empirics who refuse the co-operation of the physician; but, indeed, what physician would hold a consultation with them? Learning they despise, physicians and surgeons they are in the constant habit of ridiculing and nicknaming, and the confidence that the middle and lowest order of society have in these pretenders to the healing art, is exceedingly detrimental both to the public and the profession. No subject connected with medical economy calls more loudly for inquiry than this; these are the men to whom Salus Publica might more properly apply his epithets; it is they who are in possession of Pandora's box; they have opened it, and none can shut it but the powerful hand of an efficient act of parliament. If the law of this realm, with regard to medical men, be as Censorinus would interpret it, then it follows that no man in this highly-favored country can be accommodated with medical advice, however dangerous or urgent his illness may be, unless he sends (if in a country place, and the patient able to bear the expenses of advice,) perhaps from ten to twenty miles for a physician; if not, however reluctant, he must, per legem, be content to submit his life to the ignorant herb-doctor. Does this call for no reform of the existing laws of the nation, with regard to the easiest and best manner of accommodating the people with medical assistance? It may be said these objections apply only to inconsiderable country situations, and that where population most abounds, the physician is at hand; but will the physician visit daily the poor man's garret or cellar, accompanied by his apothecary, (or his favorite druggist,) for about two shillings per diem? for this is the full amount of the apothecaries charges, medicines included: or could a sufficient number of physicians be found to attend such of the sick as refused the assistance of the herb.doctors, the other class of lawful practitioners? I am persuaded that there would not. If, then, the lives and healths of millions are to be regarded in preference to the monopoly of fees by any set of men; if it be desirable that the ignorant vulgar should have none but practitioners of acknowledged professional skill to make choice of; if it be right that the laborer is worthy of some lawful hire, and any weight is to be attached to reasonable argumentation, then the projected Medical Reform, in some prudent way, ought to be encouraged by every lover of his profession, and well-wisher of the public. I am, Gentlemen, Your most obedient Servant, To the Editors of the Medical and Physical Journal. GENTLEMEN, HAVING perused the many excellent observations and opinions contained in the different Numbers of your enlightened Journal, on the subject of Medical Reform, I am rather surprised to find no notice taken of what I have great reason to believe is become almost a crying evil, which is destructive of many a patient, and highly injurious to the credit and character of many a physician. To guard against which, I hope the legislature will, in its wisdom, inflict a very heavy penalty on any one who shall in future venture to substitute, without leave of the prescriber, one medicine for another, in any prescription he shall undertake to prepare; or who shall not prepare it exactly according to the formula prescribed. For, whether from indolence, ignorance, or self-conceit it occurs, it is equally productive of the mischief above-mentioned; and from which I am sorry to have occasion to say, 1, and many of my patients, have been great sufferers. MEDICUS. To the Editors of the Medical and Physical Journal. GENTLEMEN, S the London Committee of Apothecaries intend to renew their application to Parliament in the next session, for a bill to regulate the profession, and earnestly solicit the continued co-operation of the country practitioners in furtherance of the same object, it behoves the latter gentlemen to re-consider the subject, and estimate as correctly as possible all the probable consequences of regulating and restraining the practice of the profession by such legislative provisions, or by any similar ones, as those last proposed by the London Committee. There was no doubt but that the majority of the profession would hail with approbation any proposal to improve its usefulness and respectability, particularly when coming from such a source as it did; but it is to be feared that this sentiment, and the expectations which were raised, have been succeeded by some degree of disappointment; and some change of opinion, as to the possibility of making any law on the subject that would be equally advantageous to the public and the profession, and whether it would not be productive of more trouble and vexation than utility. There is, I presume, no doubt that there is less need of such a law now than at any former time, from the rapid and important improvements that have taken place in our profession, which has gone on at least with equal if not with greater advances than any other of the liberal arts; and which, I believe, has received, and does still receive, a full and ample share of public estimation. I would beg permission to recal the attention of the country practitioners particularly to this subject, and submit to them whether they are not of opinion that they have some reason to decline their renewal of support to a measure which is not likely to be productive of benefit to the public or to the profession? July 18, 1813. I am, Gentlemen, your's, SURRIENSIS. Is the Division of Diseases into general and local consistent with Truth? To the Editors of the Medical and Physical Journal. GENTLEMEN, PON reading Dr. Clutterbuck's treatise on fever, pub lished about six years ago, some remarks occurred to me, which I noted at the time, and now submit to you for insertion in the Medical Journal. As I am actuated by no other motive than that of professional improvement, I trust you will not disregard my opinions because they appear unsupported by a name, and though differing from those of Dr. Clutterbuck, contain nothing derogatory to his character as an eminent physician, and learned teacher. In his able work on fever, Dr. Clutterbuck denies the existence of any general or universal disease, and supports this opinion with a variety of facts and ingenious reasoning. He states, "that, strictly speaking, all diseases are in their origin local, or affections of some particular parts or organs, and never of the entire system.' Again, a disease can only, in strictness, be termed general or universal, when it affects every part of the system at once. But there are evidently none such. The whole system may, indeed, be weakened, and all its actions be consequently diminished, as by loss of blood; but such a state, if it affect all parts equally, is not a disease, though it perhaps strongly predisposes to it. Something more is wanted to constitute morbid action. Under such a state of general weakness, the functions may continue to be carried on, though less vigorously than before, and until one or more of these become deranged or interrupted, or until some uneasy sensation is induced, disease can hardly be said to exist." The learned author then proceeds to examine the Phlegmasiæ, the Hæmorrhagia, and the Profluvia, orders of the first class Pyrexia of Cullen; which he determines to be essentially local affections; leaving the remaining orders of that class, the Febres and Exanthemata, for future consideration. With equal dispatch and facility, he disposes of the three other classes. Of asthenic diseases, we are informed "that debility, though it may give a predisposition to disease, is of itself rarely, if ever, either the proximate or the occasional cause." "It is in general an effect only, and indicates nothing cer tain with regard to the cure.". The practice of giving tonic and stimulant remedies, and administering rich diet and nu tritious food in cases of general weakness, is ridiculed and pronounced to be mischievous; because "by increasing the topical affection, they often tend to depress the energy of the system still further, instead of rousing it." As to the opposite state of the system, the inflammatory or sthenic diathesis, with excess of action, the author doubts its existence altogether. In support of this opinion, it is alleged, "that an increase or diminution of action in one part generally induces a contrary mode of acting in others; and lastly, that the causes exciting disease, all of them, produce peculiar or specific effects; it might naturally be expected that diseases would always be partial or local at their commencement." The Phlegmasia, the Hæmorrhagia, and the Profluvia, of Cullen's first class Pyrexia, are essentially local, as they are often present without any general disorder of the system; and when a febrile state of the system (which is sometimes the case) does precede these local affections several days, they are to be considered either as complications of proper fever with topical inflammation, or of a conversion of the former into the latter. In this way the author briefly disposes of every disease. I will now attempt to inquire how far his opinion is correct, The first point to be determined is, what may be regarded as a general disease and what local. The author denies a disease is general, unless every particular function and organ of the body be deranged, and undergoing morbid action; and this immediately after the exciting cause or power is applied. He has here taken a strong position, and if we admit this as the basis of his reasoning, any attempt to dislodge him must be fruitless; for, though we may conceive that every part of the body is undergoing morbid action, it is very difficult to prove it; and dissection after death not unfrequently brings diseased parts to view, which had given no previous symptom of having been the subject of disease. The author himself has informed us, that "a disease may consist merely in morbid action, occasioning derangement of functions, without any perceptible alteration of the structure or organization of the part affected; and in such cases no insight into the seat or nature of the disease can be derived from dissection after death." May we not consider a disease to be general, when from the very commencement a patient complains of universal indisposition, without being able to refer to any particular part or organ as the seat of the disorder? In this state we find the patient affected with general lassitude, cold shivering, headach, or sense of heaviness, soreness over the body, depression of mind, anorexia, and sometimes nausea; the eyes have lost their lustre, the whole countenance appears shrunk and void of animation; in a few hours, or sometimes longer, the heart pulsates quicker, and with greater or less force; the heat of the body is increased, and sometimes perspiration breaks out. At this early period, it is impossible for the most acute and experienced practitioner to pronounce what the future disease is to be; if he sees his patient within six, twelve, or even eighteen hours from the first moment of his feeling indisposed, the practitioner often shall not be able to say whether the complaint will be simply fever, inflammatory sore throat, peripneumony, measles, acute rheumatism, or in fact any disease accompanied by pyrexia and general indisposition. Are we to regard this as a fair case of disease? If we are, I ask where is the locality of the affection? If the advocates for all diseases being local, deny that it is disease; they may call it predisposition, but where is the distinction, for many cases of acknowledged disease continue and go through their course with no other symptoms? It is not unusual to meet with a complaint, which, from its extreme short duration, has been called Ephemera, and Diaria. It attacks the patient suddenly without any apparent cause. The symptoms are pain in the head, prostration of strength, and chilliness; in the course of the day, the pulse becomes very frequent, respiration quick and short; the surface of the body red, and the face is sometimes slightly swelled; and in the course of the same day, this complaint terminates with sweating; and I have the authority of Sauvages and Lommius for asserting that it is not protracted beyond two or three days at most. Surely this will not be called only predisposition; and if it is to be classed under the |