the same of all fevers, even when accompanied or caused by obvious local inflammation. Thirdly, he was a pupil of Chrysippus, who was a devoted Pythagorean, with religious scruples, probably of Egyptian origin, against shedding of blood, which scruples his shrewd courtly pupil replaced by physiological arguments. Fourthly, seeing that the blood was formed out of the food, he conceived that withholding nutriment was quite as sure, at the same time that it was a safer, way of diminishing the amount of circulation than venesection. He therefore adopted the practice, common enough in France still, though not practised in Britain, of "diéte absolue." Considering what we owe to Erasistratus as a physiologist, one feels grieved at being obliged to extract his arguments secondhand from the works of such a vigorous opponent as Galen. The above, however, seems to be a fair statement of the mode of deduction by which he arrived at a conclusion influencing practice so many hundred years after his death as Galen's time, and at a place so distant as Rome. But stay--before we wonder at their power, are we quite sure that closely analogous influences do not weigh with us now? In the first place, are we not often too much governed by theoretical explanations of what is seen in the dead body? Are we not too apt to forget the difference between that flabby decomposing substance and the brimming whirl of life, such as we see it faintly pictured in a frog's web under the microscope? Secondly. Do we not still see confounded into one common mass, and treated with one treatment, cases of low and cases of phlegmonous inflammation! We see, e.g., statistical tables of pneumonia, typhous and croupous together, where all, old, young, and middle-aged, have been bled, and antagonistic tables where none have been bled; and, as one might expect, the results are often numerically the same. Will not some one make a table of cases where those were bled who ought to have been, and where those were not bled who ought not to have been? It may be safely predicted, that a much larger percentage of recoveries will be exhibited. See how the same fallacy leads to opposite results; the Erasistrateans thought that low fever was, like inflammatory fever, only the manifestation of a local lesion; the first is better without venesection, so therefore must be the latter: the Broussaists, the other day, re-advanced the same doctrine, but as the latter is better for venesection, blood was taken from both. Thirdly. Do we not often succumb to popular prejudices against what our reason tells us is right? John Hunter himself used unfairly the typical expression of the Mosaic writings, about the blood being the life, and a great deal of the horror with which venesection is popularly regarded seems due to the Hebrew synonym of "bloodshedding" for murder. Two days before the writing of this paragraph, a leading London physician, in stating to the writer his objection to bleeding, expressed himself as "guiltless of the blood of his patients." Fourthly. Do not many of us commit the same error as Erasistratus, by thinking that the diminution of quantity is the only aim in taking blood? It is true that by starvation less will be made, and consequently that the total amount will be reduced. But then the reduction of quantity is only a temporary and partial result desired. The more important intention should be the improvement of quality, by removing some of the effete constituents destroyed by the disease, and so making room for as much fresh new blood as the system can furnish. Viewed in this light, bleeding can never have its place supplied by starvation; indeed, a sufficiency of nutriment is essential to its best success. Let two things be remarked in the above quotation as to Galen's mode of edu * One instance of the savoir faire of Erasistratus is amusing. He was physician to Seleucus Nicator, king of Syria, and was consulted by him about the heir-apparent, Antiochos. He finds that the young man's complaint is love, and that the beloved object is one who it will be easily understood would create no slight commotion at court when known. So he informs the sovereign mysteriously of the nature of the difficulty, saying that the poor youth will probably die unless he possesses the object of his affections, and that she is no other than Mrs. Erasistratus. His majesty, thinking, like the public in general, that medical men are their absolute property, begs the doctor to oblige him but this once, and save his heir's life by the gift of the lady. Then does our shrewd prophet interpret his parable-"thou art the man; it is your queen Stratonice that is the only available prescription." Strange to say, the king was unpractical enough to be persuaded by such an ad hominem argument.-Biographie Universelle, ArticleErasistrate." cating his mind. First, that he allowed a few well observed and striking instances to influence him more than any general impression derived from the diluted experience of extended practice. He may be right or wrong, but this is certainly his way of arguing, both with himself and his readers. Secondly, he lays great stress on Nature's mode of cure, and knows he cannot err in imitating it. Without hesitation he must be pronounced right in this. The specimen given of our author's easy writing is quite sufficient to explain why our limits do not allow us to exhibit the way in which, through eight more chapters, he descends in a cataract of words upon the elderly practitioners of the metropolis. This is not by any means the only example of his unbridled tongue; he himself tells us of his concluding an argument with Zú sis upos, which, however true, is unconciliating to an adversary; and it is not surprising that he soon made his adopted home too hot to hold him, and went back to Pergamos after four years' sojourn, only to return when sure of Imperial patronage and protection against the natural consequences of such phrases. A few observations, however, of his in the latter chapters of the above-quoted lecture must not be passed over. He says that loss of blood certainly does not increase the tendency to inflammation; because gladiators who bled much after incised wounds in the circus usually had their injuries healed by the first intention. On the contrary, it would appear that this unintentional venesection was a favourable occurrence. He makes also a pertinent remark on the danger of excessive abstinence--namely, that the stomach is apt to be so much weakened thereby, that food when afterwards administered is not digested. Again, he gives us a useful hint about the way in which the authorities of great names are sometimes quoted as having employed a particular line of practice, without any reference being made to the success, or the contrary, which attended it. Thus two instances accurately detailed by Erasistratus of the treatment of inflammation without bleeding were thrown in Galen's teeth by his opponents; but when they are looked into, behold, both are fatal ! Dr. Markham has pointed out an instance of the same identical fallacy leading to an opposite result in our own day. Andral, led by the authority of his masters, advocates a practice of venesection justly called excessive. But when, with rare ingenuousness, he details the cases in which it was practised, a mortality much above the average is made evident. Another tract written by Galen, seemingly about the same time, is a more direct commentary on the arguments employed not so much by the disciples as the master; it is entitled, 'On Bleeding, against Erasistratus,' and he may fairly be considered to have given a sufficient answer to all the arguments brought forward, at least at that period, against the practice. Having thus cleared the ground of those gainsayers who represented venesection as in itself objectionable under all circumstances, he lays before the public his well known Therapeutical Essay on Phlebotomy.' He publishes this as an appendix to his lectures On the Preservation of Health,' and 'On Rational Therapeutics' (sparsutixõs μsdódou λóyo d), not voluntarily, as he says at the end of the fifth chapter, but in consequence of external pressure; so that it may be looked upon in the light of an Apology." It is a rich mine of suggestions, from whence authors have dug most freely, sometimes gold, and sometimes dross. So that it is rare to find any writing on the subject where, acknowledged or unacknowledged, at first, second, or third hand, some scraps of the loquacious Greek do not appear. A specimen may be here given of his mode of referring his argument to rational physiology, extracted from a chapter in this essay, explaining how the heart and other organs are affected by changes in the fluids. By translating his imperfect chemical nomenclature into the more accurate language of the present day, it is singular how closely he is made to approach the speculations of our cotemporaries; and one sighs in reading the first sentence to think he should have hovered so near the brink of discovering the circulation, which the world was obliged to do with*See his treatise On the Presence of Blood in the Arteries. Edit. Kühn, vol. iv. p. 728. + Edit. Kühn, vol. xi. p. 250. out for fifteen centuries more. The way in which anatomy, chemistry, and mechanics are, as handmaids to physiology, brought to bear on practice, is quite in the style of the best school of modern rational medicine, and is really a model to be followed. "The blood not only supplies nutriment to the organism, but continuously keeps up the animal heat, just as a hot-air stove is kept alight with firewood, so that the whole house is warmed by it.* As, then, this fire is damped, sometimes by too many logs being thrown on to it at once, sometimes not by their being in too great quantity, but by their being wet, sometimes by none at all or too few being put on; so the heat derived from the circulation may be reduced below its natural standard either by the supply of blood exceeding the demand, or by the demand exceeding the supply, or by the incombustible quality of the blood. Or, on the other hand, it may be increased either by the heating quality of the blood, or by the natural demand being absent. Now, whatever change takes place in the combustion at the centres of circulation is quickly communicated to the rest of the body. "But occasionally, as I have often shown in other memoirs, some one organ alone is morbidly altered in temperature; and that may be referred to two sources-namely, sometimes to the heating or cooling nature of the fluids, sometimes to a morbid crasis only. Just in the same way the structure of the heart may be subjected to morbid changes in a demonstrable manner from two sources—namely, either from the combustibility or the contrary of the fluids, or from some deficiency in them. "The quickness or slowness of this combustion has been demonstrated to depend on the amount of food and drink ingested, and on the amount of repose or activity of body and mind. But as in the abdominal viscera there often occurs perfect digestion, the ingesta degenerating into mucus or bile, or undergoing some other morbid chemical change, or remaining entirely unaltered, and fermenting into flatus-just so when the blood-making functions are deficient there will occur peculiar states of the fluids in arteries and veins analogous to the above-named derangements of digestion in the abdomen. "Now since the heat and moisture of a substance seem to augment the rapidity of its chemical decompositions, especially if it be in a warm place, it will be a necessary consequence of this principle, that the nutritive matters distributed to the system through the medium of the abdominal viscera should undergo somewhere or other some species of decomposition, whenever they have not that tendency arrested by being converted normally into healthy blood. But since the decompositions which take place in matters capable of supporting combustion heighten the temperature, therefore the blood in which the above-described decomposition is going on will exhibit an abnormal degree of heat. When that high temperature is once generated, the whole body is easily heated by it, just as the whole house is by a great fire in the stove. This condition of system the Greeks call uρeròs (fever)." The rules given by Galen for the guidance of the practitioner are too diffuse for "our limits." Perhaps under the pressure of editorial scissors he might have condensed his thoughts into theses more suited to citation. However, the guiding principles seem to be: 1. That you are not to treat the disease but the man; that you are to judge of the propriety, the amount, and necessity for repetition of bloodletting, by the individual symptoms exhibited in each case, and not by the nomenclature. 2. That you are to observe, also, the natural constitution of the patient-e.g., the extremes of life, youth and old age, cause bloodletting to be badly borne. Certain races, such as the soft-fleshed Celtic nations,* do not stand it. 3. That you also take note of epidemic influences-e.g., not to bleed much in the dog-days (in Italy); and in moist, warm weather, when of course septic poisons are most rife. 4. That you are not to mistake physiological changes for morbid; such, for The Pompeian House at the Crystal Palace has misled many into a contempt for a Roman's notion of making himself comfortable in cold weather. But a different tale is told by the elaborate warming apparatus in the basement of Constantine's Palace at Treves (all brick architects should visit Treves); and the above illustration of Galen's shows that the application of the ioría (focus) to warm all the rooms in the house by tubes was common among all classes. There was only one stove in each tenement; for "focus" is used by Horace as a synonym for a country house; and by an economical arrangement, not only did that warm the apartments, but, as appears from Cato, was used also for cooking (Cato de R. R., 10 and 11), and for baking bread (id. 75). + Galen means the true Celt, with "milk-white throat," "golden hair" (Virgil), or "flaxen poll" (Claudian); his "love of drinking and brawling, loud voice, flerce eyes, and haughty insolence; and his equally pugnacious blue-eyed wife, with her swollen neck and gnashing teeth, using her fists like catapults." (Ammianus Marcellinus.) example, as the fulness of pulse which accompanies the first stage of digestion, for permanent fulness. 5. That you are to take blood from vessels which communicate directly (xa' îïğı) with the chief seat of inflammation. 6. That often, in spite of apparent or real general debility, it is desirable to take blood, since the benefit to the locally affected part, and the consequent benefit to the system, compensates for the depletion. This rationalizing of Hippocrates' empirical practice of bleeding established it on a firm basis. So that, with the exception of an occasional “unhappy revival by some chemists" (Van Swieten), the theories of Erasistratus have not again raised their heads; and the future history of the controversy has an interest more curious than practical. We will not attempt to follow it here, but will confine ourselves to the sketch given of one period, which, even if not the most critical, certainly has found the most spirited historian. ART. II. On Physical Morphology, or the Law of Organic Form. By JAMES HINTON, M.R.Č.S. IN studying the development of the mammalian ovum my attention was struck by the form in which the lamina dorsales make their appearance. The layer of cells which constitutes the germinal membrane being completely formed, and separated at one point from the enclosing membranes, the lamina dorsales rise up in this portion as two parallel ridges or folds. The thought suggested itself to me that interstitial increase of the germinal membrane, under the limiting influence of the external capsule of the ovum, must result in a folding of the membrane upon itself just in some such manner. If a flexible layer increase in length while its ends remain at the same distance from each other, it is wrinkled up; by laying a handkerchief on a table, placing the hands firmly upon it at a short distance apart, and gradually approximating them, such folds may be produced. The idea thus suggested to my thoughts led me to further investigation, and many instances soon presented themselves in which the forms assumed by develop ing structures seemed at least to be distinctly traceable to the mechanical conditions that were present. The law which prevails so generally in the vegetable world, that buds are formed in axils, occurred to me in this light. For an axil is an interspace, a point of separation, at which the resistance to the outgrowth of the plastic material might naturally be supposed less than at other portions of the stem. Following this clue, I perceived that the conception of gemmation in axils appeared applicable, to a large extent, to the processes in which development consists. The eye and the ear bud out in the interspaces between the primary divisions of the encephalon; the vascular lamina is formed between the two layers of the germinal membrane; the allantois insinuates itself between the layers of the amnion, while the amnion itself and the ventral laminæ repeat the process observed in the formation of the lamina dorsales. Everywhere I met with facts of the like apparent significance: the coiling up of the intestines would be a simple result of the greater length of the bowel than of the cavity in which they are contained, and answers to a series of such foldings as I first referred to; the convolutions of the cerebrum would necessarily arise from the expansion of its surface within the cranium.* *This has been observed by Mr. Solly in his work upon the Brain. Instances of this kind, multiplying indefinitely in whatever direction I looked, and becoming more convincing the more carefully they were examined, there was gradually forced upon me the perception that all organic form was determined by simple mechanical conditions. Which conclusion, startling as it appeared on its first enunciation, I had no sooner clearly grasped, than I perceived it to be selfevident. It presented itself to me thus: Organic form is the result of motion. Motion takes the direction of least resistance. Therefore organic form is the result of motion in the direction of least resistance. This is the position which I now propose to illustrate and maintain. Organic form is the result of motion. By this expression nothing more is meant than that, as we consider form to depend upon the position of the particles of which any body consists, so, in the case of organic bodies, these particles must have assumed their various positions by moving into them. I use it as a postulate in this abstract statement, because it is the simplest formula I can find to express our necessary conception of the facts. That motion takes the direction of least resistance also is an axiom. It is involved in the meaning of the words; for by resistance is meant that which preventing, thereby necessarily directs, the motion. It is necessary, however, to notice an ambiguity which may here present itself. Motion doubtless takes the direction of least resistance, but every motion must have an original direction, and a momentum which enables it to overcome a greater or less amount of resistance. Do these circumstances detract from or destroy the value of the axiom? Certainly they do not practically. Mechanics, as an art, reposes on it, and with none the less certainty or success because these conditions have to be remembered. Nor does the axiom appear to me to be even theoretically defective. It is true every motion must be in a certain direction, but this direction must have been assumed under the operation of the same laws as determine its subsequent course. We here, as in every case, strike upon a chain which has to the human intellect no beginning. Whatever we may suppose concerning the primary origination of motion, of every motion that we can perceive or conceive we must say that it is such as it is because motion takes the direction of least resistance. And the fact that impulse or momentum overcomes resistance only reminds us that we are apt to use the word resistance in too limited a sense. For what is it that resists motion but force? and what is force but that which, if unresisted, produces motion? It is therefore motion, or the cause of it, that is the true resistance to motion. Thus we of course include the momentum of the moving body among the resistances to be considered, and the axiom assumes the utmost logical completeness. An opposing resistance deflects or changes motion, or is overcome by it, according to whether it be greater or less than the resistance to such change or deflection presented by the momentum. For the momentum clearly becomes a resistance in relation to such change or deflection. If it were not so, indeed, the axiom itself would be unmeaning. These few remarks may sufficiently guard against a misconception of the general statement which I have introduced thus broadly. Fortunately there is the less need to dwell upon such speculative views, because the position to be established is a matter of fact and demonstration. It is remarkable that, in the various hypotheses which have been framed to account for the forms of organic bodies, no attention has been paid to the fact that they are formed, as it were, under pressure, that the process of expansion in which growth consists takes place under conditions which limit it in definite ways. It must surely have been from overlooking this circumstance that a mode of speaking has established itself among us, as if there were in the organic tissue a power of forming itself into peculiar shapes, as if masses of cells, by some power of their own, could mould themselves into complicated structures. How strangely all such |