muriate of lime. After four weeks, the eruption began to re-appear and the hearing to improve pari passu; the eruption very soon assumed its former character and the discharge became offensive. To moderate this, the ointment of hyd. sub. muriat. and arsenic was occasionally applied. The treatment was pursued for a year, when the eruption had gradually decreased and finally disappeared, while the child continued to hear perfectly.

In the case of persons born deaf, we find occasionally malformation of the throat and mechanical apparatus for hearing, but the greater, number present no appreciable change in the mechanism of the organs, and the cause of deafness in these lies in the nervous system, and, like amaurosis, cannot often be treated with success. Yet deafness may proceed from derangement of the nervous system coming on after birth, and sometimes admits of cure.

A boy, about five years of age, extremely mobile, and apparently liable to St. Vitus's dance, was observed to become dull of hearing occasionally, after his third year. He had a slight fever in the winter of eighteen hundred and forty-five and six, and afterward became still more dull of hearing. His parents were both healthy. There was no

traceable hereditariness and no appreciable change in the organs of hearing, nor yet any apparent probability of a latent eruption. But the child had been subject to frequent attacks of earache, and after each attack his mother thought his deafness increased. A small blister was ordered on the arm, to be applied every two weeks, first on the one arm and then on the other, and sarsaparilla with prinos verticillatus, and the ears to be occasionally cleansed with warm brandy. The fever returned; the child's pulse became quite frequent (one hundred and twenty,) and the hearing quite restored. When the fever had abated, deafness returned; the child was now more excitable than before. He was put on a course of Fowler's solution with muriate of lime, and after a month the excitability had greatly diminished and the hearing almost perfectly restored. Whether he will continue to

hear well, sufficient time has not elapsed for decision. December 12th, this child remains cured.

In conclusion, the causes of deafness lie sometimes exclusively in the nervous apparatus, and to this class are referable most of the cases born deaf, together with some others, connected with St. Vitus's dance, epilepsy, drunkenness, etc.; this class of cases is for the most part hopeless.

Sometimes, from an inflammation and consequent thickening and altered secretion of the membranes of the auditory passages, connected with scarlatina, measles, tonsillitis, etc., this class of cases admits of cure by care and perseverance.

Lastly, deafness proceeds in a great number of cases from eruptions, repelled or latent, and in this class the membranes of the auditory passages are not inflamed, but their usual healthy secretion becomes suspended and their surfaces become erected. This class of cases also admits of cure by causing the eruption to appear, or by arresting the tendency of an eruption, to be produced while it is imitated by blisters.

ART. IV.-An Essay on the Philosophy of Medicine, and the spirit in which it should be studied and practised. By N. S. DAVIS, M.D., New York, late of Binghamton.

ARE there at present existing a sufficient number of well-established facts and clearly-ascertained general principles, on which to found a rational and true system of medical science and practice? or, are the supposed facts and received doctrines of the profession at the present day, like those of the past, only so many bubbles that are to vanish before the new views of those who are to come after us? We do not intend to ask whether medical science has already attained perfection; but, simply, whether the experience and observation of the last 2000 years has led to the establishment of such a series of general principles as will stand the test of future time, and constitute a system of sound medical philosophy? A hasty and inconsiderate glance at the past history of medicine has led many to the conclusion, that of all sciences it is the most changeable and uncertain. For, from the days of Esculapius to the present time, theory has succeeded theory, and system followed system, almost as rapidly as one military despot succeeds another in the government of Mexico; while the reputation of particular medicines in certain diseases has been no less variable and uncertain. To-day, a medicine may be heralded almost as a specific in a given disease, and to-morrow be condemned and consigned to oblivion; and almost every day we may hear of the exclusive and universally-curative powers of Hydropathy and Lobeliapathy on the one hand and infinitesimal Homœopathy and Mesmerism on the other. But we should be careful how we judge of the condition of any science or profession by the number or reasonableness of the theories promulgated by its advocates. For such is the constitution of the human mind, that it is ever struggling to frame theories or hypotheses for the explanation of such facts as come within the scope of its investigation. And how often do we see a man's whole life spent in practices directly contradictory to his own theories; thus, we find one man denying the very existence of matter, and yet he daily treads on the earth with as much freedom and confidence as the man who believes there is nothing but matter in the universe. other theorizes himself into the belief that all animals were originally derived from one primitive type, as the Monad or Molusc; and, consequently, that man is but an improvement on the lower orders. And yet we never find one of these men actually endeavoring to raise men from monkeys, or even a Troglodyte from a Molusc. On the contrary, we observe them in practice as invariably expecting "like to beget like," as other men. The same course of remark might be extended by reference to many medical theorists of the present and past generations. But enough has been said to make good our assertion, that the practical condition of a profession cannot be inferred with certainty from the theories inculcated by its advocates. Indeed, what judicious or intelligent physician of the present day, regulates his daily practice by any of the great medical hypotheses that have held sway in the medical world, whether it be Humoralism or Solidism, Brunonism or Broussaisism, Vitalism or Chemicalism, or even that amalgamation of Swedenborgianism, and the ancient doctrine of animal spirits, the "influences of evil," and the spiritual nature of both medi

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cines and diseases, advocated by the disciples of Hahnemann? Certainly, no one. And yet, it is chiefly the number, the contradictory nature, and the absurdity of these theories or pretended systems of medical philosophy, that has caused medical science to be regarded by very many as so vague and uncertain as to be little better than a blind system of guessing. But it seems to me, that all this arises from a fundamental error concerning the real nature of medical philosophy. The human mind, led on from step to step, has ever been prone to overleap facts and realities, and struggle to fathom the unfathomable; to grasp the imponderable, infinite why and wherefore of things. And such is our mental nature, that when once imaginary hypothesis has been framed, it in fact becomes the medium of our mental vision, throwing its own shade and color over all things else; hence we might almost hazard the assertion, that a man's facts are more frequently founded on his theories than the contrary. But let us return to the important inquiry with which we commenced, and, in a brief compass, determine, if possible, what constitutes a sound and practical system of medical philosophy. The great error committed, in attempting to solve this question, generally consists in a vain effort to explain all the phenomena of life, and, of course, also all morbid actions, by means of some one general law or universallyacting agent. Thus with the ancients, the spiritus animi and the morbid humors afforded a ready explanation of all vital and morbid phenomena, while, at a later period, the spiritus archæus of Van Helmont; the rational soul of Stahl; and the siderial spirit of Paracelsus, swayed the minds of grave medical philosophers. And even at the present day, while the long-protracted war between Humoralism and Solidism is being waged with unabated ardor, we find some men resolving all vital phenomena into the effects of magnetic and electrical attractions and repulsions; others, with test-glass and microscope, make the human system a simple chemical laboratory, and make life itself but the combined result of light, heat, and moisture, acting on elementary matter; while others still, not content with making the whole animate world obedient to one universal agent, (caloric,) invest their favorite hobby with the attributes of Deity himself.* Such attempts at a sweeping generalization, and the apparent simplicity of a reduction of all vital phenomena to the agency of some one all-pervading principle or agent, may be very fascinating to the mind; but do they advance us a single step in actual knowledge? That all organized or animate matter is endowed with a power, principle, or agent, essential to its organization and vitality; and which, under all circumstances, plainly distinguishes it from unorganized or dead matter, is universally conceded. That the action of all physical agents, on living matter, is modified, and in some measure controlled, by this vital power, is equally acknowledged. Remembering these two facts, it matters but little what name we apply to this vitalizing principle; whether it be the calidum innatum, the principia vitæ, the chemical forces, animal electricty, or caloric. And all the volumes of speculation and controversy which have been written on the subject, have served more to bewilder than enlighten the reader. The simple truth is, that the Creator has endowed the living, organized part of

*See Metcalfe on Caloric.

our world with an inherent, essential power or property, which, to a certain extent at least, exempts it from the influence of those agents that control the inanimate or unorganized part. Of the essential nature of this power we know nothing. To call it a chemical force, an electric power, or caloric, or any of the imponderable agents, is but to mistake effects for causes, and render confusion worse confounded. Neither do such speculations constitute any part of medical philosophy. But the true philosopher leaves this question where he leaves the essential nature of everything else, and contents himself with studying man, not in his incomprehensible essentialities, but in the phenomena, healthy and morbid, which he presents. Bringing this spirit to his task, two fundamental facts or realities meet him at the threshold of his investigations. The first is, that man is made up of a great variety of tissues and organs, each performing its own appropriate and specific office or function, and each maintained in existence and controlled by certain invariable laws. The second is, that all these tissues and organs are liable to be influenced by morbid agents, producing changes in their functions, and alterations in their structure (conditions which we term disease); and that there are other agents and substances also capable of acting on these same tissues and organs in such a manner as to increase or diminish their diseased conditions: these are called medicinal agents or medicines. From these two starting points radiate a great number of questions, the answers to which constitute the whole sum of sound medical science and philosophy. 1st. How many distinct tissues and organs are there in the human system, and what the peculiar structure of each? 2d. What are the functions of each, and the agents and laws by which they are maintained and controlled in health? 3d. Of what morbid changes are they susceptible, and what the agents capable of producing those changes? 4th. What agents or substances are capable of acting medicinally, and on what particular organ or tissue is each capable of exciting its specific influence? 5th. What is the medium of communication between different organs, and how far can one be made to exert a healthy or morbid influence over another, or even all the rest?

Proceeding thus analytically in our inquiries, we first gain a clear and definite idea of the nature, extent, and ultimate design of all medical knowledge. The next object should be, to ascertain how far the questions propounded can be fully and satisfactorily answered in the present state of our knowledge. The first question, being susceptible of manual demonstration, is very minutely answered in the many works on general and special anatomy. The second, though in some respects less completely demonstrable to our senses, is, nevertheless, with few exceptions, quite as satisfactorily answered by the physiologist. Thus, we are quite as certain that every organ performs a specific function or office in the system-as the brain for mental manifestations, the alimentary canal for digestion, the vascular system for circulation, the liver for the secretion of bile, the kidneys for urine, the muscular fibre for contraction, etc., etc.-as we are of any other facts whatever. Equally certain it is, that each of these separate organs require for the healthy performance of their functions, the presence and influence of certain agents, as atmospheric air for the lungs, food for the alimentary canal, impressions through the medium

of the external senses for the brain, arterial blood for the heart, nervous influence for the muscles, etc. And not only has every separate organ and tissue its own distinct action or function to perform, and its natural agent or stimulant to excite it to the performance of that function, but each is liable to be acted upon and modified by some substances while it possesses an immunity from the influence of others. But while each organ thus possesses its own perfectly distinct function, and its natural attractions and repulsions, if we may be allowed the expression, they are all united in such a way as to act in perfect harmony, and mutually exert a sympathetic influence over each other. A detailed knowledge of the truths hinted at in these proposi tions is of the utmost importance to the medical inquirer; for, on the individuality of the organs and their functions on the one hand, and their close sympathetic relations on the other, rests the whole fabric of rational therapeutics; and the more clearly and perfectly these are comprehended by the practitioner, the more definite and exact will be his knowledge, both of diseases and their remedies. Here is indeed

a field still open for the investigation of the medical philosopher; for not only are there some organs, as the thymus and thyroid glands, the spleen, etc., of the functions of which we are ignorant, but there is still a great deal to be learned concerning the laws which govern the application of the natural stimuli to their appropriate organs. Many of these stimuli are compounds, the ingredients of which are ever liable to vary, as the atmospheric air for the lungs, aliment for the digestive canal, blood for the vascular and nervous systems, etc. Thus, the atmospheric air, the supporter of the vital function-respira. tion--many cubic inches of which is brought in contact with the minute vessels of the lungs at each inspiration, is not only composed of oxygen, nitrogen, carbonic acid, ammonia, and gaseous products arising from vegetable and animal matters, the three latter of which are constantly varying, but its thermometric, barometric, hygrometric, and electrical states are still more variable. That all these are constantly exerting a marked influence over the animal system, modifying its liability to particular types or forms of disease, cannot be doubted; for how else can we account for the marked changes which occur in the seat and character of diseases at different parts of the same year, or in different years; yet how vague is our knowledge on these interesting topics; and how many valuable lives have been lost at the commencement of severe epidemics, in endeavoring to combat them by the same means that has proved successful in previous years, before it was learned by experience that the disease, although the same in name, was very different in type. And I apprehend that this will continue to be the case until a medical education is made to cover not only a few text books on anatomy, physiology, surgery, materia medica, practice of medicine, and midwifery, but also the whole field of natural science. And whoever shall patiently and carefully investigate all the phenomena of the physical world, including the agents called imponderable, in reference to their influence on the healthy and morbid actions of the animal economy, will confer a great boon on medical science. This we shall undertake, so far as facts are within our reach, in a subsequent part of this essay. If a thorough knowledge of every organ, in its individual capacity, and the physical agents capable of influencing it in health, is thus important, the mutual rela