It is, therefore, a question of vital importance to determine how observation may be best advanced and perfected. But, first, let us define the meaning of the term observation, and let us analyse the act of mind by which an observation is completed. The etymological meaning of the term implies more than an act of the senses; it means the careful investigation of a thing, and thus it includes an act of mind; for nothing can be investigated carefully without reference to its relations, whether they be the antecedents or coefficients. Consequently, the reasoning as well as the perceptive powers are involved in an observation.*

We become so apt at observation by practice, and the accumulated knowledge of science is so familiar to us, that the process of observation seems simple and intuitive. While feeling a patient's pulse we note its condition, and determine its relations to the heart, lungs, and other organs of the body, and to the general symptoms of the case, without any distinct consciousness of our existing knowledge, or that there was a time when these relations were not known--a time when the physician was ignorant of the structure and functions of the heart-when he knew not the difference between arteries and veins, or between the heart and the liver. The relations of the pulse were formerly, in fact, less known and understood, and the observation of the true value of its variations more difficult, than the microscopic relations of excretions are now. This conjunction of two distinct mental acts is strongly marked out by Professor Emiliani, as necessary to constitute a true scientific observation. First, a clear and precise conception of the thing to be observed; next, an examination of its reciprocal relations and connexions. He observes the one cannot be separated from the other, and the judicious combination of both mental acts is necessary to the progress of science.

The clear conception of a thing, and of its relations, implies, first, a proper perfection and use of the senses: a training or education of the senses is evidently necessary to attain this point, however perfect they may naturally be, just as the raw giant requires a pugilistic training before he can enter the ring. This training should not only develop the senses physically, but should systematically teach how the errors of sense may be avoided-a matter now left entirely to experience. It should also inculcate a thorough scientific knowledge of the aids to the senses which have been invented from time to time, as the stethoscope, &c., and of the principles on which they are constructed.

The examination of the relations and connexions of the thing observed (the second process in the art of observing) implies scientific knowledge. In medicine, anatomy, physiology, chemistry, &c., are accessory or collateral sciences, and are only valuable to the physician by extending his knowledge of these relations and connexions. When the stethoscope got into general use, it became absolutely necessary to determine more accurately than had heretofore been done the whole mechanism of cardiac and pulmonary action, so that the relations and true pathological value of the sounds communicated along that instrument to the ear should be properly

* Sprengel's definition of observation is analogous to this. He says: "Sequitur animadversionem observatio, quæ nihil aliud est, quam attentissima et studiosa succedentium sibi phænomenorum animadversio. Quæ ut in observationem transeat, oportet primum attendere animum ad res, earum formas, qualitates, et proprietates." (V. Sprengel, Inst. Med., vol. i, in introitu.)

estimated. The relations of the urinary secretion, and of the urinary salts, remain yet almost a sealed book. The first process of the act of observing is difficult, because it demands a refined chemical analysis for its completion; and the second is impossible, because we are yet far from an accurate knowledge of the vital processes by which the urinary constituents are formed in the organism, and eliminated by the kidneys, and know still less of their intimate relations and connexions with morbid phenomena.

If medical observation be considered in all its relations, whether theoretical or experimental, it will be at once manifest that no one individual can grasp the whole. No one can have the necessary perfection of all the senses-no one can possibly understand the application of all the aids to research-no one can be the walking encyclopædia of the medical sciences, and the miracle of medical knowledge, which should understand the relations of the whole cycle of observanda. A division of labour has been found practically necessary, as well in the scientific as in the social world. Hitherto, however, the division of labour has been almost fortuitous; anything like a system is of modern growth, and is to be found only in committees of investigation, which have arisen out of scientific societies. What is wanted in the medical profession is, that the whole body shall be organized, with a view to a systematie division of labour in practising the art, and advancing the science of medicine.

The author of the article in the Westminster Review' has attempted a sketch of such a systematic organization. Setting aside the plan for a union of the members of each "grade," in one or two central colleges, he proposes the assimilation of all grades in local colleges, for the purposes of self-government and scientific research. He argues that this principle of assimilation is already acted upon in the social unions of the profession; in the Medico-Chirurgical Society for example, and other societies of the metropolis; in the Provincial Medical Association, and other societies of the provinces; and that this principle is the only foundation for a perfect organization of the medical profession, because it has been found that, while all others have utterly failed, this only has been found to be attended with any degree of success, or can theoretically combine the different branches into one body. It certainly is necessary that the principle of association and systematic division of labour should be better carried out into practice, and local incorporations of the profession would be a good and substantial basis for the purpose.

The formation of therapeutical theories, and the observation of the action of remedial agents, are closely connected, both with each other, and with physiological and metaphysical theories. That theories and hypotheses are necessary to the progress of medical science and art we have already shown. The advancement of the curative art by analogies, or, in other words, the application of a method of treatment found by experience to be useful in one form of disease to another analogous form, is based on theory, or, at least, on a theoretical inference, which has to be tested or modified by careful experiment. It is known, however, that the human mind, in the mass, advances by oscillations between antagonistic theories and systems; and that the old are continually reproduced as new, to combat the old revived. It is necessary, therefore, that this continual re

currence to past theories be restricted within its proper limits; and for this purpose we think the measure recommended by Professor Leupoldt is eminently suitable, namely, the establishment of a chair of medical history and theory in every school. Professor Leupoldt proposes that the course should be divided into two parts, and occupy two sessions. The first part to include biology, anthropology, and hygiene; the other, general pathology, therapeutics, and the history of medicine. We are certain that some such course would be beneficial, inasmuch as it would fortify the student's mind against a too ready reception of any theory, or a bigoted adherence to any. He would estimate them at their proper value as subsidiary, and not essential, to the progressive advancement of medicine: as the means and not the end. He would be prevented fixing his faith upon any one theory, or system, exclusively, whether physiological or therapeutical. He would not be a medical sceptic, and indifferent to all opinions and systems alike; for he would learn that truth is in all-is as omnipresent in human knowledge as the great God of Truth is in His creation. Thus the student would be trained to be a true Eclectic, and seek for the truth in every system and every theory. He would find it in allopathic, hydropathic, or homoeopathic systems; in bio-chemical, dynamical, or histological theories.

In conclusion. Whatever may be the result of the attempt now making throughout the civilized world to thoroughly reform medical science and art, we feel certain that the opinion enounced by Bacon, with reference to science in general in his day, and which is quoted by two of the writers before us, must be the watchword of the men of progress:

Instauratio facienda est AB IMIS FUNDAMENTIS, nisi libeat perpetuo circumvolvi in orbem, cum exili et quasi contemnendo progressu.

ART VI.

Clinical Illustrations of the Diseases of India, as exhibited in the Medical History of a Body of European Soldiers, for a series of years from their arrival in that Country. By WILLIAM GEDDES, M.D., &c. &c., late Surgeon of the Madras European Regiment.—London, 1846. 8vo, pp. 492. In the application of the numerical method to medical science, practical difficulties are encountered which, from their nature, must tend to throw doubt and uncertainty upon many of the results obtained. As one of the chief of these, we may notice the constant change of persons on whom the observations are made. In general practice an individual applies for advice, and after an attendance, perhaps of no great duration, recovers from his malady and is lost sight of; or, becoming discontented at what he considers the slow progress towards convalescence, politely bows out his medical adviser. Thus the subjects of observation are ever varying, and the effects of morbid action, or of therapeutic agents on each individual, are observed only for a short period. As a necessary consequence of this, the influence of age, temperaments, habits, and idiosyncrasies must constitute an important element in any calculation, and one of which it must be extremely difficult to form a just appreciation. Besides this, there is to be encountered the difficulty of ascertaining the previous medical history of the patient; who, sometimes from interested motives, and at others from

ignorance, misleads the physician on the subject of former illnesses, which may, perhaps, bear an important relation to the origin or nature of the present attack. The uncertainty whether the prescribed medicines have been taken, the morbid love some patients have of "cheating the doctor," forgetful that they may at the same time be inflicting a serious injury on themselves, and the difficulty, frequently amounting to an impossibility, of enforcing dietetic regulations, and of restraining hurtful irregularitiesall contribute to diminish the value of numerical observations when applied to medicine.

From most of these objections the public services are free. The military and naval surgeon has under his care, generally for a series of years, the same body of men, with the exception of such changes as arise from deaths, and the discharge of those who, old or disabled, are replaced by young men, selected as being apparently of sound constitution and in good health. These men are immediately brought before him when attacked by disease, which he has thus the opportunity of observing ab initio; he has also documents to which he can refer for the history of their previous illnesses from the period of their joining the service; he has the uncontrolled power of following out a particular plan of treatment, and the means of ascertaining that the medicine prescribed is administered, and that the regulations as to diet are rigidly enforced. He can also obtain pretty accurate information regarding their habits, and is sure that they are provided with those essentials to health-food, clothing, and lodgings. With all these advantages there are, even here, very peculiar circumstances to be taken into consideration, as exerting a powerful influence on the development and progress of disease; such as sudden change of climate, night duty, the aggregation of individuals in barracks and ships, diet, dress, drills, night watches, punishments, &c. &c. Nevertheless it is, we believe, the least objectionable field for observation, and one which we have long regretted to observe has been very inadequately cultivated.

The following observations, although now of very old date, bear so pertinently on this point in its relation to the naval branch of the public service, that we make no apology for extracting them. They form part of a paper "On the Practice of Medicine in the Royal Navy," written by the Editor of this Review, and published in the Edinburgh Medical and Surgical Journal,' for July 1810.

"It is a circumstance greatly conducive to his improvement that the young surgeon is appointed to small vessels, and that he is removed to a more extended practice as he has, or may be supposed to have, increased in knowledge. Among 70 or 120 sailors (the usual complement of such vessels) there will rarely occur so much sickness as might tend to perplex him; but he will have time thoroughly to study every case of disease that comes under his care. Unembarrassed by numbers and want of time, unseduced by any symptom, however prominent, and which might attract the whole attention of the cursory observer, he can leisurely and coolly review the whole phenomena of the disease, appreciate the value of the different symptoms, and thus be enabled to attain one of the most important of acquisitions to a medical man-a knowledge of nosology. Thus instructed, he will enter upon a larger field of practice with superior advantages; and, as he progressively arrives at greater heights, will be enabled to correct his speculations, and increase his knowledge by more extensive observation. The usual number of sick on board of our largest ships is sufficient to exercise the faculties of the experienced surgeon without fatiguing them.

"It cannot have escaped the observation of any one, who has witnessed the customs and habits existing in the navy, that the naval practitioner enjoys very superior opportunities for becoming acquainted with the laws which regulate health. Forming his observations on a limited body of men, leading the mechanical life of sailors, whose every action is public, the naval surgeon has it in his power to know the whole body of juvantia et lædentia that act upon their systems. He may not only be intimately acquainted with the character of every individual, but he may easily ascertain the quality, and even quantity, of every man's food and drink, the nature of his habits with regard to exercise, air, clothing, &c., from one year's end to another. The objects of his observations being placed, as it it were, on a stage, isolated in the middle of the ocean, and receiving, unadulterated, all the influences of the sky-it is in the power of the naval practitioner, I had almost said exclusively, to ascertain the real effects of the atmosphere on health. Living in comfortable apartments, with artificial means to counteract the season's temperature, and evade its violence, or placed in a thousand different situations, which modify or defeat its power, the inhabitants of the country or the city cannot be said to exhibit pure specimens of atmospheric influence. But the sailor, to whom no close apartments, or artificial heat, ever temper the season's rigour, or from whose head no roof or umbrella wards off the rain or sunbeam, must exhibit, in the conditions of his system, the real effects of the weather on health. And various, indeed, are the changes of the sky to which the British sailor is exposed.

Quod mare Dauniæ

Non decoloravere cædes ?

Quæ caret ora cruore nostro? HoR.

"In the actual treatment of disease also, we conceive the naval surgeon possesses some peculiar advantages; some relating to the patient's welfare, some to his own improvement. He sees the disease in its very commencement-a circumstance of great importance, both as tending to the discovery of the nature of the disease, as well as affording the best chance for curing it; for it is remarked that the progress of most diseases can only be stopped effectually in their earliest stages. In private practice the case is very different. During the cure the naval surgeon has the patient perfectly under his control. His proceedings being obstructed neither by the prejudices of ignorance, nor the weakness of affection,' he can employ and follow up the most vigorous and determined practice. And rarely, indeed, will he have to contend with the obstinacy of his patient, as frequently happens in private practice; for the simple and unpresuming seaman looks upon his medical attendant not merely as a surgeon, but, in implicitly following his directions, he not only thinks it reasonable to take the advice of the wiser man, but conceives it his duty to obey the commands of his officer. In domesticating with his patients, he can attend to every stage of the disease; is at hand on every emergency. Nor need he intrust the administration of medicines to an ignorant nurse; it is the duty of the assistant-surgeon to give them with his own hand. No food or drink can be given to the patient unknown to the surgeon. In short, as to what regards the treatment of the patient, the practice of the sick-bay is analogous to the practice of an hospital."

The Statistical Reports on the Health of the Army and Navy have put us in possession of an amount of valuable information on the influence of climate in producing disease and mortality among men in the prime of life, to which there is nothing similar in existence. But interesting and valuable as these documents are, they leave untouched the important subjects of symptomatology and therapeutics. The complex nature of the observations necessary for the elucidation of these two branches of science demands an amount of time and patient investigation which few medical men will be found able or willing to devote to it. We have great pleasure