and Dr.
Hayward, in the Massachusetts General Hospital.
The news of the discovery of anaesthesia reached
London in the middle of December, 1846, and the first
application of it was made by the late Mr. Eobinson,
for many years a friend of mine, a dentist living
in Gower Street, Bedford Square. The patient who
had the honour of being the first to be anaesthetised in
England was Miss Lonsdale, and the operation, the
extraction of a tooth, was performed at the house of
Dr. Boot, on the 12th of December, 1846. The ad-
ministration was perfectly successful.
The enthusiasm which occurred all over the kingdom
on the news of this practical discovery was an event in
medical practice perfectly unique in the history of the
reign. The lay public not less than the professional
went eagerly to see the great phenomenon of painless
operation, and medical societies and theatres of hospitals
were, for several weeks, the busy scenes of anaesthetic
deliverances from suffering. Amongst those most
interested in the subject was Louis Napoleon Buonaparte,
then an exile in London, and residing in King Street,
St. James's. I have heard Eobinson tell many times
the observation and manner of the after-Emperor of the
French when he was observing the first experiments
with ether. He seems to have looked upon them with
an almost childish wonder, "as if he were under a
fascination." Through all parts of the kingdom the
infection of surprise and admiration ran with activity.
I remember, as if it were but yesterday, sitting with my
fellow-students in the anatomical theatre of Anderson's
238 MEDICINE . UNDER QUEEN VICTORIA.
College, Glasgow, waiting for our good and admirable
professor, the late Dr. Moses Buchanan, to come in as
usual to his two o'clock lecture. Accustomed to see
him to the moment, we wondered why he delayed. He
appeared hefore us with news he could scarcely deliver,
he was so moved by it ; news from America that
surgical operations could be performed painlessly, during
deep sleep induced by inhaling the vapour of ether, and
that the experiment was about to be tried at once in the
Eoyal Infirmary. Little more was thought of that day.
We trooped in a body to the Infirmary, and ascended
straight to the domed room on the top, which at that
time served as chapel and operating theatre. There was a
scramble for places. I and one or two other students got
into the pulpit, and some into the precentor's pew,
places usually held sacred from such noisy feet as ours.
The late Professors Laurie, Andrew Buchanan, and
Moses Buchanan were with others in the arena, all on the
tiptoe of expectation. Andrew Buchanan, in his blue-
striped operating-gown, the same that was worn by the
dressers, had the first call for operation ; and Laurie, in
his brown operating-coat, with silk linings and carefully
turned-up cuffs, ready to assist his colleague. Before
the first patient was brought in, a man of the name of
Macleod if I remember rightly, who was about to be
operated upon for fistula, Andrew Buchanan read to us
in his gentle, nervous manner the report of what had
occurred " under ether " in Massachusetts Hospital. He
described the directions for administration that had been
given, and assured us that the purest ether that could be
obtained at so short a notice would be used. Then the
patient was sent for, and was asked with much con-
sideration whether he would submit to be put to sleep,
so that he should not feel what was going to be done to
ANESTHESIA. 239
him. He agreed immediately ; and the late Dr. Fleming,
assisted by one of the house surgeons, Mr. Anderson,
commenced to administer the ether from a sponge
wrapped in a towel. In a very little time the patient,
who began to talk and sing in the usual manner during
the second stage of narcotism, lapsed into quietude,
and soon afterwards was allowed to wake up with
the operation completed, without knowing that he had
passed through anything more than a curious dream,
but feeling a "wee bit fou."
The next operation, more prolonged, was not quite so
painless, but was sufficient to satisfy the most credulous
that painless surgery was the fact of the future.
The administration of ether speedily became general
for surgical operation, and on the 19th of January of
the succeeding year, 1847, it received a new develop-
ment by the application of it for removing the pangs of
parturition. Professor James Y. Simpson, of Edinburgh,
afterwards Sir James Y. Simpson, Bart., was the first
to use ether for this purpose, and his clever remark,
" That whsn God made woman from the rib of man He
performed the operation under a deep sleep," was a
saying which has taken a lasting place amongst the
brilliant repartees of the last generation.
For a time it was hoped that the administration of
ether would be practically free from danger ; but this
hope was not satisfactorily sustained. Very soon some
cases were reported one at Colchester under Mr. Nunn,
another at G-rantham under Mr. Kobbs, and two more
in London of supposed death from the inhalation. In
all these cases, iowever, death occurred several hours,
and in some of tie cases days, after the administration,
and the profession, therefore, accepted pretty generally
the opinion of D?., afterwards Sir John Forbes, that the
240 MEDICINE UNDER QUEEN VICTORIA.
cause of death was to be attributed, not to the ether, but
to what Travers had called " constitutional irritation,"
underwhich, before anaesthesia from ether was thought of,
deaths following rapidly upon operation were well known.
On the whole, it must be admitted that ether stood well
as a safe anaesthetic ; and, although the opinion of Snow,
who became one of the earliest and most skilful admi-
nistrators, that ether had never directly caused death by
inhalation, was received with some scepticism, it was
so hard to refute that practically the anaesthetic held
its own.
The vapour of ether continued to retain its place
unchallenged until the 10th of November, 1847, when it
met with a rival on the floor of the Medico-CMrurgical
Society of Edinburgh, in a paper by Professor J. Y.
Simpson, containing " An account of a new anaesthetic
agent as a substitute for sulphuric ether in surgery and
midwifery." This new agent was chloroform
Chloroform as a chemical curiosity was discovered in
the year 1831. Three chemists appear to have nearly
equal claims to the credit of the introduction. These
are Mr. Samuel Guthrie, of New York; Soibeiran, in
France ; and Liebig, in Germany. Guthrie named the
substance "chloric ether;" Soubeiran, " liquid bichloric
ether;" and Liebig, "liquid chloride of carbon." It
is quite certain, from his description of the liquid he
obtained, that Guthrie made pure chloroform ; and that
his contemporaries were impressed with the importance
of the discovery and its relations to medicine is clear
from the observation of Mr. Daniel B. Smith, of Phila-
delphia, who, in the Journal of the Colltge of Pharmacy,
in 1832, wrote that "The action of this ether on the
living system is interesting, and may hereafter render
it an object of importance in commerce. Its flavour
ANAESTHESIA. 241
is delicious, and its intoxicating qualities are equal to
or surpassing those of alcohol. It is a strong diffusible
stimulus, similar to hydrated ether, but more grateful
to the taste."
Three years after the discovery of this agent it was
investigated by Dumas, who named it chloroform.
Liebig, making a new inquiry, and confirming Dumas,
re-named it perchloride of formyle, by which name it
was long known in the chemical world ; but the simple
word chloroform has found most favour, and, indeed, has
been incorrectly extended by the public to all and every
substance which produces anaesthetic sleep.
It has been asserted that from the time of the
discovery of chloroform by Guthrie until its application
as an anaesthetic vapour it remained a mere chemical
curiosity. This is not correct. In 1831 Professor Ives,
of Newhaven, employed chloroform in a case of difficult
respiration, administering it actually by inhalation of its
vapour ; he afterwards published the facts in Sillimari's
Journal for January, 1832. Later Dr. Nathan B. Ives
employed it in asthma, and in other cases, reporting
upon it favourably. In 1838 Dr. Formby, of Liver-
pool, prescribed it in hysteria. In 1844 Mr. Tuson, of
London, used it for treatment of cancer and neuralgia ;
and in the same year M. Guillot, of Paris, followed
Dr. N. B. Ives in employing it as a remedy for asthma.
In March 1847, when etherisation was the event of
the day, M. Flourens undertook an investigation relative
to the action of vapour of chloroform on animals. His
researches were marked by all that exactitude which
ever distinguished him. Strangely, he came to a con-
clusion unfavourable to chloroform, so that from his
experiments no direct practical result accrued.
Meanwhile, many were at work, in England especially,
242 MEDICINE UNDER QUEEN VICTORIA.
endeavouring to obtain a better, and it was even hoped
a safer, agent than ether, and one offering fewer
difficulties in the way of administration. Foremost
amongst these investigators were Dr. J. Y. Simpson, of
Edinburgh, and Dr. John Snow, of London, the former
having more facility for research, and taking the lead.
Simpson studied the action of various chemical fluids,
amongst others chloride of ethylene or Dutch liquid,
acetone, nitrate of oxide of ethyle, benzin, and vapour
of iodoform. For one reason or other, he cast them all
aside as wanting in some required quality .
While the experimentalists were thus actively engaged
in their careful and refined studies, simpler men were
aiming to improve the administration of ether. Of
these the most successfully prominent was the late
Mr. Jacob Bell, the head of the firm of Bell & Co., in
Oxford Street, founder of the Pharmaceutical Society,
first editor of the Pharmaceutical Journal, and in the
world generally a truly representative man. Mr. Bell
suggested that the substance known as chloric ether
should be used for inhalation instead of rectified or
sulphuric ether. The suggestion was acted upon, and
Mr. Lawrence, afterwards Sir William Lawrence,
together with Mr. Holmes Coote, performed operations
painlessly under chloric ether at the Hospital of St.
Bartholomew.
Dr. Simpson, moving from one substance to another,
and asking, as was his wont, on all sides for information,
asking the chemists especially what they knew or how
they could help, had a talk in October 1847 with
Mr. Waldie, of the Apothecaries' Hall, Liverpool,
during a visit of that gentleman to Edinburgh.
Waldie, in a pamphlet on chloroform, published in
1847, tells us precisely what occurred. Dr. Simpson
ANAESTHESIA. 243
asked him, lie says (speaking of new anaesthetics), if he
knew anything likely to answer. Chloric ether was
mentioned during the conversation, and being well
acquainted with its composition that it was a solution
of chloroform in ether and with the volatility, agree-
ahle flavour, and medicinal properties of chloroform, he
(Waldie) recommended Dr. Simpson to try chloroform,
promising to make some for him on his return home.
This statement by Mr. Waldie was confirmed by Dr.
Simpson himself, who, in a note to his first paper on
chloroform, says, Mr. Waldie first named to him the
perchloride of formyle (chloroform) as worthy amongst
others of a trial.
Simpson experimented with chloroform to prove it
an anassthetic, and accepted the responsibility of its first
administration and first introduction.
The paper on chloroform communicated by Dr.
Simpson to the Medico-Chirurgical Society of Edinburgh
on November 10th, 1847, was, perhaps, the shortest
paper ever written on a subject that was to be of so great
an importance. It fills but twenty-three short pages of
matter, and it tells a story that has become history, in
language as forcible as it is unaffected.
The news of the discovery created an interest at the
time little less than the discovery of an&sthesia itself.
The demand for chloroform did in truth create a
commerce which Mr. Daniel Smith, of Philadelphia,
who spoke so shrewdly in 1832, hardly had dreamed of.
In every hospital, in every private practice, chloroform
ranked at once as a remedy ; and for forty years it has
been one of the most widely dispensed of all the agents
sent forth for the relief and cure of disease and pain.
There is nothing more to be said, as matter of
history, respecting the discovery of chloroform and its
244 MEDICINE UNDER QUEEN VICTORIA.
application as an anaesthetic. The facts are so simple ,
clear, and unmistakable, that the future historian
who shall read them as above rendered need feel no
doubt. But much comment was soon raised on the
question whether the introduction of chloroform was
on the whole useful. American and French authors of
good repute, men of sound and practical knowledge,
urged that ether, when skilfully applied, was perfectly
manageable, and much safer than chloroform. The
greater safety of ether became a fact acknowledged on
all hands ; but the perfect and easy management of it,
compared with the management of chloroform, prevented
for a time the return of its popularity. Snow put the
position admirably on one occasion. He was asked
why he employed chloroform instead of ether, while he
held ether to be the safer agent of the two. " I use
chloroform," he said, " for the same reason that you
use phosphorus matches instead of the tinder-box : an
occasional risk never stands in the way of ready ap-
plicability." The truth spoken by Snow is one very
generally felt, though rarely expressed with so much
terseness and candour. But, confessing that chloroform
has increased the mortality due to general anaesthesia,
we are bound, after all, to accept the introduction of
it as an advance. It is just possible that, if no such
new agent had been discovered, the practice of general
anaesthesia would have fallen into disrepute, instead of
progressing, as it has progressed until it has become
universal. Moreover, the introduction stimulated
curiosity for new research, and led to the conviction
that an immense number of other chemical bodies
possess analogous narcotic properties, some perchance
having all the value and none of the evils of chloro-
form ; nay, that there yet remains to be discovered
ANAESTHESIA. 245
by the patient inquirer an agent which shall do all
that is required for annulling pain, and yet shall
inflict no further danger than is inflicted by that
natural sleep which restores the daily life, and is
great Nature's second self.
For a very long period chloroform held all but
exclusive sway as an anaesthetic of surgery, except in
America, where ether still retained a respectable position.
At last the number of deaths caused by chloroform
enforced attention. It was elicited that out of two
thousand five hundred administrations on persons
indiscriminately subjected to chloroform, one, on the
average, would succumb under its influence. It was
further elicited that a theory which Snow had
formed, and which the late Mr. Clover supported,
namely, that danger could be averted by keeping the
anaesthetic atmosphere charged with not more than
5 per cent, of the vapour of chloroform, was not
sustainable. In plain matter of fact it was proved,
beyond dispute, that a certain number of persons were
morituri, the ready to die, from the narcotism produced
by chloroform vapour.
A very earnest discussion ensued on this subject, in
which the results of ether inhalation in America were
always favourably contrasted with those following the
administration of chloroform. The results favourable to
ether were supported by others, springing from the prac-
tice of resorting to Davy's anesthetic nitrous oxide gas
for short operations, such as extraction of teeth. It was
shown that nitrous oxide exhibited in the pure form,
without any admixture of atmospheric air, could produce
a short and deep anaesthesia, which was practically free
from danger. As the two arguments derived from the
effects of the gas and of ether gained power ; as' the mode
246 MEDICINE UNDER QUEEN VICTORIA.
of administering ether vapour became, under experience
of administration, much simpler and more certain than
in the first essays with it, ether and "the gas " began
to triumph over chloroform, and now undoubtedly hold
and maintain the first place.
Meanwhile an immense number of researches were
carried out for the purpose of discovering some new
anaesthetic, which should possess all the convenience
of chloroform combined with the safety of ether.
How earnestly this research has been pursued will be
discerned by the reader who will turn to the " Synopsis
of Anaesthetics," published in THE ASCLEPIAD for 1885,
No. 7, pp. 256-277.
Out of these researches five anaesthetics have been
introduced as rivals of chloroform, ether, and nitrous
oxide ; namely, amylene, ethylene dichloride, ethyl
bromide, methylene bichloride, and the tetrachloride of
carbon.
Amylene was introduced by Snow. It soon caused
two deaths, and was quickly given up. Ethylene
dichloride was introduced by Snow, and has been re-
introduced since his death ; but it has not been proved
safer than chloroform, and has, therefore, been given up.
Methylene bichloride has for its merit simply the fact
that it contains one equivalent less of chlorine than
chloroform, is, therefore, a lighter chemical body, and is
rather more rapid in ita action. It is used exclusively
by some surgeons, and it is also used by some dentists,
who find its rapid action very suitable for their opera-
tions. Tetrachloride of carbon, owing to its danger, has
been given up in practice.
Out of the study of general anaesthesia, some in-
teresting and useful applications of it have been
ANAESTHESIA. 247
extended to the inferior animal creation. The inferior
animals have shared with man himself in the benefits
of painless surgery. They have also obtained an
advantage which has never been extended to man and
perhaps never can be, the blessing of a painless death
in sleep when the time has come that they must die.
For the lower animals the anaesthetic or lethal chamber
is the sleeping-place of dissolution, where they taste the
euthanasia. In the lethal chamber at Battersea over
fifty thousand dogs have been subjected to this merciful
mode of death by anaesthesia. At this moment a
further advance is being carried on, under the same
method, for the painless killing of sheep and of other
animals intended for human food.
LOCAL ANESTHESIA.
Hitherto I have summarised the main facts relating
to general anaesthesia. A few words must be added
bearing on the progress of local anaesthesia, or the
production of insensibility in one part of the body
without involving the whole.
Two centuries ago this art was practised in a
gymnastic school in Naples, cold being the benumbing
agent. A thin flask of glass was made to receive
crushed ice, and the chilled flask was applied firmly to
the part that had to be benumbed. When the cold
had deadened the part to which it was applied, the
surgeon performed the operation.
The late Dr. James Arnott, a man of most vigorous
mind, took up the subject by experimenting with cold
produced by the application of a mixture of ice and salt
to the part that was to be rendered insensible to pain
for operation. The greatest credit is due to Dr. Arnott
248 MEDICINE UNDER QUEEN VICTORIA,
for the skill and energy with which he pursued local
anaesthesia.
Snow also, in the early days of anaesthesia, studied
this method by using solidified carbon dioxide for the
production of cold, and for the insensibility obtainable
from cold. He found the process troublesome, and he
also found that from the extreme action of the solid
carbonic acid, death of the part operated on often
resulted. He thereupon gave up the process.
The direct application of freezing mixtures was
followed, in 1866, by the invention of ether spray, by
which insensibility of a local surface was induced from
the cold caused by the evaporation of ether delivered
upon the part in the form of fine spray. The invention
had an enthusiastic reception, and operations under
ether spray have been many and various. The whole
list of minor operations have been performed under the
spray, and not a few major. Amputation of the
breast, ovariotomy, the Caesarian operation, amputation
of the foot, and many other similar surgical procedures
have been performed painlessly by its means. The
method, which has its advantages and disadvantages,
waits for further development. It is much aided by
pressure.
The idea of producing anaesthesia by the local applica-
tion of narcotic substances began to attract attention
so soon as modern general anaesthesia came into notice.
Mr. Nuneley, of Leeds, was the earliest inquirer into
this subject, and he was quickly followed by Snow. The
object aimed at in these researches was to get narcotic
fluids absorbed locally so as to produce insensibility
during the process of absorption. Aconite, belladonna,
chloroform, and similar substances were in this way
tested, but not with much promise. Afterwards an
ANAESTHESIA. 249
attempt was made to quicken the local absorption by
means of the voltaic current, and voltaic narcotism
was introduced as a practical study. It did not answer
the purpose intended, and the late Professor Augustus
Waller showed, probably with correctness, although
to this day I am not quite sure on the matter, that
the curious, and in many instances successful results
obtained were due to simple absorption of the narcotic
fluids applied to the skin.
The effect of creasote in relieving the pain of tooth-
ache suggested to the late Sir Erasmus Wilson the
idea of testing the local anaesthetic action of carbolic
acid on the skin. The idea was excellent, and the
production of local anesthesia by carbolic acid would
be very practical but for the caustic action of the
acid and the ulceration which sometimes follows its use.
The latest advance in local anaesthesia is the appli-
cation of cocaine. Here another real instalment, minor
but promising, has been introduced. It is not an
English idea, and does not, therefore, come strictly
into the present review ; but it has received a great
development in this country.
It would not be befitting of me to offer any special
commendations on the part which Englishmen of the
Victorian era have taken in forwarding the instalment
of good that has been offered to humanity by general
and local anaesthesia, with its pendant of euthanasia
for the lower creation. But I hope that in the future
England, which has certainly not stood out idly, will
stand out honourably.
VOL. iv. 18
CHAPTEK IV.
THE FOUETH ADVANCEMENT: THERAPEUTICAL ART.
|N the fifty years of the Queen's reign the
most extraordinary changes have been intro-
duced into therapeutical art. Methods of
treatment, which at one time were thought
to be absolutely necessary for the cure of disease,
have passed almost entirely away ; treatments once
held to be purely negative in character, or, at best,
adjunctive, have taken the first place ; and remedies
have been tested or discovered by experimental and
precise modes of research which to our pre-Victorian
forefathers would be entirely novel and peculiar. The
art of therapeutics has, in fact, been completely
revolutionised.
The first great modification in the givings up of old
and long-approved remedies is seen in the practice of
blood-letting in the treatment of disease. How com-
plete this change has been may be inferred, to some
extent, from a circumstance coming under my own
observation. In the beginning of my medical career
a surgeon, whom I knew, was threatened with legal
proceedings for mala praxis, because he had neglected,
in a certain case, to follow out, as a well-known and
approved remedy for such a case, the abstraction of
blood from the arm, by which gross neglect it was
assumed the patient lost the one and only chance of
recovery that was open to him. In these late, and as
THEEAPEUTICAL AET. 251
they are considered reformed days, I have known an
instance in which another surgeon was threatened
with action at law for mala praxis, because, in a pre-
cisely similar case, he had ventured to abstract blood
from a vein in the arm in order, as he thought, to
give the patient the one and only chance of life. I
also remember quite well the time when every medical
man carried a lancet as a matter of course ; but re-
cently, so little is the art of venesection practised, that
in one of the last cases in which I thought it advisable
to draw blood, not a medical man present had a lancet
in his pocket ; and when a lancet was obtained and the
operation was carried out to the immediate relief of
the patient, a practitioner, who was no mere stripling,
admitted that he had never performed the operation,
and that he did not remember whether he had ever
before seen it performed.
It is rather difficult to understand why, in the opinion
of the public as well as of the profession, so remarkable
a change of sentiment should have occurred respecting
a measure which was approved by the practice of more
than two thousand years. Some think that the intro-
duction of the practice of homoeopathy has been the
cause of the change ; others think that the change is
due to a revulsion from the too free use of the lancet
in the old times ; and a third class consider that the
character of disease has itself undergone so great a
change of type, that extreme measures of depression
have ceased to be called for.
I have not space here to enter upon a discussion on
these disputed points; but I must, in justice to the
truth, say that the modification of treatment which has
been recorded has been carried too far. There are
still, as there ever have been, conditions of disease in
252 MEDICINE UNDER QUEEN VICTORIA.
which the removal of a few ounces of blood is as sure
and as sound a practice as any other in the possession
of medical art ; and, in my own opinion, the great, if not
the sole reason for the dread of abstracting blood, which
now seems to exist, is the want of the knowledge when
to use the lancet discriminately, and as an instru-
ment of absolute precision. Venesection, an extreme
remedy, can no longer be used in a spirit of doubt,
and, therefore, it is disused. When doubt is dispelled
regarding it, it will regain its place, and its true
place, in curative art.
The abandonment of venesection has been followed
by the abandonment of some other remedies of the so-
called heroic class. Tartar emetic and other forms of
antimony have signally and properly fallen into dis-
favour and disuse. I candidly confess that I recall
with pain the old practice of administering tartar
emetic in small and repeated doses for pneumonia,
until a toxic action was produced by the drug. The
nausea, the diaphoresis, and the depression were ex-
treme, and the production of these symptoms can only
be excused on the argument that a truly false experi-
ence, a veritable experientia fallax, led to the honest
belief that, unless so powerful and direful a means were
used, the disease would of necessity destroy life. Worse
than all, antimony was very often clapped upon blood-
letting, and completed the remedial evil. It is little
wonder that the " cures " of the despised, but enthu-
siastic homoaopath should stand well by the side of
those who too literally killed to cure.
The wanton use of mercury has, in like manner,
become a thing of the past. Here, however, the old
remedy in a modified way still holds its own. The
modus operandi of mercury is not yet solved, yet the
THERAPEUTICAL ART. 253
remedy is constantly prescribed. The extreme saliva-
tions which it was once made to produce, have ceased
to be enforced; but a mild mercurial course and the
use of the mercurial bath finds continued favour in the
treatment of chronic forms of specific disease, and may,
I think, be said to have won specific confidence as to
its efficacy.
The system of treating some kinds of chronic disease
l>y the free and continuous administration of purgatives
the Hamiltonian system has also largely passed
away, or at most is relegated to the general or hygienic
method of " drinking the waters " at some favourite
health resort, where saline and aperient natural springs
are found. The change is, on the whole, beneficial. It
causes all that is useful and there is much which is
useful from a course of purgatives to be retained, while
it entices the patient to enjoy change of air, travel, and
recreation, all of them excellent and pleasant additional
remedies,
These givings up of old-established rules of practice
have exercised a telling influence on practice altogether,
and have led some practitioners, of good passing repute,
to teach an all but entire disbelief in the employment
of drugs of any kind. It has led to the establishment,
throughout the country, of great institutions, called
" Hydropathic," in which the " water cure of disease "
first instituted formally by a German peasant named
Preissnitz is practised with more or less of systerna-
tised regularity. It has led also to the introduction of
large sanitoriums, or houses of health, where general
hygienic measures are allowed to stand as the substi-
tutes for nearly all that was left to medicinal " skill "
fifty years ago.
That the modern hygienic system of treatment of
254 MEDICINE UNDER QUEEN VICTORIA.
disease has won an important position is shown, not
only by the number of institutions devoted to its ser-
vice, but by the popular scepticism which is now evinced
on the value of remedies. In the early part of the
reign, the family doctor was expected at the end of
each half year or year to send in his bill of "par-
ticulars," in which, on long pages of foolscap, he
entered every item of mixtures, plaisters, lotions,
blisters, ointments, packets of herbs, leeches, and pills,
as well as journeys, cuppings, venesections, tooth
extractions, and accouchements. It was a wonderful
document, and swallowed up a merciless amount of time
in compilation. But the public would have it. " No
particulars, no pay," was the laconic reply of an old lord
to a medical friend of mine, who had ventured to send
in a brief note of so many " attendances, including
medicines, for the year ending December 31st, 1850."
The old lord was laconic in expression, but not peculiar
in sentiment. " No particulars, no pay," was the rule
of the day ; now it is so far from being the rule that,
if it were attempted to be carried out, Mr. Punch,
or some of his rivals, would pillory it as a nuisance
and a bad joke.
Galen taught that every medical man should keep
his own armoury of remedies, and supply them himself
to the sick ; and for many centuries this was the plan
adopted by all practitioners, except the favoured few
who were classed as physicians, who were employed
as consultants, who had the privilege of putting the
mystic invocation to Jupiter at the head, and of
adding the initials of their names to the tail of their
prescriptions. This system is not yet quite dead, but
is rapidly dying out. The pharmaceutical chemist
now largely takes the place of the apothecary or
THERAPEUTICAL ART. 255
supplier of medicines, and begins to claim that this
is his distinct province of duty, for which he has
specially qualified himself; whilst the general prac-
titioner of medicine tell it not in Pall Mall writes
prescriptions, invokes Jupiter with the most brazen
effrontery, and positively adds the initials of his name
to the document as boldly as if he were signing an
ordinary letter, a cheque, a certificate of death, or any
other every-day paper.
Nothing more need be said to show how complete
is the revolution in the therapeutical field.
Meanwhile, although scepticism has gained such
impudent proportions as scarcely to be a proper object
for serene contemplation, what is called a science
of therapeutics, as distinct from the art, is appearing
on the scene, and is claiming a positive position most
startling in its declaration and winning in its promises.
It makes, in fact, and marks a new school of practical
physic. This school proclaims that, before any
medicinal substance should be used, its precise physio-
logical action should be understood ; and although it is,
as yet, a beardless school and fearfully distinguished by
the lisp of youthful conceit, it has the therapeutical
hope and expectation of the future that it will grow
out of its present juvenile propensities into sterling
strength and character.
The origin of this new school is traceable, easily
enough, to the researches on anaesthetics and their
application. So soon as a few men began to try
chemical substances and their effects on living bodies
in a systematic way in order to determine anaesthetic
values ; so soon as chemical substances, tried for this
purpose, were examined in the first instance in respect
256 MEDICINE UNDER QUEEN VICTORIA.
to their chemical compositions, their vapour densities,
their specific weights, their boiling-points, their
solubilities in blood, their absorption into the body
by the different absorbing surfaces, the changes they
produce in the body by degrees or stages of action,
the influence they exert on the temperature of the
organism, their effects on the force and motion of
the circulation and on the respiration, their influence
on the tissue and tone of the muscular mechanism,
(voluntary and involuntary), and their power of causing
modifications of the mental phenomena of reason,
emotion, and appetite ; so soon as researches of this
nature were pursued in relation to the modus operandi
of one class of medicinal agents, it was natural enough
that the inquiry would soon extend to other instances.
The inquiry has extended, has been fairly fruitful, and
is indisputably interesting and curious.
It has been known ever since man became a being
gifted with knowledge, that certain external impressions
would call up what are recognised as emotional
phenomena, as in the acts of blushing or becoming livid
or pale from some sight or sound, or even from some
remembrance or description that tells upon the mind.
The red and burning blush is a phenomenon the poet
and metaphysician have claimed in their descriptions as
peculiarly their own to describe and to expound. But
in our times this phenomenon has come into the work
of the physiologist who illustrates that it and allied
phenomena have so definite a physical origin, that
they can be produced in an experimental manner by
an operation on the sympathetic or organic system
of nerves. Divide a sympathetic nerve, and the parts
to which the nerve is distributed are reduced in
vascular tone, the contractile minute arterial tube loses
THERAPEUTICAL ART. 257
its regulating power, and the heart, continuing its
pressure unresisted in the affected structure, flushes
that structure with blood ; a mechanical blush of the
paralysed centre.
In the year 1863, at the meeting of the British
Association for the Promotion of Science, held at New-
castle, the discovery above named as to the effect of
division of an organic nerve received a new elucidation
in the demonstrated fact that one chemical substance
known to chemists as the nitrite of amyl, produces,
when it is inhaled in the form of vapour, the same
paralysing action as the mental impression or the
operation of the division of an organic nerve. Thus a
chemical blush was added to the mental and surgical
blushes ; and what becomes most curious in connection
with the chemical blush is the circumstance, that with
it, as with the mental blush, there is increased action
of the heart, a kind of palpitation which continues
until the action of the agent causing it is exhausted.
The chemical blush, like the mental, extends, that is to
say, so generally and through so wide a range that the
heart feels the lessened vascular tension, and responds
to it by over-action, or, as we should define it, were we
speaking of a time-piece, by running down.
What the mode of action of this nitrite is we do not
yet understand. Whether it acts by communicating a
series of vibrating shocks to the nervous system from
one centre of that system as a sound or sight does ; or,
whether it rapidly diffuses through the nervous matter,
and interferes with the continuous nervous vibration ;
whether, in other words, it acts like the bow-hand of
the violin player, or like his fingers which press on the
strings of the instrument, is not discovered ; but it is of
no little importance to comprehend that in some way it
258 MEDICINE UNDER QUEEN VICTORIA.
produces certain effects which are perfectly definite in
themselves and readily demonstrable.
By natural transition the cause of discovery was
soon pushed in new directions. Thus it was found
that the specific influence of the nitrite of amyl trace-
able also in nitro-glycerine throughout the nitrite family
of chemical bodies, extends to other families in the
chemical treasury. In a succeeding step contrasts began
to be set up, and in the end medicinal agents generally
have been partly arranged or classed according to their
effects in diminishiDg or increasing arterial tonicity,
and in modifying, thereby, the natural blood pressure.
The plan of recording the chemical construction of
each substance tested for value as an anaesthetic led, in its
turn and also naturally, to the study of chemical combi-
nations in relation to physiological effects. This idea
fructifying has brought out the study of therapeutical
results according to chemical constitution. A fine field
of research has been opened in this manner, and is
being pursued vigorously. We ask now, What is the
action of each element of an active chemical substance
on living powers and processes ? How is that primary
or elementary action modified by a binary combination
or a ternary combination with other elements ? And,
how is one element modified in action by variations of
its own condition ? Carbon seems, by the light of these
inquiries, to be the necessary basic element for those
anaesthetic substances which act slowly, and sustain a
long anaesthetic state. Nitrogen seems to exert some
specific power over muscular action. Oxygen seems to
be modified in the most signal manner by allotropic
changes, so that it may pass from being an extreme
excitant into an actual narcotic.
Connected with this subject of chemical constitution
THEEAPEUTICAL ART. 259
and physiological action has appeared another work,
marked by the endeavour to discover how to neutralise
in the living body one toxic agent by the adminis-
tration of another ; how to get, in short, at true anti-
dotes. Belladonna has thus been set up versus opium ;
amyl nitrite versus strychnia.
The experimental problems thus stated are again
being in turn reversed. Some compound substances
taken into the living body are decomposed in the
living laboratory. Chloral hydrate, it has been assumed,
is decomposed into chloroform and sodium formate ;
dilute nitric acid into ammonia ; tannin into glucose.
The same investigation has been extended to the use
of external remedies, which decompose on coming into
contact with the tissues. The ethylates of sodium, or
potassium, when applied to a vascular structure like a
nasvus, decompose into caustic soda or potassa, and
into alcohol. The caustic alkali destroys the living
structure, the alcohol coagulates and transforms the
destroyed part into a scale or scab which in time falls
off and effects the removal or cure.
Once more, by a side study, a new field of labour
has been opened in the comparison which has been
traced between the action on the living body of known
agents and the action of agents which are as yet
obscure or unknown. The symptoms caused by some
chemical bodies are so like the symptoms of some
natural diseases that the cause of both may be the same ;
i.e., the living body, by its own chemical forces, exercised
under perverting conditions, may produce or turn out
its own chemicals, and be poisoned by them in set form
and manner just as though those symptoms had been
induced by an agent swallowed, inhaled, or subcuta-
neously injected. The course of labour has progressed
260 MEDICINE UNDER QUEEN VICTORIA.
so far in this direction that we now give names to
some conditions of disease derived from supposed and
fairly supposed physico-chemical agencies. Thus we
speak of saccharine cataract, the cataract produced
in diabetes by the diabetic sugar developed in the
body of the patient ; and of acetonaemia the coma
produced by the development in the body of the sub-
stance called acetone.
In many other lines the new therapeutical school
has made its mark. It has sought and found some
agents which reduce the temperature of fever. It has
sought and found some agents which reduce the power
of the impelling stroke of the heart. It has investigated
old remedies, like digitalis, and has shown how these
agents bring about results that have long been recog-
nised, but have not been understood. It has determined
a large number of facts respecting the action of differ-
ent medicinal substances on the bodies of animals of
different species ; notably the demonstration, that in
pigeons opium is practically inert.
A further grand change in therapeutics during the
Victorian era relates to the employment of alcohol
in disease. By a strange fortuity I had almost written
fatuity the old Brunonian system of treating disease
with large quantities of alcohol, came for a time so
much into vogue, that alcohol was turned into a
panacea of almost universal application. The fashion,
for it was little more, lasted or several years, and was
hard to move. Happily for the world at large, and
the mediciners of the world in particular, the tide is
now turned, and alcohol is being relegated by all honest
men to its true place as a medicine, requiring as care-
ful study and watchfulness as any other drug in the
pharmacopeia.
THEEAPEUTICAL ART. 261
Connected with direct therapeutical art in the ad-
ministration of medicines strictly medicinal, there has
arisen the method of employing, medicinally, certain
animal substances which partake also of the nature of
foods. The most remarkable illustration of this method
has been seen in the treatment of pulmonary consump-
tion and some other exhaustive diseases by the use of
animal fatty substances. In this direction the late
Professor Hughes Bennett popularised cod liver oil as a
food medicine until it became one of the most universal
remedies belonging to the present age. The method
was not altogether new, for it was practised by Wood-
ward in the last century, but it has received an extra-
ordinary development in the Victorian epoch.
A still more original advancement has consisted in
the administration of artificially made digestive fluids
with pepsine or pancreatine as their base.
The last advancement in therapeutical art to which
the British school has originally contributed consists of
the mode of administration of remedies by hypodermic
or subcutaneous injection. Two men of inventive mind,
who have now gone over to the majority, Mr. Charles
Hunter of London, and D*. Alexander Wood of
Edinburgh, each claimed the origination of this method.
I believe each of them to have been an independent
pioneer in the same field and in the same realization, by
no means the least therapeutical instalment of the fifty
years that have passed as a tale that is told.
CHAPTEK V.
THE FIFTH ADVANCEMENT: ABDOMINAL SURGERY.
the early part of the reign there existed
what is now considered to be a practical super-
stition in respect to operations on the abdomen
involving the peritoneum. It was held,
generally, by the profession that the peritoneum was
so vital a structure that any injury inflicted upon it
was, almost of necessity, mortal.
At the time named, nevertheless, the surgeons of this
country had heard from America of the bold opera-
tion of ovariotomy, and some had undertaken to perform
the operation, foremost amongst others the late Mr.
Jeaffreson, of Framlingham, in Suffolk. It was a
desperate venture, but it was not so unjustifiable as
to be put aside.
I remember that my old and much valued friend, the
late Sir John Cormack, reckoned up the fatality from
ovariotomy previous to the year 1846 as at the rate of
three to four in every ten cases ; but as all cases which
were not operated on ended fatally, he still argued that
the chances of life afforded by the operation were such
as should not be lost.
This view of the subject took hold of the profession,
but it was not universally adopted. One well-known
obstetrician, who held a prominent, and deservedly
ABDOMINAL SUKGEBY. 26B
prominent, place in his department, stigmatised the
operation in the strongest terms he could employ, and
looked upon the daring surgeons who performed it as
little better than surgeons guilty of murder.
In spite of all opposition abdominal surgery made its
way, and the superstitions respecting the dangers of
cutting, piercing, and otherwise injuring the peritoneum,
under surgical procedures, lost its grim power.
In 1854, during the course of an epidemic of cholera
in London, another and new part of abdominal surgery
was introduced. It was suggested that for the treat-
ment of cholera in the stage of collapse, when the
body was drained of water, it might be well to inject
the peritoneum with pure water, in order to produce
an artificial ascites. From this artificial supply the
blood, it was thought, would take up a free quantity
of water by the great veins, and so the loss of water
caused by the disease might be supplemented. The
experiment of injecting the peritoneum was performed,
first, on inferior animals, with the result of discovering
that such injection could be carried out with perfect
safety, unless the quantity of water injected were in
such excess as to be equal to the fifth part of the
weight of the body of the animal ; then coma would
follow, but need not of necessity be fatal. The
operation of intra-peritoneal injection was afterwards
performed with perfect success on the human subject
suffering from cholera; and since that time the peri-
toneal surface has been made, in some cases of ex-
haustive disease, a feeding surface, when the ordinary
digestive system has failed in its function.
Later still the peritoneal cavity of some of the
inferior animals has been made an absorbing surface
for the introduction of fluids which, circulating with
264 MEDICINE UNDER QUEEN VICTORIA.
the blood through the tissues, produce, sjTithetically,
disease of organic structures. Thus diluted lactic
acid injected into the peritoneal cavity has been
made to produce rheumatic disease of the heart, while
the peritoneum itself has escaped injury from the
operation.
I notice these points incidentally to show how com-
pletely the ideal danger of operation on the peritoneum
has been exploded. The major subject lies in the
boldness of the operative procedures which have been
practised on the human subject. The great operation of
ovariotomy and of other abdominal operations have been
brought, by the skill, the patience, the courage, and
the perseverance of our English and Scottish surgeons,
to such perfection that the most astounding results are
achieved. Kemoval of large ovarian and other tumours ;
removal of the appendages of the uterus ; removal of
the uterus itself; removal of a kidney; puncture of
the gall bladder for extraction of gall stones ; punc-
ture of the liver ; opening of the abdominal cavitjr for
the removal of obstructions in the intestines, and for
division of strictures of the intestinal canal ; opening
of the colon ; opening of the stomach, and every kind of
useful operation that once could only be wished for and
looked on as impossible, is now performed as a matter
of course by the advanced chirurgeon; while operation of
incision into the cavity of the abdomen for exploratory
purposes is accepted with almost as little anxiety as
puncture or tapping for relief of ascites was looked upon
fifty years ago.
It is fair to the British school to say that to it belongs
the greater part of the credit of this astounding success,
a success won by courage, perseverance, industry, can-
dour, and acceptance of responsibilities in a spirit which
ABDOMINAL SURGEEY. 265
has not been surpassed in any age nor in any service of
man for his kind. The fact that
Men never nearer to the gods attain
Than in the art of giving health to men,
is in no sense more convincing than in these labours
for the perfection of the surgery of the abdomen. I,
who have looked upon these labours during the greater
part of the Victorian era in which they have occurred,
and have seen the science and humanity to which they
have so largely contributed, can speak of them without
bias in terms of truest admiration, and can invite
every student of the future to read up with special care
this splendid department of our current history.
If it be desired to know from such a looker-on why
and how these results have been obtained, I should
refer the success to four causes.
The first credit should be given to general anaesthesia,
without the aid of which such formidable operations
would not have been dared, or, had they been dared
by a few adventurous men, would have been stopped
by the huge mortality from shock which would have
resulted.
The second credit should be given to the daily
increasing skill of the operators ; to their detection
of many small improvements in manipulative art, their
increasing delicacy in removing adhesions, securing
bleeding vessels, clearing away all foreign substances
from the cavity, the return of the pedicle to the cavity
in ovariotomy, the extreme nicety in bringing divided
structures back to their natural apposition, and the
exclusion of air from the wound.
The third credit is due to after-treatment ; the
avoidance of unnecessary dressings, the provision for
VOL. iv. 19
266 MEDICINE UNDEB QUEEN VICTORIA.
drainage of adventitious fluid secretions, and the en-
forcement of absolute rest of the injured parts.
The last credit, and not the least, should be given to
the improved hygienic measures that have travelled
with the times : to cleanly care on the part of the
surgeons and nurses, which has been most propitious ;
to the separation of the patients operated on from
the congregation of surgical patients in large wards ;
and to the thorough cleansing and ventilating of the
small rooms or wards occupied by the patients after
they have been subjected to operation.
On these foundations of scientific surgery anaesthesia,
skilful manipulative art, judicious after-treatment, and
treatment of health throughout the world now rests
with a confidence that may be expected to increase and
grow firmer under sustainment of a success which
may be claimed as amongst the highest of beneficent
attainments it is possible for man to achieve.
In the course of the reign many improvements have
been carried out in other parts of surgery. The inven-
tion of the method of subcutaneous division of bones
within the capsule of a large joint, like the hip joint,
is one noted progress. The practice of drawing off
fluids from abscesses, cysts, and cavities by aspiration
is another important progression. And, quite recently,
the plan of operating for the removal of tumours or
of accumulations of pus or other fluids within the
cavity of the skull or of the spinal canal is a promised
development of surgery which, conducted as safely
and soundly as abdominal surgery has been, bids fair
to rival that great advancement itself.
CHAPTEE VI.
THE SIXTH ADVANCEMENT : DIAGNOSTIC ART.
N the course of the period which is under
review, no discovery in diagnosis of the
supremest original order has taken place in
any part of the world. None, for instance,
that equals in originality the discovery of auscultation
by the illustrious Laennec.
But in the absence of any such great and original
discovery there has been excellent work done in
diagnosis in many modes of detail by which various
new instalments have been initiated and some advance-
ments richly elaborated.
The first of these lies in thermometrical diagnosis.
The beginnings of this art were far back before the
Victorian era. They belong to the last century. They
commenced with Anthony de Haen in 1754. They
received an impulse from John Hunter ; and, nearer to
our time, they got a stronger impulse still from the late
distinguished Dr. John Davy.
The systematic readings began generally about 1860,
the essays of Wiinderlich on Clinical Thermometry
giving origin to a research which, once started, has
perhaps been cultivated in these islands more assidu-
ously than in any other part of the world.
We have brought the thermometer to the highest
268 MEDICINE UNDER QUEEN VICTORIA.
perfection as an instrument for clinical use, and we
have learned the use of it so extensively that every
practitioner may be said to employ it with effect. It is
now the sign regnant of alarm in states of the body
where the danger is that of fever from fatal increment
of heat. We gather from it the most important inti-
mations for the guidance of treatment, and our prime
wonder is how it was possible for our predecessors to
have treated disease, or prognosed or diagnosed, without
the thermometer. The instalment is of utmost value,
and is a sterling addition to medical art.
We have played our parts well in the art of diagnosis
called the laryngoscopic. Dr. Benjamin Guy Babington
gave the first suggestion for this art. The late Mr.
Avery, one of the surgeons of Charing Cross Hospital,
followed ; and, one still living amongst us made a more
practical advance. The idea passed to the Continent,
and came back to us marvellously simplified and per-
fected. We received it in its improved form with
acclamation, became students of it, and now in no
country is all that relates to it better or more accur-
ately known.
We welcomed with equal zest the ophthalmoscopic
art. If we did not discover or produce the art, we have
assisted largely in the advance of it up to its present
position, and we have fair claim to the advancement of
detecting by it, indirectly, some forms of cerebral disease.
During the Victorian reign the spliygmograpli has
come into existence as a means of diagnosis. The first
idea of this advancement in a practical form I should
assign to Mr., afterwards Dr. Groux, a man who was
born with a deficiency of the sternum, and whose heart,
ADVANCEMENTS IN DIAGNOSTIC ART. 269
covered only by loose skin, could be examined so readily
by the observer, that the pulsations of the auricles,
ventricles, pulmonary artery, and aorta could be felt
and even seen. Groux, whom I knew well, and whom
I examined several times, had a most ingenious plan
of fixing with wax long fine feathers on the pulsating
parts above named, and also on the radial pulses. The
feathers, fixed by their quill ends at an oblique angle
to the body, pulsated at their distal extremities through
a long space, and when a piece of paper of a different
colour to them was held behind them, they yielded a
most excellent reading, which only required to be written
down to be rendered permanent as a record.
The suggestion was too good to be lost, and on the
Continent was ably turned to the production of the
instrument to which the term sphygmograph is applied.
In this country the new instrument soon underwent
simplification and improvement by the late Drs.
Mahomet and Anstie. In the United States it passed
through still further advancements. A new lever -was
invented for it ; and, greatly reduced in size so as easily
to be carried about, and easily adjusted to the wrist, it
gradually grew into favour. Finally, by a further series
of useful changes in this country, it has become a pocket
instrument, is supplied with a standard register, and is
so manageable as a recording instrument that it puts
mere finger reading of the pulse into the history of the
past in critical cases. The sphygmograph, still in its
first days, promises to give a new literature, written by
the circulatory mechanism itself, for the future student.
Its writings are a veritable language, which may be
interpreted at a glance, by the scholar educated in it,
for the work of diagnosis, prognosis, and treatment.
In addition to the sphygmograph we have developed in
270 MEDICINE UNDER QUEEN VICTORIA.
England another instrument, called the sphygmophone.
By the sphygmophone the curves described by a needle
moved from the pulse are rendered in sounds which
correspond with the varying states of the pulsating
mechanism. These sounds may be made extremely
loud, so loud as to be heard by a large audience, if they
be increased by the use of the microphone. Or they
can be received through the stethoscope as the sounds
of the heart or breathing are received, the latter method
being the most convenient and practical. To the
sphygmograph, the cardiograph has also been added,
and has become an instrument of much promise in
diagnosis.
Various attempts have been carried out for the purpose
of making parts of the body diaphanous. Other attempts
have been made to illuminate the closed cavities of
the body, such as the bladder, and even the stomach.
Since the introduction of the electric light some of
these attempts have achieved a partial success; but they
are at present aids in waiting rather than in service.
A grand piece of diagnostic skill belongs to the
Victorian era through the late Dr. Addison. This
relates to the diagnosis of the disease which has been
called Melasma Addisonii, and in which the symptoms
of bronzed skin, anemia, and debility are found to be
accompanied with structural changes, atrophic, fibroid,
cancerous, or tubercular, of the supra-renal capsules.
On the whole, I am inclined to the belief that in the
future this discovery will be accepted as the best that
has been made in the whole fifty years of research in
diagnosis.
Another good piece of diagnostic work was added by
ADVANCEMENTS IN DIAGNOSTIC ART. 271
the late Dr. Hodgkin in the definition of the disease
which bears his name, and which is a splenic affection,
accompanied with anaemia, enlargement of the lymphatic
glands, and general anasarca. To this must be added
the later diagnosis, essentially English, of the disease
now recognised under the title of Myxodoema.
To the diagnosis of parasitic affections an incredible
amount of labour has been paid, the greatest labourer
in this field being the late Dr. Spencer Cobbold. By
the inquiries instituted in this department of medical
knowledge we must include amongst the most important
those conducted in India, which resulted in the detection
of the Filaria Sanguinis Hominis, and of the Spirillium
of famine or relapsing fever. The manner in which
the embryo of the filaria of human blood escapes from
the bodies of infected persons ; the mode in which the
mosquito, by biting the infected person, becomes first
the incubator of the filarial worm, and then the bearer
and depositor of it in water, into which its embryos
pass and vitally poison the water, charging through
it the bodies of those who drink of it with new embryos,
is, taking it all in all, one of the most curious of all
discoveries in diagnostic art.
Cobbold expressed to me that he considered this a
more remarkable exposition than Addison's definition
of the melasma from supra-renal degeneration.
By microscopical research we have added largely to
diagnostic art. The choicest labour in this direction
is that of the late Dr. John Hughes Bennett in his
original investigation of white blood cell disease, named
by him Leukemia. It is true that this condition of
the blood remains yet in an unsatisfactory stage of
discovery; but the first delineation of it reflects the
272 MEDICINE UNDER QUEEN VICTORIA.
highest credit on one of the brightest scholars of
the British school.
By the microscope we have carried out many new
discoveries in the investigation of degenerations of
organic structures, through which, indirectly, we have
been able to make or confirm practical diagnoses. We
have also turned this admirable instrument to truly
valuable research in the delineation of deposits in
excretions like the urine. It may, however, be fairly
argued that in these inquiries, fruitful though they
have been, we have not surpassed the scholars of other
and rival nations.
In matters relating to the blood we have conducted
several advanced and practical discoveries, bearing on
the detection of the symptoms which indicate separa-
tions of fibrine in the chambers of the heart and in the
channels of the circulation. It is true that we have
somewhat disfigured this part of our work by the
adoption of some foolish phrases and terms derived
from an old and mysterious nosology. At the same
time we have reason for feeling satisfied with the truths
which have been set forth. We have explained on
rational and physical principles the nature of and
symptoms springing from what the older physicians
called polypi of the heart and arteries. We have
traced out the results which follow the arrest of the
current of the blood from the precipitation of fibrine
in the different cavities of the heart ; we have suc-
ceeded in defining the symptoms which occur when
portions of a concretion are carried from the left side of
the heart into the arterial ramifications ; and we have
cleared up numerous doubts formerly held as to the
nature of sudden demonstrations of paralysis from
ADVANCEMENTS IN DIAGNOSTIC ART. 273
immediate obstruction of portions of the centro-vascular
system.
The electric balance and the microphone have been
brought into service for purposes of diagnosis. By
their means one instrument has been invented for
detecting the variations in the sense of hearing in
other words, degrees of deafness in those who are
suffering from deficient auditory capacity. By the
same instruments another apparatus has been devised
for discovering the presence and position of metallic
substances like bullets, buried in the structures of
the body.
In the application of chemistry to diagnostic art we
have been second to no other nation in industry. But
in this field I fear we must rather consider ourselves
as followers of the German school, than as originators
of new and successful methods of inquiry.
The latest advances in diagnosis, and in some degree
the most startling, bear upon diseases of the nervous
system and the detection of the precise seat of diseases
of the nervous centres by and through muscular aberra-
tions and modified local sensibilities. Here a field has
been opened, the extent of which it is quite impossible
to foresee.
JOHN SNOW, M.D., A EEPEE TENTATIVE OF
MEDICAL SCIENCE AND ART OF THE
VICTORIAN ERA.
Victorian Faculty of Physic has produced
no one man of commanding genius who has
remained in medicine, practising the art.
It has, however, produced many truly repre-
sentative men who, in their combined labours, offer a
magnificent result of work done and advancement
made. Amongst these I should place in the first rank
the late Dr. John Snow, and for this reason I bring
forward here a sketch of his career for the student of
the future.
John Snow was born at York, on June 15th, 1813.
He was the eldest son of his parents. His father was
a farmer. As a child he showed his love of industry,
and increasing years added only to the intensity with
which he applied himself to any work that was before
him. He was first sent to a private school at York,
where he learned all that he could learn there. He
was fond of the study of mathematics, and in arith-
metic became very proficient. At the age of fourteen
he went to Newcastle-on-Tyne, as an articled pupil to
Mr. William Hardcastle, surgeon, of that place. He
had also the opportunities of studying at the Newcastle
(jlutotype from a, (Presentation (Portrait, 1356, and
facsimile. 2J. W. %.)
JOHN SNOW, M.D. 275
Infirmary. During the third year of his apprentice-
ship, when he was seventeen years old, he formed an
idea that the vegetarian system of feeding was the true
and the old ; and with a consistency which through-
out life attended him, tried the system rigidly for more
than eight years. He was a noted swimmer at this
time, and could make head against the tide longer than
any of his omnivorous friends.
At or about the same time that he adopted his
vegetarian views, he also took up the temperance cause.
He not only joined the ranks of the total abstinence
reformers, but became a powerful advocate of their
principles for many succeeding years. In the latter
part of his life he occasionally drank a little wine, but
his view 7 s on the subject remained to the end unchanged.
He retained a strong faith in total abstinence, and a
belief that it must ultimately become universal.
In 1831-32 cholera visited Newcastle and its neigh-
bourhood, and proved terribly fatal. In the emergency
Mr. Snow was sent by Mr. Hardcastle to the Killing-
worth Colliery, to attend the many sufferers from the
disease. In this labour he was indefatigable, and his
exertions were crowned with great success. He made
also various observations relating to this disease, which
proved to him of immense account in after- years.
He left Newcastle in 1833, and engaged himself as
assistant to Mr. Watson, of Burnop Field, near New-
castle, with whom he resided for twelve months.
Leaving Burnop Field in 1834-5, he revisited his native
place, York, for a short stay, and thence to a certain
half-inaccessible village called Pately Bridge, in York-
shire, to act as assistant to Mr. Warburton, surgeon of
that place. Eighteen months at Pately Bridge, with
many rough rides, a fair share of night work, a good
276 . JOHN SNOW, M.D.
gleaning of experience, and, this sojourn over, our
student went back again to York, to remain a few
months, and to take an active share in the formation of
temperance societies. In leisure days during this period
it was his grand amusement to make long walking
explorations into the country, collecting all kinds of
information, geological, social, sanitary, and archi-
tectural.
At last York must again be left for the London
student life was in view. In the summer of 1836 he set
off from York to Liverpool, and, trudging it afoot from
Liverpool through the whole of North and South
Wales, turned London-ward, calling at Bath by the
way, on a visit to his uncle, Mr. Empson, to whom, to
the end of his life, he was devotedly attached. Oc-
tober 1836 eventful October brought him to the
" great city," and placed him on the benches of the
Hunterian School of Medicine in Windmill Street ; a
school long since closed, and now as mythical as the
mill which gave the name to the locality.
In October 1837 Mr. Snow began to take out his
hospital practice at the Westminster Hospital. On
May 2nd, 1838, he passed his examination, and was
entered duly as a member of the Eoyal College of
Surgeons of England. In October 1838 he passed the
Apothecaries' Hall, and was now duly qualified in
medicine. His student days were passed at 11, Bate-
man's Buildings, Soho Square.
At this time there existed in London a society (now
the " Medical Society of London "), called the " West-
minster Medical Society." It was a society which
had long given encouragement to those junior members
of the medical profession who might wish for a hearing
at its meetings and debates. Mr. Snow was not the
JOHN SNOW, M.D. 277
man to lose an opportunity such as this. I have often
heard him say, both privately and publicly, that, upon
his early connection with the "Westminster Medical,"
his continuance in London depended, and all his suc-
ceeding scientific success. When he first attended the
meetings of the "Westminster Medical," he was very
timid ; and although he always spoke to the point, he
found it difficult to obtain a favourable notice. At first
nobody ever replied to what he said. After a long time
some grave counsellor condescended to refer to him
as the " last speaker." A little later and somebody
ventured to name " the last speaker " by his name.
Then some one, bolder still, concurred with Mr. Snow ;
and ultimately Mr. Snow became recognised more and
more, until the presidential honours were his own.
Frith Street, Soho-square, No. 54, was the house at
which Mr. Snow, to use his own words, " first nailed
up his colours." He removed there from Bateman's
Buildings in September 1838. He bought no practice,
nor exhibited any pretence, but a more thoroughly girded
man for the world's encounter could hardly be conceived
than he at this time. He took no wine nor strong
drink ; he lived on anchorite's fare, clothed plainly,
kept no company, and found every amusement in his
science books, his experiments, and simple exercise.
To fill up time till the money patients should come,
he became one of the visitors of the out-patients of
Charing Cross Hospital, and to many a representa-
tive of the great poor he extended a skill which
would have been a blessing to the great rich. The
librarian of the College of Surgeons' Library con-
sidered him a quiet man, who read closely, and
was not too proud to ask for a translation when an
original bothered him. All who knew him said he
278 JOHN SNOW, M.D.
was a quiet man, very reserved and peculiar a
clever man, but not easy to be understood, and very
peculiar.
The connection with the " Westminster Medical "
led to Mr. Snow's first attempts at authorship. On
October 16th, 1841, he read at the Society a paper
on " Asphyxia and on the Eesuscitation of New-born
Children." The paper in full will be found in the
London Medical Gazette for November 5th of the
same year. The paper is remarkable for the soundness
of its reasonings and the advanced knowledge which
it displays. The object of the paper was to introduce
to the Society a double air-pump, for supporting artificial
respiration, invented by Mr. Eead of Eegent Circus.
The instrument was so devised that by one action of
the piston the air in the lungs could be drawn into
one of the cylinders, while by the reverse action the
expired air could be driven away, and the lungs
supplied with a stream of pure air from the second
cylinder. There was also advanced, in the concluding
part of the communication, the view that the cause of
the first inspiration is probably the same as the second
or the last, viz., a sensation or impression arising from
a want of oxygen in the system. So long as the
placenta performs its functions, the foetus is perfectly at
ease, and feels no need of respiration ; but whenever
this communication between the child and its mother
is interrupted, at least in the later months of pregnancy,
the child makes convulsive efforts at respiration similar
to those made by a drowning animal.
On December 18th, 1841, Mr. Snow was again
before the "Westminster Medical" with a very in-
genious instrument which he had invented for per-
forming the operation of paracentesis of the thorax.
JOHN SNOW, M.D. 279
The description of the instrument will be found in the
Medical Gazette of January 28th, 1842.
In the Medical Gazette for November llth, 1842,
Mr. Snow published a note on a new mode for securing
the removal of the placenta in cases of retention with
haemorrhage ; and in the same journal for March 3rd,
1843, he communicated an essay on the circulation
in the capillary vessels. The essay was selected and
re-arranged from papers read before the " Westminster
Medical " on January 21st and February 4th. We
have in this essay an admirable sketch of the capillary
circulation. He advanced, on this occasion, the idea
that the force of the heart is not alone sufficient to
carry on the circulation, but that there is a force
generated in the capillary system which assists the
motion. He explained also the great importance of
the cutaneous exhalation, and reasoned that in febrile
states, accompanied with hot skin, the transpiration
from the skin is in reality greater than it is in health.
Pushing on in the higher branches of his profession,
and aiming always at the best, the degree of the
University of London became a temptation, and Mr.
became Dr. Snow on the 23rd of November, 1843, by
passing the M.B. examination. He was enrolled in
the second division on this occasion. On the 20th
of December in the following year, he passed the M.D.
examination, and came out in the first division.
The harass of London life by this time commenced
to tell on Dr. Snow. He had suffered a few years
previously from threatened symptoms of Phthisis
pulmonalis, but took plenty of fresh air and recovered.
He again became unhinged for work, and in the
summer of 1845, was attacked with acute and alarming
symptoms of renal disorder. His friend and neighbour,
280 JOHN SNOW, M.D.
Mr. Peter Marshall, then of Greek Street, afterwards
of Bedford Square, gave him his ahle assistance, and
the advice of Dr. Prout and of Dr. Bright was obtained.
In the autumn of 1845 he paid a visit to his old
colleague, Mr. Joshua Parsons, at Beckington. From
Beckington he went to the Isle of Wight, but soon
returned to London and was elected Lecturer on For-
ensic Medicine at the Aldersgate School of Medicine,
an appointment held till the school ceased in 1849.
There is no night without its morning. The eventful
medical year of 1846 proved the turn of tide season
for our struggling Esculapian. In this year the news
came over from America that operations could be pain-
lessly performed under the influence of ether.
The fact was just such an one as would at once
attract the earnest attention of Dr. Snow. It was a
physiological, as well as a practical fact. It was
rational in its meaning, and marvellously humane in
its application. The question, once before him, was
in a scientific sense his own. His previous experi-
mental studies on respiration and asphyxia had pre-
pared him for this new inquiry ; he took it up for its
own sake and not from any thought, at the time, of a
harvest of gold.
The first inhalations of ether in this country were
not so successful as to astonish all the surgeons, or
to recommend etherisation as a common practice.
The distrust arose from the manner in which the
agent was administered. Dr. Snow at once detected
this circumstance ; and remedied the mistake by making
an improved inhaler. He next carried out many
experiments on animals and on himself, and brought
the administration to great perfection. One day, on
coming out of one of the hospitals I am giving the
JOHN SNOW, M.D. 281
narrative as he gave it to me he met a druggist
whom he knew bustling along with a large ether
apparatus under his arm. "Good morning!" said
Dr. Snow. " Good morning to you, doctor ! " said the
friend; "but don't detain me, I am giving ether here
and there and everywhere, and am getting quite into
an ether practice. Good morning, doctor ! " Eather
peculiar! said the doctor to himself; rather peculiar,
certainly ! for this man has not the remotest
physiological idea. An " ether practice ! If he can
get an ether practice, perchance some scraps of the
same thing might fall to a scientific unfortunate."
Consequently, with his improved inhaler, Dr. Snow lost
no time in asking to be allowed to administer ether
to the out-patients at St. George's Hospital, in cases
of tooth-drawing. Dr. Fuller, of Manchester Square,
standing by, was surprised to see with what happy
effects ether was administered when administered
properly. A day or two afterwards, a major operation
having to be performed, and the surgeon, Mr. Cutler,
not approving of the ether in the way in which it had
previously acted, Dr. Fuller remarked on the superiority
of Dr. Snow's mode of administering it ; and the result
was, that he was asked to give it on operating days.
He did so with great success. He administered it also
at University College with the same success. Liston,
then the leading operator, struck with the new man,
able as unaffected, took him by the hand ; and from
that time the ether practice in London came almost
exclusively to Dr. Snow.
The new field once open, it were impossible but that
he should cultivate it diligently. The Westminster
Medical Society was often favoured with his com-
munications and experiments on etherisation ; and in
VOL. iv. 20
282 JOHN SNOW, M.D.
the September of 1847 lie embodied, in his first work,
the whole of his experience up to that time. The
work was remarkable for the care with which it was
written, and the complete mastery of the subject which
it conveyed.
What had been a mere accidental discovery, I had
almost said a lucky adventure, was turned by the
touch of the master into a veritable science. The
book was beginning to be appreciated when the dis-
covery of the application of chloroform threw ether
into the shade, and the book with it.
Dr. Snow, though a man of great firmness when
once his mind was made up, was always ready for
new inquiry. Chloroform, therefore, was no sooner
brought before the profession by Dr. Simpson, than
he began to institute a series of independent researches,
and having satisfied himself personally as to the effects
and greater practicability of chloroform, he at once
commenced its use, and forgot sooner than most
others his predilections for ether. In 1848, he com-
menced a series of experimental papers on narcotic
vapours in the Medical Gazette, and continued them
until 1851, when the Medical Gazette ceased to exist
independently. The papers on narcotics, in accordance
with his other and earlier productions, were stamped
with the evidences of profound and careful research,
and still more careful deduction. I infer that they have
been more talked about than read, for few people seem
to be aware of the enlarged and original physiological
arguments which they contain. Chloroform and ether
are not alone discussed, but all narcotics. Narcotics
are not alone considered, but various of the great
functions of life. The records of a vast number and
variety of experiments are here related, and an amount
JOHN SNOW, M.D. 283
of information, original in kind, collected, which will
always remain as a memorable record in the history
of medical literature. But the great points in these
papers are those in which the author enters on the
physiological action of narcotics. Here appear the
generalisations and insights into the relations of allied
phenomena which mark the man of true power.
The year of the world's fair in London, 1851, may
be considered a fortunate one for Dr. Snow. His
affairs had taken a new turn, and the tide was fairly
in his favour. He had a positive holiday, physical
and mental. The harass of the professional struggle
was over, the world was opening its eyes to his intrinsic
merits ; old friends, brought to the grand show in town,
flocked around him, and all was well. He did but
little that was new this year, except to write a char-
acteristic letter to Lord Campbell, who was pushing on
a Bill in the House of Lords, called the "Prevention
of Offences Bill," in which a clause was introduced
to prevent, by severe punishment, any attempt that
might be made by any person to administer chloroform
or other stupifying drug for unlawful purposes. Dr.
Snow, believing that Lord Campbell was actuated in
introducing this clause by the fact of certain trials
having recently occurred for the offence of using
chloroform unlawfully, and being himself convinced
that, in two of the cases, one the case of a robbery
in Thrale Street, the other, of a robbery attempted
on London Bridge, the evidence against the prisoners,
of attempting to produce insensibility by chloroform,
was without any reason or possibility, he opposed the
afore-named clause in the Bill, on the ground that, if
it became law, numerous frivolous and false charges
would] be constantly brought up against innocent
284 JOHN SNOW, M.D.
people, or against guilty persons, but persons not
guilty of the special charge laid against them, that,
namely, of administering a volatile narcotic by inhala-
tion. Knowing that weakness of human nature which
leads a man, in the presence of all evidence, never
to admit intoxication as possible in his own proper
person, Dr. Snow felt that, in any case where an
intoxicated person had been robbed, such person might
allege that he had been made insensible by narcotic
vapour. The two cases specially noticed in his letter
admitted readily of such interpretation, and were
clearly not cases in which chloroform had been ad-
ministered. Lord Campbell, on the receipt of Dr.
Snow's letter, referred to it in very complimentary
terms in the Lords, but intimated that the reasoning
of the letter did not alter his determination.
In the year 1848 Dr. Snow, in the midst of his
other occupations, turned his thoughts to the questions
of the cause and propagation of cholera. He argued
in his own mind that the poison of cholera must be a
poison acting on the alimentary canal by being brought
into direct contact with the alimentary mucous
surface, and not by the inhalation of any effluvium.
In all known diseases, so he reasoned, in which the
blood is poisoned in the first instance, there are
developed certain general symptoms, such as rigors,
headache, and quickened pulse ; and these symptoms
all precede any local demonstration of disease. But
in cholera this rule is broken ; the symptoms are
primarily seated in the alimentary canal, and all the
after-symptoms of a general kind are the results of the
flux from the canal. His inference from this was, that
the poison of cholera is taken direct into the canal by
the mouth. This view led him to consider the media
JOHN SNOW, M.D. 285
through which the poison is conveyed, and the nature
of the poison itself. Several circumstances lent their
aid in referring him to water as the chief, though
not the only, medium, and to the excreted matters
from the patient already stricken with cholera, as the
poison. He first broached these ideas to Drs. G-arrod
and Parkes, early in 1848 ; but feeling that his data
were not sufficiently clear, he waited for several
months, and having in 1849 obtained more reliable
data, he published his views in extenso in a pamphlet,
entitled " The Mode of Communication of Cholera."
During subsequent years, but specially during the great
epidemic outbreak of the disease in London in 1854,
intent to follow out his grand idea, he went systema-
tically to his work. He laboured personally with
untiring zeal. No one but those who knew him
intimately can conceive how he laboured, at what cost,
and at what risk. Wherever cholera was visitant,
there was he in the midst. For the time he laid aside
as much as possible the emoluments of practice ; and
when even, by early rising and late taking rest, he
found that all that might be learned was not, from the
physical labour implied, within the grasp of one man,
he paid for qualified labour. The result of his
endeavours, in so far as scientific satisfaction is a
realisation, was truly realised, in the discovery of the
statistical fact, that of 286 fatal attacks of cholera, in
1854, occurring in the south districts of the metropolis,
where one water company, the Southwark and Vaux-
hall, supplied water charged with the London faecal
impurities, and another company, the Lambeth, sup-
plied a pure water, the proportion of fatal cases to each
10,000 houses was to the Southwark and Vauxhall
Company's water 71, to the Lambeth 5.
286 JOHN SNOW, M.D.
There was, however, another fact during this epi-
demic, which more than the rest drew attention to
Dr. Snow's labours and deductions. In the latter part
of August 1854, a terrific outbreak of cholera com-
menced in and about the neighbourhood of Broad
Street, Golden Square. Within two hundred and fifty
yards of the spot where Cambridge Street joins Broad
Street, there were upwards of five hundred fatal attacks
of cholera in ten days. To investigate this fearful
epidemic was at once the self-imposed task of Dr. Snow.
On the evening of Thursday, September 7th, the
vestrymen of St. James's were sitting in solemn
consultation on the causes of the visitation. They
might well be solemn, for such a panic possibly never
existed in London since the days of the great plague.
People fled from their homes as from instant death,
leaving behind them, in their haste, all which before
they valued most. While, then, the vestrymen were
in solemn deliberation, they were called to consider
a new suggestion. A stranger had asked, in modest
speech, for a brief hearing. Dr. Snow, the stranger in
question, was admitted, and in few words explained
his view of the "head and front of the offending."
He had fixed his attention on the Broad Street pump
as the source and centre of the calamity. He advised
the removal of the pump-handle as the grand pre-
scription. The vestry was incredulous, but had the
good sense to carry out the advice. The pump-handle
was removed, and the plague was stayed. It was my
privilege, during the life of Dr. Snow, to stand on his
side. It is now my duty, as a biographer who feels
that his work will not be lost, to claim for him not
only the entire originality of the theory of the com-
munication of cholera by the direct introduction of
JOHN SNOW, M.D. 287
the excreted cholera poison into the alimentary system ;
but, independently of that theory, the entire originality
of the discovery of a connection between impure water
supply and choleraic disease. The whole of his in-
quiries in regard to cholera were published in 1855,
in the second edition of his work on the " Mode of
Communication of Cholera " a work in the prepara-
tion and publication of which he spent more than
j200 in hard cash, and realised in return scarcely so
many shillings.
In 1856, he made a visit to Paris in company with
his uncle, Mr. Empson, who having personally known
the emperor many years, had on this occasion special
imperial favours shown to him, in which the nephew
participated. During the visit Dr. Snow lodged a copy
of his work on Cholera at the "Institute," in compe-
tition for the prize of 1,200 offered for the discovery of
a means for preventing or curing the disease. The
decision of the judges has since been published, but
with no notice of Dr. Snow's researches.
The Medical Society of London, reformed under that
name in 1849-50, by amalgamation with the West-
minster Medical, was at this time the principal scene
of Dr. Snow's scientific exertions. In 1852, the
Society elected him as Orator for the ensuing year ;
and at the eightieth anniversary of the Society, held
on March 8th, at the Thatched House Tavern, he
delivered an admirable oration on " Continuous Mole-
cular Changes, more particularly in their Eelation to
Epidemic Diseases." He made no claim to the
orator's gown ; but the address was too forcible not to
call forth the enthusiasm of the audience. He spent
nearly twelve months in the preparation of this
oration, in which he endeavoured to convey, in the most
288 JOHN SNOW, M.D.
pleasing manner at his command, a broad view of his
observations on the communication of certain spreading
diseases. He advanced, on this occasion, the idea that
the poison of intermittent fever, and perhaps yellow
fever, is carried direct, like the poison of cholera, into
the alimentary system.
Two years after this event, having, meantime, passed
the office of vice-president, the Society elected him to
the highest honour it can confer, to the presidential
chair. He took his place as President, in his un-
assuming manner, on March 10th, 1855, delivering a
short address. Throughout the year he carried out the
duties of his office with great success. One of his
presidential acts was peculiarly graceful. One evening,
while presiding, Dr. Clutterbuck then the father, or
oldest member of the Society came into the meeting
The venerable and distinguished old man, then long
past his eightieth year, had lately been a stranger to
the assembly, and was known but to few of the
members. The President, as Dr. Clutterbuck entered
the room, rose, and in a way that was irresistible in
its simple courtesy resigned his chair to the veteran
Esculapian. "It is near fifty years," said Dr.
Clutterbuck with emotion, as he took the proffered
seat, "since I last occupied this honourable position."
At the next anniversary meeting, held on March 8th,
1856, Dr. Clutterbuck came to his last meeting, and to
see his friend the President play also his last part in
presidential duties. At the anniversary dinner on that
same day, the President reviewed, in feeling terms, his
own career in the professional strife, and expressed that
his success in life had originated, in his acquaintance
with the Society.
In addition to the fellowship of the Medical Society,
JOHN SNOW, M.D. 289
Dr. Snow belonged to the Eoyal Medical and Chirurgical,
Pathological, and Epidemiological societies, and to the
British Medical Association. The Medical Society,
from its old associations, was, however, that in which
he took the most active part. Next to this, the
Epidemiological Society, founded by the late Mr.
Tucker, of Berners Street, claimed his regard.
The position which he took as an epidemiologist
was original, and in opposition to the views of many
eminent men who had, in matters relating to public
health, considerable scientific and political influence.
He contended, in regard to true epidemic disorders,
distinguished by specific symptoms, that they are due
to a specific poison, which is propagated by certain
fixed laws ; which attains its progression and increase
in and through animal bodies ; which is communicated
from one animal body to another ; and, which is the
same in its essence from first to last. This was his
position, and he adhered to it. No mere emanation
arising from evolution of foul smelling gases can, per
se, according to his views, originate a specific disease,
such as small-pox or scarlet fever ; as well expect that
the evolution of such gases should plant a plain with
oaks or a garden with crocuses. The small-pox may
occur over a cesspool as an oak may spring up through
a manure heap ; but the small-pox would never appear
over the cesspool in the absence of its specific poison ;
nor the oak rise from the manure heap in the absence
of the acorn which seeded it.
In 1855 Dr. Snow gave evidence before the select
committee on the " Public Health and Nuisances Ee-
moval Bill," in which evidence he strove to convey the
impressions condensed above. Feeling that he had not
been correctly understood, he afterwards wrote a letter
290 JOHN SNOW, M.D.
to Sir Benjamin Hall, in which he set forth the whole
of his argument very distinctly and sensibly. He
indicated in this letter that he was no defender of
nuisances, but that whereas a bad smell cannot, simply
because it is a bad smell, give rise to specific disease,
so an offensive business conducted in a place where it
ought not be, should be proceeded against by ordinary
law as a nuisance, without applying to it the word
pestiferous, or otherwise dragging in and distorting the
science of medicine.
In relation to public health Dr. Snow contributed
many other observations. In the first number of my
Journal of Public Health and Sanitary Review, he
communicated a valuable paper, previously read at the
Epidemiological Society, on the " Comparative Mor-
tality of Town and Rural Districts ; " and, previous to
his decease, he was busily occupied in investigating
the question of adulteration of bread with alum. He
made several analyses of different specimens of bread,
but his papers merely leave a brief record of the fact,
without any comments or results.
I return for a few moments to some further points
connected with his researches on inhalation. In
addition to his experiments with volatile narcotics,
he carried out for a long time a series of inquiries with
other medicinal substances, and administered many
remedies by inhalation at the Brompton Hospital,
during a period of twenty months. In 1851, he re-
corded the result of this experience at the Medical
Society of London, and explained the modes of ad-
ministering various agents. Some, as morphia and
stramonium, were inhaled with the aid of heat ; others,
as hydrocyanic acid and conia, were inhaled at the
ordinary temperature. The particulars of these ex-
JOHN SNOW, M.D. . 291
periments will be found in a short paper in the London
Journal of Medicine for January 1851.
He continued steadily to investigate the effects of
various volatile agents for the production of insensi-
bility, performing a variety of experiments with
carbonic acid, carbonic oxide, cyanogen, hydrocyanic
.acid, Dutch liquid, ammonia, nitrogen, amylovinic
ether, puff-ball smoke, allyle, cyanide of ethyle,
chloride of amyl, a carbo-hydrogen from Eangoon tar,
a carbo-hydrogen coming over with amylene, and
various combinations of these. His grand search was
for a narcotic vapour which, having the physical
properties and practicability of chloroform, should, in
its physiological effects, resemble ether in not pro-
ducing paralysis of the heart.
First he ascertained the boiling-point of the sub-
stance under investigation ; then the point of
saturation of air with the vapour at different tempera-
tures ; next the effects of inhalation of the vapour by
inferior animals ; and finally the quantity required
to be inspired, with the air breathed, to produce in-
sensibility. When he had obtained any substance
which would produce insensibility favourably on ani-
mals, he pushed it, in one or two experiments, to its
extreme in animals of different kinds. Then having
produced death by the inhalation, both by giving
rapidly a large dose, and by giving a small dose for
a long period, he observed the mode of death, whether
it occurred primarily by cessation of the heart, or by
cessation of the respiration. If the agent seemed to
promise favourably from these inquiries, he commenced
to try it on man ; and the first man was invariably
his own self. His friends, knowing his unflinching
courage in the ardour of his inquiries, often expostu-
292 JOHN SNOW, M.D.
lated with him in regard to the risks he ran. It was
of no avail. He felt the personal trial a duty, and he
did it. I do not believe, as some have supposed, that
these personal experiments had any effect in producing
his early death ; but it is certain that he underwent
many risks in the performance of his investigations,
and that he held his own life of least value when
the lives of others were under consideration.
There is yet another trait .in his character which I
canDot but notice, and which I would respectfully
commend to all physiological inquirers. While he
held it as a necessity to use inferior animals for the
purpose of experiment, he never touched living thing
with the physiologist's finger without having before
him some definite object ; and never performed experi-
ment on any animal without providing with scrupulous
care against the infliction of all unnecessary suffering.
The interests of humanity were, he thought, best
advanced by the universal practice of humanity.
By his earnest labours Dr. Snow soon acquired a
professional reputation, in relation to his knowledge
of the action of anaesthetics, which spread far and
wide, and the people, through the profession, looked
up to him from all ranks, as the guide to whom to
entrust themselves in ''Lethe's walk." On April 7th,
1853, he administered chloroform to Her Majesty at
the birth of the Prince Leopold. A note in his diary
records the event. The inhalation lasted fifty-three
minutes. The chloroform was given on a handker-
chief, in fifteen minim doses ; and the Queen expressed
herself as greatly relieved by the administration. He
had previously been consulted on the occasion of the
birth of Prince Arthur, in 1850, but had not been
called in to render his services. Previous to the birth
JOHN SNOW, M.D.' 293
of Prince Leopold he had been honoured with an
interview with His Eoyal Highness the Prince Albert,
and returned much pleased with the Prince's kindness
and great intelligence on the scientific points which
had formed the subject of their conversation. On
April 14th, 1857, another note in the diary records the
fact of the second administration of chloroform to Her
Majesty, at the birth of the Princess Beatrice. The
chloroform again exerted its beneficent influence,
and the Queen once more expressed her satisfaction.
Inquisitive folk often overburthened Snow, after
these events, with a multitude of questions of an un-
meaning kind. He answered them all with good-
natured reserve. "Her Majesty is a model patient,"
was his usual reply : a reply which, he once told me,
seemed to answer every purpose, and was very true.
One lady of an inquiring mind, to whom he was ad-
ministering chloroform, got very loquacious during the
period of excitement, and declared she would inhale
no more of the vapour unless she were told what the
Queen said, word for word, when she was taking it.
" Her Majesty," replied the dry doctor, " asked no ques-
tions until she had breathed very much longer than
you have ; and if you will only go on in loyal imitation,
I will tell you everything." The patient could not but
follow the example held out to her. In a few seconds
she forgot all about Queen, Lords, and Commons ; and
when the time came for a renewal of hostilities, found
that her clever witness had gone home, leaving her
with the thirst for knowledge still on her tongue.
From the literary and medical history of Dr. Snow,
let me turn for a few pages to his history personal as I
knew him. He was of middle height, of somewhat
slender build, and of sedate expression. His long life
294 JOHN SNOW, M.D.
in comparative student loneliness had made him
reserved in manner to strangers ; but with private
friends he was always open, and of sweet companion-
ship. With his increased popularity he became less
reserved to strangers, and in the last years of his life
he so far threw off restraint as to visit the opera
occasionally. But he moderated every enjoyment, and
let nothing personal stand in the way of his scientific
pursuits. He was the impersonation of order. He
had his time and place for everything. He kept a
diary, in which he recorded the particulars of every
case in which he administered chloroform or other
anaesthetic, with comments on the results of the
administration, and hints as to dangers avoided or
chanced. He kept a record of all his experiments
and short notes of observations made by his friends.
He rose early, and retired early to rest, at eleven
o'clock. He seemed, whenever he was waited on, as
though he had nothing in hand, and was always open
to an engagement.
Anything and everything of scientific interest that
arrested his attention aroused his enthusiasm and
his desire to be of use. When I was living at Mort-
lake, he would run down, on request, after his day's
duties were over, to a post-mortem, to see a poor
patient, or to take part in an experiment, returning as
cheerily as though he had received the heaviest fee.
This is but one example of his kindly nature.
He laid no claim to eloquence, nor had he that gift.
A peculiar huskiness of voice, indeed, rendered first
hearings from him painful ; but this was soon felt less
on acquaintance, and the ear once accustomed to the
peculiarity, the mind was quickly interested in the
matter of his discourse, for he always spoke earnestly,
JOHN SNOW, M.D. 295
clearly, and to the point. In the Societies he spoke
very often, and gave expression to views, on which he
had spent great thought, with a generous freedom
which, in so far as the fame of his originality was
concerned, had been better held in reserve. It had
been better, that is to say, for him to have carefully
elaborated some of his views in the closet, and
published them fully, than to have sent them forth in
the hurry of debate. Had he lived, he would possibly
have collected many stray labours thus put forward,
and have given to them the matured consideration
which they deserved. One of his views, on which he
would have bestowed great attention, refers to the
origin of various morbid growths, such as cancer. He
believed that these morbid formations are all of local
origin ; that they arise in the parts of the body where
they are found, from some perversion of nutrition ;
and that the constitutional effects are secondary to, and
dependent on, the local disorder. He made many
observations on this important subject, notices of
which are to be found scattered, here and there, in the
proceedings of the Medical Society of London, but no
connected record was ever completed.
His private conversation was both instructive and
amusing ; he was full of humorous anecdotes, which
he told in a quiet and irresistibly droll style.
His replies, when under the fire of cross-question, were
ready and common- sense. Once, as we have already
told, he observed that sulphuric ether is safer than
chloroform. " Why, then," said a listener, " do you not
use ether ? " "I use chloroform," he resumed, " for the
same reason that you use phosphorus matches instead of
the tinder box. An occasional risk never stands in the
way of ready applicability." On another occasion, after
296 JOHN SNOW, M.D.
one of the meetings of the " Medical Society," 
