Compiled by R. LUDLAM, M. D., Secretary.

XX. Compression of the brain. DR. G. E. SHIPMAN presented notes of this case, which read as follows:

Dee. 24th, '58., I was called about 4 P. M., to see Mrs. P-, a lady about 62 years of age, who had been suffering for 27 years or thereabouts, with frequently recurring attacks of pain in the stomach-cramp-like pain, attended with vomiting, and passing off in two or three days. These attacks had been much lighter for the past month. Some six or seven years ago, when living in Maine, her stomach was relieved, but she suffered from some affection of the brain for five months, which was finally cured by taking Croton Oil which reproduced the trouble in the stomach.

At the time above noted she was talking with the family, apparently in as good health as ever, but suddenly ceased conversing in the midst of a sentence. Her daughter looking up in a moment saw her left cheek reddened and the left eye blood-shot, and soon observed that the old lady was totally unconscious- could neither see nor speak. She was got upon the sofa directly, some slight convulsions of the jaw ensued, and soon after she vomited up her dinner, which had not been more hearty than usual. I saw her within thirty minutes of the attack: she was then lying on her back quite unconscious, breathing stertorous, face flushed and swollen, pupils insensible and somewhat dilated, pulse a little quickened but soft and regular; a spoon was still between her teeth to prevent her biting her tongue. I was misled by the account given me, and thought I had a case of temporary congestion of the brain, from over-eating or some other cause, and gave her at first strong Coffee every few moments, then Camphor and water; but after watching her for several hours and enquiring more particularly into the case, I concluded it to be a more serious one. She was put upon Bell, and Opium. In the morning she was about the same, but showed slight and doubtful signs of consciousness, breathing was more regular and without stertor, with occasional flashes of febrile excitement, pulse 120, respiration about 30.

This stats of things continued with but little change for three or four days and nights, during which time the remedies used were mainly Bell, and Opium with Aconite occasionally. Her lingering so long without growing apparently worse, led her friends and myself to cherish a hope that something might yet be done. Drs. Small and Boardman were called in about the third day. Sinapisms between the shoulders and upon the legs were tried, injections containing Croton Oil, and finally Croton Oil by the mouth three drops every six hours, but without avail. During the last thirty-six hours of her life her pulse and respiration became gradually more rapid, but the pulse did not become any weaker until Wednesday P. M.-the fifth day. Her respiration at this time was 42-44, and the pulse about 180 to 140. She gradually sunk away and died at nine P. M.

Post-Mortem Appearances. -Twenty-four hours after death we examined the body. The right side of the brain seemed healthy although the meningeal vessels were distended, as were also those distributed through the substances of the brain, as shown by minute red spots wherever a section of the brain was made. In the left hemisphere a clot was found as large at a hen's egg distending and lacerating the ventricle. There was evident congestion of the vessels of the spinal cord as the blood continued to discharge from them as long as the bead was allowed to hang down.

The stomach was also examined. The integuments of the abdomen were well provided with fat, there being a layer of nearly half an inch in thickness. The stomach was smaller than natural and showed signs of inflammation of a sub-acute character; some softening of the villous coat was also observed.

I should have stated before, that the right aide was partially paralysed, toward the close perhaps entirely so, while the left side was by turns quite sensitive.

XXI. DR. S. SEYMOUR made a verbal report of a case analogous to the foregoing.

A lady had been for many years subject to an excruciating headache, with a boring, digging pain in the left side of the head. The paroxysms became frequent, and would then subside for a week or so. This ran on for five or six years. For the last two or three weeks of her life, however, it was almost continuous. Finally she experienced a paralysis of the left side, and some time after died. Post-Mortem examination revealed a projection of bone, about the centre of the left parietal bone, of the size of half a hen's egg, though a little more conical in shape. The brain, save in the immediate neighborhood, was perfectly healthy; the external conformation of the skull quite natural. We never could discover, nor could she recollect that she had ever sustained an injury from a blow or anything of that sort. Both the lesion and the hemiplegia were upon the left side. At her death this patient was fifty years of age. Being an allopathist at that time, I administered the various anodynes, but these at last lost their effect, and I could really do nothing for her. It was of course quite impossible to make out a correct diagnosis ante mortem.

XXII. Specifics. By J. L. KELLOGG, M. D.

In considering the subject of Specifics I shall at the outset admit the existence and potency of some general laws, as expansion by heat, attraction of gravitation, etc., in general physics; and of the law represented by “Similia Similibus Curantur,” pertaining as generally to the medicinal action of drugs -indicating the specific remedy for disease as the plummet indicates the direction toward the centre of the earth, or the compass the position of the poles. These great principles of Nature exert a modifying influence upon all bodies, but are in themselves inadequate to produce or elucidate the innumerable forms of being and phenomena of Nature by which we are surrounded. To attempt the solution of the problem of the universe solely by the agency of these general principles, I think will be found quite irrational as we proceed.

This tendency to generalization in Medicine, has led men quite eminent in the profession to teach the dogma that, to successfully combat “all diseases which flesh is heir to,” the physician requires only Calomel Opium, Antimony and the lancet-directed in their use by what are termed the “general principles of Medicine.” To combat in some degree this heroic and baneful error, which pervades the mind of the profession to an unwarrantable extent, I offer for your reflection the following considerations:

When we attempt from the point of causation to conceive the origin and mode of existence of the beings and substances by which we are surrounded, the mind can only save itself from chaotic stultification by assuming the existence and energy of Specific forces. The truth of this assumption is clearly demonstrated when we start from the opposite end of the series and proceed analytically from effect to cause.

Let us look for a moment at the globe we inhabit. The law of attraction of cohesion holds its primitive particles in close proximity, and thus are formed the central nuclei of all substances. Add to this the law of gravitation, and the lesser bodies are merged in the greater, and retained in situ. This, being a general law, extends its potency to distant planets and systems, and the knowledge of it becomes a golden key by which are unlocked many of the stupendous mysteries of the Universe. In penetrating the globe, we find formations and depositions arranged in definite order, always holding specific relations to each other, insomuch that, certain formations being given an adept in Geology, other formations may be described by him, and their relative ositions indicated. In chemical combinations the same evidence of a specific law is found to exist. Atom unites with atom according to a definite law of its nature. And in obedience to these laws of combination, all mineral compounds exist-from the scintillating diamond which sparkles and glows a thing of light, to the dull clay which we thoughtlessly trample beneath our feet. It has been ascertained by Chemistry, even in its present imperfect state of development, that all substances which make up the sum of the world may be reduced to a catalogue of about sixty in number. From these simples are produced, by specific laws peculiar to each, this wondrous world of diverse forms and almost infinite qualities.

Keep the mind fixed upon the astonishing and fundamental fact, that all we behold of physical existence is the result of various combinations of (in round numbers) some half a hundred simple substances, and we will proceed to glance cursorily at some few of the facts pertaining to vegetable existence. Imagine, with me, these half hundred simples to be contained in one grand reservoir, awaiting the mandate of Specific law, and note the wondrous issues and the bearings they have upon the question under consideration. By virtue of a specific force contained within its germ, the Aloe draws or develops from these original elements the intensest bitter. From the same source the Sugar cane, by the law of its existence, elaborates its saccharine qualities. Also from the same source springs forth the majestic oak-at whose base we behold in wondrous contrast the tiniest shrub. By what reason but Specific law can we account for the vast difference existing between the magnitude of their proportions and the qualities of their composition?

Let us pass to the consideration of some illustrations of this law afforded by the floral kingdom. What human mind could have conceived the varieties which Nature presents to our view! In form, how unique and graceful; in color, how distinct and brilliant in some varieties, in others how exquisitely shaded and blended are their magnificent hues, and in others still how distinctly diversified! And most wonderful of all, how definitely true is each to the specific law of its organization. Side by side stand the thistle and the rose-the nasturtion and the sweet-pea-thh honeysuckle and the trumpet-flower- by proximity frequently intertwining their blossoms, but still, in obedience to the specific law of their existence, each maintaining with the integrity of truth, its own individuality.

These remarks apply to fruits as well as to flowers. Everywhere among them also, we shall find the evidence of a specific law, no less distinctly manifest-definite, unvarying forms, characteristic colors, diversified odors and flavors, with each variety so distinct as to be readily described, and so invariable in its individuality as not to be mistaken for another. But for the existence of such specific laws, applied to the products of the Vegetable kingdom, the beautiful Science of Botany could not be known or studied. * * * * * Next we have an application of the argument to the forms and features of animal existence. The Dr. says:-

And here, notwithstanding the perfect distinctness of varieties, both in the Vegetable and Animal kingdoms, still the two approach each other so gradually that it is as difficult for the senses to determine the exact confines of each, as for the eye to determine at the close of the day the precise moment when light ceases and darkness obtains dominion over the fading beauties of the evening landscape. But, be it the sponge or any other substance that forms the wondrous link, one thing is certain-it yields distinct obedience to the law of its nature, by that law becoming definitely the creature it is, drawing in accordance therewith from the common reservoir of simples the covering or habitation of its essential force, and through the medium of that external covering, manifesting to our senses the outlines of its character. Once entered upon the domain of the animal kingdom, our attention is as distinctly challenged to specific modes of existence as when surveying the vegetable forms of life. For a moment go back into the dim distance of the earliest era of animal life-pierce through the crusts of the globe until you descend to the fossil remains of its pioneers, and you will find, from the stellar-formed being upward, evidence of the action of undeviating specific forces, moulding from the reservoir of original simples each in accordance with its peculiar lair, a saurin or a shell-fish, and these so various yet so distinct, as to form the basis of many of the Natural Sciences. In short, everywhere, in every species of vegetable and animal, are found these distinctive marks of Specific law. By them the comparative anatomist will tell you by a single bone from what animal it came. And these qualities are so definite that should we carefully note them, the individuals of any species might be identified. The shepherd learns to know the individual members of his flock and will recognize an estray coming into, or lost from his fold; the dog will select from the common highway the peculiar quality retained in his master's track and reach him by this means alone, though every other indication of the course he had taken be blotted out. Ornithology presents us with some most pleasing illustrations of these laws, but we may not pause to quote them. Let it suffice then, so far as the general consideration of the subject is concerned, to remark that without the existence of such laws, there would and could be no science of Natural History, since the history of these invariable specific qualities forms the sum total of the ponderous volumes which make up that department of literature

We pass therefore to the consideration of specific forces as they exist in man, for the cure of whose maladies our profession was instituted. The most palpable object which meets our senses is his body, which like all other tangible things, is composed from the half hundred original simples drawn together by internal specific forces. These occult forces by virtue of their specific powers, each forming their peculiar organs, and appropriating to each organ its specific function; these grouped and brought into harmonious action by a force peculiar to the ganglionic system of nerves, constitute this vast assemblage of forces, this being which we denominate man.

Osteology with all its detail of processes, foramina and articulations, distinctly reveals the operation of specific law, by whose power the proper elementary particles were arranged in the bony frame-work with such definite regard to the purposes they were designed to subserve. About and within this skeleton are arranged the various organs of the economy, by whose specific actions the functions of the organism are performed. Every organ has its function:-the Brain, or portions it, to elaborate or manifest thought:-the nerves of animal life to communicate intelligence from the external world to this secluded seat of mind, and thence returning to convey to subordinate organs the mandates of the imperial will. Through these avenues of communication, each organ of sense becomes informer to the grand sensorium of what exists and transpires, within the laws of its limitations, in the universe without Thus the organs of the sense of sight convey to the mind a large amount of knowledge within certain boundaries and under certain conditions. But beyond its scope in all directions lie immense fields glowing with wonders, and which, unaided, it cannot explore. Immense magnitudes it cannot compass, minute substances though teeming with life and beauty and perfection of organization, or hideous and ferocious in their forms and instincts, become cognizable only when the subtle energies of the brain have placed between this organ and these minute objects the wonder-moving microscope. Great velocity-intense light-deep darkness-very close proximity or great remoteness, with many other circumstances define limits of its power. * * * * * * *

The sense of hearing has an organ also for its specific purpose; and so of all the special senses. Their functions are definite, specific, comprehensive, and yet subject to limitation So it is with the whole digestive and assimilative apparatus, whose function as a unit, is to change foreign and crude substances into its own vitalized organism, to build up and repair its physical structure and to maintain its perfect integrity. The whole physiology of life is a commentary on Specific law. * * * * * * * *

Let us now consider that condition of the organism which our profession is more appropriately related-its pathological condition. Having seen that each organ is peculiar in structure and definite in function, performing its operation through the action of stimulants proper to itself, is it not reasonable to suppose that disturbing causes would be such as have a peculiar relation and natural determination of such organ? Leaving out of account for a moment the action of the Sympathetic system of nerves, I think we can arrive at no other conclusion than that each organ must become diseased by itself, though it may be synchronously with other organs, by some force having definite relations to each organ so disturbed. If now we link these various organs together by means of the ganglionic nerves, it must be apparent that general disturbance must ensue throughout the organism as inevitably as harmony was established through the same agency,while each organ maintained the integrity of its individual action. It is admitted that some general causes as sudden and great changes of temperature, may disturb to a greater or less degree every organ of the economy. But it may well be doubted if these general influences are sufficient to establish a pathological condition of the organism while each organ is left free from the action of disturbing forces having direct relation to such organ. The harmonious antagonism of the different organs will be found sufficient to establish an equilibrium or health, unless as in case of excessive cold, or intense heat, or excessive electrical changes, the powers which resist death are blotted out.

Wherever, therefore, we find permanent and continued indisposition, we should seek the cause of that indisposition in some disturbing force, having a definite relation to one or more of the constitutional organs of the system; or in those semi-organic rudiments, the fluids, which must be recognized as such in passing from simple alimentary substances into the tissues of the various organs themselves. There is no instant in which we can conceive them changed from the one to the other condition. That these fluids may be specifically diseased originally there can be but little doubt. Miasms of various kinds reach them through the organs of respiration; and still more directly affect them by inoculation. And here, as elsewhere, we find specific causes producing definite results. * * * * * * * * * * *

The common opinion has been that cases of disease were general agencies acting upon the organism, and that the varieties observed in diseases were the results of accidental conditions existing in different individuals subjected to these general influences-producing in one person Croup, in another Cholera Morbus etc. Indeed it is more than suspected that for centuries the Small Pox itself was considered a disease resulting from general causes-and to be treated upon general principles.

No physician who has practiced his profession long and observingly can have failed to notice that diseases are generally gregarious. If we have one case of Membraneous Croup, we soon have, or hear of, others in the same vicinity. At one time every exposure to cold is followed by an Influenza, and during these periods many will have the Influenza who are confident they have not been exposed to any chill. Again, sore-throats prevail; or dysentery, acute or chronic; or at irregular intervals Typhus fever sweeps over the country a general pestilence, while again, years may transpire without a single case of it; or Intermittents, Yellow fever, Scarlatina, Pertussis, Erysipelas, etc., etc. Some of these diseases are known to be the result of a specific force, as we are able to produce them at will. Others are admitted to be the result of specific miasma, though we are wholly unable to detect the presence of the virus in the atmosphere, and only become conscious of its existence by the diseases which follow in its train-as intermittents, cholera, yellow fever, etc.

From these facts we learn that all diseases, whose causes are definitely known are the results of Specific forces acting upon the organism in accordance with the laws of their own existence,.producing morbid impressions peculiar to themselves. Is it not hence more reasonable to infer that those diseases of whose causes we are not informed are also the result of specific forces peculiar to each, (?) than to suppose, in opposition to the general course of Nature, that they result from accidental and incongruous agencies?

The erroneousness of a position is many times best illustrated by the absurdity of its results. Let us enquire into the results which have followed from the assumption of general causes of disease, and general principles, as they are termed, in the application of remedies to their cure. The central root of this mode of reasoning in pathology-seems to start from the seminal idea of the ancients, that all disease was a vague something of general diffusion in crude condition pervading the system which must by some means be concocted or cooked and then expelled by a natural crisis or some medicinal evacuant.

From the days of Hippocrates, with slight alterations, the profession has been engaged by general laws in cocting these morbific agents, and afterward by irritants exciting the various emunctory organs of the body, hoping by these discharges to purge the system of its impurities. But, say these early philosophers, it may happen that coction could not be effected, or only imperfectly. In such cases we must again recur to our general principles, and excite the general forces of the system Hill either the patient dies, or we are enabled to expel the morbific matter. In view of the history of Medicine and its results, we find among the most experienced and erudite of the profession, individuals who unhesitatingly declare that Medicine as thus practiced, has cursed as many as it has cured. Indeed statistics prove the expectant plan more successful than the enlightened generalizations of those who are treading with conservative zeal and unvarying “regularity” in the faintly expressed footsteps of their “ illustrious predecessors.” * * * * * *

These positions are well taken by Dr. K., and sustained by ample illustration of the published opinions of some of the most eminent names in the profession-Bichat, Broussais, Bouillaud, M. Louis and others. We may not quote them at length, but append the application.

Such being the result of the observations and experiments of the most gifted and learned of the profession, can any unbiased mind of common capacity fail to perceive that it were better for mankind to “throw physic to the dogs,” and leave Nature's recuperative powers unmolested to re-establish harmony among its disturbed organs? Or, in view of these disastrous results flowing from the attempt to follow as an established principle, the mere hypothesis that disease and remedies are general and not specific in their nature and action- does it not seem that nothing else than blind routinism, or over-weening self-conceit could lead one farther to pursue this ignus fatuus of the brain along the blood-stained paths so fruitlessly trodden through many centuries, by men whose discernment we well may envy, and whose eminence we can never hope to attain? In vain has the alchemist sought a law by which to transmute the baser metals into gold-the mechanic to construct a machine capable of self-sustaining, perpetual motion; and the physician to discover a general law of Therapeutics, applicable alike to all tissues and localities, operating simultaneously upon all organs, however various in structure or diseased in function. The reason of failure is the same in each case. All are alike attempting to force Nature to abandon the Creator's laws and yield herself to the control of the vagaries of a disordered imagination. If it be true that specific laws produce each organ and control its function, and that specific causes produce derangements of the various functions, does it not become self-evident that specific remedies, having natural relations to the organs affected, must be the appropriate means of restoring normal action?

A system of Medicine, to be in harmony with what we know of the nature of things, must be specific in its operations; and the fact that we are yet incapable of discerning the causes and fine distinctions existing in the aberrant action called disease-or of discerning the nicer pathogenetic action of remedies does not absolve us from the duty to seek on-much less does it annihilate the existence of an eternal principle of Nature.

Let us pursue this subject a little farther, as illustrated by Allopathic writings In their Materia Medica we find a partial acknowledgement of the special specific action and determination of medicines, in the arrangement of drugs into classes, as Emetics, Cathartics, Tonics. Diuretics, Alteratives, etc. This principle is further admitted in the sub-divisions of each class, theoretically and still more practically made, when all judicious practitioners point out Antimony as the Emetic for one case, Ipecac., for a different one, or for others Sulphate of Zinc or Mustard Seed.

Some Cathartics are said to act specifically upon the exhalents, as hydragogues; some upon the liver and the salivary glands, and some upon the rectum. And so on through all the classes of the Materia Medica. The distinctions certainly point to the specific determinations and actions of these remedies.

In that class of remedies termed Alteratives we shall find included by the practice of the profession (if not so stated in the books) nearly all the articles included in the Materia Medica. These remedies are defined to be “those medicines which are given with a view to re-establish the healthy functions of the Animal economy, without producing any sensible evacuation.” In this class upon what hypothesis, except that of specific action, can an intelligent physician select his remedies for administration? What would lead him to prefer Ipecac., to Antimony in Dyspepsia; for Piles, Sulphur instead of Gamboge; or for affections of the liver, Mercury rather than Magnesia? In short, is it not apparent that while stoutly decrying the specific use of medicines, yet the great difference in skill exhibited among physicians, results mainly from the different degrees of knowledge they possess respectively of the various local determinations and peculiar actions of medicines?

If we consult that portion of our medical Journals devoted to “Practical Medicine” we shall find but little said of General Principles. The great mass of their contents will be found to be made up of accounts of particular remedies which have proven successful in particular cases.*[Vide Braithwaite's Retrospect, or Ranking's Half Yearly Abstract, etc]

Further on the Dr. remarks:

I can construe the use of the multiplicity of remedies, each successful in one case, and each futile in others, into nothing less than incontestible evidence that diseases of the same nosological class may and do depend upon distinct specific causes, and require for their cure different remedies having specific relations to each. And I must consider this department of the Allopathic literature as nothing more nor less than a catalogue of specific remedies discovered by accident or experiment, authoritatively published by the Journals, and “regularly” and empirically practiced by the profession.

Admitting the doctrine of Specifics to be established, I am aware that it presents before the profession an extensive and intricate, labyrinthine way to be traversed. But we should not be discouraged in our investigations by the seeming impossibility of their successful issue. * * * * One fact should inspire us with courage and hope-that ideas are immortal, that though our bodies die, our truthful thoughts are indestructible and cumulative, that succeeding minds will take up the investigation and start from the result of our life-long researches. * * * * * * * * *

In view of the achievements already made in the collateral Sciences, who will be so brave a coward as to talk of the impossibility of success in the direction which we point? I am aware that Medicine is not ranked among the Exact Sciences. The same, and with equal propriety, might have been affirmed of Astronomy when its professors were Astrologers. But such assertions in either case have no effect upon the Natural laws pertaining to these subjects. Whenever the laws of Nature have been comprehended, their action has been found to be specific and unchanging, and doubtless will be found equally so in Medicine. Indeed any other view would remand one subject of Creative wisdom back to the original abyss of chaos.

---