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PROGRESS OF MEDICINE IN AMERICA.
656
deficiency of males was greatest in Districts, and least in the Central Districts; but it is not probable that the proportion of unenumerated males was The
the North
PROGRESS OF MEDICINE IN AMERICA. THE first number of the New York Qaar4 greater in the North than in the South Districts. The proportion of females in excess terly Journal contains an interesting sum. appears to have some connection with the mary of the progress of medicine in America, increase of population. The females enu- by Dr. John Watson, from which we conmerated were 28 per cent. more numerous than the males in the North Districts; 13 to 18 per cent. in the West, South, and East Districts; and 8 per cent. in the Central Districts, where the population increased (1821-31) onlyper cent. annually; while it increased about 2 per cent. in the West, South, and East Districts, and 3.3 per cent. in the North Districts.
dense the following particulars :The only schools established for medical instruction in that country, before the Revo. lution, were those of Philadelphia and New York. As early as 1762, Dr. Wm. Shippen, of Philadelphia, after having completed his education in Europe, commenced a private course of lectures on anatomy and mid. wifery, to a class of ten pupils, one of whom Females to 1 Male Annual Rate of In 1765, Dr. enumerated 1831. Increase per Cent. was the celebrated Rush. North Districts...1.28 3.3 3 Morgan commenced a similar course on the West Districts...1.18 1.8 theory of medicine, including materia medi. South Districts.. 1.15 This last gentleman 2.1 ca and pharmacy. East Districts...1.13 soon afterwards addressed a letter to the 2.0 .5 trustees of the Philadelphia college, recom. Central Districts. 1.08 mending the establishment of a medical 1.8 under their auspices : whereupon he Metropolis. 1.16 In Great Britain, including the army, the was appointed professor of the institutes of mavy, and registered seamen, the proportion medicine, and Dr. Shippen, of anatomy and of males to females, in 1831, was 1 :1.026; surgery. In 1768, Dr. Adam Kuhn, a pupil exclusive of the army, navy, and registered of Linnaeus, returning home, was chosen .seamen, 1 : 1.062, with which the preceding professor of materia medica; and in the proportions for the Metropolitan Districts following year, Dr. Benjamin Rush, having completed his studies in Europe, was called may be compared. The hospitals are distributed over the 5 to the chair of chemistry. The establish. Districts, and can exercise little disturbing ment of the first medical school in New injuueiiee upon the relativerates of mortality. York, was principally effected by the exer. tions of Drs. Peter Middleton and Samuel January 23,1840. HEALTH OF THE. METROPOLIS. Bard. These two institutions gave pro. The Week end’ing January lIth, 1840.- mise of great benefit to the community; but The mortality was below the average; in the Revolution commencing soon after their other words, the health of the week was establishment, many of their professors were 9 per cent. above the standard. The tem. called to more urgent duties; and the agi· perature fell below the freezing point, and tated,state of public affairs for several years, remained. low during the week. Persons afterwards, in a great measure deprived the above 60.suffered from the cold, as the excess public of the benefits they might otherwise of deaths at that age demonstrated ; while have experienced from them. in childhood and manhood the mortality The labours of the medical professors, was below the average, Females suffered interrupted during the war, were renewed to a greater extent than males ; the deaths with increased zeal and activity on the of 502 females, and 465 males, having been restoration of peace. Four well regulated registered. This ratio is usually the reverse, I medical colleges were soon in operation, or 520 males to 493 females, Neither and spread the seeds of medical improve.
school
small-pox, measles, hooping cough, tophus, . nor any other epidemic disease, except scarlet fever, is prevailing; and the epidemic of scarlet feveris subsiding. Pneumonia is less fatal than it was a month ago ; but asthma,
connected with and difficult respiration, proved fatal to 97, while the weekly average (1838) was 68. Two women died in child bed ; the weekly average (1838) was S. Mortification proved fatal to 8, or double the weekly average (4) ; and the number of violent deaths, from drowning and other accidents, was increased by obvious causes. The practical deductions, from these facts, need not be pointed out to medical readers.
and
dropsy, commonly
disease of the
heart,
ment.
In the autumn of 1796, Dr. Elihu H. Smith conceived the project of a medical periodical, and in August, 1797, the first number of the " New-York Medical Reposi. tory" made its appearance. This work, the first of its kind, was warmly received and ably supported. In its pages are to be found valuable records of epidemics, and the other diseases of the country. Beginning with the yellow fever of 1793, it contains the complete history of that disease, up almost to its last appearance. It contains the most ample records of the spotted fever, a very fatal disorder, that prevailed in the northern and eastern parts of
657 the United States, from about 1807 until after the late war. It contains valuable memoirs on the typhoid pheumonia, that committed such havoc among the soldiers, and spread to different parts of the country,
during the years 1813-14, and for
a short time afterwards. It is rich in medical topography, and in the chemistry of the day, on which latter subject the celebrated Priestley was one of its diligent contributors. The medical literature of America, within the last forty years, has been enriched by a number of well digested compendiums on medical science. Many of the American authors, under-estimated at home, are held in high and deserved repute in Europe. Thus, " Wistar’s Anatomy" was at one time the text book in the University of Edinburgh; and for some years back, and even at the present time, " Eeck’s Medical Juris-prudence" is the most popular work on the subject in Great Britain and Ireland. The writings of Godman and Anderson are occasionally quoted by the French ; and those of Dr. Edward Miller gave the first suggestions towards what, by Broussais, has since been called the physiological doctrine of disease. Miller was a close and constant observer; and so ably has he investigated the pathology of fevers, that Broussais has since awarded him the honour of having been the first to arrive at a knowledge of their " He was the first," says true nature. Broussais," to consider the stomach in its Under his true physiological relations. pen, the phenomena of fever and the modus operandi of medicines, have acquired an interest which they had never had in our systematic works, even the most celebrated. How is it, therefore, possible (exclaims Broussais), that having so happily commenced, he should have rested here, without discovering the whole of the physiological doctrine which we now-a-days profess!" But the pupils of this celebrated theorist, who have already forsaken him, can best give the true response to this apostrophy. Miller was too much the admirer of truth, and too close an observer of nature, to be carried away by any theory, even by his own, to the extravagant extent of Broussais. ‘° Whatever advantages," sayshe, in the prospectus to theMedical Reposi. tory’-" whatever advantages may have been temporarily derived from certain elaborate theories, it is chiefly by the new spring which they have given to thé-mind, and by the more accurate investigation of natural phenomena, to which they have excited others, that they have been permanently useful. Our knowleege of nature is too limited, our collection of materials too scanty, to enable even the most diligent and industrious to frame a correct theory." In the exposition of his views of fever, Miller gave but a digest of his own obser.
before remarked, we can vations, and, clearly ’discover in them the dawnings of Broussais’s doctrine : and, notwithstanding the pains taken by this distinguished master to shield the originality of his own system, I am well convinced, even by his own acknowledgements, and without charging him with plagiarism, that he might have found in the writings of American authors, the elements of everything that is useful, and of almost everything that is true in his own doctrine. He has acknowledged that Rush should be classed amongst those who have con. tributed to the overthrow of the Brunonian system ; and to the introduction of what all the efforts of Sydenham had failed to introduce,-the antiphlogistic treatment. The philosophic spirit of Rush, he admits, is also manifest in the entire proscription of the nosologists. " But," says he, "notwithstanding the services thus rendered by him, 1st, in pleading for the antiphlogistic practice ; 2nd, in proscribing the systems of nosology ; 3rd, in labouring to overthrow the doctrine of specific diseases ; Rush has not given much importance to the irritability of the stomach and bowels in the production of diseases, although he has ably contributed to the treatment of such of them as are acute." Now we have’already seen from Broussais’s own acknowledgement, that Miller had actually accomplished, what Rush had left undone. With facts like these before us, to whom belongs the glory, if any be attached to it, of first suggesting the principles upon which has since been founded the whole system of physiological medicine? as
Benjamin Rush was the promulgator of what
has, scarcely with propriety, been called "the American System of Medicine,"a system confined to the University of Pennsylvania. At the time of commencing his career as a teacher, the doctrines of Cullen wets in the height of their popularity ; for although Brown had already reared his well known system against them, his influeuce had not yet been sufficient to subvert them, or drive them from the schools. Rush, however, in his opposition, both to them and to those of Brown, met with more success. The burthen of Rush’s doctrine, was, to establish the unity of disease. 11 I use the term diseases," says he, 14 in conformity to custom : for, properly speaking, disease is It consists simply as much a unit as fever. in‘morbid action or excitement in some part of the body. Its different seats and degrees should no more be multiplied into different diseases, than the numerous and different effects of heat and light upon our globe should be multiplied into a plurality of suns." In defence of this doctrine he made bold attacks upon those of his predecessors, especially the nosologists. " By the rejection of the artificial arrangement ef
658
diseases," says he, 14 a revolution must follow in medicine. Observation and judgment will take the place of reading and memory, and prescriptions will be conformed to existing circumstances. The road to knowledge in medicine, by this means, will likewise be shortened : so that a young man will be able to qualify himself to practise physic, at a much less expense of time and labour than formerly; as a child would learn to read and write by the help of the Roman alphabet, instead of the Chinese
and
Philosophical Register." The subject
finally taken up by one who has proved himself competent to unravel it ; and to the classical production of Dr. Joseph M. Smith, we must refer for the most beautiful, if not also the most thorough exposition, of the laws regulating the rise and prevalence of epidemic diseases, that has ever yet
was
appeared. In the pathology and treatment of several diseases, the physicians of America have introduced important improvements. The characters." management of pestilential diseases; the Rush’s theory of fever has long since been pathology and treatment of dropsies, espe. exploded : it is, therefore, unnecessary to cially dropsy of the head, first instituted by enter into the details of it. In his own prac- Rush, and since adopted in Europe; the tice, more especially in his riper years, treatment of cholera infantum, as suggested theory was subservient to judgment. He by Miller; of dysmennorrhoea, as suggested has left us descriptions of epidemics, and of by Dewees; of delirium tremens, as sug. many individual diseases, in which, for fi- gested by Knapp ; of hysteria, as suggested delity to nature, and just therapeutical indi- by Dr. J. M. Smith ; and of lunacy, as cations, he cannot be too closely imitated. practised in the asylums, are all important By his immense amount of useful observa- landmarks in the history of American medi. tions, he has been a benefactor to the pro- cine. But surgery advanced more rapidly. To enumerate the original and important fession. But’in the hands of his early followers, the simplicity of his theory too often operations; the introduction of new ones has been everything, and the practice that from precedents elsewhere; to cite the im. resulted from it has led to many a fatal issue, proved modes of practice, by which severe In the philosophy of epidemic and endemic operations have been avoided; the advances diseases, the literature of America is pecu- in surgical pathology ; the additions to the liarly worthy of notice. In no country has armamenta chirurgica, and the improve. the subject been so thoroughly investigated. ment in instruments already long in use; The writings of Bayley, Rush, Miller, Elihu must be to prove that in no place has sur. H. Smith, Seaman, Pascalis, and others, gery been more successfully cultivated than furnish a rich fund of original information in America. The names of Bayley, Jones, on this subject; and constitute what Miller Physick, Post, M’Knight, Dorsey, Nathan has emphatically characterized as " the Smith, and Hosack, among the dead; of American doctrine concerning the origin Mott, Stevens, M’Clellan, J. Rhea Barton, and propagation of endemic and pestilential Rodgers, Warren, White, Gibson, diseases."* Muzzy, and a host of others among the Richard Bayley in 1795 published a living, are worthy of the highest rank work on the yellow fever of that year, in among the surgeons of their day, for their which he proposed a distinction between share in these improvements. In the excision of bones, Dr. Mott’s recontagious and infectious disorders.This distinction," says the late Dr. Hosack moval of the clavicle, in 1828, his operation degree opposed to Bay- for extirpating a great part of the lower (himself in some ley’s view), " is in my opinion an approach jaw, in 1821 ; Dr. Stevens’s operation on nearer to the truth than any of his prede- the upper jaw, in 1823,* his extirpation of cessors have advanced, but it does not preIn the 20th vol. of the " Medico-Chirurg. sent us with view of the whole truth upon af Dr. Miller, following up Transactions," the credit of first having reo the subject, moved the upper jaw, is attributed by Mr. this distinction, has carried the investiga- Liston to Mr. Lizars of Edinburgh. The tion farther, and pointed out divisions of Dr. Stevens, and subsequently operation among the infectious classes. The views that of Dr. David L. Rogers, then of this of Dr. Hosack were not in accordance with were both antecedent to that of the either of these writers, nor with those of city, and were completely sue. Scotch the great body of the profession here. They cessful. surgeon, An account of Dr. Stevens’s ope. are, however, worthy of consideration ; but ration, which was performed on the 13th of as we cannot at presest enter upon this once 1823, may be found in the Appen. fruitful source of disputation, we must l’e- August, dix to Sterling’s" Translation ofVelpeau’s fer to his own of them in the Surgical AnatomyN. Y., 1830. Dr. second volume ofexposition the 11 American Medical operation was performed May, 1824, and was published in the *prefere in Med. third of the ninth vol. of the vol. of the" N. Y. Med. and Phys. * Preface Repos. Journal." Mr. Liston in his historical t 11 Amer. Med. and Philosoph. Regis- notice of operations on the upper jaw, makes
Dudley,
David L. Rogers’s
of
the
ter" vol. ii. p. 15.
of
no
mention of either of these.
659 the astragalus, in 1826 ; Muzzy’s removal of the scapula and clavicle together, in 1837; and Dr. R. Butts’s removal of the ulna, published in 1825 ; are, so far as we know, all original and successful innovations. Besides which, Drs. Brown and Hunt’s operation for dissecting out the head of the humerus and fractured portions of the scapula, on a soldier injured at the battle of Plattsburgh, in 1814, with the effect of saving both the limb and the use of the joint, is worthy of special observation. In operations for diseased joints, Dr. John Rhea Barton has rendered himself conspicuous. His operation for artificial
Rodgers’s amputation 1825, all successful. Besides these
at the elbow joint, in
might
also be mentioned
extirpation of the parotid gland ; orthoplastic operations of various kinds; extirpation of the uterus, and of ovarian tumours ; lithotrity, litbotripsy, improved modes of lithotomy, and the removal of calculi from the bladder without cutting; the treatment of aneurism by cold ; and the diseases of the anus by dilatation; the Csesarian section for the removal of the extra-uterine foetus, and an analogous operation for the removal of metallic bodies lodged in the small in. testines ; all performed with success, and all
hip joint, in 1826, and that for straighten- illustrative of the rank of this art in America. In operations upon the arteries, the prining an anchylosed and contracted knee, in 1835, were peculiarly original aud success- ciples laid down by Hunter, and the appliful. In the first of these he has been fol- cation of them by himself, Abernethy, and lowed by Dr. John Kearny Rodgers, of Cooper, have been successfully carried out New York, also with success :-and these in America; and have led to a number of two are the only operations of the kind that bold and important precedents, determining
have ever been performed. what should be, as well as what should not In the treatment of diseased bursas and be again attempted in this department of of hydrops articuli, as practised by the late surgery. In these achievements, the names Dr. Hubbard, of Yale College, thel surgery of Post, Mott, Muzzy, Gibson, White, and of the joints has been improved. In the others, are peculiarly worthy of distinction. treatment of morbus coxarius, Dr. Physick’s Such, then, is an outline, and but a brief apparatus is worthy of praise. It has been and imperfect one, of some of the most imapplied successfully by other surgeons, portant and memorable points in the history especially by Dr. A. H. Stevens, in treating of medicine in America. the diseases of other joints. Dr. Physick’s operation for ununited fracture, too, is known, appreciated, and successfully employed both in America and Europe. The mode of arresting capillary heemor- ROYAL MEDICAL AND CHIRURGIrhage by exposing wounds for a time to the CAL SOCIETY. air, so as to expedite the adhesive process after capital operations, first adopted by Tuesday, January 14, 1840. Dr. David Hosack, in 1813 (who, at that Dr. COPLAND, President. period, devoted much attention to surgery), is worthy of special notice here, inasmuch Contributions to the Pathology of New-born. as it has since been recommended by the Infants. By THOMAS H. BURGESS, M.D. surgeons of Edinburgh, who, doubtless un aware of Dr. Hosack’s claims, have taken APOPLEXY and asphyxia in new-born. to themselves much credit for the practice.* infants require such speedy and opposite In the operation for artificial anus, Dr. treatment, that their diagnosis is extremely Physick, in 1809, successfully instituted a important. Dr. Burgess undertakes; in this practice which has been imitated in other paper, to illustrate apoplexy, intending, on countries, and is claimed by the French as some future occasion, to pursue the subject one of the inventions of Baron Dupuytren. by observations on asphyxia. He details a In the operation on spina bifida, by ex- case of birth, in which there was some, but cision, Dr. Sherwood, of Rutland, in 1811, not unusual delay, which would ordinarily was completely successful ; and about a lead to little fear of injury from mechanical year since, Dr. A. H. Stevens succeeded in causes. The child cried loudly after the curing an aggravated case by a modification birth of the head, and again after the expulof Sir A. Cooper’s practice by puncture. sion of the body ; some mucosities were disInamputation of the joints, American sur- charged from the mouth; some food was geons, it is true, have no right to claim the taken; but within the first hour the hands precedence; nevertheless, we may refer to were observed to be of a slaty, mottled Dr. Buy )ey’s amputation at the shouldet-joini colour. Dr. Burgess, when sent for, found in 1782, as among the first successful ope- the ehild of a blue colour all over, except rations of the kind ; Dr. Mott’s amputation the nose, which was pale and cold ; the at the hip joint, in 1824 ; and Dr. J. Kearny infant moaned feebly, the mouth was drawn aside, the fingers were clenched, and, after a * See the " Amer. Medical and Philoso- little blood had flowed from the left nostril, the child died. phical Register," vol. iv. p. 63.
deficiency of males was greatest in Districts, and least in the Central Districts; but it is not probable that the proportion of unenumerated males was The
the North
PROGRESS OF MEDICINE IN AMERICA. THE first number of the New York Qaar4 greater in the North than in the South Districts. The proportion of females in excess terly Journal contains an interesting sum. appears to have some connection with the mary of the progress of medicine in America, increase of population. The females enu- by Dr. John Watson, from which we conmerated were 28 per cent. more numerous than the males in the North Districts; 13 to 18 per cent. in the West, South, and East Districts; and 8 per cent. in the Central Districts, where the population increased (1821-31) onlyper cent. annually; while it increased about 2 per cent. in the West, South, and East Districts, and 3.3 per cent. in the North Districts.
dense the following particulars :The only schools established for medical instruction in that country, before the Revo. lution, were those of Philadelphia and New York. As early as 1762, Dr. Wm. Shippen, of Philadelphia, after having completed his education in Europe, commenced a private course of lectures on anatomy and mid. wifery, to a class of ten pupils, one of whom Females to 1 Male Annual Rate of In 1765, Dr. enumerated 1831. Increase per Cent. was the celebrated Rush. North Districts...1.28 3.3 3 Morgan commenced a similar course on the West Districts...1.18 1.8 theory of medicine, including materia medi. South Districts.. 1.15 This last gentleman 2.1 ca and pharmacy. East Districts...1.13 soon afterwards addressed a letter to the 2.0 .5 trustees of the Philadelphia college, recom. Central Districts. 1.08 mending the establishment of a medical 1.8 under their auspices : whereupon he Metropolis. 1.16 In Great Britain, including the army, the was appointed professor of the institutes of mavy, and registered seamen, the proportion medicine, and Dr. Shippen, of anatomy and of males to females, in 1831, was 1 :1.026; surgery. In 1768, Dr. Adam Kuhn, a pupil exclusive of the army, navy, and registered of Linnaeus, returning home, was chosen .seamen, 1 : 1.062, with which the preceding professor of materia medica; and in the proportions for the Metropolitan Districts following year, Dr. Benjamin Rush, having completed his studies in Europe, was called may be compared. The hospitals are distributed over the 5 to the chair of chemistry. The establish. Districts, and can exercise little disturbing ment of the first medical school in New injuueiiee upon the relativerates of mortality. York, was principally effected by the exer. tions of Drs. Peter Middleton and Samuel January 23,1840. HEALTH OF THE. METROPOLIS. Bard. These two institutions gave pro. The Week end’ing January lIth, 1840.- mise of great benefit to the community; but The mortality was below the average; in the Revolution commencing soon after their other words, the health of the week was establishment, many of their professors were 9 per cent. above the standard. The tem. called to more urgent duties; and the agi· perature fell below the freezing point, and tated,state of public affairs for several years, remained. low during the week. Persons afterwards, in a great measure deprived the above 60.suffered from the cold, as the excess public of the benefits they might otherwise of deaths at that age demonstrated ; while have experienced from them. in childhood and manhood the mortality The labours of the medical professors, was below the average, Females suffered interrupted during the war, were renewed to a greater extent than males ; the deaths with increased zeal and activity on the of 502 females, and 465 males, having been restoration of peace. Four well regulated registered. This ratio is usually the reverse, I medical colleges were soon in operation, or 520 males to 493 females, Neither and spread the seeds of medical improve.
school
small-pox, measles, hooping cough, tophus, . nor any other epidemic disease, except scarlet fever, is prevailing; and the epidemic of scarlet feveris subsiding. Pneumonia is less fatal than it was a month ago ; but asthma,
connected with and difficult respiration, proved fatal to 97, while the weekly average (1838) was 68. Two women died in child bed ; the weekly average (1838) was S. Mortification proved fatal to 8, or double the weekly average (4) ; and the number of violent deaths, from drowning and other accidents, was increased by obvious causes. The practical deductions, from these facts, need not be pointed out to medical readers.
and
dropsy, commonly
disease of the
heart,
ment.
In the autumn of 1796, Dr. Elihu H. Smith conceived the project of a medical periodical, and in August, 1797, the first number of the " New-York Medical Reposi. tory" made its appearance. This work, the first of its kind, was warmly received and ably supported. In its pages are to be found valuable records of epidemics, and the other diseases of the country. Beginning with the yellow fever of 1793, it contains the complete history of that disease, up almost to its last appearance. It contains the most ample records of the spotted fever, a very fatal disorder, that prevailed in the northern and eastern parts of
657 the United States, from about 1807 until after the late war. It contains valuable memoirs on the typhoid pheumonia, that committed such havoc among the soldiers, and spread to different parts of the country,
during the years 1813-14, and for
a short time afterwards. It is rich in medical topography, and in the chemistry of the day, on which latter subject the celebrated Priestley was one of its diligent contributors. The medical literature of America, within the last forty years, has been enriched by a number of well digested compendiums on medical science. Many of the American authors, under-estimated at home, are held in high and deserved repute in Europe. Thus, " Wistar’s Anatomy" was at one time the text book in the University of Edinburgh; and for some years back, and even at the present time, " Eeck’s Medical Juris-prudence" is the most popular work on the subject in Great Britain and Ireland. The writings of Godman and Anderson are occasionally quoted by the French ; and those of Dr. Edward Miller gave the first suggestions towards what, by Broussais, has since been called the physiological doctrine of disease. Miller was a close and constant observer; and so ably has he investigated the pathology of fevers, that Broussais has since awarded him the honour of having been the first to arrive at a knowledge of their " He was the first," says true nature. Broussais," to consider the stomach in its Under his true physiological relations. pen, the phenomena of fever and the modus operandi of medicines, have acquired an interest which they had never had in our systematic works, even the most celebrated. How is it, therefore, possible (exclaims Broussais), that having so happily commenced, he should have rested here, without discovering the whole of the physiological doctrine which we now-a-days profess!" But the pupils of this celebrated theorist, who have already forsaken him, can best give the true response to this apostrophy. Miller was too much the admirer of truth, and too close an observer of nature, to be carried away by any theory, even by his own, to the extravagant extent of Broussais. ‘° Whatever advantages," sayshe, in the prospectus to theMedical Reposi. tory’-" whatever advantages may have been temporarily derived from certain elaborate theories, it is chiefly by the new spring which they have given to thé-mind, and by the more accurate investigation of natural phenomena, to which they have excited others, that they have been permanently useful. Our knowleege of nature is too limited, our collection of materials too scanty, to enable even the most diligent and industrious to frame a correct theory." In the exposition of his views of fever, Miller gave but a digest of his own obser.
before remarked, we can vations, and, clearly ’discover in them the dawnings of Broussais’s doctrine : and, notwithstanding the pains taken by this distinguished master to shield the originality of his own system, I am well convinced, even by his own acknowledgements, and without charging him with plagiarism, that he might have found in the writings of American authors, the elements of everything that is useful, and of almost everything that is true in his own doctrine. He has acknowledged that Rush should be classed amongst those who have con. tributed to the overthrow of the Brunonian system ; and to the introduction of what all the efforts of Sydenham had failed to introduce,-the antiphlogistic treatment. The philosophic spirit of Rush, he admits, is also manifest in the entire proscription of the nosologists. " But," says he, "notwithstanding the services thus rendered by him, 1st, in pleading for the antiphlogistic practice ; 2nd, in proscribing the systems of nosology ; 3rd, in labouring to overthrow the doctrine of specific diseases ; Rush has not given much importance to the irritability of the stomach and bowels in the production of diseases, although he has ably contributed to the treatment of such of them as are acute." Now we have’already seen from Broussais’s own acknowledgement, that Miller had actually accomplished, what Rush had left undone. With facts like these before us, to whom belongs the glory, if any be attached to it, of first suggesting the principles upon which has since been founded the whole system of physiological medicine? as
Benjamin Rush was the promulgator of what
has, scarcely with propriety, been called "the American System of Medicine,"a system confined to the University of Pennsylvania. At the time of commencing his career as a teacher, the doctrines of Cullen wets in the height of their popularity ; for although Brown had already reared his well known system against them, his influeuce had not yet been sufficient to subvert them, or drive them from the schools. Rush, however, in his opposition, both to them and to those of Brown, met with more success. The burthen of Rush’s doctrine, was, to establish the unity of disease. 11 I use the term diseases," says he, 14 in conformity to custom : for, properly speaking, disease is It consists simply as much a unit as fever. in‘morbid action or excitement in some part of the body. Its different seats and degrees should no more be multiplied into different diseases, than the numerous and different effects of heat and light upon our globe should be multiplied into a plurality of suns." In defence of this doctrine he made bold attacks upon those of his predecessors, especially the nosologists. " By the rejection of the artificial arrangement ef
658
diseases," says he, 14 a revolution must follow in medicine. Observation and judgment will take the place of reading and memory, and prescriptions will be conformed to existing circumstances. The road to knowledge in medicine, by this means, will likewise be shortened : so that a young man will be able to qualify himself to practise physic, at a much less expense of time and labour than formerly; as a child would learn to read and write by the help of the Roman alphabet, instead of the Chinese
and
Philosophical Register." The subject
finally taken up by one who has proved himself competent to unravel it ; and to the classical production of Dr. Joseph M. Smith, we must refer for the most beautiful, if not also the most thorough exposition, of the laws regulating the rise and prevalence of epidemic diseases, that has ever yet
was
appeared. In the pathology and treatment of several diseases, the physicians of America have introduced important improvements. The characters." management of pestilential diseases; the Rush’s theory of fever has long since been pathology and treatment of dropsies, espe. exploded : it is, therefore, unnecessary to cially dropsy of the head, first instituted by enter into the details of it. In his own prac- Rush, and since adopted in Europe; the tice, more especially in his riper years, treatment of cholera infantum, as suggested theory was subservient to judgment. He by Miller; of dysmennorrhoea, as suggested has left us descriptions of epidemics, and of by Dewees; of delirium tremens, as sug. many individual diseases, in which, for fi- gested by Knapp ; of hysteria, as suggested delity to nature, and just therapeutical indi- by Dr. J. M. Smith ; and of lunacy, as cations, he cannot be too closely imitated. practised in the asylums, are all important By his immense amount of useful observa- landmarks in the history of American medi. tions, he has been a benefactor to the pro- cine. But surgery advanced more rapidly. To enumerate the original and important fession. But’in the hands of his early followers, the simplicity of his theory too often operations; the introduction of new ones has been everything, and the practice that from precedents elsewhere; to cite the im. resulted from it has led to many a fatal issue, proved modes of practice, by which severe In the philosophy of epidemic and endemic operations have been avoided; the advances diseases, the literature of America is pecu- in surgical pathology ; the additions to the liarly worthy of notice. In no country has armamenta chirurgica, and the improve. the subject been so thoroughly investigated. ment in instruments already long in use; The writings of Bayley, Rush, Miller, Elihu must be to prove that in no place has sur. H. Smith, Seaman, Pascalis, and others, gery been more successfully cultivated than furnish a rich fund of original information in America. The names of Bayley, Jones, on this subject; and constitute what Miller Physick, Post, M’Knight, Dorsey, Nathan has emphatically characterized as " the Smith, and Hosack, among the dead; of American doctrine concerning the origin Mott, Stevens, M’Clellan, J. Rhea Barton, and propagation of endemic and pestilential Rodgers, Warren, White, Gibson, diseases."* Muzzy, and a host of others among the Richard Bayley in 1795 published a living, are worthy of the highest rank work on the yellow fever of that year, in among the surgeons of their day, for their which he proposed a distinction between share in these improvements. In the excision of bones, Dr. Mott’s recontagious and infectious disorders.This distinction," says the late Dr. Hosack moval of the clavicle, in 1828, his operation degree opposed to Bay- for extirpating a great part of the lower (himself in some ley’s view), " is in my opinion an approach jaw, in 1821 ; Dr. Stevens’s operation on nearer to the truth than any of his prede- the upper jaw, in 1823,* his extirpation of cessors have advanced, but it does not preIn the 20th vol. of the " Medico-Chirurg. sent us with view of the whole truth upon af Dr. Miller, following up Transactions," the credit of first having reo the subject, moved the upper jaw, is attributed by Mr. this distinction, has carried the investiga- Liston to Mr. Lizars of Edinburgh. The tion farther, and pointed out divisions of Dr. Stevens, and subsequently operation among the infectious classes. The views that of Dr. David L. Rogers, then of this of Dr. Hosack were not in accordance with were both antecedent to that of the either of these writers, nor with those of city, and were completely sue. Scotch the great body of the profession here. They cessful. surgeon, An account of Dr. Stevens’s ope. are, however, worthy of consideration ; but ration, which was performed on the 13th of as we cannot at presest enter upon this once 1823, may be found in the Appen. fruitful source of disputation, we must l’e- August, dix to Sterling’s" Translation ofVelpeau’s fer to his own of them in the Surgical AnatomyN. Y., 1830. Dr. second volume ofexposition the 11 American Medical operation was performed May, 1824, and was published in the *prefere in Med. third of the ninth vol. of the vol. of the" N. Y. Med. and Phys. * Preface Repos. Journal." Mr. Liston in his historical t 11 Amer. Med. and Philosoph. Regis- notice of operations on the upper jaw, makes
Dudley,
David L. Rogers’s
of
the
ter" vol. ii. p. 15.
of
no
mention of either of these.
659 the astragalus, in 1826 ; Muzzy’s removal of the scapula and clavicle together, in 1837; and Dr. R. Butts’s removal of the ulna, published in 1825 ; are, so far as we know, all original and successful innovations. Besides which, Drs. Brown and Hunt’s operation for dissecting out the head of the humerus and fractured portions of the scapula, on a soldier injured at the battle of Plattsburgh, in 1814, with the effect of saving both the limb and the use of the joint, is worthy of special observation. In operations for diseased joints, Dr. John Rhea Barton has rendered himself conspicuous. His operation for artificial
Rodgers’s amputation 1825, all successful. Besides these
at the elbow joint, in
might
also be mentioned
extirpation of the parotid gland ; orthoplastic operations of various kinds; extirpation of the uterus, and of ovarian tumours ; lithotrity, litbotripsy, improved modes of lithotomy, and the removal of calculi from the bladder without cutting; the treatment of aneurism by cold ; and the diseases of the anus by dilatation; the Csesarian section for the removal of the extra-uterine foetus, and an analogous operation for the removal of metallic bodies lodged in the small in. testines ; all performed with success, and all
hip joint, in 1826, and that for straighten- illustrative of the rank of this art in America. In operations upon the arteries, the prining an anchylosed and contracted knee, in 1835, were peculiarly original aud success- ciples laid down by Hunter, and the appliful. In the first of these he has been fol- cation of them by himself, Abernethy, and lowed by Dr. John Kearny Rodgers, of Cooper, have been successfully carried out New York, also with success :-and these in America; and have led to a number of two are the only operations of the kind that bold and important precedents, determining
have ever been performed. what should be, as well as what should not In the treatment of diseased bursas and be again attempted in this department of of hydrops articuli, as practised by the late surgery. In these achievements, the names Dr. Hubbard, of Yale College, thel surgery of Post, Mott, Muzzy, Gibson, White, and of the joints has been improved. In the others, are peculiarly worthy of distinction. treatment of morbus coxarius, Dr. Physick’s Such, then, is an outline, and but a brief apparatus is worthy of praise. It has been and imperfect one, of some of the most imapplied successfully by other surgeons, portant and memorable points in the history especially by Dr. A. H. Stevens, in treating of medicine in America. the diseases of other joints. Dr. Physick’s operation for ununited fracture, too, is known, appreciated, and successfully employed both in America and Europe. The mode of arresting capillary heemor- ROYAL MEDICAL AND CHIRURGIrhage by exposing wounds for a time to the CAL SOCIETY. air, so as to expedite the adhesive process after capital operations, first adopted by Tuesday, January 14, 1840. Dr. David Hosack, in 1813 (who, at that Dr. COPLAND, President. period, devoted much attention to surgery), is worthy of special notice here, inasmuch Contributions to the Pathology of New-born. as it has since been recommended by the Infants. By THOMAS H. BURGESS, M.D. surgeons of Edinburgh, who, doubtless un aware of Dr. Hosack’s claims, have taken APOPLEXY and asphyxia in new-born. to themselves much credit for the practice.* infants require such speedy and opposite In the operation for artificial anus, Dr. treatment, that their diagnosis is extremely Physick, in 1809, successfully instituted a important. Dr. Burgess undertakes; in this practice which has been imitated in other paper, to illustrate apoplexy, intending, on countries, and is claimed by the French as some future occasion, to pursue the subject one of the inventions of Baron Dupuytren. by observations on asphyxia. He details a In the operation on spina bifida, by ex- case of birth, in which there was some, but cision, Dr. Sherwood, of Rutland, in 1811, not unusual delay, which would ordinarily was completely successful ; and about a lead to little fear of injury from mechanical year since, Dr. A. H. Stevens succeeded in causes. The child cried loudly after the curing an aggravated case by a modification birth of the head, and again after the expulof Sir A. Cooper’s practice by puncture. sion of the body ; some mucosities were disInamputation of the joints, American sur- charged from the mouth; some food was geons, it is true, have no right to claim the taken; but within the first hour the hands precedence; nevertheless, we may refer to were observed to be of a slaty, mottled Dr. Buy )ey’s amputation at the shouldet-joini colour. Dr. Burgess, when sent for, found in 1782, as among the first successful ope- the ehild of a blue colour all over, except rations of the kind ; Dr. Mott’s amputation the nose, which was pale and cold ; the at the hip joint, in 1824 ; and Dr. J. Kearny infant moaned feebly, the mouth was drawn aside, the fingers were clenched, and, after a * See the " Amer. Medical and Philoso- little blood had flowed from the left nostril, the child died. phical Register," vol. iv. p. 63.