PHYSICIAN AND SURGEON

-In undertaking the treatment of a patient, the physician enters into a legal obligation and assumes legal liabilities, which, though seldom expressly defined, are yet, in the apprehension of the law, fixed and certain. The law holds that he contracts for the possession of that reasonable degree of learning, skill, and experience which the members of his profession ordinarily possess. Those also who, like oculists, aurists, or dentists, claim to be particularly conversant with and skilful in the treatment of the diseases of single organs, must be held to a peculiar responsibility. The same is true of physicians of great pretensions in large cities as compared with those residing in remote and thinly settled districts. In undertaking a case, the physician also contracts that he will apply the skill which he possesses, whatever be its degree, with reasonable and ordinary diligence and care. Extraordinary care is no more implied than extraordinary skill; nor is the practitioner supposed to guarantee a cure, though he may if he chooses contract to effect a cure, and then he must answer for a failure. The physician's skill in a given case will ordinarily be required to embrace those phases and phenomena which usually characterize the dominant disease; and any mischance which connects itself immediately with these will involve the question of skill. His diligence and care will be exercised in watching for and guarding against the numerous accidental influences which, if overlooked, may delay or even prevent the restoration of the patient, such as latent predispositions to certain diseases; a lack of vital or recuperative power in the patient; the effects of melancholy and of other passions of the mind; the effect of the want of pure air and good food, of careful attendance and nursing; the neglect of the patient to follow the physician's advice or to take the medicines which he prescribes. If he have brought ordinary skill and care to the treatment of his case, the physician is not responsible for want of success nor for mistakes in cases of real doubt and uncertainty. The same is probably true of errors of judgment; though there is a late case in the Maine reports, where a verdict of heavy damages against a physician for alleged malpractice in a case of amputation was sustained on appeal, though the court expressly admitted that the verdict was found against the defendant on the ground of his error of judgment in not removing more than he did of the amputated limb. The physician's liability in cases of malpractice is ordinarily only a civil one, and the injury he does can usually be compensated by damages. But, in cases where death has followed the treatment, and it has seemed to be the direct consequence of the treatment, there have been, not unfrequently, charges of criminal malpractice preferred against the medical practitioner. To constitute a crime, there must be a malicious or criminal intent. This intent may exist in an actual design, or the law will infer it from gross rashness or want

of circumspection.-Where no statutory prohibition intervenes, all regular and irregular practitioners are to be placed on the same footing. Leaving out of consideration cases of express malice, which would hardly be included under the designation of malpractice, our topic is reduced to those cases in which the charge is founded upon gross ignorance, gross negligence, or gross rashness. With particular reference to the charge of manslaughter, the law, especially in England, is that "if one, whether a medical man or not, profess to deal with the life or health of another, he is bound to use competent skill and sufficient attention; and if he cause the death of the other through a gross want of either of these, he will be guilty of manslaughter;" or as an eminent American authority, Mr. Bishop, states the law: "The carelessness in a medical man which, if death follow, will render him liable for manslaughter, is gross carelessness, or, as it is more strongly expressed, the grossest ignorance or most criminal inattention."-Criminal malpractice in relation to infanticide is considered under the title PREGNANCY.

PHYSICK, PHILIP SYNG, an American physician and surgeon, born in Philadelphia, July 7, 1768, died there, Dec. 15, 1837. He was graduated at the university of Pennsylvania in 1785, afterward studied medicine, and in 1788 went to London, where he became the private pupil of John Hunter. In 1790 he was admitted as house surgeon to St. George's hospital; and after residing for a year at Edinburgh, he returned in 1792 to Philadelphia, and there began the practice of medicine. In 1805 he was appointed professor of surgery in the university of Pennsylvania, in 1819 was transferred to the chair of anatomy, and in 1824 was elected president of the Philadelphia medical society. He wrote for medical journals accounts of cases he had treated, or of proceses or instruments he had invented. He has been called the father of American surgery.

PHYSICS. See NATURAL PHILOSOPHY. PHYSIOGNOMY (Gr. Qvois, nature, and yivworkw, to know), the name given to the human countenance as indicative of the character, or to the art or science of discerning the character by the cast of the features. The claim of physiognomy to be considered a science rests upon the assumption that the habitual exercise of any feeling will leave upon the face a certain impression by enlarging, strengthening, and rendering permanent in position the muscles associated with such emotions. Thus to a certain extent every man is a believer in the science, because every man forms some opinion of those he sees, especially for the first time, by the expression of their countenances. The first elaborate attempt to elevate physiognomy to the rank of a science was made by Lavater in 1775-'8; but no special application can be made of the general rules he has furnished, on account of the number of exceptional cases arising from accidents of education,

from the transmission of features from parents to children without the transmission of disposition, and from various other circumstances. Beside Lavater, others have written on the same subject, as Spurzheim in his "Phrenology in connection with Physiognomy" (Boston, 1834), and J. Cross, author of "An Attempt to establish Physiognomy upon Scientific Principles" (Glasgow, 1817).

PHYSIOLOGY (Gr. qvois, nature, and λoyos, doctrine), strictly speaking, the doctrine of nature, embracing a knowledge of all the physical and natural sciences, but now restricted to the science which treats of the vital actions peculiar to organized bodies, whether animal or vegetable; including histology, which treats of the elementary tissues as distinct from the organs which they compose, but excluding pathology, which concerns the vital functions in a state of disease. These distinctions, however, are arbitrary, as physiology cannot be dissociated from histology, nor be separated by a definite line from pathology, since it is impossible to determine exactly where health terminates and disease begins; some writers use the term biology, as comprehending the doctrine of life, whether in health or disease. Comparative physiology discusses the phenomena of life throughout the whole chain of beings, their differences and relations; physiology is general, special, or human, according as it takes up the subject in an abstract manner, as applied to a single species, or to man.-Living beings may be distinguished from inorganic matter by the peculiar arrangement of their heterogeneous parts, solid and fluid, mutually acting upon each other, by their definite form, and determinate bulk; by their origin from parents in the form of germs; by their powers of drawing sustenance from the external world, of excretion, and of growth; and by the phenomena of disease. In eggs and seeds the vital properties exist, though in a dormant state. Even presupposing the existence of organized structure, it is impossible to give a precise definition of life. The ancients held to the opinion that there is an independent entity or vital principle, whose union with the body causes life and its separation from it death. The moderns, however, regard life as a series of phenomena in organized beings, dependent partly on structure and chemical composition, whose various properties are brought into play by external stimuli. According to Bichat, "life is the sum total of the functions which resist death;" Treviranus makes it "the constant uniformity of phenomena with diversity of external influences;" and Beclard calls it "organization in action." Physiology, there fore, presupposes a knowledge of the structure of the tissues (whether molecules, cells, fibres, or tubes), and their properties and natural stimuli, including organic chemistry, and must be the basis of all just conclusions in pathology, therapeutics, and hygiene, whose avowed principles and practice are always the reflections

of the physiological ideas of an age. The theories of the principle of life may be divided into 3 groups: 1, those which consider the body an inert mass, into which an animating principle, called by various names, has been introduced; 2, in which life is explained by physical laws; 3, which recognize special vital properties or a vital force. In the 1st belongs the ancient theory of animism, according to which the world is vivified by a soul or spirit everywhere diffused, a portion of which gives life to man, animals, and plants. The ancient philosophers compared the human microcosm to the macrocosm of the universe, and recognized the same motor forces for organic and inorganic matter. Hippocrates considered unintelligent nature as the mysterious agent in the vital processes. Plato and Aristotle admitted 3 animating spirits, the vegetative in the plant, the vegetative and sensitive in the animal, and in man an additional intelligent and reasoning spirit, nobler and purer than the others. Paracelsus, in the 16th century, pretended to explain the functions of life by chemical and cabalistic arts, attributing to sidereal spirits and the planets a direct action upon the body, the sun upon the heart, the moon upon the brain, &c. Van Helmont afterward personified the vital principle under the name of archæus, a name previously employed by Paracelsus; this power was situated at the cardiac orifice of the stomach, and presided directly over digestion by the agency of the gastric juice; the pylorus, another dignitary of the organism, the doorkeeper of the stomach, opened or shut the passage into the intestine under its control; this duumvirate had its subordinates in each organ, which executed the special orders; health reigned during the peaceful and orderly state of the archaus, but its anger, fright, or irregularity produced diseases—an allegory under which we perceive the dimly shadowed idea of the sympathy and mutual dependence of organs now universally recognized; by the aid of a chemical ferment the archæus could organize matter directly, without the intervention of an egg. Stahl, early in the 18th century, though educated in the chemical school of physiology, found so many vital phenomena inexplicable by physical laws, that he sought for a new basis for the physiological edifice; insisting on the inertia of matter, organization to him was nothing without the rational soul, at the same time that the latter could do nothing without the body which was created for it; all physiological acts were established and directed by the soul in order to preserve the integrity of the body, by which it is brought into relation with the external world; most of the functions were destined to prevent the decomposition of the soft solids and liquids of the body, and all the movements were voluntary. Descartes, early in the 17th century, put an end to the theory of Van Helmont's archai; notwithstanding the immense power he attributed to the soul, this philosopher's theories led to

the establishment of the chemical and mechanical schools of physiology; he favored the former by introducing ferments, acidity, alkalinity, and effervescence of the humors, among the nutritive functions; and he influenced the latter by explaining the secretions by the round, cubic, or pyramidal forms of the molecules, and the functions of relation by a vibratory movement excited in the nerves by external impressions, propagated to the pineal gland in the brain, and terminating in the cerebral fibres on which it left material traces. Sylvius of Leyden, in the last half of the 17th century, explained all the functions of the body by the effervescence and fermentation of the fluids, excluding entirely the solids from his physiological scheme; food fermented in the stomach under the influence of the gastric fluids, and digestion was perfected by the actions established by the addition of the bile and the pancreatic secretion; the movement of the blood in the heart was due to the effervescence arising from the meeting of an oily volatile salt of the bile with a saccharine acid of the lymph, producing at the same time the animal heat; the vital spirits, entirely material, were prepared in the brain by distillation, having much of the properties and nature of alcohol; all diseases were caused by the predominance of this or that chemical element in the fluids, and to counteract a supposed acidity very powerful chemical preparations were rashly administered. While Sylvius taught these doctrines upon the continent, Willis promulgated similar ones in Great Britain; he made also the chyle effervesce in the heart under the influence of salt and sulphur, which took fire together and produced the vital flame. According to Haller, even the great mind of Newton was led astray by such vagaries as these. Many of the popular ideas of peccant humors, for which a multitude of empirical remedies are continually extolled and exhibited, date back to the chemical theories of the 17th century. Boerhaave and his school, early in the 18th century, substituted mechanical for chemical forces in physiology, explaining the phenomena of life on the principles of mechanics and mathematics, according to the idea of Descartes; the then admitted doctrine of Harvey of the circulation of the blood and the discoveries of Galileo favored the progress of this school. Food was reduced in the stomach to minute particles by trituration; the circulation was a complete hydraulic machine, and the heart a perfect sucking and forcing pump; the weight of the blood and the loss of its motive power from friction in the vessels were exactly calculated, and the force of the heart's contraction estimated at 180,000 lbs.; the differences in the secretions were explained by the diameter, foldings, and number of the divisions of the vessels in the secreting organs, and by the diverse forms of the molecules, some of which were admitted and others excluded by these kinds of organic sieves; animal heat was the

299

result of the friction of the blood globules against each other and against the walls of the minute vessels. Electricity was at one time considered the active agent of the vital functions, and certain analogies indeed favored this view; electricity dethroned the vital principle, and the barrier erected with so much labor between living and inorganic bodies was again thrown down. Glisson, in England, toward the middle of the 17th century, while the physical theories of life were in vogue, seems to have been the first to shed light on the path in which modern physiology has since so rapidly advanced; he maintained the activity of matter, and that all the functions of life depend on a property of living animal substance which he calls irritability, entirely independent of physical or mechanical forces-all parts of the body, even the bones and the fluids, possessing this property. This theory was completely forgotten until toward the middle of the 18th century, when various authors made use of the terms contractile force and tonicity. Haller (1747) admitted two properties, irritability and sensibility (vis insita and vis nervea); his irritability is the property of contracting under stimuli (the will for the ordinary muscles and their contents for the hollow ones), now styled contractility, distinct from and more powerful than elasticity, independent of the nervous force, and improperly called vital inasmuch as it is manifested after death; his sensibility is the power of perceiving the impressions derived from contact. This theory gave a great impulse to physiological science, which before this was in a very confused state. Barthez, in the last half of the 18th century, adopted the phrase vital principle, which he regarded as distinct from the soul, and as having its own proper existence and its motor and sensitive forces, the former residing in the muscles, the latter in the fluids and especially in the blood; this system met with great favor. Bichat, a quarter of a century later, reduced the vital properties to two, contractility and sensibility, each divided into the animal or voluntary and the organic. Brown, a few years before this, had elevated the property of incitability in the tissues into the vital principle; according to him, all diseases are either sthenic or asthenic, the vital force being increased in the former and diminished in the latter; this doctrine gave rise to the contra-stimulant practice of Rasori and others. Blumenbach, toward the end of the 18th century, attributed all the formative actions to a force which he called nisus formativus. Broussais, early in the 19th century, made pathology a branch of physiology, and gave to his system the name of physiological doctrine of disease; his celebrated theory placed essential fevers among the inflammations of the digestive tube, as forms of gastro-enteritis. Gerdy admits 17 vital principles, or so many distinct series of phenomena inexplicable by physical laws, a list which on his principles might be very greatly and inconveniently ex

tended.-Modern physiology, as illustrated by Tiedemann and Gmelin, Burdach, Müller, Wagner, Bérard, Carpenter, and Todd and Bowman, recognizes that many of the changes which take place in the living body are effected by the same forces which act in the inorganic world and out of the body; but beside these chemical, mechanical, and electrical forces, there remains a principle peculiar to life, or the properties inherent in the various forms of organized structure as much a part of them, and equally inexplicable, as are gravitation, magnetism, and electricity, properties inseparable from inorganic matter. The harmony and mutual adaptation of the phenomena within living organisms, as well as those manifested in the external universe, must alike be attributed to the infinite wisdom and power of the divine mind. The term "vital principle" should not be understood as intimating the existence of a separate and unknown cause of life, like the animism of the old writers, but be used simply as a convenient expression for "the sum total of the powers which are developed by the action of the vital properties of organized structures," stimulating instead of checking inquiry into their causes. Life, which it is the province of physiology to study and explain, involves the idea of constant change in the tissues composing an organism; the vital actions of the parts of a living body are mutually dependent on each other, and all are harmonious, during health, in the maintenance of the life of the organism as a whole. These actions are associated into groups called functions, which concur in effecting certain purposes, such as respiration and circulation. These functions may be divided into the organic or vegetative and the animal, according as they are concerned in the development and maintenance of the body, or render the individual a conscious and moving being; in the former belong those of digestion, absorption, assimilation, circulation, nutrition, respiration, secretion, and reproduction; in the latter those of sensation and motion. Though the organic, animal, and reproductive functions are intimately blended in the higher animals, as we descend the scale the animal or nervous functions gradually disappear (first mind, then voluntary motion, and finally sensation), until in the simplest animalcules we find nothing but an absorbing membrane capable of reproduction. To show at a glance the scope of physiological science, the following brief notice will be serviceable: A. The functions of the animal or intellectual life are concerned in establishing the relations of animals and man with surrounding objects; they constitute essentially man as a moral being, suppose an intellectual principle, and their organs are symmetrical and correspond by means of nerves with a central brain; this life is subjected to the law of sleep, is influenced by habit, begins with birth, and becomes gradually extinct with age; these functions are sensations (vision, hearing, touch, smell, and taste), the intellectual faculties,

emotions, the will, voluntary motion, and sleep or the rest of the nervous and muscular systems. B. The functions of organic life have for their object the nutrition of the organs; most of their organs are of irregular shape, do not communicate with the brain, are independent of the will, and act without interruption from the moment of conception until death; they are digestion, absorption (lymphatic and venous), circulation, respiration, exhalation, secretion, and reproduction (with the secretions of sperm and milk, and the phenomena of menstruation, conception, and gestation).-The functions concerned in these vital processes will be found treated under ABSORPTION, ABSTINENCE, ADIPOSE, AGE, ALIMENT, ANIMAL, ANIMAL ELECTRICITY, ANIMAL HEAT, ANTHROPOLOGY, BILE, BLOOD, BONE, BRAIN, CAPILLARY VESSELS, CARTILAGE, CELL, CHYLE, CHYME, CIRCULATION, COMPARATIVE ANATOMY, DENTITION, DIETETICS, DIGESTION, EMBRYOLOGY, GLAND, HEART, HISTOLOGY, HUNGER, KIDNEY, LIVER, LUNGS, LYMPH, MUSCLE, NERVOUS SYSTEM, NUTRITION, PERSPIRATION, RESPIRATION, SECRETION, SKIN, VOICE, &c. Beside the authors above named, reference may be made to the writings of Adelon, Sir Charles Bell, Bernard, Brown-Séquard, Flourens, Liebig, Longet, Magendie, Marshall Hall, Matteucci, Paget, Richerand, Roget, Rudolphi, Serres, Simon, Valentin, Verdeil, and Robin, in Europe; and in America to those of Dalton, Draper, Dunglison, and Paine, with the numerous references therein named.

PIACENZA (anc. Placentia), a city of Italy, capital of the former duchy of Parma and of a province of the same name, situated in an extensive and fertile plain on the right bank of the Po, about 2 m. E. from its junction with the Trebia, and nearly equidistant from Parma and Milan; pop. 31,403. It is fortified by a citadel and old earthern ramparts and ditches. It has a cathedral, built in the 12th century, and other churches; a podesteria or town house; a library of 30,000 volumes, &c. Cotton, silk, firearms, &c., are manufactured.Placentia became in 219 B. C. the seat of a Roman colony, and the next year the battle of the Trebia between Hannibal and Sempronius was fought in its neighborhood. It remained faithful to Rome at a later period of the war, and withstood a protracted siege by Hasdrubal, but in 200 B. C. it was captured by the Gauls. The Emilian way, constructed not many years after, originally terminated at Placentia. In the war between Marius and Sylla, Lucullus, the general of the latter, defeated the partisans of Carbo in 82 B. C. in its vicin ity; and here also the mutiny in Cæsar's camp broke out during the war between him and Pompey. During the empire Placentia seems to have been one of the most flourishing towns of Gallia Cispadana, and the desolation which overtook the whole of that province in the barbarian irruption did not entirely destroy its importance. In 1126 it became an independent republic, and in 1254 subject to lords

PIACENZA

of the families of Pallavicino, Scotti, and Landi, and subsequently to the Viscontis of Milan. In 1447 it revolted, but was retaken the same year by the Milanese under the command of Francesco Sforza. In 1512, after the battle of Ravenna, it came into the hands of the popes, and in 1545 Paul III. presented it to his son Pietro Luigi Farnese, along with the duchy of Parma, of which from that time it formed a part. In June, 1799, the French were defeated near it by Suwaroff. In 1860 it was annexed to the kingdom of Sardinia.

PIACENZA, DUKE OF. See LEBRUN, CHARLES FRANÇOIS.

PIANOFORTE (Ital. piano, soft, and forte, loud), a musical instrument, the tones of which are elicited by means of the blows of small hammers upon a series of tightly stretched elastic strings; the hammers being caused, through certain connections, to rise upon striking the corresponding keys of a finger board, and the tones being strengthened and rendered melodious by the reciprocal vibrations of a proper ly prepared sounding board, over and near to which the strings are stretched. In his recent history of the pianoforte, Dr. Rimbault traces the first principle of the instrument, the stretched string, to the ancient lyre; and from this he shows a course of gradual modification through the forms of the harp, the psaltery, the dulcimer, &c. The first marked approach to the pianoforte appears in the transition from the dulcimer to the clavicitherium (keyed cithara), which was a small oblong box, holding a series of strings in triangle form, and struck by plectra of quill attached to the inner ends of the keys. This application of the keyboard to stringed instruments is believed to have been first made in the 12th century. Next followed the clavichord, which continued in favor for about 6 centuries, though in part giving place to varieties known as the cymbal and manichord. It is remarkable that the damper, a contrivance allowed to fall or rest upon the string, so as to arrest its vibration when the key has been released by the finger, was introduced at an early period into the clavichord. An improvement upon the keyed cithara, called the virginal, was very popular with Queen Elizabeth and ladies of her time. In this the strings, of catgut, were at once struck and pulled by pieces of quill fixed in the upper end of short, upright jacks upon the inner ends of the keys. The spinet, of about the same period (1500 1760), was a larger box of triangular form, having sometimes 49 strings, some of steel wire, and also played on by means of a jack and quill (spina). The body of the so called square pianoforte, which is oblong in form, is evidently copied from that of the clavichord; while the almost triangular arrangement of the strings as clearly has its origin in the form assumed by the strings of the spinet. The harpsichord was substantially a horizontal harp, played by means of keys with jacks and quills. It was manufactured in Italy early in the 16th century, and

The

long maintained its place, being extended from 4 to at least 6 octaves, and often having double strings; while into some of its improved forms were introduced pedals, and even arrangements for transposing the music by shifting the action of the keys to different sets of strings. The most distinguished harpsichord maker of London, from about the year 1740 to 1775, was Burckhardt Tschudi, whose son-in-law, John Broadwood, was one of the earliest piano makers in England, founding the firm still represented in London under this name. transition from the instruments now named to the piano appears to have taken place about 150 years since; and yet, unless we may rely on the article by Maffei in the Giornale de' litterati d'Italia (Venice, 1711), we must regard the place of this important invention and the inventor's name as obscure, or even lost. The invention has been claimed in turn by Italians, Germans, French, and English. By some writers it is asserted that the first improvement from the spinet and harpsichord consisted merely in the introduction into the latter of hammers, formed each of a leather button on the top of a short stout wire, taking the place of the jack. These hammers could not readily enough quit the string after striking, and its tone was in this way deadened. Such a change would form no marked improvement on those instruments. But the article of Maffei, above mentioned, which is full and specific, and accompanied with a cut, and which is translated at length in Rimbault's work, describes, as having been constructed by Bartolommeo Christofali, a harpsichord maker of Padua, an instrument in which the strings were vibrated by hammers, and each through a complex mechanism, the parts of which were a key, lever, movable tongue acting on the hammer, the hammer, its rest of silk strings, and a damper. Such a mechanism would allow of the rapid stroke and sudden recedence of the hammer, leaving the string free to vibrate until, by releasing the key, the damper should be allowed to check its movement; and thus it would accomplish in a manner all that was aimed at in the earlier "actions" of German and English makers. If this account be genuine, it settles a long controversy, and proves Christofali (before 1711) the real inventor of the pianoforte. In 1716 Marius, a French maker of harpsichords, submitted to the academy four forms of instruments of which he claimed to be the inventor, and termed by him clavecins à maillets (hammer harpsichords). In some of these the hammers were in a degree detached from the keys. A third claimant to the invention is Christopher Gottlieb Schröter, who asserted some years later the fact of his having devised in 1717 an arrangement of keys, springs, and hammers, which others were already employing without due credit. He is believed by some to have suggested the present name by his statement, in a published account in 1768, that on his instruments the performer at pleasure