PREFACE

TO THE

FIRST EDITION.

IN adding another to the many existing Treatises on the Practice of Medicine, the author may be reasonably expected to show upon what grounds he has ventured to advance a new claim to the public attention, already so fully occupied. He has no other excuse to offer than this; that he has written in obedience to impulses which he could not well resist. Having been engaged, for nearly thirty years, in public and private practice, and, during that time, devoted an almost exclusive attention to the study of diseases and their remedies, he has accumulated facts, and formed opinions, which have been long soliciting expression, with an urgency to which he has at length yielded, though unfeignedly distrustful of their sufficient value.

It will be inferred, from what has been said, that the present work claims to be something more than a mere compilation. In giving it the form of a General Treatise on the Practice of Medicine, it was incumbent upon the author, in order to do justice to his readers, to gather from every attainable source the knowledge which he might deem important; and he has accordingly consulted numerous works upon the different branches of his subject, and made ample use of the materials which they afforded. But these materials have for the most part been maturely considered, have been submitted to the closest scrutiny of which he was capable, and have been re-arranged in accordance with his own best judgment. In relation to facts, which, from having been known for a certain length of time, have become the common property of the profession, he has not deemed it necessary to quote authorities; but, wherever the influence of a name was thought necessary to support a position, or justice to individuals required that they should be noticed in connexion with their

discoveries or opinions, he has considered it his duty to make the requisite references in the text.

As to those portions of the work which have been drawn from his own stores, the author does not wish to urge any strong claims to exclusive originality. The sources of our knowledge are so various, we learn so much from books, and hear so much from others, in addition to all that may be derived from our own observation, or result from our own reflection, that it would be extremely difficult for one who has lived long, and sought knowledge wherever it was to be found, to analyze what he may possess, and determine how much, if any, originated entirely with himself.

It would be impossible to enumerate, in this place, all the sources to which the author is indebted for the materials of the work. Many of them are mentioned in connexion with the subjects, in relation to which they were particularly consulted. He wishes, however, to acknowledge a peculiar obligation to the several contributors to those excellent works, the "Dictionnaire de Médecine," the publication of which has been but recently completed in Paris, and "The System of Practical Medicine," arranged and edited by Dr. Alexander Tweedie. It will be seen, from the frequent references in the following pages, that he has also derived great aid from the "American Journal of Medical Sciences," edited by Dr. Isaac Hays, which comprises a body of the progressive medical knowledge of the last twenty years, especially of that contributed by the physicians of this country, which it would be difficult to find elsewhere. Nor would the author be doing justice to his feelings, without acknowledging his indebtedness, for much of his practical information, to two individuals; the late Dr. Joseph Parrish, his private preceptor, whose intimacy it was long his happiness to enjoy, and whose peculiar views and modes of practice were as familiar to him as if they were his own; and Dr. N. Chapman, Professor of the Theory and Practice of Medicine in the University of Pennsylvania, under whose public instruction it was his good fortune to sit thirty years ago, and from whom were undoubtedly imbibed many of the facts and opinions which will be found detailed in the following treatise.

In relation to the mode in which the work has been executed, the author has little to say. The reader will draw his own inferences, as to its merits, not from what he may find in the preface, but from the book itself. The author claims no indulgence on the score of haste. His leisure has been for several years devoted to the preparation of the work, and there was no urgent necessity for its publi

cation, which could justify him in giving it prematurely to the world. It may possibly be thought by some that diseases of little importance have, in many instances, received an undue share of attention; but the author has proceeded upon the ground, that every disease, which is at all worthy of notice, should be well understood. Nothing more than is necessary to this object should be said of the most important disease; and nothing less of that which is least important. It may not be amiss to state, in addition, that, in using the first person singular, when speaking upon his own authority, the writer has been actuated by no spirit of egotism, but merely by a wish to express the fact, without affectation, in the shortest and simplest mode.

The author is sensible of many imperfections in the work. He will undoubtedly discover others, when time shall have in some measure obviated the inevitable partiality of recent authorship. It will be his duty and his pleasure, should the work have the good fortune to reach a second edition, to correct, as far as may lie in his power, these defects, and all others, which a just and candid criticism, hereby cordially invited, may point out.

PHILADELPHIA, January 1847.

PREFACE

TO THE

FOURTH EDITION.

FROM the original preface it may be gathered that the design of the author, in preparing this work, was to present, along with the results of his own personal observation, experience, and reflection, in reference to the Practice of Medicine, such a view of this important department of medical science, as fairly to represent its general condition at the time. He wished, and spared no pains, to make the Treatise a safe and useful guide to the student and young practitioner; and was not without the hope, that the old and experienced might find something in it to aid them in the clearer understanding and treatment of disease. From the speedy exhaustion of three successive editions, all of them large, he feels justified in concluding that the work has, in some degree, met the wants of the profession; and the favour with which it has been received has served as a strong stimulus to him, in the several revisions it has undergone, to make it still more worthy of approval by increasing its practical usefulness. Since its first publication in 1847, there has been great activity almost everywhere of the medical mind; and a flood of new facts, observations, and speculations has been poured forth in the journals, in monographs, and in treatises more or less general, from which the author has faithfully endeavoured to gather whatever appeared to him true, and likely to be useful. In every revision, numerous alterations and additions have been made; and if, at present, the work is not better calculated than at any former time to fulfil the purposes for which it was written, the fault must be ascribed to the want of ability, and not to that of earnest endeavour, on the part of the author. One object with him has always been to increase its bulk as little as possible consistently with its more important qualities. This object he has sought to accomplish by studying brevity of expression; and it is surprising how much may be gained by sacrificing words, useless if not weakening to the sense, which, nevertheless, constantly present themselves to the writer, and are apt to escape a careless attention. As the reader will readily perceive, the same end has been promoted by consulting economy of space; so that few original works, it is presumed, will be found, which, with the same size of type, contain more printed matter within given limits than this. The author, therefore, ventures to hope that any increase in the value of the Treatise will be estimated, rather by the improved quality and greater amount of its matter, than by the number of its pages; though it has been found necessary also to swell the volumes considerably. With these prefatory remarks, he offers the work for the fourth time to the medical public, quite confident, from previous experience, that the profession will be disposed to judge favourably of his efforts, and to give them all the countenance they may be found to merit.

PHILADELPHIA, January, 1855.