the sexes; still less do we find it asserted that their cure was attended with any particular difficulty, or that any after consequences resulted from them. Thus presenting us with a strong and marked line of distinction between these complaints and the venereal disease of modern times.

Hippocrates, in several separate portions of his writings, and particularly when describing the diseases of the female, mentions ulcers of the womb and of the pudenda, warts, swellings of the groin, &c. and he directs them to be cured by the most simple applications. On examining the writings of Celsus, we shall be much struck with the very precise and clear account which he has left us of several affections of the parts of generation; and here I cannot again help remarking, how impossible it would have been for this elegant and acute writer to have omitted noticing the sequelae of the disease, had any such existed in his days. Neither ought we to be surprised, considering the debaucheries, the luxurious modes of living, and other concurrent causes which tend to produce disease in other parts of the dermoid system, that the parts of generation should have been occasionally liable, among the profligate and luxurious of those days, to breaches of surface, to eruptive diseases, and to inflammation and its consequences. In the 6th book of Celsus is to be found an excellent description of a phymosis, and the method of treating it; directions are also given as to the mode of curing the sores that shall be found underneath the prepuce, when the glans is denuded. Several distinct species of ulceration are detailed. He distinguishes tubercles or puμara, from puшov or verrucula. Two kinds of cancer are also mentioned, to one of which he gives the name of phagedena; and he also speaks of rhagades or serpigenous ulcerations in the neighbourhood of the perinæum, and of condylomata or tumors about the anus, which he ascribes to the action of previous inflammation. I shall beg in this place to give you a translation of a passage from this author, which is no bad specimen of the surgery of the time in which he wrote, and which negatively at least may be considered as a pretty strong confirmation of the opinion I have ventured to pronounce, as to the total ignorance of this writer of any

after consequences arising from these ulcerations, which he otherwise could not have failed to allude to in this place:

"Therefore if, in consequence of inflammation, the penis becomes swollen, and the prepuce cannot be drawn over the glans, it is to be fomented with warm water; but when the glans cannot be denuded, a syringe must be inserted between it and the prepuce, and the parts washed out: if then the prepuce gives way, the cure will be more expeditious. If, however, the swelling prevents this, a poultice of lentils, or horehound, or olive leaves, boiled in wine, to each of which a little honey may be added, may be applied, and the penis must be again bound up against the belly, a precaution necessary to be taken in every mode of treatment of that part; and the patient must also be abstemious, and content himself with water only to quench his thirst. The next day the same means of fomentation, &c. are to be repeated in the same manner, and then a little effort may be made to draw back the prepuce; if this cannot be done, it may be slightly opened with a scalpel, the discharge consequent upon which will diminish the swelling of the part, and the skin will be drawn back more easily. In whichever way this end is accomplished, ulcers will be found either in the inner part of the prepuce or on the glans, or even beyond it, on the penis itself, which are either clean or dry, or moist and purulent."

The different methods adapted to the treatment of these various ulcers is then detailed; but in every variety the healing of the ulcer is evidently the completion of the cure, for neither in his chapter on diseases of the skin, hor in that in which he describes ulcers of the throat and nose, do we find the slightest insinuation of such symptoms being found in connexion with ulcerations of the sexual organs. The story told by the younger Pliny, in the 24th epistle of the 6th hook, is scarcely deserving of being related at length: it evidently alludes to the destruction of the penis, and it was followed by the death of the sufferer, though his death was not immediately caused by the disease. This story adds no direct strength to our argument, it is true; but it may be observed, that the relation would have afforded an opportunity for the writer

to have descanted upon the disease and its consequences, had he heard of it, either in degree or kind, as we are accustomed to see it now. I might have extended this account by drawing your attention to a passage or two in Galen bearing upon this point; but the remarks I have already made upon what Hippocrates has said, apply with equal force to his commentator.

The evidences of the antiquity of the venereal disease which have been culled from the writings of the Pagan philosophers and poets, will next demand a little of our attention. The list of these authorities is certainly formidable, both in point of number, as well as from the reputation of the authors. We find included in this list the names of Herodotus, Tacitus, Suetonius; and still later, Eusebius, the ecclesiastical historian; and Palladius, the bishop of Hellinopolis. Among the poets, Martial, Juvenal, Horace, and Ausonius, have each afforded some expressions which have been eagerly laid hold of by the supporters of this doctrine. After having enumerated this long list of great authorities, I need surely no longer insist upon the necessity of being acquainted with this branch of the subject; and how little should we be prepared to encounter an adversary armed with these learned and imposing names, unless we were in possession of the facts upon which the belief of the antiquity of syphilis is founded; but when once acquainted with them, very little explanation or argument will, I imagine, be necessary to point out the fallacy of the doctrine. For this purpose, I shall first mention what Herodotus relates concerning the spoliation of the temple of Venus Urania by the Scythians, when they invaded Palestine, on which account, says the historian, their descendants were afflicted with a disease which is called in the Latin tongue "morbus fæmineus," and which the best commentators suppose to have been really a gonorrhoea, or flow of semen, in the strict sense of the word, by which their testicles became wasted, and, in fact, they lost both the powers as well as the appearance of men. So that it is clear, if this mean any thing at all, at least it has no reference to the question at issue. Suetonius, in speaking of the Emperor Augustus, says, Corpore ipsum fuisse maculoso, dispersis per pectus et alvum, genitivis notis in modum

66

et ordinem ac numerum stellarum cælestis Ursæ, sed et callis quibusdam ex prurigine corporis, assiduoque et vehemens strigilis usu plurifarium concretis, ad impetiginis formam."

The passage from the annals of Tacitus is still less to the purpose, for we are simply informed that the Emperor Tiberius, a man infamous for his debauchery, had, in his old age, a bald head, an ulcerated face, and was completely worn out and bent double. I have already alluded to the story told by Palladius, who informs us that a certain person named Hieron, much addicted to intemperance of all kinds, whilst at Alexandria, fell into the snares of a female performer at the theatre, with whom having sinned, he was visited by the divine wrath with an anthrax on the glans penis, which terminated in the loss of all the parts of generation; after which it appears that he recovered, and became a miracle of penitence and piety.

The case related by Eusebius is that of a man who had, in the secret parts of his body, an abscess and a fistulous ulcer, which proved to be incurable, breeding an infinite quantity of worms, and of a most foetid and intolerable odour. Here the precise part affected is not even designated: the phrase is "in mediis, occultiorum corporis partium locis;" and may as well apply to a fistula in the perinæum, or in the scrotum, as to any disease else. No general bodily affection is hinted at, nor are we told that the complaint originated in any improper conduct upon the part of the patient. It will surely not be necessary to pursue this phantom any farther: whoever wishes to consider the arguments which have been drawn from the Roman poets, may consult the second Satire of Juvenal, the 37th Ode of the first book of Horace, the sixth book of Lucretius, and the first book of the Epigrams of Martial;-in these passages he will find abundant evidence of local disease, but not a word that can be construed into any similarity between those affections and the lamentable consequences attending the invasion of syphilis; consequences which might have afforded the finest scope to the satirists and the moral writers of antiquity, and which, in times comparatively modern, as Dr. Friend has justly remarked, has not been alluded to in the writings of either Dante or Boccacio

who were not a whit more likely than their predecessors to have suffered so fertile a subject to have escaped them.

[To be continued.]

PATHOLOGY OF THE BRAIN AND NERVOUS SYSTEM.

Abstract of the Croonian Lectures, Delivered at the Royal College of Physicians, BY DR. FRANCIS HAWKINS.

Lecture I.-May 14, 1828.

IN the medical writings and conversations of the present day, there is no subject on which we are accustomed to dwell with greater complacency, and even exultation, than on the rapid progress which pathological knowledge has made in modern times. But, as often as the boast is uttered, it is checked by regret because the practice of medicine and the cure of disease have not kept pace with the improvements in pathology. Nay, some proceed further, and complain that constant attention to the effects of disease must have a tendency either to discourage our curative efforts or to draw off attention from the means of alleviating symptoms; since, they affirm, the best pathologists are often inefficient practitioners, or seldom at least fertile of expedients, or dexterous in the application of the resources of art. Hence a prejudice is in some minds raised against anatomical pathology, as if it were not only devoid of practical use, but even positively inju

rious.

It is needless, in this place, to refute a prejudice so groundless, or to shew that unless it can be proved that pathological studies have a direct and necessary tendency to impair the discharge of practical duties, all arguments against the extension of knowledge, to the utmost possible limits, which are drawn from the imperfections of ordinary minds, are of a narrow and illiberal character. Are we to reject the lights of science because a weak sight may be dazzled, or a diseased eye pained by their brightness? Still less can the fault be justly charged upon pathology, if through indolence or neglect we fail to apply the knowledge which she has

placed at our command. We often see that men who are chiefly intent upon the accumulation of wealth have neither the turn nor inclination to apply it to its proper uses; but it would be a contradiction to the very terms in which wealth is defined, to argue thence that wealth is useless. Let us not therefore fear that in collecting pathological facts we are hoarding up unprofitable possessions. If we derive not all the advantage which they might afford ourselves, our wiser and happier posterity will supply perhaps our deficiencies. Let it be our ambition to bequeath to the next generation a rich inheritance of accumulated knowledge; and thus endeavour to acquit the debt which we owe to the labours and observation of those who have gone before us.

The dispute which has been alluded to between professed pathologists and practical physicians is not unlike that which formerly prevailed between the rational and empirical sects of old. And now, as formerly, each party has thus much of truth on its side;-that the branch of knowledge which either advocates ought not to be neglected, nor yet to be cultivated to the exclusion of the the other. It is possible that of late, whilst we have been engaged in examining the effects of disease, and reasoning upon the causes which must have operated to produce them, we have been less attentive to that most necessary, but somewhat more empirical part of medicine,—the study and observation of symptoms. The tendency of the times, and the voice of the public, have diverted us, perhaps, from the patient pursuit of clinical medicine. We know that of late the natural sciences have been largely cultivated and greatly improved, and a general taste for such pursuits has been diffused amongst all classes. In proportion as a larger induction of facts has given a more certain character to physical science, speculation and theory, however ingenious, have been discouraged, and demonstration has been called for in their stead. Hence, perhaps, discoveries in anatomy and physiology have accorded better with the disposition of the times, than the less showy possession of acquaintance with disease: and it has been sometimes thought that the credit of anatomical knowledge is a surer passport to public favour than even practical skill or great experience. The propensity also to over-rate the

importance of that which lies beyond their reach, and to undervalue that which they think they might possess, may lead men to entertain an undue estimate of the effects of anatomical knowledge. The nurse, they think, may understand the signs of disease; but it is the surgeon only who is minutely acquainted with the structure of the human frame. And here, as in other cases, the public opinion is a mixture of truth and error. The public can understand that anatomy must be the best, the only foundation for medical science; but they do not perhaps rightly appreciate the relation which it bears to practice. They overlook the many steps which intervene between the study and the application of anatomy. They are not aware that a man may be able to trace the nerves and arteries to their minutest ramifications, and yet be incapable of interpreting the phenomena of fever, or of distinguishing between irritation, congestion, inflammation; and still less competent to adapt the means of art to the treatment of individual cases. Even where the diagnosis might be supposed to be connected most nearly with anatomical knowledge, this has not always been sufficient: thus an abscess in the liver, which could not be detected by the tact of the anatomist, has been recognized at once by the experienced eye of an acute observer of symptoms. The students of the present day are doubtless right in withdrawing their confidence from the symptoms of nosologists, which are too artificial and too full of theory to be safe or efficient guides; but with them has perhaps declined the due attention to the signs and characters of disease. The good sense, however, of the public, which generally settles in the proper mean, will at length discover that the study of symptoms, the true department of the physician, is neither a mean nor an unprofitable employment; that it is the diligent acquisition of knowledge thus obtained which distinguishes the man of observation and experience from the theorist; and that in proportion to his proficiency in this department of science is the practitioner deserving of confidence, and worthy of being a guardian of the health of the community.

The remarks into which I have been led, (and for which I should apologize, as too familiar to the audience which I am

addressing) are far from being intended to detract from the infinite value of anatomical and physiological knowledge; of which we most of us possess too little, and none can ever comprehend too much. They relate only to an erroneous disregard in the public, and neglect in the student, if such in truth exist, of those higher studies, which, if either must be omitted, must be allowed to be even more necessary than the for

mer.

It is clear, however, that the connexion of practice with the anatomy of morbid parts, is more close than with that of natural structure. Yet because the anatomy of the dissecting room must necessarily precede the examination of morbid parts, the difference between them is scarcely borne in mind by half-informed persons. But the well-informed know that it is through pathological anatomy that we must seek to obtain a more intimate knowledge of disease, and to understand the rationale of symptoms. For in what manner does nature require herself to be approached? Whether we are enquiring into the laws of life, or of gravitation; of those which govern animate or inanimate bodies, it still is necessary to ascend from effects to causes: and the laws of nature, in what are called her deviations, we find to be not less regular than when she proceeds in her more ordinary course. The physicians of the present day are certainly well aware of the importance of pathological knowledge, and are labouring in this department with the most distinguished zeal and diligence. Witness the works which they have published, and the museums which they have formed. It is needless to instance any publication, where so many are conspicuous, and impossible to enumerate the various pathological works which testify the great attention which physicians are paying to this pursuit. Amongst such helps to science the museum of the College will soon be deserving of a distinguished situation. It is formed in a manner to be especially serviceable, for with every specimen presented to it, care is taken to preserve a brief but sufficient record of the case. A collection destitute of this advantage is like an inscription written in an unknown tongue, of which a portion only can be decyphered by ingenious conjecture; but when the explanations are preserv

nerves.

ed, the language which it speaks is understood, and every part obtains its definite and appropriate meaning. The College, therefore, intends that its museum shall be at once a record of facts, and a mine for pathological research. There is no part of pathology which has of late attracted more attention than that which relates to the brain and The anatomy and physiology of this system, which, on account of its complex and mysterious nature, had been less understood than those of any other parts of the animal economy, have heen recently cultivated with extraordinary zeal and success. In our researches, therefore, into the pathology of these organs, we may now attempt that which was before impossible, to build upon the sure foundation of anatomical and physiological discoveries.

The Croonian lectures having been instituted for the purpose of illustrating either the muscular or the nervous system, I have chosen the latter for my subject, proposing to direct our attention, first, to the pathology of the brain and spinal cord; and afterwards, if our time should allow, to proceed to that of the nerves. And if we can succeed in connecting pathological facts, with a due attention to symptoms, we need not fear but that, sooner or later, some practical advantage will be derived from such enquiries

Prefixed to the valuable series of engravings with which Mr. Herbert Mayo has illustrated the structure of the brain and spinal cord, there is a just and animated remark which may serve to encourage the labours of the anatomist, and to excite the hopes of the pathological enquirer. Mr. Mayo observes, with reference to Dr. Hooper's splendid work on the morbid anatomy of the brain, that it "shews how much may be done with the assistance of the rude anatomy which alone has hitherto been taught. And results even more important may be expected, when similar researches are conducted with that precision which necessarily follows upon a more exact and refined knowledge of natural structure." The expectation thus expressed, attaches additional interest to the researches, in themselves sufficiently interesting, which have recently engaged the attention of anatomists and experimental physiologists. And, upon this view of the subject, it would seem to be a natural introduction

to the enquiries into which it is proposed to enter, to consider briefly the discoveries already made, and the opinions at present entertained respecting the structure and uses of the different parts of the brain and nervous system. An account, therefore, of the existing state of our knowledge of this important subject, I shall endeavour to derive from the best and most recent authorities.

The popular theory and opinions promulgated under the name of phrenology, have doubtless had considerable influence in attracting notice to the anatomy and physiology of the brain; or at least in fixing attention upon the notion long entertained, but never so far pursued, that different portions of it are subservient to different functions. Similar views with respect to the nerves have recently received a signal confirmation in the splendid discovery, which has shed more fight than any other upon the nervous system, of the distinct nature of the double roots of the spinal nerves, and of the individual nerves which rise from the medulla oblongata.

Drs. Gall and Spurzheim deserve the credit of having directed attention to the relative disposition of the white and grey matter in the brain; or at least of having maintained that the white matter is disposed as a medium of communication between masses of the grey or cineritious substance. The alternations of white and grey matter had indeed been already described and delineated by Willis, and by Vicg d'Azyr. [The plates of Willis, Vicg d'Azyr, and Gall and Spurzheim, were here exhibited.] And with respect to the office of the medullary part, as a medium of communication, a similar notion had been long ago entertained, and on it was founded the whole doctrine of the animal spirits. The animal spirits, says Willis, are generated in the cortical part, and the medullary part serves for their distribution. In support of this doctrine, he alleges, 1st, the superior vascularity of the cortical substance, in which he says, the animal spirits are secreted from the blood; 2dly, the similarity which exists between the medullary substance of the brain, and the medulla oblongata and spinalis; and further observes, that if a portion of the brain be gently scraped with a knife, an appearance is produced of certain striæ, which he calls "tractus medullares, quasi totidem nervi ;" and at another time they are termed