of that side, nothing appearing wrong in the coats or humours of the organ. This pain continued till the patient was 20 years of age, when she happened to fall down a flight of stairs. This accident was followed by an abundant discharge of muco-purulent matters from the nostrils, and then the pain in the orbit ceased. In the beginning of Nov. 1825, she began to experience pains, sometimes in one, sometimes in the other side of the head, accompanied by a sense of tension. Towards the end of the same month, the left eye became the seat of a very severe pulsating pain, soon followed by blindness of that eye also, so that she could now scarcely discern light from darkness. Blood-letting, local and general, was several times practised, together with blisters, &c. but no relief had been obtained. On the 9th December, Professor Polidoro examined the patient attentively, and nothing particular could be ob served in the state of the eyes, except dilatation of the pupils, with insensibility to the brightest light, blindness, squinting, and a pale corneous spot at the bottom of the right eye. She refused to have a seton, but took a grain of tartar-emetic in eight ounces of the infusum arnica montanæ. 11th. Two grains of the tartrite were given in the same vehicle -vomiting induced. 12th. The same medicine, and the same effect. Some vision in the left eye. 13th. The same medicine. After vomiting, she experienced a tensive pain at the bottom of the orbits. Liquid stools followed the vomiting. 14th. Same treatment. She could now see to thread a needle with the left eye. The same medicine was continued. 17th. She begins to have some slight vision with the right eye, which had been blind for more than 20 years. The nitrate is continued, but does not produce vomiting. 19th. The dose is increased to three grains of the tartrite daily. 20th. Several vomitings by this last dose. She can distinguish some objects faintly by means of the right eye alone. 24th. She could now read with the left eye, and could distinguish letters of a certain size with the right, but not in their proper place. 25th. The pupils contracted to their natural size, and were obedient to light. The patient less frequently vomited than before. 26th. She could see the buttons on a person's coat with the right eye, and the sight of the left was nearly as good as ever. She now demanded per mission to go from the hospital, and she was discharged towards the end of February, 1826. She has since been seen, and continues to preserve her sight.-Journ. Complem. Nov. 1826.

It is evident that the optic nerves and retina, in this case, were not disorganized, but only their functions prevented by some deposition which has been removed by the long-continued vomiting which was perseveringly employed, and most patiently submitted to. The powerful absorption which obtains under the action of emetics, is not suffici ently appreciated in this country-or, at least, we do not avail ourselves of this mode of exciting the absorbents so much as we ought to do. When we speak of exciting the absorbents, we know that we are treading on tender ground; but we are speaking practically rather than physiologically; and, on such terms, we say that vomiting increases absorption-whether by directly or indirectly exciting the absorbents, is not very material.

Quarterly Periscope

OF

PRACTICAL MEDICINE;

BEING

The Spirit of the Medical Journals,

Foreign and Domestic ;

WITH COMMENTARIES.

PART III.

ANALECTТА.

"Nihil est aliud magnum quam multa minuta.”

1. DIVISION of medicine into PHYSIC ANd surgery.

MR. LAWRENCE's introductory lecture to his Spring Course has been published in the Lancet, No. 181, and the lecturer has exerted all his talents and rhetoric to prove, that no real distinction or line of demarcation can be drawn between physic and surgery, whether we look to education or practice. We shall here bring forward a document, shewing how far Mr. Lawrence has been original in his arguments and illustrations, on this point of medical jurisprudence. The following paper was written and published by the Editor of this Journal ten years ago, and may be seen in the 4th volume of the Medico-Chirurgical Journal, pages 342-7. It will be evident that Mr. Lawrence has taken the arguments, the illustrations, and almost the identical expressions of this paper for his introductory lecture.

"The boundaries between physic and surgery have not till this moment been defined-a strong presumption that nature does not sanction them! The distinction of internal and external diseases is any thing but correct or satisfactory. Gout, for instance, alternates with erysipelas. In the first form the physician claims it as his own; in the second, the surgeon steps in, and demands the treatment. But is not the erysipelas in this case, and indeed in almost every other case, dependent upon an internal, or what is termed a constitutional cause? and can it be, with any degree of safety, treated as a topical affection? Here, then, must not Physic and Surgery be united?*

"The same may be said of anthrax, and a great majority of inflammatory affections, whose prominent and apparent seats are indeed external, but

"When we look to the nature, causes, and treatment of diseases, the distinction between internal and external appears pre-eminently absurd. Internal causes produce external diseases, and external agencies affect internal parts. Erysipelas, gout, carbuncle, ædema, exemplify the former— pneumonia, catarrh, and many forms of rheumatism, the latter."-Lawrence. VOL. VI. No. 12.

2 P

whose cause and origin are internal. If the surgeon treats them without the aid of physic, he does wrong: the physician considers them as out of his province; and if he does undertake the cure, he must use surgical means with medicinal. How preposterous would it be to have a physician combating the cause, and a surgeon the effect-or, more correctly speaking, to employ the physician to lop off one arm of the disease, while the surgeon is busy in extirpating the other? Either, then, the physician and surgeon must be of one opinion, and consequently be equally informed on the subject, or the practitioner must unite physic and surgery in his own person. In short, the distinction between internal and external diseases has no more foundation in nature or truth, than that between diseases of the right and of the left side of the body.*

"The allotment of all diseases requiring manual assistance to the department of surgery would create equal confusion. A patient is seized with violent pneumonia. The physician is sent for: he declares that venesection is immediately necessary, and the paramount remedial measure. But in these times the surgeon no longer obeys the orders of the physician; they are independent of each other, and act only from their own judgment. But, granting that a bleeder is procured to act under the physician, and things go on well for a time, it may and does happen that pneumonia terminates in empyema. Then comes the difficulty. It is surely as necessary (indeed it is much more so) to know when, as how, to perform an operation. The surgeon, on whom the responsibility of the operation rests, must select his time for the performance, and for that purpose ought to know the nature and exact state of the case as well as the physician. Here physic and surgery must be again united.

"On the other hand, let us take the purest surgical case-a compound fracture of the leg. When the surgeon has reduced the fracture, and comfortably adjusted the limb on a pillow, his work is far from being finished. The local will soon produce general derangement, and the whole fabric of the constitution will be in danger without physical aid. Here, then, as a contrast to the first example, the physician will be set to work on the effect, while the surgeon is occupied with the cause! What matchless absurdity. But will it be said, that the febrile commotion excited by the fracture differs in any essential point, either in its nature or treatment, from that occasioned by an internal inflammation, as of the lungs? By no means. Yet the latter is placed exclusively under the physician, and the former under the surgeon. The distinction, then, between local and general diseases, cannot be maintained, since organs the most distant are sympathetically influenced, and constantly drawn into consentaneous derangement. All diseases, in fact, are local in their origin. They commence in one organ or set of organs, spreading to all others with more or less rapidity, according to the degree of lesion and importance of function in the organ first affected.

"A late eminent French writer (Richerand), who by the bye seems no great friend to the separation of physic from surgery, proposes a new classification of diseases for the more accurately distinguishing the limits of the two branches. All diseases, according to him, may be said to consist in physical derangements, organic affections, and lesions of the vital powers lesions des propriétés vitales.' To the former only, or physical derangements, consisting of wounds, dislocations, obstructions, &c. and

"If you must have a distinction, separate the disease of the right and left side, or of the upper and lower half."-Lawrence.

their consequent operations, he would confine the province of surgery, leaving a wide field, indeed, to Messieurs les Medecins. "Les lesions physiques sont presque toujours le resultat de l'action d'un corps exterieur sur le notre; ce sont des effets méchaniques d'une cause qui l'est ellemême. Les plaies ou solutions de continuité produites par un instrument tranchant, piquant ou contondant; les fractures occasionées par l'alongement forcé du tissu osseux; les luxations amenées par la violence des mouvemens imprimés a nos parties; une hernie, resultat de l'effort méchanique des puissances expiratoires, reconnaissent une cause physique, apporte a nos fonctions un obstacle mechanique, et reclament pour leur guérison, l'emploi des moyens du meme ordre.'

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According to this scale, the surgeon might still, as he does now, claim the treatment of a chancre, as being the effect of un corps exterieur ;' but, as soon as the virus had shifted its seat from the prepuce to the tonsil, the physician would say, 'Now is my turn!' But does the treatment of a venereal sore in the former situation differ from that in the latter? And if not, why not? seeing that they are treated by different orders of the profession? Here physic and surgery are evidently interlocked. Well may Monsieur Richerand say, Ces matières Medico-Chirurgicales peuvent, ce me semble, être comparées à ce crepuscule qui conduit du jour à l'obscurité.' But, taking M. Richerand on his own ground, I would ask him, can the external impression of rain, and a piercing cold wind on the surface of the body, checking the perspiration, breaking the balance of the circulation, and inducing pneumonia, be considered strictly, and philosophically, less une action d'un corps exterieur sur le notre,' than the puncture of a bayonet, producing the same effect? Yet, in one case, the inflammation le resultat de l'action, &c.' is medical, and in the other it is surgical What are intermittent fevers-typhus, the plague itself, but the effects of foreign bodies on our own? What is hydrophobia? What is traumatic tetanus, but le resultat de l'action, &c.'

"In no possible way can we find any natural or just distinctions between physic and surgery; and yet I do not object to the distinctions in practice. It is against the idea of a difference in education and study that the above remarks are levelled. It is morally impossible that a man can be a good physician without knowing the principles of surgery; and it is still more absurd, to think that a man can be a good surgeon without being intimately acquainted with the principles of physic. If it be objected that an intimate acquaintance with the minutiae of both branches is too much for one person to acquire, I answer, 1st. in the words of Richerand, l'etendue de la science ne justifie point les limites arbitraires que l'on voulu tracer entre ses diverses parties.' 2d. I am of opinion, that it is much more easy to acquire a profound knowledge of both branches, than of either one separately and for the reasons already stated, that the two sciences are interlocked at all points, even the apparently most distant; for instance, pneumonia and fracture. Hence, to attempt to learn the one without the other, is to tie up one of our arms when we commence a mechanical trade! "Is it not absurd to say, that a moderate knowledge of anatomy and surgery is useful to the physician, and deny that a minute knowledge would be still more so? As for the surgeon, he cannot move a step in safety, without an intimate knowledge of all the laws of the animal œconomy, which the physician studies and observes.† His very operations for the removal

"These remarks apply only to the study of the medical profession, which must be learnt as a whole."-Lawrence.

"I cannot quit this subject, without impressing on you most earnestly

of diseases that would otherwise prove mortal, are inflictions that often require the most consummate knowledge of physic to counteract. What madness, then, for the surgical student to direct his attention so exclusively, as he too often does, to the study of anatomy and surgery, when he is assured by grey hairs, that nine-tenths of his future professional labours (whatever line he may take) will be what are termed purely medical! Let him compare M. Richerand's list of Physical Lesions' with the long black catalogue of organic and vital; and he will see that it is but a drop of water in the ocean.

"Not that anatomy and surgery are not to be most minutely studied; but I would say, that these branches are only parts of a grand whole, all of which must be studied with equal care, or every branch is imperfect.

"Let us glance at the great disorders of the three principal cavities of the body. Is idiopathic phrenitis more dangerous and difficult to treat than that from a fracture of the skull? Are idiopathic convulsions more terrible than those from a splinter of bone driven through the coverings of the encephalon? Is idiopathic tetanus more fatal than traumatic? In what consists the difference between idiopathic and traumatic pleuritis, pulmonitis, carditis, diaphragmitis, hepatitis, gastritis, splenitis, enteritis, peritonitis, cystitis?—None. Or, if there be any difference, the difficulty and the danger are on the side of surgery.

"What then remains? Fever? Does the hectic of the lungs exhibit a greater spectacle of horror and emaciation than the hectic of lumbar abscess, or disease of the hip-joint? Is the inflammatory fever resulting from aerial vicissitudes to be compared with that supervening on a lacerated member or crashed knee-joint, where the dire commotion threatens every instant to annihilate the living fabric at a blow? The typhoid fevers differ in no respect from the ulterior stages of inflammatory and symptomatic fevers.

"Seeing, then, that the greatest and most dangerous diseases, both in physic and surgery, to which humanity is subject, are completely identified, is it not evident that the surgeon, in acquiring a knowledge of these, must, in course, acquire a knowledge of the minor and intermediate maladies, which are reckoned Medico-Chirurgical by both professions? And, is it not evident from these premises, that the surgeon, if properly qualified, must add to the science of the physician the art of operating? Anatomy, physiology, and surgery, are merely the first steps by which the student gains a footing on the hill of science. When he can unravel the brain without a light, or take up the external iliac blindfold, he is scarcely advanced a day's march on the great journey of medical science. These, which are termed, and justly, elementary branches, are little more than the alphabet of medicine, though they are considered at the beginning as the ultima thule of professional knowledge. The surgical student thinks himself armed at all points; but every year's subsequent experience shews him more and more his own ignorance!

"In fine, physic and surgery are only parts of a grand whole; one cannot be properly known without the other, no more than navigation can be learnt without the aid of arithmetic. The distinctions between the two branches cannot be drawn or maintained, even in the largest cities. To be convinced of this, let any one sit down by the side of Cooper and Abernethy for a day, and he will see these illustrious surgeons lopping off nine surgical

the advantages—nay, the necessity, of studying medicine comprehensively.” -Lawrence.