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NORTH AMERICAN REVIEW.

No. CCXL.

JULY, 1873.

ART. I.-1. Medicine in Modern Times, or Discourses delivered at a Meeting of the British Medical Association at Oxford. London: Macmillan & Co. 1869. 12mo.

(1.) The General Relations of Medicine in Modern Times. By HENRY W. ACLAND, M. D., F. R. S., LL. D., etc., Regius Professor of Medicine in the University of Oxford, President of the Association.

(2.) Clinical Observations in Relation to Medicine in Modern Times. By SIR W. W. GULL, Bart., M. D., D. C. L. Oxon.

(3.) Therapeutical Research in Relation to Medicine in Modern Times, as illustrated by Researches into the Action of Mercury on the Biliary Secretion. Report by PROFESSOR J. HUGHES BENNETT, M. D., F. R. S. E., etc.

2. The Physiology and Clinical Uses of the Sphygmograph. By F. A. MAHOMED, Student of Guy's Hospital. London Medical Times and Gazette, 1872, Jan. 20, Feb. 3, Feb. 24, March 2, March 23, April 13, May 18, etc., etc. 3. On the Use of the Ophthalmoscope in Diseases of the Nervous System and of the Kidneys; also in certain other General Diseases. By THOMAS CLIFFORD ALLBUTT, M. A., M. D., Cantab., etc. London and New York: Macmillan & Co. 1871. 8vo. 4. On the Temperature in Disease, from the 2d German Edition [Das Verhalten der Eigenwärme in Krankheiten. Leipzig. 1870]. By C. A. WUNDERLICH. Translated by W. B. VOL. CXVII. NO. 240.

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WOODMAN. New Sydenham Society's Publications, Vol. XLIX. London. 1871. 8vo.

5. De l'Electrization Localisée et de son Application à la Pathologie et à la Therapeutique par Courants induits et par Courants galvaniques interrompus et continus. Par le DOCTEUR DUCHENNE (de Boulogne). Troisième édition entièrement refondue, etc., etc. Paris. 1872. 8vo.

6. On the Pathology and Treatment of Cholera. By GEORGE JOHNSON, F. R. C. P., Physician to King's Hospital. MedicoChirurgical Transactions. Vol. L. Art. X. London. 1867.

THE long array of titles in medical literature we have thought proper to associate with this article need not excite in the reader any apprehension that he will be called upon to assist in the process of conventional criticism. But we have selected them for the reason that, each and all, they march upon the highest planes of medical thought, and are themselves the very standard-bearers of its advance. Upon their authority we shall rely for the ideas we hope to develop, and it is with their assistance that we propose to sketch in consecutive narration such accepted general principles and such special but essential technicalities as shall constitute in reality an essay upon the thesis of Modern Medicine.

Medical men are charged with a liability to fall into one or the other of two opposite errors. They are charged with either being too content to regard their profession exclusively as an art, and with rather exulting in the assumption of an attitude of pure empiricism, or, on the other hand, there is ascribed to them an ambition to associate medicine with the dazzling but often delusive propositions asserted from time to time with a confidence which rarely accompanies even the best demonstrated facts in science. The truth is, we cannot establish with exactness or logical precision many of the fundamental notions to which medicine, as a profession, owes its very existence. Often we have to depend upon personal conviction alone, reasoning to ourselves from facts which we cannot explain, and acting in emergencies solely upon our rapid estimates of the probable. Pure Science admits no uncertain elements, but we cannot wait for her elimination of them; and when a phy

sician, upon a balance of probabilities alone, acts, as he must, with a promptness flush with his decision, he is only like the navigator who trusts to his instincts in the tempest as readily as to his observations in the calm.

The older physicians conducted their observations in the true spirit of science, and reasoned with a caution which grew out of their consciousness of the uncertainty of the ground to be explored, and of the intrinsic inadequacy of their methods. Within certain limits we can place far more reliance upon the results of our own observations; but with more extended and precise methods comes the possibility of being found wanting in their characteristics of patience and care; while the ingenious mechanical appliances upon which we depend may be as much the measure of weakness as the proof of strength; and though by their aid the immediate judgment is rendered less difficult, the art of judging as a process of reasoning may eventually come to languish from disuse.

Without any sympathy with purely empirical medicine, we are still less in accord with that disposition to remote theorization which assumes that the spirit of modern medicine requires us to subordinate its advance to the vast and exhaustive generalizations of the science of the day. We can fit to no place in practical medicine the new dicta of the speculative physicists which assert that "an action of which we are immediately cognizant is but the result of the operation of the solar heat upon and through independent and correlative existences; that all things in this system are capable only of interchange; that there can be no destruction of that which exists, and no creation of new energy"; "that the human mind itself, emotion, will, and all their phenomena were once latent in a fiery cloud"; "that all our poetry and science and art, Plato, Shakespeare, Newton, are potential in the fires of the sun.”

Now, instead of demanding upon what rests this projection of human thought into the infinite unknown, some of our outposts concede the very key to our position by the surrender of all notion of a vital principle or a Final Cause. This theorem of the conservation of energy controlling the laws of affinity and bringing all vital phenomena within the domain of physical necessity enters into every conception of organic

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III. THE PROPOSED CHANGES IN THE TELEGRAPHIC SYSTEM 80

IV. FIRES AND FIRE DEPARTMENTS

1. Report of the Commissioners appointed to investigate the Cause and Management of the Great Fire in Boston.

2. Records of the late London Fire-Engine Establishment. By CAPTAIN EYRE M. SHAW.

3. Reports of the Chief Officer of the Metropolitan Fire Brigade on the State of the Brigade and the Fires in London during the Years 1870, 1871, 1872.

4. Fire Surveys, or a Summary of the Principles to be observed in estimating the Risk of Buildings. By E. M. SHAW.

5. Annual Report of the Fire Marshal of the City of New York for the Year ending April 4, 1872.

6. Annual Report of the Board of Fire Commissioners of the Philadelphia Fire Department, 1872.

7. Report of the Philadelphia Fire Insurance Patrol for the Year 1872.

8. Report of the Board of Police in the Fire Department to the Common Council of the City of Chicago, for the Year ending March 31, 1872.

9. Addresses of the President of the National Board of Fire Underwriters at the Sixth and Seventh Annual Meetings in 1872 and 1873.

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Biographical Sketches of Graduates of Harvard University, in Cambridge, Massachusetts. By JOHN LANGDON SIBLEY, M. A.

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Buckle's Posthumous Works, 223. - Skinner's Issues of American Politics, 229. Mrs. Leonowens's Romance of the Harem, 237. — Arnold's Literature and Dogma, 240.- Paine's St. Peter, an Oratorio, 247.

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