Dr. FRIEDRICHS: Don't you think that you make a rather broad assertion there?

Dr. ATKINSON: I don't care to be quizzed about the breadth of my assertion, if it is true.

Dr. FRIEDRICHS: I do not think there is a man in the practice of medicine in the world who actually knows the effect that a medicine will have when he administers it. Only from empirical knowledge or from mere observation, can physicians say that if a certain remedy is administered perhaps certain results may be attained, but they do not know how the medicine acts or how these results are obtained. Dr. ATKINSON: I do not see that that is a question.

Dr. FRIEDRICHS: I think it is a generally conceded opinion by all enlightened physicians, that so far as the influence of medicine. is concerned we are considerably in the dark in regard to its action, and I can hardly take for granted that there is a molecular affinity contained in the medicine to cure the disease.

Dr. ATKINSON: I don't think I catch your question. I think I can help you by naming the formula I use to my pupils when I am speaking of the changes of food. I say that the feeder has to be fed upon a substance that has died, has had a life-career, and that that substance must have been passed into the condition that is called died or dead, but that being only died and not entirely effete, anything that is capable of being used as food may, under certain circumstances, become either poison or remedy, by reason of the satisfaction or dissatisfaction of the typal proportion of energy in the tissue that is to be fed or is to be restored; and this depends solely upon that hidden law of affinity that resides in the atoms. We have not been able to get behind atoms, but we find that they are in combination; for instance, take water, H2O—we used to say HO. What do we mean by putting numbers to the symbols? We mean bonds of energy or measures of affinity. And when they are brought together by an electric or magnetic current from the positive to the negative pole, we have two gases that are combined into a liquid which we call water, and it is by reason of the awakening and engaging of these bonds of affinity that they form water. Everything in medicine does that very thing, and that is what we call molecular action.

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Dr. FRIEDRICHS: I do not wish to discuss this matter, because we might talk all day and arrive at no conclusion. The main thing in all scientific discussions and papers ought to be demonstrable facts, and in discussions of this kind where no facts can be brought for

ward we do not derive any benefit, and that is the point I wished to make when I spoke in regard to the effects of medicine as given to cure disease. The facts have not yet been sufficiently demonstrated to show in what mode they act. They may be either a food or a poison, but, nevertheless, we make use of them, because through observation we have found that certain results are obtained from their administration, and that is all. As to how these results are effected we know nothing.

Dr. BUCKINGHAM: Matter is inert. It is only when combined that it produces its effect: We do not know how medicines act, but we know that if we use a certain kind of medicine it produces a certain effect upon the individual, and if by repeated experiment we find its action uniform, we are led to believe these phenomena establish a law. We cannot tell whether the medicine acts as a whole or whether it acts through decomposition. Some medicine acts by being decomposed, and thus acts chemically. Some medicine acts as a whole. Several of our strongest poisons are composed of the same elements in very nearly the same proportion. Carbon, hydrogen, oxygen, and nitrogen, compose nearly all our strongest poisons, and yet these are substances that we are taking in constantly in the shape of food. When these elements are combined together in certain proportions. they produce certain effects. By repeated experiments of these matters we may judge to a certain extent how the substance works.

Dr. WATT: The statement is too general, that we do not know how medicines act, and that we know nothing about them. It seems to assume that medicine is medicine, that medicine is a unitary idea. Now, we do understand how some medicines act, and we do not understand how some others act. Take as an illustration the treatment of malarial disease-our autumnal fevers, especially in their chronic form-by the use of arsenious acid. The manner in which that medicine acts is very simple. The man in working Indian corn acts in such a way as to kill the weeds without interfering with the corn, and we administer arsenic upon the principle of interfering with the germs of organisms which cause the disease. Here is a chronic ague, and the tissue has been built and rebuilt, and taken down and rebuilt anew, and here is a great lot of morbid tissue. It is not as thoroughly alive as the tissue built up in a state of health, therefore it is easier killed. Now we introduce our poison, for it is a poison and medicine both,—we introduce arsenic in that case to kill these morbid tissues, because they have a lower vitality than the best-made tissue in the body. The

medicine may have such strength as to kill them and not kill the healthy tissue, and then the emunctories carry out the dead matter. So there is one medicine, the action of which we know. Take another instance: An anæmic girl comes to us almost bloodless. Some reason exists why she lacks red corpuscles. There has to be an improvement. It is found that iron is an important constituent of the red corpuscles. It is better to furnish the iron in some assimilable form to aid the system in taking it up, in order to get it into the red corpuscles. We often administer food that contains iron as one of its constituents, or if we take the finely-subdivided iron precipitated by hydrogen, we will get iron in a shape that the system, will appropriate in some way or other-I do not mean to tell you how. Some of you say it cannot be assimilated, but I know very well that I have seen scores of pale girls and boys just take metallic iron sprinkled on their bread and butter, and the red blood was developed in them much faster than in their brothers and sisters who did not take the iron. We know how that acts. Some medicines we do know. I think I have illustrated that we do know something about how some medicines act, and we do know a good deal about how food acts, and I don't think I am ready to subscribe to what my friend from New Orleans says. He nearly always sticks to the point, but I do not think it will do to assume that we know nothing about the effect of medicine only empirically. My opinion is that all medicines act chemically, but I will not press that.

Dr. BUCKINGHAM: The doctor says he knows that arsenic produces such an effect. How does it produce that effect? Does it combine chemically, or does it act by its presence?

Dr. WATT: It combines chemically and kills, just as it combines with the albuminous tissue of the rat and kills it.

Dr. BUCKINGHAM: And arrests the vitality?

Dr. WATT: Yes; produces a state of the machinery that is incompatible with vitality.

Dr. BUCKINGHAM: How do you find this out?

Dr. WATT: By analysis.

Dr. BUCKINGHAM: You find that it arrests vitality by experiment? Dr. WATT: I find by experiment that it kills the rat, and by analysis I find out how it kills it.

Dr. ATKINSON: That is experiment, too.

Dr. FRIEDRICHS: I believe that it is customary before physicians treat a case for them to know the cause of the disease they are treating. The doctor said he knew how arsenic acted in case of

fever. Now, in order to get the medicine to counteract the cause we should know what the cause is. I would like to ask the doctor what causes chills and fever?

Dr. WATT: Go up to my friend Dr. Saulsbury, of Cleveland, and he will show you the little trees. I am not a microscopist, but I have looked at them through the microscope, and they have been taken away to the tops of the Alleghanies and placed on a sleepingroom window, and the sleeper of that room, all unconscious of what has been done, has contracted autumnal fever.

Dr. FRIEDRICHS: Is this question settled in the medical fraternity— the cause of chills and fever?

Dr. WATT: It is settled, but a great many don't know that it is settled.

Dr. KULP: The doctor spoke of children being improved by taking metallic iron upon their bread and butter. I have always contended that in taking medicine for curing disease, it is necessary to take it in such form that it would assimilate easily, and the point which Dr. Watt made, that he saw this great improvement in these patients by taking metallic iron on their bread and butter suggested to me that that was the very reason they were improving,-because they were taking it on the bread and butter. If they had taken it in some other form, nature would have rejected it.

Dr. ODELL: It strikes me that Dr. Watt has sufficiently made out the case that he does not understand anything about the action of medicine, and that consequently Dr. Friedrichs was correct in his statement. The "action of medicine," so called, to a certain extent, we understand; at least we think we do; but when you come to the question underlying that which Dr. Friedrichs asked of us, or of Dr. Atkinson, that is too much for us. How the medicines act, is always a point to which we cannot go. Certain medicines act by assimilation; that is, they must be assimilated in order to act at all, and when we have gotten that far we think we have answered the question, and we have only begun; we are hardly at the A, B, C. We only know that a medicine being present, the result follows, and that is empirical; and when we come to the how (which was Dr. Friedrichs's question) we are quite at our wits' ends, and we have no means yet discovered of arriving at the solution of this question. Other medicines act simply by presence. Take the substance of nitrate of bismuth as an illustration. I don't know that you may really call it a medicine in the ordinary acceptation of the term. But it acts by slathering over the surface of the intestines, in conse

quence of which protective coating all the benefit arises; but we get no assimilation, consequently there is one case where assimilation is not necessary. In speaking of the action of arsenic, Dr. Watt simply stated to us what has been stated for a hundred years or more, that arsenic cures or removes the difficulty; but he has not the first glimmering of an intimation as to why or how it does act. I think we can come a little nearer than that; for arsenic is a medicine which by proof, by tests which are within our reach, has been shown to act upon the nervous system; so by simply a change of the mode of motion (if you may so call it) of the nervous system, we get a different sort of movement, which enables the system itself to resume its normal train of action. Whether arsenic can kill certain low forms of life within the system in the method that he intimates, is to me quite doubtful. It is possible that it may, and it is possible that it may not, but my judgment would seem to intimate that it rather enables the organization itself to work on in its normal train, and thereby get rid of all that is irritating and all that affects the nerves deleteriously.

Dr. WATT: I don't believe Dr. Odell heard me. We do know that these lower organisms die under the administration of arsenic, and that they and the arsenic come out together. It is extremely improbable that the arsenic has its influence on the nervous system by virtue of its affinity for these objectionable albuminoid substances. It simply gives the nervous system a chance to act by cleaning out the débris. The nervous system is always ready to act, if it is healthy and normal, unless there is foreign matter crowding it, and we know that arsenic meets these substances that I have referred to, and comes out in combination with them-that these effete matters do come out and are expelled in the excretions. We know about as much about the action of some medicines as we know about anything. We do not know how it is that the plow turning a furrow pulverizes the soil. We do not know why the soil does not stick together and lie there just as it was before the plow turned it over -that it is not as solid as it was before it turned it over. We do not know why the horse pulling the plow impels it through the ground. We do not know anything in the sense in which Dr. Odell has criticised me. I will acknowledge that I am the leading know-nothing in the whole assembly, but I object to the statement that, as compared with our knowledge of other things, we really know nothing about the modus operandi of medicine. There is a sense in which we know nothing about it, and in which we know