HARVEIAN SOCIETY. MR. COULSON, PRESIDENT.

418 make but small advances in the very science which we profess, But to do this properly we must associate ourselves with others; for no man’s experience, however great, can supply him with the whole of what is necessary for a complete inducThe great philosopher who gives his name to our tion. observes, in his dedication to his immortal work,, Society " True philosophers, who are only eager for truth and knowHARVEIAN SOCIETY. ledge, never regard themselves as already so thoroughly inMR. COULSON, PRESIDENT. formed, but that they welcome further information, from whomsoever, and from whencesover, it may come; nor are NOVEMBER 1854. THURSDAY, 2ND, they so narrow-minded as to imagine any of the arts or sciences transmitted to us by the ancients in such a state of THE first meeting of the session was held this evening; forwardness or completeness that nothing is left for the there was a very full audience. As is usual on the opening and ingenuity of others; very many, on the contrary, industry night, the PRESIDENT delivered an inaugural address. He maintain that all we know is infinitely less than all that still said :remains to be known. Nevertheless, philosophers do not pin " Gentlemen,-The laws of our Society prescribe to the their faith to other persons’ precepts, in such wise that they President the duty of addressing you, at the commencement of lose their liberty and cease to give credence to the conclusions every session, on the objects of the Society, and the best of their proper senses." methods of accomplishing them. The institution of this Harvey, we see, recognised the value of the intercomcustom, like that of the Society itself, is founded upon a keen munication of thought between classes of scientific men, and he insight into the nature and wants of the medical profession. gave a proof of his recognition of the value of societies by his It is very possible that, after the labours consequent upon magnificent donation to the College of Physicians. He saw practice were terminated for the day, we might be tempted to clearly enough that the collision of thought produced sparks, take advantage of our meetings in the evening as a means of from which the lamp of science might be lighted; and our exrelaxation and friendly intercourse, and forget the great perience must teach us the same lesson. Not only are most objects which have brought us together. I think, therefore, men’s experience deficient in extent, but suspicious in quality; that the object of the law which renders it incumbent upon not only can no single man collect all the facts, but the mirror your President, to the best of his ability, to address you at the in which they are seen is coloured and distorted. A fact is not commencement of each session, on the proper objects of the same thing to one observer as it is to another. The powers the Society, is a good one. But I have said that the institution of perception vary in different individuals; two persons of the Society (and, I might have added, of all societies of this look at the same fact, perhaps from different points of view, and kind) is founded on a similar insight into the nature and consequently receive two different impressions. Induction is wants of our profession. If we stand in need of the agency difficult, then, in medical science, not only on account of the imof such societies to give us strength as men, we are no less in possibility of the observer collecting a sufficient number of need of them as members of the medical profession. Not only phenomena, but on account of the idiosyncrasies of the observer himself. We always have been, and always shall be, under the our own individual weakness imposes upon us the necessity of meeting together in friendly union, but the very peculiarities influence of the idols or spectres which Bacon has delineated in of the profession to which we have devoted ourselves render it sucha masterly manner. The spectres of the tribe (id(51a tribus) equally imperative. No other profession depends so much still exercise their baneful influence in distorting our judgment, upon the assistance which it may receive from the operation of by causes which arise from the very defects of the human mind: societies as ours, and it will be worth while to inquire into the spectres of the den (iclolcc specûs) still operate, by causing the reason of this. We do not hear of active lawyers feeling it us to measure the laws of the universe by our individual incumbent upon them to hold meetings for the of standards: the spectres of the market-place (idõla fori) still enlarging their acquaintance with the principles and practice disturb our judgment, by the misconceptions which arise from of law, or of extending its operation. And the same holds our intercourse with each other: the spectres of the theatre with respect to other professions. The difference seems to me (iclola theatrical) still trouble, by raising philosophical dogmas into to be this : in no other profession is the connexion between general laws, by making us consider the world of imagination science and art so necessary to be kept in mind as in our as the only true world. A Society like the present is the most own ; practice so absorbs the faculties of the medical man that efficient check upon the dangers to which we are exposed from he is ever in danger of drifting away from scientific principles. this source. We can never flatter ourselves that the bye-path We find, therefore, that in all countries where medical men we have chosen is the high road, when we see so many persons have endeavoured to elevate medicine into a science, medical travelling towards the goal in so many different directions. You will agree with me, then, that a Society like this is not societies have been more numerous and far more flourishing , than any other institutions of a similar nature. This may be only useful to ourselves, but of benefit to the science of whieli accounted for in the following manner: The leading men in we are students. We assist each other, and, in so far as we do this, we become benefactors to the world. In reference to our profession, in proportion as they become more skilful, incur the danger of losing sight of general laws. Our skill what I have just said relative to the necessity, not only of a mainly depends upon the opportunities offered to us of large experience, but of a multiplied experience-not only of a practice. Coeteris paribus, he will be the best practical multitude of facts, but of a multitude of observers, to establish physician or surgeon who is most constantly occupied. But the principles of medical science, it may be instructive to couin this very occupation there is danger. While we are so con- sider the state of medical opinion with respect to the pestilence stantly engaged upon particulars, we lose sight of the necessity which has been lately raging amongst us, and even nowis of generalization. We keep so close to the beaten path that lingering here, "loath to depart." Many distinguished and This laborious members of our profession have devoted a large we have no idea, too often, of the map of the country. is the danger that is ever presenting itself to the medical man, i portion of their time and energies to the investigation of the The cause, essential nature, and treatment of cholera. Each cf a danger, be it remembered, that increases with time. these has had a large number of cases brought before him; each more phenomena we see, the less, very frequently, are we able to soar to the conception of general laws. The time that we has brought to the consideration of these cases the resources expend in the collection of materials is so great, that we have of a mind well stored with the knowledge of medical science in not any left for philosophizing upon them. The larger our its present state; each has conscientiously exercised the whole practice, the more, by that very fact, are wedeprived of the powers of his mind upon the consideration of the phenomena leisure which is required in order that we should make a before him. Nevertheless, it is but too well known to all of proper use of it. We are so much of workmen that we have you, how divergent are the theories which attempt to account for cholera-how various are the modes of treatment adopted. some difficulties to struggle against when we wish to become philosophers. This is a difficulty, however, which is inherent This arises, not only from the want of a sufficiently extended in the very nature of our profession, and it is one which may experience-not only from the peculiar colouring with which be met most appropriately by the institution of societies. We each man, by nature or education, unconsciously covers the meet here to throw all our experience into one common stock, objects of his observation-but also from the want of that and to endeavour to trace the hidden laws which underlie the instinctive prescience which exists in the mind of every great phenomena which our experience has brought before us. discoverer. It is not merely phenomena that are required, it is a deep certainty that these phenomena are all sprouts from we are at work in the day we observe only; when we bring the results of our observations here in the evening, we the same tree, and a craving to get at the knowledge of the We begin to war from the region nature of the tree. Kepler, with all his facts before him, was are enabled to philosophize. of fact to that of principles; and unless we do this we shall. ! tormented by the presence, felt, but not seen, of a law which.

successfully treated by operation; and a case by Mr. HENRY THOMPSON of hernia, complicated by the presence of a non-descended testicle in the canal. A discussion followed on each of these cases. A report will appear in the next LANCET.

cataract

purpose

While

419 would explain all these facts, and rested not until he tore away the thread of facts which enveloped the principle, and published to the world his three laws." Newton, with all Kepler’s knowledge imprinted on his mind, with a larger experience, derived from his own observation, was not content until he dived deep down into the ocean of facts, and brought up the great law of gravitation. These examples, and those of our great medical discoveries, must be ever present to our minds, inciting us to look upon experience, however necessary, as the All these separate mere guiding-posts to a true philosophy. observations on cholera may have their use. A philosophical observer will gain something, not only from the truth that is contained in the deductions from them, but from their errors, Let us, however, when we speak of the pestilence, remember, that although medicine has not done much to discover or to remove the cause, it has been of incalculable use in moderating the effects. No one who is acquainted with the results of hospital or private practice in this direction, will deny that increased experience has brought with it the knowledge of various methods of alleviating pain, and of arresting symptoms which formerly were the precursors of death. There can be no doubt, also, that the sanitary measures which have been adopted, and which the profession have recommended for years past, have in many instances prevented the outbreak, or diminished the violence, of the disease. It is to the medical profession mainly that the adoption of sanitary measures by the Government and local authorities is due. The labours of many of you in this direction have been of incalculable use to the public, and you may congratulate yourselves that you have laboured in the right way, even if you have not finished your work. If we ever arrive at the ultimate cause of cholera, each observer who has contributed one fact necessary to the induction may be consoled that he has been useful in the great achievement, although he may bear away but a fractional portion of the glory. I trust that the position of our place of meeting will be found in future to be even of greater advantage to the progress of our Society than it has hitherto been; I mean, in consequence of the neighbourhood of St. Mary’s Hospital, and the recent establishment of its school, A large hospital furnishes incalculable opportunities for the due prosecution of our studies, and at St. Mary’s the medical staff-if I may allude to a body of which I am myself a member-is composed of men some of whom have an European reputation. There is every probability that the active labours of that staff in the field of operation opened to them will not be without its influence on our meetings. It is, however, gentlemen, mainly dependent upon yourselves to elevate the character of the Harveian Society. Unless we individually work for the good of the institution, all the advantages which centuries of study and research have placed within our reach, will be practically of no benefit to this institution. If each person will make it a matter of duty to bring before the notice of the Society, at its periodical meetings, the results of his observations on the cases before him, and the facts which presented themselves to him, we shall assuredly prosper, and the Society will vindicate to itself the propriety of dignifying itself with the great name of the discoverer of the circulation. It will be a disgrace to us who have associated ourselves with the name of Harvey, if we flag in pursuing our course along the road which led him to immortal honour. In proportion as our resources are greater than those in the possession of the physicians and surgeons of the time of Harvey, our responsibility is increased. Any one who reads his graphic and philosophical account of the manner in which he proceeded to the discovery of the circulation, and the methods he adopted in carrying on his researches into the nature of generation, will be struck with the fact, that had Harvey possessed those common appliances which are now in the possession of most medical men, he would have been saved hours and days of anxious labour. What would Harvey have done had he had the microscope, such as it is with the modern improvements, to assist him in his operations ? What might we not have expected from this most acute of observers, had the tremendous world, to which the microscope alone could introduce him, been laid open before him? If he did so much with imperfect tools, what would he have effected with tools of a power of which imagination itself would scarcely have dared to dream the extent ? Harvey did the work of a giant with the armour of a dwarf; let us guard ourselves against the imputation of having armour fitted to the limbs of giants, but being no more able than dwarfs to make use of it. With the vast increase of power which modern discoveries have placed in our hands, If we have such vast facilities for our responsibility increases. doing good compared with those which were the property of our we shall basely neglect our duty if we do not

ancestors,

know how to use them. I havealready alluded to the microscope as having laid open nature in her inmost recesses. It is our business to strive that the knowledge thus given to us shall not have been given in vain. Chloroform is another of those new elements of strength which have added to our power. Making some necessary deductions from the indiscriminate praise which was at first lavished upon its prbperties as an anaesthetic agent, still there are few of us who have not had experience of its wonderful effects in sparing our patient the action of pain, and smoothing away many difficulties which we ourselves might experience in the course of our operations. There are a few cases where its application might be injudicious, but these form but a small proportion of those in which its agency is of the greatest possible benefit. It is of the utmost importance that the operation of chloroform should be carefully watched, and the members of the Harveian Society should make a point of communicating here the results of investigations If I were to go over the long list of the on this subject. increased forces which medical men possess now compared to those which were in the possession of their predecessors, I should be merely repeating what has been said before, and should be wearisome without being instructive. It may be advisable, however, to glance at one or two of the advances which have been made during the last year. It cannot be said that many startling changes have taken place; and the proper way of estimating our progress would be to take account of that gradual increase in the powers of the united profession which increased knowledge, closer co-operation, and a deeper sense of our responsibilities, have produced. We may have made no very brilliant discoveries, but if we compare the tone of the profession with that which existed thirty years ago, I think it must be admitted that there has been a great advance, and there is a gradual annual progress in this. It must, I think, be confessed that, as a profession, we become annually more earnest in our endeavours to seek for scientific We are less solutions of the problems we have to solve. bigoted and exclusive. We are more willing to share the results of our experience with olhers. We are less disposed to lock up our knowledge in secret corners, and let no one have access to it. In addition to this, I firmly believe that we are more filled with a solemn feeling of the great duties we owe to Him who gave us our powers, and to His creatures for whose use they were granted. If a profession like ours, numbering its members by thousands, makes a slow but sure progress of this nature, we may be certain that its capabilities for good are wonderfully increased. It will act with augmented force upon the world, and the results will be sensible in a large diminution of suffering and disease. Although, however, we may have to look to the growth of strength in the whole profession, more than to the development of any particular department of its operations, for the proof of our improvements, there have been still several instances of discovery which show that agencies are at work similar to those which produced the grand results in the history of medicine and surgery. There are a few other improvements which may be worth mentioning as having their value in increasing the general stock of professional knowledge. I may allude to the production of local anesthesia. This we must acknowledge is a point of first-rate importance. To produce insensibility to pain without depriving the patient of consciousness would be the very triumph of medical science. It would be premature to pronounce upon the merits of the invention at present, but we know that, amongst other instances, local anaesthesia has been produced in cases of cancer of the uterus, by an ingenious instrument for projecting chloroform or ether upon the part, and favouring rapid evaporation. I may also mention that, during the last year, the cure of small aneurisms, nevi, and erectile tumours, by means of the concentrated solution of the perchloride of iron, has been repeatedly effected. The same solution is now much used as a styptic to bleeding surfaces, and generally succeeds in arresting haemorrhage in a very short time. M. Chassaignae. of Paris, has made known to the surgical world a case which shows that, after all, spina bifida is not an incurable malformation, for he succeeded in obtaining the closure of the sac and the recovery of the child, by injections of iodine. I may add that M. Bonnet, of Lyons, continues to use the same injections into the cavity of chronic abscesses, and even into the peritoneal cavity, with a certain amount of success. I need not, however, occupy your time with accounts of scientific discoveries, with which you must be as well acquainted as myself. I allude to them simply to show that weare not standing still. It is enough for us to see, in the intervals between the pulsations of scientific discovery, that science still lives and is active. This gives us the certain hope that science will still animate our profession; that we may look forward to

420 discoveries as great as those which have made the glory of the illustrious heroes of invention. It is for us singly, gentlemen, if we cannot obtain the high distinction of connecting our names with any grand incident in medical discovery, to work diligently to prepare the road, and the materials for those who Wecan all dig materials out of the quarry, if we cannot can. construct the edifice ourselves. It behoves all of us, then, to work diligently in our individual paths, and to throw whatever observations we make into a common stock for the benefit of the profession and mankind. The Harveian Society is intended to help you in this latter purpose. Each member who wishes to see the Society prosper should not neglect to keep records of the cases under his charge. The principal symptoms should be noted, the effects of peculiar treatment should be described, and the salient points, both in the manifestations of the disease and the result of treatment, laid before the Society as matters of consideration. If this were to be done conscientiously and religiously by all of us, such a body of facts would be brought forward bv different observers as would materially assist the practice of the art, and ultimately, it may be hoped, lead to the establishment of general principles. "There is no way,"says Harvey, in a letter to Vlackveld, "more calculated to advance the proper practice of medicine, than to give our minds to the discovery of the usual law of nature by the careful investigation of the rarer forms of disease." This is precisely the object we propose to ourselves in the Harveian Society. The careful investigations of the rarer forms of disease is much more possible when entrusted to a hundred investigators than to one or two. The very error that may haveled one clever man astray, and set him wandering far from the road which leads to truth, without any possibility of his ever reaching the goal, may have We save been detected immediately by another observer. labour at the same time that we are able to produce more general results. These are the considerations which I would urge upon the members of the Society. While we work together wecannot fail to work usefully. If we shut ourselves up from all sympathy and co-operation, our selfishness will meet with its due reward. On the motion of Dr. RAMSBOTHAM, seconded by Dr. JoHN GRAY, a vote of thanks was proposed to the President, and carried by acclamation. Mr. COULSON briefly acknowledged the compliment, and the meeting adjourned until Thursday, the 16th inst.

large institutions there would be no great difficulty, during the

prevalence of an epidemic, of trying many different means of prevention at the same time, in various divisions of such buildings ; and by experiments of this kind it was possible that we might be able to effect much good. Not even with regard to house-to-house visitation and the advantages of the early treatment of diarrhoea to checking cholera, had there been a sufficient

amount of evidence collected to warraut a final and definite conclusion upon the point. The President also directed attention to the interesting point of the influence of the causes of cholera upon persons who were not attacked by the disease itself, an influence which was shown to exist, to some extent at least, by the greater susceptibility of most persons at these times Then with regard to treatto the effects of purgatives, &c. ment, there was no lack of suggestions, but, excepting in particular instances, there was much difficulty in carrying out particular lines of treatment in such a way as fairly to test their advantages. The President, after alludingto the papers which had been read, and to the labours of the special committee, strongly urged the necessity of the Society publishing the papers read before it, and suggested that it might be easily managed, by each member subscribing for one or more copies of the proposed volume, at the same time expressing his willingness to put his own name down for ten copies. Having made some observations upon the constitution of the late and of the present Board of Health, the President sat down amidst loud

cheering.

close confined

EPIDEMIOLOGICAL SOCIETY. DR.

BABINGTON, PRESIDENT. MONDAY, NOVEMBER 6TH, 1854. DR. BABiNGTO’’sr commenced his address by congratulating those members of the Society who were present upon their once more meeting together, notwithstanding the danger to which they had all been more or less exposed, both as medical men and as members of the community, during the prevalence of the late fatal epidemic. At the same time he had to express his great grief at the loss which the Society had sustained by the death of the late Dr. Roupell, who had been carried off by cholera since their last meeting. The President then alluded to the fact that now, instead of as formerly having to hold their general meetings in the rooms belonging to the Medico-Chirurgical Society, and their council meetings at the private residences of individual members, they had been enabled to provide the room in which they then were for their general meetings, and a smaller adjoining room for their council meetings. A repository had also been provided for the hooks belonging to the Society, a measuree which would be productive of great benefit, by promoting the circulation of works relating to Epidemic Disease. Remarking upon the necessity of the careful and accurate collection of all the important facts having relation to epidemic cholera, the President observed that we had no difficulty in tracing as definite a line of effects produced as in the plainest example of poisoning, but that it was the nature of the cause producing these symptons at which we wish to arrive. A great step would be made in this inquiry could we define any circumstances or sets of circumstances under which cholera could not exist. It had been found in manv instances that, on persons being removed from certain localities, cholera was stayed, whilstcertain localities appeared to predispose large numbers to be attacked at the same time. Many of these cases had been observed, but there had been no such collection of them as would allow of any important deductions being drawn as to the causes of such variations. But little appeared to have been done by way of testing the power of various prophylactic measures. In

°

The SECRETARY having read his report, Dr. RICHARDSON made some observations in relation to some remarks which had fallen from the President with regard to the practice pursued in olden times, oflighting large bonfiresininfected districts. From the researches into the historical part of the subject, which he hacl made in conjunction with Dr. Moffat, he had ascertained that this measure had in different cases appeared to have produced very opposite results, which he thought might be owing to the causes of the epidemic being within or without the place where the fires were used, as their only action could be in producing a draught of air from surrounding parts to those in which they were lit. Dr. J. BIRD moved a vote of thanks to the President for the great interest and zeal he had displayed in promoting the objects of the Society. He referred to the testimony of the late Dr. M’Kenzie, with regard to the necessity of checking the premonitory diarrhoea, as well as to the influence of a

atmosphere

in

promoting the spread of

the dis-

ease.

Mr. RoGERS, seconding the vote of thanks to the President, bore testimony to the efficacy of the house-to-house visitation in the district of the parish of St. Anne’s placed under his care.

The vote of thanks having been put, and carriedDr. SNOW read some statistics, which tended to prove that Mr. Rogers was mistaken in attributing the sudden decrease of cholera in the parish of St. Anne’s to the steps taken by the authorities to ensure the prompt treatment of premonitory symptoms, the decline of the epidemic having commenced before those measures were adopted. Mr. HUNT read a paper by Mr. Bennett, Medical Officer to St. Giles’s parish, showing the influence which the sanitary measures adopted in that parish had had upon the progress of cholera since the first outbreak of the disease in London. Mr. Bennett considered that diarrhoea had no necessary connexion with cholera, excepting as a predisposing cause. That the outbreak of the disease might, or might not, be preceded by certain symptoms; which, however, were only to be looked upon as manifestations of the action of a peculiar poison previously introduced into the system. He thought the noncontagiousness of the disease to be proved by the fact, that although every case of cholera which applied was admitted into St. Giles’s workhouse, none of the previous inmates caught the disease. Dr. HEADLAM GREENHOW thought that house-to-house visitation had never been fairly tried, having generally been adopted too late ; but in places in which he had seen it tried, it appeared to him to have produced great effect in causing a decline of the disease. To provethe efficacy of early treatment, he mentioned the case of two workhouses, situated in the heart of an infected district, in one of which no case of cholera, and in the other only two, had occurred, owing to the strict measures which had been adopted for the treatment of premonitory symptoms. In one of them, St. Mary’s, Newington, Mr. Lownes, the medical officer, had adopted the system of posting persons at the doors of the water-closets, who reported the names of all who visited them more than once during the half day. By this means, they had discovered 260 cases of diarrhcea,