on this mucous membrane, to muscular tone, to endosmosis and exosmosis, to defective and increased secretion, and the various morbid sympathies, with their reflex influences-worthy of a clearer status in our practice than that of simple assertion or denial of their existence? Are not these inquiries such as appeal to the judgment of the physician as vital to the success of the treatment of many chronic diseases, to be decided long before an autopsy can deny, from want of appreciable change of structure, a serious retrenchment of vital power?

We pass, in the second place, to speak of the importance to positive Therapeutics of our individual judgments upon the limitations and contra-indications of medicines. It is no fault of our science that it does furnish literature enough upon the properties and specific action of drugs. The massive accumulation of the Materia Medica attest the zeal of the profession on this branch of our study.

Nor is this enthusiasm attendant upon the introduction of new medicines only, but is an element of a prescription which carries many an old remedy beyond its legitimate sphere, and tends to obscure that more exact application which adds so much to success in treatment.

The value of contributions in this direction is seen in the dealings of experience with an old and once foremost article of the Pharmacopeia.

To mercury, in its most proper representative, calomel, was assigned an almost unlimited field of adaptation, viz. as an indispensable cathartic with specific action on the liver, a power to remove accumulations of mucus, the immediate adjunct of bloodletting in inflammations, a frequent component of prescriptions for dropsies, the great destroyer of syphilitic poison, a mysterious ef fect upon the blood by which it relieved congestion in the extreme vessels, a power to promote absorption, secretion, or to remove obscure pathological states. To this extended use the only limit set

was that of profuse salivation, whilst milder constitutional effects were sought for.

The teachings of chemistry, confirmed by experience, have greatly limited its use, by showing its arrest of oxygenation of the tissues, that it is powerfully destructive of the albuminous principles of the blood, lowering its vitality, and retarding restorative processes after disease has been subdued; practical ideas plainly set forth to this Society in a communication from one of its honored. Fellows some years since.

So, also, when we consider the leading tonic, quinine, which, through the fashionable theory which made debility the chief essence of diseased action, has acquired a foremost place. We can predicate but one disease in which its use can be justified without reference to contra-indication, namely, the congestive intermittent of our Southern clime, in which the intensity of the malarial poison must be overcome without reference to minor hindrances. absolute in the medical mind is its antagonism to all intermittent action, so extensive its use, with its corroborant, iron, and its congener, whiskey, in the stimulism of a few years past, that its limitations would seem to have been lost sight of.

So

Yet, that care in its use, which was exercised by those who introduced it, is just as necessary to us, so that we temper its prescription to the remissions of fever, note its liability to add to gastric irritation, regard its suspension when cerebral irritation, tending to acute mania, is imminent, and not keep out of sight its remote power to cause the opposite condition of profound coma.

The cool and careful experience of Braithwaite, in warning us not to carry the parturient effects of ergot beyond the point of intermittent uterine action, making it the gentle toner of nature's ef fort only, is a striking illustration of the value of our rule. But a most encouraging confirmation is from the teaching of Handfield Jones, who, after discussing the pathology of Functional Nervous Disorders in the light of the most recent discoveries of neuropathology, deals mainly with old remedies, points out their just and

more exact application, and illustrates the value of that experi ence which points out the reservation of remedies to their proper spheres, and thus adds to positive Therapeutics.

In the third place, these considerations, drawn from the fields of our daily experience, but indicate the necessity which binds us personally to inquire how much of all that is positive in Therapeutics lies in ourselves-there only, and nowhere else. That is a common impulse which urges each earnest laborer with the difficulties of medication to look, in times of perplexity, to the teachings of high authorities and foremost investigators for solution of the problems which confront him in practice. When he thinks of microscopic revelations and chemical tests, of vivisections and the newer aids which make diagnosis plain to the senses, he is apt to feel his own impotence to solve these difficulties. This feeling is encouraged by the frequent repetition that Therapeutics is not an exact science; taking up this cry, and denying that ordinary daily experience can add much to clear up the many subjects of doubt, even in this day distinguished authorities would claim that investigations by specialists, apart from the busy world, are alone wor. thy of being received as scientific. It may be asserted with safety, however, that no advance or clearing up in our science can make its dicta absolute, or take away that inward sense of responsibility which makes each one feel that all that approaches the mathemati cal in Therapeutics, must be left to his individual judgment, experience or observation, and that the how much, how long, how far, and just when, are for him alone to determine.

He is the best practical obstetrician who, with no more knowl edge of the theory of the mechanism of parturition than others, exercises his skill in accurately determining the position, watches the true proportion of expulsive force to the amount of resistance in each case, and tempers the assistance of art to its just require

ment.

The simpler solution of one of the problems of obstetrics, namely, the treatment of prolapse of the funis by change of position, is an

illustration of the power of reflection to solve, and how near we may be to the end of many another perplexity in a way hardly to be called scientific.

This impossibility of establishing, independent of individual judgment, positive rules for the treatment of familiar diseases, even from massive records and frequency of recurrence, may be learned from the history of one of them.

Pneumonia-always recognized with comparative ease by rational signs-science, by the clearer rules of auscultation, enables us to mark its extent with nice precision-to demonstrate its stage -to mark its tendency toward resolution or progress toward a fatal termination. From its familiarity, and the encouraging success which attends different methods of treatment, we have demonstrated the value of bloodletting in the early stages of sthenic forms the necessity for quinine and stimulants in the asthenicthe good effect of diuretics in removing chlorides, and the claims of antimony and veratrum viride as representatives of their class. But when we turn from a success truly gratifying, and recall the tendency to death in fatal cases, we find this quite as frequently beginning at the brain or the heart-that it occurs from coma or asthenia failure of nerve power, or of the circulation, as often as by apnea, the more probable form from the organs diseased, teaching us the lesson that, whilst treatment directed to the actual disease is ever essential, the keener observation of the attendant upon the general life-force-its strength, its liability to sudden failure, and its tendency to yield in one or the other of the modes named -can decide the positive treatment by which we relieve, ward off, or uphold against impending complication.

So, when a venerable professor, learned in all the literature of the science, from vast stores of personal experience, tells his class, that with cholera asphyxia" some begin to die as soon as they are taken," he but recognizes the overwhelming influence of a morbid poison that no medicine has the power to overcome. When he passes on to detail the most reliable treatment which often avails

in less desperate forms of the disease, and is effective in many severe cases, and still more positively urges the great importance of available medicine in mild and early stages, he but illustrates the general principle, which attaches to much of our practice, that it is not alone on the clearness of diagnosis or the abstract effectiveness of remedies we are to rely, as in combining with these that close and severe application of our resources with reference to time, place, quantity, and the many other questions in which is involved the successful management of severe disease.

And this is but the reproduction of that innate truth which made one to define the office of the physician to be "the minister and interpreter of nature;" like that epitome of an honored practitioner of our State, which declared the whole art of medicine to consist in knowing when to stimulate and when to deplete," "an aphorism," says another," which requires but slight modification to be level with the present knowledge."

Whilst, then, we aim at the highest skill in diagnosis, and own the definite power of pathology to point out the wreck, the way, and where it may occur, let us ever regard in its true light that clear sagacity and intuitive power which we must cultivate, and by the aid of which, with the fullness of science, we must aim to carry the effectiveness of medicine to the furthest point of its capability to cope with disease, and thus honor our art, our profession and ourselves, through the extremest good it can do to mankind.

It is by an easy gradation that we pass from these claims of our art on individual ability to note the moral power of that office of benevolence and charity which the founders of our Society included in the mission of the physician.

When we recall the necessity which made the work of the earliest practitioners of our State an appendage to the higher duties of the Christian ministry, and the fact that the first President of our Society was a missionary of the Society for the Propagation of the Gospel in Foreign Parts, as well as a skillful physician, we see the source of the close affinity in which these moral graces