namely the present condition of medicine, which is, as indeed it ought to be in the present advanced state of general science, much improved from former times. Its very nature prevents it from proceeding in that uninterrupted progress of improvement which some other departments of knowledge might be expected to do, as it is after all a matter rather of individual observation, than consisting of facts, or codes and precepts, which may be handed down from father to son, like the facts of natural science, or the principles resulting from moral and political investigations; but medicine is in a better state than it was formerly, were it only that its professors have come to recognise duly its peculiar nature, and the mode which each individual is to pursue if he wishes to learn the science as it ought to be learned, or practise it as it ought to be practised. 206. The medical art, says an able writer of the present day, is one of judgment, not of rules. Unless the judgment have been exercised and matured, rules are of very little use. This peculiarity belongs almost exclusively to medicine. The divine has the authority of Scripture for his guide; the lawyer the decisions and precedents of former times. What was yesterday true and binding in doctrine, or in authority, is equally so to-day. But the physician has no standard to direct him in the hour of doubt and danger. The father and founders of his art may assert, but cannot determine for him. Upon his own clearness of perception, and soundness of judgment, must his reputation, and the life of his patient, stand or fall. The young practitioner, who, with a name for curing disease, thinks he has also an infallible rule to guide, him in his treatment, often finds himself involved in perplexities which no rule of art will assist him to unravel. 207. We shall merely add that the medicine of the present day has been much improved by the successful labors of the anatomical physiologists, especially of Bichat, in pointing out the peculiar susceptibilities of the respective membranes which enter into the composition of the human frame. It must be allowed that the pathological and therapeutic principles which have resulted from these membranous views, if so they may be termed, have been taken up and acted upon in too extended and exclusive a spirit; but it must at the same time be admitted that much of practical good, as well as of theoretical precision, has resulted from a temperate and moderate application of the doctrines to which they have conducted. One of our latest and best authors on medicine has dwelt particularly on these points, as giving a new complexion to the theory of the science; and we cannot perhaps better conclude this preliminary discourse, than by presenting our readers with the following extract from the writer to whom we refer-Dr. James Gregory. It has appeared to the author,' says Dr. G. in the preface to his Elements, that in the course of the last twenty years the science of medicine has undergone so considerable a change, as to render an attempt to give a new view of the elements of pathology, and the practice of physic, not altogether presumptuous. Without desiring to enquire to what particular causes this change is to be ascribed, or how far the science has profited by it, it will be sufficient for his purpose to allude very generally to the influence which the works of Baillie and Bichat have had in bringing it about. To the former much praise is due for directing the attention of the profession to the investigation of morbid anatomy, more effectually than had been done by Morgagni, his laborious, but diffuse, predecessor, in the same branch of study. The effects of disease in the alteration of structure have been by his means more clearly developed, and in many cases the seats of disease more accurately ascertained. 208. But it is to the labors of Bichat that medicine is more particularly indebted for those changes in its aspect to which allusion has just been made, and which must be obvious to all in the general tone and character of the medical writings of the present time. His Anatomie Générale, and Traité des Membranes, present new and beautiful views of the animal economy, which are obviously fitted to become the basis of all pathology, by illustrating the origin of disease in the different structures of the body. The influence of these views on medical reasonings is daily becoming more apparent, and is now felt, if not acknowledged, by many who are yet strangers to Bichat's works. 209. It is a supposition borne out by the evidence of history, that the progress of medicine is upon the whole in the great road of improvement. It is unfair to argue that the science is retrograde because we occasionally recur to an ancient opinion or practice. Considering the mass of books which have been written on medical subjects, it would appear scarcely possible to invent a practice, or to offer an opinion, which may not be traced in the writings of former authors; but it is not in this way that the value of any new suggestion can be ascertained, or the state of medical practice at any one period justly appreciated. To form an estimate of either, it is necessary to look to the great body of pathology, and it is here that we shall find those improvements which modern medicine may boast. Nor must it be supposed that improvements in pathology are necessarily followed by corresponding changes in the methods of treating diseases. These, it has long been observed, have continued nearly the same through every variety of pathological doctrine. It is enough to say, that the powers of medicines do not necessarily keep pace with the powers of the human mind, in investigating the causes, and tracing the relations, of disease.' PART II. NOSOLOGY AND NOMENCLATURE. 210. Since the human mind is so constructed as that order and arrangement prove vast assistants to observation and memory, the cultivators of all sciences, the objects of which embrace many particulars, have ever been industriously engaged in forming schemes, by which, principally upon the ground of analogy and resemblance, the memory is materially assisted. It is upon this approach as it were to accordance, that those classifications have been made in the science of natural history, which have essentally abridged the labors of the student, and thus served greatly to invite and assist in the acquisition of knowledge. In that branch, for example, of natural science, which is termed botany, the projectors of the schemes now referred to have assumed, that if out of three plants two of them are analogous in more particulars than the third, they shall as it were be made to have a nearer relationship to each other in the way of designation—or shall, in the distribution of particulars, be referred to one class; and whatever scheme of classification be pursued, whether from more obvious and natural, or more assumed, or, as it may be considered, artificial alliance, the fundamental principle of all arrangement is the same, viz. a point or points of resemblance. Hence the origin of class, order, genus, species, and varieties. Now it was natural enough for those individuals who gave themselves to the study of disease, and to facilitating the acquisition of medical knowledge, to conceive that the multiform aspects of disordered manifestations might be brought within the compass of a generalising scheme upon the same principles as those which had regulated other branches of science. 211. But, in the application of these principles to the medical art, difficulties oppose themselves which are not found to interfere with truth and precision, to any thing like the same extent, in other cases. If we are not allowed to call medicine occult and conjectural, it is at least, so to say, circumstantial; and to suppose that two diseases may be identified, by certain parts and properties, as you name and classify a plant by the number of its petals and the form of its corolla, is to assume a matter upon a somewhat erroneous ground. We allow, indeed, that external circumstance, as in the case of more or less of artificial cultivation even in the vegetable tribes, will come eventually to transform external appearance, and thus to interfere with the order of arrangement which has been instituted upon outward resemblance; but this does not take place with any thing like the same rapidity and facility as occurs in the instance of disorder, in which, unless the cause which excites it operate with so much force as to overcome constitutional states, and thus to authorise designation from the exciting cause, as we find in the specific distempers of small pox and measles, and some other malignant contagions; unless, we say, this be the case, the excitation of disease shall be so modified by the varied circumstances or constitutional susceptibilities of the recipient, that a certain number and aggregate of external symbols can never be predicted as absolutely necessary for the presence of this or of that malady. 212. When, therefore, systematic authors even name a disease, we must for the most part take such enunciation as having something in it presumptive and uncertain; unless indeed, by a kind of metonymical management, we substitute the cause of the ailment for the actual ailment itself, as is sometimes done in medical nomenclature; when, for example, we say of an individual that he has got a cold. But even in this case, and supposing this principle of designation to obtain universally, how great would be the consequent confusion and indecision; for when a person speaks of having a cold in his head, his limbs, or his chest, he often applies the same term to affections widely differing in their essential nature and external showings, since cold may produce spasm, excite inflammation, or derange in a variety of ways and degrees; and classification at once from cause and symptoms would be wanting in every thing that should approach to precision. 213. But, besides this source of indistinctness and error, there is yet a further objection, and that of a formidable and insuperable nature, against precision in nomenclature, when the cause is thus taken for the effect; inasmuch as a diversity of opinion exists as to the actual essence and mode of operation of the cause itself. The term typhus, in its application to a form of fever excites in the minds of many physicians the idea of contagion, of a specific or peculiar kind, as the source of the distemper; others again conceive that atmospheric change, or change of temperature, or famine, or filth, may produce typhus without the aid of contagion; while a third set of theorists altogether contemn and deride the notion of contagious influence as excitative of the malady in question; and contend that there is not only no necessity for a miasm or poison to engender the malady, but that it never is so produced; and this point, which à priori one should imagine would soon and easily be brought to the test of ascertainment, is still one of dispute and uncertainty. 214. If then the mere naming or designation of a disease with any thing like precision be attended with so many impediments, how much must the difficulty be increased when we attempt to arrange and to classify morbid states according to analogical resemblances! Let us turn to that scheme which has obtained the greatest credit in this country of any that has yet been offered, and which we ourselves, for reasons afterwards to be given, shall adopt in the present article, viz. that framed by the celebrated Cullen. Now this author, and we take the example at random, places hæmorrhage from the lungs, and intermittent fever, in the same class-and why? Is it because the two maladies have any character in common like the number and shape of petals in two plants? No; it is simply because both diseases, widely different as they are both in cause and symptoms and every thing in fact, have to do in an especial manner with the bloodvessels; and even in this particular an hypothesis is involved, which is inconsistent with accuracy of arrangement, since it may be disputed whether this same intermittent fever has not more to do with the nerves than with the bloodvessels, and, therefore, whether it might not with more propriety have been classed among derangements of the nervous system. 215. A recent attempt has been made, of a learned and laborious cast, to arrange and designate diseases as the separate functions considered physiologically are affected. This system of nosology comprises seven classes, viz. diseases of the digestive function; the respiratory function; the sanguineous function; the nervous function; the sexual function; and the excernent function: the seventh division or class com prehending fortuitous læsions or deformities. But this system is, in common with all others that have preceded it, obnoxious in the first place to similar objections, viz. the frequent difficulty, nay occasional impossibility, of predicating by any certain signs the particular function which was first the subject of disorder; and more especially since one function cannot well take on a deranged action, without at the same time, or in short succession, deranging several others. Allowing, for example, that the word asthma stands as a proper cognomen for the internal condition it professes to point out, how shall we with any propriety class it as an affection either of the respiratory or digestive function, till we are agreed as to the manner in which the malady is engendered, or till we have settled the disputed point whether it be one of sympathy with the first passages, or whether it be inherently, absolutely, and invariably a pulmonary, or, in other words, a respiratory de rangement. 216. But, further, these physiological systems or schemes of arrangement have another very material inconvenience to contend with, since, for the sake of following functions, they necessarily separate by very wide gaps disorders of the same organs and parts; for while,' as the learned author whose system we now more particularly advert to, himself admits, 'inflammation of the stomach and bowels belong as inflammatory affections to one class, indigestion and cholera, though disorders of the same organs, must necessarily from their nature be ranged under another.' 217. These objections apply mainly to classification; the nomenclature from symptoms, or supposed causes, must necessarily be open to the same sources of error in this as in every other invention of the nosologist to comprise morbid states under a few leading divisions, according to their points of resemblance. 218. By some individuals, who have seen the difficulties connected with the formation of schemes and classifications in the abstract way above referred to, an anatomical plan of procedure has been proposed, such as taking the human body and commencing with any given portion of it, proceeding upwards or downwards as we shall have fixed upon any starting point. But unfortunately, as it has elsewhere been remarked, medical and anotomical science do not go hand in hand through all the mazes of morbid being; or at any rate sometimes one and sometimes the other will be lost in shade as the eye of the observer aims at pursuing them through all their intricate walks and meanderings. Epilepsy, for instance, in an anatomical scheme of classification would be put down as a disorder of the head; but who that has not a disorder in his own head does not know, that this manifestation of morbid state at times arises from deranged conditions of parts very different from the head? And whether, when we take anatomical topography for our guide, should we be right in classing gout, when we had got to the head, or the stomach, or the liver, or defer it till we had traced our course of descriptive affection down as far as the great toe? 219. Although then, as will immediately be seen, we shall select a plan of arrangement of an artificial or abstract kind, when we come to trace the several items of disordered being; we wish to impress on our readers, and on students of medicine generally, that the classifier and namer of diseases is very differently circumstanced from the individual who undertakes to invent classes and orders for the designation and distribution of the particulars belonging to the science of natural history. 220. Plater, in his Praxis Medica, published in 1602, was the first distinctly to indicate the possibility of thus arranging diseases, and the celebrated Sydenham almost simultaneously conceived the same design; but to Sauvages are we indebted for the primary elaboration of a systematic arrangement, founded upon the intimations of the above-named individuals. The celebrated Linnæus followed in the same track, and Vogel followed Linnæus. Sagar again enlarged and modified the system of Sauvages into one of his own. Cullen's, which is the system we shall adopt, for reasons immediately to be given, succeeded to that of Vogel. M'Bride and Crichton proposed improvements upon the Cullenian synopses, and Dr. Darwin's system of nosology is entirely novel. Dr. Parr subsequently made an attempt, under the feeling that the natural order of the diseases had been too much disregarded by his predecessors; and Dr. Mason Good, as we have above intimated, has presented a labored and most ingenious classification, founded on physiological principles. 221. We shall only be able to find room for the heads or leading divisions of these several schemes, with the exception of that invented by Dr. Cullen, whose classification we shall transcribe through all its details, as it is the system we shall adopt in the present article; and we shall do this first, because we think the definitions of Dr. Cullen, are the most faithful that have been given; secondly, because its terminology, however open to objection in many of its particulars, harmonises more than any other with the language which is still generally employed in most schools of medicine in this country; and lastly, because by recognising the three leading principles of the animal economy-circulation, sensation, and absorption, his system is perhaps as physiologically accurate as it is possible for one to be constructed. The great defect of Dr. Cullen (we speak now upon the assumption of schemes being admissible) is the introduction of the class locales; for, besides that objections might be urged against the propriety of thus separating general from topical disorders, many of the affections which are comprised among the local are unequivocally of general or systematic origin; but on this head we shall have to offer another intimation or two in our running commentary on the nosology, to which we shall proceed after first, as it has been proposed, presenting the general heads of the systems above referred to. Of these systems, Dr. Good will fall the last in order, and to its transcription we shall take the liberty of adding a long extract from his System of Nosology, bearing upon a most important part of the medical science, we mean the nomenclature. It cannot be expected that reformations, such as Dr. Good contemplates, will be all at once 3. Fluxes. 4. Painful diseases. 5. Spasmodic diseases. 6. Weaknesses or privation. Class II. Local diseases. 2. Of the external senses. 3. Of the appetites. 4. Of the secretions and excretions. 5. Impeding different actions. 6. Of the external habit. 7. Dislocations. 8. Solutions of continuity. Class III. Serual diseases. Order 1. General proper to men. 2. Local proper to men. 3. General proper to women. 4. Local proper to women. Class IV. Infantile diseases. Order 1. General. 2. Local. VOL. XIV. 6. Eccritica. 7. Tychica, which includes fortuitous læsions, and deformities. 222. We now present our readers with the following promised extract from the ingenious framer of the last of the above schemes, and we recommend the book itself from which we extract it to the attention of the medical student as full both of literary and practical information. We recommend at the same time, to the literary student of medicine, Dr. Young's Introduction to Medical Literature, which beside being a digest of anatomical, physiological, and therapeutical knowledge, contains also another indication of a nosological scheme founded on the principles of physiology, or natural function. 223. In the hope, says Dr. Good, of giving some degree of improvement to the medical vocabulary, as far as he may have occasion to employ it, the author has endeavoured to guide himself by the following general rules:-First, a strict adherence to Greek and Latin terms alone. Secondly, a use of as few technical terms as possible, and consequently a forbearance from all synonyms. Thirdly, a simplification of terms, as far as it can be done without violence or affectation, both in their radical structure and composition. Fourthly, an individuality and precision of sense in their respective use. 224 (1). As the science of medicine is open to all ages and nations, it would be highly beneficial, if it could be accomplished, that its technology should be confined to one alone of the many tongues from which it is at present derived. No modern tongue, however, would be D allowed such a precedency; and, were it to be granted, there is no none so richly endowed with distinct names for diseases as to enable it to specificate every complaint of which a system of nosology is expected to treat. Dr. Macbride has made a trial of our own tongue, and has completely failed; for the generic terms, under several of his orders, are entirely exotic, and under most of them very considerably so, being partly Greek, partly Latin, and partly English, uncouthly mixed together for the sake of convenience, like foreigners from all countries at a Hamburg hotel. 225. Our choice, therefore, is limited to the Greek and Latin, which have for ages maintained so equal a sway in the province of medicine, that they must still be allowed to exercise a joint control. It is a singular fact, that the Greek has furnished us with by far the greater number of terms that distinguish the higher divisions of systematic nosology, the classes, orders, and genera; and the Latin those employed to indicate the species and varieties. The systems of Linnæus and Darwin offer, perhaps, the only exception to this remark; for here we meet with attempts to use the Latin tongue alone, or at least to give it a considerable preponderancy. These examples, however, have not been followed, and are not likely to be so. The greater flexibility, indeed, and facility of combination belonging to the Greek has, on the contrary, induced almost all other nosologists, as well as almost all other men of science, to turn to it for assistance far more frequently than to the Latin. The author has availed himself of this general taste; and, by an occasional revival of terms which ought never to have been dropped, has been able so far to simplify the nomenclature of his classes, orders, and genera, as to render them exclusively Greek; and consequently to take his leave, thus far, of all other languages whatever. The changes introduced for this purpose are by no means numerous, and will in no instance, as he trusts, betray affectation or coercion. His authorities will usually be found in Celsus or Galen, who have carefully handed down to us the distinctive terms both of the earlier and the later schools of Greece; and, if at any time he has had occasion to wander farther, he has usually supplied himself from Aetius, Cælius Aurelianus, Dioscorides, or Aristotle. The sources, however, from which he has drawn, are in every case indicated, and, he ventures to hope, will be generally, approved. Concerning the specific names he has been less scrupulous; and has allowed those to stand, whether Greek or Latin, that are already in most common use; or has drawn from either language such as may most fitly express the essential character, wherever such character can be traced out. Yet even here he has never wandered from the Greek farther than into the Latin. 226. (2). The machinery of every art or science becomes simpler, and its auxiliary powers fewer and less needed, as it advances towards perfection. It is the same with their technology. While we are but loosely acquainted with the principles of an art we speak of them with circumlocution, and employ more words than are necessary, because we have none that will come immediately to the point. As we grow more expert we learn to make a selection; we give to many of them a greater degree of force and precision; and separate those that are thus rendered of real value from the leather and prunello,' the heavy outside show of useless and unmeaning terms with which they are associated; and thus gain in time as well as in power. In unison with these ideas the author, as soon as he has pitched upon a word that will best answer his purpose, will be found, as he hopes, to adhere to it wherever he has had occasion to advert to the same idea, without indulging in any play of synonyms, or different terms possessing the same or nearly the same meaning. Marisca and hæmorrhois have been equally employed by medical writers to distinguish the disease which we call vernacularly piles. The first is a Latin term, and refers to the tubercles of the disease, and the second a Greek, and refers to a discharge of blood which occasionally issues from them. As commonly used they are direct synonyms notwithstanding this difference of radical meaning, and either might answer the purpose; the diversity of the disease being pointed out by distinctive adjuncts, as cæca, mucosa, or cruenta. Sauvages and Sagar, however, have employed both; but have labored to establish a difference, without having succeeded even in their own judgment. So that, in these writers, we have one and the same disease described under two distinct genera in distinct classes; the first occurring in Sauvages under class i. ord. v. entitled, vitia, cystides: the other under class iv. ord. ii. entitled fluxus, alvifluvus, and introduced with this remark, hæmorrhoides vero nihil aliud sunt quam mariscæ, gazæ apud Aristotelem.' In the present system marisca is alone retained; and the author has preferred it to hæmorrhois, first, because hemorrhage is only a symptom that characterises a peculiar species, or rather, perhaps, a variety of the disease; and next, because hæmorrhois, or rather hæmorrhoidæ (apopoda), was employed among the Greeks, as well vulgarly as professionally, in a much wider sense than that of modern times, and imported flux of blood from the vagina, as well as from the anus; and, in fact, from any part of the body, when produced by congestion and consequent dilatation of the mouths of the bleeding vessels, which were supposed in every instance to be veins. So Celsus, Tertium vitium est, ora venarum tanquam capitulis quibuscum surgentia quæ sæpe sanguinem fundunt: aoppoidas, Græci vocant. Idque etiam in ore vulvæ fæminarum incidere consuevit.' To the same effect Hippocrates, Lib. de Morb. Mulier. Galen uses it in a still wider extent, De Morbis Vulgaribus: and hence the woman with an issue of blood in St. Matthew, ch. ix. 20, is termed in the Greek text γυνη αιμορουσα. Gaza (yala), the term used by Aristotle, would have answered as well as marisca, but that it is less common in the present day, and an exotic term even in the Greek. Hesychius calls it a Persian word, and Scaliger coincides with him; translating it, 'thesaurus, reditus, tributus,' 'a treasury,' or place of deposit or accumulation, chiefly of tri |