the interest and claim the attention of our readers, and, through them, of the profession generally.

It would be presumptuous in us, in the present stage of the question, to attempt to give even a formal Outline or Sketch of the Reform in Practical Therapeutics which appears so necessary, and which we believe to be impending. This is a work which can only be the result of mature reflection, and of the labour of many years and many hands. All which we can think of attempting at present, is to set down, almost at random, a few of the various considerations that press upon us, touching the many things to be thought of and done, the manifold evils to be abated, the manifold benefits to be achieved, by the enthusiastic and active spirits whom we have heretofore sportively personified under the name of "YOUNG PHYSIC," and to whom we look with confidence for the consummation of the great REFORMATION which assuredly will come.

In submitting these suggestions to criticism, we would request, that their extemporaneous and undigested character be borne in mind. All of them, we believe, to be true and just; many of them of high importance; and although more mature reflection may prove some of them, at least, to be neither the one nor the other, we shall, nevertheless, not regret having written them. They may excite others to consider this momentous subject, and thus elicit from better minds, thoughts worthier of remembrance and fruitful of greater things.

COGITANDA-EXCOGITANDA-AGENDA.

1. To endeavour to ascertain, much more precisely than has been done hitherto, the natural course and event of diseases, when uninterrupted by artificial interference; in other words, to attempt to establish a true Natural History of human diseases.

2. To reconsider and study afresh the physiological and curative effects of all our therapeutic agents, with a view to obtain more positive results than we now possess.

3. To endeavour to establish, as far as is practicable, what diseases are curable and what are not; what are capable of receiving benefit from medical treatment and what are not; what treatment is the best, the safest, the most agreeable; when it is proper to administer medicine, and when to refrain from administering it; &c. &c.

4. To endeavour to introduce a more philosophical and accurate view of the relations of remedies to the animal economy and to diseases, so as to dissociate in the minds of practitioners the notions of post hoc and propter hoc.

The general adoption by practitioners in recording their experience, of the system known by the name of the Numerical Method, is essential to the attainment of the ends proposed in the preceding paragraphs, as well as in many that are to follow.

5. To endeavour to banish from the treatment of acute and dangerous diseases, at least, the ancient axiom, melius anceps remedium quam nullum, and to substitute in its place the safer and wiser dogma-that where we are not certain of an indication, we should give nature the best chance of doing the work herself, by leaving her operations undisturbed by those of

art.

6. To endeavour to substitute for the monstrous system of Polyphar

macy now universally prevalent, one that is, at least, vastly more simple, more intelligible, more agreeable, and, it may be hoped, one more rational, more scientific, more certain, and more beneficial.

7. To direct redoubled attention to hygiene, public and private, with the view of preventing diseases on the large scale, and individually in our sphere of practice. Here the surest and most glorious triumphs of medical science are achieving and to be achieved.

8. To inculcate generally a milder and less energetic mode of practice, both in acute and chronic diseases; to encourage the Expectant preferably to the Heroic system,—at least where the indications of treatment are not manifest.

9. To discountenance all active and powerful medication in the acute exanthemata and fevers of specific type, as small pox, measles, scarlatina, typhus, &c., until we obtain some evidence that the course of these diseases can be beneficially modified by remedies.

10. To discountenance, as much as possible, and eschew the habitual use (without any sufficient reason) of certain powerful medicines in large doses, in a multitude of different diseases, a practice now generally prevalent and fraught with the most baneful consequences.

This is one of the besetting sins of English practice, and originates partly in false theory, and partly in the desire to see manifest and strong effects resulting from the action of medicines. Mercury, iodine, colchicum, antimony, also purgatives in general and bloodletting, are frightfully misused in this manner.

11. To encourage the administration of simple, feeble, or altogether powerless, non-perturbing medicines, in all cases in which drugs are prescribed pro forma, for the satisfaction of the patient's mind, and not with the view of producing any direct remedial effect.

One would hardly think such a caution necessary, were it not that every-day observation proves it to be so. The system of giving and also of taking drugs capable of producing some obvious effect,-on the sensations, at least, if not on the functions, has become so inveterate in this country, that even our placebos have, in the hands of our modern doctors, lost their original quality of harmlessness, and often please their very patients more by being made unpleasant!

12. To make every effort not merely to destroy the prevalent system of giving a vast quantity and variety of unnecessary and useless drugs, (to say the least of them,) but to encourage extreme simplicity in the prescription of medicines that seem to be requisite.

Our system is here greatly and radically wrong. Our officinal formulæ are already most absurdly and mischievously complex, and our fashion is to double and redouble the existing complexities. This system is a most serious impediment in the way of ascertaining the precise and peculiar powers (if any) of the individual drugs, and thus interferes, in the most important manner, with the progress of therapeutics.

We are aware of the arguments that are adduced in defence of medicinal combinations. We do not deny that some of these combinations are beneficial, and therefore proper, but there cannot be a question as to the enormous evils, speaking generally, resulting from them. Nothing has a greater tendency to dissociate practical medicine from science, and to

stamp it as a trade, than this system of pharmaceutical artifice. It takes some years of the student's life to learn the very things which are to block up his path to future knowledge. A very elegant prescriber is seldom a good physician. And no wonder. Tailors, barbers, and dancing-masters, however learned they may be in the externals of gentility, are not expected to be fine gentlemen or men of fashion.

13. To endeavour to break through the routine habit, universally prevalent, of prescribing certain determinate remedies for certain determinate diseases or symptoms of diseases, merely because the prescriber has been taught to do so, and on no better grounds than conventional tradition.

Even when the medicines so prescribed are innocuous, the routine proceeding impedes real knowledge by satisfying the mind, and thus producing inaction. When the drugs are potent, the crime of mischief-making is superadded to the folly of empiricism. In illustration, we need merely notice the usual reference, in this country, of almost all chronic diseases accompanied with derangement of the intestinal functions, to "affection of the liver," and the consequent prescription of mercury in some of its forms. We do not hesitate to say, that this theory is as far wrong as the practice founded on it is injurious; we can hardly further enhance the amount of its divarication from the truth.

14. To place in a more prominent point of view the great value and importance of what may be termed the physiological, hygienic, or natural system of curing diseases, especially chronic diseases, in contradistinction to the pharmaceutical or empirical drug-plan generally prevalent. This system, founded as it is on a more comprehensive inquiry into all the remote and exciting causes of disease, and on a more thorough appreciation of all the discoverable disorders existing in all the organs and functions of the body, does not, of course, exclude the use of drugs, but regards them (generally speaking) as subservient to hygienic, regimenal, and external means, such as the rigid regulation of the diet, the temperature and purity of the air, clothing, the mental and bodily exercise, &c., baths, friction, change of air, travelling, change of occupation, &c. &c.

15. To endeavour to introduce a more comprehensive and philosophical system of Nosology, at least in chronic diseases, whereby the practitioner may be led less to consider the name of a disease, or some one symptom or some one local affection in a disease, than the disease itself,- that is, the whole of the derangements existing in the body, and which it is his object to remove, if possible.

16. To teach teachers to teach the rising generation of medical men, that it is infinitely more practical to be master of the elements of medical science, and to know diseases thoroughly, than to know by rote a farrago of receipts, or to be aware that certain doctors, of old or of recent times, have said that certain medicines are good for certain diseases.

17. Also to teach students that no systematic or theoretical classification of diseases, or of therapeutic agents ever yet promulgated, is true, or anything like the truth, and that none can be adopted as a safe guide in practice. It is, however, well that these systems should be known; as most of them involve some pathological truths, and have left some practical good behind them.

18. To endeavour to enlighten the public as to the actual powers of

medicines, with a view to reconciling them to simpler and milder plans of treatment. To teach them the great importance of having their diseases treated in their earliest stages, in order to obtain a speedy and efficient cure; and, by some modification in the relations between the patient and practitioner, to encourage and facilitate this early application for relief.

19. To endeavour to abolish the system of medical practitioners being paid by the amount of medicine sent in to their patients; and even the practice of keeping and preparing medicines in their own houses.

Were a proper system introduced for securing a good education to chemists and druggists, and for examining and licensing them-all of easy adoption-there could be no necessity for continuing even the latter practice; while the former is one so degrading to the medical character, and so frightfully injurious to medicine in a thousand ways, that it ought to be abolished forthwith, utterly and for ever.

20. Lastly, and above all, to bring up the medical mind to the standard necessary for studying, comprehending, appreciating, and exercising the most complex and difficult of the arts that are based on a scientific foundation, the art of Practical Medicine. And this can only be done by elevating, in a tenfold degree, the preliminary and fundamental education of the Medical Practitioner.

Such are a few of the labours in store for our young Hercules of Physic; a few samples of the varied contents of the stable he is called upon to cleanse; and a few pailfuls, it may be, of the veritable Alpheian he is to work withal:

An experimental Inquiry into the Pathology and Treatment of Asphyxia. By JOHN E. ERICHSEN.-Edinburgh, 1845. pp. 56.

THE author of the present treatise was appointed by the general committee of the British Association for the Advancement of Science, at the meeting held at Manchester in the year 1842, to form, in conjunction with Dr. Sharpey, a commission to make an experimental inquiry into the subject of asphyxia. Professor Sharpey shortly afterwards retired from the commission, and our author continued to prosecute his inquiry alone. His report, which was read at the fourteenth meeting of the British Association, and for which the Royal Humane Society awarded the Fothergillian gold medal, is the work before us.

Mr. Erichsen first considers his subject with reference to its pathology, and then enters into the question of the treatment of asphyxia.

In the first part of the subject, the pathology of asphyxia, Mr. Erichsen examines experimentally the merits of the three leading opinions each of which has, in turn, been received as the fundamental fact of asphyxia :

"Ist, That the circulation ceases in consequence of the arrest of the respiratory movements; 2d, in consequence of want of power in the heart; 3d, in consequence of an obstruction in the passage of blood through the lungs " (p. 2.)

Each of these opinions has received the investigation of careful, and, in our opinion, in the main, conclusive experiments; though, as we have often had occasion to express ourselves before, so great do we consider the violence done to the system in these experiments on living animals, sufficient of themselves to cause death, that we cannot accept all their results without some reservation.

With regard to the first and second of the above views of the leading cause of the phenomena of asphyxia, as the conclusions of Mr. Erichsen are in unison with those of Dr. Kay, now, we believe, so generally received,—and for a concise and clear expression of which we may refer to a book in every one's hands, the excellent lectures of Dr. Watson (vol. i, p. 45)--we do not deem it needful to follow him through his reasonings and experiments, but shall satisfy ourselves with expressing his conclusions, only adding on our own part, that we consider them borne out by his experiments. We give them in his own words:

"Ist. That although the persistence of the respiratory movements has some influence in maintaining the circulation through the lungs, yet that their arrest is not by any means the sole cause of the cessation of the circulation.

"2d. That a diminution in the force and frequency of the contractions of the heart, consequent upon the altered quality and lessened quantity of the blood circulating through its muscular substance, is one of the principal causes of the cessation of the circulation in asphyxia, as is evident from the fact, that, when the force of the heart's contractions is maintained by a supply of arterial blood to its muscular substance, it is enabled to propel black blood through a collapsed lung." (p. 31.)

It is, however, in the investigation of the third opinion, the obstruction of the circulation through the lungs, that Mr. Erichsen finds the main cause of the arrest of the circulation. As on this point, however, we find him somewhat at issue with Dr. Kay, whose opinions on this, as on the other heads, have, we believe, received general assent, we here propose to follow him, in some measure, into the details of his reasoning and experiments. While Dr. Kay holds "that the main cause," we quote the clear and concise account of Dr. Watson,*" of the failure of the circulation seems to be the difficulty with which the non-arterialized blood finds its way though the capillaries of the lungs," Mr. Erichsen, on the other hand, is of opinion that the obstruction is in the passage through-not the capillaries but-the smaller ramifications of the pulmonary veins, believing "that the venous blood which circulates in asphyxia may act as a stimulus to the smaller branches of the arterial system, [by analogy, those of the pulmonary veins,] exciting the contractility of these vessels, and that thus the obstruction in the circulation may be occasioned." (p. 26.) Mr. Erichsen dismisses the claim of the action of the capillaries in producing this result, by arguing, as "stated by Dr. Alison, that the stagnation cannot arise from the stimulus of the venous blood, being insufficient to excite the capillaries, as it has not been proved that these vessels are irritable, nor that they possess coats." (p. 26.) But, to proceed from the negative

• Lectures on the Practice of Medicine, vol. i, p. 45.