R797 1845 tavaaii ivnoiivn jnoiqjw jo iniiii ivnoiivn Jnijiojw jo uvhm ivnoi ivn ini) ioiw jo Aevaan ivnoiivn 3 n i a i a 3 w jo a» v »b m t vnoi i v n snoic NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIC CINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRAR M1VN 3NI3I0 3W JO A»V»an IVNOIIVN 3NI3IQ3W JO ABVUail IVNOIiVN 3 N I 3 I ^ 5 r ICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATK < 5I1VN 3NI3I03W JO A » V II 8 I 1 IVNOIiVN 3NI3KJ3W JO A II V B a I 1 IVNOIiVN 3NI3 iasa«v\ I /. ICINE NATIONAL LIBRARY OF MEDICIN > /X/ 5 !*< NATIONAL LIBRARY OF MEDICINE N A T I JliVN 3NI3IQ3W JO A « V . a II IVNOIiVN 3NI3IQ3W JO A « V » 9 II IVNOIiVN 3NI3 ! < IINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATI THE REFORMED PRACTICE OF MEDICINE, BASED UPON THE PRINCIPLES /F CHRONO-THERMAL SYSTEM PRACTISED BY THE CELEBRATED DR. DICKSON, OF LONDON BY J. S. ROSE, M.D. Graduate of the University of Pennsylvania of the year 1820; Honorary Member of the Medical Society of Philadelphia; Lecturer on the Reformed Practice of Medicine, &c. &c. " Seize upon truth where'er 'tis found, Among your friends, among your foes, On Christian, or on heathen ground, The flower's divine where'er it grows." "V > PHILADELPHIA: J. PENNINGTON, CHESNUT STREET, ABOVE FIFTH. NEW YORK: W. H. GRAHAM, TRIBUNE BUILDINGS. 1845. Entered, according to act of Congress, in the year 1845, by J. S. ROSE, in the clerk's office of the District Court for the Eastern District of Pennsylvania. King & Baird, Printers, 9 George Street. PREFACE. The Science of Medicine, like the Doric Column, should stand simple, pure, and majestic, having fact for its basis, induction for its pillar, and truth alone for its capital. The life of a good physician is one of toil and privation from the beginning to the end of his career; and the more eminent he becomes, the greater are his anxieties and fatigues. Unlike men of other professions, age does not exempt him from labour, nor does wealth allow him leisure ; be he rich, or be he poor, he must give his services by day and by night, and often without fee, or even the reward of sym- pathy. He holds a mysterious power over the minds of his pa tients; they willingly put their life in his hands, and they trust he will be merciful. He is merciful; for, scorning the base practice of reducing a man to the verge of the grave that he may show his skill in bringing him up again, he uses some simple, yet effectual remedy, and the case is dismissed. He is sparing of the lancet in what are called bilious attacks, for he knows full well how careful nature is to preserve the blood. His skill teaches him that to draw this vital pabulum from the system while the biliary ducts are in a sluggish state, is to endanger life. Our good physician is not a gossip; he speaks not of what passes in the sick chamber; he tells no anecdotes, nor betrays IV PREFACE. confidence; you can trust him as if he were your father. But there are medical gossips, and heaven help the patients! for their aches and their pains, their foibles, and worse than all, their poverty, are exposed to all who will listen. Merchants have clerks of various grades, assisting them in every effort they make; the mechanics have their workmen j the men of the bar have assistants, who do their drudgery; and the clergy have their wardens and their vestry, all of whom take off the burdensome part of their labours. But the physician has to depend upon himself alone—he has no help—he must think and act without the aid of menial or equal, for it is life that he is to save. It will be said that he, also, has relief, for that the nurse follows his direction and administers the medicine which he prescribes. If this were so, he might indeed rejoice ; but expe- rience teaches us that this is error. When the merchant finds that his affairs are going wrong, owing to incapacity, or want of good principles of his clerks, he dismisses them, and reco- vers of the blunders they made. But when the nurse diso- beys the orders of the physician, it then requires the help of Heaven to remedy the evil. The good physician, therefore, has to contend with disease, with refractory and thoughtless patients, and with the igno- rance and bad principles of nurses. We cannot conceive of a more responsible or more wearisome profession than that of a physician—one who has a conscience—one who knows and feels, every hour of his life, that the eye of God is watch- ing his motions. Men of business settle their accounts at the end of a week, a month, or a quarter; but the physician humbly waits for twelve months, and sometimes longer; yet his bill always comes too soon, and it is always considered as extravagant. Independently of this, he is expected to visit the poor gratis, and cure the servants and poor relations of the family he visits gratis—in short, gentle reader, if you have a good phy- sician, and his bill lies on your desk still unpaid, reflect upon PREFACE. V all his cares, his labours, and, in fact, his trials, and cheerfully pay him his just demands. The improvement of medical science should be the study of all who embark in the profession: Rush knew more of the nature of consumption than most of the doctors of the present day. Had his system been continued in the schools, with the general improvements that time has produced, we should now not be so much annoyed by Thomsonians, Brunonians, Broussaisans, &c. &c. &c, but would have the true chrono- thermal practice adopted, to the exclusion of all humbug, and for the general welfare of all mankind. Rush was unita- rian in medicine, and well knew the effect of time and tempe- rature. But how can the science of medicine be advanced, when those who would improve it by a steady, persevering, and de- termined zeal, are continually cried down by usurpers, whom chance has elevated for a time to the high seats in science, (and whose giddy heads, from their unnatural position, are continually vacillating and changing about, apeing novelty, and constantly misleading the student,) shall be continued as professors. These professors invite many to the study of physic whom Nature intended for a very different pursuit; and so long as this system of teaching continues, we shall find genuine prac- tice in the hands of the few. Until the system of teaching I have hinted at in page 166 be adopted, we shall have much weakness in the medical ranks. There are many brilliant men in the medical profession, I admit, but their brilliancy did not show itself until they had shaken off the errors of the schools, and reflected for them- selves. But as soon as such men make discoveries, and systematize a practice of their own, they are hooted at by professors during their lives, and their practice adopted after their de- mise. Socrates says, that previous to his being declared the wisest man living by the Delphic Oracle, he had but few ene- VI PREFACE. mies, but after that, from envy and jealousy, their name was legion. Ultimately, by them he was compelled to drink the poisonous draft. " Envy never smiles but when the wretched weep, Nor lulls her malice with a moment's sleep, Restless in spite, while watchful to destroy, She pines and sickens at another's joy." The inspired book says:—" Anger is cruel and wrath out- rageous, but whd is able to stand against envy." Let a young man who wishes to enjoy a manifestation of the agents of envy and jealousy, which are falsehood and slander, make a brilliant discovery, which may give him reputation, success, and fortune above his compeers, and he will have enemies swarming around him, like the locusts of Egypt, or the wasps in the fable, who m court demanded the honey that was found as theirs, and thei own manufacture, which was claimed by some bees, because their bellies were larger, and they were connected to their heads by a similar contracted point as the bee's. But a man who has not such enemies is unworthy of notice. In the beginning of my practice I was in the habit of writing prescriptions, but for the past few years I have prepared all my remedies, and would recommend this course to all prac- titioners. By tnis plan you can improve in compounds until you may ultimately obtain specifics for all diseases; this has been my aim, and I am flattered in the result. In consumption, to remove irritability and strengthen the body, I rely on the prophylactic syrup, the cough syrup, and breathing-tube. In all forms of fever, on my vegetable anti- dyspeptic pills and tonic fever mixture. In stomach diseases, on my anti-dyspeptic vermifuge and tonic alterative pills. In scrofula, I rely decidedly on the prophylactic syrup, and in all chronic diseases, upon these medicines singly or com- bined. In diseases of the heart, on my nervous cordial and tonic alterative pills. PREFACE. Vll In bronchitis, on the cough syrup and fever miiture, with the powder for bronchitis. In all cases of fever, the tonic fever syrup and vegetable anti-dyspeptic pills. To prove my work on consumption (published in 1841) correct, I have introduced the following plates, representing the curable and incurable stages of consumption. The plates will show the state of the lungs in the curable and incurable condition, taken from persons who died of other diseases. Plate I, fig. 1, represents a section of the upper portion of the right lung, with diseased glands called tubercles on the upper surface c, b, c, and an excavation by softened tubercles, d, cicatrized or healed up. This subject died of cholera, after being well for three years. Fig. 2, the left lung, with small tubercles, a, b, c, d, e,f g, h, in the interior. Plate II, fig. 1, represents the upper portion of a lung taken from a subject who died of typhus fever, with tubercles in the upper part of the right lung, a, b, d, e,f, c, the bronchia; fig. 2, the opposite lung, with tubercles, a, b, c, d, e. This patient had a dry cough some years before death, but never sus- pected consumption, or my cough syrup would have pro- duced a different state upon inspection. Plate III. represents the lung hepatized or solid, like the liver, a, b, c, d, e, small spots of ulceration ; this state is in- curable, although a man may live a long time if the opposite lung remains sound. Plate IV, fig. 1, represents the subject from whom this lung was taken ; the left side of the chest contracted, the right lung filled with small tubercles, portions of it represented in figs. 2 and 3. As I have never yet seen consumptive symptoms follow cold or catarrh treated by my cough syrup, I am naturally inclined to place great reliance on its use, and consequently recommend it above all other expectorant mixtures for colds, &c.; a trial will convince the most sceptical of this fact. Vlll PREFACE. But my'Object in writing this work is to correct the general practice of medicine, and thereby render chronic diseases and consumption rare. I have combined my views with those of the celebrated Dr. Dickson, of London, which renders the system complete. We shall no doubt meet with many object tions from the profession, but, like him, I may quote, in the stubbornness of my belief, proven by twenty-five years con- stant success, "----Though I hope not hence unscathed to go, Who conquers me shall find a stubborn foe! The time hath been when no harsh sound would fall, From lips that now would seem imbued with gall, IVor fools nor follies tempt me to despise The meanest thing that crawls beneath mine eyes; * But now, so callous grown, so changed since youth, I've learned to think, and sternly speak the truth,— ^ Learned to deride the critic's starched decree, And break him on the wheel he meant for me; To spurn the rod a scribbler bade me kiss, Nor care if courts or crowds applaud or hiss.—" To those who would ask who should study medicine, I would say, read the 38th chapter of Ecclesiasticus. * i 'PLATE III. C FU7.7. a. enT? "uthat this Practice has so long maintained its ground ? By the same influence that for thirty centuries de- termined the Indian widow to perish on the funeral pile of her husband—the influence of authority and custom simply. PRACTICE OF MEDICINE. 39 In physic, as in other things, "men are bred to think as well as speak by rote; they furnish their minds as they furnish their houses, or clothe their bodies, with the fancies of other men, and according to the age and country. They pick up their ideas and notions in common conversation or in their schools. The first are always superficial, and both are com- monly false," says Bolingbroke. The first step that I myself made in rational medicine, was to unlearn all I had been taught; and that at the beginning was difficult. How I ever came to believe one half the rubbish propounded by medical teachers, I cannot now understand*, especially the fact that my teachers (the Professors in the University of Pennsylva- nia gave a certificate that they knew nothing of practice, and re- lied on a certain [0 my country !] panacea to cure what they could not,) for the whole doctrines of the schools are a tissue of the most glaring and self-evident absurdities. At a future period of this work I shall prove my assertion; but before you can detect error, you must first know truth, and this it shall be my endeavour to point out to you. To return, then, to fever. From the facts and observations already stated, you at once perceive, that during the whole of the paroxysmal stages of an ague, the entire economy is more or less altered and revolutionized. It matters very little upon what part of the body the exciting cause or causes of this corporeal disturb- ance shall first fall—whether directly upon the brain, in the shape of a passion, a poison, or a blow on the head—or more remotely, as in the case of a sudden chill, or the mechanical injury of a joint or other external part—to the consequent derangement of the brain and nervous system, we still refer the whole paroxysmal symptoms. Why, after these symp- toms have once completely passed away, and the economy has been comparatively restored to its usual healthy motive condition, periodical repetitions of the diseased motions should yet recur, is a thing not more inexplicable than that the vari- ous habits of health should in certain instances with our know- ledge, and in certain other instances without it, all have a ten- dency periodically to repeat themselves. Upon this subject. I will touch more at large hereafter. Meantime as the symp- toms of an uncomplicated ague-fit stand out boldly in relief— and as in every other form of disease, however named or by whatever caused, these symptoms or shades of symptom may readily be traced; you at once see the reason why I have taken ague as the type of the whole. But while with this explanation I assume every disease to be in the first instance 40 CHRONO-THERMAL an ague—do not suppose for a moment that I employ the term in any confined sense. Call the symptoms ague, fever, or what you please, constitutional disturbance is the pre- lude to every disease—the precursor of every kind of local mischief—though in numerous cases, if not in all—more espe- cially after repeated paroxysmal recurrence, superadded phenomena appear, and these last may be either functional or organic—and in some instances they are of a kind so grave and important, as to throw the constitutional symptoms for a time altogether in the shade. Some part of the system, in a word, may be so much more prominently implicated than another, as to become the chief feature of the case—function- ally if the motions be only atomically altered—organically, if the part in question be threatened with a change in its structure tending in any way to its destruction or decay. Of the first you have an example in the spasm or palsy of a mus- cle, or the suspension or too great flow of a secretion. Of the second I can give you no better instances than that disor- ganizing disease of the knee-joint, termed " white-swelling," and that too common termination of chest disease in this country—phthisis as it is termed by medical men—consump- tion or decline by the people. The propriety of adopting any remedial measure has in every case more or less relation to time and temperature. But the beneficial influence of the Peruvian bark, and its preparation quinine, would appear, more than any other agent, to depend upon the period in which we administer it. The proper period for its exhibition is during the remis- sion. With the exception of opium, it is more strictly a preventive than any other known agent. So generally, in- deed, has it been found to answer this purpose in the treat- ment of ague, that many teachers of medicine have vaunted it as a specific for this distemper; and you may produce a specific action, it is true, but as we have already stated to you, there is no such thing as a specific in nature for any dis- ease whatever. Had there been a specific for ague, do you think the court doctors would have permitted Oliver Crom- well to die of it? Whatever be the agency by which this or any other disease has been cured, you shall find in the course of this work ample evidence that its influence relates in every case to change of temperature. Major-General Sir R---- A------, while serving in Portugal, became the subject of severe ague, which resisted a host of remedies prescribed for him by numerous medical friends—bark among the number. PRACTICE OF MEDICINE. 41 One day, when riding out, he was seized with a paroxysm. The inmate of a little shop where he dismounted till the fit should be over, suggested to him to try the barber-surgeon of his neighbourhood. Willing to be cured by any body, or by any thing, Sir R. at once agreed. The ambidexter man of medicine came, ordered him a large plaster to his back, and the ague was forthwith cured ! To what, but to the im- provement of the temperature of the spine, must we attri- bute the success of that plaster ? The general good effect of quinine in keeping off the ague-fit, when it proceeds from viewless causes, is sufficiently well known to every member of the profession ; but it is not so generally understood that the same agent may be equally serviceable in cases pro- duced by local injury. Of this, however, I will give you a proof. A gentleman, shortly after having had a bougie passed, was seized with ague of the most perfect kind; two days after, at the same hour, he had a return, and every alternate day it recurred, till he had experienced about twelve parox- ysms ; then, for the first time, he took quinine, and he had no repetition. He never had ague before that occasion, nor ever afterwards, unless when compelled to use the same in- strument. I do not know that I could better commence my proof of the intermittent nature of disease generally, than by entering into a short consideration of what are termed Spasmodic Complaints. Such complaints being unattended with any structural change, are termed by the profession functional ; a word, as we have seen, expressive of their simplicity. What is the mean- ing of the word spasm? It means an irregular or unnatural contraction of some muscle of the body, and in the case of the voluntary muscles, you cannot, by any effort of the will, control or counteract it. By rubbing and ivarming the part, you may sometimes succeed, and there are a great many medicines by which, when taken internally, the same effect may be produced; but what will answer in one case may not answer in another. The disease is sometimes termed con- vulsion, and cramp also, more especially if the spasm be painful. (Harris's Case of Convulsions.) The difference of locality in which spasm takes place in different persons, has afforded professors an excellent opportunity of mystifying the whole subject. When it happens in the membranous lining of the lachrymal duct, you shall see the tears accumulating 4* 4^! CHRONO-THERMAL at the inner angle of the eye, the passage to the nose being closed up by the contracting spasm. This disease is called epiphora, and sometimes, though not quite correctly, fistula lachrymalis. A young lady, after two operations, was more benefitted by tonics. Sneeze, hiccough, and yawn, are also effects of spasmodic action. Occurring in the muscular apparatus of the windpipe, or its divisions, spasm is familiar to you all in the word asthma ; and it is also termed dysp- noea, from the difficult breathing which it certainly occasions. When this spasmodic action affects the muscles about the jaws and throat, and the patient at the same time has convul- sions of the face and limbs, there is usually loss of conscious- ness, with a sudden loss of power in all his members, which causes him to fall. This is the epilepsy or " falling sickness." The subject of the disease termed jaundice, in ninety-nine cases out of a hundred, owes the yellow colour of his skin to spasm—spasm of the gall-ducts—though any other obstruc- tion of these passages—a gall-stone, for example, may give rise to the same effect. Taking place in the ilium, or small intestine, spasm is termed the iliac passion ; in the colon or great intestine, colic; in the urethra, spasmodic stricture. The lock-jaw affords yet another example of spasm. That all these various diseases are merely effects of the same action in different parts, is proved by each and all of them having been known to assume the most perfectly periodic type in individual cases, and by all being more or less amenable to the same class of remedies most generally influential in keep- ing off the ague-fit. Like every other force in nature, remedial powers act by attraction or repulsion, and, for a reason to be afterwards given, every remedy can act both ways in different individu- als. They are all capable of producing inverse motion,—in one case curing or alleviating, in another causing or aggra- vating disease. Opium, for example, will set one man to sleep, and keep another wakeful. Arsenic has cured the tremor and heat of ague, and set up both in a previously healthy person Opium, bark, copper, have done the same. Moreover, all four have produced diseases with fits and re- missions. A girl took a large dose of arsenic (sixty-four grains) for the purpose of suicide; her design was discovered in suffi- nlehnpJrei!0 IT^f" death5 but a Penodic epilepsy, ushered in by chills and heat, was the result. A man of 30 after a course of hard drinking, became epileptic; his disease PRACTICE OF MEDICINE. 43 came on every second day at the same hour. Quinine, silver, and calomel, were tried without success. I then gave him arsenic, after which he never had another fit. In these two cases, then, arsenic produced inverse motions, causing epi- lepsy in the first, and curing it in the second. When I come to treat particularly of the passions, I shall show you that the same passion which has caused an ague or an epilepsy, may cure either. In truth, I scarcely know a disease which the passions rage and fear have not cured and caused, accord- ing to their attractive or repulsive mode of action in parti- cular cases. I have said that asthma is an intermittent disease. " The fits of convulsive asthma," according to Darwin, " return at periods, and so far resemble the access of an intermittent fever." Had this physician's knowledge of the symptoms of asthma been sufficiently complete, he would have added that in almost every instance the subject of it shakes or shivers, and in all complains of a chilly feeling, followed by heat of skin. Then, doubtless, he would have found that between asue and asthma, there is something more than a resemblance —that asthma, in fact, is an ague, with the further develop- ment of spasm of some of the muscles of the windpipe. But call the disease what you like, I have generally cured it with one or other of the chrono-thermal remedies; and with two or more in combination, I can most truly say I have sel- dom been compelled to complain of ill-success in its treat- ment. In one case, however,—that of a gentleman who had the disease every second night,—I had the greatest difficulty in effecting a cure, for it was not till I had nearly exhausted all my best resources that I succeeded to my heart's content by applying a warm plaster all along his spine. Here you again see, in the most direct manner, the advantage of atten- tion to temperature: the spine, in this case, was always chilly, but became warm and comfortable under the use of the plas- ter. Many medical writers have detected the analogy which subsists between spasm and tremor, without being at all able to explain in what it consists. Analyze tremor, or, as it is more commonly called, "shivering," "shaking," or "trem- bling" and you will find it to be merely a rapid succession of incomplete spasms. In St. Vitus's dance, or, as it is some- times termed, "the leaping ague," which is also a periodic disease you may see every variety of spasmodic and tremu- lous action a muscle can take. It is a disease which I am very often consulted for in children, and in most cases I 44 CHRONO-THERMAL speedily succeed with minute doses of one or more of the chrono-thermal remedies ; one remedy, of course, answering better in one case, another in another. With the same agents, prescribed upon the same principle, I have been equally fortunate in the treatment of urethral stricture—a disease for which the bougie, in general practice, is far too indiscriminately employed. You all know the bene- ficial influence of warm baths in this affection, and some of you may have heard of the advantages to be obtained from the internal use of iron. But the influence of quinine over stricture is not so generally known. It is unnecessary for me to give any instance of my own evidence of this, Sir Benja- min Brodie having published at length the case of a gentle- man affected with spasmodic stricture of the tertian type— that is to say, which came on every alternate night about the same hour,—and which yielded, in his hands, to quinine. The'marked periodicity of this case doubtless pointed out the proper treatment; but in cases where this is less striking, you have only to ask the patient if there are times when he passes his water better than at others; and if he answer in the affirmative, you may be sure the stricture depends less on a permanent thickening of the mucous membrane of the ure- thra, than upon a remittent spasmodic action of its muscular apparatus. Such a patient, on coming out of a warm room into a cold one, will find himself, all in a moment, unable to pass a drop of water. See then the effect of thermal change —of change of temperature—in producing spasm—and hence too the benefit to be derived from the warm bath in the treat- ment of spasm generally. In the great majority of stricture- cases, the surgeon may save himself the trouble, and his pa- tient the torture, of passing the bougie at all, by treating the disease chrono-thermally; that is, if he prefers the interest of the public to his own; but this mode of preventing the return of disease is obviously less lucrative than that which enables him to give temporary relief at the expense of a long attendance. We now come to that form of disease termed Palsy or Paralysis— An affection in which there is a still greater loss of muscular power than in any of those we have hitherto considered. From the suddenness with which the patient is in most in- stances affected or "struck," this disease is known to every body under the name of " paralytic stroke," or more fami- PRACTICE OF MEDICINE. 45 liarly still, " a stroke." It consists either in a partial or com- plete inability to use the affected muscles—for there are de- grees of palsy as of every other disease—inability to control their actions in any manner whatever by the will. Now it is a common error of the schools to teach that such disorder is always dependent on some pressure on the brain or spine. But paralytic disease has often been produced by a purge, and oftener still by loss of blood ;* and many weakly persons, on suddenly rising from their chair, have all ar once lost the use of a leg or arm. Most cases of paralytic disease, if pro- perly sifted, will be found to be only the termination of pre- vious constitutional disturbance ; previous threatenings of such loss of power having been more or less frequently felt by the subjects of every case. Moreover, in a number of cases, palsy is an intermittent disease throughout its whole course, being preceded by chills and heats, and going off with a return of !he proper temperature of the body. How can you reconcile the idea of permanent pressure with such phe- nomena ? I now will give you a case—JUphonia, as it is called by professional men—taken from a foreign journal [Hecker's]. "A peasant girl was attacked in the following manner:— Speechlessness came on every day at four o'clock, p. m., ac- companied by a feeling of weight about the tongue, which remained about a quarter of an hour. The patient, while it lasted, could not utter any sound, but occasionally made an indistinct hissing noise. Consciousness did not seem impaired during the fit. She ascribed her inability to speak to a feel- ing of weight in the tongue. The paroxysm went off with a large evacuation of watery urine, accompanied by perspi- ration and sleep. Ten such attacks had occurred, when Dr. Richterwas called to see her; he ordered her considerable doses of sulphate of quinine with immediate good effect from the first day. The attack returned, but in a mitigated form, and on the second day no trace of it was visible, except a certain degree of debility and fatigue felt at the usual hour of its coming on." . , I am sorry the corporeal temperature is not stated by trie reporter of this case, but the periodic manner in which it came on and went off, together with the mode of its cure, suffi- ciently illustrate its nature. Not long ago I was consulted in * The recent case of Sir William Geary must be still fresh in every- k„^„'c mind That gentleman met with a sudden loss of blood from an accfdenlal wound of The carotid artery. Palsy of the left side ensued. 46 CHRONO-THERMAL a similar case, which was moreover complicated with palsy of one side. Sarah Warner, aged 25, married, had suffered periodically from loss of speech, and also from an inability to move the leg and arm of one side. Various remedies had been ineffectually prescribed by her medical attendants, who all looked upon her disease as apoplectic—in other words, they supposed it to be caused by pressure on the brain. One of them,indeed, proposed to bleed her, but she would not consent. When she applied to me, I ordered her a combination of quinine and iron, after which she never had another fit. I shall now give you the details of a case of palsy which I treated successfully after it had long been considered hope- less :— Mrs. S., aged 40, a married woman, and the mother of several children, had kept her bed for eight years, on account of paralysis of the lower extremities; during which period she had been under the treatment of eight or nine different physicians and surgeons. Such at least was the woman's own statement, confirmed to me by many people of respecta- bility, who had visited her from the commencement of her illness. When I first saw her, she could not move either leg; her voice was an almost inaudible whisper; she was liable to frequent retchings, and she complained of spasms, with much pain of the loins and limbs. Her last medicine, mercury, which she believed had been given her by mistake, had produced salivation, but with decided aggravation of her symptoms. In this case I prescribed a combination of reme- dies, the principal of which were hydrocyanic acid and tinc- ture of cantharides. Under this treatment her voice returned in about a week; her recovery from every symptom was complete in six weeks, and she had no return in three years after she was under my care. Charles 0., aged 10, had been in a curious state for some months previous to my first visit. I found him lying upon a couch, every muscle of his face in such complete repose, that his countenance seemed quite idiotic; his arms and legs were perfectly powerless, and if you held him up, his limbs doubled under him like those of a drunken person. Upon whichever side you placed his head, he was unable to remove it to the other. It was with difficulty he swallowed his food, but the heart and respiratory muscles performed their respective offices with tolerable correctness. The patient laboured under com- plete loss of speech the entire night, and nearly the whole PRACTICE of medicine. 47 day. About the same time daily—noon—he could utter the monosyllables yes and no, but this power remained with him for half an hour only. The remedies to which I resorted in this case were minute doses of iron, quinine, and hydrocyanic acid,—all of which improved him, but the last proved the most effectual. In less than three weeks he was running about, well in every respect, and the change in his countenance, from apparent idiocy to intelligence, was as perfect a transforma- tion as it is possible to imagine. You marked, I hope, the periodic, though imperfect, remissions which this case exhi- bited. The case of the celebrated Madame Malibran may still be fresh in some of your minds. It was completely the con- verse of this boy's disease, for at particular times every mus- cle of that actress became stiff and rigid throughout the en- tire body. When taken together, these cases show the analogy which subsists between paralytic and spasmodic affections; indeed, in many cases, both affections coexist at the same time in different muscles of the same person—sometimes they are complicated with imbecility of mind or insanity. A young girl was lately carried jnto my room by two of my servants. Her mother brought her to me, at the request of the Rev.-------. Not only had this girl lost the use of one side, but her reason was gone; in fact, her appearance was quite idiotic, and she was utterly helpless in every way. She had, moreover, an epileptic fit every night when she was put to bed. In this case I prescribed a combination of cop- per, silver, strychnia, and quinine. What a medley ! I hear some of you say; but don't be too quick, for mark the result. About six weeks afterwards a young person walked into my room with a letter from her reverend friend. It was the same girl, looking quite intelligent, and speaking and walking as well as she had ever done in her life. Her epileptic fits had become faint, few, and far between, and she was then the monitor of her class ! I was suddenly called to see Mrs. T----, whom I found with complete loss of the use of one side, and partial palsy of the muscles on the same side of the face. She had been nervous and ill for some time, and the night before she had been suffering from domestic affliction. The next morning, while entering her own door, she fell as if she had been shot. When I first saw her, her face was pallid, and her feet were cold. The people about her were urgent that she should be bled but I ordered her warm brandy and water instead. A 4S CHRONO-THERMAL gentleman, who was formerly her medical attendant, was sent for, and agreed with me that she should not be bled. Under the use of quinine and strychnia, continued for about six weeks, with country air, she recovered the use of her side so far as to be able to walk without a stick ; the use of her arm has also since returned. Had this lady been bled or leeched, she would now, in all probability, be in her coffin. I will now give you a case or two exemplifying the cure of palsy of a single limb. Mary B., 18 years old, from the age of eleven, had weak- ness of the back and loins, and she gradually lost the use of the right leg. In this state she remained for three years; sixteen months of this period she was an inpatient of an in- firmary. But cupping, bleeding, leeching, blistering, were all ineffectual. The patient complained of having suffered from shivering fits, followed by heats, and sometimes perspi- rations. The same mode of treatment as in Mrs. S.'s case, with the addition of a galbanum plaster to the loins, in which she complained of coldness, was adopted, and followed with like success. She had scarcely been a fortnight under my care before she completely recovered the use of her paralytic limb, and she has had no relapse during the last four or five years. Miss M., aged 25, had lost the use of both limbs for seven years; all that time she had been confined to her bed, and though she had had the advice and attendance of the late Sir Charles Bell, who was a friend of her family, she never once could stand up during the whole of that period. She was brought up to town from Yorkshire, a distance of 260 miles, on a sofa-bed, to be placed under my care. I immediately put her on a course of chrono-thermal treatment, and we had not long to wait for improvement, for in five days this young lady could walk round the table with the partial support of her hands. At the end of two months, without any assist- ance whatever, without even the support of the bannisters, she could run up and down stairs nearly as well as ever. If a knowledge of anatomy could confer a knowledge of physic, why did Sir C. Bell fail in this case ? No man knew anatomy better; few knew the nervous system so well. But to know the anatomy of the dead is one thing, and to know how to influence the motions of the living is another. Sir C. Bell was a profound anatomist, and an admirable operative surgeon; he excelled in Mechanics, but not in Medicine. 1 he mast of a ship is kept erect by the stays and shrouds; PRACTICE OF MEDICINE. 49 if you divide or loosen these on one side, the mast falls more or less in an opposite direction. The human spine is kept upright by a similar apparatus—the muscles. If any of these muscles from bad health become weakened or paralyzed on any side, the spine, from the want of its usual supporting power, must necessarily, at that particular place, drop to the other side. But being composed of many small-jointed bones, —the vertebrae,—the spinal column cannot, like the mast, preserve its upright form, but when unsupported, must double more or less down in the shape of a curve or obtuse angle; and the degree and situation of this curvature will depend upon the number and particular locality of the mus- cles so weakened or paralyzed. This disease, or " deformi- ty," (for Mr. Abernethy would not allow it to be any thing else,) under all its uncomplicated variations of external and lateral curvature, is the result of muscular weakness or palsy; which palsy, for the most part, is a feature or termination of long remittent febrile disorder. It is often a more or less rapid development of the usual diseases of children—scarlet fever, chicken-pox, measles, and so forth; all of which, as I shall afterwards show you, are purely remittent fevers ; but whether complicated with vertebral disease or not, curved spine is no more to be influenced by issues, setons, moxas, &c., except in so far as these horrible measures almost inva- riably confirm it by further deteriorating the general health of the patient. In the commencement of most cases of this kind, the pa- tient is taller one day than another,—a proof that it depends upon the state of health of the hour; and never do I remem- ber to have had such a patient who did not confess to chills and heats, or vice versa. I will give you two cases in which these phenomena were observed. A young lady, aged 16, had a lateral curvature of the ver- tebrae of the upper part of the back, (that is, a curvature to one side,) causing the inferior angle of the shoulder-blade to protrude. I prescribed for her quinine, in small doses, and directed her to have her spine rubbed night and morning with my liniment. In less than a month the patient had gained three inches in height, and in two months more, she was erect. A lady, 45 years of age, the mother of children, had her spine so much curved at the lower part of the loins, that, to use the phrase, her " tiip grew out." This case came on sud- denly. I ordered a warm plaster to be applied to the spine, 5 50 CHRONO-THERMAL and prescribed hydrocyanic acid and quinine. In three weeks she stood upright. Four years afterwards she had a return, when the same means were again successfully put in practice. These two cases were cases of simple, uncomplicated palsy of the muscles of the back. There are yet other ways in which curved spine may take place—though these still de- pend on a loss of health of the general system. The mere weight of the body will in some cases produce waste, or, professionally to speak, interstitial absorption of particular vertebra, or of their parts. A curve of course must follow ; but curvature of the spine is not unfrequently the effect of a consumptive disease of the substance of the vertebree—a pro- cess by which one or more of these small bones fall into a state of ulcerative decay. Still, even in these cases there is, at the same time, a greater or less loss of .power in particular muscles—for the same general bad health that weakens the bones must weaken them also. I will give you two cases illustrative of this last complica- tion. Mrs. C, aged 25, had, for upwards of eighteen months, great weakness in the upper third of the back, where a swell- ing made its appearance, gradually increasing in size. Ac- cording to the statement of this woman, she had been an in- patient of an infirmary for seven months, during which she had been treated by issues and other local measures, but with no good effect. When I first saw her, she could not walk without assistance. Upon examination, I found a considera- ble ea^curvature, involving the third, fourth, and fifth verte- brae of the back,—which vertebrae were also painful and en- larged, and the skin which covered them was red and shining. The patient was 6extremely dispirited, shed tears upon the most trifling occasion, and was subject to tremblings and spasms. She was generally chilly, and suffered much from coldness of feet. She also complained of flushes. Some days she thought the "swelling" in her back was not so great as upon others; and upon these particular days she also remarked her spirits were not so low. I directed the issues to be discontinued, and ordered a combination of hydrocy- anic acid and tincture of cantharides, to be taken three times a-day. These medicines she had scarcely continued a fort- night, when the improvement in her general appearance was most decided ; the protuberant part of her spine had in that period considerably diminished—her health daily became bet- ter, and, in less than a month, her cure was accomplished. PRACTICE OF MEDICINE. 51 A permanent curve, slight when compared with her former state, still remains. A young gentleman, nine years of age, had external cur- vature of the upper vertebrae of the back; one or more of which were in a diseased and even ulcerated state, as was obvious, from a discharge which proceeded from an opening connected with the spine. His mother observed that he stood more erect some days than others. When I was first con- sulted, he had an issue on each-side of the spine; but these, as in the former case, having been productive of no good, I ordered to be discontinued. Keeping in view the remittent and constitutional nature of the disease, I prescribed small doses of my chrono-thermal remedies. The very next day the discharge was much diminished, and a cure was obtained in about six weeks. The ulcer in that time completely healed up, but a permanent angular curve, of course, remained— trifling, however, when compared with the state in which I first found him. I might give you many other such cases, but my object is to illustrate a principle, not to confuse you with too much detail. These two cases are sufficient to show you the na- ture and best mode of treating what you may call, if you please, vertebral consumption ; though I am not so sure the schools will agree with you in the designation. The one case was in its incipient state, the other fully developed. It occasionally happens that the matter proceeding from a diseased vertebra, instead of making its way out by the back, proceeds down the loins internally, till it reaches the groin, where it forms a tumour; this tumour is called by the pro- fession lumbar, or psoas abscess. With the exception of opening the tumour to allow the collection of purulent or other matter to escape, this disease, like the cases just de- tailed, should be treated almost entirely by such constitutional measures as tend to the improvement of the health generally. It has been for some time the fashion to confine all patients with spinal disease to a horizontal posture; and a rich har- vest makers of all kinds of beds and machines have derived from the practice. In the greater number of cases this treat- ment is erroneous from beginning to end. Constant confine- ment to one posture is sufficient of itself to keep the patient nervous and ill; while his own feelings and wishes are, for the most part, the best guide as to whether he should rise, walk, sit, or lie down. In this he has no theory—the doctor too often has nothing else. 52 CHRONO-THERMAL Equally effectual have I found the chrono-thermal princi- ple of treatment in that particular palsy of one or more mus- cles of the eye-ball, which give rise to squint, or strabismus, as the faculty phrase it. Parents who have children thus affected will tell you that the little patients some days scarcely squint at all. You see then that this affection, at the com- mencement at least, is in most instances an intermittent dis- ease. Can the intermission here, like that, of the ague, be prolonged to an indefinite period by bark, opium, &c?— Oh, I could give you half-a-hundred instances where I have prolonged it to a cure by these remedies. In a case lately under my care, the squint came on regularly every alternate day at the same hour, and lasted an hour. The subject of it, a boy of eleven, after taking a few minute doses of quinine, never squinted more. In another case, as nearly as possible the same, I ran through almost all the chrono-thermal medi- cines ineffectually, but succeeded at last with musk. I was lately consulted in the case of a young gentleman affected with squint, who had also a tendency to curved spine. A few doses of quinine cured him of both. The subjects of all these cases had corporeal chills and heats,—showing clearly that the local affections were merely developments of remittent fever. Were medical men only to attend a little more to con- stitutional signs, they would not, I am sure, leech, blister, and cup away at localites, as they are, in general, too fond of doing. If properly treated at the commencement, squint is very generally curable by internal remedies; but when,from long neglect or ill-treatment, it has become permanent, the position and appearance of the eye may be made all but na- tural by a surgical division of the opposite muscle. If the squint be partial only, a surgical operation will make the patient squint worse than ever—and even in the case of com- plete squint, should the paralytic muscle upon which it de- pends recover its power after the operation, a new squint would follow of course. There is yet another paralytic affection of the eye which I must explain to you. I allude to what is called amaurosis or nervous blindness. In this case, a non-medical person could not tell the patient was blind at all, the eye being, to all appearance, as perfect as the healthy organ. Now, this affection, in the beginning, unless when caused by a sud- den blow or shock, is almost always a remittent disease. Some patients are blind all day, and others all night only. Such cases, by the profession, are termed hemeralopia and PRACTICE OF MEDICINE. 53 nyctalopia, or day and night blindness. These, then, are examples of intermittent amaurosis; and they have been cured and caused, like the ague, by almost every thing you can name. You will find them frequent in long voyages,— not produced in that case by exhalations from the fens or marshes, as many of the profession still believe all intermit- tent diseases to be,—but by depraved and defective food, with exposure to wet, cold, and hard work, perhaps, besides. In the London Lancet, [8th Dec. 1827,] you will find the case of a girl, twelve years of age, who had intermittent blindness of both eyes, palsy of the limbs, phrenzy, and epi- lepsy, from all of which she recovered under the use of am- moniated copper—a chrono-thermal remedy. This case fully establishes the relations which these various symptoms all maintain to each other ; and their remittent character, together with the mode of cure, explains the still greater affinity they bear to ague. " The remedies which have been found most efficient in per- manent nervous blindness, have been the chrono-thermal, or ague medicines, occasionally combined with mercury, or creo- sote. I will give you a case which I treated successfully by an internal remedy. Charles Emms, aged 25, stated to me that he had been completely blind of both eyes for upwards of nine years, four of which he passed in the Bristol Asylum, where, after having been under the care of the medical officer of that establishment, he was taught basket-making, as the only means of earning his subsistence. He had been previ- ously an in-patient in the Worcester Infirmary, under Mr. Pierrepoint, but left it without any benefit. Some days he perceived flashes of light, but could not even then discern the shape or shade of external objects. Before he became completely blind, he saw better and worse on particular days. When he first consulted me, his general appearance was very unhealthy, his face pale and emaciated, his tongue clouded, appetite defective and capricious, and he described himself as being very nervous, subject to heats and chills, palpitations and tremblings; his spirits were depressed. My first pre- scription, quinine, disagreed; my second, silver, was equally unsuccessful; with my third, hydrocyanic acid, he gradually regained his vision—being, after an attendance of four months, sufficiently restored to be able to read large print with facility. Such has been his state for upwards of two years. I need not say his general health has materially improved—his appe- 54 CHRONO-THERMAL tite, according to him, having become too good for his cir- cumstances. In confirmation of the value of hydrocyanic acid in nervous blindness, I may mention that many years after I first published this case, Dr. Turnbull detailed as a great discovery some cures which he made in similar cases by applying the vapour of this acid to the eye."' If patients who are subject to deafness be asked whether they hear better upon some days than others, the great ma- jority will reply in the affirmative ;—so that deafness is also for the most part a remittent disease. That it is a feature or development of general constitutional disorder is equally cer- tain, from the chills and heats to which the great body of patients affected with it acknowledge they are subject. Deaf- ness from organic change of the ear, is infinitely less frequent than that which arises from nervous or functional disorder. Hence the improvement to be obtained in the great majority of diseases of this organ, by simply attending to the patient's general health. By keeping in view the chrono-thermal prin- ciple, I have been enabled to improve the hearing in hundreds of cases. One old gentleman, upwards of 70 years of age, after having been all but quite deaf for years, lately con- sulted me for his case; he recovered completely by a short course of hydrocyanic acid. The like good effects may also be obtained by chrono-thermal treatment in ringing of the ears, &c. Indeed, very few people get much out of health without suffering more or less from noise in the ears ; some- times so great as to cause partial deafness. Cases of loss of the sense of touch, and also those of par^ tial or general numbness, will, in the greater number of in- stances, be found to exhibit remissions in their course. So also will almost every instance of that exalted degree of sen^ sibility known by the various names of tic douloureux, scu atica, &c, according to the locality of the various nerves supposed to be its seat. Look at the history of these diseases. What have your surgical tricks done for'their relief,—your moxas, your blisters, your division of nerves? The only measures to which these diseases have yielded, have been the chrono-thermal remedies—bark, arsenic, iron, prussic acid, &c, the remedies, in a word, of acknowledged efficacy in ague. I shall here present you with a case from the London Medical and Surgical Journal, illustrative of the nature of tic, when involving the nerves of the face. The pain first supervened after a fright; it returned every day at two PRACTICE OF MEDICINE. 55 o'clock, commencing at the origin of the suborbital nerve, extending along its course, and lasted from half an hour to an hour. Two grains of sulphate of quinine, given every two hours for three days, produced in so short a period a com- plete cure. The same prompt and favourable effects were observed in another case of frontal tic, that appeared without any known cause. Now, this frontal tic is commonly known by the name of brow-ague. Why, then, mystify us with neu- ropathy, neuralgia, and a host of other jaw-breaking terms, that, so far from enlightening the student upon the subject of medicine, do nothing but lead him into darkness and confu- sion. All these are mere varieties of ague; the place of pain making the only difference. Loss of the sense of taste is an occasional effect of con- stitutional disturbance, and so is depraved appetite. An ex- ample of what is called bulimia or excessive appetite, occurs in the lectures of Mr. Abernethy: " There was a woman in his hospital who was eternally eating; they gave her food enough, you would have thought, to have disgusted anybody, but she crammed it all down; she never ceased but when her jaws were fatigued. She found out that when she put her feet into cold water, she ceased to be hungry." What could be this woman's inducement to put her feet in cold water in the first instance ? What, but their high temperature—the fever under which she laboured? A gentleman, who was fond of play, told me, that when he lost much money he was always sure to become ravenously hungry ; but that when he won, this did not happen. The temperature of his body, as well as the condition of his brain, must have been differ- ent at these different times. To the state of corporeal temperature we must also refer the various degrees of thirst, from which so many invalids suffer. This, like hunger, when extreme, is a depraved sen- sation. If we have intermittent fever, so also must we have intermittent hunger and thirst among the number of morbid phenomena. Colonel Shaw, in his Personal Memoirs and Correspondence, has this remark: " I had learned, from my walking experience, that to thirsty men, drinking water only gives a momentary relief; but if the legs be wet, the relief, though not at first apparent, positively destroys the pain of thirst." We have hitherto confined ourselves, as much as possible, to simple or " functional" diseases,—those forms of disorder 56 CHRONO-THERMAL in which there does not appear any tendency to local disor- ganization or decay. Hereafter we shall enter into a consi- deration of those disorders which manifest more or less change of structure in their course. Such diseases are termed " organic" by medical writers, and to a certain extent they are more complicated than those we have just left. To a certain extent, too, they admit modification of treatment. In most cases of this kind, though not in all, it is my custom to prescribe one or more powers, having a general chrono- thermal influence, with one or more having a local bearing. I have necessarily, on occasion, combined remedies which may partially decompose each other. In continuing still to do so, I am justified by successful results, the only test of medical truth—the ultimate end and aim of all medical treat- ment. A charge of unchemical knowledge has been occa- sionally urged against me for this, by chemists and drug- compounders. But what says Mr. Locke ?—" Were it my business to understand physic, would not the surer way be to consult nature itself in the history of diseases and their cures, than to espouse the principles of the dogmatists, me- thodists, or chemists?" This charge, then, I am willing to share, with numerous medical men, whom the world has already recognized as eminent in their art. By such, the answer has been often given, that the human stomach is not a chemist's alembic, but a living organ, capable of modify- ing the action of every substance committed to it. We have hitherto derived our illustrations of the unity and intermittent nature of disease, almost entirely from such forms of disorder, as, by the profession of the present day, are termed functional ; that is to say, such as are uncom- plicated with organic decomposition, or any marked tendency thereto. Now, in the commencement, all complaints are simply functional. I do not of course include those organic diseases that have been the immediate effect of mechanical or other direct injury—such as the passing of a small sword through the lungs or liver. I speak of disease in the medi- cal acceptation of that term—disease in which one or more constitutional paroxysms occur before organic change be- PRACTICE OF MEDICINE. 57 comes developed. Inquire the sequelae of those agues for which the usual routine of medical treatment may have proved unavailing. Do not these comprise every structural change to which nosologists have given a name ?—hemor- rhage, or rupture of blood-vessels wherever situated,—dis- eased lungs, by whatever termed; with all the various vis- ceral alterations which have obtained designations more or less expressive of the localities in which they become known to us—the enlarged, softened, or otherwise disorganized heart, liver, spleen, and joint—the indurations and other changes which take place in the several glands of the body, whether called scrofulous or consumptive, cancerous or scir- rhous. When patients thus afflicted complain of the ague- fits, from which they suffer, their medical attendants too often point to the local disease as the cause, when, in reality, such local disease has been a mere feature or effect of repeated paroxysms of this kind. Even John Hunter, with all his acuteness, fell into this error, when he said, " We have ague, too, from many diseases of parts, more especially of the liver, as also the spleen, and from induration of the mesenteric glands." It is only of late years that the better informed members of the profession have begun to suspect that these structural alterations, instead of being the causes of the "con- stitutional disturbance," are the results. But this phrase, in most instances, they use without any very definite idea of its meaning—and when questioned in regard to it, they either confuse the matter with the mixed-up jargon of incompatible theories, or frankly confess that they entertain notions which they feel themselves unable by any form of speech to impa/t to others. " Constitutional disturbance," when analyzed, will be found to be neither more nor less than an excess or di- minution of the healthy temperature and motions of various parts of the body,—amounting, when the disease is recent, (or "acute,") to the bolder features of intermittent fe- ver—and in cases of longer standing (or " chronic") coming at last to the more subdued symptoms of that universal disease. Between these two extremes you have every kind of intermediate shade,—which shade sometimes depends upon duration, sometimes upon individual constitution. Every child of Adam comes into the world with some weak point, and this weak point necessarily gives the sub- ject of it a predisposition to disease of one locality or tissue of the frame rather than another; but many persons, from accidental causes, have also their weak points. Of this kind 58 OHRONO-THERMAL are such parts of the body as, after having been externally injured, get so well, that while you continue in health, yon suffer no inconvenience ; but as old age steals upon you, or when your general health gives way, you are reminded by certain feelings of weakness in the parts injured, of the acci- dents that have formerly happened to you, and that to keep the affected parts in tolerable strength, you must not play tricks with your constitution. Individuals so situated can predict every change of weather; they are living barometers, and can tell you what kind of a day it shall be, before they rise in the morning. They obtain their knowledge of this from the experience of their feelings in their old wounds and fractures. Now this is what you ought to be prepared to expect; the atoms of repaired parts always have a weaker attraction to each other than the atoms of the other parts of the frame—and they must, therefore, in the very nature of things, be more liable to be influenced by external agency— by every thing, in a word, that has the power to put matter in motion. Whatever, under ordinary circumstances, shall slightly shake or affect the whole body, must, under the same circumstances, be a subject of serious import to its weaker parts; and this argument also applies with equal force to the atoms of those parts of individual bodies, which, by hereditary predisposition, manifest a similar weakness in the attractive power of their atoms to each other. As the child is but an extension of the living principle of the parents, its frame must naturally, to a certain degree, partake of the firmness and faults which characterized its progenitors, whether mental or corporeal—resembling them, not only in external features, but copying them even in their inward con- figuration. Such similitude we see extending to the minutest parts, whether such parts be fully developed, or defectively, or even superfluously constructed. As instances of these last, I may mention, that I have known particular families, where the frequent repetition of six fingers to the hand has taken place in successive generations, and others, where the same members have been as hereditarily reduced beneath the correct human standard. Then in regard to hereditary men- tal resemblances, you will see children, whose father died before they were born, manifesting the same facility or stub- bornness of temper, the same disposition to moroseness or jocu- larity, which characterized the author of their being. Friends and relatives will sometimes hold up their hands with aston- ishment at this mental likeness of children to their parents; PRACTICE OF MEDICINE. 59 "he is just his father over again," is a common and correct remark of the least observant. In the doctrine of hereditary predisposition, then, the profession and the public, I believe, are equally united in opinion; but whether they be so or not, is of very little import while you have eyes to look around you, and can judge for yourselves. I must, however, tell you, that in cases of hereditary predisposition, much will de- pend upon circumstances, whether or not such predisposition be actually and visibly developed in the individual members composing a given family. A person, for example, in whose family the heart or lungs is the weak point—by guarding himself against too rapid changes of temperature, and avail- ing himself of a fortunate position in society as to pecuniary and other means, may so control numerous exciting elements of disease, as to pass through life happy, and comparatively healthy ;—while his less fortunate brother, worn down by an accumulated weight of domestic and other trouble, shall not only suffer in his general health, but shall as surely have the weak point of his family's constitution brought out in his in- dividual person. We are all, then, more or less, the "sport of circumstances." Among the various diseases which, from their frequency, we justly recognize as the most prominent and important that affect the inhabitants of this country, I may mention spitting of blood, consumption, and glandular disorders. The rapid transitions of temperature, so characteristic of this climate, certainly predispose us to these complaints;—for while in the warmer countries of the South dysentery and abscess of the liver carry off the greater number of the various races that compose the population,—the natives of India who have died on our shores, have generally fallen victims to glandular and chest disease. Even the monkey acknowledges the baneful effects of such rapid thermal transitions on his respiratory organs. More than one half of this class of animals that come to this country, die of consumption of the lungs. Dis- eases of the chest and glands certainly become hereditary; but under that head you may include a great many others,— epilepsy,apoplexy,palsy,mania—and perhaps every purely constitutional complaint which has obtained a name. Could the breeding of mankind be as closely watched and as easily controlled as the breeding of our domestic animals, incalcula- ble advantages, moral as well as physical, might be the effect of judiciously crossing particular races with each other. The tendency to the particular passions and diseases which cha- 60 CHRONO-THERMAL racterize nations and families, might, in this manner, be as certainly diminished, as the beauty of the face and form might be exalted in its standard;—for both depend greatly upon hereditary configuration, or upon that particular atomic asso- ciation of certain parts of the body, which you find prevail- ing in families—other external modifying circumstances being, at the same time, kept in view,—such as climate, tem- perature, social and political relationship, &c. But be this as it may, whatever will agitate the whole frame of an indivi- dual,—whatever will in any manner touch the stability and strength of his corporeal totality, must to a certainty with much more severity affect the weakest point of his body, whatever that point be. This doctrine I mean now to ap- ply to Apoplexy. The great system termed the human economy is made up of numerous lesser systems, each having a fabric or material peculiar to itself. By anatomists these various fabrics are termed the tissues. Thus we have the osseous or bony tis- sue of the skeleton, the cartilaginous and ligamentous tissues of the joints; the glandular tissue, different in different sys- tems of the glands, but without which there could be no se- cretion—no saliva—no bile—no perspiration, and the like ;— the muscular and tendinous tissues, so necessary to locomo- tion ;—the nervous tissue,—of two kinds,—one to convey impressions from the brain to all parts of the body, the other to convey impressions back to the brain. Then there is the vascular tissue, partly muscular in its nature, comprising the heart and its infinity of blood-vessels;—to say nothing of the cellular tissue, which, like a web or net, invests and insinuates itself into the whole tissues of the body. The tissue of the lungs and that of the intestinal tube are principally com- pounded of the others ; so, also, are the lining membranes of the various cavities and canals that convey the secretions- mucous membranes, as they are termed—for the membranes that line shut cavities, such as the cavities of the chest and abdomen, are distinguished by the term serous. The cuta- neous, or skin-tissue, performs the part of an outward en- velope to all. Now, as there is seldom such a thin* to be seen as a man or woman whose body is so perfectly made in its outward form as to stand the scrutiny of a sculptor or painter m all its parts, so, in the internal configuration of all bodies, will there be parts, as we have already seen, inferior PRACTICE OF MEDICINE. 61 to other parts in strength and so forth. Some tissue, or por- tion of a tissue, may be at fault. Well, then, suppose the fabric of the blood-vessels.of a part to be the least strongly constructed tissue of a given individual, can you doubt that any thing which might injure that individual's health gene- rally, would, among other phenomena, develope such original weakness in that part of his vascular tissue, even where it had not been before suspected ? Suppose you were to starve a person slowly, or to bleed him day by day, would you'not in that case be sure to break down his whole health ?— Would you not also weaken the coats of the blood-vessels generally by what so palpably weakened every tissue of the frame ? Now, suppose one or more vessels of the brain to be the least strongly constructed parts of an individual body, would not such starvation or such blood-letting be sure to produce so great a weakness of the coats of these vessels as to give them a tendency to rupture, the consequence of which would be effusion of blood upon the brain,—in other words, apoplexy ? I think you must, even in theory, come to that conclusion. But I will give you a fact, or rather a host of facts, which you will be glad to take in change for a thousand theories. The inmates of the penitentiary prison, by very gross mismanagement, were put upon a diet from which ani- mal food was almost entirely excluded—they were all but starved—" An ox's head weighing eight pounds was made into soup for one hundred people, which allows one ounce and a quarter of meat to each person. After they had been living on this food for some time, they lost their colour, flesh, and strength, and could not do as much work as formerly." " The affections which came on during this faded, wasted, weakened state of body, were headache, vertigo, delirium, convulsions, Apoplexy." Remember, this is not my state- ment—no distortion or corruption of words made by me as a party advocate. It is literatim et verbatim extracted from the official report of Dr. Latham, the physician who was de- puted by government to inquire into the cause of the great mortality in the penitentiary. If you place any confidence in its accuracy,—if you believe Dr. Latham to be an honest man, there is only one conclusion you can come to, which is this, that the practice of starving and bleeding to prevent or cure apoplexy, is the most certain mode of producing this disease in persons predisposed to it, and of confirming it in such as have already shown the apoplectic symptoms. You seem startled at this, and no wonder—for some of you have 6 62 CHRONO-THERMAL doubtless lost relatives by the practice. How then, you have a right to demand, must apoplexy be treated? Inat apoplexy, like every other disease, is a development of gene- ral constitutional disturbance,—that it is a remittent disease, and in many instances curable by the remedies so generally influential in the treatment of intermittent fever, according to the various stages of that complaint, I could prove to you by a multitude of evidence. Dr. Graves, of Dublin, gives the case of a gentleman living in the neighbourhood of Donnybrook. This gentleman, Dr. Graves tells us, " had slept well till four o'clock in the morn- ing, when he was awakened by a general feeling of malaise, shortly after which he complained of chilliness, some nausea, and headache. [Here then was the cold stage.] After these symptoms had continued about an hour, his skin became ex- tremely hot, the pain of the head intense, and drowsiness was complained of, which soon ended in perfect coma, with deep snoring and insensibility; in fact, he appeared to be labouring under a violent apoplectic fit. He seemed to derive much advantage from bleeding and other remedies, and to my surprise was perfectly well when I visited him in the evening. The day but one after, at the very same hour, the very same symptoms returned, and were removed by the very same remedies. [So at least the doctor thought.] I must confess," he continues, " that I could not explain in a satisfactory manner the perfect freedom from all cerebral and paralytic symptoms after two such violent attacks of apo- plexy. But when a third attack came on, I then saw it was a cace of the tertiana soporosa of nosologists, [what jar- gon !] and I prevented the return of the fit by the exhibition of quinine." The quinine, you see, proved at once an effi- cient preventive of the returning fits, while repeated blood- letting, whatever might have been its effect in shortening them, had not the slightest influence in that more salutary effect. But when Dr. Graves supposed that his bleedings did actually shorten the duration of the fits, may he not have been deceived by the approaching remission of the disease- may he not have mistaken this natural phenomenon of all disorder for the effect of his remedies ? However that may be, I can say this much for myself, that since I gave up the practice of bleeding in apoplexy, I have found that disease in the young as generally curable as any other, and in the old much less fatal than when treated by the lancet. PRACTICE OF MEDICINE. 63 That you may cure the disposition to Ruptured Blood-vessels or Hemorrhage in other parts of the body, as well as in the brain, by cold affusion, I could give you an infinity of proofs. What is the old woman's practice in bleeding from the nose ? To put a cold key down your back, and thus, by the sudden shock, change in a moment the whole corporeal temperature. The principle is the same in both cases, and the good effects of that measure ought long ago to have suggested to medical practitioners a better practice in apoplexy and other haemor- rhages than is at present the fashion with fashionable doctors. Cold water has many virtues, but a great deal depends on the mode of its application.* The suddenness of the dash is the chief thing to be attended to in cases of this na- ture. So much, then, for the proper treatment of the patient during the fit of bleeding; but what is to be done to prevent its return ? Practitioners, almost to a man, bleed and purge you. The following case may open their eyes ; and as it is not taken from my own experience, but from a German Medical Journal of repute, it may perhaps carry more weight with it on that account. " A strong man, aged 27, suffered on alternate days from very violent bleeding at the nose, which continued from four to six hours, and could neither be stopped nor diminished by the usual styptics, nor by any of the other means commonly employed in similar cases.— Taking into account the remarkable periodicity of the bleed- ing, the treatment was changed for a large dose of sulphate of quinine with sulphuric acid. During the twenty-one days following, the bleeding recurred but twice, and was then readily stopped. The patient subsequently continued quite well."—[Med. Zeitung, No. 33, 1836.J In the case of a young lady afflicted with priodical vomit- ing of blood, for which she had been repeatedly bled with- * Much is said now-a-days of Hysrofathy, which, whether a novelty or not, ought rather to be called Hydro-BATH-y. Hydropathy, on a right prin- ciple, is only a fragmental part of chrono-thermal means. Practised as it is by Priessnitz and his followers, on the old erroneous humor-al doctrine, it must occasionally injure those who submit to it. Of this I lately had an instance in the person of a female patient who had partially lost the use of her right arm and leg. The case was of a paralytic kind, and among other means for its relief, the patient had tried a hydropathic establishment, which, she declares, not only made her worse, but " all but killed her." Under a chrono-thermal course, I am happy to say, she has very nearly recovered the original power of the affected muscles. G4 chrono-thermal out the smallest advantage—or rather to the great injury of her general health,—I effected a rapid cure with a combina- tion of quinine and alum. The same disease I have again and again cured by arsenic, opium, and prussic acid, &c. You will now, I have no doubt, be prepared to question the propriety of the usual murderous treatment adopted for spitting of blood—pulmonary apoplexy, as it has been called. Is not the lancet, in almost every such case, the first thing in requisition, and death the almost as invariable result of the measure? What say the older authors upon this matter? Listen to Heberden, a physician who, for upwards of thirty years, had the highest and most extensive practice in London : " It seems probable," writes this veteran in medi- cine, " from all the experience I have had of such cases, that where the haemorrhage proceeds from the breach of some large vein or artery, there the opening of a vein will not stop the efflux of blood, and it will stop without the help of the lancet, when it proceeds from a small one. In the for- mer case, bleeding does no good ; and in the latter, by an un- necessary waste of the patient's strength, it will do harm. But if the opening of a vein be intended to stop a hemor- rhage, by deprivation or revulsion, may it not be questioned whether this doctrine be so clearly established as to remove all fears of hurting a person- who has already lost too much blood, by a practice attended by the certain loss of more ?" With which reasoning I hope you are all, by this time, pre- pared to agree. But men who know nothing of the economy of the human system, will sometimes dispute this matter with you, by saying that their patients make blood so fast, that they must periodically bleed them, to keep down the disposi- tion to haemorrhage. These practitioners deceive themselves; they are deluded into this false and fatal practice by the re- turning febrile fit—a fit that will recur and re-recur at more or less regular periods, while there are blood and life in the body; and the more frequent the bleedings practised in the case, the more frequently will this febrile fit come on, and with it the very haemorrhage which it is the object of their solici- tude to prevent. Does it not stand to reason, that the more you debilitate the whole body, the more certainly must yott weaken at the same time the already too weak tissue of the vascular coats, that tissue whose original weakness consti- tutes the tendency to haemorrhage! Instead of being the consequence of any constitutional plenitude of the blood itself, spitting of blood is only a natural effect of real weakness PRACTICE OF MEDICINE. 65 in the coats of the containing vessels of the lungs; so that not only is the theory of making too much blood absolute nonsense, but the measures which medical men have for cen- turies been putting in force, for the cure of haemorrhagic dis- eases, have been one and all as fatal in their tendency, as the theory that led to them was in principle false. Look at the pale and ensanguined countenances of the unfortunate indi- viduals who, whether for spitting of blood, apoplexy, or other haemorrhages, have been subjected to such cruel discipline, and tell me if these poor creatures make too much blood ?— Too much blood !—only place your finger on the artery of the wrist, and you may feel it jerking, and compressible, like that of a female who has suffered from repeated floodings. Even during the febrile paroxysm, you may see by the cir- cumscribed flush of the face that this patient is actually dying of hectic or inanition. What fatal mistakes have not origi- nated in the notion of making too much blood !—To bleed in the case of a ruptured blood-vessel, then, is positive madness. If you open a vein in the arm of any man, whether healthy or the reverse, and let blood, will the opening of another vein stop the flow of blood from the vein first opened? So far from that, both veins will go on bleeding till the patient either faint or die ! Should not this fact have long ago opened the eyes of the profession to the fallacy of their practice ! How can you doubt, for a moment, that the coats of the blood- vessels, like every other tissue of the body, must be equally implicated in the general debility that cannot fail to be pro- duced by whatever abstracts from, or prevents the entrance of, the material necessary to the healthy organization of every part of the human frame ? To bleed or starve a person hav- ing a hereditary predisposition to spitting of blood or apo- plexy, is the most certain method to develope these diseases in their worst forms! Yet this is the daily practice of the most eminent physicians 1 one among many proofs, that in the medical profession, eminence is less frequently attained by successful results in practice, than by the dexterous em- ployment of all those mean arts and petty intrigues with which mediocre but unscrupulous minds too often beat men of genius in the game of life. So far as practice is con- cerned, the eminent physician generally confines himself to the fashion of the day—the more especially if that fashion be profitable to the apothecary; for in such case he is sure to become the fortunate puppet of those whose bread depends, 6* 66 CHRONO-THERMAL not so much upon the cures they shall effect, as the quantity of physic they shall manage to sell! What a happy nation of fools must that be, which supposes that any class of man- kind will put the interests of the public in competition with their own. Benighted and misguided people ! you call upon men to relieve you from your sufferings, while you hold out to them the most powerful of temptations to keep you on your sick-beds! You pay for physic what you deny to talent—for a long illness, what you refuse to a speedy reco- very ! Do you think medical men angels, that you thus tam- per with their integrity ? Your very mode of remunerating them forces them to be corrupt—and that, too, at a moment when their numbers are so great, that could even one half of them live honestly, the other half must starve! Hear Mr. Abernethy on this subject:—" There has been a great increase of medical men, it is true, of late years; but upon my life, diseases have increased in proportion;—that is a great comfort!" To whom is it a comfort ?—to the public or the profession ?—When you call in the physician recon mended by your apothecary, how can you be sure that he is not a confederate ? or that, when the farce of a " consulta- tion" is gone through, you are not the dupes of a petty in- trigue to pick your pockets ? Uncharitable man! some of you may possibly say, how can you thus malign the members of your own profession ? When so many of ?ny profession, and those not always of the lowest class, descend to practices which degrade medicine into the vilest of trades; when, like the Thugs of Indi^ numbers of them silently and secretly enter into systematic collusions and conspiracies for the pur- pose of inveigling and plundering, under friendship's garb, the unfortunate victims who too confidingly repose on their honour and integrity, But to return to the subject of ruptured blood-vessels. You will find that in every case, except where it has been pro- duced by mechanical or other local agency, this disease is the effect or development of general intermittent fever; the symptoms of which fever vary in their degree of severity with every casein one being bold and well marked, in another, so softened and subdued, as almost to escape the patient's own observation;—curable, too, like the simplest ague, by the cold dash, or an emetic given during the hot fit; and to be prevented from recurring by chrono-thermal treat- ment during the interval of remission. I could give dozens PRACTICE OF MEDICINE. 67 of cases of every kind of constitutional haemorrhage cured m this manner; but the details of one would.be the details of all. Yes, I repeat, by the early use of emetics, the proper application of heat and cold in the different morbid conditions of the body constituting the febrile fit, and by the judicious exhibition of the chrono-thermal medicines during its remis- sion, I have successfully treated every kind of hemorrhagic disease. The same system of treatment has enabled me effec- tually to cure many cases of enlarged veins—varicose veins, as they are termed—and the mention of this recalls to my recollection the case of an aged female who had a painful varicose ulcer—that is, a sore with blood-vessels opening into it—for which I prescribed the internal use of arsenic, with almost immediate relief to her pain, and the subsequent cure of her ulcer. From the happy result of that and other similar cases, the surgical mechanic may learn that there are other and better modes of treating " varicose veins," than by bandages and laced stockings, Well, then, I have said tM»I mean to say upon the subject of haemorrhage, and I have anticipated something of what naturally belongs to the treat- ment of diseases of the Chest. Of these I must now speak at some length. It has ever been the policy of teachers and professors to affect to penetrate farther into a millstone than their pupils; and, seeing that for the most part such professors know as little of their particular subject as those they, pretend to en* lighten upon it, so far as their own reputation is concerned, they are doubtless right. The great millstone of the present day is the chest,—and Laennec's bauble, the divining rod by which our modern sages pretend to have obtained their knowledge of it. If you believe them, a hollow piece of stick they have nicknamed " the stethoscope," is the greatest invention of these times ! By means of it you may discover every motion and change of motion that ever took place in the organs within the cavity of the chest, and some that never could take place in them at all. What an invaluable instru- ment must it be—^that stethoscope ! The enchanter's wand was nothing to it! Aaron's rod perhaps came the nearest to~ it! But, seriously speaking, just observe how gravely your hospital tyros hoodwink and hocus each other with the phrases "hypertrophy" here, and "atrophy" there; 'e right but the received doctrine." Yet, in the words of the same acute writer, " An error is no better for being common, nor truth the worse for having been neglected; and if it were put to the vote any where in the whole world, I doubt, as things are managed, whether truth would have the majority; at least while the authority of men, and not the examination of things, must be its measure." The operation of blood-letting is so associated, in the minds of most men, with the practice of physic, that when a very sensible German physician, some time ago, petitioned the king of Prussia to make the employment of the lancet penal, he was laughed at from one end of Europe to the other. This you will not wonder at, if you consider that the multitude always think " whatever is, is right;" but a little reflection will teach you, that there must have been a period in the world's history when the lancet was unknown as a remedy; and that many centuries necessarily elapsed before it could even be imagined that loss of blood might alleviate or cure disease. Nations, nevertheless, grew and prospered. To what daring innovator the practice of physic owes the curse of the lancet, the annals of the art leave us in igno- rance ; but this we know, that its introduction could only have been during the infancy of medicine; when remedial means were yet few, and the mode of action of remedies totally unknown. It was the invention of an unenlightened, possibly a sanguinary age, and its continued use says but lit- tle for after discoveries, or the boasted progress of medical science. Like every other lucrative branch of human know- ledge, the practice of medicine was 'at one lime entirely in the hands of the priesthood. Might not blood-letting have been first introduced as a sacrifice or expiation on the part of the patient, for his supposed sins against an offended Deity? for that, till very lately, was the ecclesiastical cause of all diseases I am inclined to this belief from the fact, that one of the kings of Spain made his peace with the inquisition, after a bitter quarrel with that body; they condemned him, as a penance, to lose a pound of his blood, which was after- wards burnt in public by the common hangman Of what is the body composed ? Is it not of blood, and cblood only ? What fills up the excavation of an ulcer or an abscess ? What reproduces the bone of the leg or arm, after PRACTICE OF MEDICINE. 83 it has been dead, and exfoliation *akes place in nearly all its length ? what but the living blood, under the electrical influ- ence of the nerves from the brain? How does the slaughtered animal die ? Of loss of blood solely. Is not death, too, the result of badly treated uterine haemorrhage ? Is not the blood, then, in the very impressive language of the scriptures, the life of the flesh ? How remarkable, that while the value of the blood to the animal economy should be thus so distinctly and emphatically acknowledged, blood-letting is not even once alluded to among the various modes of cure mentioned in the sacred volume. We have balms, balsams, baths, charms, physic, poultices even—but loss of blood, never ! Had it been practiced by the Jews, why this omission ? Will the men who now so lavishly pour out the life's blood dispute its import- ance in the animal economy ? Will they deny that it forms the basis ? that when the body has been wasted by long dis- ease, it is by the blood only it can recover its healthy volume and appearance ? Has not nature done every thing to pre- serve to animals of every kind " The electric blood with which their arteries run?"—Bybos-. She has provided it with strong, elastic vessels, which slip from the touch, and never suffer their contents to escape, ex- cept where their coats have been injured by disease or acci- dent. Misguided by theory, man, presumptuous man, has dared to divide what God, as a part of creation, united ; to open that which the Eternal, in his wisdom, has made entire. See, then, what an extreme measure this is. Yet what is daily more readily submitted to, under the influence of au- thority and custom ? If, in the language of the chemist Lie- big, the blood be indeed " the sum of all the organs that are being formed," how can you withdraw it from one organ without depriving every other of the material of its healthy state ? Yet enter our almshouse or hospital, and see how mercilessly the lancet, the leech, and cupping-glasses are used in the treatment of the diseases of the poor. Look at the pale, ghastly faces of the inmates, and see the contrast be- tween their complexion and that of the eager pupils and attendants thronging around their beds—those attendants with bandage and basin, ready at a moment's warning to take from the poor, already exsanguined creatures, whatever quantity of their life's blood solemn pedantry may prescribe as the infallible means of relieving their sufferings. Witness • 84 CHRONO-THERMAL this, and refrain, if you cam, from exclaiming with Bulwer— " WThen poverty is sick, the doctors mangle it." What are the causes which predispose to disease in this class of people ? In the majority of cases defective food and impure air. By these has their blood been thinned and dete- riorated ; and for what does the so-termed man of science remove it—to make room for better ? No. Goaded on by the twin-goblins "congestion" and "inflammation," to dete- riorate still further by starvation and confinement. These terms play in physic much the same part as others, equally senselessly misused, play in the common affairs of the world. "Religion, freedom, vengeance, what you will, A word's enough to raise mankind to kill, Some /iarty-phrase, by cunning caught and spread, That guilt may reign, and wolves and worms be fed.—Byhon." The first thing the surgeon or physician thinks of, when called to an accident, is how he shall most quickly open the floodgates of the heart, to pour out the stream of an already enfeebled existence. If you fall from a tree, house, or horse are you not instantly bled ?—or when stunned by a blow, is not the lancet in requisition ? If you faint from great exer- tion or exhaustion, is it not the common practice to bleed you ? Or suppose, from constitutional debility, you are sub- ject to epileptic fits, does not the doctor declare there is no- thing so proper as blood-letting—and what is the result ?—a certain return of such fits. The case of the inimitable Malibran may be familiar to many of you. She, who so often, by her varied and admira- ble performance, moved to tears and smiles, by turns, her whole audience. She was playing her part upon the stage, and entering into it with her whole soul, rivetting her audi- ence to the spot "by the very intensity of her acting;" and thPwh.7 PtTWerS W6re LhUS taXed t0 the uttermost, and when the whole house was about to pour forth their enthusiastic ZnTe%ttfaitted,andfe11- APhysi^n instant yTeapd En X le f ag"-t0 administer a cordial, or loosen her dress? No!-to bleed her; to take life's fluid from a weak worn down and exhausted woman .'-and the resultMS£ nTer rallied from that unlucky hour. Had the^ ^ticfstonned wirh'^I^i7 Valuarble Uvesmight h*ve been aved PYe1 me Ian et b^m^/ ^Self have <*en erred in the use o hL my own ReZJ WaS ,more the ^nlt of my teachers man my own. Reflection and experience have opened my PRACTICE OF MEDICINE. 85 eyes, and now 1 use the lancet only when the vessels of the lungs become congested, preventing full and deep inflation by inspiration, and known by applying the ear to the chest, and marking the respiratory murmur; if this be very indistinct in an individual healthy a few days or hours before, take three, four, five, or six ounces of blood : this will relieve the venous plethora, and the volume of the vessels being thus diminished, that of the air-cells will increase. If moderate bleeding be not practised in such a case, you may have nature acting, and a ruptured vessel and spitting of blood the result: of two evils choose the least. But these cases are so rare, that in prescribing for 1400 persons in the last two years, I have only met with three cases. I have said three, four, five or six ounces, but the colour of the blood drawn will be your best guide, and if, after the flow of two, three, or four ounces, the dark and carbonized colour should change to lighter, or red blood enough has been taken for all purposes, and as this can onlyi)e known by one well skilled in the art of medicine, trust not the life of your patient in the hands of a bleeder, for no physician can know beforehand how much or how little will answer the purpose. The office of the lungs is dis- tinct from the other organs of the body; the admission of the lancet here is not for the purpose of lessening the mass of blood, but simply to enable the lungs to do their office of res- piration more perfectly, by removing that blood which cannot become arterial, and hence useless. Such cases are, as I have already said, extremely rare. In every case of stun, or faint, the use of the lancet must bean additional injury; in all there is a positive enfeeble- ment of the whole frame, evidenced by the cold surface and weak or imperceptible pulse; positive exhaustion, which loss of blood, so far from relieving, too often converts into a state of utter and hopeless prostration. Some men recover after being bled freely and frequently; but these are not cures— I call them escapes! , . , , c t_i j " How few the diseases are which loss of blood may not of itself produce. If it cannot cause the eruption of small- pox, nor the glandular swellings of plague, it has given rise to disorders more frequently and more immediately fatal than either. What think you of cholera, asphyxia—Asiatic cholera as it has been called? The symptoms of that dis- ease are the identical symptoms of persons bleeding to death ; the vomitings, cramps, sighing, the long gasp for breath, the leaden and livid countenance, which the painter gives to the 8 86 CHRONO-THERMAL dying in his battle-pieces, are equally the symptoms of cho- lera and loss of blood." Among the numerous diseases blood-letting can produce, says Darwin, gout is frequent. John Hunter mentions lock- jaw and dropsy; Travers, blindness and palsy; Marshall Hall, mania; Blundell, dysentery; Broussais, fever and con- vulsions. When an animal loses a considerable quantity of blood, says John Hunter, the heart increases in its frequency of beats and in its violence; yet these are the symptoms for which professors tell you to bleed. They tell you, also, to bleed in inflammation ; yet, as I have shown you, this state is the effect of loss of blood. How do all the writers on in- flammation define it ? They say it consists in a distended state of the blood-vessels, and a consequent sluggish motion of their contents; and when thus weakened and distended, is not the most rational practice to give them support by pressure, cold applications, and tonics. If these distended vessels remain distended long, suppuration is the result. The blood changes into pus, and an abscess is the end—where you will always find loss of colour, debility, &c. But each of these states will be preceded by chill and fever, and would disappear if you cure such chill and fever by chrono-thermal medicines. But let physicians treat fever in their way, or the old way, by the lancet, emetics, nauseating doses, &c, and you will find their patients, if they should recover from such fevers, predisposed to, or actually have, abscesses, tumours, gatherings, &c, which the doctors will call critical, meaning a fortunate termination of fever. Suppose the lungs of their , patients should be the weakest part, then perhaps they would be the seat of this so-called critical abscess ; and the result? why then their doctor discovers he has mistaken the case- the patient is actually consumptive; and therefore I do con- tend that this disease is as often produced by improper medi- cal treatment as from any other cause The long shiver of the severest ague, the burning fever, the fatal^lock-jaw, the vomiting, cramps, and asphyxia of ot» i,m tht TiSm, °,f aSt u™'and ePile-ps^ the P*™ of rheull w I Palpitating heart, the faint that became death,-all hese have I traced to loss of blood. Ask physicians why lanTe? tnU", T*> * !™tin* fitS' in exhaustion or cS tun orllu7 it 7t°U " 1S t0 Te]}eVe congesti°n 5 and after a stun or fall ?-it is to prevent inflammation. Now, although I have, in my early practice, bled often, I have never seen PRACTICE OF MEDICINE. 87 the lancet prevent what is called inflammation, or relieve congestion. But have we never seen inflammation of a vein, after bleeding—inflammation caused by the very act? and have we not seen such inflammation end fatally ? Have we not seen leech-bites become inflamed, after these reptiles had exhausted the blood of the part to which they were applied? And how came this about? Simply thus ! however perfectly you exhaust any part of the body of its blood, you do not thereby prevent that part from being filled again with it: or rather, you make it more liable to be so filled, by weakening the coats of the containing vessels. The beneficial effect of blood-letting, where it has been beneficial in the cure of dis- ease, relates solely to temperature. In the congestive and non- congestive stages of fever—the cold, the hot, the sweating stages—the lancet has had its advocates; blood-letting, under each of these stages, has changed existing temperature.— Why, then, object to the lancet? For this best of reasons— that we have remedies without number, possessing each an influence equally rapid, and an agency equally curative, with- out being, like blood-letting, attended with the insuperable disadvantage of abstracting the material of healthy organiza- tion. I deny not its power in certain cases, but I question its claim to precedence in all of these. As I have already said, in positive venous congestion of the lungs, the lancet may be admissible to a moderate extent; but these cases do not occur more than once in a hundred. How often do we find the patient we have bled, cold in the morning, hot and feverish at night, and frequently with an aggravation of all the symptoms, demanding more bleed- ing ;°and if we bleed more, how often do we have the return of fever greater. Did the lancet ever cure fever, or any so- called inflammation, without the use of other remedies ? And again—have not other remedies often cured inflammations and fevers where no bleeding was practised ? Have you ever read or heard of the case of Dr. Dill, given in the Lon- don Medical Gazette? it runs thus— **< Inflammation of the Brain:'—(I give it to show the Smion and result of practice among physicians generally.)— Dr Dill being threatened with an attack of high inflamma- tion of the brain, I was called to see him (says Dr. Smith) before there was any pain in the head or back, while he was vet only feeble and chilly. The aspect of his countenance, the state of his pulse, which was slow and labouring, and the answers he returned to two or three questions, satisfied CHRONO-THERMAL me of the inordinate, I may say ferocious, attack that was at hand. I bled him twenty ounces; this blood did not look inflamed; severe pains in the limbs, loins, and head, imme- diately came on. The following morning I took away six- teen ounces more, which somewhat relieved the pains. The next evening I bled him sixteen ounces more, and this blood produced the bufly coat, or surface, upon standing a few hours in the basin, met with in inflammation." Now mark Dr. Smith's own account!—the first blood drawn showed no buff or inflammation—the last did; now, if the lancet can cure inflammation, how happened this after its use ? He goes on to say—"During the night the pains returned, and in the morning, notwithstanding the eyes were dull and blood- shot, the face pale, and the pulse slow and intermittent, twelve leeches were applied to the temples, and as these did not re- lieve the pain, sixteen ounces more blood was taken by cup- ping; the pain now left him, but on the following day it returned with great violence. Typhoid symptoms now began to appear, and our system could not be carried on with safety any longer. What was to be done ? Cold water and tonics we now used, and the symptoms were relieved, and by their con- tinuation he finally got well." Most sincerely do we congratu- late Dr. Dill on his escape—not from a dangerous disease, but from a dangerous remedy. What other remedy but the lan- cet would have been trusted so long, without the least good effect ?—None. Lord Byron anathematized medicine—the destructive art of healing. How truly it proved so in his case, you may learn from Mr. Moore's account of it, given in his last ill- ness. " Of all his prejudices," says Mr. Moore, "he declared the strongest was that against blood-letting. His mother had obtained from him a promise, never to consent to be bled, and whatever arguments might be produced, he said his aversion was stronger than reason. < Besides, is it not,' he asked, < asserted by Dr. Reid, in his Essays, that less slaughter is effected by the lance than the lancet; that minute instal- ment of mighty mischief!' On Mr.Millengen observing tSt this remark related to the treatment of nervous, but not to inflammatory complaints, he rejoined, in an angry tone, 'Who is nervous, if I am not ? and do not those words of his apply n°flt?irSeVlhT hG SayS Vhat drawinS bl°°d from a nervous nhZVl i l0Tr,grthe cords of a musical instrument, whose tones already fail for want of sufficient tension Even PRACTICE OF MEDICINE. 89 rt !iG lllness> you yourself know how weak and irritable I had become, and bleeding, by increasing this state, will inevitably kill me. (Mark how he plead for life.) Do with me what else you like, but bleed me you shall not. I have had several inflammatory complaints during my life, and at an age when more robust and plethoric, yet I got through them all without bleeding; this time also will I take my chance.' After much reasoning, and repeated entreaties, Mr. Millengen at length obtained from him a promise that, should he feel his fever increase at night, he would allow Dr. Bruno (who was left with him) to bleed him. " On revisiting the patient early next morning, Mr. Millen- gen learned from him, that having passed, as he thought, on the whole, a better night, he had not considered it necessary to ask Dr. Bruno to bleed him. What followed, I shall, in justice to Mr. Millengen,give in his own words:—' I thought it my duty now (he says) to put aside all consideration of his feelings, and to declare solemnly to him how deeply I la- mented to see him thus trifle his life away, and show so little resolution. His pertinacious refusal had already caused much precious time to be lost; but few hours of hope now remained, and, unless he submitted immediately to be bled, we could not answer for the consequences ; it was true, he cared not for life, but who could assure him that, unless he changed his resolution, the uncontrolled disease might not operate such disorganization in his system, as utterly and forever to deprive him of reason ! I had now hit at last upon the sensible cord, and partly annoyed by our importunities, partly persuaded, he cast at us both the fiercest glance of vexation, and throw- ing out his arm, said in the angriest tone : " There, you are, I see, a set of butchers,—take away as much blood as you like, but have done with it." We seized the moment, (adds Mr. Millengen,) and drew about twenty ounces. On coagu- lating, the blood presented a strong buffy coat; yet the relief obtained did not correspond to the hopes we had formed, and during the night the fever became stronger than it had been hitherto, the restlessness and agitation increased, and the pa- tient spoke several times in an incoherent manner.'" Surely this should have convinced the most schoolbound of the worse than inoperative nature of the measure. Far from it, however, in this case. On the following morning, 17th of April, the bleeding was twice repeated, and blisters applied to the feet. Well might Mr. Moore exclaim, " it is 8* 90 CHRONO-THERMAL painful to dwell on such details." For our present purpose, it will be sufficient to state, that although the treatment re- moved some rheumatic pains he had suffered from, it was at the expense of his life. He died on the 19th, three days after the first bleeding. ASTHMA. This term, though indefinite, still continues to be employed by the scientific as well as the uneducated! though asthma not unfrequently exists under the name of phthisic,a term often used in some parts of the country. " Difficulter respirare," is perhaps as significant a name as we can give asthma under its varied forms. A name can be of little importance to an individual suffocating with asthma, and yet a name will frequently relieve a patient or destroy the peace of a whole family. Among nosological writers, names have produced much confusion, and as a necessary consequence, have led to a simi- lar result in practice. What one nosologist considers a cause, another describes as an effect; and medicines highly extolled by one physician, are often decried by another. Attempts have been made by writers from the earliest his- tory of medicine to distinguish asthma from other diseases of the chest, and this end was supposed to be attained by term- ing a slight difficulty of breathing dyspnoea, and laborious respiration asthma. The moderns recognize two primary species—the spasmodic and the humoral. The parenchyma of the lungs is seldom, if ever, affected by the disease, while the mucous membrane will invariably be found to be its seat, having its remote cause in the digestive organs primarily, disordering the nervous system, and through this connection, affecting the lining membrane of the bron- chial tubes. In this way the system is continually predis- posed to attacks, and when exciting causes occur, such as wet feet, exposure to a damp and cold wind, or a location in a low and marshy section of country, the disease will be produced. Or derangement of the nervous system, proceeding from other causes, may produce asthma, independent of disordered di- PRACTICE OF MEDICINE. 91 gestion. A remarkable case of this kind occurred to me in 1837. A gentleman in Pittsburgh, having received a severe blow upon the back, near the sixth dorsal vertebra, from the falling of a brick while passing under a scaffold erected in front of a new building, was immediately seized with great difficulty of breathing, strongly resembling spasmodic asthma. His physician pursued the best treatment for his relief, which was soon obtained ; he was bled freely, and repeatedly leeched on the contused part of the back ; purgatives and antispas- modics were used with a mild diet: under this treatment the patient soon recovered. At the expiration of six weeks from the accident, his breath- ing became oppressed, and now assumed the decided charac- ter of asthma, which yielded to the application of 40 leeches to the spine, and large doses of gum foetid. His third attack was as punctual, as to time, as the second had been, six weeks having again elapsed: this third attack occurred while on a visit to our city, and I was called to visit him during the paroxysm. He gave me the above history of his case, and declared his digestion had never been out of order in the least. Upon examination of the spine, I was at once con- vinced of the fact, that the shock received by the sympathetic nerves, had been sufficient to occasion all the inconvenience from asthma which this patient suffered ; and as he had been repeatedly leeched, I presumed all the benefit that could be obtained from this remedy, the patient had experienced. I, therefore, applied moxa about three inches above and below the tender spot on the back, and slight galvanic shocks, with eight drops of Fowler's solution, to be taken night and morn- ing. This attack subsided in half an hour after the applica- tion of the moxa and galvanism, when the patient observed that he had found the right thing at last. These sores were kept open with Savin ointment, and the solution continued with galvanism for twelve days. He returned home in the third week after my treatment commenced, and has had but one slight attack since that time; this occurred at the expira- tion of the first six weeks from his visit to our city. After a lapse of five months, he suffered the sores to heal. Asthma, in my opinion, is originally spasmodic; becoming humoral either from being connected with some latent inflam- mation or from long continued habit. There is doubtless a third species, namely, from gout, which will generally be found to be hereditary. This we should try to fix in some part less necessary for the functions of life. 92 CHRONO-THERMAL Sauvage has employed the suspirium, used by Celsus and Seneca, as a general term to designate asthma. Independ- ently of this authority, it has perhaps a claim to admission into the medical vocabulary from being identified with the person of Virgil; and this, moreover, through the pleasant observation of Augustus, who, alluding to the asthma of the epic poet, and the weak eyes of Horace, when seated between them at table, observed that he was "inter suspiria et lachry- mas," (between sighs and tears.) The treatment I have found most beneficial, has been that which was required for the correction of disorders which may be its cause. Derangement of the liver, of the uterus, of the bowels, stomach, spine, or brain, with injuries of the bony walls of the chest, predispose to, while irregularity in sleep- ing, eating, clothing, and weather, excite the disease. These causes can all be removed by proper medical treatment, and great care on the part of the patient. The dyspnoea requires, during an attack, some relief, which will always be obtained by taking small doses of the tincture of lobelia and ether, and inhaling a mixture of oxygen and ethereal vapour. My practice in asthma has invariably been, to remove the predisposing cause of the disease; when this is accomplished, I have generally found its exciting causes were harmless.— My experience teaches me that the remedy most successful is the regular use of my asthmatic elixir, a chrono-thermal remedy. OF CONSUMPTION. DESCRIPTION OF THE LUNGS. The human body, properly so called, is divided transversely into two distinct cavities, by a thin, fine membrane, which is termed the diaphragm. The superior cavity contains the lungs, heart, &c, and is termed the thorax, or chest. The lungs, called also the lights, are enclosed in two distinct sacs, or bags, by the pleura, so that the two principal lobes of the lungs have no direct communication with each other. As both lungs are seldom affected, except in the advanced stage PRACTICE OF MEDICINE. 93 of the disease, Nature has kindly arranged them in such a way as to have no immediate connection with each other, so that a disease of the one may not immediately affect the other. Besides, it appears that every minute lobule of the same lobe is so admirably contrived as to perform its function independ- ent of the others, so that each vesicle, or air-cell, continues to return and receive its portion of air, until it is actually de- stroyed. Accordingly we find, on dissection of consumptive subjects, parts of the lungs destroyed, whilst the remainder are comparatively sound. To return:—these sacs meet near the middle of the chest, and by their adhesion form a perpen- dicular membrane called the mediastinum, but separating again, a third sac is formed, which is termed the pericar- dium, or heart-case. The lungs, in a healthy state, are extremely light and spongy, and are composed of numerous air-cells, blood- vessels, lymphatics, or vessels containing a watery fluid and cellular membrane, which does not appear to be vascular or irritable. The blood-vessels of the lungs differ in some respects from those of the other parts of the body, inasmuch as the arteries of the lungs contain venous, or dark red blood, while the veins contain the arterial, or bright red blood, which is transmitted by them to the heart, from which it is conveyed by the arteries to the various parts of the body. The small branches of the pulmonary arteries form a beautiful net-work of vessels on the internal membrane of the air-vesicles.— During expiration, the air-vesicles are collapsed, consequently the blood-vessels become tortuous, and the blood is prevented from passing. In inspiration, the air-vesicles being dilated, the tortuous vessels are elongated, and a free passage afforded to the blood. The coats of these vessels are so thin as to suffer a chemical action to take place between the air in the vesicles and the blood in the vessels. Besides the veins and arteries already mentioned, they are furnished with another distinct set of vessels, whose sole office appears to be the nourishment or support of the lungs." The air-cells, or vessels, are extremely small tubes, branch- ing off from the windpipe, very nearly in the same manner the twigs and branches of a tree do from the main trunk.— In health, the air passes freely from the windpipe to the air- cells, so that every time we draw a full breath, or inspiration, the air-cells are filled or distended. The lymphatic vessels are distributed on the surface of the lungs; their office is to absorb the lymph, and convey it into the thoracic duct, the 94 CHRONO-THERMAL common trunk of the absorbent system, where it is mixed with the chyle, and both are immediately afterwards carried into the current of the venous blood, near the heart. Like the chyle, the lymph contributes to repair the losses of the blood, which is first subjected to the action of the lungs, in combination with the chyle and venous blood, and the whole compound is converted into arterial blood. Like the chyle, too, the lymph bears a strong analogy to the blood in its com- position and properties. The nerves are very small branches furnished, or proceeding principally from the par vagum, or eighth pair and great intercostal. The windpipe, or arteria asperia, is a long cylindrical tube, composed of alternate cartilaginous and fleshy rings, defective behind, through which the air is conveyed to and from the lungs in breathing; it is furnished with a membrane on its internal surface of exquisite sensibility, which, in the healthy state, is continually lubricated by a thin, bland mucus, se- creted by a number of small glands situated behind the rings, and prevents irritation. As we shall have to notice this mem- brane again, when we come to treat of its connection, or sym- pathy with the skin, we shall now proceed to the considera- tion of the functions supposed to be carried on by the lungs; we say supposed, because, strange as it may appear, physi- ologists are not yet agreed as to the precise nature of their office'; as a variety of conjectures, for most of them amount to nothing more, have been offered on this subject, we shall only notice that which appears the most probable, that it is in the lungs the blood is vivified, decarbonized, or, as some term it, oxygenized, by which a certain quantity of oxygen is ab- stracted from the atmospheric air, and at the same time, a part of the noxious morbid matter generated in the system is thrown off; and that the principal uses of respiration is to relieve the body of a certain matter perspirable only from the lungs, which, if entirely retained, is incompatible with exist- ence, and if retained in part, is productive of disease, and this is said to be effected by a number of small ducts leading from the pulmonary arteries to the air-vessels, where it is dis- solved and carried off by the air during respiration. This theory, which we believe is that which is most generally con- sidered orthodox, is only true in part, as we shall presently show, when we come to treat of the functions of the skin, and the intimate connection, or sympathy, existing between it and the mucous membranes of the lungs, liver, &c. PRACTICE OF MEDICINE. 95 Of the Serous and Mucous Membranes. The air passages, &c, are lined by an extremely elastic and extensible membrane, termed serous, which is analogous to the cuticle of the external skin, and being, like that, possessed of less sensibility, serves to defend the more highly organized mucous membrane, over which it is placed, from injury. The serous membrane is said to consist of condensed cellular tissue, in which there cannot be detected the least trace of a vessel. They are moistened with a watery fluid, from whence they derive their name. The mucous membranes line all the cavities which open upon the surface of the body. They are also composed of a modification of cellular tissue, which bears a close analogy to the skin, or outward covering of the body, and is by many supposed to be a continuation of it, as in the lips, nostrils, eyelids, &c, they pass into each other. " The mucous mem- branes are more highly organized than the serous. They are of a loose, spongy texture, and of a reddish colour, and are largely supplied with blood-vessels and nerves. They are furnished with numerous small glandular bodies, called mu- cous glands, or follicles. In a healthy state, these membranes are always covered with a slimy substance, which is secreted by them, and from which they derive their name. These membranes sheath and protect the inner surfaces of the body, as the skin does the outer; and, by means of the mucus se- creted by them, to screen those surfaces from the contact of irritating substances, which may either be introduced from without, or generated within the body." The mucous mem- brane also enters into the structure of the different organs which are concerned in the assimilation of the aliments, in respiration, and the secretion and excretion of the various fluids. They may also be considered as the basis of the glands, into the substance of which they everywhere pene- trate. Of Tubercles. When you see a person harassed with cough, and losing his flesh, and if, at the same time, he complain of shortness of breath and pain of the chest, and begins to expectorate a muco-purulent-looking matter, you may certainly set his dis- ease down as consumptive ; for not only is his general health in that case manifestly wrong, but his lungs are more or less implicated,—and what does it signify in which of their tis- 96 CHRONO-THERMAL sues?—what does it signify whether it be their mucous mem- brane, their glands, or their interstitial substance. If his gene- ral health, from the time he becomes your patient, improves, he will naturally live as long as it continues to do so,—if not, and if it as progressively continues to grow worse, he must die ! Any further discussion of the matter, quoad hoc, re- solves itself into the interminable question of tweedle-dum and tweedle-Gfee. " Can consumption be cured ?" asked Mr. Abernethy, add- ing, in his own sarcastic manner, "Odd bless me! that's a question which a man who had lived in a dissecting-room would laugh at. How many people do you examine who have lungs tubercular which are otherwise sound. What is consumption ?—It is tubercle of the lungs—then if those tu- bercles were healed, and the lungs otherwise sound, the pa- tient must get better; but, if the inquirer shift his ground and say, ' It was the case I meant of tubercles over the whole lungs,' why, then, he shifts his ground to no purpose, for there is no case of any disease which, when it has proceeded to a certain extent, can be cured." The next question is, what are tubercles ? I take this to be the true answer, and I wish it well considered, for it is, or I should rather say it was, until I took the liberty of enlight- ening the profession, totally at variance with their notions; some of them even now believing tubercles to be parasitical animals ! For the requisite lubrication of the mucous mem- brane of the cells and other air-passages of the lungs, there must be a certain amount of secretion. To supply this secre- tion, there must be a glandular apparatus; and accordingly a number of minute and almost imperceptible glands in reality intersperse the entire tissue of the lungs—the pulmo- nary tissue, as it is called—but abound more particularly in the upper portion of it—that identical portion in which patho- logists imagine they have detected the commencement of con- sumption. But what they call the commencement is nothing more than an effect or development of general constitu- tional disorder. If it be the beginning, it is the beginning of the end—the end of previous repeated febrile paroxysms of greater or less intensity. During such constitutional disorder, and particularly during the course of severe fevers—such as a long remittent fever, the fevers termed small-pox, measles, and the like, these minute pulmonary glands become dis- eased, there being a previous predisposition of course; in other words, these glands being the original weak point of PRACTICE OF MEDICINE. 97 individuals having the consumptive tendency. Tubercles, then, are diseased pulmonary glands. How many peo- ple have traced the consumption of their children to the small- pox or measles—but would any man in his senses say the con- sumption was the cause of these fevers? Here it must have been the effect, and so also it may be the effect of any other kind of fever, and in no case can it be the cause of such fever —though, as in the giving way of any other part of the body, the local disease may, in the course of time, aggravate and keep up the febrile state. The affected gland is in this instance at first almost microscopically minute, and as the dis- ease advances, it swells and becomes of a reddish gray colour, or it may at once take on a suppurative action—it may become an abscess varying from the size of a pea or less to that of a walnut or more, or it may go on enlarging to any extent without suppurating or becoming an abscess at all—the function of the affected lung in this case being, never- theless, as completely disturbed as if it did take on the sup- purative state ; but in most cases of consumptive disease, both kinds of disorganization go on at the same time, one gland or cluster of glands suppurating, and sooner or later bursting, and discharging their contents into the air-passages, rendering the lungs at the same time more or less cavernous and hollow—another gland or cluster of glands swelling and coalescing so as to fill up and solidify the air-cells of the part they occupy. These at least are among the principal changes to be found in the lungs of persons who die of consumption, and they are all, as I have already said, more or less gradu- ally produced in the course of repeated paroxysms of gene- ral remittent disorder. The matter expectorated by the pa- tient consists of the contents of the tuberculous abscess, and more or less mucus, sometimes mixed with blood ; while the cough is at one mejuent produced by a lodgment of matter in the air-passages, at another it is an effect of the cold air coming in contact with the ulcerated surface of the diseased lungs,—though almost every patient has it periodically spas- modic. To understand this subject in all its bearings, you have only to observe the more palpable changes which take place in the glands of the neck of certain patients. These glands, in the healthy living subject, can neither be seen nor felt- but apply any general influence that shall excite fever in an individual predisposed to glandular disorder,—such as starvation, exposure to cold, or the abuse of mercury, and what do you find ? Why, these very glands gradually enlarge 9 9S CHRONO-THERMAL and form tumours, which tumours, as in the case of tubercles of the lungs, are sometimes of a solid kind, and when ex- amined after death, have the same reddish-gray appearance, but more frequently, like them, terminate in abscesses, the contents of which, so far as mere likeness is concerned, are the identical contents of pulmonary tubercles, or vomicae, as these tubercles are sometimes called. In the one case, the pa- tient is said to have the "evil," or "scrofula," in the other, phthisis or consumption;—the difference of place, and the degree of importance of this in the animal economy, making the only difference between them. In still farther proof of the correctness of this explanation, I may mention, that Louis and others have detected tuberculous matter in various other glandular parts of the body of patients who have died con- sumptive. If it be objected that they have also detected it in the bones, I answer, bones, like every other part, have a glandular apparatus. We now come to the question of cure, and from what we have already said, you must be aware, that however curable pulmonary consumption may be in the commencement, in the later stages—that is, where a very considerable portion of the lungs is destroyed—it cannot possibly be cured, though even in this case, the disease, by proper management, may some- times be arrested. But here, instead of confusing you with fine-spun differences and distinctions, the delight of the school- men, I shall try to explain my meaning to you by simili- tudes; for similitudes, in the words of Fuller, are indeed " the windows that give the best light" Many, doubtless, have had a certain portion of a tooth slowly consumed by disease, which disease, [tooth-consumption?] by some change in your manner of living, or otherwise, has all of a sudden stopped, and the remaining sound portion of that identical tooth has continued to be useful to you for years ! Such arrest of the consumption of a tooth I have often myself obtained by quinine internally administered ; and Dr. Irving of Chel- tenham, some time ago, detailed to me two cases in which he succeeded with that remedy. Well, then, with medicines of this class, and sometimes, even without any medicine at all, the same thing may take place in the lungs; and I have known persons reach a good old age, who had portions of their lungs destroyed, but who, by proper medicine, and at- tention to the temperature of their chambers, preserved the sound parts from going into further decay. Such persons, at greater or less intervals of time, may even be free from the PRACTICE OF MEDICINE. 99 graver symptoms of consumption, and only commence to ex- pectorate during some change of weather, when they have slight febrile attacks, but these will leave them again on the return of warm weather. I have no wish to puff myself off as the only person in the world who has cured consumption; for, as I shall shortly show, this disease has been cured by others, though I am not so sure that the persons who cured it knew the principle upon which their remedies acted. Its real nature, I am satisfied, no author has ever explained before me ;—and my explana- tion is now, I believe, pretty generally admitted to be the cor- rect one. The same power that may set a ship on the right course, improperly applied, will set it on the wrong. This is exactly the case with medicine; the same power that has cured a disease in one person, may cause or aggravate it, ac- cording to circumstances, in another. How frightful, then. that such powers should be daily wielded by men who have not the smallest idea of the principle upon which their reme- dies act ? No wonder we have such contrary estimates of the value of remedies in pulmonary consumption. A case of this disease, which was cured, I will now give; it is from the pen of the patient, himself a physician,—I believe the late Dr. Currie of Liverpool, who wrote the Life of Burns,—and it is given by Dr. Darwin, in his Zoonomia. " J. C, aged 27, with black hair, and a ruddy complexion, was subject to cough from the age of puberty, and occasion- ally to spitting of blood; his maternal grandfather died of consumption under thirty years of age, and his mother fell a victim to this disease, with which she had been long threat- ened, in her 43d year, and immediately after she had ceased to have children. In the severe winter of 1773-74, he was much afflicted with cough, and being exposed to intense cold in the month of February, he was seized with peripneumony, [inflammation of the pleura, now called pleurisy.] The dis- ease was violent and dangerous, and after repeated bleedings, as well as blisterings, which he supported with difficulty, in about six weeks he was able to leave his bed. At this time the cough was severe, and the expectoration difficult; a fixed pain remained in the left side, where an issue was inserted. Regular hectic [habitual or wasting fever] came on every day about an hour after noon, and every night heat and rest- lessness took place, succeeded towards morning by general perspiration. The patient, having formerly been subject to a part of a medical education, I shall strictly confine myself tc » a statement of facts, in ordinary language. Whilst ascending the Ohio in a steamboat, in June, 1842, , in company with part of my family, on a northern tour, I was , without any apparent cause, suddenly attacked with hemor- • rhage of the lungs, which caused me to abandon my trip, , and return to my residence in Mississippi. I immediately ■ consulted my family physician, a gentleman who stands at ; the head of his profession. On a minute examination, he as- ■ sured me that there was a predisposition to consumption, , rather than an actual attack. After following his directions for • some time, the hemorrhage gradually disappeared. The succeeding fall and winter were passed in only tolerable ; health. As the warm weather approached, I began to feel, , towards the evening of each day, a general weakness, which . gradually increased. Expectoration of a whitish colour ap- • peared, and in April of the present year, all the symptoms : becoming daily more alarming, my physician was requested I to repeat his examination, and give a candid opinion, which i was, that my lungs were affected,—I could not be cured,— ■ might live many years, but it was uncertain, Within two weeks after this, a severe attack of hemorrhage s came on at night while in bed. By the sedulous care of my ' medical attendant, I was relieved in a few days, but was left t in such a weak condition as to be unable to leave my cham • ber. My physician now recommended a trip to the sea shore , as soon as it could be undertaken. This course was adopted , H2 CHRONO-THERMAL On my arrival at Philadelphia, on the 20th of June last, I had occasional fever and night-sweats. Any exertion in conver- sation produced weariness and hemorrhage. My voice was not natural and full, but hollow and incomplete. Rest at night much broken, slight cough, pain, sometimes in the breast, at others between the shoulders, shortness of breath, digestion impaired and bowels constipated. Having taken lodgings at the Franklin House, I accidentally heard of Dr. Rose, as a very skilful physician in diseases of the lungs, and was prevailed on by a friend, to call upon him, although con- trary to my intentions, as I considered it useless to consult any one. Accordingly I repaired to his residence in Arch street in a carriage, being unable to walk so far. Having no hope of a cure, I merely asked him, after he had examined me, if he could give me any relief; he very promptly replied, he could cure me. This announcement at the time did not afford me that satisfaction which it would have done, had I not thought him mistaken. Being, however, interested in his conversation, and pleased with his manners, I determined to give his remedies a trial, especially as they appeared to be at least innocent, while his views seemed rational. These *• impressions were confirmed on reading a book which he had published on the curability of consumption, and I now began to*fefcl gratified that I had made his acquaintance. After using the remedies ten days, expectoration increased, but was made with more ease ; it then began gradually to di- minish, and at the present time has almost entirely disap- peared. My strength has regularly improved. In one month, my chest had increased more than an inch in size; and in another, over half an inch more. Fever and night-sweats entirely disappeared in thirty days; and for two months I gained in flesh one pound per week. My digestion is now better, and my skin clearer, than it has been for ten years. My breathing is full, my voice strong and clear, and I am able to walk several miles a day without inconvenience. Although I have exposed myself to night air, to damp, and even wet, rainy weather, I have not taken the slightest cold. Exposure to heat affects me more, and cold less, than for- merly. And now, sir, from the great change which has taken place in my system, I think I am warranted in believing, that by continuing the remedies some time longer, my health will be entirely restored. In closing this communication, allow me to express for Dr. PRACTICE OF MEDICINE. IK * Rose the grateful feelings of my heart, and a sincere wisl i his life may be long, prosperous, and happy; and that it may r prove as great a benefit to thousands of suffering people, at I it has been to your friend and obedient servant, W. Hatch. In view of the above case it may be asserted with grea t safety, that there can be no good reason why others havin§ J similar symptoms, may not, by the same treatment, experi - ence in their own persons the like happy results. Case 2.—J. B. S----, aged forty-two years, applied to m e in December, 1833, for the relief of a severe neuralgic pai a of the heart, attended with much palpitation, and constar it cough. He stated that he had been directed by his physicia n to observe perfect rest, to eat no animal food, and to take c >f Lugol's solution five drops night and morning. His symptoms (for which he supposed he was using th e best remedy) increased, and he became alarmed for his ow: n safety; after persevering for several months without reliej f, I was consulted. I found, upon examination of the chest, that the summi t of the left lung was the seat of an abscess, occasioned, n< d doubt, by a severe inflammation of that part, which h< 3 stated had existed a few weeks before the palpitation of thi J heart commenced. I assured him at once that the heart was free from disease , although its motion was somewhat out of order, and com- • menced a different treatment. I directed one of my prophylactic pills to be taken nightly, and the application of my liniment to the spine, immediately over the fifth dorsal vertebra, and a ride of half a mile in an open carriage in the morning of every fine day; on the fourth day of this treatment, my patient called at my office some little improved in spirits, with rather less frequency of pulse. The expectoration was still very great, but the cough less frequent; the pills had improved the state of his digestion, and the uneasy feeling he had complained of for many months, was in a great measure removed. I directed the left side of the thorax to be bathed night and morning with the irritative liniment, and the pills to be continued. On the twelfth day of my treatment he called again, to say the sore- ness had all left him; upon applying my ear over the upper portion of the left lung, I found distinct pectoriloquism; I now furnished him with a small tube, directing him to 10* 114 CHRONO-THERMAL breathe through it as long as he could at one period, without being oppressed, to continue the pills and liniment, and to call in a few days again. On the following day he left the city, and remained at his brother's residence, in Delaware, for two months; at the ex- piration of this time he returned, when the change for the better prevented my immediately recognizing my patient. He stated that the cough had left him gradually, his expec- toration was gone, and that he was now able to leave for the West—which had been his determination a year previous,had not his heart affection prevented it. (Still harping on the old palpitation.) Two years after I received a letter from J. B. S----, informing me his health was never better, and that he had married and transferred his heart affection. Case 3.—A young lady, the daughter of a very respectable grocer in this city, who had for many months suffered from weak digestion, and consequent debility, for which she had taken various remedies without permanent benefit, became consumptive; after many proofs from various symptoms of the existence of phthisis, I was called to visit her in consulta- tion with her uncle, her attending physician, who gave it as his opinion that she could not survive six weeks; and ob- served that I had been called to satisfy her brother. I replied, as I was then in the house, perhaps he was already satisfied^ and that I conceived the next step of importance was to ex- amine the case. I found the patient much emaciated, with some cough and night-sweats, and upon applying my ear to trie chest discovered the existence of a small cavity at the summit of the right lung, while I also detected a dry crepitous rattle with bubbles, manifested by auscultation—the certain proof of emphysema. This state arose from a spasmodic af- fection of the throat, which the patient had been subjects Z^Zwha? f yGar; uThGre exisled much oppression, and upon being informed that this symptom had come on sud- denly after a distinct sound in the chest, resembling the tear- ng of parchment, I concluded in my own mind that a rup- SdS would hlr-°ellS h,ad taukGn P^and that in Ze of Theparenchvl iT* fhr°Ugh the conse for a painful affection of the chest, attended by considerable cough and expectoration of blood, mixed with frothing yellow matter. She stated that she had lost her mother and sister with the same disease, and believed she herself was going rapidly; upon exploring the chest I found the summit of each lung was obstructed by tubercles, several existed on the sides of the neck, and many under the Srfe experienced much inconvenience from these small tumours, when her bonnet pressed them • I oronosed their ~»ivft sh,vrded' ,•»•and -™™ °a %»z treatment: I directed her to leave the city, to use dailv a FhT,,0fdl"nb-belI\t° mak* full inspirations /enuenty through r ?Ze«Zm?Jj w Tds fr°m the l0™ KmSVo peach svruDs and a i„l I 10caJ10n-) , * provided her with my the orchard swmgmg upon some of the^ori^mallimb-s? The PRACTICE OF MEDICINE. 119 expectoration gradually diminished, her strength returned, her chest and hips expanded, she became robust, and still enjoys good health; her chest in August, 1844, when I last examined it, showed no marks of disease. I then for the first time since I had made it, observed that I had kept my pro- mise, and that with common prudence she might enjoy a long life.* I had left one of the small tumors on the head, for the pur- pose of seeing whether the internal use of medicine could produce its absorption; upon searching for it after she re- turned to the city, I could discover no trace of this tubercle. Case 7.—Mrs. S. W----, aged thirty-nine, applied to me in May, 1835, for advice in her case. She stated that for eighteen months previous, her health had been declining, with continued cough, much expectoration of bloody matter, and hectic fever. She had been for six months under the care of two very able physicians, whose treatment corres- ponded with that of others under the same circumstances: as she had received no benefit from medicine, and as dropsy had taken place, which, in her opinion, was to end her suffer- ing, she gave up all hopes of recovery ; but as her cough and expectoration had diminished, while her strength had in- creased, and her chills, fever, and night-sweats had com- pletely left her, she consulted me for the cure of her dropsy. This I observed might be accomplished, but that, in my opin- ion, she owed her recovery from cough to this disease. This opinion I formed from the fact of there being no oedema, which led me to conclude the dropsy was encysted, while the abdomen was as large as is generally met with in the last months of gestation. I had no doubt that the relief from her pectoral affection was owing entirely to the support the diaphragm and lungs received from the existence of this dis- ease. . I therefore advised her to continue without medicine, and to let me know immediately, if any of her old symptoms of cough or expectoration should take place. In October, 1835, I was again called to visit this patient, when she requested that I would do something for her dropsy, as she had no re- turn of cough or spitting, and thought that dropsy had done all it could for her, and that now she would like to do with- out it, if possible. Having some suspicion of large hydatids * I have never known my prophylactic syrup fail in removing tubercles, (or curing scrofula,) when used in time. 120 CHRONO-THERMAL in the uterus, I proposed an examination per vaginum, and soon discovered that the views I had of her case were well founded. The uterus was as large as we generally meet with at the ninth month of gestation ; I proposed the intro- duction of a common sound, through the os uteri, which was acceded to, and by making a few rotatory movements, broke the sac containing the fluid, and in a few moments my pa- tient was relieved from all her distress from dropsy. I direct- ed her to lie with her head and shoulders low, and to keep constantly applied round the lower part of the abdomen a broad bandage moderately tight; my object was to support the diaphragm as much as possible. She soon recovered without the use of any medicine, and now continues in per- fect health. Case 8.—A. W----, aged thirty-two, consulted me in No- vember, 1836, for the relief of a troublesome cough, with scanty expectoration of matter streaked with blood, which had existed for several months. He had been frequently leeched on the throat, and as often blistered. He had also inhaled iodine for a long time by the advice of his physician, and had tried a short sea voyage without relief. Upon ex- ploring the chest, I found the parenchyma healthy through- out. He complained, when exposed to the atmosphere of heated rooms, of a deep-seated pain and sore feelings at the upper part of the sternum, (or breast bone,) which was much increased by inhaling a very cold air, but was greatly les- sened when the weather was temperate. He had avoided all stimulating drinks, and animal food, dressed warm, and particularly protected the chest and neck. This I directed he should remove as soon as possible, and bathe the part night and morning with cold salt water; I supplied him with my solution of gold, and ordered him to touch the fauces with a soft camel's hair pencil, moistened with the solution, night and morning; to commence the daily use of the Lisbon diet drink, and one of the compound prophylactic pills to be taken nightly. At the expiration of one week A. W----called at my office much improved, his expectoration had diminished very considerably, his soreness of throat nearly gone. He continued to mend from this time, and after this treatment had lasted two months, he considered remedies unnecessary. This patient continues to enjoy perfect health. Case 9.—Miss E. D----, aged twenty-four, came from the state of Maryland to consult me in the month of September, 1840; she complained of great soreness of the throat, with en- PRACTICE OF MEDICINE. 121 larged tonsils, and continued cough, except a few hours after the use of a cough mixture, which always produced sleep. 1 he upper lobe of the right lung yielded a dull sound upon percussion, and she complained of a deep-seated soreness when pressure was made on the ribs over this part. Her cough was very constant, but without expectoration; her pulse frequent and tense, the tongue coated except near the end, which was of a deep red, her cheeks occupied by a hec- tic blush, lips thick and protruding. In fact all the marks of incipient tubercular consumption, commencing in a constitu- tion loaded with scrofula. The indications in this case were plain; to soften and cause absorption of the tubercles, to re- move the hectic, and change the diseased action into healthy. Laennec it would appear by reference to his work on diseases of the chest, places little confidence in remedies said to pos- sess the power of softening tubercles; I am by no means astonished at this. By a perusal of his writings, it will clearly be seen that this "great author," like many of his predecessors, introduces to the reader a variety of remedies, the utility of which in his mind is doubtful; without attempting to account for their failure, or proposing a better means of cure. He classes under the head of empirical remedies, mercu- rial salivation, emetics, (which have been highly recommend- ed by many distinguished practitioners in imitation of a sea voyage ;) why they should select the most unpleasant part of a sea voyage, has I must acknowledge, always appeared strange to me : and from what I have already said in relation to the advantages of a sea voyage, it must appear evident that I place little reliance on the mere effect produced on the stomach. Laennec also places under the head of empirical means; charcoal, mushrooms, red cabbage, wolf's bane, crabs, oysters, frogs, vipers, electricity, opium, cicuta, cinchona, hydrocyanic acid, the seeds of the phellandrium aquaticum, &c, &c. How the opinions of Laennec have been received by those practitioners who have relied on opium, cicuta, hy- drocyanic acid, mercury, &c, I know not.—But to return to my subject; I directed this patient to use all the out door ex- ercise practicable, to throw off corsets and all restrictions to a free motion of the muscles of the body or limbs, to have a double ladder erected in the chamber, and a single large sized rope suspended from the top round ; on this ladder she was to perform all the evolutions and calisthenics in her power, to climb the rope to the top by the use of the hands and arms alone to use dumb-bells twenty minutes night and morning, 11 122 CHRONO-THERMAL and ride or walk out whenever the weather would permit; I directed as medicine the daily use of my prophylatic com- pounds, and every evening ten grains of the nitrate of potash. To rub the upper portion of the right side of the chest with an ointment of iodine nightly, and use the inhaling tub every four hours, for twenty-five minutes at each time. I prohibited all animal food, except wild meats, and these were to be used but once in twenty-four hours. With a continuation of these directions, I visited my patient every three or four days, per- ceiving improvement at every visit. Much change in the skin, and whole expression, was soon remarked by all her friends ; the thickness of the lips began to diminish, the hectic left the cheek, the tongue lost its morning dryness, the stoop and dis- position to approximate the shoulders was soon changed to an erect and broad expansion of the chest, and at the expi- ration of four months she left the city in good health- I fre- quently see the relatives of this patient, and learn from them the pleasing fact that she still enjoys most excellent health. Case 10.—S. M----, aged thirty-three, called on me in February, 1837, with bloody expectoration, mid-day chills, evening fever, and nocturnal perspiration ; much emaciated, considerable cough, and great loss of strength, most sensibly felt early in the day from the constant perspiration of the night. I directed my liniment to be applied over the fifth dorsal vertebra, and a tonic alterative pill every night. At the end of one week he called at my office free from pain or soreness in any part of the chest, and upon exploration with the ear, I could distinctly perceive the existence of a cavity near the right lung with clear pectoriloquism; the corresponding portion of the left lung yielded a dull sound by percussion, while the respiratory murmur was very dull and indistinct. The night sweats still continuing, without perceptible chill, or much fever preceding. Having frequently met cases that were releived of this unpleasant symptom by a remedy often used in the practice of my late and highly esteemed friend Dr. Joseph Parish, whose medical career was noted for success, I determined upon its trial in this case. I therefore directed the whole surface to be spunged every night with a strong solution of alum in hot water, to which had been added a small portion of brandy; ordering at the same time the regu- ar use of my prophylactic pills and a full inflation of the lungs through the inhaling tube, which I had provided for this patient made of glass, two feet in length, having a cali- bre one and a half lines in diameter. The soreness originally PRACTICE OF MEDICINE. 123 complained of never returned sufficiently to demand notice —the expectoration diminished gradually, the bathing or sponging was used for two weeks, when the night-sweats had completely subsided. The prophylactic pills were used for three months, and the inhalation continued at intervals for two; at the expiration of this time the lungs became voluminous, the pecloriloquism was no longer heard at the summit of the right lung, while in the left the respiratory murmur was now distinct: October, 1841,continues to enjoy good health. Flattered by my success, I determined to test my genius, if any I possessed, to the construction of better inhaling tubes; these I subsequently contrived of various material; of gum elastic stomach tubes, of large catheters, of lead, and of wood. They answered my purpose tolerably well, until a friend of mine returned from a visit to Europe, who supplied-me with breathing tubes from the maker employed by the celebrated Dr. Ramadge. In many respects these tubes are superior to any I have ever used, and I have had a large supply con- structed by a mechanic in this city for general use. There is one great advantage in having a maker at hand, the length of tubes may be increased or diminished, while the calibre can be made to suit the peculiar state of the lungs, or age of the patient; much attention to this is required when tubes are used. . . Case 11.—In February, 1839, I was called to visit the daughter of a respectable merchant of New York whose hearth had been declining for more than eighteen months; she complained of constant pain about the middle lobe of the right lung, with palpitation of the heart, and much oppression in breathing: she had been confined to the house for more than six months, by the advice of her former physician, but not to her bed. She had taken many mixtures for her cough, which was very troublesome, but without relief. She com- plained of some soreness upon pressure being applied to the fifth, sixth, and seventh dorsal vertebras : this led her parents to believe the cough and emaciation was occasioned by a dis- ease of her spine, for which I was consulted. Upon exami- nation of the spine I could not perceive any derangement in its column, but had no doubt that the state of the lungs com- municated through the nervous system, their increased sensi- bility to this part. The locality of pain is deceptive, and often will mislead a superficial observer; we have often seen cases of severe hemiplegia, treated with blisters, setons, 124 CHRONO-THERMAL emetics, narcotics, &c, without relief, at once cured by the extraction of a decayed tooth, which had not attracted the attention of the patient or perhaps occasioned the least un- easiness. Upon exploring the chest, the cause of this sore- ness of the spine was soon discovered; there existed about the middle of the right lung a space of about six inches in circumference occupied by tubercles, a circumstance sufficient in my opinion, to account for the derangement of the motion of the heart, as well as the existence of all the unfavourable symptoms. There were several small moveable tumors in the direction of the absorbents on the right side of the neck, which the patient stated, had existed for more than twelve months; the skin was always dry and the temperature above the natural standard of health. I commenced the treatment, by causing all the articles of dress (corsets, tight frock bodies, &c.,) to be removed, and to use no garment that could in the least impede a full inflation of the chest, or prevent the arms from being raised perpen- dicularly above the head; I had my liniment applied to the portion of the spine complained of, and directed one of the prophylactic pills to be taken morning, noon, and night; to rid the system more perfectly of all the scrofulous tendency, I directed at the same time my prophylactic syrup every four hours, and a bath daily of salt water at a temperature of eighty degrees Fahrenheit. This treatment was con- tinued for one week with decided improvement, and at the expiration of that time, finding less cough and pain in the chest, I added to the remedies the use of the inhaling tube, a double ladder, dumb-bells, &c. In about six weeks from the commencement of the treat- ment the small tumor on the neck subsided, the pain left the 31 ^Jf comPletely>the respiratory murmur was dis- tinctly heard throughout the chest, and the patient now took fortLepXpTSe^°n.h0rSebaCu- She conti»^d under my care in nerfrPfTDSf &*' "- ^ KtUTned t0 her nalive city ^S^^^iSf hGar fr°m ^is patient, who £ Lr;theput them in form f°r >ui=: i*-3 sumotion »?!P manuscriPt account of each case of Con- sumption always m my note book, which will be found upon Sent6 ' WUh thG name and residence of most of EJ PRACTICE OF MEDICINE. 125 In the treatment of consumption, many remedies that are worse than useless, are still recommended by some physicians, such as the removal of tonsils, the use of blisters—sometimes perpetual—.emetics, cathartics, expectorants, demulcents, nar- cotics, alterative mercurials, astringents, tonics, balsams, in- haling iodine, sea voyages, southern climate, &c. &c. But as I have used all these, and witnessed their full trial in the hands of others, I conceive myself fully prepared to pass judgment, and declare them utterly inefficient. Exercise of the body and lungs, by inhalation, by gymnas- tics, or by the common pursuit of business (where this is suf- ficient), regulation in diet and digestion, attention to the healthy action of the skin, and all the secretions, by the daily use of remedies I shall style prophylactics, will soon accom- plish what the patient may look for in vain from the use of medicines already tried and justly condemned. These prophylactic compounds will be constantly kept, by some of our most respectable druggists, accompanied with full directions. In conclusion I would romark, that in the foregoing very brief sketch of the pathology and treatment of a disease hitherto considered as admitting of little more than palliative remedies, I aim at no literary fame. The harassing engage- ments of a laborious profession leave but little leisure or in- clination to cultivate the graces of composition. My object will be fully accomplished, if by the labour, anxiety, and in- tense application of many of the best years of my life, I have succeeded in disarming of its terrors one of the most formi- dable diseases to which flesh is heir; and of infusing into the hearts of despondent and weeping relations the cordial—hope. Justice must cede to me the merit of having contributed largely to effect this important and most desirable consum- mation; and I fully acquit myself of the charge of arrogance or presumption, when I assert my ability to control and cure a large majority of the cases of clearly developed pulmonary consumption. For proof of the curable nature of consumption, see plates, with description, in front of this book. Glandular Disease. I will just shortly observe, that complaints of this kind, whether involving some large gland, such as the liver, pan- creas or spleen,—if the last mentioned viscus be indeed a 11* 126 CHRONO-THERMAL 'Hand,—or taking place in the glandular apparatus of canals, the lachrymal or biliary ducts, the eustachian, salivary, and urinary passages, for example,—such disorders may all be advantageously treated by the various chrono-thermal medi- cines. Disorders of the smaller glands, whether situated in the neck, arm-pit, or groin, or in the course of the mesentery, are for the most part termed "scrofula," and by some prac- titioners presumed to be incurable,—than which nothing can be more erroneous, unless it be the system which renders them so ;—namely, the application of leeches to the tumours, and the purgatives so unsparingly employed by many in their treatment. All these various diseases are features or effects of remittent fever; by controlling which with the chrono- thermal agents, they may all, in the earlier stages, be at once arrested, and some, even of a chronic character, perfectly cured by a combination of these remedies with prophylactic syrup and pills. I could give cases innumerable in proof of this. Consumptive Diseases of Joints. "Very much akin to the consumption of the lungs are various diseases which, from their external manifestations, have been too long left under the exclusive dominion of the Surgeons, namely, those destructive affections of the joints, which so often bring the subjects of them to the amputating table. I forget the particular operative eminent who thanked God he knew nothing of physic ! Such a confession was very proper for a butcher—for the barber-surgeons of former ages;—but the medical man who, by well-directed remedies, prefers the honest consciousness of saving his patient from prolonged suffering and mutilation, to the spurious brilliancy of a name for "Operations," will blush for the individual whose only title to renown was the bliss of his boasted ignorance, and a mechanical dexterity of hand, unenviably obtained by an equally unjustifiable waste of human blood. It is truly atro- cious in the legislature of this country to permit the present hospital system,-a system that only■ encodes ignorance wo'uldTm himsPd,fheaHtle^ Cn,eUy- N° man » ^is senS would put himself under the care of an " Hosoital Snra^n » ! S *rVe: iesacrly one of;hose ^^i:zz,s is in the very least acquainted with physic What wnnM some of these supercihous mechanics^ to Z fo.Iowhig » PRACTICE OF MEDICINE. 127 Case 1.—Harriet Buckle, seven months old, had what is called a scrofulous elbow. The joint was much enlarged, red, painful, and previous to the probe, with discharge. The patient was the subject of diurnal fever. Notwithstanding the assurance of the mother that amputation had been held out as the only resource by two "hospital surgeons," under whose care the child had previously been, I confidently cal- culated on success. A powder containing calomel, quinine, and rhubarb, in minute doses, was directed to be taken every third hour. The case was completely cured in a fortnight, without any external application. Case 2.—A young gentleman, aged 11 years, had enlarged knee, with great pain and heat, which came on in parox- ysms. Leeches, blisters, and purgatives had all been inef- fectually tried by his "hospital surgeon," who then proposed amputation; the boy's mother hesitated, and I was called in. I prescribed minute doses of quinine. From that time the knee gradually got better, but a stiff joint was the result,— anchylosis or adhesion having taken place before I was con- sulted. Case 3.—Another young gentleman, aged seven years, son of Lord C—, was brought to me with his knee as large as a young child's head; abscesses had formed about the joint, and were still discharging when I first saw him. I prescribed chrono-thermal treatment; and notwithstanding that his limb had been condemned to the knife by his Brighton " hospital surgeons," I obtained a complete cure—a partial anchylosis only remaining. He had also been a patient of Sir B. Brodie before I was consulted. Case 4.__A boy, aged 6, began to lose flesh, to walk lame, and to complain of pain of knee, stooping occasionally to place his hand upon it when he walked. There was some alteration in the appearance of the hip of the same side when I was requested to see him. I adopted a similar treatment as in the above case, and the child rapidly recovered his health, with the complete use of his limb. He had been pre- viously seen by a surgeon, who rightly pronounced the case to be hip-disease. Case 5 —A girl, aged 12, had enlarged ankle, with an open ulcer leading into the joint. Amputation, according to the mother was looked upon as the inevitable termination of the case "by two "Hospital" surgeons, under whose care the patient had been for twelve months previously to my seeing • 12S CHRONO-THERMAL her. With small doses of quinine and -------, the girl re- gained her health, and the ankle got well in six weeks. The curious in Nosology (or the art of naming diseases) might demand the technical terms for the various affections. Will they be content with the simplicity of joint consump- tion? Truly in surgical authors they may find verbiage enough to distinguish them all, such as " scrofula," " white- swelling," " morbus coxarius," " the evil," &c, but whether or not these words be explanations, 1 leave to more learned heads than mine to decide. There is not a disease, however named, or by whatever caused, of which the most perfectly periodic examples might not be given, and the only difference between diseases in this type, and the more apparently continued forms, is, that the periods of the latter are less perfect, and the stages of their curriculum less marked than in the former. No physician will doubt that a purely periodic disease, whatever be its nosological name, partakes of the nature, and is more or less amenable to the treatment successfully followed in ague. Why then deny that the same disease, when less obviously periodic, partakes of that variety of ague misnamed con- tinued fever, since all disorders like it have remissions and exacerbations, more or less perfect in character, throughout their whole course ? What are such diseases but varieties of the more purely intermittent type ? And what are the reme- dies found to be most beneficial in their treatment, but the remedies of most acknowledged efficacy in simple ague. Remission and paroxysm are equally the law of what are termed local diseases, as of the more general symptoms which are supposed to be the exclusive province of the physician. John Hunter seems to be the only surgeon who has remarked this:—" exacerbations," he says, " are common to all con- stitutional diseases, and would often appear to belong to many local complaints." They belong to all. They may be ob- served even in the case of disease from local injury and here I may give an instance in illustration of this, contained in a letter to me from Mr. Radley, of Newton Abbot, Devon, a gentleman well known for his improved method of treating fractures. Mr. Radley writes thus—"Many thanks to you for the 'unity of disease,' which contains in it more of the true philosophy of medicine than any book I have ever yet seen. There are some passages that threw me into an ecstasy of delight on reading them. On the other side I send PRACTICE OF M3DIDINE. 129 you a case strikingly illustrative of the truth of your new doctrine, and one that was presented to me in my own fa- vourite class of subjects. It was not elicited by inquiry, but thrust most unexpectedly upon my notice ; and had not your work prepared me for such a fact, 1 will be so candid as to say the fact would have been lost upon me:—G. Manning, aged 42, fractured the tibia on the 2d instant. It was a sim- ple fracture, with much contusion. To soothe the pain, he had solution of morphia after the limb had been laid on a pil- low. When three days had elapsed, he still complained of pain, and on my inquiring when he suffered most, 'why, sir, 'tis very curious to me, for the pain comes every twelve hours quite regular, about midnight, when it lasts one hour and a half or two hours, and again in the middle of the day.' The patient is now doing well under bark." Every surgeon of experience is aware of the severe and occasionally fatal operations resorted to for the purpose of obtaining a" reunion of fractured bones in particular consti- tutions,—of the setons which have been passed between their ends, and of the knives and saws by which they have been scraped and pared,—those horrible local means for constitu- tional causes. Dr. Colles of Dublin, indeed, introduced a con- stitutional mode of treating such cases ; but it was confined to one medicine, mercury, and that failing in other hands, it has not been generally followed. Several years ago, while in medical charge of Her Majesty's 30th Foot, in the East Indies it was my fortune to obtain the most satisfactory re- sult, in the case of a soldier of that regiment, by the exhibi- tion of quinine. The man had remittent fever,—the true constitutional reason why fractured bones refuse to unite un- der ordinary means. Inquire of the subject of goitre or other tumour; question the unfortunate persons who ask your advice in cases of can- cer- such as suffer from abscess or ulcer, or those even who consult you for the true aneurismal tumour of an artery, and each and all will admit that ihey are one day better another worse; that their swellings at intervals decrease; that their ulcers become more or less painful; that the size of both varies with the variations of heat and cold, damp or moisture of the weather; that their diseases are often materially influ- enced by a passion, or by good or bad news; that in the com- mencement at least, there are days, nay hours of the same davwhen they have a certain respite from their pain and suffering- and that they all experience in their bodies the 130 CHRONO-THERMAL thermal variations which we call fever,—some referring these last to the head or back, while others associate them with the chest, loins, arms, or feet. Can any one doubt the advan- tage of pursuing a chrono-thermal system of practice in such cases ? For the present we must pause. Our next business shall be to explain the meaning of the word inflammation, and to expose the terrible errors daily committed in the treatment of cases so called. When medical men hear that I am in the habit of treating all kinds of disease without blood-letting, they generally open their eyes with a stare, and ask me what I do in inflamma- tion. Inflammation ?—who ever saw any part of the body on fire, or in flames ? for the word, if it means any thing at all, must have something like that signification. To be sure, we have all heard of "spontaneous combustion," but I con- fess I never saw it, and what is more, nobody that ever did! What, then, is this inflammation—this term which our great modern doctors so dogmatically assure us is the head and front of every corporeal disorder ? It is a metaphor merely— a theoretical expression, which, torture it how you please, can only mean a quicker motion and a higher temperature in the moving atoms of a given structure than are compatible with the healthy organization of that structure. When you find a considerable degree of heat and swelling, with pain and redness in any part, that part in medical language is inflamed. Now, what are these phenomena but the signs of approach- ing structural decomposition ? During the slighter corporeal changes, the coincident variation of temperature is not always very sensibly perceptible; but whenever there is the least tendency to decomposition, this thermal change is sure to be one of the most prominent features. The phenomena of in- flammation, then, very closely resemble, if they be not indeed identical with, the chemical phenomena which take place pre- ceding and during the decomposition of inorganic substances. Now, when this kind of action proceeds unchecked, the re- sult in most cases is a tumour, containing purulent matter, which matter being a new fluid product, differs entirely in its appearance and consistence from the original tissue, in which PRACTICE OF MEDICINE. 131 it chanced to become developed. This tumour we call ab- scess. And how is it to be cured ? In most instances, the matter, after working its way to the surface, escapes by an ulcerated opening of the integument, while in others, an arti- ficial opening must first be made by the knife of the surgeon. In either case, the part in which the abscess was situated, generally recovers its healthy state by the reparative powers of nature. But there is yet another mode in which a cure may be effected, namely, by absorption ; that is to say, the matter of the abscess may be again taken up into the sys- tem by the inscrutable chemistry of life, become once more a part and parcel of the healthy fabric of the body!—being thus again reduced to the elements out of which it was origi- nally formed. How analogous all this to the operations of the chemist, who, by means of the galvanic wire, having first reduced water to its elemental gases, again converts these, by electrical means, into the water from whose decomposition they are produced. Such, and many more chemical operations, nature daily performs in the animal body; and that she does all this through the electric or galvanic medium of the brain and nerves, cannot possibly admit of dispute, when you come to consider that under the influence of a passion (the most un- questionable of cerebral actions), large abscesses, and even solid tumours, have often completely disappeared in a single night. There is not a passion,—grief, rage, terror, or joy,— which has not as effectually cured abscesses and other tu- mours, as the most powerful agents in the materia medica. The writings of the older authors abound in instances of this kind. But there are yet other terminations to the inflamma- tory process. For example, after having proceeded to a cer- tain extent, in the way of change, but still falling short of actual purulent decomposition, the atoms of the inflamed part, by the renewal of a healthy condition of the body generally, of by the direct application of cold or other agency, may again, with more or less quickness, subside into the degree of motion and temperature characteristic of their natural revolutions. This termination is called resolution. When the inflammatory action is more than usually rapid, the result may be the com- plete death of the part implicated,—a black organic mass being left in the place of the tissue which it originally com- posed. This last we term mortification or gangrene. But medical men extend the term inflammation to some other morbid processes^ which, under the various names of 132 CHRONO-THERMAL gout, rheumatism, and erysipelas, we shall hereafter explain to you. A great many books have been written upon the sub- ject of inflammation, but I must own I never found myself one whit the wiser after reading any of them. Their writers m almost every instance, use language which they do not them- selves seem to have understood, otherwise they would have confined themselves to one sense instead of including under the same term states the most opposite. Were I to tell you that the word " inflammation" is used by many writers when a part is more than usually cold, you would think I was laughing at you ; yet there is nothing more true, and I will give you an instance.—A carpenter had his thumb severely bitten by a rattlesnake ; and the effects of the venom are thus described by one of the most learned of living medical writers, Mr. Samuel Cooper :—" The consequence was that in ten or eleven hours, the whole limb, axilla, and shoulder became very cold and enormously swollen up to the neck ; in fact, the surface of the whole body was much below the natural temperature. The swelling you know is produced by that kind of inflammation which is called diffuse inflammation of the cellular tissue."—[Mr. S. Cooper's Lecture in Med. Gazette.] Was there ever such an abuse of words—such. an abandonment of common sense as this? The arm was "very cold"—"much below the natural temperature,"—yet it was inflamed—on fire ! Restricted to the sense in which I have already spoken of the term, namely, heat, swelling and pain, " inflammation," like "fever," or any other abstract word, may be used as a "counter to reckon by," and, like almost every other pheno- menon of disease, it is a development of previous constitu- tional disturbance. I do not speak of immediate local inflam- mation produced by a chemical or mechanical injury—leaving that to the surgeons to elucidate or mystify, according to their particular inclinations; I talk of inflammation from a general or constitutional cause. Has an individual, for example, exposed himself to a cold draught, or to any other wide- ly injurious influence, he shivers, fevers, and complains of pain, throbbing, and heat in the head, chest, or abdomen, phenomena gradually developed according to the patient's predisposition to organic change in this or that locality. Phrenitis, pneumonia, peritonitis, (technical terms for in- flammation of the brain, lungs, and membranous covering of the bowels,) are consequences or features, not causes of the constitutional disorder. But are the symptoms of inflamma- PRACTICE OF MEDICINE. 133 tion in such parts equally intermittent with the diseases of which we have already treated ? Listen to Lallemand :—" In inflammation of the brain," he tells you, " you have spas- modic symptoms, slow and progressive paralysis, the course of the disorder being intermittent." So that inflammation, like almost every other morbid action, is for the most part a feature or development of intermittent fever. Dr. Conolly, in his Cyclopaedia of Medicine, says, " diurnal remissions are distinguished in every attack of inflammation." Now, if you prefer the evidence of another man's eyes to your own, this statement ought to be more than convincing, for it comes from the enemy's camp. To return to inflammation. Whether the particular con- dition so called, be termed erysipeloid, gouty, rheumatic, scro- fulous, it is still remittent; and if you question the patient, he will in almost every case admit that it was preceded or accompanied by cold or hot fits, or both. May not inflam- mation, then, yield to bark—to quinine ? The late Dr. Wal- lace of Dublin maintained the affirmative, dwelling more par- ticularly on its good effects in that disorganizing inflamma- tion of the eye, termed iritis, in which disease he preferred it to all the routine measures which, on the strength of a theory, medical men have from time to time recommended as anti- phlogistic. During an attack of ague, he tells us, iritis with inflammatory affection of other parts of the eye, occurred in the person of a patient under his care. " For the for- mer complaint, namely, the intermittent fever, he administer- ed bark; by the exhibition of which, he was surprised at seeing the inflammatory affection of the eye, as well as the fever, disappear." This was the case which first led him to suspect the fallacy of the blood-letting system in inflamma- tion of the eye. Now I shall tell what first led me to enter- tain similar doubts of its efficacy. A medical officer of one of Her Majesty's regiments serving in India, couched a wo- man for cataract. The next day, the eye having become inflamed, according to received practice he bled the patient; but scarcely had he bound up her arm, when she fell as if she had been shot, and lay, to all appearance, dead. With the greatest difficulty, he succeeded in recovering her from this state**but it was not till four long hours had passed, that he felt he could safely leave her with ordinary attendants; for during the greater part of that time, when he ceased to chafe her temples or otherwise call up the attention of the brain by the application of stimulants to the nose, mouth, 12 134 CHRONO-THERMAL &c, she relapsed into a death-like swoon. More than once he was even obliged to inflate her lungs to keep her from dying. But in this case the blood-letting did not cure the inflammation, for the next day the eye was more painful than ever, and the poor woman, after all the blood she had lost— and who will say that she was not bled enough?—did not recover her sight. It is now many years since that case came under my observation, and it made an impression on my mind 1 shall never forget. Had that woman died, would not everybody have said that the gentleman who bled her had killed her? and very justly too, though he, good man, only conscientiously put in practice what he had been taught to consider his duty. We see, then, that blood-letting, even to the point of death, is no cure for inflammation; and that it cannot prevent its development, 1 shall furnish ample evi- dence before I finish this subject. Meantime, I will tell what can do both—bark and opium. These are the remedies to give before an operation, and they are also the remedies best adapted for the relief of inflammation after it has come on ;— and their beneficial influence will be more generally certain in the latter case, if you first premise an emetic, and wait till its action has ceased before you administer them. " The Peruvian bark," says Heberden, " has been more objected to, than any of these medicines (bitters) in cases of considerable inflammation, or where a free expectoration is of importance; for it is supposed to have, beyond any other stomach-medicine, such a strong bracing quality, as to tighten the fibres (!) still more, which were already too much upon the stretch in inflammation, and its astringency has been judged to be the likely means of checking or putting a stop to expectoration." All this appeared much more plausible when taught in the schools of physic, than when I attended to fact and experience. The unquestionable safety and ac- knowledged use of the bark, in the worst stage of inflamma- tion, when if is tending to a mortification, affords a sufficient answer to the first of these objections; and I have several times seen it given plentifully in the confluent small-pox, without lessening in any degree the expectoration. Some time ago, I was called to see a young gentleman, who had a swelling under the arm-pit, extendinglbThe side. The skin was red and hot, and the tumour so painful as to have deprived him of all rest for the three previous nights. Though suppuration appeared to me to have commenced, I at once ordered quinine, and begged him to poultice the PRACTICE OF MEDICINE. 135 tumour. By these means, he was perfectly cured in three days, the swelling having, in that period, completely disap- peared. The subject of this case was, in the first instance. attacked with shivering and fever, which had repeatedly re- curred, but disappeared under the use of the quinine. Mat- ter, I have no doubt, was absorbed in this instance, but so far from this absorption producing shiverings,—which, accord- ing to the doctrine of the schools, it ought to have done,—the very reverse took place. I shall now give one of many instances of indubitable and palpable inflammation—if the word have a meaning at all— as a proof of the value of opium in the treatment of this affec- tion. Case.—An old officer, Major F., 89th foot, who had pre- viously lost one eye by acute ophthalmia, notwithstanding a vigorous antiphlogistic discipline, had the other attacked in a similar manner with great pain, redness, and throbbing. I found him leaning his head over a chair-back, his face indi- cative of intense agony. For ten nights, he assured me, he had been unable to tolerate any other position, and it was only towards morning, when overcome by suffering, that he could, at last, obtain anything like repose. The pain came on at bed-time in an aggravated degree, and remitted princi- pally in the afternoon. Three grains of opium, which I directed him to take half an hour before the recurrence of the expected paroxysm, procured him a whole night of profound sleep, and his eye, in the morning, to his astonishment, was free from pain, and only slightly vascular. He had been repeatedly bled, leeched, purged, and blistered, without even temporary benefit—indeed, the gentleman who attended him in the first place, plumed himself upon the activity of his treatment. But how, some may ask, can pleurisy and pneumonia be cured without blood-letting? What are pleurisy and pneu- monia ?—Any rapid tendency to atomic change in the sub- stance of the lungs, from the real pain and presumed increase of temperature at the same time developed, is termed pneu- monia—vulgo inflammation of the lungs. A similar ten- dency to change in the atomic relations of the membrane (pleura) which covers the outer surface of the lungs, or of that portion of it which is continued over the inner surface of the chest is called the pleurisy. Now, authors have thought it a fine thin" to be able to tell pleurisy from pneumonia, but the thing is impossible; and what is more, if it were possible, so 136 CHRONO-THERMAL far as treatment is concerned, it would not be worth the time we should spend in doing it. Such distinctions only lead to interminable disputes, without in the least tending to im- provement in practice. This much, however, I do know,— both diseases are developments of intermittent fever, and both may often coexist at one and the same time. And in the Medical Gazette there is an excellent case of the kind, which, as it in a great measure illustrates the chrono-thermal doc- trine and treatment in both, I shall give in the words of its narrator.—"The patient's symptoms were difficult respiration, dry cough with stringy expectoration, pulse full. The dis- ease commenced with an intense fit of shivering, followed by heat and a severe cough. Every day at noon there was an exacerbation of all the symptoms, commencing with very great shivering, cough, and intolerable pain in the chest, a fit of suffocation, and finally perspiration;—at the end of an hour the paroxysm terminated. Ammoniacal mixture was first given, then two grains of quinine every two hours. The next day the fit was scarcely perceptible ; the day after, there was no fit at all. An observation worthy of remark is, that the symptoms of pleuro-pneumonia,—which continued throughout in a very slight degree, it is true, in the intervals of the paroxysms—disappeared completely, and in a very short time, by the effect of the sulphate of quinine." Who are the persons most subject to inflammatory disease of the chest ? Medical theorists answer, " strong, healthy labourers, and people much exposed to the air." How these gentlemen deceive themselves ! If I know any thing at all upon any subject, I know that the fact in this case is just the reverse. The subjects of chest-disease in my experience have been almost all persons of a delicate habit, many of them con- fined to badly ventilated rooms, and the greater number bro- Ml\tlU fb£starvatr\ blood-letting, or previous disease. M. Louis of Pans, a physician, who for many years has made chest-disease his study, speaking of his consumptive paSs ot^rvS- '"^l? °f ^""atory disLse, fas this observation :—" As we have already remarked in sneaking of pneumonia, the invasion of ph JrisyCO S''ma la J proportion of our patients with the peJodof^reme wJak moma>' Does tnnf T treatment °f Ple«™y and pneu- s^mg.a^^ in blood-letting, But what are the re^ilto mercury sometimes ? wnat are the results ?-relapse or repetition of the parox- PRACTICE of medicine. 137 ysm from time to time,—long illness,—weakness ever after, and death too often. Even in these cases of extreme ema- ciation, M. Louis applies leeches ! Contrast the case I have just given you from the Medical Gazette, with the case and treatment of an individual, whose omnipotent power of set- ting a theatre in a roar may be still fresh in the recollection of many—the celebrated Joe Grimaldi. The very name excites your smile !—but upon the occasion to which I refer, the poor clown, instead of being in a vein to move laughter, very much wanted sympathy. "Monday, the 9th of October," says Mr. Charles Dickens, " was the day fixed for his bene- fit, but on the preceding Saturday, he was suddenly seized with severe illness, originating in a most distressing impedi- ment in his breathing. Medical assistance was immediately called in, and he was bled until nigh fainting. This slightly relieved him, but shortly after he had a relapse, [return of the paroxysm ?] and four weeks passed before he recovered sufficiently to leave the house. There is no doubt (continues Mr. Dickens) but that some radical change had occurred in his constitution, for previously he had never been visited with a single day's illness, while, after its occurrence, he never had a single day of perfect health." If you reflect that medical relief was immediately called in, you may be inclined, like myself, to ascribe poor Grimaldi's damaged constitution, not so much to the effect of the original disorder, as to the sangui- nary treatment adopted in his case. Whether or not he had the additional medical advantage of being starved at the same time, I do not know; but lest it might be inferred that his continued illness was owing to the neglect of this very ex. cellent part of antiphlogistic practice, I may just hint that there have been such things as inflammation of the lungs, brought on by starvation. Witness the verdict of a coroner's jury, in the case of a pauper, who died not long ago in the ______________. « That the deceased died from inflammation of the lungs, produced by exposure and want." The verdict in question was only in accordance with the evidence of the surgeon of the work-house. In acute disease of the chest—whether involving the pleura simply, the interstitial substance of the lungs, or the mucous or muscular apparatus of their air-tubes, the first duty is to premise an emetic. So far from acting exclusively on the stomach medicines of this class have an influence primarily cerebral'and may therefore act powerfully upon every mem. 13S CHRONO-THERMAL ber and matter of the body. By emetics you may change the existing relations of the whole corporeal atoms more rapidly and effectually than by any other agency of equal safety in the materia medica. Every kind of chest-disease being a mere feature or development of fever, whatever will relieve the latter will equally relieve the former. The value of emetics in the simpler forms of fever, few will be sufficiently bold to deny; and the quickness with which the same medi- cines can alter the state of an inflamed part may be actually seen by their effects on the eye, in the inflammatory affections of that organ. You have only to try them in chest-disease to be satisfied of their inestimable value in cases of this kind. Instead, therefore, of talking of the temporary good that has occasionally been done by the lancet in inflammations of the chest, call to mind the many deaths you have witnessed where it had been most freely used,—to say nothing of the long illnesses which have been the lot of such as have es- caped the united bad effects of chest-disease and loss of blood. Whatever salutary influence, as a present means of relief, blood-letting may produce, it is infinitely inferior to what you may obtain by emetics. Do people at this time of day require to be told that you may purge a healthy man to death .'—that by any class of purgatives, whether vegetable or mineral, you may so disturb every action of the body—may so alter every corporeal struc- ture and secretion, that no one shall be of natural consistence or appearance ! By the eternal use, or rather abuse, of any purgative you please, in a previously healthy body, you may so change the alvine secretions, that they shall take the form of any "impurity" you fancy—and for this impurity of your own creation you may, day by day, and week by week, purge and purge till you have brought your patient to the state of inanition which constitutes, as I shall explain to you, the dis- ease termed << ship-scurvy." See, then, the effect of that hu- moral doctrine! But even this kind of folly appeared too simple to some teachers, and these taxed their invention to make nonsense compound. Who has not heard of rheuma- tic-gout ?_and who will be so bold as to deny its existence ? Yet what is it but a self-evident absurdity? Its literal mean- ing is "fluid-fluidity." You might as well call an injury from fire "an^^-eous burn!" Does such jargon convey the hSv tT ldGa °f ihe tme motions which take place in the body m the course of any one disease ? How then can you PRACTICE OF MEDICINE. 139 wonder at men of observation laughing at the whole medical profession ? It is only a fool or a physician who could be duped for a moment by such puerility ; and Lord Stowel was right when he hinted a man might be both at forty. "When youth made me sanguine," says Horace Walpole, " I hoped mankind might be set right. Now that I am very old, I sit down with this lazy maxim, that unless one could cure men of being fools, it is to no purpose to cure them of any folly, as it is only making room for some other." This, I believe, was said in regard to religious doctrines—but that it applies equally well to medical doctrines, may be seen from a state- ment of Sir William Temple:—"In the course of my life," he says, " I have often pleased or entertained myself with observing the various and fantastical changes generally com- plained of, and the remedies in common vogue, which were like birds of passage, very much seen or heard of at one sea- son, and disappeared at another, and commonly succeeded by some of a very different kind. When I was very young, nothing was so much feared or talked of as rickets among children, and consumptions among young people of both sexes. After these the spleen came into play, and grew a formal disease. Then the scurvy, which was the general complaint, and both were thought to appear in many various guises. After these, and for a time, nothing was so much talked of as the ferment of the blood, which passed for the cause of all sorts of ailments, that neither physicians nor pa- tients knew well what to make of; and to all these succeeded vapours, which serve the same turn, and furnish occasion of complaint among persons whose bodies or minds ail some- thing, but they know not what; and, among the Chinese, would pass for mists of the mind or fumes of the brain, rather than indispositions of any other parts. Yet these employ our physicians more than other diseases, who are fain to humour such patients in their fancies of being ill, and to prescribe some remedies, for fear of losing their practice to others that pretend more skill in finding out the cause of dis- eases or care in advising remedies, which neither they nor their patients find any effect of, besides some gains to one and amusement to the other. As diseases have changed vogue, so have remedies, in my time and observation. I re- member at one time, the taking of tobacco, at another, the drinking' of warm beer, proved universal remedies—then swallowinCT of pebble-stones, in imitation of falconers curing 140 CHRONO-THERMAL hawks. One doctor pretended to help all heats and fevers by drinking as much spring water as the patient could bear; [Priessnitz's plan ?] at another time swallowing up a spoon- ful of powder of sea-biscuit after meals, was infallible for all indigestion, and so preventing diseases. Then coffee and tea began their successive reigns. The infusion of powder of steel has had its turn* and certain drops of several names and compositions. But none that I find have established their authority, either long, or generally, by any constant and sensible successes, but have rather passed like a mode which every one is apt to follow, and finds the most convenient or graceful while it lasts, and begins to dislike in both these respects when it goes out of fashion. Thus men are apt to play with their healths and their lives as they do with their clothes; which may be the better excused, since both are so transitory, so subject to be spoiled with common use, to be torn by accidents, and at last to be so worn out. Yet the usual practice of physic among us runs still the same course, and turns in a manner wholly upon evacuation, either by blood-letting, vomits, or some sorts of purgation; though it be not often agreed among physicians in what cases or what degrees any of these are necessary, nor among other men whether any of these are necessary or no. Montaigne ques- tions whether purging ever be so, and from many ingenious reasons. The Chinese never let blood." You now see the correctness of a remark of the late Dr. Gregory, that medical doctrines are little better than " stark-staring absurdities."— And God forgive me for saying it, but their officers, for the most part, have been very nearly allied to those charlatans and impostors who wrap nonsense round In pomp and darkness, till it seems profound; Play on the hopes, the terrors of mankind With changeful skill; * * * While Reason, like a grave-faced mummy stands With her arms swathed in hieroglyphic bands."—Moore. As for the Schools, at this very moment the whole regime of medical teaching is a system of humbug, collusion, and trick—-embracing intrigue and fraud of every kind, with the necessary machinery of periodical journals and reviews, by which the masters are enabled to keep down truth and mystify and delude the student and country practitioner at their pleasure. In physic, now as formerly, the very clever world J PRACTICE OF MEDICINE. 141 "------bows the knee to Baal, And hurling lawful Genius from his throne, Erects a shrine and idol of his own,— Some leaden Calf—" who, by virtue of his puppet position, maintains a reputation and a rule in matters medical, to which neither his merits nor his learning in the very least entitle him;—nevertheless he reigns the ^Esculapius of the day, and it is only in the next age that "------the vulgar stare, When the swoln bubble bursts and all is air!" But what do the Faculty of our own time mean by the term Gout ? What do they mean by it! You may ask them that indeed. Crabbe, who studied physic, but left the profession in early life to take orders, when describing some of the doctors of his day, among other things, tells us, " One to the Gout contracts All human pain, He views it raging on the frantic brain, Finds it in fevers all his efforts mar, And sees it lurking in the cold catarrh." Gout, then, may be any thing you please ; for, according to received opinion, this offspring of Nox and Erebus, this vox et preterea nihil, takes shapes as many and Protean as there have been authors to treat of it. This much I may venture to say, that nothing will so soon help a man to a chariot as to write a book with Gout for its title—for being supposed to be a disease peculiar to aristocracy, every upstart is fain to affect it. You cannot please a mushroom squire or a retired shopkeeper better, than by telling him his disease is "gout" —" gout suppressed"—" gout retrocedent"—" gout" in this place, or "gout" in that! And what is gout? "------Of all our vanities the motliest— The merest word that ever fooled the ear, From out the schoolman's jargon."—Btron. In sober seriousness, is there such a disorder as gout ?— As a " counter to reckon by," you may use the word ; having first so far made yourselves acquainted with its real meaning that nobody shall persuade you that it is in itself any thing but a piece of hypothetical gibberish, invented by men who 142 CHRONO-THERMAL knew as little of disease and its nature as the tyros they pre- tended to illuminate. When a lady or gentleman of a cer- tain age complains to you of a painful swelling in some of the small joints of the hand or foot, you may say, if you please, that such patient has got 1he gout. If the same kind of swelling should appear in the knee or hip-joint, or take the shape of an enlarged gland or a rubicund nose, you must then change your phrase; and you may easily exhaust a volume in^ pointing out the differences between them. But as neither this kind of disquisition, nor the baptizing your patient's disease by one name or another, can in the very least help you to cure it, I may just as well explain to you that this swelling, like every other malady incident to man, is not only a development of constitutional disease, but comes on in fits or paroxysms. Now you will find this fit in one case perfectly periodic and regular in its recurrence ; in ano- ther less determinate as to the time of its approach. The re- sult of repeated paroxysms, as in other diseases where great heat and swelling take place, must be a tendency to decom- position, and in this instance the product, for the most part, is a deposit of chalky or earthy matter. In that case nobody will dispute the name you have given to the disorder; but should the result of the decomposing action be purulent mat- ter, or ichor, instead of chalk or earth,—which neither you nor any body else can know beforehand,—you must not be astonished if a rival practitioner be called in to give the dis- ease another soubriquet,—to christen it anew by some other phonic combination, full as indefinite as the first, and which may thus serve you both to dispute about very prettily from one end of the year to the other, without either of you be- coming a whit the wiser ! You see, then, that the only differ- ence between what is called "gout," and what is called "in- flammation," is, that the result of the morbid action in the former case, is earthy instead of purulent deposit, a solid in- stead of a fluid product. Now this difference may be ac- counted for partly by hereditary predisposition, and partly by the age of the respective subjects of each. Young plants contain more sap than old ones; the diseases of both must, therefore, in some points vary; for though in the blood of the old or middle-aged man we find the same elemental princi- ples as that of infancy and youth, from these being in differ- ent proportions, the result of decomposition must, mutatis mutandis, be different. What are the causes of gout ?— One writer says one thing, another, another. Dr. Holland, PRACTICE OF MEDICINE. 143 physician extraordinary to the queen, is among the latest who has written upon the subject, and he says the cause is a " morbid ingredient in the blood ;"—nay, he says, "it cannot be denied." Still, not only do I presume to dispute the dic- tum, but I challenge him to bring forward a tittle of proof in support of it. His whole doctrine of gout, I apprehend, is a fallacy ; for if you inquire, the patient will tell you that he took too much wine the night before his first fit; or that he had got wet; or had been exposed to the east wind ; or had been vexed by some domestic matter.—From which you see the causes of gout are any and every thing that may set up any other disease,—small-pox and the other contagious fevers of course excepted. A paroxysm of gout has been actually brought on by loss of blood, and also by a purge, for which statement, if you will not believe me, you may take the au- thority of Parr and Darwin. What, then, is the remedy? If you ask me for a specific, I must again remind you there is no such thing in physic; and what is more, the man who understands his profession would never dream of seeking a specific for any disorder whatever. No, the remedies for gout are the same that cure other diseases—namely, attention to temperature during the fit, and the exhibition of the chrono-thermal or ague medicines during the remission;— for we have seen that, like the ague, it is a periodic disorder, and such is the description of it given by Sydenham, who was half his life a martyr to it,—to say nothing of Dr. Samuel Johnson's explanation of it in his dictionary. That it comes on like the ague, with cold shiverings, the experience of almost every case will tell you ; but as your minds may be too much occupied with school theories to mark that fact for yourselves, I will give it to you in black and white, in the words of Darwin. Speaking of some cases of the disease, he says, " The patients, after a few days, were both of them affected with cold fits like ague-fits, and their feet became affected with gout." To meet it in a proper manner, you must treat the disease purely as an ague. With quinine, arsenic, opium, and colchicum,! have cured it scores of times, and truth obliges me to say, I have sometimes failed with all. Now what can I say more of any other disease ? Every day you hear people talk of the "principle" of a thing, but really without knowing what they are talking about. The true meaning of the word principle is unity—something sim- ple or single, to which you may specially refer in the midst 144 CHRONO-THERMAL of an apparently conflicting variety. That a perfect unity of type pervades all the variations of disease is indisputable, and of the correctness of a unity or principle to guide your treat- ment, there is as little doubt. What, then, are all your school-divisions but " flocci, nauci, nihili, pili!" I shall now give you a case or two which may perhaps suffice to show you my treatment of gout. Colonel D-------, aged 60, had a fit of gout which came on every night, and for which leeches and purgation had been ineffectually prescribed before I was called in. I ordered a combination of quinine and colchicum, but as this did not stop the fit, I changed it for arsenic, after taking which the patient had no return. Captain M-------, aged 56, had a fit of gout, which recur- red every night during his sleep. I prescribed arsenic with- out effect; I then gave him quinine, which acted like magic. The same gentleman, twelve months after, bad a recurrence, but was much disappointed, on resuming the quinine, to ob- tain no relief. I then prescribed arsenic, which, though it failed the year before, this time perfectly succeeded !— a les- son to such as would vaunt any remedy as a specific for any disease. The influence of the passions in causing or curing gout is well known. One of many cases so cured comes just at this moment to my mind. A clergyman was laid up with a se- vere attack of the gout; his wife having heard of the effect of surprise in cases of the kind, dressed up a large hare in baby-clothes, and brought it to his bed-side, telling him how fearfully changed their child had become. The old gentle- man eyed the animal with a look of terror, sprung out of bed, and complained of his foot no more. Now, as gout, like ague, is a remittent disease, and curable in the same manner,—whether by mental or physical agency, —what right have we to assume that its cause is a " morbid ingredient in the blood," any more than that the cause of ague is ? Still, we shall suppose for a moment that it is the effect of a "morbid ingredient in the blood;"—what, then, let me ask is this morbid ingredient doing all the time of re- mission ? Does it sleep or wake during this interval of immu- nity ?-and how comes it that arsenic, quinine, and colchi- 2f Pft^ neude of tre"- Tver tnrnentinP ""T*6 t0. °pium' arsenic> guiaic> with silver, turpentine, copaiba, arnica, montana, aconite, or sal- PRACTICE OF MEDICINE. 149 phur—-or combinations of them—all of which remedies have succeeded and failed in ague as well as in rheumatism. In most instances of acute rheumatism, the first combination will be found to answer perfectly; though, in cases of long stand- ing, you may have to run from one medicine and combina- tion of medicine to another, before being able to bring about this desirable termination;—and it is my duty to confess to you, that in some cases, particularly where either much de- pletion, or much mercury, or both, have been employed—as, I grieve to say, they too often are in the primary treatment— you may fail with every means you may devise. Under the head of rheumatism, medical men also include certain muscular pains, which occur in various parts of the body, but which are unattended by any apparent morbid structural development. With nitrate of silver and prussic acid, I have often cured these pains; and with the cold plunge- bath, I have sometimes succeeded after every other means had failed. Of my mode of treating acute rheumatism, I will give two examples. A young man, aged 25, had been suffering severely from rheumatism for four or five days before I saw him. At this time the joints of his wrists and ankles were much swelled and exquisitely painful; his heart laboured, and was in such pain as to impede his breathing; his tongue was foul and furred, and he had been occasionally delirious. I ordered an emetic, which was some time in operating, but when it did, the relief was signal. I followed this up with pills contain- ing a combination of quinine, musk, and colchicum, and in two days he was sitting up, with scarcely any swelling re- maining in the affected joints; in two days more he had no complaint. Not a drop of blood was taken in this case. A gentleman, aged 30, after exposure to wet and cold, had a shivering fit with fever, in the course of which almost every joint in his body became swollen and very painful. He was bled, leeched, blistered, and took mercury, to no purpose, be- fore I was called in. I ordered him a combination of quinine, colchicum, and opium, which agreed so well with him, that in three days I found him free from every symptom but weak- ness, which I presume was as much the effect of the former sanguinary treatment, as of the disease ; at any rate, he had certainly suffered very severely. But, like every other dis- ease incident to man, rheumatism may not only be cured with- out loss of blood, but without any physic at all; and in evi- 150 CHRONO-THERMAL dence of this, I will read to you an extract from the writings of Sydenham: " As to the cure of rheumatism, he says, " I have often been troubled, as well as you, that it could not be performed without the loss of a great deal of blood, upon which account the patient is not only much weakened for a time, but if he be of a weakly constitution, he is most com- monly rendered more obnoxious to other diseases for several years, when, afterwards, the matter that causes the rheuma- tism [Sydenham, like Hippocrates, was a disciple of the hu- moral school] falls upon the lungs, the latent disposition in the blood being put into motion by taking cold, or upon some slight occasion. For these reasons, I endeavour to try for some other method different from bleeding, so often repeated, to cure this disease ; therefore, well considering that this dis- ease proceeded from an inflammation, which is manifest from the colour of the blood, which was exactly like that of pleu- ritis. I thought it was probable that this disease might be as well cured by ordering a simple, cooling, and moderately nourishing diet, as by bleeding repeated, and those inconve- niences might be avoided which accompanied the other method ; and I found that a whey diet, used instead of bleed- ing, did the business. After last summer, my neighbour Mat- thews, the apothecary, an honest and ingenious man, sent for me ; he was miserably afflicted with the rheumatism, accom- panied with the following symptoms. He was first lame in the hip for two days, afterwards he had a dull pain upon his lungs, and a difficulty of breathing, which also went off in two days' time, [both remittent,] after which his head began to pain him violently, and presently the hip of the right side, which was first seized; and afterwards, according to the usual course of the disease, almost all the joints, both of the arms and legs, were afflicted by turns. He being of a weak and dry habit of body, I was afraid that by taking away much blood, his strength, before but infirm, would be wholly van- quished ; especially the summer being so far spent, it was to be feared winter would come before he could recover his strength, weakened by frequent bleeding, and therefore I or- dered that he should feed on nothing but whey for four days. Afterwards I allowed him, besides the whey, white bread instead of a dinner, namely, once a day, till he was quite well. He being contented with this thin diet, continued the use of it for eighteen days; only I at last indulged him with bread at supper too; he daily drank eighteen pints of whey, PRACTICE OF MEDICINE. 151 made at home, wherewith he was sufficiently nourished. After these days, when the symptoms did no more vex him, and when he walked abroad, I permitted him to eat flesh, namely, of boiled chickens, and other things of easy digestion; but every fourth day he was dieted with whey, till at length he was quite well; the inconveniences mentioned above being quite remedied by this method, with which he was grievously afflicted ten years before, bleeding being then used by my order for his cure, and often repeated. If any one shall con- demn this method because it is plain and inartificial, I would have such a one to know that only weak people despise things for their being simple and plain ; and that I am ready to serve the public, though I lose my reputation by it. And I will say that I do not at all question, were it not for common pre- judice, that the said method might be accommodated to other diseases, the names whereof I conceal at present, and that it would be more beneficial to the sick than the common pomp of remedies that are used for people when they are just dy- ing, as if they were to be sacrificed like beasts."—But The Stone ? You will doubtless ask me whether or not I look upon that also as an effect of intermittent fever ? To this question I have only to say, that stone must be admitted to be a result of morbid urinary secretion. Can any secretion become mor- bid without the previous occurrence of constitutional (in other words, intermittent febrile) change ? Certainly not; then, without such change, how could stone become developed at all ?—moreover, are there not times of the day, when the sub- ject of it is better and worse, and this not altogether to be referred to the period of micturition. A "fit of the stone" is as common an expression as a fit of the ague. Drs. Prout and Roget, who have paid much attention to calculary dis- eases, state, while medicines styled lithontriptics exert but little influence in such cases, tonics have almost universally ameliorated the condition of the patient;—and what are the medicines usually termed tonics, but the remedies for ague ? Whether gout and rheumatism be remittent diseases or not, or whether they be remarkable for the changes of tempera- ture and action, termed fever, nobody but such as prefer books of nosology to the book of nature and common sense, would be so ignorant as to question. Whether they be varieties of the same disease, is another thing ; but this I know, they are 152 CHRONO-THERMAL both first-cousins to ague, and by treating them as such, the practitioner may save himself a world of trouble, and the pa- tient a world of pain, which neither might escape, in adopt- ing the doctrine of the " pathologists," that these are inflam- matory diseases, and only to be subdued by leech, lancet, and mercury to salivation. Laugh at the pathologists, and laugh too at their disputations, which being all about nonsense, can never possibly come to a satisfactory conclusion. The calculary (gritty) or stony concretions which are oc- casionally deposited in the different joints during gout, sug- gested to medical men, even at an early period, the analogy subsisting between that disease and stone. During constitu- tional disorders, calculus may be developed in any tissue or structure of the body. Salivary concretions are common; of pulmonary calculi I have seen two instances: in one case they were expectorated by a consumptive female, who died; in the other by a gentleman whose lungs being otherwise organi- cally uninjured, recovered his health completely by attending to the temperature of his chest, and by the occasional use of hydrocyanic acid and quinine, which I prescribed for him. This patient had previously consulted two of the best em- ployed medical men in London, one a physician, the other a surgeon, neither of whom held out a hope for him but in a warm climate. Dr. Chalmers and Sir B. Brodie, for these were the practitioners the patient previously consulted, show- ed in this instance, at least, their good opinion of attention to temperature. How often the liver, gall-bladder, and kidney are the seat of stone, I need not tell you. Taking place in the course of an artery, calculus is erroneously termed ossifi- cation. I wonder it never occurred to authors to call it the gout! seeing that there is, at least, this resemblance betwixt them, that both generally become developed after middle age has marked the subjects of them with her seal. There are not wanting authors who have traced an analogy betwixt rheumatism and Cutaneous Disease—or Disease of the skin—and as all disorders are cousins-german to ague, we must give them full credit for their powers of observation—stating, at the same time, our readiness to help them out to a still more comprehensive view of the relation- ship which subsists between «the various genera of disease." What a fine thing to be able to master the cloud of ridicu- PRACTICE OF MEDICINE. 153 lous distinctions and definitions by which Drs. Willan and Bateman have contrived to disguise the whole subject of cu- taneous disorder;—to distinguish, for example, psoriasis from lepra—erythema from erysipelas, diseases only differing from each other in being acute or chronic, or from being more or less extensively developed ; all, too, depending upon the same constitutional unity and integrity of state—all more or less amenable to identical agency ! Most truly, then, has my Lord Bacon remarked, " Divisions only give us the husks and outer parts of a science, while they allow the juice and kernel to escape in the splitting." What! I shall be asked, is erysipelas or rose nothing more than a result of ague—ery- sipelas, for which, according to Mr. Lawrence we must make incisions in the skin at least a foot long—gashes not quite so short, but quite as deep as sabre wounds ! Hear what Sir James Mackenzie says when describing his own case; and the accuracy of his description will scarcely be questioned, if it be remembered that previously to entering upon his legal career, Sir James had not only studied but taken his degree in physic:—" We had an unusually cheerful day," he says, "but just as I was going to bed I was attacked by a fit of shivering, which in the morning was followed by a high fever, and in two days by an erysipelas in the face. The dis- ease went through its course mildly, but it is liable to such sudden turns, (fits?) that one is always within six hours of death." For the value of quinine or bark in this disease I could cite many authorities, but the candour of Mr. Travers entitles his evidence to a preference. At a meeting of the Me- dico-Chirugical Society, he is reported to have stated that in "a great many instances (of erysipelas) he had found the most decided benefit from the use of Bark and other tonics, and which at the commencement of the disease, he had often seen highly useful in the practice of others, even in cases where he would have employed the antiphlogistic treatment, if the patient had fallen into his own hands."—Lancet. Every medical man of experience knows that erysipelas is very often epidemic; in other words it prevails at a partic- ular time to a greater or less extent among a particular peo- ple or class of people. Wherefore it seems to depend upon a peculiar constitution of atmosphere; for during the time it is prevalent in camps and cities, the slightest scratch on the skin will set it up. I have known it follow the application of a blister to the chest, and remember when in Edinburgh Castle with the Royals, I was obliged to tell the officer com- 154 CHRONO-THERMAL manding the troops a little of my mind upon the subject of corporeal punishment; one poor fellow had just escaped with his life from the erysipelas brought on by a flogging. But even at periods when the disease is not epidemic, it may be produced by one of the thousand things that daily occur in life. Cold and wet are frequent causes; and there are indi- viduals who cannot take mercury in any shape or dose with- out being liable to an attack of it—nevertheless, I have cured many cases with mercury. The best practice, however, is to treat it like other acute fevers. Begin with emetics, and fol- low them up with arsenic or quinine; this will apply to all diseases of the skin, by whatever names they may be known or distinguished. What are the causes of cutaneous diseases generally ? Eve- ry thing that can set up fever;—and what agent in nature, which may not do that ? Cutaneous disease may be produced by mechanical injury even—a blow, or a fall, for example. A friend of mine, who hunts a great deal, has had several falls from his horse, and on each occasion the accident was followed by an eruption all over his skin. I have known eruptions to be a constant effect of the introduction of a bou- gie into the urethra of a particular individual. What will the gentlemen of the Humoral school say to this ? for you know the partizans of that school trace all such diseases to a "morbid ingredient in the blood," they look upon eruptions as an effort of nature to expel the " peccant humour." Be careful, they tell you, not to drive it in ! Now, what is an eruption but the effect of a tendency to decomposition of the matter entering into a detached portion of the cuticular tissue, so as to produce an arrangement and motion of the atoms composing it, different from their motion and arrangement in health ? Such caution, therefore, amounts exactly to this: be careful that you do nothing that shall make these cuticular atoms resume their respective places in the economy, so as to resemble the healthy skin ! See then to what a ridiculous pass the humoral doctrine leads us ! When that doctrine was more prevalent than it is at present, cutaneous diseases were very generally classed under the head of " scurvy " or scorbutic; whoever had eruptions on his skin of a chronic character, was said to have the scurvy. Now, if this phrase had been used simply as a sign or "counter to reckon by," no great harm could have ensued; but like " scrofula," and the « gout," " scurvy" in process of time came to perform the part, not of a sign merely, but of a corporeal something— PRACTICE OF MEDICINE. 155 an indefinite entity or essence,—or any thing but a real sense, which, like a will-o-the-wisp, played its "fantastic tricks" now in this part of the body, now in that. Some wise pro- fessor made his pupils suppose that he had detected it in the blood even ; and from that moment not only did people be- lieve that scurvy wasaspecifie disease, but the whole faculty were anxious to discover a specific remedy for it. A specific for what ? for an " airy nothing," that only existed in theo- retic visions of their own mystified brains. Stare as you please—but this after all, is the truth. What, then, will be demanded, is the disease which doctors call " ship-scurvy!" Now to this most reasonable question, I will endeavour to reply in a reasonable manner. Having been myself for months at sea without landing or seeing land, my evidence may be just as good as that of others who have handled the subject before me. During long and harassing voyages, what from being forced by foul weather to sleep under close and consequently unventilated decks—what from being obliged to watch and work hard upon a short allowance of food and water—together with the anxiety and depression of spirits produced by " hope deferred," the men gradually begin to show signs of a constitutional " break up." You will find them with faces pale and bloated ;—their skins rough, rugged, and exhibiting petechiae and haemorrhagic ulcers ; their gums weak, spongy, and bleeding; their hair harsh,dry,and falling away, and their bowels subject to fluxes; a low fever wastes them day by day and night by night, and they become at last so ill as to faint from the least exertion. This is ship-scurvy, —not depending on a something noxious in the blood, but upon a positive want of something essential to its healthy re- production. And how, think you, is this disease to be cured ? By wholesome food and pure air, you will naturally reply. No such thing ; nothing so simple would do for scientific peo- ple. It can only be cured by lemon juice ! Lemon juice, ac- cording to the greatest medical professors, is not only a pre- ventive of the bad effects of starvation—but a substitute for pure air and proper food in the cure of diseases produced by a deprivation of both ! Now, it is a curious fact in the ^ history of ship-scurvy, that just about the time that lemon-juice came into fashion as a cure for it, great improvements began to be made in navigation, as also in ship-building, and in the ventilating and victualling of fleets; voyages that formerly took a vear, can now be completed in a month or two, and the natural good effects of all this upon the habits and 156 CHRONO-THERMAL constitution of the seamen are, up to this moment, very mo- destly claimed by the doctors as the result of their employ- ment of lemon-juice. And not only are there fools in the world, but philosophers also who daily echo this trumpery story! There is not a disorder of the skin, however named, that I have not myself cured with quinine,—and I have met with examples of every kind of skin disease, that have baffled me with every thing I could think of. I may here, nevertheless, state in regard to cutaneous disease generally, that I have not very often been at a loss, while I had at my disposal qui- nine, arsenic, oxymuriate of mercury, hydriodate of potass, creosote, iron and lead. In a very obstinate case of scald- head, the subject of which was a young artist of talent, a combination of belladonna and stramonium effected a com- plete cure in about a fortnight. The disease, in this instance, had been upwards of twelve months' standing, and had resisted the prescriptions of some of the ablest men of Dublin and London. Baths, of which I shall hereafter speak, I have found of great service in diseases of the skin—and what do all these remedies come to at last, but to thermal change? In the great majority of instances, then, the local disorder from which physicians now almost invariably name disease, and to which they almost as invariably confine their atten- tion, is only one of many features of universal disturbance. So far from being the cause of such disturbance, the local tendencies to disorganization are merely hereditary or acci- dental developments occurring in its course—developments expressive, for the most part, of the weak points of individual constitution—though sometimes determined by climate or other speciality of cause. In England, for example, the vis- cera of the chest are the organs which chiefly suffer—while in the East and West Indies, the liver and other contents of the abdomen become more frequently implicated. Remittent fever, I need not say, is the parent of both. Injuries, passions, poisons, then, are each capable of pro- ducing the same constitutional disturbance with every kind and degree of organic change to which the subjects of them may, by original weakness of configuration, be predisposed. To use a homely phrase—" when the whole house shakes, the worst built room suffers most,"—and this, of course, differs with every house. A blow on the head—nay, an injury to so minute a member as the finger, may produce a general febrile disorder, ending in abscess of the lungs or liver, PRACTICE OF MEDICINE. 157 according to the predisposition of the patient. Even in the course of the contagious or Pustular Fever, we daily find all kinds of organic change developed—change which no man in his senses would place in the light of a cause of those fevers. Among the organic and other disturbances induced by the Small-Pox Fever or Variola, as it is called by the profession, I have noticed sore throat, deafness, dropsy, consumption, glandular swel- lings, rheumatism, and palsy, just as I have seen the same localisms developed in the course of a common remittent fever,—such sequelae depending, of course, upon the original predisposition of the patient to the development of this or that complaint by any agency capable of injuring the general con- stitution. And how should it be otherwise, when we come to reflect that the small-pox fever, like every other fever, con- sists in a succession of paroxysms so exactly resembling ague, that, before the appearance of the eruption, it cannot possi- bly be distinguished from it!—Nor, so far as individual treat- ment is concerned, does that matter a straw—for however perfectly specific the cause of the disorder undoubtedly is, the disease itself admits of no specific mode of treatment. To shorten the cold stage, the nearest cordial that can be got may be resorted to. During the hot, keep the patient as cool as possible, or endeavor to break it by an emetic, which, in nine times out of ten, may easily be done ; and when that and the sweating stage are ended, endeavor to prolong the interval of remission by opium, hydrocyanic acid, or quinine. That I believe comprehends nearly the whole duty of the physi- cian in this, as in every other acute disorder. By a reverse course, the most perfectly curable case of small-pox may be very speedily rendered malignant. During the spring of 1824, a great many instances of the disease occurred in Edin- burgh, and I remember two cases which, from the difference of the practice employed, and from the difference of the re- sults, made a strong impression upon my mind. The first case was treated by the late Dr. Mackintosh by repeated bleeding and purgation ; in consequence of which the patient became delirious, and the pustules were rendered confluent. The subject of the second case was myself; having frequently visited the former gentleman during his illness, I may fairly presume I took the infection from him. But the treatment, in my own instance, was restricted to an occasional antimo- 14 158 CHRONO-THERMAL nial, and an opiate about seven in the evening, which had the effect of either entirely preventing the anticipated parox- ysm, or rendering it so trifling as to pass without observation. On two occasions it was neglected, and a night of fever and restlessness each time was the result. I was out of the house in ten days, and J have not a perceptible mark on my coun- tenance, while the other gentleman was confined to his room for more than a month, barely escaping with his life, and when he made his appearance in the streets, his face was so disfigured by scars, that his most intimate friends did not know him when he addressed them. During the autumn and winter of 1825, while I attended the Parisian Hospitals, the small-pox was raging fearfully in France. But so un- successful was the treatment employed, bleeding, leeching, and purgation, that the dissecting-rooms of Paris were liter- ally crowded with the bodies of people who had died of the disease. Some of these bodies bore the mark of vaccination on their arms. But what is vaccination? Vaccination is only the artificial introduction into the human system of an animal poison; and it was first practised by Dr. Jenner of Berkley, in Gloucestershire. Now Jenner was a man of great observation—great penetration—a man upon whom facts were never lost,—not a mere collector of facts,—not one of those poor creatures who cry " facts, facts, give me facts— I never think,"—men who might as wittily cry " bricks, bricks, give me bricks—I never build !" Of a quite different stamp was Dr. Jenner. Practising his profession, chiefly at first among the poor of his native county, from them he learned that the people connected with dairies, had their hands very often attacked with an eruptive disease, which ' they traced to a similar eruption on the teats of the cows they milked, and their general belief was that such as had this eruption could not take the small-pox. All through Glou- cestershire this fact was known to the peasantry,—but the wise doctors only looked upon it as a popular superstition. Not so Jenner,—who set about an investigation, and he dis- covered it to be the truth; and, in spite of the greatest oppo- sition from men of his own profession, and others whom they secretly influenced, he finally succeeded in establishing the practice of vaccination-so called from vacca,the kZ for cow. Jenner, then, was the first who artificially Ltroduced cow-pox as a preventive of small-pox; and thafiis indSd a preventive we will have no difficulty in believing, if we choose to recall to memory the number of persons wholes PRACTICE OF MEDICINE. 159 were fretted and seamed by the small-pox in our younger days, and the few instances of a similar kind we meet with in these times, since vaccination has been practised. Do you doubt the preventive effect of small-pox against a recurrence of small-pox ?—No more can we doubt the effect of vaccina- tion—for though small-pox does occasionally attack individ- uals who "have previously undergone vaccination, so also does it recur occasionally in persons who bear the indelible marks of having previously suffered from small-pox itself. What is the vaccine disease but a modification of small-pox ? It is small-pox in a milder form, a fact which Jenner suspected, and which Mr. Ceely of Aylesbury has recently proved by a very simple experiment. He first inoculated a cow with the matter of a small-pox pustule. From the new pustules which were in due time produced in that animal, he took matter and inserted it into the arm of a child. The vaccine or cow-pox pustule was the result—and these experiments he has several times repeated with the same success, in the presence of many medical men,—so that the cause of small- pox in man (whatever its real nature be) becomes so altered in its vaccine or cow modification, as to constitute a most val- uable preventive against the severer form. What is the nature of the specific agent which produces and reproduces, through such an infinity of individuals, an effect so gene- rally specific ? Can it be, as Linnaeus thought, of an animal- culine character ? or, is it at all analogous to the influence produced by the magnet on iron ? which metal, all know, may, from the contact of a magnet, become itself magnetic. These are the most probable relations in which the subject may be viewed—if indeed, it have not some analogy to the continuation and reproduction of all animal life. There are a few questions connected with this subject, which I confess myself unable to answer. Perhaps the ingenuity of some one may solve them for me. 1. Why is small-pox, when directly inoculated, more gene- rally mild than when taken casually by infection ? 2. Why, after vaccination, have we, in the majority of cases, only one pustule instead of many, as in the case of the small-pox ? 3. Why is the cow-pox not infectious, like small-pox—see- ing that it is a mere modification of identical agency ? The cow-pox, so far as we know, can only be communicated by direct inoculation. 4. Has the protection which the cow-pox and the small-pox 160 CHRONO-THERMAL afford to the constitution against recurrence, any analogy to agricultural exhaustion—to the impossibility to obtain more than a given number of successive crops of a particular her- bage, from a particular soil, in a given period of years ? But the small-pox fever is not the only fever which once having attacked an individnal during his life, for the most part renders him unsusceptible of its recurrence; all the truly contagious fevers have this effect—chicken-pox, measles, scar- let-fever, hooping-cough, seldom affect the constitution above once in life—though sometimes, like small-pox, they make their appearance twice, and even three times in individuals. By some authors, the chicken-pox has been supposed to be a modification of small pox—an opinion to which I myself lean—for when we consider how remarkably small-pox be- comes modified after vaccine transmission, we can scarcely doubt that it may admit of still further modifications, by passing through the bodies of other animals besides the cow. This much is certain, that every one of the contagious dis- eases has the most perfect analogy to the ague—seeing that all have remissions and exacerbations of fever more or less perfect in kind, and that all are more or less amenable to the chrono-thermal remedies—not one of which remedies, how- ever, possesses such specific influence over them, as to be ex- clusively relied upon in the treatment of any case. Is not this the best of all proofs that there is no specific in physic ? If in a most decidedly specific disease we have no specific re- medial agency, how can we possibly expect to find such for any one of the great family of disorders which may be pro- duced by anything and everything that can derange the gene- ral health ? Yet Dr. Holland hopes that medical men may one day find a specific remedy for gout, and another for con- sumption—diseases which may be produced and cured by any agency that can alter the moving powers of particular individuals! Is the Plague an intermittent fever ?-The case of Corporal Farrel, as de- tailed by Dr Calvert, [Medico-Chirurgical Transactions'] SI JLaJufficien'answer touthe his Rothes, according to an order to that effect. On coming out of the water he was seized with violent shivering and headache, succeeded by heat of skm and afterwards by sweating, which alleviated PRACTICE OF MEDICINE. 161 the distressing symptoms. On the following day the paroxysm was repeated. He was permitted to remain in the barracks from a belief that his complaint was intermittent fever. The next day his fever returned as usual, but it now declared itself to be the plague by a bubo (glandular swelling) aris- ing in the groin while the seat of the pain seemed to be sud- denly transferred from the head to that part. The paroxysm was again followed by an intermission or remission. But the next morning, while dressing himself to go to the lazaret, he dropped down and expired." Disputes still exist as to whether plague be contagious or not. On which ever side truth lies, there can be no difficulty as to the proper treatment. The indications in plague, as in simple intermittent fever, or the small-pox, are to regulate the temperature in the cold and hot stages by the means already pointed out, and to prolong the remission by quinine, opium, arsenic, &c, according to particular constitutions. Treated in this manner the disease could not by any possibility be more fatal than we are told it is under the present routine of prac- tice. " In all our cases," says Dr. Madden, " we did as all other practitioners did,—we continued to bleed, and the pa- tients continued to die !"—[Madderts Constantinople.] From the same candid author, I find that the Yellow Fever of the West Indies, is not less remarkable for its periodic re- missions and exacerbations than for the shiverings and alter- nations of temperature characteristic of every other disorder. The yellow appearance of the patient, like the milder jaun- dice, is a mere effect of spasm of the gall ducts. Jaundice, then, is a symptom, not a disease ; it is the result of spasm developed in the course of a febrile paroxysm. People will say, " You would not give quinine or bark in jaundice." But wherefore not ? seeing I could muster a good half-hundred instances where I myself have cured the disease by one or the other. Dr. Madden details a case of yellow fever cured by quinine, a case in which he says, " had the gentleman been bled, after the fashion of the country, I think in all pro- bability he would have died; or had he survived, that he would have left a debilitated constitution and a dropsical diathesis to encounter in his convalescence." Previous to my embarkation for the East Indies, where it was my chance to serve five years as a medical officer of the 162 CHRONO-THERMAL army, I read Dr.- James Johnson's work on the " Diseases of Tropical climates." Impressed when a boy Avith his pretty style, I put his sanguinary treatment and his twenty-grain doses of calomel to the test. But so far from confirming his assertions, my own after-experience led me to adopt conclu- sions much the same as Dr. Madden. Captain Owen of the Royal Navy, too, who could neither have a theory to sup- port nor any interested end to serve, one way or the other, details at great length the mortality which took place among his people while employed in surveying the African coast. " It may in fact be questioned," says this intelligent naviga- tor, "whether our very severe losses were not, in some mea- sure, attributable to European medical practice, bleeding and calomel being decidedly the most deadly enemies in a tropical climate. During the whole time of the prevalence of the fever, we had not one instance of perfect recovery after a liberal application of the lancet or of this medicine." Cap- tain Owen farther states, that he himself recovered without either bleeding or calomel, while the ship-doctor fell a martyr to his medical faith,—he bled himself, took calomel, and died ! [The above remarks were first printed in 1840. Two years afterwards, 12th November 1842, extracts from the Report of the Select Committee on the Western coast of Af- rica, appeared in the Times newspaper, wherein among other things, is the following: "The bleeding system has gone out of fashion, and the frightful mortality that attended its prac- tice is now no longer known on board our ships."—Dr. James Johnson, are you satisfied !] But the eastern practitioner will tell me, possibly, that Dysentery cannot be safely treated in any other fashion. Is he sure he knows exactly what is meant by the word dysentery ? I shall say nothing of its etymology, but rather give you the symp- toms included by Sydenham under the name.—" The pa- tient," he tells us, " is attacked with a chilliness and shaking, which is immediately succeeded by a heat of the whole body. Soon after this gripes and stools follow." What, then, is this dysentery but an ague, with increase of secretion from one surface instead of another—from the mucous surface of the bowels instead of the skin, and the skin is only a continua- tion of the mucous membrane of the bowels. Now, Dr. Uimmmg, late of the East India Company's medical service, PRACTICE OF MEDICINE. 163 informs us, that while ascending the Nile, in 1836, heAvas at- tacked with dysentery. After suffering for a week with " in- tervals of remission," he fairly gave himself up, and so did his attendants, for he had nothing in the shape of medicine with him. As a forlorn hope, however, he ordered his guide to sponge him Avith warm water. And this simple remedy, [attention to temperature,] Avith fomentation of the abdomen, was the only treatment employed. He took a little wine and water, Avhich remained upon his stomach; he then became drowsy, slept for a short time, felt his skin hot and burning, and, in brief, began to recover, and that rapidly. In about a Aveek afterwards, he writes in his journal, " My recovery is almost complete, and the rapidity of my convalescence leads me to contrast my late attack with a precisely similar one which I had at Cawnpore, in the autumn of 1829. On that occasion I was largely bled at the arm, had fifty leeches ap- plied to the abdomen, and during the first four days of the disease, in addition to extensive mercurial frictions, I swal- lowed two hundred and sixteen grains of calomel. True, I recovered! or rather I did not die! whether in consequence or in spite of the above heroic treatment, I will not venture to say. My face was swollen to an enormous size; every tooth was loose in my jaws, and for six or eight weeks I could eat no solid food; my constitution received a shock from which it never fairly recovered, and I Avas obliged to come to Eu- rope on furlough. On the present occasion, fortunately for me, the vis medicatrix naturse was my sole physician, [he forgot the sponging part!] and I am now almost as well as before the attack commenced. All medical practice, in my humble opinion, deals too much in heroics." That opinion has for many years been mine. Such a case, from such a quarter, must doubtless be more than sufficient to Avarn against the sanguinary and mercurial practice intro- duced into the East by the influence of Dr. James Johnson's work on the diseases of India. What an idea, first to break down by the lancet and mercury to salivation the attractive power of every atom of the body, in the expectation of thereby strengthening its weakest parts! Does this savour of mania, or does it not ? and that, too, as I hinted before, madness of rather a homicidal kind ? 164 CHRONO-THERMAL Dropsy. How can there be a morbid superabundance of any secre- tion Avithout a corresponding change of temperature ? He Avho will rigidly scrutinize this disease shall find that the same shiverings and fever which precede the sweat of ague, usher in the tumid abdomen and swollen legs of dropsy. Dropsy, then, may be termed an ague with inward sweat. That it is a remittent disease may be seen by the palpable diminution of the swelling on particular days; to say nothing of the hopes both of the patient and physician on such days being excited by general improvement throughout. How should the disease be treated ? Not, according to modern practice, by diuretics and sudorifics solely; but by a combination and alternation of these remedies with the medicines of acknow- ledged efficacy in that most perfect type of all disease, the ague. Of cases successfully treated by me in this manner, I could give you hundreds—but to what purpose? The recital would only comprehend the symptoms of ague Avith increase of the natural secretions of the various cavities even to effu- sion, (or cellular substance,) instead of perspiration by the skin ; and the remedies, quinine, opium, arsenic, hydrocyanic acid, combined or alternated with creosote,squill, ipecacuanha, colchicum, mercury, &c. What other proofs do you want of the unity of all disease! The paymaster-serjeant of the royals had dropsy, Avhich, notwithstanding the usual treat- ment by diuretics, purgatives, &c, Avas daily getting worse, when Dr. Stephenson, of the 13th Dragoons, suggested the application of poultices of lichen vulgaris to the loins. From that day the amendment was rapid, and the patient subse- quently got well. Every one believed that there must have been some magical virtue in the lichen. But Mr. Brady, the surgeon of the regiment, thinking that the plant had less to do Avith the cure than the heat Avhich, in the form of a poul- tice, it produced, determined to try poultices made Avith rice in a case exactly similar. The result was the same—a cure; proving how right he was in his conjecture. Since I entered into private practice, I have repeatedly applied poultices to the loins with advantage, and have also, with the assistance of plasters of pitch, galbanum, &c, succeeded in curing cases of dropsy, that resisted every kind of internal remedy. PRACTICE OF MEDICINE. 165 Cholera,— the scourge of nations,—will cholera be found to partake of the same universal type of disease, the ague ? You will be the best judges when I draw my parallel. While in India, I had ample opportunities for ascertaining its nature. Tremu- lous and spasmodic action belong equally to ague and to cho- lera ; vomiting or nausea characterizes both. The ague pa- tient has sometimes diarrhoea or looseness ; oppression at the chest, and coldness of the whole body, are the primary symp- toms of each. The increased flow of pale urine, so often re- marked in ague, is an occasional symptom of the epidemic cholera. In more than one instance of cholera which came under my observation Avhile serving in the East, that secretion passed involuntarily from the patient a short time before death. Suppression of urine, so common in the late epidemic, was a frequent symptom of the Walcheren ague. When there is no hot fit or reaction, death is usually preceded by a sleepy stupor in both. You have ague, too, Avith hot skin and bounding pulse, a state analogous to the milder forms of cholera, in which you remark the same phenomena. When not fatal, cholera, like ague, has a hot and sweating stage.— Moreover, when ague terminates life by a single paroxysm, you find the same appearances after death in the bodies of both. Lastly, phrenzy, disease of the lungs, liver, and spleen, with dysentery and dropsy, to say nothing of epilepsy and apoplexy, have been the occasional sequelae of each. Cho- lera, then, is an extreme of the cold stage of ague. What are the remedies most beneficial in cholera ? Atten- tion to temperature comprehends every thing that has either failed or succeeded. Were I myself to become the subject of it, I should feel inclined to trust more to a bottle of brandy than to any thing contained in the Materia Medica. While serving in the East Indies, I saw many hundred cases of the disorder, but I never could convince myself of the superiority of any one kind of medical treatment over another. In my work upon the Diseases of India, I have proved that death, in the great majority of instances of cholera, takes place from a palsy of the pneumogastric nerves,—those nerves that in- fluence the functions of the lungs and stomach. If you divide these nerves in the dog, you have the essential symptoms of cholera viz. loss of voice, vomiting, and difficult breathing always,__cramps and flatulence frequently ; and the animal seldom survives the third day. On dissection, you find the 166 CHRONO-THERMAL vessels of the head, lungs, and intestines, filled with black blood. That is exactly what you find on opening the bodies of persons who have died with cholera. Shortly after my re- turn from India, Dr. Wilson Philip read a paper at the West- minster Medical Society, in which he took the very same view of cholera, but Avherein he forgot to say that his views of the disease had been, every one of them, anticipated in my re- marks upon it, published in the Lancet, some months before I quitted India. I cannot refrain from introducing here the observations made in 1832 on the cholera, and the state of the medical profession in Philadelphia, by a distinguished practitioner.— And I would ask whether the public can rely on their judg- ment hereafter in any case, in the curability of consumption or any other disease ? He thus Avrites— " There are tests for all things. Now a dangerous epidemic always shows the difference between the strong and the weak, the candid and the crafty, among physicians. It is equally true, that the same occasion displays, even to the common observer, the real condition of their art:—whether its precepts are exact or indefinite, and its practice consistent or contradictory. Upon these points, and bearing in mind- that we have now in medicine the recorded science and prac- tice of more than two thousand years, let the reader refer to the proceedings of the medical profession, during the preva- lence of the so-called < Asiatic cholera,' and he Avill find their history everywhere exhibiting an extraordinary picture of prefatory panic, vulgar wonder, doubt, ignorance, obtrusive vanity, plans for profit or popularity, fatal blunders, distract- ing contradictions, and egregious empiricism:—of twenty confounding doctors called in consultation, to mar the saga- cious activity of one;—of ten thousand books upon the sub- ject, with still an unsatisfied call for more;—of experience fairly frightened out of all his former convictions;—and of costly missions after moonshine, returning only with clouds. "Now I do assert, that no art which has a sufficiency of truth, and the least logical precision, can ever wear a face so mournfully grotesque as this. In most of the transactions of men, there is something like mutual understanding and col- lective agreement, on some points at least; but the history of the cholera, summed up from the four quarters of the earth, presents only one tumultuous babel of opinion, and one una- vailable farrago of practice. This even the populace learned from the daily gazettes ; and they hooted at us accordingly. PRACTICE OF MEDICINE. 167 But it is equally true, that if the inquisitive fears of the com- munity were to bring the real state of professional medicine to trie bar of public discussion, and thus array the vanity and interests of physicians in the contest of opinion, we should find the folly and confusion scarcely less remarkable on nearly all the other topics of our art. "Whence comes all this? Not from exact observation, which assimilates our minds to one consenting usefulness :— but from fiction;—which individualizes each of us to our own solitary conceit, or herds us into sects, for idle or mischievous contention Avith each other ;—which leads to continual impo- sition on the public, inasmuch as fictions, for a time, always draw more listeners than truth;—which so generally gives to the mediocrity of men, and sometimes even to the palpably weak, a leading influence in our profession;—and which helps the impostures of the advertising quack, who being an una- voidable product of the pretending theories of the schools, may be called—a physician with the requisite amount of fic- tions, but without—respectability.*" " * The sketch of the medical history of the cholera given above, in illus- tration of the fictional and distrusted condition of our art, is true in most points, of the professional transactions in Philadelphia, during the epidemic of 1832. And I presume it happened elsewhere as here, that the sanatory affairs were conducted by a chosen assemblage of the highest municipal authorities, and the first intelligence, learning, and skill of the faculty. "lam thus reluctantly obliged to refer to these high official facts and exam- ples, in order to show, a fortiori, what the entire condition of our art must be. And I shall greatly regret if my argument should be otherwise regarded; since for many of the individuals who fell into the error and confusion of that period, I have much personal respect and esteem. If a distinction can be drawn, their faults were less their own than those of the system of medi- cine they follow;—a system of distracting words and notions, which, even with the warning recollections of the last epidemic, would not serve them better in a thousand to come. " Other places may answer for the part they took in the fright and fatality of the cholera; but I am inclined to believe that the then special empiricism of Philadelphia, as well as a general depreciation in the character of its medical emulation and success, that we all see and must suffer under, is ascribable, in part, to the manner in which our profession has, in this city, for more than twenty:years past, been governed. The leading medical insti- tution of Philadelphia, which by its lucrative professorships, must hold out rich temptation to the scrambling of interest and* the intrigues of ambition, and which, by the policies incident to such a state of things, is enabled to give the tone of intellect and morals to the mass of the profession, has, for a quarter of a century, been directed by a self-electing Board, com- posed principally of members of the bar, with an utter exclusion of phy- sicians. " Accident sometimes steps into folly,—folly into habit,—habit into the feelin0, of natural right. And so it is, that the trustees o four medical school 16S CHRONO-THERMAL have really brought themselves to an advocate's conviction, that physicians are not the best judges of the higher qualities of teachers in their own art; and by long acting under this conviction, it is not beyond possibility that they may at last bring about that degraded condition of the Faculty, which their contemptuous rule over it now presupposes. It often happens that the most striking instances of the ridiculous are the result of unsuccessful at- tempts at the sublime. And certainly the grave sittings and counsels of a body of eighteen lawyers, four divines, and two manufacturers, upon the affairs of medicine, without even one physician, merely to help them in technical pronunciation, must now and then turn a broad laugh into the sleeve of some among them who have not, by the gradual thievery of cus- tom, lost all perception of this monstrous incongruity between their ability and the duties of their office. " Ignorance in office is an awkward thing,—a dangerous thing,—and a slavish thing:—for it aims to act what it cannot conceive;—it must fre- quently act wrong;—and knowing nothing of its duty, it may become the tool of Cunning, who always knows his. And thus, in a presumptuous at- tempt to administer the affairs of medicine by incompetent agents, the ruling counsel may be some self-interested contribution, with the twofold conse- quence of a back-stair government.----The misleading counsellors escape responsibility, and the unconscious agents remain incorrigible. "If I here speak unacceptably, it is with a right to speak on this subject. For though a quiet but contented devotion to labours, of future efficacy, as I hope, in my profession, has placed me beyond the desire for its official honours, I am, through the exercise of daily duties as a practitioner, still within the influence of its common rights and its wrongs. And the total ex- clusion of physicians from even a part in the direction of their own schools of medicine, is a flagrant and preposterous act of usurpation, which might call for the light of further inquiry, if the glaring sense itself of the ques- tion, now it is broached, should not sufficiently illuminate it. " Unfortunately for the precision and progress of medicine, it is a popular art. Colleges and such institutions can be no otherwise useful to it than by exerting their senatorial influence, if I may so call it, in behalf of those who, being by originality and independence capable of effecting its reforma- tion and advancement, are yet obnoxious to that popular favour which gives success to the mere politic and whim-watching practitioner. "But if the patronage of chartered institutions is to be entrapped by the vulgar baits of ambition:—if any thing in a First-of-April suit is likely to be caught up by mistake for the succinct enrobing of science:—if professor- First—Second—and Third is to be chosen respectively from the North, the South, and the West, merely to secure, like political weight, the profitable pupilage of districts:—if professors are to be allured into the service for the purpose, if I may use the poacher's phrase, of crippling a rival institu- tion :—if one is to be chosen because he votes the right side in politics ;— another because he has the support of a religious sect;—a third to prevent the desertion of an indispensable myrmidon;—and last, but not least,—a fourth, because his cousin's wife is the favourite niece of an influential man- ager. If all this should be done, it may indeed be no more than the worldly way and means of so many other undertakings that evade their promises implied, and slip their obligatory duty. But such medical patronage can do no more than entrench beyond all means of dislodgment, except ultimate self-destruction, the mercenary interests and manoeuvring policies of the every-day ambition and ability of our art. "I may be wrong in the event, yet I am willing to make myself responsi- ble to time by the following conditional prophecy. PRACTICE OF MEDICINE. 169 " There are now some eight or ten medical schools in the United States ; severally varying in their annual classes from thirty to three hundred and fifty. Without valuing here the youthful pupils' admiration of the unparal- leled talents of their respective masters; and apart from that especial slang of 4he day about 'splendid genius,' and 'gigantic minds;' it seems, from the dead level of scholastic medicine, that the intellectual character, with regard to scientific originality and to the accomplishments of learning, is about the same in all: the fancy and the fact of each being compiled from the same common materials of the art. Thus there may be very distin- guished teachers of medicine in Boston: yet I believe it must be allowed that there are quite as good in the four schools of Philadelphia. Indeed, the disinterested and intelligent admit the like equality among the whole. And so, I venture to predict, they will remain, whilst that mode of special policy and general supervision, which has made them equal, shall continue. "But the first of those ten schools, which by design or accident shall em- ploy professors, and a better taste will breed such, whose powers of obser- vation can penetrate to the unrecorded phenomena, and compass the broad relationships of science;—who can find so much newness in nature, that they need not ape originality by perpetual vacillations in opinion ;—who have not served so long at the table of the times, that they cannot relish and dare not offer unsavoury truth;—who can hold their steadfast—No, for a public benefit, when that public would set them in golden honour for say- ing—Yes, to is injury;—who have grown into respect with the wise, by steady reliance on themselves; and who are not, when summoned to the all- requiring labours of fame, already half eaten up in character, by cancerous schemes for reputation. I say, the first school that shall have the cunning forecast so to endow itself, though it may be at present the very dog-tail of them all, will soon be raised on high, as the cynosure of American medi- cine. And like Aaron's serpent, as an emblem of our art, shall swallow up the serpents of those popular magicians who, in emulation, shall continue to play their theoretic slights of instruction on the world. "There never has been a school distinguished for strength or brilliancy of fame, without one or more professors of this character, and there cannot be. The multitudinous and lower house of the world, which yet contains 'many mansions' of rank and learning, will never advance such men to medical stations. But if there is yet a senate in science, and if it has not in truckling policy, gone down to a joint sitting with the popular branch,— that senate should." During the cholera I attended 162 cases, and cured 14S; my treatment was peculiar, and of course chrono-thermal. After a long intercourse with the world, and a rigid ex- amination of what, in his day, was called its wisdom, the great Lord Bacon, musing doubtless over his own philosophical dis- coveries, thus Avrites :—" It is a view of delight to stand or walk upon the shore-side, and to see a ship tossed with tem- pest upon the sea, or to be in a fortified town, and to see two 170 CHRONO-THERMAL battles join upon a plain ; but it is a pleasure incomparable, for the mind of man to be settled, landed, and fortified in the certainty of truth; and from thence to descry and behold the errors, perturbations, labours, and wanderings up and down of other men." But, however exciting this kind of pleasure be to him, Avho should be content with merely making a dis- covery to himself—the making of it public has its drawbacks; for "whoever," in the words of Johnson, "considers the revolutions and various questions of greater or less impor- tance, upon Avhich wit and reason have exercised their power, must lament the unsuccessfulness of inquiry, and the slow advances of truth, when he reflects that great part of the labour of every writer is only the destruction of those that went before him. The first care of the builder Of a new sys- tem, is to demolish the fabrics that are standing." But how can you brush away the cobwebs of ages from the windows of truth, without rousing the reptiles and insects that so long rejoiced in the darkness and secrecy these cobwebs afforded —the bats and spiders, to whom daylight is death ! Truth, like a torch, does two things; for not only does it open up to mankind a path to escape from the thorns and briers which surround them ; but breaking upon a long night of ignorance, it betrays to the eyes of the newly awakened sleeper, the bandits and brigands who have been taking advantage of its darkness to rob and plunder him. What has truth to expect from these ?—What, but to be Avhispered away by the breath of calumny, to be scouted by knaves and fools, whom inter- est or intercourse has leagued with the public robber as his partisans. Who Avill talk to me of conciliation ? Who will tell me that mild and moderate measures ever bought over such implacable enemies to the ranks of their destroyer; or that robbers rioting in the spoils of their victim, will listen to the voice of the charmer, charm he ever so wisely ? Surely people must be out of their senses, who imagine that any ex- position of truth will be acceptable to men whose emoluments are chiefly derived from a course of studied and systematic mystification—professors who lure the student by every pos- sible promise to their schools, and, Avhen once in their net, keep him there by every possible artifice and pretext which collusion and corruption can devise ! one day entangling him m a web of unmeaning sophistry—another, stimulating him to waste his time and labour in splitting straws, or in magni- fying hairs—now encouraging him in a butterfly chase after shadows—now engaging him in a wordy and worthless dis- PRACTICE OF MEDICINE. 171 putation with his fellows ! I appeal, if this is not the mode in which, in most cases, from four to six years of the best part of a man's existence are passed in our medical schools— passed in the fruitless endeavour to know a profession, upon the exercise of which, he is too often compelled to enter Avith no other pretensions to a knowledge of its principles than the trumpery certificates and diplomas for Avhich he has been duped and deluded. How is that student to be repaid the capital of time and money he has expended upon what he calls his education ? How, but by deluding and mystifying in his turn the suffering sick who apply to him for relief. For relief?—Vain hope ! Look at the numbers of persons who live, or try to live by physic,—doctors, surgeons, apothecaries, druggists, cuppers, nurses—and ask yourselves how even one tithe of these can do so, but by alternately playing upon the passions and prejudices,—the hopes, fears, and ignorance of the public?—in one case inflicting visits too numerous to be necessary ; in another, employing draughts, mixtures, or mea- sures, too expensive, too frequently and too fruitlessly repeat- ed, to be all for the benefit of the patient! Think you, that the members of the medical profession are different in their feelings from every other human being—that their minds are so constituted, that under, the most terrible temptations, they can so far set at defiance the stern law of necessity, as in their present crowded and starving state, receive with open arms a system that threatens so many of their order Avith ruin ? Is it in the nature of things that they will welcome a practical improvement, by which the practitioner may, in a feAV hours, cut short cases and chances, which, by daily visitations, or by three draughts a-day, might be profitably protracted to a month, if the system on which it is based were only advo- cated in calm, mellifluous and complimentary language ? As ,soon may you expect a needy attorney to be prevailed up- on by his client's tears to cut short a chancery suit; or the master of a sailing-smack to listen patiently to the praises of steam; or a coach-proprietor to admit the safety and supe- riority of railroad over coach conveyance, when estimating each the losses they shall respectively sustain by the too gen- eral use of the superior motive power. What, though the present condition of medical practice be less the crime of the profession, than the fault of the legislature, that permits men clothed with collegiate authority,—professors enjoying the sanction of its protection,—annually to lure by misrepresen- tation and lying promises, thousands of credulous and unsus- 172 CHRONO-THERMAL pecting youths into a path strewed, even in the very best of times, with thorns and briers innumerable ? Better far that one half of these should at once abandon a Avalk of life where the competition is so keen and close, that comparative- ly few in the present day can live honestly by means of it,— than, that they should hereafter have to eat their precarious bread, at the daily and hourly sacrifice of their own honour, and their patients' interests. Who will tell me half-measures can be of any avail, under circumstances like these ? In cor- rupt and difficult times, half-measures, so far from succeed- ing, have either been taken as a sign of Aveakness in the cause, or as a symptom of timidity on the part of the advo- cate. Away then, with half-measures!—away with the idea of conciliating men^ the already rotten tree of whose suste- nance you sap—the long-cemented system, whose existence depends, not on a virtuous adherence to nature and truth, but upon a collusive and fraudulent perversion of both! When persons little versant Avith the present state of medical affairs, see men of established name supporting a system of dishonesty and error, they too often doubt the light of their own reason. " Would Dr. So-and-So," they ask, " and Mr. Such-a-One, hold this language, if they did not themselves believe it—men so respectable, and so amiable in private life?" —But tell these simpletons, that Dr. So-and-So's bread de- pends upon his belief—that Mr. Such-a-One's family would wither with his fading fortunes, if the father, in the language of Hazlitt, " ceased to support that Avhich he had so long sup- ported, and which supported him"—and you bring an argu- ment which, though not quite convincing in itself, will at least compel a closer investigation of the system it is your Avish to expose and crush.—I have been blamed for the tone and spirit in which I have spoken of adversaries—I have been asked why assail their motives—why not keep yourself to their errors ? But in this particular instance, I have been only the humble imitator of a great master—a man whose name will at once call up every sentiment of veneration—the indomitable Luther. Magnis componere parva, I have fol- lowed in his wake—I hope soon to add passibus sequis. Think you, the Reformation of the Church could have pro- gressed with the same rapidity, had its most forward cham- pion been honey-mouthed—had his lip been all smiles, and his language all politeness—or had he been content, in pointless and unimpassioned periods, to direct attention solely to the doctrinal errors of Rome ? No—he thundered, he de- PRACTICE OF MEDICINE. 173 nounced, he heaped invective upon invective, and dealt in every form of language which could tell best against his enemies, Avhether in exposure or attack. Too wise to leave them the moral influence of a presumed integrity, which they were far from meriting, he courageously tore away the cloak of sanctity and sincerity, with Avhich, in the eyes of the vul- gar, they had been too long invested. Had he done other- Avise, he might have obtained the posthumous praise of mod- eration, at the price of defeat and the stake. Let it not for a moment be supposed, that in thus sweep- ingly arraigning the present system of medical polity, I can have the remotest wish to degrade the profession of the phy- sician. On the contrary, it has been my endeavour through- out to improve his morale, and to elevate his condition,—to render him a useful, honourable, and honoured person,—to make him what neither the mere lawyer, nor the mere churchman can possibly be—a student of nature, and an in- tellectual expounder of his Maker's works;—one from whose ranks kings may still, as they once did, choose their counsel- lors. And how can this be done but by rescuing the art of medicine from the hands of the miserable creatures who at this moment principally usurp its practice ? Nor do I for an instant Avish to insinuate that among the individual members of the profession there are not numerous exceptions to the line of conduct pursued by these creatures. In every one of its grades and conditions,—apothecary, surgeon, and phy- sician,—I have had the pleasure to meet practitioners who not only heartily join me in deploring the present shameful state of practice, but Avho aid me Avith their best efforts to expose and correct it. One and all of these honourable per- sons acknowledge that unless some great and speedy change in the mode of educating and remunerating medical men be introduced by the legislature, Medicine must shortly cease to be regarded in the light of a liberal profession ; for as things now stand, the only sure path to lucrative popularity in phy- sic, is a complete sacrifice of conscience and principle on the part of the physician. How often have I been told, in my own case, that by courting the apothecary, and offering up incense at the false shrine of the professors, I might easily and cheaply obtain the bubble reputation, to be blown me by their breath;—while, by exposing the intrigues of the schools, and the collusions and corruptions of the professional Avorld, not only do I stand as one man to a host, but I lay myself 174 CHRONO-THERMAL open to the secret stabs of a thousand unseen assassins. To tempters of that sort this has been my answer—let it be yours also— " Slave! I have put my life upon a cast, And I will stand the hazard of the die." That hazard now, thank heaven, is small—for the daily increasing number of upright and honourable practitioners Avho espouse my views, place me already sufficiently far above the reach of my enemies, to enable me to despise them thoroughly; and at this moment I feel as secure of victory as at one period of my life I feared defeat! As yet I have only assailed the system, carefully avoiding individual attack. True, I have repelled the attacks of others, somewhat strongly too; but that was in self-defence. If, in tearing away the veil of iniquity, I have not altogether remained unscathed, I have, at least, the satisfaction to knoAV, that my enemies have done every thing but laugh at the blows I dealt them. If it be said I have used language too strong for the occasion, I answer in the words of Burke: " When ignorance and cor- ruption have usurped the professor's chair, and placed them- selves in the seats of science and virtue, it is high time to speak out. We know that the doctrines of folly are of great use to the professors of vice. We know that it is one of the signs of a corrupt and degenerate age, and one of the means of insuring its further corruption and degeneracy, to give lenient epithets to corruptions and crimes." What reformer has not been called a " violent person ?"—none that I ever heard of. Now to the more orthodox part of this matter. We have hitherto spoken of the brain as a unity—yet this organ is divided into two hemispheres. Like the features of the face, it is twofold. We have two eyebroAvs, two eyes, two nostrils, two ears, and, in the early foetal state, the mouth and chin are separated in the middle—you have the marks of this original separation in the infant,—I may almost say in the adult. Now, though a man may lose one eye, he is not there- fore blind; or, though he lose the hearing of one ear, he is not necessarily deaf. It is just possible that a small part of one of the hemispheres of the brain may in like manner be- come diseased, and the subject of it shall appear to reason very fairly to the last. But that must be a shalloAv observer indeed, who from such a possible fact should draw the ficti- tious inference that even one hemisphere of the brain may be PRACTICE OF MEDICINE. 175 disorganized throughout its entire substance, Avithout the in- tellectual powers being at all disturbed ! If you read of such facts, set them doAvn as false facts. The brain, then, like the body, in some of its parts is double, yet, like the body in its integrity, the brain is a unity, and like the same body, it also has a diversity of parts. That the scalpel has hitherto failed to trace any well-marked divisions betwixt the various cere- bral portions to which phrenologists have ascribed variety of function, is no argument against this doctrine. Do not all the different parts of the frame merge into each other—the elboAV into the arm—the arm into the hand, &c. ? What is more clearly a unity than the hand ?—Yet do we not frequently find, from a weakness of one or more of its joints or mus- cles, an inability on the part of its possessor to do a particu- lar work, though he may still accomplish many others by means of it. It is the same thing with the head. Partial dis- ease of the brain produces partial intellectual injury, and you see the effects of such injury in those persons Avho reason rightly upon every subject but one,—monomaniacs as they are called. Oh ! I want no better proof of diversity of parts in the brain than this. Like every other organ, the brain of man commences its fcetal existence in the lowest type of the same organ of those animals that possess a brain—gradually assuming, by additions and superadditions, the form of the infant brain. In some instances, as in the case of other or- gans of the body, one or more of the superadditions are never properly developed. The result can be anticipated. Idiocy, according to the degree of the defect; and yet there are medi- cal twaddlers who say the brain is not the organ of intellect! This much I have thought it right to premise before entering upon the subject of Dyspepsia, or Indigestion ; for to the state of the brain and nervous system we shall have to ascribe the disease. When treating of pulmonary con- sumption, I explained to you that no individual could possi- bly suffer from any complaint whatever, Avithout his digestion being more or less implicated. The patient who labours un- der any severe form of disease, such as gout, consumption, or erysipelas, has all the symptoms, or shades of symptom, that medical men group together under the head of indigestion ; but the gravity, prominence, or locality of the superadded symptoms, which may dispose the physician to term the dis- 176 CHRONO-THERMAL ease consumption, erysipelas, or gout, may also dispose him to overlook, or esteem as insignificant, the coincident errors and disorders of the digestive apparatus. In the lower and more subdued forms of fever, the patient very often has no particular tendency to decomposition in any organ or locality, but from every function being more or; less wrong, he very naturally turns his attention to his stomach or bowels, the errors of which come more particularly under the immediate cognizance of his feelings. Such a patient Avill complain to you of flatulence and acidity, or of that distressing symptom termed " water-brash." If you ask him about his appetite, he will tell you it is " so-so," or " he cares nothing about eat- ing," or it is positively "excellent"—Avhich last, I need scarcely tell you, means that it is morbidly craving. Ten to one it is capricious,—the patient now wishing for this, and now for the other, and rejecting Avhat he desired most the moment it comes before him. Perhaps he has thirst. He is Avearied upon the least exertion, has little inclination to get up in the morning, and when he does get up he is indolent, and dawdles his time away. He is apathetic in mind as he is in- dolent in body; and he has often a great disposition to sleep, especially after meals. Others again will just be quite the reverse of all this; these perpetually harp upon some parti- cular topic—fidget themselves and every body else about tri- fles, and look always at the dark side of life. Some fly in a passion for nothing, or upon the least contradiction, and in a few minutes after the gust of passion has passed away, they lament their mental weakness. Their nights are either sleep- less or broken and disturbed by unpleasant dreams. One mo- ment, they dream of robbers, from whom they cannot eseape; or they are on the eve of tumbling down a precipice ; dream- ing sometimes Avithin a dream—asking themselves, even in the very act of dreaming, Avhether they dream or not—and they will satisfy themselves by a process of unreason, that they are actually awake and walk the air. Even during the day many of these patients have their dreams or reveries—pleasurable sometimes, but more often the reverse;—they see things either as if " through a glass darkly"—or their perceptions are all exaggerated and unna- tural. Phantoms may even pass before them at mid-day, phantoms such as they see in their dreams of the night. The very colours of things may be altered to their eyes—red ap- • pearing to them green, and vice versa. Even the shapes and ' PRACTICE OF MEDICINE. 177 dimensions of bodies may be quite changed to their sight— though the greater number have sufficient judgment remain- ing, to know this to be an optical delusion merely. ' John Hunter had the sensation that his own body was reduced to the size of a pigmy!—I have met with some patients who have even at times doubted their oAvn existence.—Light and shade have wonderful effects upon most invalids of this class. One is perfectly miserable, except when he is in the sunshine —another cannot bear the light at all. Ringing in the ears, or partial deafness is a complaint of dyspeptic persons. Some can only hear distinctly during the noise of passing carriages, or in the hum of a city, or of falling waters; while others hear so acutely, that they complain of the ticking of the clock. The sense of touch is very often similarly vitiated; one pa- tient having partial or general numbness,—another so sensi- tive that he shrinks with pain if you merely touch him. Oc- casionally, though more rarely, you have examples of a reverse kind ; the patient in that case will say—" Oh, do not take your hand away, the pressure does me good—it acts like magnetism." All kinds of aches are complained of by dyspeptic patients —headache perhaps more frequently,—headache, for which, on the hypothetical assumption of fulness of blood in the brain, the leech, lancet, and cupping-glass are so frequently in requisition. But to what end ? In the words of Aber- nethy, supposing such assumption to be correct—"Does blood-letting cure diseases in which there is fulness of blood in the head ? It must be granted, that in many instances, it temporarily alleviates them, but in others, it fails to relieve, and even aggravates them."—What are those headaches, those night and day dreams, all those various signs and sen- sations, but the effects of a great instability of brain, now brought on by one thing, now by another? I have known the most severe and distressing headaches arise from loss of blood, and I have known them originate in a long fast Sure- ly for such diseases, the leech and the lancet are not the pro- per remedies. But, there are many other ways by which the brain may be weakened. You may as certainly exhaust it bv prolonged literary or mental labour, as by starvation or loss of blood; for there are times to think and times to cease thinkine; and if the brain be eternally harassed by an over anxiety in any of the pursuits of life ; if it be always at work on one subject, not only will there be headache, or confusion of head, but the constitution must be injured. How can this 178 CHRONO-THERMAL organ painfully revolve again and again the occurrences of the exlennal Avorld, and give the proper attention to the inter- nal economy, over which it presides ? When you listen to an orator Avhose discourse powerfully affects you, the brain becomes so engaged, that it cannot at the same time attend to the breathing—and you are compelled ever and anon to draAV a long breath—you must take a deep sigh, to make up for the ordinary succession of short inspirations and expira- tions, which constitute the natural art of breathing. Now, if the function of the lungs be so easily disturbed in this Avay, can you doubt that the heart, stomach, bowels, and other parts, may be similarly influenced ? What are the complaints of men Avho have much on their minds, of bankers, mer- chants, and great lawyers ?—what the diseases of aged per- sons—persons whose brains become weaker and weaker by the slow but certain operation of time?—Do not these pa- tients constantly complain of their stomachs and bowels? Do not many of them suffer from palpitations of the heart,— from giddiness and sensations like fainting, with a fear of falling? Now, this giddy sensation, this disposition to fall, is most commonly felt upon suddenly raising the head, or. in rising from a chair. What surer sign of cerebral Aveakness? Yet, not long since, two gentlemen, each upwards of seventy, informed me, they had been bled and leeched.by their respec- tive apothecaries for this disease of pure cerebral exhaustion. Bless my life, you may bleed or purge a healthy man into this state any day! In these diseases, one patient will tell you he is troubled by a feeling of sinking and pain of stomach, which is only relieved by eating. Another suffers from spasm, and pain of the heart or stomach, with acidity or flatulence, the moment he begins to eat; and in either of these cases the pain may sometimes become so violent, that if it did not soon go off, the patient must die. Now, this kind of spasm Avhether affecting the stomach or heart, is a disease, for which you are expected to give immediate relief, and nothing will do so more readily than a glass of hot water—water as hot as the patient can possibly drink it. This point of practice we owe to John Hunter, who having frequently suffered from spasm of the stomach, tried every thing he could think of, and among others hot Avater. The ease Avhich this gave him, led him to extend its use to his dyspeptic patients; and my own expe- rience of its virtues, enables me to bear him out in the enco- miums he has passed upon it. To this simple means, palpi- PRACTICE OF MEDICINE. 179 tations, spasms, headaches, Avind and acidity will all some- times yield as to a charm. Is not this another instance in proof, how mere change of temperature acts on the body under disease ? Now, as hydrocyanic acid frequently gives the same immediate relief in every one of these affections, we at once see that its medicinal power must depend upon the change of temperature which it electrically produces. Of the various cordials to Avhich you may have recourse for spasmodic pain of the heart or stomach, there is none so good as noyeau, and the virtue of this "strong water" depends very much upon the prussic acid it contains. Of all the re- medies with Avhich I am acquainted, there is none equal to this acid, in convulsions and spasms of every kind. But spasms of the stomach and heart are not the only ones of which dyspeptic patients complain. Some are troubled with a sense of tension of the brain—others with a tightness of the throat or chest, and some, particularly females, suffer from a spasmodic affection of the gullet, which gives them a feeling as if they had a ball there. Others are subject to stitch, or pain in the side, produced by cramp of the muscles of the ribs. How correctly Shakspeare described the nature of these pains Avhen he made Prospero say to Caliban in the Tempest, " For this be sure, to-night thou shalt have cramps, Side- stitches, that shall pen thy breath up! The common practice in these cases is to say, " draw your breath," and if you cannot do so for pain, " inflammation" is the imaginary goblin of the doctor, and blood-letting in some of its forms the too ready remedy (?) to which he flies;—how vainly for the patient—how profitably for himself, truth must one day tell! To small doses of nitrate of silver, prus- sic acid, or quinine, such pains will often yield, after having resisted every form of depletion with all the usual routine of blisters, black draught and blue pill to the bargain. The great error of both patient and practitioner, in dyspeptic cases, is to seize upon some of the most prominent features as the cause of all the others. In one instance they will blame the wind__in another acid. But as it happens, these, instead of being causes, are only the common and coincident effects of great cerebral Aveakness, and not the product, as many ima- gine, of fermentation of the food—they are morbid secretions from the lining membrane of the alimentary canal. And of this you may be assured, not only by the mode of their pro* 180 CHRONO-THERMAL duction but by the manner of their cure, when that happens to be accomplished. Just watch a dyspeptic patient when he receives a sudden or unexpected visit; his " heart-burn,' as he calls his acidity, comes on in a moment, and his boAvels commence tumbling and tossing about, and will often guggle so audibly as to make even the bystanders feel sorry for him, —showing you clearly that this acidity, as well as the gases so suddenly extricated, are the effects of a weakened nervous system,—that they are, in a word, the common effects of wrong secretion. Now the term secretion is so constantly associated in the mind of the student with the notion of a liquid, that some of you may not all at once comprehend how gas can be secreted; but, is not every tissue of the body the result of secretion ?—are not the hair and the nails as certainly secreted as the saliva, or bile ? Only place your naked arm for a few minutes under water, and you will find bubbles of air constantly forming upon it—such air being in that case actually secreted before your eyes by the glandular apparatus of the skin ! Can you be at any difficulty now, to concieve how flatus is a secretion from the alimentary canal ? If a doubt remain, you have only to debilitate the brain of an animal by bleeding him slowly, and his bowels will become full of flatus, even to bursting. Then again, as regards the cure of dyspeptic patients, a drop or two of prussic acid, twice or thrice a-day for a week, or a short course or treatment by quinine, nitrate of silver, or alternations and combinations of these medicines, will often do away for months and even years, with every symptom of wind and acidity—while cor- dials, alkalis, and mild laxatives, seldom do more than give a temporary relief. Oh ! I never saw much good done by that placebo mode of practice—nor is this at all to be wondered at, if you reflect, that every part of the constitution of a dys- peptic patient is more or less disordered. In every case of this kind there is an unnatural temperature of body; some patients complaining to you of chills or heats or alternations of both in the back, stomach, hands, and feet, &c. In these cases the skin,partially or generally, is either more moist than in health, or it is harsh and dry,—perspiring, if at all; with difficulty. In the latter case some other secretion may be morbidly active. The urine or the bile may be in excess; or the natural fatty or watery deposit of the great cavities of the chest and abdomen, may be in superabundance. The looker- on may even have a false impression of the patient's case and condition from the increase of either in the minute cells of PRACTICE OF MEDICINE. 181 the investing membrane of all the cellular substance. Should such a patient complain of being ill, he is sure to be laughed at for his pains—for nobody has any sympathy with him— and this is one of the many cases in the world," where appear- ances are deceitful." The dyspeptic patient is either torpid, and with difficulty roused to exertion, whether corporeal or mental, or he is acted upon by every thing he hears. The last person that speaks to him is the man for him. His spirits are depressed by the merest trifle, and raised again by a straAv or a feather. Then as regards his actions or his promises, you can scarcely de- pend upon any thing he tells you. What he is dying to do to-day, he is miserable till he can again undo to-morrow;—he spends his life betwixt acting and regretting;—hesitating, hoping and fearing by turns—one moment all confidence, the next all suspicion. Now, is not this one of the strongest of the many striking proofs how much our mental workings are the effects of our material state—the result of our brain's con- dition, and its atomic relations and revolutions ? It is in per- fect accordance with what we observe in all our corporeal motions. If the muscles be tremulous, can you Avonder that the mind should be vacillating and capricious ?—or when these are cramped and spasmodic, why should you be aston- ished to find a corresponding wrong-headedness, and perti- nacious and persevering adherence to a wrong opinion?— mens sana in copore sano. You may argue for hours to no purpose whatever,with some patients;—for how can you expect the wrong brains of wrong bodies to reason rightly? These persons are like the inebriated, who see two candles when there is only one—their perceptions being false, so also must be their mode of reasoning. The plunge bath, or a short course of chrono-thermal treatment will make them alter their minds sooner than the most powerful and persua- sive arguments of a Cicero or Demosthenes. Lady Mary Montague held the notion that the whole world hated more or less to be told the truth. She formed her opinion, doubtless, from observing how badly the public had for the most part, treated its benefactors. From what I have seen of mankind myself, I cannot help thinking of the ass that kicked the good-natured man, when trying to relieve it from the Aveight of its panniers ! NeVef yet did I attempt to open the eyes of a person imposed upon, but he Avas sure to abuse me. The poet was therefore right when he said, 16 182 CHRONO-THERMAL " The pleasure surely is as great, Of being cheated, as to cheat." In all my experience, the more unscrupulous and unprin- cipled the impostor has been, the more certainly he has ap- peared to fascinate his dupes. All he had to do Avas to hold out an impossibility to them, and they were sure to dance at- tendance at his door for months. Taking advantage of a popular but puerile prejudice against mineral medicine, the medical charlatan is very careful to prefix the word vegeta- ble to his nostrum ; and this, he tells the public, is safe, in every form, dose, and degree—which being in utter repug- nance to every other thing in nature, is greedily swallowed by the multitude as an indisputable truth! Can weight, measure, heat, cold, motion, rest, be so applied to the human body with impunity ? Can you without injury cover your- selves Avith any weight of clothes, or swalloAv any measure of food ? Or can you retain any part of the body in perpe- tual motion or repose Avithout that part suffering ? No, truly! responds the same dyspeptic, Avho believes that such and such a medicine is safe in every form, dose and degree ! When treating patients of this class, it is better not to tell them Avhat they are taking ; but should they chance to find out that you have been giving them arsenic, prussic acid, or nitrate of sil- ver, you will be sure to be Avorried to death by questions, dictated sometimes by their own timidity, and sometimes by the kind feeling of some " damned good-natured friend," se- cretly set on by some equally damned good-natured apothe- cary. Now, as these patients are for the most part, great sticklers for authority, your only course is to tell- the truth— Avhich, after all, in nine cases out of ten, will make no im- pression—and that is the reason why the quack and the sub- ordinate practitioner who can keep their medicines secret, have an advantage over the honorable physician—an advan- tage so great, that in a few years, if matters do not take a turn, I doubt if one such will be found practising medicine at all. You may say then, what, if it have no effect with pa- tients themselves, will at least appear reasonable to their friends—that the medicines you ordered, are all contained in the pharmacopoeias of the three colleges of Edinburgh, Lon- don, and Dublin, and that they are therefore recognized as medicines of value by all physicians who have a character to make or a name to lose—that the dose in which you give them is perfectly safe, inasmuch as, if it disagree with their PRACTICE OF MEDICINE. 1S3 particular constitutions, it will only cause a short temporary inconvenience; and to sum up all you may quote Shakspeare, who says, and says truly," In poison there is physic." And again; " Oh ! mickle is the powerful grace that lies In herbs, plants, stones, and their true qualities, For nought so vile that on the earth doth live, But to the earth some special good doth give; Nor aught so good but strained from that fair use, Revolts from true birth, stumbling on abuse. Virtue itself turns vice, being misapplied, And vice sometime 's by action dignified. Within the infant rind of this small flower, Poison hath residence, and medicine power!" So that poison and physic—whether vegetable or mineral— are either poison or physic, according as they are wrongly or rightly applied. But to return to dyspepsia, or that low fever, so termed. In cases of this kind, my practice is to combine the chrono- thermal remedies with what you may call, if you please, Symptomatic medicines. For example, where flatulence is the most prominent symptom, I prescribe quinine, hydrocy- anic acid or nitrate of silver, with anniseed or cardamoms. In acidity, either of the two first remedies will often answer very well Avith soda or potash. Where the bowels are slow and torpid, rhubarb, aloes, or both, are very good medicines with which to combine the chrono-thermal medicines. In such cases, purgative effervescing draughts are also useful. Should the patient complain of muscular or other pains, you may add colchicum or guaiac—and so proceed in a similar manner with other symptomatic remedies for other local in- dications; keeping in mind, however, that these sympto- matic medicines are merely a means of secondary importance in the treatment of a great constitutional totality of derange- ment. In addition to these measures, plasters to the back or stomach may be very beneficially resorted to in many cases of dyspepsia, and you may also run the changes upon various kinds of baths. The cold plunge and the shower baths are my favorites, though I need not tell you that the feelings of the patient, after he comes out of it, are abetter guide to you in your choice and continuance of any bath, than all the the- ories of all the doctors that ever Avrote or reasoned upon dis- ease and its treatment. " How do you think me iioav, doc- tor ?" is a question I am asked every day, and every day I give the same answer ; " How do you feel ?" If the patient 184 CHRONO-THERMAL is better, he says so; if worse, he will be sure to tell me he is not so Avell; and according to his answer, do I change or continue his physic. Now, whether this be common sense, or not, I leave you to judge. Heaven only knows it is not science, or what very learned people call science ; for when the patient says he gets worse and worse every day, science generally tells him to continue his medicine, for that he has not taken enough of it, and that he will be worse before he be better—Avhich I need not tell you is a lie—or more polite- ly to speak—a piece of imposture. Should the patient die, why, then, he dies a natural death, and he has had the first advice, for not only did Mr. So-and-so, the fashionable apo- thecary, attend him, but Dr. Such-a-one, the great physician, Avas also called in, and he said all was right, and that nothing better could be done. Had the doctor said all was wrong, he might perhaps have been nearer the mark—but, in that case Avhat apothecary would either call him in again himself, or let him in again Avhen requested, Avhere he could by a lit- tle gentlemanly trickery keep him out ? In my own par- ticular case, the custom of the apothecary has been secretly to play upon the fears of the patient or his friends against " strong medicine," to shrug up his shoulders and smile con- temptuously. " Oh I can tell you something of Mr. Dickson," he has said, " but you must not give up me as the author;" —whereupon he has proceeded to lie Mr. Dickson's life away; and when he had thus to his own seeking, sufficiently poi- soned the ear of his patient, he has turned round in this man- ner to him—" But if you still want a second opinion, why do you not call in Dr. This or Sir Thingumy T'other—they are leading men you know !" Now that only means, that the physicians in question are the fashionable puppets whom he and people like him, call in to conceal their bad work—men, Avho would as soon think of differing with the opinion of their supposed subordinates but real patrons, as of quarrelling with their breakfast because it was purchased with the shilling of a dead man's guinea ! What a just observation Avas that of the author of Lacon. " The rich patient cures the poor physician much more often than the poor physician the rich patient; and it is rather pa- radoxical, that the rapid recovery of the one usually depends upon the procrastinated disorder of the other. Some persons will tell you with an air of the miraculous, that they reco- vered although they were given over, when they might with more reason have said they recovered because they were PRACTICE OF MEDICINE. 185 given over." But in very truth "the great success of quacks in England has been altogether owing to the real quackery of the regular physicians." What does that mean ? Just this, that the morality of many legalized practitioners even of the highest grade, is not one remove above that of the Morisons and St. John Longs, Avhose dishonest practices they are con- stantly decrying ! Now, this you will say is a startling state- ment—and much will doubtless depend upon the character of the person making it, whether you treat it with a laugh of contempt, or listen to it with something like respectful atten- tion. The man Avho deliberately put that on paper, (and I quote him to the letter) was no less a person than Adam Smith—the author of the Wealth of Nations ! If such, then, was the certain and settled conviction of that very keen- sighted observer of mankind, will any assertion, any asseve- ration on the part of individuals interested in declaring the contrary, weigh you one straw against the evidence of your own senses, Avhen you choose to examine this matter fairly and fully for yourselves ? So far as my own experience goes —that is, from what I have seen of the profession in London and the English country towns, eminence in medicine is less a test of talent and integrity than a just reason of suspecting the person who has attained to it, of a complete contempt for both ! I say suspecting—for I have met with exceptions, but not many, to the rule. Could you only see as I have seen, the farce of a medical consultation, I think you would agree with me, that the impersonation of physic, like the picture of Garrick, might be best painted with comedy on one side and tragedy on the other. In saying this much not only have I acted against everything like medical etiquette—but I shall be sure to be roundly abused by the medical profession for it. The truth, however, I maintain it to be—but ndt the whole truth; for the world must have its eyes a little more open be- fore it can believe all that I happen to know upon the sub- ject. By and by I shall tell the people something that will make their ears tingle ! To return to the consideration of disease. You now see that in all the cases of which Ave have been speaking, the constitution is for the most part primarily at fault, and that the names of disorders depend very much upon the greater or less prominence of some particular symptoms,—which symptoms, or their shades, may be readily detected in all dis- eases. With every case of dyspepsia, depression of spirits, 16* 136 CHRONO-THERMAL and more or less mental caprice, with hasty or erroneous no- tions upon one or more points, will be found to be associated. When such depression amounts to despondency, medical men, according to the sex of the patient, change the word dyspep- sia into hysteria. (In short, in all cases of dyspepsia, I have always succeeded by the use of my Tonic Anti-Dyspeptic Vermifuge, and Anti- Dyspeptic Pills, Avhen all the directions accompanying them are fully attended to.) Hypochondria, or Hysteria; and some professors are very particular in their directions how to distinguish the one from the other! What is the meaning of Hysteria ? It is a corruption of the Greek word {.offpj^Hys- tera) the Avomb; and it was a name given by the ancients to the particular symptoms Ave are now considering from a hy- pothetical idea that in such cases the womb was the principal organ at fault. From the same language we also derive Hy- pochondria, a compound word formed of ifto, (Hypo) under, and %ovSpo(, (Chondros) cartilage, from the supposed seat of the disease, being the liver or stomach ; for both of these organs, as you know, are situated under the cartilaginous portions of the lower ribs. So that Avhen a female suffers from low spirits and despondency, with occasional involuntary fits of laugh- ing, crying, sobbing, or shrieking, you must call her state hys- teria ; and when a male is similarly affected, you must say he has the hypochondria. Now it so happens, that medical men sometimes pronounce even their male patients to be hys- terical ! And this brings me in mind of an honest quaker of the profession, Avho being very ill, had three doctors to attend him —Mr. Abernethy, Dr. Blundell, and a physician whose name I now forget. Each of these had his own notion of the disease : Mr. Abernethy of course said, it was all OAving to the " diges- tive organs." Dr.------, being a stethoscope man, main- tained that the " heart" was affected, and Dr. Blundell, in the true spirit of a man midwife, declared that their patient was only " hysterical." Now the patient, though a quaker was a humorist; so he ordered in his will, that when his body Avas opened after his death his digestive organs should be presented to Mr. Abernethy, his heart to Dr________. and to Dr. Blundell his womb, if he could find one ! That the brain is the principal organ implicated in all disorders, which come within, the physician's province, more especially in such as^ PRACTICE OF MEDICINE. 187 are termed Hysteria or Hypochondria, the smallest reflection will convince you. Suppose a person of either sex had been accidentally debilitated by loss of blood—a person who pre- viously was strong in nerve as in muscular fibre; suppose a letter comes with a piece of bad news,—the patient in that case bursts into tears, laughs and cries time about, and then sinks into a state of dismal and gloomy despondency. And all this, forsooth, you must put down to the state of the womb or digestive apparatus, according to the sex of the patient, instead of placing it to the account of the brain and nerves, without which the ill-timed letter, the cause of all, could not, by any possibility, have affected the mind in the least! Ano- ther class of practitioners, scarcely less unreasonable than those to Avhom we have just alluded, will have it, that pa- tients coming under the head of hysteria and hypochondria, are not ill at all.—" Oh! there is nothing the matter with this man ;" they will say, " he is only hipped!" and if a female, " she is only hysterical." Dr. Radcliffe, Avhen he re- fused to come to Queen Anne, declared he would not stir a foot, " for there Avas nothing the mater with her but the Va- pours !" Such was the term by Avhich the doctors of that day characterized the shifting shades of symptom now called Hysteria. Do I require to tell you that no man or woman suffers from melancholy, or indulges in whims and fantasies, without being positively ill. Whoever labours under mental delusion or despondency has alternate chills and heats; and remissions and exacerbations of the more prominent symp- toms characterize the disorder in every form. The late Lord Dudley, in a letter to the Bishop of Landaff, relates his oAvn case, and it is so like Avhat you will daily meet in practice, that 1 shall give it to you in his own Avords :—" It is in vain," he says, " that my reason tells me that the view I take of my situation is exaggerated. Anxiety, regret for the past, appre- hensive uneasiness as to my future life, have seized upon me as their prey. I dread solitude; for society I am unfit; and every error of which I have been guilty in life stands con- stantly before my eyes. I am ashamed of what I feel when I recollect how much prosperity I still enjoy, but it seems as if I had been suddenly transplanted into some horrible region beyond the bounds of reason or of comfort: now and then I enjoy a few hours respite, (the remission ?) but this is ray general condition. It is a dismal contrast; for you will re- member that I was naturally gay and cheerful." Noav, al- 188 CHRONO-THERMAL though Lord Dudley recovered perfectly from this particular attack, his disease, at a later period of his life, returned; but this time he was less fortunate; for the symptoms of his dis- order gradually deepened in their hue, until they amounted to the most complete Insanity— a proof to you that the hypochondriac Avhim and the hyste- ric fancy differ from hallucination and mania in shade merely, and the chills and heats which precede or accompany them, from the cold and hot stages of the most intense fever, in no- thing but degree. Has not the maniac in every form of his delusion, lucid intervals—remissions ? Your schoolmen, your " pathologists," your profound medical reasoners, speak of madness and other diseases, as if they were the effects of some fixed cerebral malformation, instead of being the conse- quences of external influences acting on an atomic instability of brain. They tell you they are curable or not, according to the cause ;—they look in the dead body, for the cause of an intermittent living action, for the origin of hypochondria and mania—diseases which they have even themselves, per- haps, traced to hard study or a passion ! External agencies, then, Avere the real causes, not the structural deviations de- tected within, after death, by the scalpel. Students of medi- cine ! young men, honorably ardent in the pursuit of know- ledge, for the sake of your profession and your future patients, learn to think for yourselves. Pause, examine, Aveigh, before you give a slavish assent to the dicta of your teachers. When these tell you that madness with a lucid interval is an inflam- matory essence, or that it depends upon some cerebral mal- formation or tumour, ask them how they reconcile days or even hours of sanity and sense with a cerebral structure thus partially, but permanently malformed or disorganized ! That medical men, mystified from boyhood by their teachers should fall into such errors, is not so astonishing as that the leaders in our periodical literature should be equally unfortu- nate. What, for example, can be more egregiously absurd, than an observation the reviewer of Lord Dudley's letters in the Quarterly Review has allowed to escape from his pen ' « The gifts of fortune and intellect," says this writer « were counterbalanced by an organic malformation of the 'brain " How can intellectual power even for one moment be compat- ible with a defective cerebral organization ? How can the PRACTICE OF MEDICINE. 189 cause of an intermittent disease be a coporeal entity, or some- thing permanently fixed ? Let no sounding words, no sense- less sophistry, cheat you of a reply to this question. The maniac Avho has lucid intervals is curable in the greater number of instances—the hypochondriac Avho at any time of the night or day enjoys the very briefest immunity from his miserable feelings, may be equally susceptible of improve- ment from well devised remedial means. The modern med- ical treatment of both, being essentially aggravant, can you wonder that these diseases should so often remain unrelieved, or that a sceptic smile should be the reward of the individual who tells you that in his hands at least, they have ceased to be the opprobia of medicine ! What has been the result of the anti-phlogistic treatment of insanity ? Let the physicians who attended Lord Dudley in his last illness, answer that question, for they spared neither lancet nor leech in his case. In the case of Lord Byron, delirium, which is only another word for mania, was actually produced by the lancet. But the better to open your eyes to the effect of such cruel treat- ment in this disease, I will give a short extract from a letter I received from Dr. Hume, the same staff-surgeon whose suc- cessful practice I have already had occasion to detail you.— " I lately," he thus writes, " paid a visit with our depot pay- master to the Armagh lunatic asylum. Being the receptacle for the insane poor, of four counties, namely, Monaghan, Fermanagh, Cavan and Armagh, it generally contains about 150 inmates. Having visited the different apartments I en- quired of the manager, Mr. Jackson, the treatment pursued. His answer was," Although I am not a professional man, I have paid great attention to the treatment of the insane for the last five and twenty years, and the result of my observa- tion is, that the usual practice of bleeding, leeching, cupping, &c, only aggravates the condition of the patients. Of those who Avere bled on admission, I never saw one recover. Now this is a curious fact elicited from a plain practical man of great experience, who, had he known I belonged to the med- ical profession, might not perhaps have been so candid in his remarks." Dr. Conolly, in his Report of the Han well Luna- tic Asylum, is obliged to admit that great numbers die short- ly after their admission into that establishment. The large abstraction of blood which he so lauds in his work on insa- nity, will easily account for the unsuccessful termination of his cases. Well then, Hysteria, Hypochondria, Mania, are merely 190 CHRONO-THERMAL modifications or developments of chronic or habitual low fever. And since I commenced to treat them as such, I have had a practical success and a mental satisfaction, that con- trast somewhat strongly with the poor opinion I entertained of the resources of our art, and the vexation I experienced when first entering upon my professional career. This much you should know, hoAvever, that in all such disorders you will be obliged to change your remedies frequently—for in chronic diseases what will often succeed to admiration one day, may as often have an opposite effect the next; and this is strictly in accordance with what you find in every thing in life. The toy that will stop the cry of the Aveeping child to- day, may make it cry more loudly to-morrow. You must in that case, change its rattle for some other gew-gaw ; and so it is in the diseases we have been now considering—diseases where the temperament of the body, like the temper of the mind, is constantly varying. The great secret of managing chronic diseases, then, consists in the frequent changes and right adjustment of the chrono-thermal and other remedies, to particular cases —and this also explains the good effect of travelling upon many of these patients, for to the con- stant shifting scenes and to the frequent repetition of novel cerebral excitement produced by these scenes, we must as- cribe the chief advantages of such a course ; clearly proving that the brain in this instance, as in every other, is the true key to all good medical treatment. Whajtever then, be the name by which you choose to designate your patient's com- plaint, you will be sure to meet with nothing but disap- pointment, if you pin your Jaith exclusively to any one med- icine. To-day a mild emetic will give relief—temporary only if you do not follow it up to-morrow, with iron, opium, musk, quinine, or the bath. One week arsenic will be a di- vine remedy, the next, having lost its power, you may dis- miss it for prussic acid, valerian, creosote,strychnine, or silver. In regard to silver, the nitrate is the preparation Avhich I am in the habit of using, and an admirable medicine it is, when properly managed. Boerhaave, the greatest physician that ever lived, speaks in raptures of its remedial powers in "ner- vous complaints." Cullen, Pitcairn, every medical man but the most ill-educated apothecary, or the equally ill-educated puppet who enjoys, at the mercy of his breath, the reputation of being par excellence a physician, will bear testimony to its safety and value as a medicine. Like every good thing how- ever, the nitrate of silver has been abused in practice and in PRACTICE OF MEDICINE. 191 some half-dozen instances, it has been pushed to so great an extent as to give the patient a permanent blueness of skin for lite ; but in these cases, the practitioners who employed it committed the double error of giving it too long, and in too great quantities; and that people should entertain a prejudice aP1Iijt ? °n that score> is Just as reasonable as that a man should be afraid to warm himself when cold, because his next-door neighbour had burnt his fingers. For myself, I can truly say, that though I have prescribed the nitrate of silver, in some thousand cases of disease, I never had the misfortune to give the slightest tinge to the skin of a single individual. But should objections to the use of this medicine still continue to be urged, after a proper explanation on your part, you may be pretty sure that some ignorant or interested rival has been secretly playing upon the timidity of your patient or his friends. In that case you are less to be pitied than the pa- tient : for if you have no remedy for rascality, he may have no relief for his suffering. So much then for one of many annoyances every practitioner must experience Avhen his pa- tient happens to be " the tool That knaves do work with, called a fool." But we must not suppose that medicine is the only profession where able and honourable men experience such annoyances. Doctors of divinity and doctors of law are equally obnoxious to intrigue and prejudice,—ay, and State doctors too, as Dr. Peel and Dr. Melbourne could tell if they were asked. To return. The shifting shades of mental distress, and the vari- ous vagaries and wrong thoughts—to say nothing of wrong actions—of persons Avhose diseases come under the head Ave have just been considering, are so many and so multifarious, that to attempt to describe them all Avould be a mere waste of time and labour—inasmuch as however greatly they may appear to differ from each other in shape or hue, they all de- pend upon a similar totality of corporeal infirmity, and yield, when they yield at all, to one and the same system of corpo- real treatment. A feAv instances in proof may suffice to show this:— A married lady consulted me under the following circum- stances:—Every second day, about the same hour, she had an unconquerable wish to kill her children, and Avhen she hap- pened to look at a knife, her terror, lest she should do so, Avas extreme. Noav, as every function of this lady's frame Avas 192 CHRONO-THERMAL more or less wrong, I prescribed for her quinine with sulphu- ric acid. From that day she had no return of the homicidal feeling. A gentleman, every second day, took a fit of suspicion and jealousy of his wife, without the slightest cause whatever, as he confessed to me, on the day of remission, when he called to consult me; and however absurd and unreasonable the idea which haunted him, he found it impossible to drive it from his mind. Prussic acid and the plunge-bath cured him completely. Another gentleman, after a hard contest at his university for prize honours, suddenly became moody and sullen, lost his flesh and appetite, and fancied himself Judas Iscariot. Such was his belief one day—to be laughed at, even by himself, the next! I saw him six times, at the end of which he was perfectly cured by chrono-thermal treatment. Two years afterwards his sister consulted me for " nervousness," when I learned that her brother had not had the slightest symptom of return. Whoever, in his progress through life, takes the trouble to study individual character, must be struck by the perversities, inconsistencies, and other bizarreries of the human mind.— Many people, for example, commit follies, faults, and crimes, even involuntarily, and without any apparent object. Some may possibly remember the case of Moscati, a person singu- larly gifted with talent, but who, at the same time, had such an invincible disposition to lie, that nobody would believe him, even when by accident he spoke the truth. A lady, Avho was once a patient of mine, told me that every time she became pregnant, she caught herself frequently telling lies, for no end or purpose whatever. I knew a gentleman, with high feelings of honour, who Avas occasionally in the habit, when under the influence of wine, of pocketing the silver forks and spoons within his reach; you can easily imagine his distress of mind the next day, Avhen he packed up the ar- ticles to return them to their owners. From these cases may be seen how much the morale of every one must depend upon his physique; for if I know any thing in the Avorld, I know that attention to corporeal temperature will be found of more avail in mending the morals of some individuals than a well-written homily. How many pretty things have been said for and against the morality of suicide! I wish it were always in a person's power to abstain from it. But that the disposition to commit PRACTICE OF MEDICINE. 193 it, may, like many other bad dispositions, be cured by medi- cine, I could give a great many proofs. I shall, however, content myself with giving part of a letter I some time ago received from Dr. Selwyn, formerly of Ledbury, now of Cheltenham. Speaking of Mr. Samuel Averill, of the Plough Inn, Dynock, Gloucestershire, Dr. Selwyn says:—" Before he came to me, he consulted Mr.------, of Ledbury, and other medical men, to no good purpose, as you can easily under- stand, when I tell you they principally Avent over the old routine of cupping, purging, &c. Mr. Averill's symptoms were depression of spirits to crying—thoughts of suicide, fears of becoming a lunatic, sleepless nights, and, generally speaking, the greatest possible state of mental wretchedness. He passed immense quantities of urine, as pale and pellucid as water from the pump. Finding no particular organ in a worse state than another, I thought this a good case for your doctrines; and accordingly I rang the changes on the nitrate of silver, strychnine, musk, prussic acid, creosote, iron, qui- nine, and opium—varying and combining these according to circumstances with valerian, hartshorn, blue pill, &c. In a fortnight you Avould have been astonished at the improve- ment effected upon him. In about six weeks more he had no complaint, and he was with me about a month ago, when I considered his cure complete. I have treated a great many cases of dyspepsia successfully, by attending to the intermit- tent principle; and I had lately a case of tic douloureux, which, after having been under the successive treatment of several eminent practitioners with no perceptible improve- ment, yielded to the chrono-thermal remedies. The subject of it, Miss T----, was formerly a patient of your own for some other complaint. I still hold that, in chronic diseases, by keeping your principles in view, we have a great help in many of these anomalous cases, which I would defy a nosolo- gist or pathologist to name or classify; and as I am still con- sulted in such cases, I do not, I assure you, lose sight of them. Often, indeed, when I should, under the scholastic system, have been completely puzzled what to do, I now proceed at once to act upon the intermittent principle, and I have every reason to be satisfied with my success." That the numerous diseases Avhich medical men group to- gether under the head of dyspepsia, hysteria, and hypochon- dria, are caused by circumstances from without, acting upon an a'tomic instability of brain Avithin, might be proved by an affinity of facts. But this instability may be produced, or 17 194 CHRONO-THERMAL rather put in action, by different influences in different indi- viduals—one patient being only susceptible to one agent, while another may be acted upon literally by every wind that blows. General O'Hara, when he commanded the troops on the Mediterranean, Avas so sensible of the Levant wind, that be- fore he rose in the morning, he knew if it had set in by the effect it had on his temper; and during its continuance, he suffered from a moroseness and irritability no effort on his part could conquer; by his own desire his servants kept out of his way on these occasions. The different effects of the Avinds on the human system Shakspeare Avell knew when he made Hamlet say «------I am only mad north, north-west, When the wind is southerly I know a hawk from a handsaw." In confirmation of Shakspeare's truthfulness to nature in this, as in most of his other observations Sir W. Parish, in his pub- lication upon Buenos Ayres, tells us that " not many years back, a man named Garcia was executed for murder. He was a person of some education, esteemed by those who knew him, and, in general, rather remarkable than otherwise for the civility and amenity of his manners. His countenance was open and handsome, and his disposition frank and generous; but when the north wind set in, he appeared to lose all com- mand of himself, and such Avas his extreme irritability, that during its continuance, he could hardly speak to any one in the street without quarrelling. In a conversation Avith my informant, a few hours before his execution, he admitted that it was the third murder he had been guilty of, besides having been engaged in more than twenty fights with knives, in which he had both given and received many serious Avounds, but he observed that it was the north wind, not he that shed all this blood. When he rose from his bed in the morning, he said, he was at once aware of its accursed influence upon him:—a dull headache first, then a feeling of impatience at everything about him, would cause him to take umbrage, even at the members of his own family, on the most trivial occurrence. If he went abroad, his headache generally be- came worse, a heavy weight seemed to hang over his tem- ples—he saw objects as it were through a cloud, and was hardly conscious where he went.—Such was the account the wretched man gave of himself, and it was corroborated after- wards by his relations, who added that " no sooner had the PRACTICE OF MEDICINE. 195 cause of his excitement passed away, than he would deplore his weakness, and he never rested till he had sought out, and made peace with all Avhom he had hurt or offended." The same difference of effect upon individuals may take place from any of the common articles of diet. Dr. Millingen in his Curiosities of Medical Experience, tells us he knew a person Avho could never indulge in tea Avithout experiencing a disposition to commit suicide, and nothing could arouse him from this state of morbid excitement but the pleasure of de- stroying something—books, papers, or anything Avithin his reach. Under no other circumstance than this influence of tea were these fearful aberrations observed. Coffee affects many people with fever. But if coffee, tea, and other things so ap- parently trifling sometimes set up severe disorder—things equally trifling will sometimes cure it—indeed there is no- thing, perhaps, in the Avhole history of disease more curious than the readiness with which the paroxysm of many com- plaints will occasionally yield to measures so simple and so apparently powerless in themselves, that it might almost seem puerile to suggest their application. Who, for example, could, a priori, suppose it possible to stop a fit of mania with a thread ? or who would be believed, were they to tell a person that had never heard the like before, that aches and agues had been cured with a song ?—Yet in sober truth, such things have been actually done! Effect of Ligatures. Of the power of mere Avords over the morbid motions of the body, Ave shall afterwards have occasion to speak. Of the efficacy of a thread or ribbon in arresting the maniacal paroxysm, I shall now give you a striking example. " Mr. R., a chemist, naturally of a gentle disposition, voluntarily claimed admission to a madhouse in the Faubourg St. An- ionic on account of a desire to commit homicide, Avith which he was tormented. He threw himself at the foot of the altar, and supplicated the Almighty to deliver him from the horri- ble propensity. Of the origin of this disease he could say nothing • but when he felt the accession of the fatal desire, he was in the habit of running to the chief of the establish- ment and requesting him to have his thumbs tied together with a ribbon. However slight the ligature, it sufficed to calm the unhappy R----; though in the end, he made a des- narate attempt upon one of his keepers, and perished, at last, in a paroxysm of fury ."-[Annates d> Hygiene Publique, 196 ■-: chrono-thermal et de Medecine Legale.] Now, every man of any informa- tion in the profession, knows that the application of a ligature to the arm or leg will frequently stop the commencing ague- fit. Dr. Davis, in his account of the Walcheren ague, tells us that he very often arrested it merely by grasping the leg or arm strongly Avith his hand. Putting aside, then all consider- ation of the remitttent nature of the case of homicidal mania I have just related, all consideration of the thermal and other changes which usher in the fit of every maniacal case, you could not fail to find, in the very simple measure which may equally succeed in preventing or arresting the fit of mania and ague a new bond of connection with which to associate ague and mania together in the same category. But these are not the only complaints in which the ligature may be thus advantageously employed. In epilepsy, asthma, and other convulsive affections, I have often obtained the same salutary result by its application. Not very long ago, I happened to be in the room of a medical man, when he Avas unexpectedly seized with severe cramp in the back and loins. Observing him to become pale and shiver all over, I caught him sud- denly by the arm and opposite leg. "My God!" he exclaimed, " I am relieved." And his astonishment was extreme ; for immediately afterwards he became warm and comfortable, though for several days previously he had been suffering from cold feet and general malaise. Mania, epilepsy, asthma, cramp, ague, then, completely establish their fraternal rela- tionship by means of the ligature ; for had we no other facts, no other bond of association than that Avhich the ligature fur- nishes us we should still be led to the irresistible conclusion, that those particular diseases, at least, amid all their apparent diversity, have yet some principle in common which deter- mines their unity. When I come to explain to you the man- ner in which the ligature acts, you will find that the connect- ing link of the whole is the brain. They are all the result of a weak and exhausted state of that organ ; but not produced, as the late Dr. Mackintosh of Edinburgh supposed, by any con- gestion or fulness of its blood-vessels. That was his doctrine of the cause of the ague;—and as he was a very eloquent man, and a very pleasant and gentleman-like person to boot, he made many proselytes to his opinion, not only among his own pupils, who were very numerous, but also among the profession generally. To prove his hypothesis, or dream rather, he was in the habit, first of detailing the " congestion" found on dissection of the heads of persons who had died of PRACTICE OF MEDICINE. 197 the cold stage of ague, and then he appealed to the relief which very often followed the practice of bleeding at the commencement of that stage. " Behold the fact," he Avould say; " behold how the shiverings cease the very moment you open the vein—what can be a more triumphant answer to the opponents of the lancet!" But mark the fallacy of that fact—mark how the too-confident doctor was deceived by his own practice. The relief of which he boasted, for the most part temporary only—instead of being produced by the very trifling quantity of blood which flowed before such relief Avas obtained, was in reality nothing more than the effect of the ligature by which the arm was necessarily bandaged for the operation. The late Dr. Parr tells us, that when called to a patient in the fit of asthma, he was in the habit of tying up the arm as if he intended to bleed, but that though he never did more than scratch the skin with the lancet, the fit was at once arrested. Ague, asthma, epilepsy, nay, every one of the non-contagious diseases to which man is liable, have all been produced by loss of blood. In that case, at least, they must have been diseases of exhaustion, the effects in a Avord of di- minished cerebral power. But Avhen we come to consider that in every instance in which the causes of the diseases noAV under consideration have been known, the brain has been suddenly and primarily affected—as in the case of a blow, a poison, a purge, a passion, we can be at no loss in forming an opinion as to the real nature of these diseases— they are all the effect of cerebral Aveakness, and have all more or less analogy to faint. Faint, in fact, may be the premoni- tory symptom of them all; and the Walcheren ague in par- ticular, generally began with a fainting fit, which faint was sometimes so alarming as to cause the greatest possible anxi- ety in the minds of the attendants for the immediate result. Now, what is the condition of the body you call Faint? Is it not a state very like death ! A person, from his brain all at once ceasing to act, becomes instantly pale and pulse- less ._the blood, having suddenly left the arteries and exter- nal vessels of the body, must go somewhere else. Had Ave never dissected a person who had died of a faint, we should naturally expect it to settle in the internal veins; and there accordingly, when we do dissect the bodies of such persons, we do find the greater part of the blood. Now, this was 17* 19S CHRONO-THERMAL what first misled Dr. Mackintosh. On opening the heads of subjects who had died in the cold fit of ague, he almost in- variably found the veins of the brain gorged with blood. This constant effect of every kind of exhaustion he at once presumed Avas the cause of such exhaustion. He did not know that the very same internal vascular fulness may be seen on opening the bodies of those who die of the loss of blood ! To prove, however, what I say,—to demonstrate to you that this Congestion— this bug-bear of medical quidnuncs—instead of being the invariable cause, is in reality the invariable effect of sudden exhaustion. I shall now read to you one of several experi- ments in which Dr. Seeds bled healthy dogs to death. The editor of the Medical Gazette will pardon me for quoting it from his pages, but as my facts have been sometimes said to be " selected facts," I have at least this answer in store, that in the greater number of instances, they have been selected from the writings of my opponents. " All the larger veins of the legs," Dr. Seeds tells us, " were opened in a small dog. At first, the pulse was accelerated— soon after it became slow and languid. The heart's motions, though feeble, were never irregular ; and, indeed, long before death, they could neither be seen nor felt. Borborygmi [fla- tulent gurglings] were early heard and lasted a long time. The breathing at first was hurried ; soon it became slow and laborious,and at last convulsive. The pupils Avere frequent- ly examined ; they became gradually less and less obedient to the influence of light, and at length ceased to contract al- together. [That is, they became dilated.] Slight spasmodic contractions took place, first in the femoral and abdominal muscles; then the head, neck, and fore-legs, Avere likewise powerfully affected with spasms, [or convulsions.] At this time, a deep sleep seized the animal; he breathed sloAvly and with difficulty, and for a little time before death, respiration at intervals was suspended altogether. [All the symptoms of apoplexy.] Whenever the breathing was strong and quick, the pupils recovered their tone, and the blood was more strongly propelled. In an hour death closed the scene." Noav for the dissection:—"The dissection of the head was first begun. The membranes of the brain were loaded Avith turgid vessels, the larger of which were of a very dark calour. PRACTICE OF MEDICINE. 199 A bright red spot was observed near the cornea, where some degree of sanguineous effusion had taken place. The sinuses were full of blood. In all the ventricles there was more or less water effused; the base of the brain and the eighth and ninth pairs of nerves, Avere inundated with Avater. A net- work of red vessels was spread round their origins, and the optics were in the same state. In the cervical and lumbar regions of the spinal marrow there was a considerable de- gree of redness. The right side of the heart was full of blood ; the left auricle contained a little. Some blood was found in the large veins, and a few clots in the thoracic aorta. The stomach, and all the intestines were tumid with flatus; the veins of the mesentery were turgid. The turgid state of the veins of the head was very remarkable ; indeed, throughout the whole body the veins were tumid." > Now, if anything in this world could open the eyes of •'pathological" professors—if facts or reasoning of any kind could possibly move those mechanical-minded persons, Avho plan their treatment of living men from what they see in dis- secting dead bodies,—this and similar experiments ought surely to do so. For here you not only find dilated pupil, convulsions, deep sleep, slow and difficult breathing, with other apoplectic symptoms, the effect of literally bleeding a healthy animal to death ; but, to complete the deception of such as constantly ascribe these phenomena to pressure on the brain, the cerebral and other veins of the same animal were found after death, loaded and congested with blood throughout! Nay, in addition there Avas water on the brain, with " some degree of sanguineous effusion " even.* Not long ago, I was shocked with the details of an inquest which took place " before the coroner for Middlesex, Mr. Wakley, who is also the editor of the Lancet. The inquest, according to the report in that paper, was held on the body of a man, who, in the act of disputing, with his master about his wages, "turned suddenly pale, and fell speechless and in- sensible for a time, breathing heavily until his neckerchief was loosed. In falling, his head struck the edge of a door, and received a deep wound three inches long, from which blood flowed enough to sink through a thick mat on the • We constantly hear of children dying of "water on the brain." I scruple not to declare, that in ninetyTnine of every hundred of such cases, the water in the brain is produced by the lancet or leeches of the doctor. 200 CHRONO-THERMAL floor." Before being taken from his master's shop to his own house, he recovered sufficiently to complain of pain of his head, and this fact I beg you will particularly mark. His wife immediately sent for "a doctor:" and what do you think was the first thing the doctor did—what can you pos- sibly imagine was the treatment which this wise man of Go- tham put in practice the moment he was called to a person Avho had fallen down in a faint, and who from the injury oc- casioned by the fall, had lost blood " enough to soak through a thick mat ?" Why, to bleed him again ! And what do you think Avas the quantity of blood he took from him? More than three pints! The landlady of the house—and she was corroborated by other Avitnesses—swore that " she thought that about three and a fifth pints of blood was taken besides what Avas spilt on the floor. The bleeding, she cal- culated, occupied tAventy minutes. The bandage also got loose in bed, and some blood, not much, was lost there before its escape was discovered. He had convulsions on Saturday, after Avhich he lay nearly still, occasionally moving his head. On Sunday he was more exhausted and quiet; in the evening he was still feebler, and on Monday afternoon at ten minutes to one, Avithout having once recovered his insensibility to surrounding objects, he died." Remember, he did recover his insensibility after he left his master's shop, and only lost it again on repeated bleeding. And how could he possibly survive such repeated bleeding ? That he died from loss of blood, was the opinion of every person who heard the evi- dence till the coroner, luckily for " the doctor," had the corpse opened. Then sure enough, just as in the case of the dog that was bled to death, the internal veins were found to be turgid and congested throughout. Deceived by this very constant result of any great and sudden loss of blood, Mr. Wakley and the jury Avere now convinced, not that the man had been bled to death, but that he had not been bled enough ! One of the strongest proofs of bad treatment Avas thus re- ceived as evidence of the best possible treatment under the circumstances—and a verdict pronounced accordingly ! That an ignorant coroner and an ignorant jury should be imposed upon in this manner, were nothing very wonderful, but that the editor of the Lancet, who publishes the case, and who from his position, knows every thing going on at the present time in the medical world, should in his capacity of coroner pass over without a word of reprobation, a mode of practice PRACTICE OF MEDICINE. 201 no conceivable circumstances could justify, only shows the lamentable state of darkness in which the profession are at this very moment on every thing connected with the proper treatment of disease ! When St. John Long, or any other unlicensed quack, by an over dose or awkward use of some of our common remedies, chances to kill only one out of some hundreds of his dupes, he is immediately hunted to death by the whole faculty ; but when a member of the profession at one bleeding, takes more blood by three times than is taken on any occasion by practitioners who kill their man every day Avith the lancet—not from a strong powerful man,but from a person so Aveakly that during the excitement of a tri- fling dispute with his master, fainted and fell, and in falling had already lost- blood enough to soak through a thick mat, —not a word of blame is said ! On the contrary, it was all right, or, if there was any error, it was on the safe side ! If such things be permitted to be done in the heart of the me- tropolis, not only without censure, but with something like praise, even, homicide may henceforth cease to be looked upon as a reproachable act. The only thing required of the perpetrator is, that he should do it under the sanction of a di- ploma and secundum artem ! But to return to ague, and the other morbid motions which led to this digression. Some may be curious to know how so simple a thing as the ligature can produce such a salutary ef- fect in these disorders. I will tell you how it does this—and the explanation I offer, if received as just, will afford you an additional proof not only that these diseases have all their common origin in the brain, but that they are all the natural consequences of an arrest or other irregularity of the atomic movements of the different portions of that organ ; for to the diversity of the cerebral parts, and the diversity of the parts of the body which they respectively influence, we ascribe the apparent difference of these diseases, according to the particu- lar motion of the brain that shall be most affected by some outward agency. Thus, after a blow on the head, or elbow even one man shall become sick, and vomit, another fall into convulsions, a third shiver, fever, grow delirious and become mortally insane. In all these diseases, the atomic move- ments of the brain being no longer in healthy and harmoni- ous action, the natural control which it exercised in health, over every part of the body, must be then more or less with- drawn from the various nerves through Avhich it influenced the entire economy. The consequence of all this is, that 202 CHRONO-THERMAL some organs are at once placed in a state of torpidity, while others act in a manner alike destructive to themselves, and the other parts of the body with which they are most nearly as- sociated in function. We find palsy of one organ, and spasm or palpitation of another. In fact, if I may be permitted to use so bold a simile, the various organs of the body when be- yond the control of the brain, resemble so many race-horses that have escaped from the control of their riders—one stands still altogether, another moves forward in the right course perhaps, but with vacillating and uncertain step, while a third endangers itself and every thing near it, by the rapidity or eccentricity of its movements. When the atoms of the various parts of the brain, on the contrary, act in harmony with each other, there is an equally harmonious action of every organ of the body—supposing, of course, every organ to be perfect in its construction.— Whatever suddenly arrests or puts into irregular motion the whole cerebral actions, must with equal celerity influence the previous motive condition of every member and matter of the body—for evil in one case, for good in another. Were you suddenly, and without any explanation, to put a ligature round the arm of a healthy person, you would to a dead cer- tainty excite his alarm and surprise. Now, as both these are the effects of novel cerebral movements, should you not thereby influence in a novel manner every part of his econo- my? How should you expect to influence it? Would not most men in these circumstances tremble, or show some kind of muscular agitation ?—their hearts would probably palpi- tate—they would change colour, becoming pale and red by turns, according as the brain alternately lost and recovered its controlling power over the vascular apparatus. If the alarm was very great, the pallor and tremor would be pro- portionally long. But in the case of a person already trem- bling and pale from another cause, the very natural effect of suddenly tying a ligature round the arm would be a reverse effect—for if the cerebral motive condition should be thereby changed at all, it could only be by a reverse movement; and such reverse cerebral movement would have the effect of re- versing every previously existing movement of the body. The face, that before was pale, would now become redder and more life-like; the trembling and spasmodic muscles would recover their tone; the heart's palpitations would be- come subdued into healthy beats; and a corresponding im- provement would take place in every other organ and func- PRACTICE OF MEDICINE. 203 tion of the body. The ligature, then, when its application is successful, acts like every other remedial agency ; and a pro- per knowledge of its mode of action affords us an excellent clue to the mode of action of medicinal substances generally, all of which, as you have already seen, and I shall still far- ther show, are, like the ligature, capable of producing and curing the various morbid motions for which we respectively direct their administration. It is in this manner that every one of the various passions may cause or cure every disease you can name—always excepting, as I have said before, the properly contagious disorders. The brain is the principal or- gan to which, in most cases, you should direct your remedial means. When a person faints and falls, whatever be the cause of such faint—a blow, a purge, or loss of blood—the first thing to be done is, to rouse the brain. You must throAV cold Avater on his face, put hartshorn, snuff, or burnt feathers to his nose, and a little brandy, if you can get it, into his mouth. You may also slap or shake him strongly with your hand—if you can only make him feel, you will be almost sure to recal him to life ; but to think of bleeding a person in such a state—ha ! ha ! After all, this is no laughing matter; for when we see such things done in the nineteenth century, we should rather blush for a profession that Avould endeavour to screen any of its members from the contempt they merit, when they have so far outraged every thing like decency and common sense. The proper treatment of a fit of fainting or convulsion, should be in principle the same as you may have seen practised by any well-informed midwife, in the case of children that are still-born—chidren all but dead. You may have seen the good lady place the child on her knee and beat it smartly and repeatedly with her open hand on the hips and shoulders, or suddenly plunge it into cold water: now while this is doing, the infant will often give a gasp or two and then cry—that is all the midwife wants. And if you Avill only follow her example in the case of Infantile Convulsions,— which, after all, are the very same thing as epileptic fits in the adult,—you will often succeed in substituting a fit of cry- ing, which, I need hardly say, is attended with no danger at all, for a spasmodic fit, which, under the routine treatment, is never free from it. Only get the child to cry, and you need not trouble yourself more about it,—for no human creature can possibly Aveep and have a convulsion fit of the epileptic 204 CHRONO-THERMAL or fainting kind at the same moment. Convulsive sobbing, is a phenomenon perfectly incompatible with these movements —for it depends upon a reverse action in the atoms of the brain. The only thing which may prevent some of you from doing your duty on such occasions, is the fear of offending an ignorant nurse or mother, who will think you a monster of cruelty for treating an infant so. These persons do not know how difficult it is to get a child to feel at all;—and in proof of this, such slaps as in a perfectly healthy child would be followed by marks that should last a week, in cases of this description leave no mark whateA'-er after the paroxysm has ceased. During the fit, the child is so perfectly insensible, as to be literally all but half dead. Now this brings to my mind a case of infantile convulsions, in which I was veiy gravely requested to meet an old woman in consultation— a nurse or midwife, I forget which, who, being much with children, must necessarily be Avonderfully clever in the cure of their diseases. Many will smile, doubtless, that I should be asked to do any thing of the kind; but it was in the case of the child of a relative; and relatives sometimes take strange liberties with each other. But it was not alto- gether to tell this that I reverted to the case in question—it was, on the contrary, to show what a wise person the female doctor proved who was, on this occasion, proposed for my co- adjutor. On being asked by the mother what should be done in the case of a return of the convulsion fits, the old lady an- swered, " Oh, madam, you must let the child be very quiet and not disturb it by noises, or anything of that sort!"__ which sapient advice I have no doubt was found one of the best antidotes in the world to a state in which, if you were to roar till your lungs cracked, you could not by any possi- bility make the subject of it hear at all. What is the present routine treatment of an infant taken with convulsion fits? That I can scarcely tell you; but when I settled in praetice, the school doctors, who, of course, give the tone to the profession in the country, had had no hesitation in applying all at Once the eight lancets of the cupping instrument behind the ear of infants under six months old,-and that, in some, repeatedly! In addition, they were in the habit of leeching, purging, and parboiling the poor little creatures in warm baths !• If mothers will really suffertheir children to be treated in this manner, surely they only deserve to lose them The,strongest and healthiesi child in existence, far less a sick one, could scarcely survive the PRACTICE OF MEDICINE. 205 routine practice. But whether you believe me or not, there is nothing more true than what the duke says in the play of The Honey Moon, such fits are "------seldom mortal, Save when the doctor's sent for." In the case of adult epilepsy, especially at the commence- ment of the fit, a very little thing will often at once produce a counter movement of the brain, sufficiently strong to influence the body in a manner incompatible with its further continu- ance. The application of so simple a means as the ligature may then very often do this at once; but, like every other remedy frequently resorted to, it will be sure to lose its good effect when the patient has become accustomed to it; for in this and similar cases, every thing depends upon the sudden- ness and unexpectedness of the particular measure put in practice, whether you influence the brain of a patient in a novel manner or not. The sudden cry of fire or murder, nay, the unexpected singing of some old song, in a situation or under circumstances which surprised the person Avho heard it, has charmed away a paroxysm of the severest pain. In the army, the unexpected order for a march or a battle, will often empty an hospital. The mental excitement thereby pro- duced, has cured diseases which had baffled all the efforts of the most experienced medical officers. In the words of Shak- speare, then, you may positively and literally "Fetter strong madness with a silken thread, Cure ache with air, and agony with words!" Many have doubtless read or heard of Dr. Channing, of Boston, one of the boldest and most eloquent of American writers. In a little essay of his, entitled " Self-Culture," I find some observations bearing so strongly upon the subject of this work, that I cannot resist the temptation to give them at length. How far they go to strengthen the view I have given, the reader will have an opportunity of judging:— " Intellectual culture," says this justly eminent person, "con- sists not chiefly, as many are apt to think, in accumulating information—though this is important, but in building up a IS 206 CHRONO-THERMAL force of thought which may be turned at will on any subjects on which we are forced to pass judgment. This force is manifested in the concentration of the attention—-in accurate penetrating observation—in reducing complex subjects to their elements—-in diving beneath the effect to the cause—in detecting the more subtle differences and resemblances of things—in reading the future in the present,—and especially in rising from particular facts to general laws or universal truths. This last exertion of the intellect—its rising to broad views and great principles, constitutes what is called the phi- losophical mind, and is especially worthy of culture. What it means, your own observation must have taught you. You must have taken note of two classes of men—the one always employed on details, on particular facts—and the other using these facts as foundations of higher, wider truths. The latter are philosophers. For example, men had for ages seen pieces of wood, stones, metals falling to the ground. Newton seized on these particular facts, and rose to the idea that all matter tends, or is attracted towards all matter, and then defined the law according to which this attraction or force acts at differ- ent distances;—thus giving us a grand principle, which we have reason to think extends to, and controls the whole out- ward creation. One man reads a history, and can tell you all its events, and there stops. Another combines these events, brings them under one view, and learns the great causes which are at Ayork on this or another nation, and what are its great tendencies—whether to freedom or despotism—to one or another form of civilization. So one man talks con- tinually about the particular actions of this or that neighbour, while another looks beyond \he acts to the inward principle from which they spring, and gathers from them larger views of human nature. In a word, one man sees all things apart, and in fragments, whilst another strives to discover the har- mony, connection, unity of all." That such unity does actually and visibly pervade the whole subject of our own particular branch of science—the history of human diseases, is a truth Ave have noAV, Ave hope, placed equally beyond the cavil of the captious and the in- terested. In this respect, indeed, we find it only harmonizing with the history of every other thing in nature. But in making intermittent fever or ague the type or emblem of this unity of disease, we must beg of you, at the same time, to keep constantly in view the innumerable diversities of shade PRACTICE OF MEDICINE. 207 and period, which different intermittent fevers may exhibit in their course. It has been said of faces, " ■-----Facies non omnibus una, Nee diversa tamen—." And the same may with equal truth be said of Fevers—all have resemblances, yet all have differences. For, betwixt the more subtle and slight thermal departures from health,—those scarcely perceptible chills and heals, Avhich barely deviate from that state, and the very intense cold and hot stages cha- racteristic of an extreme fit of ague, you may have a thou- sand differences of scale or degree. Now, as it is only in the question of scale that all things can possibly differ from each other, so also is it in this that all things are found to resemble each other. The same differences of shade remarkable in the case of temperature may be equally observed in the mo- tive condition oi the muscles of particular patients. One man, for example, may have a tremulous spasmodic, or lan- guid motion of one muscle or class of muscles simply—while another shall experience one or other of these morbid changes of action in every muscle of his body. The chills, heats, and sweats, instead of being in all cases universal, may in many instances be partial only. Nay, in place of any increase of perspiration outwards, there may be a vicarious superabun- dance of some other secretion within : of this, you have evi- dence in the dropsical swellings, the diarrhoeas, the bilious vomitings and the diabetic flow of urine with which certain patients are afflicted. In such cases, and at such times, the skin is almost always dry. The same diversity of shade which you remark in the symptoms may be equally observed in the period. The degree of duration, completeness, and exactness of both paroxysm and remission, differs with every case. The cold stage, Avhich in most instances takes the pa- tient first—in individual cases may be preceded by the hot. Moreover, after one or more repetitions of the fit, the most perfect ague may become gradually less and less regular in jts paroxysms and periods of return ; passing in one case into a fever apparently continued—in another, reverting by succes- sive changes of shade into those happier and more harmo- nious alternations of temperature, motion, and period, which Shakspeare, with his usual felicity, figured as the " fitful fe- ver" of healthy life. If you take health for the standard, every thing above or beneath it—whether as regards time, temperature, motion, or rest, is disease. When carefully and 208 CHRONO-THERMAL correctly analyzed, the symptoms of such disease, to a physi- cal certainty, will be found to resolve themselves into the symptoms or shades of symptom, of intermittent fever, te- ver, instead of being a thing apart from man, as your school doctrines would almost induce you to believe, is only an ab- stract expression for a greater or less change in the various revolutions of the matter of the body. Fever and disease, then, are one and identical. They are neither " essences to extract, nor " entities" to combat—they are simply varia- tions in the phenomena of the corporeal movements; and in most cases, happily for mankind, may be controlled without the aid either of physic or physicians. The same reparative power by Avhich a cut or a bruise, in favourable circum- stances, becomes healed, may equally enable every part of a disordered body to resume its wonted harmony of action. How often has nature in this way triumphed over physic, even in cases Avhere the physician had been only too busy with his interference ! It is in these cases of escape that the generality of medical men arrogate to themselves the credit of a cure. " It was a beautiful speculation of Parmenio," remarks Lord Bacon," though but a speculation in him, that all things do by scale ascend to unity." Do I need to tell you, that every thing on this earth which can be weighed or measured, is matter—matter in one mode or another. What is the dif- ference betwixt a piece of gold and a piece of silver of equal shape and size ? A mere difference of degree of the same qualities,—a different specific gravity, a different colour, a different ring, a different degree of malleability, a different lustre. But who in his senses Avould deny that these tAVO substances approach nearer in their nature to each other than a piece of wood does to a stone ; yet may not a piece of wood be petrified, be transformed into the very identical substance from which at first sight it so strikingly differs ! Nay, may not the bones, muscles, viscera, and even the secretions of an animal body, by the same inscrutable chemistry of nature be similarly transmuted into stone ? Gold and silver have differences assuredly, but have they not resemblances also,— certain things in common, from which we deduce their unity, when Ave speak of them both as metals ? How much more akin to each other in every respect are these substances than water is to either of its own elemental gases ? What certainty then have you or I that both metals are not the same matter, only differing from each other in their condition or mode ? Does not every thing in turn change into something else,—the PRACTICE OF MEDICINE. 209 organic passing into the inorganic, solids into liquids, liquids into gases, life into death, and vice versa ? The more you reflect upon this subject, the more you must come to the opinion, that all things at last are only modes or differences of one matter. The unity of disease is admitted by the very opponents of the doctrine, when they give to apoplexy and toothache the same name—disease or disorder. The ap- proaches to unity may be traced throughout every thing in nature. Betwixt the history of man's race, for example— the revolutions of empires, and the history of the individual man, the strongest relations of affinity may be traced. The corporeal revolutions of the body, like the revolutions of a kingdom, are a series of events. Time, space, and motion are equally elements of both. " An analyst or a historian," says Hume, " who should undertake to write the History of Europe during any century, would be influenced by the con- nection of time and place. All events Avhich happen in that portion of space and period of time, are comprehended in his design, though, in other respects, different and unconnected. TJiey have still a species of unity amid all their diversity." The life of man is a series of revolutions. I do not at this moment refer to the diurnal and other lesser movements of his body. I allude now, to those greater changes in his econo- my, those climacteric periods, at which certain organs that were previously rudimental and inactive, become successively developed. Such are the teething times, the time of puberty, and the time when he attains to his utmost maturity of cor- poreal and intellectual power. The girl, the boy, the Avoman, the man, are all different, yet they are the same ; for when we speak of man in the abstract, we mean all ages and both sexes. But betwixt the female and the male of all animals there is a greater degree of conformity or unity than you would at first suppose,and which is greatest in their beginning. Now, this harmonizes Avith every thing else in nature; for all things in the beginning approach more nearly to simplicity. The early fcetus of every animal, man included, has no sex, __when sex appears it is in the first instance hermaphrodite, just as we find it in the lowest tribe of adult animals, the oyster for example. In this particular, as in every other, the organs of the human foetus, internal as well as external, first come into existence in the lowest animal type—and it depends entirely upon the greater or less after development of these several hermaphroditic parts, whether the organs for the pre- 18* 210 CHRONO-THERMAL servation of the race, take eventually the male or female form. How they become influenced to one or the other form we know not. Does it depend upon position? It must at any rate have a relation to temperature. For a bng time even afterbirth, the breasts of the boy and the girl preserve the same appearance precisely. You can see that with your own eyes. But the comparative anatomist can point out other analogies, other equally close resemblances in.the rudimental condition of the reproductive organs of both sexes. During the more early fcetal state the rudiments of the testes and the ovaries are so perfectly identical in place and appearance, that you could not tell whether they should afterwards become the one or the other. What in the male becomes the prostate gland, in the female takes the form of the womb. To sum up all, the outward generative organs of both sexes are little more than inversions of each other. Every hour that passes, however, while yet in its mother's Avomb, converts more and more the unity of the sex of the infant into diversity. But such diver- sity, for a long period, even after birth, is less remarkable than in adult life. How difficult at first sight to tell the sex of a child, of two or three years old when clothed: at puber- ty the difficulty has altogether vanished. Then the boy be- comes bearded and his voice alters; then the breasts of the girl—which up to this period in no respect differed from his, in appearance at least—become fully and fairly developed,— assuming by gradual approaches the form necessary for the new function they must eventually perform in the maternal economy. Another, and a still greater revolution, imbues them with the power of secreting the first nutriment of the infant. But even before the girl can become a mother a new secretion must have come into play,—a secretion which, from its period being, unlike every other, monthly only, is known to physicians under the name of Catamenia or the Menses. How can such things be done but by a great constitutional change, —without a new febrile revolution of the whole body ? Mark the sudden alternate pallor and flush of the cheek and lip, the tremors, spasms, and palpitations, to say nothing of the uncontrollable mental depressions and exaltations,—to which the girl is then subject, and you will have little difficulty in detecting the type of every one of the numerous diseases to which she is then liable. Physicians may call them Chlorosis, green-sickness, or any other name ; you will recognize in them the developments of an intermittent fever simply,—as various PRACTICE OF MEDICINE. 211 in its shades, it is true, as a fever from any other cause may become,—producing, like that, every Avrong action of place and time you can conceive, and like other fevers, often curing such wrong actions as previously existed, when it happens to reverse the atomic motions of the various parts of body. Ber fore touching upon the principal Diseases incidental to Women, I must tell you that the Catamenia, in most cases, disappears during the period of actual pregnancy; nor does it return while the mother continues to give suck. During health, in every other instance, it continues from the time of puberty, or the period Avhen women can bear children, to the period when this reproductive power ceases. As with a fever it comes in- to play, so with a fever it also takes its final departure. Why it should be a peculiarity of the human female, I do not know, —but in no other animal has any thing analogous been ob- served. Some authors, indeed, pretend to have seen it in the monkey ; but if this were really the case, I do not think so many physiologists would still continue to doubt it, especially as they have every opportunity of settling the question de- finitively. Various speculations have been afloat as to the uses of this secretion, but I have never been satisfied of the truth of any of them. I am better pleased to know that the more perfect the health, the more perfectly periodical the re- currence of the phenomenon. It is therefore without ques- tion a secretion, and one as natural and necessary to females of a certain age, as the saliva or bile to all people in all times. How absurd, then, the common expression that a woman, during her period, is " unwell." It is only when the catame- nia is too diffuse or too defective in quantity, or too frequent or too far between in the period,—when the quality must also be correspondingly altered,—that the health is in reality im- paired Then, indeed, as in the case of other secretions im- perfectly performed, pain may be an accompaniment of this particular function. . Need I tell you that no female of a certain age can become the subject to any fever without experiencing more or less change in this catamenia? or that during any kind of indis- position, how slight soever it may be, some corresponding alteration in this respect must with equal certainty, take place ? In cases where the alteration thus produced takes the shape of a too profuse flow, practitioners are in the habit 212 CHRONO-THERMAL of prescribing astringents and cold applications. Happily for the patient the medicines usually styled " astringents," (iron, bark, alum, opium, &c.) are all chrono-thermal in their action ; and the general salutary influence which they consequently exercise over the Avhole economy, very frequently puts the catamenia, in common Avith every other function, to rights, —when the practitioner Avho prescribes them has no idea that he is doing more than attending to the derangement of a part. He accordingly places profuse menstruation in his list of local diseases ! When deficiency or suppression of this secretion, on the contrary, chances to be the coincident fea- ture of any general constitutional change,—a thing Avhich may happen from a transitory passion even,—such effect or coincidence of cerebral disturbance is by many practitioners assumed to be the cause of all the other symptoms of corpo- real derangement! And under the formidable title of " ob- struction," how do you think some of your great accoucheur- doctors are in the habit of combating it ?—By leeching the patient—by applying leeches locally. Now, I only ask you what you would think of a practitioner, who, on finding the same patient feverish and thirsty, should leech her tongue ? or when she complained of her skin being uncomfortably dry, should apply leeches to that ? You would laugh at him of course; and so you may Avith just the same reason laugh at fashionable practitioners of the day, when you find them leeching their patients for defective or suppressed menstrua- tion,—a derangement of function Avhich a passion might pro- duce, and another restore to its healthy state. Is it, then, a local disease or a disease of the brain and nerves—an affection of a part or a disorder of totality ? If the latter, who but a mechanic would think of applying leeches locally ? In either case, who but a cow-leech or a quack salver would dream of restoring any periodical secretion by a mode of practice so barbarous and disgusting ? You might just as reasonably, in the absence of an appetite for dinner, expect to make your " mouth Avater" by the application of leeches to your stomach when the clock should strike five ! Having thus far explained the nature of these cases, I have now little else to say of them. The general principle of treat- ment is obvious—attention to temperature ; for, in every case of catamenial irregularity, Avhether as regards quantity, qua- lity or period, the temperature of the loins, must be more or less morbid,—one patient acknowledging to chill, another to PRACTICE OF MEDICINE. 213 heat. In the former case, friction or a warm plaster, may be tried as a local means—in the latter, cold or tepid sponging; though I may tell you, that, with the chrono-thermal reme- dies singly, you may produce the most perfectly salutary re- sults in numerous cases. In both instances, cold, warm, and tepid baths may also be advantageously employed, according to the varying circumstances of the case. The majority of women who suffer from any general in- • disposition short of acute fever, are more or less subject to a particular discharge which, by the patients themselves, is very often termed weakness, but Avhich is more familiar to the profession under the name of Leucorrhcea or whites. ■ The usual concomitant of this disease is a dull aching pain at the lower part of the back. Now, I never questioned a woman who suffered from it, but she at once acknoAvledged that the local flow was one day more, another less, and that she had, besides, the chills, heats, and other symptoms of general con- stitutional derangement. But of that derangement, the dis- charge so often supposed to be the cause, is in the first in- stance, nothing more than a coincident feature or effect; though from pain or profuseness, it may again react upon the constitution at large, and thus form a secondary and su- peradded cause or aggravant. In cases of this kind, I am in the practice of prescribing quinine, iron, or alum, sometimes with, and sometimes without copaiba, catechu, or cantharides —one medicine answering best with one patient, another with another. I- have been frequently consulted in cases of painful whites, and also in cases of painful menstruation, disorders which practitioners as remarkable for their professional eminence, as for their utter Avant of high professional knowledge, had been previously treating by leeches, some applying those to the loins, Avhich in every case, whether of whites or irregu- lar menstruation, is weak, and consequently painful; some, to the disgust of every woman of sensibility, introducing them even to the orifice of the womb itself. What practice can be more erroneous? What relief, if obtained, more de- lusive ? Bark, iron, opium,—these are the remedies for cases of this description : and the general constitutional improve- ment which, for the most part follows their use, together with the disappearance of the more prominent local irregularities for Avhich your aid had been asked, affords the best answer to any hypothetic objection that may be brought against their employment. The best topical application in these cases— 214 CHRONO-THERMAL and you will find it useful in most—is a plaster to the spine to warm and support it; though cold, hot, or tepid, fomenta- tion to the loins or Avomb may also be occasionally employed, according as one or other shall prove most agreeable to the patient's own feelings. The various female disorders of which I have just been treating, are matter of daily practice. The more formidable affection to which I now draw your attention. Cancer of the Breast, fortunately for the sex, is of rare occurrence—not one woman perhaps, in five thousand, ever becoming the subject of it. Noav,what is cancer? What but a slow and painful decom- position—a canker or blight of the particular organ affected. The manner in which cancer of the breast generally com- mences, is this:—A tumour, at first smaller than a nut, possess- ing more or less hardness, and to a certain extent circum- scribed, is observed in the neighborhood of the nipple ; the patient's attention, in most cases, being first called to it by a slight itching or uneasiness in the part affected, Avhich soon deepens into a " pricking," " darting," or " shooting " pain— for such are the various phrases by which different patients de- scribe their pains. The tumour slowly, but gradually, increases in size and hardness,Avhile the pain becomes more and more in- tolerable and " lancinating." The disease, in every case, is intermittent, and in most instances, this intermission is peri- odical, the tumour being one day perceptibly diminished, an- other as obviously enlarged. The pain, in like manner, dis- appears more or less, completely, for a time, to return at a particular hour of the clock, with undiminished violence. Now, when surgeons were more in the habit of performing operations, in cases of this kind, than at present, such tu- mours, after removal by the knife, were usually, from mo- tives of curiosity, bisected. If their internal structure when thus divided, resembled something betwixt a turnip and a car- tilage, the disease was pronounced to be " true cancer"—a schirrus or carcinoma. On the contrary, if, instead of this ap- pearance, the tumour had a resemblance to the substance of the brain, or to lard, jelly, or was of a mixed character, dis- putes frequently arose as to the name by which the disease should be christened ;—as if it signified one straw whether the breast, when so completely changed in its structure and nature, as to be productive of nothing but misery to its owner, should be called schirrus, carcinoma, cancer, or anything else ! PRACTICE OF MEDICINE. 215 Oh ! it matters very little, what the organic change be termed when, as in all these cases, the glandular fabric of the breast becomes at last completely destroyed and decomposed. How and in what manner, is this disease developed ? It is the result of general constitutional change. It is the effect of a weak action of the nerves on an originally weak organ; and of this you may be satisfied, when I tell you that in most instances, cancer is a hereditary disease; or, to express my- self better, there is hereditary predisposition, and what is more, the disease generally makes its first appearance about that period of life when the breast ceases to be anything but a mere personal ornament to its possessor. It comes on much about the same time Avhen the catamenial secretion is about to terminate for life. Can such termination take place with- out a new corporeal revolution ? Certainly not: every female at such time, suffers more or less from constitutional dis- order. Analyze this disorder, and you will find that it re- solves itself into a general intermittent febrile action of the whole body, varying in its shade with every case. Cancer, then, is a development of that fever. Now, why is it that, the word cancer sounds so fearfully in the female ear ? The diffi- culty to cure it simply—the difficulty in most instances—the absolute possibility in many. To understand the reason of this difficulty, we must consider the nature and uses of the organ. However beautiful and ornamental to its possessor, the breast is not, like the heart or lungs, an organ of the least importance to her own vital economy. It is a part super- added for the preservation of the race. Rudimental, or all but absent in the child, this organ only reaches its full maturity of development when the girl becomes the woman. After the woman ceases to bear children, or Avhether she has borne them or not, when the period of the possibility of her being pregnant has passed away, the substance of the breast is gen- erally more or less absorbed, though you occasionally meet with instances where it becomes enlarged beyond its previous size. In fewer cases still it takes on a process of decay—in other words, it becomes cancerous. But nature in this in- stance, even when aided by art, will not often exert her usual reparative efforts—she will not put forth her powers, so to speak, for the preservation of a part which noAV, not only so far as the individual economy is concerned, but so far also as regards the race, has become a useles part. This I take to be the true reason of the difficulty to cure a cancer, for although in many cases more or less improvement in the state of the 216 CHRONO-THERMAL affected organ may follow the employment of remedial means —such means as beneficially influence the whole health—still, as if to prove more fully the truth of my explanation, you may even succeed to a great extent in raising the general healthy standard, and yet fail to procure the slightest arrest of the local process of decay. While a cut or bruise upon any other part of the body of a cancer patient will heal with ease, the breast, partaking no longer in the preservative power of the economy, may perish piece-meal. Never, in my life, did I meet with a cancer in any state or stage, the subject of which did not acknowledge to chills and heats, or who did not admit errors of secretion ; to say nothing of variations in the volume, temperature, and sensation of the part affected. I lately attended the sister of a Fellow of the Royal College of Physicians, Avho was first induced to consult me, from hearing that I looked upon ague as the primary type or model of all complaints. Her own cancer, she assured me, was preceded by shivering-fits, which she traced to a sudden chill; and during the Avhole progress of t^he disease she suffered more or less from aguish feelings. Previously to my seeing her, she had been visited by a surgeon of eminence, Avho ordered her to apply leeches ; but the effect of their employment was an increase of her pain. And no wonder—for if that great man had only taken the trouble to inquire, he would have found that, instead of the hypothetic " inflammation," which doubtless suggested their employment, the breast, in that in- stance, was generally cold ! Would not a warm plaster under these circumstances have been of more service? You may try at least, and if you do not find it produce more or less re- lief in many similar instances, I know nothing whatever of the science I now pretend to teach you. No local application however, will be long productive of any very effectual ad- vantage in this or any other disease, without attending to the chrono-thermal principles of paroxysm and remission. Arse- nic, quinine, opium, copper, prussic acid, may be all succes- sively tried. But you must here always keep in mind that cancer is a chronic disease, a disease of time; and you must farther hold in your remembrance, what I have already said in regard to most of chronic diseases, namely, that no medicine will produce its beneficial effect for any great continuance in those disorders ; for once the constitution becomes accustomed to the use of a remedy, such remedy either loses its salutary influence altogether, or acts in a manner the reverse of that which it did Avhen tried in the first instance. No medi- PRACTICE OF MEDICINE. 217 cinal agent had a greater reputation at one time, in the treat- ment of cancer, than arsenic ; arsenic in fact was supposed to be a wonderful specific in cases of that nature. What was the consequence ? Like every thing else in this world, whether person or thing, physician or physic, that ever en- joyed the temporary distinction of infallibility, after a feAV decided failures, in particular instances, this mineral came at last to be almost entirely abandoned in such cases. And yet, notwithstanding this, I do not know a remedy which may be more successfully used in cancer than arsenic. " We have seen from its use," says Dr. Parr, in his dictionary, published in 1809, " an extensive, cancerous sore filled with the most healthy granulations, the complexion become clear, the appe- tite improved, and the general health increased." " Unfor- tunately," he continues, " these good effects have not been permanent. By increasing the dose, Ave have gained a little more, but, at last, these advantages were apparently lost." And was it ever otherwise with any other remedy? No power on earth could always act upon the living body in the same manner. The strongest rope will strain at last, and so Avill the best medicine cease, after a time, to do the Avork it did at first. But a physican Avho should, on that score, de- spise or decry a power that had, for a given time, proved de- cidedly advantageous in any case, Avould be just as wise as the traveller who, on reaching his inn, instead of being thank- ful to his horse for the ground it had enabled him to clear, should complain of it for not carrying him without resting to the end of his journey. What, under the circumstances men- tioned by Dr. Parr, either he or any other doctor should have done,—and what I have confidence in recommending you to do on every similar occasion, is this,—Having obtained all the good which arsenic or any other remedy has the power to do in any case, change such remedy for some other consti- tutional power, and change and change until you find im- provement to be the result; and when such result no longer follows its employment, change your medicine again for some other; or you may even again recur with the best effect to one or more of the number \ro-u had formerly tried with benefit; for Avhen, if I may speak so metaphorically, the con- stitution has been allowed time to forget a remedy that once beneficially influenced it, such remedy, like the re-readmg of a once-admired, but long-forgotten book on the mind, may come upon the corporeal economy once more Avith much of its original force and freshness. In all such cases, then, you 19 218 CHRONO-THERMAL must change, combine, and modify your medicine and mea- sures in a thousand ways to produce a sustained improvement. Arsenic, gold, iron, mercury, creosote, iodine, opium, prussic acid, &c. may be all advantageously employed, both as in- ternal remedies and as local applications, according to the changing indications of the case. When cancer is suffered to run its course undisturbed by the knife of the surgeon, or the physic of the doctor, the usual termination of it is this:—A small ulcer shows itself upon the skin of the most prominent part of the tumour, gradually increasing in dimension. And so exceedingly Aveak do the atomic attractions of the matter of the breast become during the change produced by the disease, that scarcely has the at- mospheric air been allowed to come in contact with the tu- mour, than it commences to mortify and die—falling away in most cases, as it did indeed in the case of the lady to Avhich I have already alluded, after a certain time, in a dead and cor- rupted mass. The ulcer which it leaves behind, is in all such cases, extremely foetid, and shows a great disposition to spread; the reason of Avhich is this,—first, because the whole constitution of such persons is more or less weak ; and secondly, because the particles of dead, or half-dead matter, which coat the bowl of the ulcer, not only have no poAver of reparation in themselves, but are the cause of a further failure of reparative power in the already weak parts with which they come in contact. Exactly the same thing takes place Avhen any part of an old tree becomes decayed, and very much after the manner of such vegetable decay, as you may see it in a gnarled oak, we have in this disease mushroom like and other excrescences springing from the sides and bottom of the ulcerous and decaying part, and that too, with a rapidity truly astonishing. A case of this kind I lately attended Avith Mr. Farquhar of Albemarle street. Un- less every portion of these fungoid bodies be completely re- moved, you must not hope to arrest the progress of the dis- ease. The whole surface of the ulcer should be cauterized and completely destroyed with a burning iron, nitrate of sil- ver, ammonia, or potass. All four may, in some cases, be resorted to Avith advantage. Nor must you here spare any part that shows even a symptom of weakness; but cauter- ize, and cauterize again and again, until you get red, small, healthy granulations to appear. The dressings Avhich you will now find most successful, are ointments or other prepa- rations of the red oxide of mercury, iodine, arsenic, creosote, PRACTICE OF MEDICINE. 219 lead, &c, and each and all of these will only prove beneficial in particular cases, and for particular periods. The law that holds good in the case of internal remedies, will be no\v more conspicuous in the case of external applications,— namely, that all medicinal powers have a certain relation to persons and periods only, and must in no case be a priori expected to do more than produce a temporary action. If that action be of a novel kind, they will produce benefit; if on the contrary, the increased motion from their action be in the old direction, and which cannot be foreseen till tried, the result of such trial will be a greater or less aggravation of the state for whose improvement you ordered them to be applied. Dr. Abel Stewart, while practising in the West Indies, Avhere the disease is more frequent than in England, had many opportunities of making himself acquainted with every one of the various states and stages of cancer—and since I settled in London, where he now also practises, he has shown me cases of this kind, Avhich he has treated with the greatest success. You must not then suppose, like most of the vulgar, and not a few of the members of the profession, that cancer of the breast is necessarily a mortal disease. So long as you can prevent the ulcer from spreading, and at the same time keep up the general health to a certain mark, how can there be danger? The breast, I repeat, is not a strictly vital organ ; it is not, like the lungs or heart, necessary to the individual life,—it is a part superadded for the benefit of another gene- ration. How many women, at one time remarkable for a large and full breast, in the course of years lose every appear- ance of bosom by the slow but imperceptible process of inter- stitial absorption; what inconvenience do these suffer in con- sequence ? But for the tendency to spread, and the accom- panying pain, cancer Avould seldom terminate fatally at all; it is the pain principally that makes the danger not any loss of the organ itself. Pain alone will wear out the strongest: relieve this, therefore, in every way you can, but avoid leeches and depletion, which, I need not say, are the readiest means, not only to exhaust the patient's strength, but to pro- duce that extreme sensibility of nerve, or that intolerance of external impression, that converts the merest touch into the stab of a dagger. Strong people seldom complain of pain: it is bloated and emaciated persons Avho mostly do so. Keep no your patient's health, then, by every means in your power, and she may live as many years with a cancer of the breast, 220 CHRONO-THERMAL as if she had never suffered from such a disease. Sir 13. Brodie mentions the case of a lady who lived twenty years with cancer, and died at last with an affection of the lungs, with which it had no necessary connexion. What shall I say in regard to amputation of the breast ? Will amputation har- monize the secretions? Will it improve the constitution in any way whatever? Those patients who, in the practice of others, have been induced to undergo operations, have seldom had much cause to thank their surgeons—the disease having, for the most part, reappeared at a future period in the cica- trix of the wounded part. You have only to look at the pallid, bloated, or emaciated countenances of too many of the suffer- ers, to be satisfied that something more must be done for them than a mere surgical operation—a measure doubtful at the best in most cases, and fatal in not a few. Shiverings, heats, and SAveats, or diarrhoea, or dr6psy,—these are the constitu- tional signs that tell you you have more to do than merely to dissect away a diseased structure, Avhich structure, so far from being the cause, Avas in reality but one feature of a great to- tality of infirmity. That the knife may sometimes be advan- tageously employed I do not deny, but instead of being the rule, it should be the exception; for the majority of honoura- ble and enlightened surgeons will admit how little it has served them in most cases beyond the mere purpose of tem- porary palliation. When you hear a man now-a-days speak- ing of the advantage of early operating, you may fairly ac- cuse him of ignorance, Avith which, I regret to say, interest, in this instance, may occasionally go hand in hand. The large fee for amputating a breast enters into the calculation of some of your " great operators"—for that they get whether the operation be successful or not. I have twice in my life seen cancer of the male breast— the subject of one Avas an European, the other a native of India. Let me now say a few words on Tumours generally; premising that the term tumour is merely the Latin word for any swelling, though Ave commonly employ it in the more limited sense of a morbid growth. It is a very common error on the part of medical men, to state, in their report of cases, that a "healthy" person presented himself with a particular tumour in this or that situation. Noav such practitioners, by this very expression, show how much they PRACTICE OF MEDICINE. 221 have busied themselves with artificial distinctions—distinc- tions which have no foundation in nature or reason—to the neglect of the circle of actions which constitute the state of the body termed health. Never did a tumour spring up in a perfectly healthy subject. In the course of my professional career, I have witnessed tumours of every description, but I never met one that could not be traced, either to previous constitutional disturbance, or to the effect of local injury on a previously unhealthy subject. Chills and heats have been confessed to by almost every patient, and the great majority have remembered that, in the earlier stages, their tumour was alternately more and less voluminous. Every individual, Ave have already shown, has a predispo- sition to disease of a particular tissue. Whatever shall de- range the general health, may develope the weak point of the previously healthy, and this may be a tendency to tumour in one or more tissues. The difference in the organic appear- ance of the different textures of the body, will account for any apparent differences between the tumours themselves; and Avhere tumours appear to differ in the same tissue, the difference will be found to be only in the amount of the mat- ter entering into such tissue, or in a new arrangement of some of the elementary principles composing it. It is a law of the animal economy, that Avhen a given secretion becomes mor- bidly deficient, some other makes up for it by a preternatural abundance. If you do not perspire properly, you will find the secretion from the kidneys or some other organ increase in quantity. I was consulted some time ago by a female pa- tient, whose breasts became enormous from excess of adipose or fatty deposit. Now, in the case of this female, the urine Avas always scanty, and she never sweated. Every tissue of the body is built up by secretion. The matter of muscle, bone and skin, is fluid before it assumes the consistence of a tissue, and the atoms of every texture are constantly passing into each other. " The great processes of nature,'" says Professor Brande "such as the vegetation of trees and plants, and the phenomena of organic life generally, are connected with a series of chemical changes." But this chemistry is of a higher kind than the chemistry of the laboratory:—it is vital che- mistry under the influence, as I shall afterwards show, of vital electricity. Secretion of every kind is the effect of this vital chemistry; and tumours, instead of being produced, as Mr. Hunter supposed, by the "organization of extravasated 222 CHRONO-THERMAL blood," are the result of errors of secretion. They are prin- cipally made up of excess of some portion of the tissue in which they appear, or the result of new combinations of some of the ultimate principles which enter into its composi- tion. If you search the records of medicine upon the subject of tu- mours, you will find that the medicinal agents by Avhich these have been cured or diminished,come at last to the substances of greatest acknowledged efficacy in the treatment of ague. One practitioner (Carmichael) lauds^iron; another (Alibert) speaks favourably of the bark; the natives of India prefer arsenic; Avhile most practitioners have found iodine and mercury more or less serviceable in their treatment. The reader does not require to be told that these substances have all succeeded and failed in ague ! Wonder not, then, that each has one day been lauded and another decried, for every disease which has obtained a name, tumours of every description among the number. We noAV come to Pregnancy. But this, you will very likely say, is not a disease. In that case, I must beg to refer you to ladies who have had children, and I will wager you my life, that they will give you a cata- logue of the complaints that affected them during that state, equal in size to Dr. Cullen's Nosology. In the case of every new phenomenon in the animal economy, whether male or female, there must be a previous corporeal revolution. We find this to be the case at the times of teething and puberty —and so Ave find it in the case of pregnancy. Can the seed- ling become an herb in the frost of winter, or the sapling grow up into maturity without a series of changes in the tem- perature and motion of the surrounding earth ?__No more can the infant germ become the foetus without a succession of febrile revolutions in the parent frame! Once in action, it reacts in its turn. The influence of the mother's brain over the growth of the child while in the womb, is sufficiently proved by the effects of frights and other passions, induced by the sight of objects of horror, and so forth, while in the pregnant state Hare hps, distortions, moles, marks, &c, have in too many instances been traced by the mother to such passions, to render us in the least sceptical upon that point. Now, in this particular PRACTICE OF MEDICINE. 223 instance, some of the parts or divisions of the mother's brain must act in association or simultaneously, while others act in- dependently or in alternation, for otherwise you could not un- derstand how the brain of the mother should influence the growth of the child in utero, and at the same time continue to play its part in the parental economy. Some of its various portions must act in these respects alternately, for they cannot do both at one and the same moment of time. But, here again, as in other instances, a Avant of harmony may arise— the brain may continue to exercise its influence over the child too long ; in other cases it may forget the child for the mother. How such want of harmony affects the child, we can only guess from analogy. How a too long cerebral neglect of the mother's economy may influence her, we may daily see in the numerous disorders to Avhich she is then liable—more particularly in the periodic vomitings Avhich take place in most instances, and also in the swoon or faint which occasionally comes on during the pregnant state. Are not these the very symptoms that happen in the case of a person who has had a blow on the head, or Avho has been much bled? It appears to me probable that the infant's growth must take place prin- cipally during the period of maternal sleep. For it is chiefly in the morning, just as she awakes, that the mother experi- ences those vomitings and other symptoms from which I infer the brain has been too long neglecting her own economy.— But even as a natural consequence of the more favourable alternations of cerebral movement Avhich takes place during pregnancy, the mother for the most part experiences chills, heats, and sweats; she has symptoms, or shades of symptom, at least, of the same disorders that may arise from any other agency affecting the brain in a novel or unusual manner—she becomes at certain times pale and flushed alternately, and, as in the case of other fevers, frequently complains of head- ache. WThen blood-letting—the usual refuge of the ignorant— is in such cases tried, the blood drawn exhibits the same iden- tical crust Avhich, under the name of " buffy-coat," "in- flamed crust," &c, so many practitioners have delighted to enlarge upon as the peculiarity of "true inflammatory fever " Pregnancy has been defined by some very great doctors, to be a " natural process." Now, that certainly is a very great discovery; but they might have made the same discovery in the case of disease and death. Is not every thing in nature 224 CHRONO-THERMAL a natural process, from the fall of an apple to the composition of the Iliad ! Every thing that the eye can see or the ear can hear is natural; miracles only are miraculous ; for they are events that are contrary to the natural order of things. Pregnancy, then, is a natural process; but is it on that account the less surely a febrile state ? Is it for that reason the less cer- tainly an intermittent fever?—What disorders have originated in pregnancy? What, in cases where they previously existed has it not, like every other fever, cured ? If it has produced epi- lepsy, apoplexy, toothache, consumption, palsy, mania,—each and every one of these diseases have I known it to ameliorate, suspend, or cure ! I remember the case of a lady who, before her marriage, squinted to perfection. But Avhen she became pregnant her squint diminished, and long before the period of her confinement it was cured;—never did I see such an im- provement in the face of any person. Still, if pregnancy has cured squint, I have known cases where it produced it. How completely, then, does this harmonize with the unity which pervades disease generally! Parturition, I have already said, is a series of pains and remissions, but it is not an intermittent fever; nor indeed, has it any resem- blance to that affection ! So, at least, I have been assured by very clever doctors : and they have told me the same of pregnancy ! Is this question, then, completely settled in the negative? Certainly—It is settled to the satisfaction of all who pin their faith upon mere human authority. But human authority seldom settled any thing with me; for wherever I have had an interest in knowing the truth, I have generally ap- pealed from the decree of that unsatisfactory court to the less fallible decision of the Court of Fact. And what does fact say in this instance ? Fact says that child-labour, in almost every case, commences with chills and heats, and that these are again and again repeated with longer or shorter periods of immunity during its progress. But how do I know all this? you will ask,—I who hold modern midwifery in such horror ! I will tell you truly—I first guessed it; for I could not suppose that parturition, unlike every other great revolu- tion of the body, could either be painless or an unperilous state, or that it could be free from the chills, heats and remis- sions, Avhich I had always observed in cases of that character. Still not being a person easily satisfied with guess-work I PRACTICE OF MEDICINE. 225 took the trouble, in this particular instance, to interrogate na- ture. And as sure as the sun ever shone on this earth, nature completely verified the fact of my anticipation, that parturi- tion, in every instance, is an intermittent fever. In some of my medical books, too, I found shiverings among the numer- ous other symptoms mentioned as incidental to women at this period. " Sometimes," says Dr. Ramsbotham, himself a man- midwife, " they are sufficiently intense to shake the bed on which the patient lies, and cause the teeth to chatter as if she were in the cold stage of an ague fit; and although she com- plains of feeling cold, the surface may be warm, and perhaps warmer than natural." Now, this cold sensation, as you well know, is often complained of by ague patients, even in the hot stage. In spite of every assertion to the contrary, then,—in spite of every declaration on the part of medical or other persons, pregnancy and parturition are agues—agues in every sense of the word; for not only do their revolutions take place in the same manner as ague, but, like ague they may both be influenced by medicines as Avell as by mental impressions. Indeed, in most cases of parturition, the labour- fit—mark the word !—will stop in a moment from the new cerebral movement induced by fright or surprise. In some the fit never returns, and the most terrible consequences ensue. When the foetus is fairly developed in the case of pregnancy, and the labour completed in that of parturition, health is the general result; but in the course of both, as in the course of other fevers, every kind of disease may show itself, and, when developed, may even proceed to mortality. An occa- sional termination of pregnancy is Abortion or Miscarriage ; And this in every case is preceded by the same constitutional symptoms as pregnancy and parturition, namely, the symp- toms or shades of symptoms of ague. Moreover, Avhen a woman gets into a habit of miscarrying, such miscarriage, like an ague recurs periodically, and takes place almost to a day at the same month as the first. A lady Avho had been married several years, but who had never borne a living child, although she had had frequent abortions, consulted me upon the subject. Her miscarriages having always taken place at the same period of pregnancy—about the end of the third month—I desired her when she should again become preg- nant to let me hear from her Avithin a fortnight of the time she might expect to miscarry. She did so, telling me at the 226 CHRONO-THERMAL same time she knew she should soon be taken ill as she had already had shiverings. 1 directed her to use an opium sup- pository nightly, which she did for a month, and she was thus enabled to'carry her child to the full time. She has had two children since, and all three are now well and thriving. I have succeeded in similar cases with the internal exhibition of quinine, iron, hydrocyanic acid, &c. But opium, where the drug does not decidedly disagree, will be found the most gen- erally useful of our medicines in checking the habit of mis- carriage. Need I tell you that in no case should it be con- tinued where it excites vomiting. The tendency to return of any action which has once taken place in the constitution, is a law even in some effects of ac- cidents. A lady, Avho from fright during a storm miscarried of her first child, a boy, never afterwards, Avhen pregnant Avith boys, could carry them beyond the time at which she miscarried of the first. On the other hand, she has done well with every one of her daughters, five in number, all of whom are at this moment living. To mothers and nurses, next to pregnancy and parturition, there is no subject so interesting as that of Teething. The birth of the first tooth, like the birth of a first child, is commonly expected by both with a certain degree of anxi- ety, if not with fear. Why is this? Why, but because as in the case of pregnancy, before the dormant germ can be called into action—before the embryo tooth can be developed —there must be a complete corporeal revolution, an inter- mittent fever, of more or less intensity, varying according to the varying conditions of particular constitutions. And what a curious unity runs through all creation, producing those wonderful analogies that alone can lead us to the pro- per study of nature. The embryo tooth, like the embryo in- fant, is the offspring of a womb—tiny indeed, but still rightly enough termed by the profession, matrix—that being only another Latin word for uterus or Avomb. Both also come into the world by a fever. The more healthy and vigorous the child, the more subdued will the teething fever for the most part be, and the teething itself will consequently be less painfully accomplished; just as under the same circumstances the parturient mother will more surely bring forth her young in safety. In those cases, on the contrary, where the child is weakly or out of health, the fever will be proportion- PRACTICE OF MEDICINE. 227 ally severe. The generality of teething children, after having been comparatively well during the day, become feverish at a particular hour in the night. Now, the newly developed tooth, though in the first instance itself a mere effect of the fever, very soon contributes, by the painful tension Avhich its increasing growth produces in the gum, to aggravate and pro- long the constitutional disorder. It is first an effect and then a superadded cause, or aggravant. In this fever we have a fresh illustration of the unity Of disease—a fiesh proof that intermittent fever, in some of its many shades, is the consti- tutional revolution which ushers in every kind of corporeal disorder. How many varieties of local disease may not be produced during the intermittent fever of teething ! Every spasmodic and paralytic distemper you can name—convul- sions, apoplexy, lock-jaw, squint, curved spine, with all the family of structural disorders from cutaneous rash and erup- tion to mesenteric disorganization and dysentery. Should the gum be lanced in these cases ? Who can doubt it ? If you found the painful tension produced by the matter of an abscess keeping up a great constitutional disorder, would you not be justified in letting out the matter with a lancet ? The cases are similar. In many instances of teething, then, the gum-lancet may be used with very great advantage—but Avith greater advantage still may you direct your attention to the temperature of the child's body. When that is hot and burning, when its little head feels like fire to your hand, pour cold water over it, and when you have sufficiently cooled it throughout, it will in most cases go to sleep in its nurse's arms. During the chill-fit, on the contrary you may give it an occasional tea-spoonful of weak brandy and water, Avith a little dill or aniseed to comfort and warm it—having re- course also to friction Avith hot flannel, or to the warm bath. During the period of remission, the exhibition of small doses of quinine, or opium, Avith prussic acid occasionally, will often anticipate the subsequent fits or render them trifling in com- parison Avith those that preceded them. Considerable opposition may sometimes be met Avith on the part of the wiseacres of the profession, when you pro- pose quinine, or prussic acid in infantile disease. I Avas once requested to see the infant son of a gentleman, which had been suffering from convulsions and flatulence. You re- member Avhat I told you of this disease—that infantile con- vulsion depends in every instance upon cerebral exhaustion. It is often the effect of cold, and frequently follows upon a 228 CHRONO-THERMAL purge ; I have known the disease come on after the appli- cation of a leech. " No fact," says Dr. Trotter, " is better known to the medical observer than that frequent convul- sions are a common consequence of the large loss of blood." And you may recollect that in the experiment of the animal bled to death by Dr. Seeds, flatulence and convulsions were among the symptoms produced by the evacuation. But to return to the child in question. Before I saw it, the little thing had been the subject of thirteen distinct convulsive fits, with an interval of remission of longer or shorter duration between each. What do you think was the treatment to which this infant had been in the first instance subjected by the practi- tioner, then and previously in attendance ? Though its age Avas under six months, and the disease clearly and obviously remittent, he had ordered it to be cupped behind the ear,— afraid, as he explained to me, of the old bugbear pressure on the brain! How compatible this doctrine, permanency of cause, with remission of symptom ! The quantity of blood taken was about an ounce, but the convulsions recurred as before. This was the reason why I was called in. The child at that particular moment had no fit—so after taking the trouble to explain the nature of the symptoms to the attend- ing sangrado, I suggested quinine as a possible preventive. The man of cups and lancets stared, but acceded. The qui- nine, however, upon trial proving abortive in this instance, I changed it, according to my custom, for prussic acid—after taking which, the infant was free from fits for a period of at least five or six Aveeks,—when the convulsive paroxysm again recurred—from Avhat cause I know not, unless it might be from a purge Avhich its mother injudiciously gave it on the morning of recurrence. The flatulence, too, with Avhich the child was all along troubled, began to diminish from the moment it took the prussic acid. You may perhaps ask me in what dose I prescribed the acid here. I ordered one drop to be mixed with three ounces of cinnamon water, and a tea- spoonful of the mixture to be given every two hours all that day—so that there is no earthly agent, however powerful, even in a small quantity, that may not, by dilution, or some other mode or diminution, be fined away to any state and strength—to any age or condition of life for which you may be desirous of prescribing it. In this respect medicine resem- bles every thing in nature. Take colours, for example;__the most intense blue and the deepest crimson, by the art of the painter, may each be so managed that the eye shall not detect PRACTICE OF MEDICINE. 229 in his design, a trace of either one or the other. In the case of the infant just mentioned, the dose'of prussic acid Avas about the twenty-fourth part of a drop, and its good effects were very im- mediate and very obvious. Nevertheless, when the attending practitioner came in the morning to see the little patient, then completely out of danger, he Avas so horrified by the medicine which had produced the improvement, that he stated to the family he could not, in conscience, attend with me any longer. He accordingly took his leave of the child he himself had brought into the world, and all because he, a man-midwife ! could not approve of the treatment that saved its life. Yet this very person, without hesitation, let loose all at once the eight lancets of the cupping instrument on the head of the same infant, whose age, be it remembered, was under six months ! Though I will not condescend to name the in- dividual who having so heroically, in this instance, swalloAved the camel, found such a difficulty afterwards in approaching the gnat, I may state for your diversion that he is a very great little man in his Avay—being no less than one of Her Ma- jesty's principal accoucheurs—a proof to you that "court- fools" are as common as ever. Indeed, the only difference I see in the matter is this,—that whereas in the olden times such personages only exhibited in cap and bells at the feast and the revel, they now appear in a less obtrusive disguise, and act still more ridiculous parts on the gravest occasions. One very great obstacle to improvement in medicine has been the very general preference given by Englishwomen to male over female practitioners of midwifery. For by means of that introduction, numbers of badly educated persons not only contrive to worm themselves into the confidence of fa- milies, but by the vile arts to Avhich they stoop, and the col- lusions and conspiracies into Avhich they enter Avith each other, they have in a great measure managed to monopolize the entire practice of physic in this country. And what an infamous business medical practice has become in their hands! To check the career of these people, Sir Anthony Carlisle wrote his famous letter to the Times newspaper, wherein he declared that " the birth of a child is a natural process, and not a surgical operation." NotAvithstanding the howl and the scoavI with Avhich that letter was received by the apothe- caries it is pleasing to see that the public are now beginning to be aware of the fact that more children perish by the med- dlesome interference of these persons, than have ever been saved by the aid of their instruments. How many perish by 20 230 CHRONO-THERMAL unnecessary medicine common sense may form some notion —for the fashion of the day is to commence Avith physic the moment the child leaves the Avomb—to dose every new-born babe with castor oil before it has learnt to apply its lip to the nipple ! Who but an apothecary could have suggested such a custom ? Who but a creature Avith the mind of a mechanic and the habits of a butcher Avould think of applying a cupping instrument behind an infant's ear to stop wind and convul- sions? The nurses and midwives of the last age knew better. Their custom in such cases Avas to place a laurel-leaf upon the tongue of the child. The routinists laughed at Avhat they called a mere old woman's remedy, and declared that it could have no effect whatever; they little knew that its strong odour and bitter taste depended upon the prussic acid it con- tained ! An excellent hint may be obtained from every de- scription of old woman but the old women of the profession —the pedantic doctors, who first laugh at the laurel-leaf as inert, and yet start at the very medicine upon which its vir- tues depend, when given with the most perfect precision in the measured form of prussic acid ! men who, in the same mad spirit of inconsistency, affect to be horrified at the mention of opium or arsenic, while they dose you to death with calomel and colocynth, or pour out the blood of your life as if it were so much ditch-water ! There is such a thing as Hereditary Periodicity. If you take a particular family, and, as far as practicable, en- deavour to trace their diseases from generation to generation, you will find that the greater number die of a particular dis- ease. Suppose this to be pulmonary consumption. Like the ague, which makes its individual revisitations only on given days, you shall find this disease attacking some families only in given generations—affecting every second generation, in one case ; every third or fourth in another. In some families it confines itself to a given sex, while in the greater number, the age at Avhich they become its victims is equally determi- nate—in one this disease appearing only during childhood, in another restricting itself to adult life or old age. By diligently watching the diseases of particular families, and the ages at which they respectively reappear, and by directing attention in the earliest stages of constitutional disorder to those means of prevention Avhich I have in the course of this work so frequently had occasion to point out to you, much might be done to ren- practice of medicine. 231 der the more formidable class of disorders of less frequent occurrence than at present—mania, asthma, epilepsy, and consumption might thus to a certain extent, be made to dis- appear in families Avhere they had been for ages hereditary. But alas! then, for the medical profession, the members of which might in that case exclaim, " Othello's occupation's gone!" [While the second edition Avas in the course of printing I received the three following letters, Avhich as they go far to bear me out in many of my previous observations, may not be deemed by the reader to be entirely out of place here. The first is from Dr. M'Kenzie of Kenellan, in Scotland. " Kenellan, near Dingwall, 24th Feb. 1841. " Dear Sir,— " After studying at Edinburgh, London, and Paris, I grad- uated in 1824, and immediately afterwards received an ap- pointment to the Medical staff of the army. I conceive that, phrenologically speaking, my head is a fair sample of the common run; and during my period of pupilage I had the very best opportunity of acquiring what most people call " medical information." In the military hospital at Fort Pitt I had abundant opportunities of testing its value, yet though I did my best to put into practice the rules and directions which I had so sedulously studied in the schools of medicine, the result of their application was anything but satisfactory to me;. nor did the observations I made on the practice of my comrades mend the matter. The Sangrado system was in full operation. Like my neighbours, I did as I had been taught, but the more I considered the result of our practice, the more convinced I became that we Avere all in the dark, and only tampering with human life most rashly, in a multi- tude of cases. Still I thought it my duty to do as my supe- riors directed, hoping soon to see my way more clearly. In process of time I was appointed to a regiment, with which I served about two years. I then married, and finding that a married man has no business to be in the army, I resolved to embark in private practice, expecting that with the excellent opportunities of becoming acquainted with disease in every form I had possessed in the army, and aided by numerous friends I might rise easily in my profession. I settled m Edinburgh, and became a Fellow of the College of Physi- cians I soon found, however, that in leaving the army for pri- vate practice, 1 Avas " out of the frying pan into the fire;"— 232 CHRONO-THERMAL there were obstacles to success that I had never even dreamt of. In the military hospital I had only to say " do," and it Avas done; and I knew to a nicety the effect of my remedies, for in every instance they were faithfully administered. In private practice all this was changed. There, in order to live like other men by labour, I found it absolutely essential to practice the suaviter in modo on many occasions when the fortiter in re would have been the best for my patients. I therefore felt myself obliged to consider how others managed such matters, and I Avas soon able to divide the medical body into three classes. At the top of the tree I noted here and there a solitary individual whose word was law to his pa- tients. I endeavoured to trace the career of these favoured practitioners, and was grieved at being compelled to think that in few instances had they ascended to their eminence by the ladder of integrity, talent, or real medical knowledge. On the contrary, I Avas compelled to believe that these quali- ties often were a bar to a physician's rise, and that flattery and humbug were far more valuable qualities in the eyes of the Avorld, and, if skilfully practised, would ensure first rate emi- nence. Lower doAvn I found a certain number who, like myself, did their best to retain practice, and preserve the vul- tus ad sidera. But when I looked to the bottom of the tree, I saw around it a host of creatures void of any scruples, de- termined to acquire Avealth,and to act on the ancient maxim, rem sipossis recte ; si non, quocunque modo rem ; [Make money,—honestly if you can ; if not, make money!] men who, void of integrity and all honourable self-respect, looked upon such as differed from them in this point as insane. I cer- tainly was taken quite aback, and looked and better looked in hopes that my senses deceived me; but the more I looked the more was I satisfied, or rather cfossatisfied with the cor- rectness of my views. It was now quite clear that I never should rise in the profession, and that < although bred to physic, physic Avould never be bread to me.' I could not scramble for subsistence at the expense of self-respect, and live upon an ipecacuan loaf In spite of the lamentations of my friends and patients, Avho thought me < getting on so nicely,' Avho were unable to read my real feelings, and at the expense of being ridiculed by many who supposed me actu- ated by foolish pride, &c, I bade adieu to private practice, and turned my lancet into a ploughshare. In short, I took to farming, in which vocation I have now continued for nine years, enjoying a happiness and peace of mind that I think PRACTICE of medicine. 233 few medical men can understand. Among the poor I still keep up a little practice, and occasionally am consulted by my country practising friends, but, like my old lancet, I grow very rusty. Perhaps you will say, so much the better. And now, why have I troubled you Avith all this from an entire stranger ? Simply as a preface to the thanks that I now beg to offer you for the new light that broke upon me on reading your Fallacies of the Faculty, sent me by a non-medical friend. My ideas on physic have been totally revolutionized by it, and I now recall to my mind many cases where I made most fortunate cures accidentally, by following your system, though without any knowledge of the principles of its appli- cation. Most sincerely do I congratulate you on your dis- coveries, and most confidently do I look forward to the day, not distant, when they will be duly appreciated. I have my- self been all but a martyr at the shrine of Sangrado, but no- thing will ever again induce me to part with a drop of blood, so long as it will circulate in the veins of—Your obliged and faithful "J. M'Kenzie, M.D." The next letter is from Dr. Charles Greville of Bath :— "Bath, Feb. 24, 1841. " My Dear Sir,— "I have perused Avith much interest your excellent and original lectures on the Fallacies of the Faculty, and have much pleasure in attesting the truth of your remarks. I have treated numerous cases of disease upon the chrono-thermal principle, Avith perfect success. Should time permit, I will furnish you Avith various instances. I have no doubt the pub- lic will eventually appreciate the superiority of your views, and take its leave of the nefarious apothecary, Avhose exist- ence seems to depend upon the deluging of his patient Avith unnecessary and too often deleterious compounds.—I remain, my dear Sir,—Yours very faithfully, "Charles Greville." The third .letter is from Mr. Henry Smith, a surgeon in very extensive practice at Cheshunt, in Hertfordshire :— « Cheshunt, Feb. 24,1841. " My dear Sir, # ,,,.,. "At a time when your doctrines are so much the subject of discussion, both Avith the profession and the public, the evi- dence of a country practitioner, as to the result of their ap- 20* 234 CHRONO-THERMAL plication in his hands, may not be altogether unacceptable to their author. The first time I heard your name, was about eighteen months ago, when the Hon. Edmund Byng sent your Unity of Disease to my father-in-law, Mr. Sanders. We were both equally struck with the novelty and simpli- city of your views, as there detailed, and we determined to put them to the test. You will be gratified to hear, that nei- ther Mr. Sanders nor myself, from that time, have ever had occasion to use either leech or lancet in our practice, though formerly we felt ourselves compelled to use both. Every day has confirmed us in the truth of your opinions by our increased success. I have treated cases of apoplexy with the most per- fect success with no other means than the application of cold Avater dashed over the head and face—following that up after the fit had gone off with quinine, ammonia, and prussic acid. I have cured all kinds of cases of convulsion by the same treatment; indeed, in the convulsive diseases of children, the prussic acid has been my sheet-anchor. In cases where chil- dren have been apparently still-born, I have succeeded in rousing them by dashing cold water over their bodies. With quinine, and prussic acid, I have treated many cases of croup, and in no instance do I remember to have lost a patient. Many cases of hysteria, and some of epilepsy, have been cured or relieved by creosote, after every other medicine had been tried in vain. I have treated cases of both chronic and acute rheumatism successfully by arsenic. By the tonic prac- tice I have been equally successful in inflammations of the chest and bowels. Before concluding this hasty sketch,permit me to express how thankful and grateful I feel towards you for the light by which you have expelled the darkness in Avhich medicine was formerly so much enveloped by its pro- fessors. Yours, my dear Sir, very faithfully, " Henry Smith." Since the publication of the second edition of this Avork, Mr. Smith confirms his previous statement by a further ex- perience of eighteen months—three years in all—during which he has not used a leech or lancet. I have also received among other communications, the following from H C De- shon, Esq., surgeon :— " Shroton, Blandford, Nov. 10, 1841. " Dear Sir, I have from time to time anxiously waited to hear of the state of health of that beloved relative [his mother] I left under PRACTICE OF MEDICINE. 235 your care, and I am now glad to hear that she considers her- self better. * * ■■•■ I have cured palsy and epilepsy by hydrocyanic acid, quinine, arsenic, &c, and I have also found these medicines of avail in convulsions and dropsies. Indeed, I am confident that most diseases may be cured (I refer to chronic diseases chiefly) by medicines useful in ague, and on your principles, Avith reference to periodicity and tempera- ture. Dear Sir, very truly yours, "Henry C. Deshon." From Charles Trotter, Esq., surgeon:— " Holmfirth, near Huddersfield. " Dear Sir, " Having read your second edition, Fallacies of the Fa- culty, I have been induced in a great number of cases to try the chrono-thermal system of treatment, and I must confess that in very many instances it has exceeded my expectations. I have cured Avhat are termed inflammations Avithout the pa- tient losing a single drop of blood. Very recently I succeeded in bringing a case of peritonitis (inflammation of the mem- branous covering of the bowels) to a favourable result with- out bleeding at all. Several well-marked cases of pneumonia, (inflammation of the lungs,) as well as of pure bronchitis, (inflammation of the air-passages,) have also yielded to medi- cine without any bleeding whatever. And I may at the same time observe, the recovery was in every case quicker, and the consequent weakness less than if blood had been drawn. " Yours truly, " Charles Trotter." From Dr. Fogarty, surgeon of the St. Helena regiment: " London. " My Dear Sir, I have read with the greatest delight your Fallacies of the Faculty. Every Avord ought to be Avritten in letters of gold. " Yours faithfully, " M. Fogarty." From H. W. Bull, Esq., Surgeon R. N. :— a Working ham, February 5, 1843. " Dear Sir, "I beg to forward you a statement of my own case, and one or two cases of others, treated on your plan, all of Avhich are evidence of the value of the chrono-thermal system. I 236 CHRONO-THERMAL was attacked by paralysis on the 28th October, 1841, which deprived me of the use of my right arm and leg, affected the same side of the face, and produced some difficulty of speech. The usual plan was adopted—bleeding, purging, leeching, mercury, and blisters. In this state I crawled on to May, 1841, when I lost more blood to prevent another anticipated attack, goaded on by what you term the bugbear congestion. In this manner I went on, occasionally cupping and purging, and with a very restricted diet. In consequence of all this, I was much reduced, and I became exceedingly Aveak,—the heart palpitated very much on the least motion, and I had in addition, occasional fainting fits. Last May my son sent me some extracts from your work, the Fallacies of the Faculty, the perusal of which induced me a few days after to state by letter the particulars of my case to you. The first prescrip- tion you Avere so kind as to send disagreed ; you then ordered quinine, and this I took with good effect. The shower-bath which you also ordered I found very beneficial. I have fol- lowed the plan laid down by you with very great advantage —changing the different medicines from time to time as oc- casion required; and I can now Avalk two miles without as- sistance. I have not only power to raise my right arm and wave it round my head, but I can lift a weight of forty pounds with it. I am now following the same plan with very good effect; I must confess I was at first startled by a practice so very different from all I had been taught in the schools, but a practice, I can truly say, to which I owe my life. Like Dr. M'Kenzie, nothing will ever induce me to lose a drop of blood again, so long as it will circulate in the veins of "Yours, most sincerely and faithfully, " H. W. Bull, Surgeon R. N." Cases alluded to in the above letter. "Case 1.—Mr. C----was attacked with acute rheumatism in almost every joint, great difficulty of breathing, and vio- lent pain in the chest. I prescribed an emetic, but he refused to take it,—he is a Hampshire man, and almost as obstinate as one of his own hogs. He continued in this state two days more; at last he Avas prevailed on to take the emetic. It ope- rated soon, and gave him instant relief. I followed it up with quinine and colchicum; he is noAv quite well, and has gone to his brother's house, some distance from this. "Case 2.—A girl, twelve years of age, was brought to me PRACTICE OF MEDICINE. 237 from Binfield in convulsive fits. The pupils of her eyes were very much dilated, and the fits followed each other in rapid succession. I first gave her a purgative, and followed it up Avith prussic acid;—this was on a Monday. The fits became less and less frequent, and from the following Friday they en- tirely ceased. I also lately used the prussic acid Avith the best effect in the case of a child seven Aveeks old. "Case 3.—A gentleman lately brought his child, a fine boy, to me for squint; the age two years. Some days the boy squinted less than others. I gave him six powders, contain- ing quinine and a little calomel: no other medicine was pre- scribed. There has been no squint since the powders Avere finished. In many other cases I have followed your plan with the best success. H. W. B." From John Yeoman, Esq., a surgeon in extensive practice at Loftus, in Yorkshire :— "Loftus,Feb. 2, 1843. " Sir, " Hearing that you are about to give us another—a third edition of the Fallacies of the Faculty, I beg now to offer to you my best thanks for the service you have already done the medical profession by the publication of your original doc- trines on disease. Being convinced, from my own experience and observation, that there is a periodicity in most diseases, and that blood-letting is resorted to, as a curative measure, far too indiscriminately, I have read the Fallacies of the Fa- cully Avith very great interest and advantage. With interest, because I have been anxious and ready, for the last two years, to test the chrono-thermal doctrine and remedies fairly, and with advantage, because I have succeeded in a wonderful manner to cure diseases, by acting up to the principles and practice you recommend. I have treated several cases of de- cided pleurisy and pneumonia according to the chrono-ther- mal system, using emetics, purgatives, tartar emetic, prussic acid, and quinine, and without the aid of lancet or blister, most successfully. In croup and typhus fever, I can bear ample testimony to the good effects of emetics, cold affusions, prussic acid, and quinine; and with these agents alone,I have cured several cases of both within the last six months. You are at liberty to make use of these few remarks, to make them known to the profession, or the world, as you please; and wishing you every success in your future efforts, good health, and happiness, I am, sir, yours sincerely, "John Yeoman." 23S CHRONO-THERMAL From J. H. Sprague, Esq., M. D., formerly a medical officer on the staff:— " Clevedon, near Bristol, Feb. 6, 1843. " My Dear Sir, " Having read over and over again your invaluable work, The Fallacies of the Faculty, and having devoted much time to the study of the principles laid down, I am desirous to convey in plain language my sentiments in regard to the immense benefit which would indubitably be conferred on mankind by the general adoption of your opinions and prac- tice. I Avas strictly educated to the medical profession from my youth up, and have been in actual practice for more than thirty-three years—time enough, you will say, to be rooted and grounded in all the prejudices of an age of such superfi- cial thinking as the present. Those prejudices, doubtless, I should have imbibed, and possibly cherished, like many others who know no better, had I not been taught at an early age by my mother, a Avoman of superior sense and discernment, to imitate the example of one whom I am proud to call my ancestor—the immortal John Locke. Her constant advice was, Think for yourself, and never take any man's assertion for proof. Examine before you believe,— "Seize upon truth where'er 'tis found, Among your friends, among your foes, On Christian, or on heathen ground, The flower's divine where'er it grows."—Watts. I have, therefore, through life carefully examined and com- pared effects with their supposed causes, believing nothing upon the mere assertion, or ipse dixit of any authority, how- ever high. It Avas my fortune to be a pupil of the late once popular Dr. Beddoes, at a period when Pneumonic medicine was all the fashion, or in other words, when the inhalation of various gases was prescribed for chest diseases. At that time, it Avas also common to place consumptive patients in cow-houses, to breathe the odour of the animal, then believed to be a specific for that complaint. Beddoes, however, pre- scribed digitalis (foxglove); maintaining that he could cure consumption with that drug, as certainly as he could cure an ague Avith bark. Yet all these things are now candidly allowed to be only specious fallacies. Soon after this origi- nated the doctrine first brought to this country by invalids returning from India, that the liver is the seat of all disease ; and this doctrine my friend and correspondent, Dr. Curry of PRACTICE OF MEDICINE. 239 Guy's Hospital, promulgated to the world as true, in his at- tractive and eloquent lectures ; assuring his numerous pupils, at the same time, that the cure was to be effected by calomel, in scruple and half-drachm doses ! So extensively, indeed, at one time, was this mercurial used through Dr. Curry's influence, that calomel Avas generally known at the drug- gist's shops in London by the name of Curry powder ! Hoav many thousands of lives have been destroyed by the mercu- rius dulcis, or sweet mercury, as calomel Avas once called ! On the subsidence of the Hepatic mania, Mr. Abernethy ap- peared upon the medical stage Avith his blue pill and black draught, which, with decoction of sarsaparilla, Avere long considered as the only remedies required for 'all the ills that flesh is heir to.' Somewhat later, began the rage for profuse bleeding, which with very feAV exceptions, has up to the pre- sent time been zealously advocated by the Avhole medical fraternity. 'The Sanguinary Science,' as you have most appropriately named it, has been, and is still taught and in- culcated in all the English schools of medicine; and sanc- tioned by such authorities, the practice of phlebotomy has spread through the land like a destructive torrent. Whether the doctor entered the rich man's habitation, or the poor man's dwelling, the first Avord was ' You must be bled !' Or if the operation had been performed, the next most important ques- tion to be decided was, ' Has enough blood been taken ?' Among the principal British slaughter-houses, I must reckon the army hospitals. There the living blood was, and is still poured out, as if it were the most pernicious element in na- ture__so much poisonous ditch-water. I recollect a spruce young surgeon, of the 13th Regiment of Foot, with Ayhom I was in garrison in the Island of Jersey, who made it his boast that' when the battalion Avas in Canada, he thought nothing of having seventy or eighty pounds of blood thrown out upon the dung-hill every morning! !' To preserve my credit Avith the Director-General of the Army Medical De- partment, I was of course obliged to follow at a humble distance this terrible practice ; for had not the letters V. S., or Venee Sectio, appeared opposite to the patient's name in my returns to the medical board, I should undoubtedly have been deprived of my commission ; so indispensable Avas the operation considered to be ! But, even at this early period of my life5 °y a judicious use of emetic tartar and other medicines, which I noAV call chrono-thermal remedies, I Avas much more successful in my practice than those who trusted 240 CHRONO-THERMAL almost exclusively to the lancet. A feAV years after the time I refer to, a perusal of the excellent practical treatise of Dr. Balfour led me to adopt the Antimonial treatment. Up to this hour, in this part of the country, the dangerous system of depletion is thoughtlessly persisted in, and the delicate and weakly, as well as the more robust, are every day drained of their life's blood,—the unfortunate patient sinking into a state of exhaustion—and death produced not by disease, but the doctor. But of all the sanguinary projects ever had re- course to, surely there is none so barbarous and cruel as the practice of scalping a patient by a cut of six or seven inches along the upper part of the head, for the purpose of making an issue. I have known cases in this neighbourhood Avhere the patient has rapidly sunk from loss of blood, shortly after the infliction of such an incision ; and other cases in which the bleeding has been so impetuous, that it could only be stopped by means of searing the wound with a red hot iron ! What an idea, to call the practice of illiterate quacks in ques- tion, when medical men are permitted to perform operations so unprofitable ! Lord Ellenborough's act for ' cutting and maiming' surely applies to these tortures of their fellow- creatures. A very clever physician, Avhom I lately had the pleasure of meeting in Devonshire, showed me a preparation of the head of an unfortunate man who had formerly been a patient of his, and who had cancer of the eye. A short time before his decease, the poor man went to Bristol for ad- vice, where his case Avas treated by two medical men, a phy- sician and an oculist, as inflammation of the brain. This patient, by their directions, Avas unmercifully leeched and then cut and hacked, as I have described to you, and he re- turned home with an issue, containing fifteen beans, in his scalp ! after which, he lingered a few weeks, and died of complete exhaustion. Notwithstanding the strenuous and persevering advocacy with Avhich blood-letting has been so universally urged, and that too, in the face of the great de- struction of human life indubitably produced by it, to you, Sir, belongs the honour of triumphantly proving by evidence the most incontrovertible, that 'all diseases which admit of relief can be successfully treated without loss of blood.' And here do I most willingly record my unbiassed testimony to this important truth. Let me further add, that by a course of patient investigation, and much practical experience, I had arrived at the same conclusion before I had the pleasure of perusing your writings. I am therefore bound to acknowledge PRACTICE OF MEDICINE. 241 how highly I value the moral courage which has induced you to promulgate your invaluable opinions, and which, I believe, are built upon an immoveable foundation. In proof of the benefits derived by the application of your principles in my own practice, I annex a few remarkable cases, some of them highly inflammatory, which I have lately cured by the chro- no-thermal treatment, without the loss of a single drop of blood. With a deep sense of obligation to you for the in- formation I have derived from your yarious writings, espe cially, the < Fallacies of the Faculty,' I remain, my dear sir, yours very faithfully, « J, H, Sprague, M. Dr" Cases referred to in Dr. Sprague's letter :— Case 1.—I was suddenly called upon to see the butler of Sir C. A. Elton, Bart., Clevedon Court, who, I was told had brain-fever, and Avas < ramping mad.' On my arrival, I found that a practitioner, previously in attendance, had bled him largely at the arm, and applied leeches to his head, and put him on a low diet. His slate when I saAV him, was one of great danger. He looked wild and agitated,—big head at in- tervals being intensely hot, succeeded by a low sinking pulse, and his skin bedewed Avith clammy perspiration ; he had not slept for seven nights. The case was evidently delirium tre- mens. I immediately ordered the cold dash to the head, which Avas repeated at intervals in the course of the day. Mulled port to be taken occasionally Avith some cordial medi- cine and an opiate. The next day he was effectually relieved, having had six hours' comfortable sleep. A remission of symptoms being thus established, I prescribed quinine, and other chrono-thermal medicines; and at the end ot a fortnight he was so far recovered as to be able to walk a distance ot two miles, much to the surprise of all who heard of his illness, the medical man formerly in attendance having declared that if he did not die, he must become the inmate of a madhouse. He is now doing his duty as butler in good health Case * — A <*irl, aged four, who had been ill four days, was broueht to me, with intense pain of head, and the pecu- liar scream that generally attends inflammatory brain affec- tion She had much fever, with hard and incompressible DUlse—the pupil of her eye was contracted—she was intole- rant of li<*ht, and she had repeated fits of vomiting. Having had her head shaved, cold applications in various forms were employed, a"<* Her feet at the same time, vyere l^cept Ayarm 21 242 CHRONO-THERMAL with hot Avater bottles. An emetic Avas also given, with other medicines, to subdue the fever. In the course of three weeks, this severe case of cerebral inflammation was completely cured, Avithout the loss of a single drop of blood. Under the antiphlogistic plan, such cases usually terminate in water of the head, and death. Case 3.—A child, twelve months old, had croup ; he was hot and feverish, had great difficulty in breathing and cough, with the metallic sound peculiar to that disease. By an emetic twice repeated, followed up Avith quinine, and sulphate of copper, in minute doses, to say nothing of Avarm applications to the throat and other chrono-thermal means, the child re- covered rapidly. Under the old system of leeching, bleeding and blistering, such cases, if the subjects of them survive at all, which is seldom, generally end in along protracted Aveak- ness of body. Case 4.—Miss S----, aged 30, had repeatedly suffered from spitting of blood, for which her physician in Bath had ordered her to be repeatedly bled and leeched. When called upon to see her, she was bringing up considerable quantities of florid blood, and her anxious friends, in the belief that I would bleed her, had the bandage and basin ready for the operation ! I ordered an emetic instead, which at once stop- ped the haemorrhage. This I followed up Avith antimonials and opiates. I then prescribed quinine, and other chrono- thermal medicines, with nutritious diet, directing her chest, at the same time, to be sponged with cold water. In the course of three Aveeks, her health was very greatly improved. In six weeks more, she left Clevedon quite an altered person, and that without any apparent tendency to return of the haemorrhage. Case 5.—Mrs. S----, aged about 38, applied to me for a lancinating pain of the left side, cough, and difficulty of breathing, increased by inspiration, with the other common symptoms of pleurisy. I prescribed an emetic, and having, by means of this, and antimonials in small doses, subdued the more urgent symptoms, I ordered a mustard cataplasm to the chest, and prescribed the usual chrono-thermal remedies, which, in a few days, cured an attack of as severe pleurisy as I ever Avitnessed, and that, too, without the abstraction of a drop of blood in any form. Case 6.—Mr. T----N----, age about 28, from exposure to Avet, Avas seized with severe shiverings, followed by violent fevar, in the course of which the elboAV, Avrist, and ankle PRACTICE OF MEDICINE. 243 joints became so swollen, painful, and agonizing, as to pre- vent his moving in any manner. Emetics, opium, bark, and Avarm fomentations to the affected joints, rapidly produced a cure. Since that attack, he has had much better health than formerly, without any return of rheumatism, to which he was before very liable. Case 7.—H----D----, age about 50, had for years suf- fered from severe pain in the back and limbs, the temperature of his skin being colder than natural. Cupping, bleeding, blisters, &c. had all been tried in his case unavailingly. I prescribed quinine, sulphur, guaiac, and small doses of tur- pentine, which, with a liniment of turpentine and mustard, worked wonders on him. These measures, and an occasional tepid bath, cured him completely in three weeks. The causes of disease, we have already said and shoAvn, can only affect the body through one or more of the various modifications of nervous perception. No disease can arise independent of this—no disease can be cured Avithout it. Who ever heard of a corpse taking the small-pox ? or of a tumour or a sore being healed in a dead body ? A dreamer or a German novelist might imagine such things. Even in the living subject, when nerves have been accidentally para- lyzed, the most potent agents have not their usual influence over the parts which such nerves supply. If you divide the pneumogastric nerves of a living dog—nerves which, as their name imports, connect the brain with the lungs and sto- mach—arsenic will not produce its accustomed effect on either of these organs. Is not this one of many proofs that an exter- nal agent can only influence internal parts banefully, at least, by means of its electric power over the nerves leading to them? Through the same medium, and in the same manner, do the greater number of our remedial forces exert their salutary in- fluence on the human frame. But whether applied for good or for evil, all the forces of nature act simply by attraction or re- pulsion' The brain and spinal column—the latter a prolon- gation of the former—are the grand centres upon Avhich every medicine sooner or later tells, and many are the avenues by which these centres may be approached. Through each of 244 CHRONO-THERMAL The Five Senses^ the brain may be either beneficially or baneftilly influenced. Indeed, take away these, Avhere would be the joys, sorrCAVs, and more than half the diseases of mankind ? We shall first speak of sight. The yiew of a varied and pleasant country may, of itself, improve the condition of many invalids—while a gloomy situation has too often had the reverse effect. There are cases, nevertheless, in which pleasant objects only pain and distract the patient by their multiplicity or brightness. Night and darkness, in such cir- cumstances,- have afforded both mental and bodily tranquillity. The presence of a strong light affects certain people with headache; and there are persons to Avhom the first burst of sunshine is troublesome, on account of the fit of sneezing it excites. A flash of lightning has caused and cured the palsy. LeenneC mentions the case of a gentleman who, AVhen pur- suing a journey on horseback, suddenly arrived at an exten- sive plain. The view of this apparently interminable waste affected him with such a sense of suffocation that he was forced to turn back. Finding himself relieved, he again at- tempted to proceed ; but the return of the suffocative feeling forced him to abandon the joUrney. The common effects of gazing from a great height are giddiness, dimness of sight, with a sense of sickness and terror; yet there are individuals who experience a gloomy joy Upon such occasions; and some become seized with a feeling like what we suppose inspira- tion to be—a prophetic feeling that leads them to the utter- ance and prediction of extravagant and impossible things. Others again under such circumstances, have an involuntary disposition to hurl themselves from the precipice upon which they stand. Sir Walter Scott, ih his CoUnt Robert of Paris, makes Ur- sel say, " Guard me then, from myself, and save me from the reeling and insane desire which I feel to plunge myself in the abyss, to the edge of which you have guided me.'* Every kind of motion upon the body may affect the brain for good or for evil; and, through the medium of the eye, novel motion acts upon it sometimes very curiously. You have all experienced giddiness from a few rapid gyrations, Every thing in the room then appears to the eye to turn round. If you look from the window of a coach in rapid motion, for any length of time, you will become dizzy. The same thing produces sickness Avith some. Many people be- PRACTICE OP MEDICINE. ■Mo come giddy, and even epileptic, from looking for a length of time on a running stream; with others, this very stream gazing induces a pleasurable reverie, or a disposition to sleep. Apply these facts to animal magnetism—compare them with the effects of the manipulations, so called, and you will have little difficulty in arriving at a just estimate of their nature and mode of action. What is animal magnetism ? It con- sists in passing the hands up and down before the eyes of another slowly, and with a certain air of pomp and mystery ; now moving them this way, now that. You must, of course, assume a very imperturbable gravity, and keep your eye firmly fixed upon the patient, in order to maintain your men- tal ascendancy. On no account must you allow your features to relax into a smile. If you perform your tricks slowly and silently in a dimly-lit chamber, you will be sure to make an impression. What impression?—Oh ! as in the case of the stream-gazer, one person will become dreamy and entranced, another, sleepy, a third, fidgety, or convulsed. Who are the persons that, for the most part, submit themselves to this mummery ? Dyspeptic men and hysteric Avomen—weak, curious, credulous persons, Avhom you may move at any time by a straw or a feather. Hold up your finger to them and they will laugh ; depress it, and they will cry ! So far from being astonished at anything I hear of these people, I only Avonder it has not killed some of them outright—poor fragile things ! A few years ago I took it into my head to try this kind of pawing in a case of epilepsy. It certainly had the effect of keeping off the fit; but what hocus-pocus has not done that ? I have often done the same thing with a stamp of my foot. In a case of cancer upon Avhich I tried the "passes," as these manipulations are called, the lady got so fidgety, I verily believe, if I had continued them longer, she would have become hysterical or convulsed! That effects remedial and the reverse, however, may be obtained from them, I am perfectly satisfied. Nor do I mean to deny that in a few__a very few instances, these, or any other monoto- nous motions, may produce some extraordinary effects— effects which, however, are the rare exception instead of the general rule. Whatever any other cause of disease may produce on the human body, these manipulations may by possibility occasion—somnambulism, catalepsy, or Avhat you please. There is no more difficulty in believing .this, than there is difficulty in believing that the odour of a rose, or the 21* 2-4 r, rHRONO-THERMAL sight of a cat will make certain people savooii away. Thi? much then I am disposed to admit.—But when the animal magnetizers assert that the senses may be transposed,—that the stomach may take the office of the eye, and render that beautiful organ Avith all the perfect but complex machinery by which it conveys light and shadow to the brain, a work of supererogation on the part of the Creator, I turn from the subject Avith feelings of invincible disgust. If it be objected that the magnetizers have produced persons of both sexes, Who with their eyes closed and bandaged read a book placed upon their stomach, by means of that organ, through waist- coat, body-laCe, and heaven knows what all!—I reply, that the charlatans of all countries, every day perform their tricks Avith a swiftness that altogether eludes the unpractised eye. Thousands of persons have seen the Indian juggler plant a mango-stone in the ground, and in the course of a few min- utes do what nature can Only do in the course of years, make it successfully produce a plant With leaves, blossoms, and lastly fruit! How this trick is done, the witnesses who de- scribe it know no more than I how the magnetizers perform their juggleries; but few who have seen the Indian trick believe in the reality of any one of the various transforma- tions with which their eyes have been cheated. The trans- position of the senses, is only an old whimsy, newly dressed up under the name of "clairvoyance." We read in Hudi- bras of " —-—'-^----Itosicrtician virtuosis Who see with ears and hear with noses ^ The greater part of the influence of external impressions upon the eye, as upon other organs, depends upon noVelty solely, for pomp and pageantry affect the actors and the spectators in exactly opposite Ways. With What different feelings* for example, the courtier approaches his sovereign, from a person newly " presented.*' The one, all coolness, looks only for an opportunity of improving his advantage, Avhile the other's only care is not to niake a fool of himself. How different the effect of a punishment parade upon the raw recruit and the old soldier ! In a regiment of veterans, a thousand strong, not a man will mo\te from his place__not a countenance shall change its cast or hue, Avhile lash follows lash, and the blood flows in streams from the back of the cul- prit. The same scene enacted before a body of neAvly enlisted PRACTICE OF MEDICINE. 247 lads of equal numerical strength, will alter the expression of every face ; nay, a dozen or more will drop, some fainting, some vomiting, some convulsed and epileptic. A medical student of my acquaintance, the first time he saw an ampu- tation', not only fainted, but lost his sight for nearly half an hour; yet the same student afterwards became celebrated for his manual dexterity, and the coolness and steadiness Avith Which he performed his amputations. To Use a vulgar phrase ■—familiarity breeds contempt. How awkward most persons feel AVhen, for the first time, they experience a ship's motion at sea. The young sailor, like the young surgeon, soon gets cured of his squeamishness ; for the disposition to be sea-sick Vanishes after a voyage or two. Now all this ought to con- vince you of the necessity of changing your remedies in dis- ease ; for what will produce a particular effect one day will not always do it another. With the body, as with the mind, novelty and surprise works Avonders. Do you require to be told that you can influence the whole corporeal motions through the organ of hearing ? I have stopped the commencing epileptic fit by simply vociferating in the ear of the patient. The atoms of the brain, like the atoms of other parts, cannot do two things at once; they cannot, at one and the same moment of time, maintain the state of arrest which constitutes attention, and the state of motion on which the epileptic convulsions depend. Produce cerebral attention in any way you please, and there can be no epilepsy. In this way, a word may be as efficacious as a medicine. Certain sounds, on the contrary, set the teeth on edge. The influence of melody upon the diseases of mankind was so fully believed by the ancients, that they made Apollo the god both of medicine and music; but sweet sounds, like other SAveets, are not sweet to every body. Nicano, Hippo- crates tells us, swooned at the sound of a flute ; Avhat would he have done had he been obliged to sit out an opera ? Many people are melancholy AVhen they hear a harp ; yet the melancholy of Saul was assuaged by David's harping. Some persons become furious Avhen a fiddle plays, « And others, when the bagpipe sings i' the nose, Cannot contain their urine,—for Affection, Mistress of Passion, sways it to the mood Of what it likes or loathes."—Shakspeahe. Everybody has heard of the wonderful effects of the Ranz 248 CHRONO-THERMAL des Vaches—that air which, according to circumstances, may either rouse the Switzer to the combat, or stretch him hopeless and helpless upon the sick-bed from which he shall rise no more. Oh ! these national airs have marvellous effects Avith many people! I have known them produce and cure almost every disease you can name ; but their influence in this case greatly depends upon association. Captain Owen had more faith in an old song as a remedy for the tropical fever, from Avhich his crew suffered, than in all the physic prescribed for them by the ship's surgeon. The singing of a long remembered stanza, he assures us, would, in a minute, completely change for the better the chances of the most desperate cases. Upon what apparently trifling things does not life itself often turn !— "----------It may be a sound, A tone of music, summer's eve or spring— A flower, the wind, the ocean, which shall wound, Striking the electric chain with which we are darkly bound."—Brnosr. How strangely some people are affected by Smell. Who that had never seen or experienced it, would believe that the odour of the rose could produce fainting ? or that the helio- trope and the tuberose have made some men asthmatical ?— There are persons who cannot breathe the air .of a room con- taining ipecacuan, Avithout suffering from asthma. The smell of musk, so grateful to many people, sickens some. An odour, in certain cases, may be as good a cordial as wine : every old woman knows the virtue of hartshorn and burnt feathers. I am almost afraid to speak of Taste, for, you know, de gustibus non est disputandum. Might not the red Indian, Avhen taunted for devouring vermin, retort upon the " Pale- face" for his mite-eating propensity ? The Esquimaux, Avho rejects sugar with disgust, esteems train-oil a luxury; but, though he prefers a tallow candle to butter, he has as perfect a taste for whiskeyas any Irishman among us—that is, before Father Matthew and temperance societies became the rage.__ How you Avould stare to see aman,in his senses,che wing quick- lime ; yet I have seen some hundreds at a time doing that. I allude to the practice of the Asiatics, Avho first Avrap up a little portion of lime in a betle-leaf, and chew both, as our sailors do tobacco. Now, that very tobacco-chewing has always seemed to me an odd taste, and I do not Avonder that fine ladies have sickened at the sight of a quid. Was there PRACTICE OF MEDICINE 249 ever sdch a fancy as that of the Chinese, who eat soup made of birds' nests ! Morbid in the first instance, such tastes, like other diseases, spread by imitation or contagion. In the West Indies, the negro is liable to a peculiar fever, called, from the avidity with which he devours clay, Mai d'Estomac. His Avhole sensations then are, doubtless, more or less de- ranged. What extraordinary likings and longings ladies in the family way often take ! Some will eat cinders, some have a fancy for rats and mice, and some, like Frenchmen, take to frog-eating! I remember reading of a lady who paid fifty pounds for a bite of a handsome young baker's shoulder; the same lady went into hysterics because the poor fellow would not permit her to take another, at any price. If many will smile, and feel incredulous at this—how will they receive Avhat I am now going to tell ? While I was myself studying at Paris, some fourteen or fifteen years ago, a woman was tried for decapitating a child, When asked her motive for a crime so horrible, she replied, " Venvie d'unefemme grosse." Well, now, I think we have had quite enough of Tastes— Ave shall therefore say something of Touch. You Avill tell me, perhaps, not to trouble you on that subject;—no great good or ill can happen from a touch, you will say. But here you are mistaken: many curious and even dangerous affec- tions may originate in touch simply, provided it be of a novel or unusual kind. Touch the white of the eye, however lightly, with your finger, or a feather, and you shall have pain that may last an hour. The application of either the one or the other to the throat or fauces may vomit you as effectually as tartar emetic or ipecacuan : every nurse knows that. A bristle introduced, in the softest manner, into the nose or ear, has thrown some people into fits. Then what extraordinary effects may sometimes follow the most painless touch of the bladder by a catheter or a bougie. I do not know Avhat other medical men have seen, but I have over and over again wit- nessed ague, epilepsy, faint, vomit, and diarrhoea, all from the mere introduction of the catheter or bougie ; and I have even traced rheumatism and eruptions to the same operation. All knoAV the effect of tickling. Now what is tickling but a suc- cession of short touches? And see how wonderfully it affects most people !—some men may be driven mad by it. Though it has been carried so far, in some cases, as to have produced convulsions, and even death itself, Mr. Wardrop actually found it efficacious in some convulsive affections. I have al- ready given you instances where the mere application of a 250 CHRONO-THERMAL ligature to the arm or leg arrested the fit of mania, epilepsy, &c. Now the influence of that apparently trifling application depends upon the cerebral attention Avhich it excites through the double influence of sight and touch. As I hinted before, the lancet has often got the credit for the good effects pro- duced by the bandage. Fear of the operation may also, on some occasions, have aided its efficacy. How many virtues were, at one time, attributed to a king's touch!—how many more are still believed to attach to the touch of relics—the bones, rags, and other rattle-traps of saints! Priests and princes, you have by turns governed mankind—justly and well sometimes—more frequently you have deluded and de- ceived them. If the credulity and weakness of the masses have, in most cases, been your strength, here at least the dupe has not always been a loser by the deceptions you practised. The emotions of faith and hope Avhich your mummery in- spired, by exciting new revolutions in the matter of the brain, have assuredly alleviated, and even cured, the sufferings of the sick. Strange infatuation of mankind,—with whom, where truth fails, imposture must succeed ! In what does the adult differ from the infant—gullible man, who gives his gold for an echo, from the child who caresses its nurse when tell- ing lies to please it ? Ignorance in degree makes the only difference. Let us now inquire into the manner in Avhich the human frame may be influenced through the medium of The Passions. What are the Passions ? Grief, Fear, and Joy—what are these ?—are they entities or actions—the workings of demons within, or corporeal variations caused by impressions from without ? Have not the Passions all something in common, some features or shades of feature so precisely the same as to form a bond of unity by which they may be all linked to- gether ? Are not the resemblances, in many instances, so very close that you could not tell one from another > A per- son is pale in the face, his lip quivers, his whole frame trem- bles or becomes convulsed. Is this fear, rage, love, or hate ? May it not be the effect of a change of temperature simply ? Badly when on the scaffold, was taunted by the bystanders with trembling. Yes, he replied, "but it is with cold" You are pale, sir; your fears betray you." « If I am pale it is with astonishment at being accused of such a crime >" ' You blush, madam, you are ashamed of yourself " «par don me, sir, it is your audacity brings the redness of ra^e to PRACTICE OF MEDICINE. 251 my cheek." You see, then, hoAV like the passions are to each other, and how difficult it is to guess at the causes of them from mere appearance. Like the various diseases of which we have had occasion to speak, the mental emotions, or rather the corporeal actions so called, have all been associated with particular organs and secretions. Their very names have changed with the changes in medical doctrine. Who among you would dream of placing grief in the liver ? That the ancients did so, is evident by the name they gave it—melancholy literally signifies " black bile." Envy or spite we still call the "spleen," and when a person is enraged, Ave say " his bile is up." Europeans place courage, benevolence, and fear, in the heart,—the heart, Avhich has quite enough to do in the performance of its own proper office, namely, that of a vessel to circulate the blood through the system! The Persians and Arabs associate fear, courage, and benevolence with the liver: " white-liver," is their 'term for a coward. Shakspeare uses the word lily- livered in the same sense. People often speak of temperament, and professors of phi- losophy tell us there are four kinds. If a man is hasty or violent, his temperament is said to be choleric, or bilious; if mentally depressed, melancholic, or black bilious; if of a joyful and happy turn of mind, he is of a sanguineous, or full-blooded temperament; if apathetic or listless, the tem- perament is phlegmatic--a word somewhat difficult to trans- late, inasmuch as it originated in a fanciful phantom, which the ancients believed to be an element of the body, and which they termed " phlegm." Some add another temperament, Avhich they call leuco-phlegmatic, or white phlegm. I won- der they never took the saliva to distinguish a temperament; surelv the "salivous temperament" would be quite as rational as the " bilious." What then are all these temperaments— so far at least as their nomenclature goes, but pretty gibber- ish ?-mere sounds, in fact, invented by ignorant knavery to cheat still more ignorant folly; or, in the words of Home Tooke " an exemplar of the subtle art of saving appearances and of discoursing deeply and learnedly on a subject with which we are perfectly unacquainted " It never occurred to The sophists of the schools that man's mental dispositions, like his corporeal attributes, are every day altered by time and circumstance. Need I tell you, that disease has made the bravest man quake at his own shadow, and turned the most joyous person 252 CHRONO-THERMAL into a moody and moping wretch ? When the doctrines of the Humoral School prevailed, the Avord temperament gave way to humour, and good and bad humour took the place of cheerful and sulky temper. We are in the daily habit of speaking of "the spirits." We say " low spirits," and "high spirits;" which forms of expression may be traced to the period Avhen physicians Avere so ignorant as to suppose that the arteries, instead of carrying blood, contained air or " spi- rits," from spiritus the Latin for breath or air. That Avas the reason Avhy these blood-vessels Avere first called aer-teries. The confusion which pervades all language has materially im- peded our knowledge both of the physical and moral man. Locke must have felt this Avhen he said, " Vague and insig- nificant forms of speech, and abuse of language, have so long passed for mysteries of science, and hard or misapplied Avords, with little or no meaning, have, by prescription, such a right to be mistaken for deep learning and height of specu- lation, that it will not be easy to persuade either those Avho speak or those Avho hear them, that they are but the covers of ignorance and hindrances of true knowledge." " We cannot entertain a doubt," says Sir H. Davy, " but that every change in our sensations and ideas must be ac- companied with some corresponding change in the organic matter of the body." Through the medium of one or more of the five senses must some external circumstance first ope rate on that part of it called the brain, so as to change the existing relations and revolutions of its atoms, before there can be Avhat we term a passion. Whatever shall alter the cerebral atoms must alter the actions of every part of the body—some more, some less. According to the prominence and locality of one set of actions or another, do we for the most part name the passion. The jest that will make one man laugh may enrage another. What are the features com- mon to all passions ?—Tremor, change of temperature, change of secretion. Do not these constitute an ague-fit ? Shakspeare,with his accustomed penetration, speaks of "this ague-fit of fear," and he stretched the analogy even to the world around him :— " Some say the earth was fevered and did shake," Hate and love are equally remarkable for their ague-like changes. You remember what Hudibras says of love__that it is only an ague fit " reversed." The same may be said of hope, joy, and rage; for \n all these passions the " hot fit PRACTICE OF MEDICINE. 253 takes the patient first." That at least is the general effect of them, but in particular instances, as in the real ague, coldness and pallor usher in every one of those passionate fits. I care not what be the nature of the passion, joy, grief, or fear—the constitutional circle of actions is still the same; differing, where they do differ, in shade, place, and prominence solely —but in no greater degree than one fever differs from ano- ther. Moreover, there is no constitutional affection Avhich these passions may not excite or cure. In this respect, also, they resemble the ague, that type of every disturbed state, whether of man the microcosm, or the globe he inhabits. We have already, to a certain extent, demonstrated the influ- ence of particular passions in the production of certain dis- eases. We have further proved that the same morbid actions which we recognize under so many different names, Avhen arising from a blow or a poison, may be equally the result of a mental impression : we have established their absolute identity by curing them with the same physical agents. The history of medicine, on the other hand, presents us Avith in- numerable instances of the beneficial agency of these very passions in every kind of disorder, whatever may have been the nature of the primary cause. Faith, confidence, enthu- siasm, hope, or rather the causes of them, are as powerful in the cure of the sick as any remedies Ave possess. Not only, like bark or Avine, do they often produce a salutary excite- ment, or mild fever, sufficient to prevent the access of the most malignant diseases—but, like these agents, they have actually arrested and cured such diseases after they had fairly and fully commenced. A stone, or ring Avith a history real or supposed, a verse of the Koran or the Bible sewn in a piece of silk—these worn, now on one part of the body, now on another, have inspired a mental firmness and induced a corpo- real steadiness which have enabled the Avearer to defy the united influence of epidemic and contagion. If the Arabs have still their talismans, and the Indians their amulets, the Western nations have not ceased to vaunt the cures and other miracles effected by their relics, their holy Avells and holy water. When Ave boast of the success of a particular measure, avo say it acted like a charm. What is a charm ?—Avhence its origin ? It is a corruption of the Latin Avord carmen, song or verse. In all times, and in all countries, there have bejn men Avho have found their advantage in playing upon the ignorance of their fellow-men; he that Avould appear Aviser than another has always had recourse to some kind of im- 22 254 CHRONO-THERMAL posture; and as priest, poet, prophet and physician Avere of ten united in one person, it was not wonderful that such per- son should clothe his mummery and mysticism in verse. To be able to read or spell was, at one time, a mark of superior wisdom,and he Avho could do so had only to mutter his "spell" to cure or kill. From the earliest antiquity, we find charms a part of medical practice; Homer in his Odyssey, introduces the sons of Autolycus charming to stanch blood; the physi- cians of Egypt and India are to this day charmers; the north men composed Rhunic rhymes to charm away disease. In- deed, with the Norwegians and Icelanders verse or song Avas supposed to be all-powerful; one of their poets thus ex- presses the belief of his time and country in this respect. " I know a song by Avhich I can soften and enchant the arms of my enemies and render their weapons harmless. I knoAV a song which I need only to sing when men have loaded me with bonds; for the moment I sing it, my chains fall in pieces, and I walk forth at liberty. I know a song useful to all the children of men; for as soon as hatred inflames them I sing it, and their hate ceases. I know a song of such virtue, that I can hush the winds with it, and subdue the storm to a breath." Such Avas the origin of Enchantment, or Incanta- tion, terms borrowed from the Latin verb, canto, I sing. With the Jews, the simple enunciation of their mystical word, abracalan, was sufficient to inspire the confidence that baffled disease; nay, Quintus Severinus Simonicus vaunted his suc- cess in the cure of the hemitritic fever, by pronouncing mys- teriously the Avord, abracadabra, a phonic combination of his own invention ! At this very hour the Caffre rain-maker, the Cingalese devil-dancer, and the Copper Indian sorcerer, with their charms and chaunts, are enabled to work changes in the bodies of their several countrymen that put the boasted science of the school-men to shame. That these act by inspir- ing confidence simply may be seen from what took place in 1625, at the seige of Breda. " That city, from a long siege, suffered all the miseriesthat fatigue,bad provisions,and distress of mind could bring upon its inhabitants. Among other misfor- tunes, the scurvy made its appearance, and carried off great numbers. This, added to other calamities, induced the gar- rison to incline towards a surrender of the place, when the Prince of Orange, anxious to prevent its loss, and unable to re- lieve the garrison, contrived, however, to introduce letters to the men promising them the most speedy assistance. These Avere accompanied Avith medicines against the scurvy, said to be of great price, but of still greater efficacy; many more Avere PRACTICE OF MEDICINE 255 to be sent them. The effects of the deceit Avere truly aston- ishing. Three small vials of medicine were given to each physician. It was publicly given out that three or four drops were sufficient to impart a healing virtue to a gallon of water. [Mark this, Homoeopathists !] We now displayed our won- der-working balsams. Nor even were the commanders let into the secret of the cheat upon the soldiers, They flocked in crowds about us, every one soliciting that part may be re- served for his use. Cheerfulness again appears in every coun- tenance, and an universal faith prevails in the sovereign vir- tues of the remedies. The effect of this delusion was truly astonishing; for many were quickly and perfectly recovered. Such as had not moved their limbs for a month before, Avere seen walking the streets Avith their limbs sound, straight, and whole! They boasted of their cure by the Prince's remedy."—[Ives9 Journal, 1744.] And AvhatAvas this remedy? —a mere sham medicine. After this, do I require to caution you, Avhen you visit your patients, not to put on a lugubrious or desponding look before them. Such conduct on the part of a medical man is unpardonable; yet there are practitioners so base and sordid as to make it a part of their policy to re- present the malady of eVery patient as dangerous. These find their profit in croaking; for it is a course of conduct that almost infallibly contributes to keep up disease. To God and their consciences I leave these men.* Such of you as might be disposed to question the depress- ing influence of a long face upon the sick, may read the history of Lord Anson's voyages Avith profit. There you will find it recorded," that whatever discouraged the seamen or at any time damped their hopes, never failed to add new vigour to the distemper, the scurvy, for it usually killed those Avho were in the last stages of it, and confined those to their hammocks who Avere before capable of some kind of duty. And this is in perfect accordance with the observation of Solo- mon, that " a merry heart doeth good like medicine, but a broken spirit drieth the bones." Let me, therefore, counsel you not only to assume a cheer- ful look in the presence of the sick, but endeavour at the same time, in Byron's Avords, " To render with your precepts less The sum of human wretchedness, And strengthen man with his own mind." • What have the alarmists among the doctors in Philadelphia now to say of their conduct during the cholera of 1332? How many did their long faces killl 256 CHRONO-THERMAL What are all your trumpery pathology and dissecting-room knowledge compared Avith this ? You may dissect dead bodies for twenty years and never be one whit the wiser on the mode of influencing the motions of the living. Now, this brings to my mind certain lines of a cotemporary poet, the celebrated Beranger; but as some may not understand the French language, I shall offer no apology for giving his sentiments in my own not over poetical English :— " Was ever such.an ass as that Who hoped by slicing mutton-fat, And pulling candle-wicks to pieces, To tell why light should spring from greases? Yes one—that still more precious fool, Who in the anatomic school Expected with dissecting knife To learn from death the laws of life! Ha! ha ! I'd rather beg some old Domestic nurse to cure my cold, Than trust to such pedantic brain To wake my lamp's low flame again!" But seriously, I have knoAvn a great many first-rate anato- mists in my time; yet there are old women Avho never saw the inside of a dead body, whom I would sooner consult in my own case than any of these hair-splitting gentry. These men are mere geographers, Avho will point out rivers and towns, if 1 may say so—corporeal hills, dales and plains,—but Avho know nothing of the manners, customs, or mode of in- fluencing the animated atoms constantly entering into and departing from them. If any such mechanical-minded creature presume hereafter to mystify vou on this point, tell him to watch the Avounded of contending armies; and ask him to explain to you Avhy the same description of injuries Avhich heal with rapidity Avhen occurring in the persons of the victors, too often prove intractable, or even fatal, to the vanquished ! He might dissect their dead nerves as clean as he pleased, and never find out that the living body of man may be either weakened or strengthened through the medium of his own mind. The depressing poAver of grief is familiar to every body ; but there are cases where a reverse effect may take place from it—and Shakspeare with his usual accuracy, explains the reason of this. r "In poison there is physic—and these news, Having been well, that would have made me sick Being sick, have in some measure made me well • ' And as the wretch, whose fever-weakened limbs ' PRACTICE OF MEDICINE. 257 Like strengthless hinges buckle under life, Impatient of his fit, breaks like a fire Out of his keeper's arms, even so my limbs, Weakened with grief, being now enraged with grief, Are thrice themselves." The strength imparted to the constitution in cases of this nature, has a relation to the novel atomic revolutions caused by desperation ; or that determination to act in an energetic manner, which so often comes upon a man in his extremity. Such reaction resembles the glow that succeeds the sudden shock of a cold shower-bath. There are persons whom a slow succession of petty misfortunes would worry to death ; but who, on sudden and apparently overwhelming occasions, become heroes. It Avill be readily admitted by all who have profited by their experience of life, that one half the Avorldlive by taking advantage of the passions and prejudices of the other half. The parent of prejudice is ignorance; yet there is no man so ignorant but who knows something which you or I may not know. The Avisest judges haA^e played the fool sometimes from ignorance ; they have allowed themselves to be gulled by individuals of a class they despise. Poor, decrepid, ih- educated females calling themselves witches, have imposed upon the ablest and most learned men of a nation. Lord Bacon and Sir Mathew Hale, for example, believed in witch- craft ; nay, the latter judge went so far as to sentence to death wretches supposed to be convicted of it, and they were exe- cuted accordingly. Samuel Johnson was a believer in ghosts, and the second-sight. Where, then, is the country so en- lightened that, upon some points, the wisest and best may not be mystified? If such a country exists, it must be this at the present moment; if there is a profession in which deception is never practised, it must be medicine Happy land! happy medicine! where all is perfect and pure- where the public are neither cheated by an echo nor led by a party for party interests. Here collegiate corruption is un- known, and corporate collusion is a mere name ; here Ave hav^no diploma? or certificates to buy-no reviewers to bribe -no humbug schools-no venal professors; here having no mote inTir wn medical eye, we can the better distinguish Td p ck out that of our neighbours. Who wil doubt our superioi'y in this respect over all the other nations of the pZb" Or who will question me in what that excellence nrincipally consists ? Scapegrace, sceptic, read Dr. Hawkins read Dr Bisset Hawkins' Continental Travels-and you will 2 5S CHRONO-THERMAL there find it recorded, that the brightest feature of British medicine—the most distinguishing point of excellence in English treatment—is the copious blood-lettings Ave practise. " The neglect of copious blood-lettings," quoth Hawkins, " is the great error of the continental hospitals!" Let us laugh, then, at the do-little " medecine expectante" of the French, ridicule the do-nothing homoeopathy of the Germans, and turn up our lip in derision at the counter-stimulant doctrine of the Italians. What are the greatest medical pro- fessors of the continent, in comparison with our own meanest apothecaries even—to say nothing of our leading surgeons and physicians—presidents and vice-presidents of learned societies ! Only look at the number of scientific bodies to which these little great men belong—you will find their names enrolled in every (so called) literary and scientific institution throughout the country—astronomical—botanical —geological—antiquarian—royal! Amiable and respectable persons ! worthy of the carriages in which you ride, and the arms you bear; you are gentlemen—friendly and disinter- ested gentlemen; you owe your elevation to your own in- dustry ; you preserve your position by your incorruptible honesty; you recommend yourselves and each other, neither by letter nor affection, but upon the score of talent and integ- rity solely ; you are all honourable men. Unlike the " hon- ourable members" of a certain honourable place, who have been purchased, you, the members of an equally " honour- able" profession, are unpurchaseable ! This your colleges and coteries declare—this, the discriminating Avorld believes and echoes. Who but the reptiles—the few that never think, never reflect—would answer, all is not gold that glitters! What is the difference betwixt a guinea and its counterfeit ? Do not both sparkle Avith equal brightness ? Have they not the same metallic impress, the same form, the same exterior colour ? Can the eye detect the imposture ? No ! it is only by comparative trial of their respective weight and ring that you can make out the difference. Do you think mankind are to be judged in any other way than this ? Is it not as necessary for a person to be a successful cheat, that he should borrow the exterior of Avorth and integrity, as it is for Jhe counterfeit guinea to bear the name and livery of the coin it purposes to be, before it can pass for genuine. Be not, then, satisfied Avith fine names and appearances only ; do not take men for Avhat they pretend to be solely by their manner or title__be- cause they are doctors of this college, or professors of that PRACTICE OF MEDICINE. 259 university. What is a professorship but a place ? " He Avho has the best talents for getting the office, has most commonly the least for filling it; and men are made moral [medical] and mathematical teachers by the same trick and filthiness with which they are made tide-waiters and clerks of the kitchen." —Sydney Smith. Depend upon it, professors thus elected, will always stand by each other—right or wrong, they will always support the same system. In this, they do no more than the members of the swell-mob, who Avork together by coterie and collusion. Like these professors too, they are all very respectable in their appearance, some of them doing business in a carriage even ! Where is the individual that has not his moral as well as his physical weakness ? Upon this point at least, Ave are all liable to be overreached. Here we are every One of us im- becile as the infant; for we are placed as completely at the mercy of the charlatan, as the child is at the disposal of the parent, whose mental ascendancy he acknowledges. Speak |o the prattler of the "haunted chamber," his countenance instantly falls. With the adult, assume an air of mystery, mut- ter darkly and indefinitely, and mark how his brain will reel. Is he sane ? he becomes your tool. Has he come to you in his sicfeiess? you gull him and guide him at your pleasure. But how can you wonder at the effect of this kind of agency on individuals, when you have seen a Avhole nation similarly hoodwinked by a coterie of doctors ? I allude to what was done when the cholera first appeared in England. The influ- ence of fear, in disposing to spread an epidemic, you know; the effect of confidence in strengthening the body against its attacks, you also knoAV. What was the conduct of the Col- lege of Physicians Avhen the cholera broke out ? Did they try to allay the alarm of the masses ? did they endeavour to inspire them with confidence and hope, that their bodies might be strengthened through their minds? No! they publicly, and by proclamation, declared the disease to be contagious ; without a particle of proof, or the shadow of a shade of evi- dence, they solemnly announced that, like the small-pox, it Avas communicable from man to man ! That Avas the signal to get up their cholera boards; and cholera bulletins, forsooth, must be published. I had just then returned from India, where, though I had seen more cases of cholera than all the Fellows of the College put together, I never heard of cholera contagion; no, nor cholera boards. In the barbaric East, the authorities, civil, military, and medical, acted Avith firm- 260 CHRONO-THERMAL ness: what they could not arrest they awaited with fortitude ; they placed themselves and those committed to their care at the'mercy of the great Disposer of events; Avhile in England, enlightened England, the leading lawgivers, under the influ- ence of the leading medical men, introduced acts that dis- grace the statute book, and permitted medical jobs to be got up that did any thing but honour to the medical profession. A neAV tax was actually levied to defray the salaries of their cholera boards ! The consequences of these measures might have been foreseen. Throughout the country universal panic Avas spread and universal gloom prevailed. The rich shut themselves up in their houses, each in terror of his neigh- bour's touch ; the middling classes suffered from the general stagnation Avhich ensued in consequence, for every trade, but the drug-trade, languished or stood still; and the poor when taken ill—for the disease was chiefly confined to that class— were by act of Parliament, dragged from their homes, and conveyed to cholera hospitals,—where, if they did not perish of the prostration induced by their removal, they had salt and water injected into their veins by the medical madmen in charge! Debarred the society of their nearest and dearest relatives, and tortured in every possible way by their pe- dantic doctors, Avas it wonderful that few of these unfortu- nates should escape from the pest-houses in which they had been so inhumanly immured ? All this, the leading men of the country, peers, judges, and members of Parliament, saAV and permitted from a puerile dread of the phantom contagion Avhich the ignorance or cupidity of the College of Physicians had conjured up. When acted upon by intimidation, to what miseries will not the feeble submit, if "Even the wisest and the hardiest quail To any goblin hid behind a veil!" Is not this a subject for deep reflection ? To some it may suggest a feeling like shame. Let me speak of shame. Gene- rally speaking, this is a depressing passion, and under its in- fluence men sometimes, and women daily, commit suicide. I Avill give you an instance where it had the reverse effect. The girls of Miletus, a town in Greece, were seized Avith a mania that led them to believe self-destruction an act of hero- ism ; and many, accordingly, destroyed themselves. Physic and argument having been alike ineffectually tried, the au- thorities to prevent the spread of this fatal rage, ordered the bodies of the suicides to be dragged walkthrough the streets PRACTICE OF MEDICINE. 261 of the city. From that moment the mania ceased. But every- thing depends upon a contingency, Avhether a particular pas- sion act as a depressant or a tonic in disease. In the case of shame, the past and the future make a great deal of dif- ference. Some may, perhaps, feel inclined to remind me of the effi- cacy of fear in the cure of diseases; but in this case the fear must neither be a dread of the disease nor its event, but a dread of some circumstance completely unconnected with it. Thus, Sir John Malcom, in his History of Persia, tells us of a certain Hukeem who cured ague by the bastinado. In this case the Persian doctor availed himself of the double influ- ence of fear and pain, neither of which were contingent upon the disease. The effect of terror in removing tooth-ache is familiar to many who have knocked at the dentist's door. The gout, too, has been cured and caused by every passion you can name. There does not pass a day but we hear of people being frightened into epileptic fits ; yet Boerhaave ter- rified away an epilepsy from a school where it prevailed, by threatening to burn with a red-hot poker the first boy that should have another paroxysm. I have known asthma cured by rage, and also by grief; yet, if Ave may believe Avhat Ave hear, people occasionally choke of both ! Few medical men Avill dispute the influence of a passion in the cure of ague. Mention any mental impression, such as faith, fear, rage, or joy, as having succeeded in this affection, and they doubt it not; but superadd to the patient's state a palpable change of volume or structure, such as an enlarged gland or ulcer, and they smile in derision at the efficacy of a charm. Extremes in scepticism and credulity are equally diseases of the mind. The healthy brain is ever open to conviction, and he Avho can believe that the Obi-charm, or the magic of a monarch's touch, can so operate on the nervous system as to interrupt or avert the mutations of motion and temperature constitut- ing an ague-fit, should pause before he denies their influence over an ulcer or a tumor, which can only be developed or removed by or Avith change of temperature. Indeed, from what we have already said, it is impossible for any individual to be the subject of any mental impression Avithout expe- riencing a chill or heat, a tremor or a spasm, with a greater or less change in the atomic relations of every organ and se- cretion. Baron Alibert gives the case of a Parisian lady, who had a large Aven in the neck—a goitre—which, from its deformity, occasioned her much annoyance. That tumor, 262 CHRONO-THERMAL Avhich had resisted every variety of medical treatment, dis- appeared during the Reign of Terror—a period Avhen this lady, like many others of her rank, experienced the greatest mental agony and suspense. The agony and suspense in that case referred to a contingency altogether unconnected with her disease. The mere act of dwelling upon sickness will keep it up; while whatever withdraws the mind from it is bene- ficial. In my own experience, abscesses of considerable mag- nitude have been cured both by fear and joy. Few surgeons in much practice have been without the opportunity of satis- fying themselves that purulent swellings may recede under the influence of fear. They have assured themselves of the presence of matter—they propose to open the tumor—the frightened patient begs another day, but on the morrow it has vanished. Akin to terror is disgust, or that feeling Avhich a person naturally entertains when, for the first time, he handles a toad or an asp. This passion has worked Avonders in disease. The older physicians took advantage of it in their prescriptions; for they Avere very particular in their directions how to make broth of the flesh of puppies, vipers, snails and milipedes. The celebrated Mohawk chief, Joseph Brandt, Avhile on a march, cured himself of a tertian ague, by eating broth made from the flesh of a rattle-snake ! Here the cure must have been altogether the effect of disgust, for in reality, the flesh of a rattle-snake is as perfectly innocuous, and quite as nutritious as the flesh of an eel. Mr. Catlin, in his Letters and Notes on the North American Indians, tells us that Avhen properly broiled and dressed, he found the rattlesnake to be " the most delicious food of the land." But when you come to think of the living reptile and the venom of his fang, Avho among you could at first feed upon such fare without shuddering, shiver- ing, shaking—without, in a word, experiencing the horrors and horripilations of ague ! Spider-web, soot, moss from the dead man's skull, the touch of a dead malefactor's hand, are at this very hour remedies Avith the English vulgar for many diseases. With the Romans the yet Avarm blood of the newly slain gladiator Avas esteemed for its virtues in epilepsy. Even at this day, in some countries of Europe, the lower orders cure the same disorder by drinking the blood as it flows from the neck of the decapitated criminal. In the last century, a live toad hung round the neck was much esteemed, by the same class, for its efficacy in stopping bleeding at the nose. Now that the toad is known to be free from venom, PRACTICE OF MEDICINE. 263 it might not be so successful as it once was in this instance. Any temporary benefit, real or supposed, which has accrued from the employment of the leech has appeared to me to be in many instances the effect of the horror the patient very naturally entertained for the reptile. A consideration of the power by which the passions cure and cause diseases, affords at once the best refutation of medi- cal error, and the most perfect test of medical truth. By this test I am willing that my doctrines should stand or fall. Take the influence of fear simply—Avhat disease has not this pas- sion caused ?—what has it not cured ? The mode of its action, then, establishes beyond cavil not only the unity of disease, but the unity of action of remedy and cause. What does the proper treatment of diseases come to at last, but to the com- mon principle of reversing the existing motion and tempera- ture of various'parts of the body ? Do this in a diseased body, and you have health—do the same in health, and you repro- duce disease. Whatever will alter motion will cure or cause disease. This, then, is the mode in which all our remedies act. Just observe the effect of Baths. In what disease have not baths been recommended ?—and in what manner can they cure or ameliorate, but by change of temperature—by change of motion ? Put your hand into ice-water—does it not shrink and become diminished in size ? Place it in water as hot as you can bear—how it swells and enlarges. You see, then, that change of temperature neces- sarily implies change of motion ;—and that change of motion produces change of temperature, you have only to run a cer- tain distance to be satisfied; or you may save yourself the trouble, by looking out of your Avindow in a winter morning, when you will see the hackney coachmen striking their breasts with their arms to Avarm themselves. Depend upon it, they would not do that for nothing. Heat, then, so far from being itself a material substance, as Black, and other chemists assert, is a mere condition of matter in niotion-it is no more a substance than a colour, sound, or fluidity. Like all these, it is a motive condition merely, or an association of matter What can be greater nonsense than an impondera- ble substance—as heat and light have been sometimes called? That only is matter or substance which can be Aveighed and measured—and this may be done Avith invisible as well as visible things,—in the case of a gas for example. I am often asked, what baths are safest, as if every thing 264 CHRONO-THERMAL by its fitness or unfitness is not safe, or the reverse. The value of all baths depends upon their fitness ; and that, in many instances, can only be known by trial. It depends upon constitution, more than upon the name of a disease, whether particular patients shall be benefited by one bath or another. Generally speaking, when the skin is hot and dry, a cold bath will do good ; and when chilly, a hot bath. But the reverse sometimes happens. For example, I have seen a shivering hypochondriac dash into the cold plunge bath, and come out, in a minute or two, perfectly cured of all his aches and Avhimsies. But in cases of this nature, every thing depends upon the gloAV or reaction, Avhich the bath produces; and that has as much to do with surprise or shock as with the temperature of the bath. I have seen a person, with a hot dry skin, go into a Avarm bath, and come out just as refreshed as if he had taken a cold one. In that case, the perspiration Avhich it excited, must have been the principal means of relief. So far as my own experience goes, I prefer the cold and tepid shower-baths, and the cold plunge-bath to any other; but there are cases in Avhich these disagree, and I. therefore, occasionally order the warm or vapour bath instead. In diseases termed " inflammatory," what measure so ready or so efficacious as to dash a few pitchers of cold water over the patient—cold affusion as it is called? When I served in the army, 1 cut short, in this manner, hundreds of inflammatory fevers—fevers that, in the higher ranks of so- ciety, and under the bleeding and starving systems, Avould have kept an apothecary and physician—to say nothing of nurses and cuppers—visiting the patient twice or thrice a day for a month, if he happened to live so long. With the cold dash, you also may easily, " While others meanly take whole months to slay, Produce a cure in half a summer's day."* That being the case, do you wonder that prejudices should still continue to be artfully fostered against so unprofitable a mode of practice ? Why do not the gullible public examine for themselves? Why will they continue to bribe their medical men to keep them ill? In their shops and out of * I have stated in a former note that "Hydropathy," on a right principle is an excellent chrono-thermal remedy. But in spite of the wrong princi- ple on which it is practised by Priessnitz, I am bound to declare that I think some of the modifications of his application of cold water not only original and ingenious, but also exceedingly serviceable in many diseases. There is no question of their utility in particular cases. PRACTICE OF MEDICINE. 265 their shops, the people of this world generally enact two very different characters. There they take advantage of their customers in every possible way ; but the moment they leave their counters, the same persons drop the knave, and become the dupe. The merchant and shop-keeper, who buy cheap and sell dear—the landowner and farmer, Avho keep up the corn-laws by every possible sophistry—the barrister and attorney, who rejoice and grow fat on the imperfections and mazes of the law—the clergyman and his clerk, whose gospel knowledge and psalm singing, are generally in juxta- position Avith tithes and burial fees—become all perfect lambs when they leave their respective vocations,—each giving the others credit for a probity and disinterestedness in their par- " ticular line, which himself would laugh at as sheer weakness, were any body to practise in his own ! With the most childish simplicity, people ask their doctor what he thinks of this practice, and Avhat he thinks of the other—never for a moment dreaming that the man of medicine's answer, like the answer of every other man in business, will be sure to square with his OAvn interests. Instead of using the eyes that God has given them, they shut them in the most deter- mined manner, that their ears may be the more surely abused. " What a delightful person Dr. Such-a-one is," you will hear persons say ; " he is so very kind, so very anxious about me." Just as if all that affected solicitude, and all that pretty man- ner of his, Avere not part and parcel of the good doctor's stock in trade. Silly, simple Americans! why Avill you pin your faith to fallible or fallacious authority, when you may get the truth so easily by a little personal examination !—To be able to discriminate in the choice of a physician, and to guard against medical imposture, would not cost you half the time or any thing like the trouble of mastering the inflections of t-^to, verbero, or Amo, amare ! Which kind of knowledge is of most use in life, I leave to pedants and philosophers to settle between them. Meantime, I shall beg your attention to the subject of Exercise. The effects of mere motion upon the body are sometimes very surprising. Only think of horse-exercise curing the people of consumption ! A case of this kind, you remember, I gave you, on the authority of Darwin. I knew a gent e- mln Avho was affected with habitual asthma, but who breathed freely when in his gig. I know, at this moment, 23 266 CHRONO-THERMAL another, afflicted with giddiness, who is immediately " him- self again," Avhen on horseback. A dropsical female, who came many miles to consult me, not only felt corporeally better when she got into the coach, but her kidneys acted so powerfully as to be a source of much inconvenience to her during the journey. This corporeal change she experienced every time she came to see me. The motion of the circular swing has cured mania and epilepsy. But what, as we have repeatedly shown, is good for one patient, is bad for another. You Avill not, therefore, be astonished to find cases of all these various diseases, where aggravation may have been the result of horse exercise, and the other motions we have men- * tioned. Exercise of the muscles, in any manner calculated to oc- cupy the patient's whole attention, will often greatly alleviate every kind of chronic disease. Dr. Cheyne was not above taking a useful hint on this point, from an Irish charlatan. " This person," says Dr. Cheyne, " ordered his epileptic patients to walk, those Avho were not enfeebled, twelve, fifteen, or even twenty miles a day. They were to begin Avalking a moderate distance, and they Avere gradually to extend their Avalks, according to their ability. In some of the patients, a great improvement took place, both with re- spect to digestion and muscular strength; and this was so apparent in a short time, that ever since this luminary shone upon the metropolis of Ireland, most of our patients affected with epilepsy, have been with our advice peripatetics." Ex- ercise then, is one of the best remedial means. Moreover, it may be turned to very great advantage in our common do- mestic matters. Were I to tell you all at once, that you might keep yourselves Avarm by a single log of wood all the winter over, you would think I was jesting, but really, the thing may be done. I believe we owe the discovery to our OAvn coun- trymen ; and I may as Avell give you the recipe;—" Take a log of wood of moderate size, carry it to the upper garret, and throw it from the window into the street, taking care, of course, not to knock any body on the head ; this done, run down stairs as fast as you can; take it up again to the garret, and do as before. Repeat the process until you are suffi- ciently warm—when—you may lay by the log for another occasion !" " One of the reverend bishops, Avho, Syndenham tells us, was famous for prudence and learning, having studied too hard a long while, fell at length into a hypochondriacal dis- PRACTICE OF MEDICINE. 267 ease ; which afflicted him for a long time, vitiated all the fer- ments of the body, and wholly subverted the concoctions. [Such was the jargon of the eminents of Syndenham's time.] He, the bishop, had passed through long steel courses more than once, and had tried almost all sorts of mineral waters, with often repeated purges and antiscorbutics of all kinds, and a great many testacious powders which are reckoned proper to sweeten the blood (!) and so being in a manner worn out, partly by the disease, and partly by physic used continually for so many years, he was at last seized with a colliquative looseness Avhich is wont to be forerunner of death in consumption and other chronical diseases when the diges- tions are wholly destroyed. At length he consulted me ; I pre- sently considered that there Avas no more room for medicine, he having taken so much already Avithout any benefit; for which reason I advised him to ride on horseback, and that first he should take such a small journey as was agreeable to his condition. Had he not been a judicious man, and one that considered things well, he would not have been per- suaded so much as to try such a kind of exercise. I entreated him to persist in it daily, till in his own opinion he was Avell, going daily farther and farther, till at length he went so many miles, as prudent and moderate travellers that go a long journey upon business use to do, without any regard to meat or drink, or the Aveather, but that he should take every thing as it happens like a traveller. To be short, he continued this method, increasing his journey by degrees, till at length he rode twenty or thirty miles daily, and when he found he was much better in a few days, being encouraged by such a wonderful success, he followed this course for a pretty many months, in which, as he told me, he rode many thousand miles; so that at length he not only recovered, but also regained a strong and brisk habit of body. Nor is this kind of exercise more beneficial to hypochondriacal people than to those that are in a consumption; whereof some of my relations have been cured by riding long journeys by my advice ; for I knew I could not cure them better by medicines of what value soever, or by any other method. Nor is this remedy proper only in small indispositions, accompanied with a frequent cough and leanness, but also in consumptions that are almost deplorable when the looseness above mentioned accompanies the night sweats, which are wont to be the Jbrerunners of death in those that die of a consumption. To Be short, how deadly soever a consumption is, and is said to 26S CHROXO-THERMAL PRACTICE OF MEDICINE. be—two-thirds of it dying who are spoiled by chronical dis- eases—yet I sincerely assert that mercury in the French pox and the Jesuit's bark in agues, are not more effectual than the exercise above mentioned in curing a consumption, if the patient be careful, and the sheets be Avell aired, and that his journeys are long enough. But this must be noted, that those Avho are past the floAver of their age, must use this exercise much longer than those that have not yet arrived at it; and this I have learned by long experience which scarce ever failed me. And though riding on horseback is chiefly beneficial to people that have consumption, yet riding jour- neys in a coach is sometimes very beneficial." Sydenham's views Avere correct as regards exercise, but in addition to exercise, I use my cough syrup, my liniment, my breathing-tube, and prophylactic syrup, and my success be- ing so far above the practice used in Sydenham's day, I am necessarily inclined to place more reliance on exercise com- bined with proper treatment. The poet Coleridge, while at Malta, Avas in the habit of attending much to those about him, and particularly those who were sent there for pulmonary disease. " He frequently observed how much the invalid, at first landing, was relieved by the climate, and the stimulus of change, but Avhen the novelty arising from that change had ceased, the monotonous sameness of the blue sky, accompanied by the summer heat of the clime, acted powerfully as a sedative, ending in speedy dissolution." Is not this a proof of the correctness of my previous observation, that in chronic disorder, remedies require to be frequently changed? The benefit to be derived from travelling, often great in chronic disorders, is partly to be ascribed to the change of motion, and partly to change of air and scene. Like every mode of treatment presenting frequent novelty, travelling therefore, offers many advantages to the invalid in every kind of chronic or habitual disease. How often, alas ! do we find it recommended, as a last resource, under circumstances where it must inevitably hasten the fatal catastrophe. The breath that might other- wise have fanned the flame, noAV only contributes to its more rapid dissolution. Hoav much the success of a measure de- pends upon time and season ! THE END. p/rJWX^ /. // " fjS^- "■'■■ ■' .1 ■ ■ ' ' J i ! ■■-. ;\. t. 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