WBjJ My' 1 *r#*J i VT S* r 'TaJ aT "' V r ■ ^O'CD'O^ i'LJ'OlVOSS Surgeon General's Offic: V.JVL ' 4NHEX THE PRINCIPLES OF THE f r € • CHRONO-THERMAL SYSTEM OF MEDICINE; WITH f FALLACIES OF THE FACULTY. IN A SERIES OF LECTURES, ORIGINALLY DELIVERED IN 1840, AT THE EGYPTIAN HALL, PICCADILLY, LONDON. NOW ENLARGED AND IMPROVED: ,9)1 SAMUEL DICKSON, M.D LATH A MEDICAL OFFICER ON THE BRITISH STAFF. FIRST AMERICAN, FROM THE THIRD LONDON (PEOPLE'S) EDITION AN INTRODUCTION AND NOTES/-^ ^ 0 w..« 0 uj , <■» WM. TURNER , M.D., ""Vw^.oiir1 LATE HEALTH COMMISSIONER OF THE CITY AND COl'NTY OF NEW YORK—MEMBER OF THG NEW YORK MEDICAC WjC.KTY, &C. &C. NEW YORK: J. S. REDFIELD, CLINTON HALL. BOSTON: REDDING & CO.—PHILADELPHIA: ZEIBER & CO, BALTIMORE :—SHURTZ & TAYLOR. 1845 . \ A* .f « -»» , " \. * Wfi3 I?55fp " Look at these two men just about to be buried—they were brothers and had the same disease—but they treated themselves differently. One had a blind confidence in his doctor—the other left himself entirely to nature;—both, nevertheless, are, as you see, on the way to their long home —the first because he took all the physic ordered him—the second because he would take none at all." "How very embarrassing!" said Leandro. " What in such a case, Friend Asmodeus, would you advise a poor patient to do ?" " Ah ! I wish I could tell you that," replied the Cripple; *' I know plenty of good remedies, but it would puzzle us both to find a good doc- tor !"—Le Sage's Diable Boiteux. S. W. BENEDICT, Stereotyper and Printer, 16 Spruce Street. ADVERTISEMENT TO THE PEOPLE'S EDITION. The first edition of " The Fallacies of the Faculty," containing one thousand copies, having been exhausted in less than twelve months, the Author, in the spring of 1841, published a second and more enlarged edition of fifteen hundred copies. This also has been most favorably received by the Public, and, it gives him pleasure to be able to add, by a considerable part of his own Profession—many of whom, with equal courage and disinterestedness, have unhesitatingly borne their testimony to the correctness of the Chrono-thermal System of Medicine, and the great success with which they have carried out the Author's principles in their own practice. The second edition of this Work has been translated into the French language. The present edition is now in progress of translation into the German; and there are not wanting practitioners in both countries who publicly acknowledge the superiority of the Chrono-thernaal System. Thus encouraged, the Author now a third time presents " The Fallacies of the Faculty" to the world in a cheaper and more popular shape. Much new matter has been added, and he has made some improvement in the manner—clearing his pages, at the same time, as far as he could, of everything like technicality, so as to bring his labors within the scope of the unprofessional public. Until mankind cease to prefer Signs to Sense—men's Words to the examination of God's Works;— until they take the trouble to make themselves acquainted with the Laws of their own economy, they can never learn to distinguish the true physician from the mere pretender—whether the latter be a literate person with a diploma, or an unlettered quack without it. The present work, it is hoped, will tend to lead them into the right path ; but for the perfect comprehension of any part of it, the whole must be carefully perused. Reform not often proceeds from within, and in no time or coun- try did it ever make much progress unless assisted from without. The favor which the Author has already extensively experienced in this latter respect is his chief reason for the present publication. Clarges Street, Piccadilly, March 1,1843. TO RICHARD C. M'CORMICK, ESQ., Secretary to the New York Merchant's Exchange Company, Dear Sir, You will remember that about Ihe middle of Decem- ber, 1843, while I was treating the case of a distinguished gen- tleman then in this city, with marked success, and in a mode diametrically opposed to the received opinion concerning the disease in question, we met each other accidentally in the Ex- change, and that in reference to this treatment you exclaimed, " Why, Doctor, what have the physicians been about for these four thousand years ?" The answer to that question will be found in the following pages. Your obedient servant, Wm. Turner. New York, April, 1845. INDEX, OF FORMS OF DISEASES, TREATMENT, REMEDIES, &c. Anatomy. • •}.........».............24 Attraction,............•............21 Asthma,................38, 39, 205, 210 A^ssafetida,........................213 Amaurosis,.....................46,204 Alkalies,..............>...........205 Abernethy,.........44, 56,134,164,202 Arsenic,..........................215 Abscess,...........................75 Aneurism of heart,.................210 Antimony,.....................11,200 Air, change of,..........• •..........63 Abstinence,..............».........93 Acidity,.......................121,211 Acids,.............................205 " dilute Nitric,................205 " do. Sulphuric,............205 Apoplexy, • • •.............»......51,91 Aphonia, • • •.......................40 Absorption, • ■ •....................75 Abortion,.................•......156 Accoucheurs,.....................158 Ammonia, • •......................215 Alcohol,..........................212 Ague..............................32 AlumT ...i.....................54,205 Affusion, cold,.....................181 Baths,.........................66, 180 Bark,.............................206 Balsams,..................•.......205 Bandage,..........................195 Brain,.........................17,123 " fever of,....................210 Baillie, Dr.,.................-•••9,25 Brandy and water,..............42, 120 Bacon, on Unity,...................145 Barytes,..........................205 Bleeding, effects of,.................86 " at nose,....................91 Belladonna,.......................205 Blindness, nervous, permanent,- • -46, 213 " remittent, ................47 Bismuth,..........................215 Brown, Dr.,.........................14 Blood,.............................84 Blood-letting,.......................83 Blood, spitting of,..........'......166 " vomiting of,.................54 Bone, fracture of,....................74 Bone, disease of,.........* • <.......203 Bronchitis,........................162 Bronchocele,......................203 Bougie,........................37, 171 Broussais,.........................101 Bulimia,........«•........•.........48 Buboes,...........................200 Byron, Lord,..............>.....13, 89 Charms,..........................174 Cramp,........................38,127 Catarrh,..........................211 " pulmonary,................210 Cataract, • • *........................78 Catalepsy,.....................22, 1 69 Cantharides,......................205 Cancer,...........................207 " >f the breast,............149, 210 Catheter,..........................171 Channing, Dr.,.........•...........143 Camphor,.........................213 Calomel,..........................202 Chest, tightness of,................126 Creosote,..........................204 Chinese never bleed, • • • •............103 Chicken-pox,- • •...................116 Cold water,........................54 Copaiba,..........................205 Cholera,..........................113 Chorea,............................39 Coffee,............................137 Copper,...............-...........215 Congestion,...................138,163 Confidence, influence of,- • •.........189 Colic,..............................38 " painter's,....................210 Constipation,......................211 Colchicum,..............•........204 Cow-pox,.........................115 Cooper, Sir Astley,..............49, 77 Consumption, • • • 13,60, 183, 200,203, 210 Convulsion,................38, 126, 162 " infantile,............142,163 Croup,............................166 INDEX. 112,203 .....161 .......14 ......17 • ■14,27 .....166 ......47 • 23,217 ......24 .....200 .....147 ----202 ......58 ......94 ......96 Cutaneous disease,...... Cures, accidental,........ Curved spine,............. Cupping instrument,..... Davy. Sir H.,............. Delirium tremens,........ Deafness,................ Disease,................. " causes of,......... " acute,............ " of women,........ " of children,....... '" of the heart,....... Digestion,................ Diet,..................... " vegetable,.....................95 " whey,........................HO Digitalis,.........................-04 Disgust,...........................179 Doses of medicine,.................222 " enormous,....................201 Dropsy,...........24, 119, 202, 20:3,205, " in the head,.................139 Dyspepsia,................202, 210, 224 Dysentery,........................118 " chronic,..................215 Dyspnoea,..........................38 Earths,...........................205 Elephantiasis,.....................207 Emetics..........................198 " their action cerebral,........199 Electricity,...................185,195 Electric shock................../.. - 66 Enteritis,---...................---82 Emetic, tartar,................,... 165 Exercise,....................i... 182 Epilepsy,.....................138,213 Eruptions,........................202 Erysipelas,........................112 Fainting,......................85, 138 " treatment of,..............142 Flatulence,...................127,211 Fear,.........................173,217 Fever,.........................32, 133 " continued,...................34 " remittent....................34 " typhus,.....................34 " eruptive,...................200 " brain,......................210 " yellow,....................117 Fistula lachrymalis,................38 Forceps,..........................195 Glands, disease of,..........72, 203, 214 Galvanism,.......................185 Gangrene,..........................76 Gleet,........................205, 214 Gregory, Dr.,........................9 Grief,............................176 Goitre,.........................74, 203 Gout,.............................104 Gums,............................205 Guiac,............................205 Harvey,............................11 Hahnemann,......................l^'1 Health,........................20,217 Heart, disease of,....................■& " aneurism of,................210 Hearing,..........................i7u Herpes,...........................210 Hemeialopia,.......................46 Hemorrhage,...................54, 200 Hippocrates,....................15,220 Hiccough,.........................38 Horse exercise,.................63, 183 Homoeopathy,........-............1 ^4 Hunter, John,...................28, 73 Hysteria, .....................131,215 Hypochondria,....................131 Hydropathy,.......................54 Inflammation,......................75 Insanity,..........................120 Intermission,.......................29 Intermittent fever,..................32 Ipecacuan,........................200 Iliac passion,.......................38 Indigestion,.......................202 Iritis,..........................78,205 Itching of skin,....................210 Iron,.............................215 Iodine............................203 Jaundice.......................38, 20l Jenner, Dr.,........................12 Joints, diseases of,..................72 Knighton, Sir W.,....................9 Lancet.........................17,222 Lepra,............................207 Lead,.............................203 Leech,.............................17 Letters,...........................160 Ligatures, effect of,.................137 Life,......................... 146, 185 Lime.............................205 Liver,.............................72 Leucorrhoea,..................148, 205 Lock-jaw,.........................38 Lobelia,..........................205 Louis XIV.,.......................199 Lumbago,.........................200 Man, life of,.......................146 Mania,...........................132 Malibran,....................... 42, 85 Magnetism, animal,................168 Malt liquors,......................212 Membrane, mucous,................101 Medicine, vegetable,................21S " mineral,...................218 " sham,.....................175 " its doses, . .'................222 " acts electrically,............19;j " symptomatic,...............206 " chrono-thermal,.............206 Menstruation, painful...............143 Mercury,.........................201 " oxymuriate,..............202 Montague, Lady,....................u Mortification,....................76,78 INDEX. IX Motion,............................21 Morphia,.........................211 Musk,............................213 Newton, Sir I.,......................16 Neuralgia,..........................47 Noyeau,...........................126 Nyctalopia,.........................46 Ophthalmia, acute,.................200 Ointments,........................184 Ossification,.......................Ill Opium,...........................211 " smoking,..................212 Paracelsus,.........................11 Pare, Ambrose,.....................11 Palsy,.....................40, 202, 210 Plasters,..........................184 Pancreas,..........................72 Plague,...........................117 Palpitations,.......................126 Passions,..........................172 Panic,............................178 Pain after eating,..................214 Paroxysm,.........................29 Parturition,.......................155 " a natural process,........159 Pregnancy,........................154 Predisposition,......................50 '• hereditary,..............49 Periodicity, do. .............159 Peritonitis,.........................76 Phrenitis,..........................76 Pleurisy,..................79,167, 200 Pneumonia, ................78, 79, 210 Psoas Abscess,.....................45 Potash,..........................205 Point, weak,........................50 Poison in physic,..............129, 191 Poultice,..........................119 Purgatives,........................201 Prussic acid,......................209 Quacks,......................105,16S Quinine,..........................206 Remedial means,..................195 Remission,.........................29 Remittent fever,....................34 Rheumatism,.....101,109, 200, 204,211 " acute, ............101,167 Repulsion,.........................21 Resolution,........................76 Rickets,...........................207 Rush, Dr.,.....................13,220 Shame,...........................178 Spasm,.........................39,126 Spasmodic complaints,..........38, 126 Strabismus,........................46 Saint Vitus's dance,.................39 Stramonium,......................205 Smallpox,........................114 Sleep,.............................22 Spleen,............................72 Sneeze,...........................38 Smell,...........................170 Salivation,........................204 Senses, the five,...................158 Specifics,..................30,187,20l Stethoscope,.......................58 Splint,...........................159 Squill,...........................204 Stitch,...........................214 Skin, disease of,.......112, 203, 211, 215 " blue,.......................214 Smith, Adam,.....................130 Sight,............................168 Spina bifida,.......................207 Sciatica,..........................47 Spine and spinal nerves,.............44 Silver,...........................213 Stricture,...................38, 39, 210 Stone,............................m Scott, Sir W.,......................91 Sore throat,.......................200 Soda,............................205 Scrofula,.....................101, 207 Sulphur,.........................204 Scurvy.......................101, 175 Sydenham,- •...................25,182 Strychnia,.......................213 Syphilis,.........................218 Tar,.............................204 Taste,............................171 " loss of sense of,..............48 Travelling,.......................183 Tea,.............................137' Teething,.........................157 Temperature,..................29, 219 Temperament,....................172 Temple, Sir W.,...................102 Terror,...........................179 Tremor,.......................39, 205 Tickling,.........................171 Tic douloureux,....................47 Totality of disease,.................215 Throat, tightness of,................. 126 Tobacco,.........................205 Tooth-ache,....................62, 179 Touch,...........................171 " loss of sense of,...............47 Tubercles,.........................61 Turpentine,.......................205 Tumor,...........................153 Type of disease, ague,...............28 Typhus fever,......................34 Unity of disease,................15, 220 " of all things,..................143 Valerian, .........................213 Vaccination,...................12,115 Vegetable diet, .....................95 Veins, varicose,....................57 Vertigo, ......................205, 214 Vomicae,...........................62 Vomiting,........................204 Warm baths,......................181 Water brash,......................210 " cold,.....................54,181 " hot,.........................181 " on the brain,.................139 X INDEX. Walking,.........................182 Wind............................126 Whites,..................148,205,211 White swelling....................200 Wine.............................JJJ " antimonial,.................1WJ Worms...........................|jj Womb, irritable,..................£"J Whooping-cough,.................^"' Yawn,...........................•*? Yellow fever......................i1' Zinc.............................215 INTRODUCTION TO THE AMERICAN EDITION. This work was published in London under its second title," Fallacies of the Facul- ty," a phrase not calculated to convey a proper idea of the important character of the production; but rather, as is the case with such publications as the " Curiosities of Literature" and the like, to lead people to suppose it designed simply to attract the attention of the curious, or to divert the idle. Hence, with due deference to the au- thor, I have given prominence to what he had made the second branch of its title, as best calculated to indicate the use and nature of the book. Dr. Dickson's views of disease are simple and easily understood. " More than twenty-three centuries," he says, " have elapsed since Hippocrates distinctly an- nounced the Unity of Morbid Action—" omnium morborum unus tt idem modus est," The type of all disease is one and identical. These are his words and that is my case. That is the case upon which unprejudiced and disinterested pos- terity will one day pronounce a verdict in my favor—for the evidence I am pre- pared to adduce in its support, will be found to be as perfect a chain of positive and circumstantial proof as ever was offered to human investigation." This " type" is fever and ague, or intermittent fever. The following are the conclusions to which Dr. Dickson arrives on the subject of Health and Disease: 1. The phenomena of perfect Health consist in a regular series of alternate mo- tions or events, each embracing a special period of time. 2. Disease, under all its modifications, is in the first place a simple exaggeration or diminution of the amount of the same motions or events, and being universally alternative with a period of comparative Health, strictly resolves itself into fever,—Remittent or Intermittent, Chronic or Acute;—every kind of structu- ral disorganization from Tooth-Decay, to Pulmonary Consumption, and that decom- position of the knee-joint, familiarly known as White-Swelling, being merely devel- opments in its course:—Tooth-consumption, Lung-consumption, Knee-consump- tion. 3. The tendency to disorganization, usually denominated Acute or inflammatory, differs from the Chronic or Scrofulous in the mere amount of motion and tempera- ture ;—the former being more remarkably characterized by excess of both, conse- quently exhibits a more rapid progress to decomposition or cure : while the latter approaches its respective terminations by more subdued, and therefore slower and less obvious terminations of the same action and temperature. In what does con- sumption of a tooth differ from consumption of the lungs, except in the difference of the tissue involved, and the degree of danger to life, arising out of the nature of the respective offices of each . The remedies used in the treatment of Disease, Dr. Dickson terms chrono-ther- mal, from the relation which their influence bears to Time or period, and Temperature (cold and heat), Chronos being the Greek word for Time, and Therma for heat or xii INTRODUCTION TO THE AMERICAN EDITION. temperature. These remedies are all treated of in the various modern works upon the Materia Medica. The only agents this system rejects are " the leech, the bleed- ing-lancet, and the cupping instrument." The subject of blood-letting occupies a considerable portion of these lectures. What first caused the author to perceive its dangers will appear in the following passage :—" I have not always had this horror of blood-letting. In many instances have I formerly used the lancet, where a cure, in my present state of knowledge, could have been effected without; but this was in my noviciate, influenced by others, and without sufficient or correct data to think for myself. In the Army Hospitals, I had an opportunity of studying disease, both at home and abroad. There I saw the fine tall soldier, on his first admission, bled to relief of a symptom, or to faint- ing. And what is fainting ? A loss of every organic perception—a death-like state, which only differs from death, by the possibility of a recall. Prolong it to perma- nency, and it is death. Primary symptoms were, of course, got over by such meas- ures—but once having entered the hospital walls, I found that soldier's face become familiar to me. Seldom did his pale countenance recover its former healthy charac- ter. He became the victim of consumption, dysentery, or dropsy ; his constitution was broken by the first depletory measure to which he had been subjected." Our author objects to the use of blood-letting, for this best of reasons, " that we have remedies without number, possessing each an influence equally rapid, and an agency equally curative, without being, like blood-letting, attended with the insu- perable disadvantage of abstracting the material of healthy organization. I deny not its power as a remedy, in certain cases; but I question its claim to precedence even in these. Out of upwards of Twelve Thousand cases ofdiseases that have, within the last few years, been under my treatment, I have not been compelled to use it once. Resorted to under the most favorable circumstances, its success is anything but sure, and ifs failure involves consequences which the untoward administration of other means may not so certainly produce. 1 have never taken credit for being the first opponent of the lancet. But one thing in regard to this matter I do claim credit for—I claim credit for being the first man who, by a strong array of facts, and some force of reasoning, produced an impression on the public that all the facts and all the arguments of former opponents of the lancet never before produced on the Profession—namely, an impression of the dangerous nature of the remedy; and whether they like to be told of it or not, I claim to have either convinced or com- pelled the profession materially to alter their practice. To say blood-letting is a bad thingis one thing, to prove it to be bad is another; to force the world to believe and act upon your arguments against it, in the teeth of the opinion of the world, is a still greater achievement. That merit I distinctly claim." Having always had a repugnance to the letting of blood, the practice of my pro- fession (according to the light in which I was instructed) was, up to 1841, especially in the treatment of acute diseases, a source of great dread. I could not see my way clear; was not satisfied, and I revolted from a system of practice to which my un- derstanding could not give its full and entire sanction. In the year mentioned, a copy of Dr. Dickson's work was placed in my hands. I read it with delight and with a strong conviction of its truth—a conviction which time and*experience have amply confirmed. Some examples of the results of this experience will be found among the few notes I have added in the course of the work. Disease being thus simplified, according to the system of Dr. Dickson, it follows that it is,to use his words, amenable to a principle of Treatment equally simple. Partaking, throughout all its modifications, of the nature of Ague, it will be best met by a practice in accordance with the proper principle of treatment of that dis- INTRODUCTION TO THE AMERICAN EDITION. xiii temper. To apply warmth, or administer cordials in the cold stage ; in the hot, to reduce the amount of temperature, by cold affusion and fresfT air: or, for the same purpose, to exhibit according to circumstances, an emetic, a purgative, or both in combination. With quinine, arsenic, opium, &c, the interval of comparative health—the period of medium temperature, may be prolonged to an indefinite period, and in that manner may Health become established in all diseases—whether, from some special local development, the disorder be denominated mania, epilepsy, croup, cynanche, the gout, influenza ! In the early stages of disease, to arrest the fever is, in most instances, sufficient for the reduction of every kind of local development. A few rare cases excepted, it is only when the case has been of long standing and habitual, that the physician will be compelled to call to his aid the various local measures, which have a relation to the greater or less amount of the temperature of particular parts. Such being the rational and intelligible doctrines of the Chrono-Thermal system of Medicine, it will be found that its practice is equally salutary and benign, and that its chief feature is to make short work of disease. As an instance of the latter, I will give the history of one case of treatment of acute disease, without blood-letting. A lady who had been attending an evening lecture in the Tabernacle in January, was attacked with violent chills, followed by darting pains in the lungs, severe head- ache, a rapid pulse, hurried respiration and all the symptoms of inflammation (so called) of the lungs. Added to this, owing to compunction in having gone out against the advice of a parent, she had a severe nervous or hysterical attack, with sobbing and crying. A sharp emetic relieved the severity of all the symptoms almost at once, and an opiate brought on rest and repose through the night. Peru- vian bark and rest were the chief remedies for the two following days. On the third day. she was well enough to participate with the family at meals at the table; and in a fortnight, notwithstanding it was winter, she was pronounced strong enough and well enough to go out. She had no relapse, but has continued in good health to this day. In the treatment of diseases of children, and especially of those of females, who are more liable to disorder, owing to the periodical changes peculiar to the sex, the Chrono-thermal system, from its simplicity and efficacy, will be found to be particularly valuable and eligible. Other distinguishing features of the Chrono-thermal system of Medicine are, 1st, A demonstration of the fallacious character of the ideas entertained by the profession and the public in reference to inflammation and congestion, those fruitful sources of error ; 2d, That calomel is no longer placed in the first rank of remedies, and when given is prescribed only in minute doses, as fractions of a grain ; 3d, That the Chro- no-thermal Medicines are to be used generally in minute doses, and that hence but little medicine is required; 4th, The doctrine that all remedies act primarily upon the brain and thence, electrically or magnetically, through the system. Writers on Medicine, pursuing a false analytical mode of disquisition, have for a long time been engaged in dividing and subdividing the subject until it reached its acme in the elaborate and ponderous tomes of the learned and classical Dr. Good; in which such is the extent of subdivision and subtility attained by the author that the recol- lection of the mere names of the various diseases as classified, would be a severe trial to a memory of ordinary tenacity. At this period, Dr. Dickson arose and seized upon the question, by the true analytical grasp of his genius reducing the whole to a system of simplicity. So that a complete, highly scientific and rational doctrine of disease and its treatment is embraced in the small volume which the reader holds in his hands. Some unprofessional readers, in taking up this book, may possibly xiv INTRODUCTION TO THE AMERICAN EDITION. think, from its subject, that it is adull, dry and tedious disquisition upon matters of interest to the medical fraternity alone. This would be a great error. The author has adapted it to popular use; on which account, he has discarded as much as pos- sible all technical terms. He has also enlivened his production by the introduction of apt facts and incidents, and pertinent arguments and illustrations—so that instead of being dull, dry and tedious, the reader will find it eminently sprightly, amusing and instructive. Scattered throughout the work will be met with, testimony by distinguished Phy- Bicians and Surgeons of Great Britain in favor of the system of Dr. Dickson— amongst the rest a letter from Sir Astley Cooper, who, on receiving a copy of a pre- vious edition, under the title of the " Unity of Disease," sent an answer, in which he styled it a " valuable work." It will be noticed, too, that the work has been trans- lated into French and German, for the use of the people of those nations. An index is added for convenience of reference, to those who may be disposed to make the work a subject of study. New York, 518 Broadway. POSTSCRIPT TO THE INTRODUCTION. While the following work was passing through the press, the April steamer arrived, bringing copies of several new medical works from the London publishers. Among them were two books, fresh from the London press, which, as they are cor- roborative of the truth of the Chrono-thermal system, and indicative of the pro- gress that benign and salutary system is making among active and scientific minds in the British metropolis, I have thought it would not be unprofitable to devote a little extra space to their examination. The first, a beautifully printed volume, is entitled " Practical Observations on the diseases most fatal to Children; with reference to the propriety of treating them as proceed- ing from Irritation aud not from Inflammation. By P. Hood, General Practitioner in Medicine and Surgery." The writer states the chief object of his work to be to call the attention not only of Medical men, but of all persons who may be interested in the matter, to the investigation of the mode of treatment which may be most appro- priate in the more serious diseases of children. The treatment generally adopted, he adds, in most of those diseases where they are severe, and more especially in such of them as affect the organs of respiration, is founded on the opinion that they either proceed from, or resolve themselves into, inflammation; and that this so- called inflammation, if not properly checked by bleeding and the administration of active antiphlogistic medicines, speedily causes death. Now, he proceeds, without entering here into any pathological discussion respecting the symptoms and conse- quences of inflammation, but supposing that it exists oris to be apprehended in the diseases referred to, it may yet be confidently affirmed, on evidence furnished by the Reports of the Registrar-General, that the mode of treatment above mentioned is improper. After discussing certain tables constructed from that report, he con- cludes as follows:—" The mode of treatment developed in the following pages is founded on the principle that the diseases of children, and of adults also, proceed from irritation, considered in a general sense, as distinct from inflammation, and indicating an opposite course of treatment. Having so frequently witnessed the benefi- cial effects of this mode of treatment, not only in the diseases of children expressly mentioned in the following pages, but in others also, whether occurring in children or adults, I have ventured to publish the present work, with the view of calling the attention of both medical practitioners and parents more expressly to the sub- ject." The subjects treated of are, inflammation, irritation, teething, bronchitis and inflammation of the lungs, whooping-cough, croup, measles, scarlet-fever, small- pox, convulsions and inflammation of the brain, scrofula and cachectic diseases, con- stipation, and lastly the effects of calomel on children. Under the head of inflam- mation of the lungs, he says, " I do not hesitate to declare that the great mortality of young children, from this particular affection, arises chiefly from the attempts made to subdue the disease by the abstraction of blood." In discussing inflammation of the brain, he remarks, " in looking over several cases which I have known treated m POSTSCRIPT TO THE INTRODUCTION. b bleeding or leeches, when the brain was suffering from congestion in infants, lam unable to point to one, in which the treatment was successful. There was nsually an abatement in the violence of the symptoms for a short period, when blood had been drawn, but they invariably returned with redoubled vigor; and death appeared to be hastened by the use of blood-letting as a remedy." The other work, also a fine specimen of typography, is entitled " A Collection of Cases of Apoplexy; with an explanatory Introduction. By Edward Copeman, surgeon." The author has transcribed from various authentic books and journals, and from his own note-book, no less than two hundred and fifty cases of apoplexy, in order to convince himself of the correctness of an opinion he had long entertained that the popular, as well as professional, prejudice in favor of bleeding in affections of the brain is not justifiable by the result of the practice. The following is the conclusion at which he has arrived:—"A comparison of the success attending the practice of bleeding in apoplexy, with that where bleeding was not employed, as shown by the following cases, is decidedly in favor of the latter; and should be considered suffi- ciently correct, from the number of cases reported, to neutralize the far too preva- lent idea that bleeding is the only remedy to be depended upon in apoplexy. The practice 6f giving emetics when the attack has succeeded a full meal, has not only been safe but effectual. In cases occurring in old age, brandy and other stimulants have restored animation and removed the apoplexy. Purgatives have always been acknowledged to be of essential service in most cases that have recovered. The application of cold to the head, sinapisms to the lower extremities, warm pediluvia, and vesications, have each in their turn appeared to be useful; and are at all events free from the objections that they can either produce or add to the mischief. I would, therefore, strongly urge those who may take the trouble to examine the fol- lowing collection of cases, to dismiss from their minds all the notions which their experience does not justify; and henceforth to treat apoplexy on the same scientific and rational principles that guide their practice in other diseases." The following are tables of the cases alluded to above :— " Number not bled, 26. Cured, 18; died, 8. Number bled, - - - 129. Cured, 51; died, 78." " Number of cases in which the treatment is specified, 155. Proportion of cures in cases treated by bleeding, - - - - 1 in 2| Proportion of deaths in do. do. about, - - - 1 in 1J Proportion of cures in cases not bled,..........linlj Proportion of deaths in do ..........1 in 3 J Behold, then, the answer to the question which, above all others, is asked by the devotees of the old school of medicine," If blood-letting is to be prohibited in all cases of disease, what in the world is to be done in apoplexy ." Great credit is certainly due to Mr. Copeman for the happy conception of investigating this subject in the manner he has done, and for the industry and assiduity he has manifested in reduc- ing it to a mathematical demonstration. THE CHRONO-THERMAL SYSTEM OF MEDICINE, LECTURE I. introduction--phenomena of health and sleep--disease and its type--causes. Gentlemen, We daily hear of the march of intellect, of the progress or perfection of many branches of science. Has Medicine keptpace with the other arts of life—has it fallen short or excelled them in the rivalry of improvement? Satisfactorily to solve this question, we must look a little deeper than the surface—for Truth, as the ancients said, lies in a well, —meaning thereby that few people are deep-sighted enough to find it out. In the case of Medicine, we must neither be mystified by the boasting assertions of disingenuous teachers, nor suffer ourselves to be misled by the constant misrepresentation of the medical press—for these publica- tions for the most part are nothing better than mere organs of party, and, like the newspapers of the day, do often little more than crush and cry down any truths that militate against the interests of the schools and coteries they are employed to serve. The late Sir William Knighton was at the head of his profession; he was, moreover, physician to George the Fourth. Joining, as he did, much worldly wisdom and sagacity to a competent knowledge of the medical science of his age, his opinion of the state of our art in these later times maybe worth your knowing; more especially as it was given in private, and at a period when he had ceased to be pecuniarily interested in its practice. In one of his private letters, published after his death, he thus delivers himself:—" It is somewhat strange that, though in many arts and sciences improvement has advanced in a step of regular progression from the first, in others, it has kept no pace with time; and we look back to ancient excellence with wonder not unmixed with awe. Medicine seems to be one of those ill-fated arts whose improvement bears no proportion to its antiquity. This is lament- ably true, although Anatomy has been better illustrated, the Materia Me- dica enlarged, and Chemistry better understood." Dr. James Gregory, a man accomplished in all the science and literature of his time, was for many years the leading physician of Edinburgh ; but he nevertheless held his profession in contempt. On visiting London, he had an opportunity of being introduced to his equally celebrated countryman and contem- porary Baillie. Curious to know Gregory's opinion of the man who then swayed the medical sceptre of the metropolis, his friends asked him what he thought of Baillie. " Baillie," he replied, " knows nothing but Physic;" in revenge for which, Baillie afterwards wittily rejoined, " Gregory knows 2 10 LECTURE I. everything but Physic." But what was Dr. »ai11^8 °^dTinAhemany profession after all ? I do not now allude to his iJJJ^d^gSe^Sb years he was in full practice; then doubtless ™th ^™^™£jdid thronged his door, he really believed he ^ew a great ae^ ° . c^ahvifaXRhubarb purge. No such thing; he only confessed thalhe Sw nothing of the manner of action of these substances on the body noTthl principle upon which they should be used _ Now, what would you think of a sailor who should express himself in the same wav in regard to the rudder and compass,—who should tell you that he had no faith in either instrument as a guide to steer a vessel by /-why, certainly that he knew nothing of the profession by which he gamed his living And such really was Dr. Bailhe's case. Ihe great bulk of man- kind measure the professional abilities of individuals solely by their de- gree of reputation—forgetting Shakspeare's remark, that a name is very often got without merit and lost without a fault. That Baillie actually attained to the eminence he did, without any very great desert of his, what better proof than his own declaration ?—a declaration which fully bears out what Johnson tells us in his life of Akenside : " A physician in a great city, seems to be the mere plaything of fortune; his degree ot reputation is for the most part totally casual; they that employ him know not his excellence—they that reject him know not his deficiency." But still some of you may very naturally ask, how could Dr. Baillie, in such a blissful state of ignorance or uncertainty, contrive to preserve for so long a period his high position with the professional public ? This I take to be the true answer:—the world, like individuals, has its childhood—a. period when, knowing nothing, it may fairly be excused for believing anything. When Baillie began practice, the profession were slowly and tardily groping their way in the dark; a few practical points they of course knew; but of the true principle of the application of those points, they were, as I shall afterwards show you, entirely ignorant. Most of them were, therefore, very ready to follow any one of their own number who should most lustily cry, Eureka—I have found it !—that was what Dr. Baillie did. At the commencement of his career, few medical men open- ed the bodies of their dead patients, for Sydenham, the English Hippo- crates, had long before ridiculed the practice. It was, therefore, all but in disuse, and all but forgotten, when Dr. Baillie published his book on Morbid Anatomy,—a book wherein, with a praiseworthy minuteness and assiduity, he detailed a great many of the curious appearances so usually found in the dissection of dead bodies. Had he stopped here, Dr. Baillie would have done Medicine some little service; but by doing more he ac- complished less—more for himself, less for the public; for by further teaching that the only way to learn the cure of the living is to dissect the bodies of the dead, he put the profession on a wrong path,—one from which it will be long before the unthinking majority can in all likelihood be easily reclaimed. In the earlier part of his career, Dr. Baillie, it is only fair to suppose, believed what he wrote, though by his after-declaration he admitted himself wrong. His arguments nevertheless succeeded but too well with the profession; proving the truth of Savage Landor's obser- vation, that, "In the intellectual as in the physical, men grasp you firmly and tenaciously by the hand, creeping close at your side, step by step, while you lead them into darkness, but when you lead them into sudden light, they start and quit you!" To impose upon the world is to secure your fortune; to tell it a truth it did not know before is to make your ruin LECTURE I. 11 equally sure. How was the exposition of the Circulation of the Blood first received? Harvey, its discoverer, was persecuted through life; his enemies in derision styled him the Circulator,—a word in its original Latin signifying vagabond or quack; and their efforts to destroy him were so far successful, that he lost the greater part of his practice through their united machinations. " Morbi non eloquentia sed remediis curantur'Ms an observation some of you may have met in Celsus, which, if you will allow me, I will translate:—Diseases are cured by Remedies, not by Rho- domontade. Yet strange to say, the generality of great professors who have successively obtained the public ear since the time of the Roman phy- sician, have been most inveterate against everything savoring of innova- tion in the shape of remedies. Let me give you examples. When a limb is amputated, the surgeons, to prevent their patient bleeding to death, as you all well know, tie the arteries. In the time of Francis the First, they followed another fashion: then, and formerly, they were in the habit of stanching the blood by the application of boilmg pitch to the surface of the stump. Ambrose Pare, principal surgeon to that king, introduced the ligature as a substitute—he first tied the arteries. Mark the reward of Ambrose Pare: he was hooted and howled down by the Faculty of Phy- sic, who ridiculed the idea of hanging human life upon a thread, when boiling pitch had stood the test of centuries. In vain he pleaded the agony of the old application; in vain he showed the success of the liga- ture. Corporations, colleges, or coteries of whatsoever kind, seldom forgive merit in an adversary; they continued to persecute him with the most remorseless rancor: luckily he had a spirit to despise and a master to protect him against all the efforts of their malice. What physician now-a-days would dispute the value of antimony as a medicine ? Yet, when first introduced, its employment was voted a crime But was there no reason! Yes, it was introduced by Paracelsus—Paracelsus, the arch- enemy of the established practice. At the instigation of the college, the French parliament accordingly passed an act making it penal to prescribe it. To the Jesuits of Peru, Protestant England owes the invaluable bark; how did Protestant England first receive this gift of the Jesuits ? Being a popish remedy, they at once rejected the drug as the invention of the father of all papists—the devil. In 1693, Dr. Groenvelt discovered the curative power of Cantharides in dropsy; what an excellent thing for Dr. Groenvelt!—Excellent indeed ; for no sooner did his cures begin to make a noise than he was at once committed to Newgate, by warrant of the president of the College of Physicians, for prescribing cantharides inter- nally. Blush! most sapient College of Physicians—your actual president, Sir Henry Halford, is an humble imitator of the ruined Groenvelt! Before the discovery of vaccination, Inoculation for Small Pox was found greatly to mitigate that terrible disease. Who first introduced small pox inocu- lation ? Lady Mary Montague, who had seen its success in Turkey. Happy Lady Mary Montague! Rank, sex, beauty, genius—these all doubtless conspired to bring the practice into notice. Listen to Lord Wharncliffe, who has written her life, and learn from his story this terrible truth—that persecution ever has been, and ever will be, the only reward of the benefactors of the human race. " Lady Mary," says his lordship, " protested that in the four or five years immediately succeeding her ar- rival at home, she seldom passed a day without repenting of her patriotic undertaking; and she vowed she never would have attempted it if she had foreseen the vexation, the persecution, and even the obloquy it brought upon her. The clamors raised against the practice, and of course against her, were beyond belief. The faculty all rose in arms to a man, foretelling failure and the most disastrous consequences; the clergy de- scanted from their pulpits on the impiety of thus seeking to take events <3pt of the hands of Providence; and the common people were taught to 12 LECTURE I. hoot at her as an unnatural mother who had risked the lives of her own children. We now read in grave medical biography, that the discovery was instantly hailed, and the method adopted by the P™^™^* of that profession. Very likely they left this «corded-to, whenever an invention or a proiect, and the same may be said of persons,has made its wlv so well by itself as to establish a certain reputation, most people are sure to find out that they always patronized it from the beginning, and a happy gift of forgetfulness enables many to believe their own assertion But what said Lady Mary of the actual fact and actual time? Why, that the four great physicians deputed by government to watch the progress of her daughter's inoculation, betrayed not only such incredulity as to its success, but such an unwillingness to have it succeed—such an evident spirit of rancor and malignity, that she never cared to leave the child alone with them one second, lest it should in some secret way suffer from their lTitprfGrGiiCG " Gentlemen* how was the still greater discovery of the immortal Jenner received—Vaccination ? Like every other discovery—with ridicule and contempt. By the Royal College of Physicians, not only was Jenner per- secuted and oppressed; but long even after the benefits which his practice had conferred upon mankind had been universally admitted, the pedants of that most pedantic of bodies refused to give him their license to practise his profession in London; because, with a proper feeling of self-respect, he declined to undergo at their hands a schoolboy examina- tion in Greek and Latin. The qualifications of the schoolmaster, not the attainments of the physician; the locality of study, rather than the extent of information possessed by the candidate, were, till very lately, the indispensable preliminaries to the honors of the College. Public opinion has since forced them to a more liberal course. But, to return to Jenner; —even religion and the Bible were made engines of attack against him. From these Errham of Frankfort deduced his chief grounds of accusation against the new practice; and he gravely attempted to prove from ?[uotations of the prophetical parts of Scripture, and the writings of the athers of the church, that Vaccination was the real Antichrist.' Can you wonder that medicine should have made so little progress, if those only make fortunes by means of it who know nothing more than the jargon and crudities which pass for medical science with the vulgar ? How true are the words of the Son of Sirach,—after searching the world he " returned and saw under the sun, that there was neither bread to the wise, nor riches to men of understanding, nor favor to men of skill." Gentlemen, the ancients endeavored to elevate physic to the dignity of a science, but failed. The moderns, with more success, have endeavored to reduce it to the level of a trade. Till the emoluments of those who chiefly practise it cease to depend upon the quantity of useless drugs they mercilessly inflict upon their deluded patients—till surgeons shall be other than mechanics, and physicians something more than mere puppets of the apothecary—till the terrible system of collusion, which at present prevails under the name of a " good understanding among the different branches of the profession," be exposed, the medical art must continue to be a source of destruction to the many—a butt for the ridicule of the discerning few. The wits of every age and country have amused them- selves at the expense of the physician; against his science they have directed all the shafts of their satire; and in the numerous inconsistencies and contradictions of its professors they have found matter for some of their richest scenes. Moliere, so long the terror of the apothecaries of Paris, makes one of his dramatis personal say to another;—" Call in a doctor, and if you do not like his physic, I'll soon find you another who will condemn it." Rousseau showed his distrust of the entire faculty, when he said, " Science which instructs, and physic which cures us, are ex- LECTURE I. 13 cellent certainly; but science which misleads, and physic which destroys, are equally execrable; teach us how to distinguish them." Equally sceptical and rather more sarcastic in his satire of the profession was Le Sage. " Death," says he, " has two wings; on one are painted war, plague, famine, fire, shipwreck, with all the other miseries that present him, at every instant, with a new prey. On the other wing you behold a crowd of young physicians about to take their degree before him. Death, with a demon smile, dubs them doctors {leur donnele bonnet), having first made them swear never in any way to alter the established practice of physic." But it is not our continental neighbors only who have labored to expose medical pretension. Locke, Smollet, Goldsmith (all three physicians), held their art in contempt. Swift, Temple, Hume, Adam Smith,—to say nothing of Byron, Hazlit, and other cotemporaries—were equally severe on its professors. Byron, indeed, anathematized it as " the destructive art of healing;" and when writing to a friend the details of a fever from which he had suffered, he tells him, " I got well by the blessings of barley water, and refusing to see my physician!"—Gentlemen, do you think that all these great men were inferior in observation and reflection to the herd of doctors and apothecaries who swarm in these times ? Bnt so completely at variance with each other are even the greatest medical authorities on every subject in medicine, that I do not know a single disease in which you will find any two of them agreeing. Take the subject of Pulmonary Consumption, for example: " The celebrated Stohl attributed the frequency of consumption to the introduction of the Peruvian bark. The equally celebrated Morton considered the bark an effectual cure. Reid ascribed its frequency to the use of mercury. Brillonet asserted that it is only curable by this mineral. Rush says, that consump- tion is an inflammatory disease, and should be treated by bleeding, purging, cooling medicines, and starvation With a greater show of reason, Salvidora maintained the disease to be one of debility, and that it should be treated by tonics, stimulating remedies, and a generous diet. Galen, among the ancients, recommended vinegar as the best preventive of consumption. Dessault, and other modem writers, assert that con- sumption is often brought on by a common practice of young people taking vinegar to prevent their getting fat. Dr. Beddoes recommended foxglove as a specific in consumption. Dr. Parr, with equal confidence, declared that he found foxglove more injurious in his practice than beneficial! Now, what are we to infer from all this ? Not, as some of you might be tempted to believe, that the science is deceptive or incom- prehensible throughout, but that its professors to this very hour have neglected to make themselves acquainted with the true principles upon which remedies act, and know as little of the true nature of the diseases whose treatment they so confidently undertake. And what is the daily, the hourly result of this terrible ignorance and uncertainty ? In the words of Frank, " thousands are slaughtered in the quiet sick-room." " Governments," continues the same physican, " should at once either banish medical men and their art, or they should take proper means that the lives of people may be safer than at present, when they look far less after the practice of this dangerous profession, and the murders committed in it, than after the lowest trades." " If false facts," says Lord Bacon, "be once on foot, what through ne- glect of examination, the countenance of antiquity, and the use made of them in discourse, they are scarce ever retracted." The late Professor Gregory used often to declare in his class-room, that ninety-nine out of a hundred medical facts were so many medical lies, and that medical doc- trines were for the most part little better than stark-staring nonsense;— and this, Gentlemen, we shall have some amusement in proving to you. In the mean time, we may observe, that nothing can more clearly explain 14 LECTURE I. the difficulties which beset the student of physic—for who can under- stand nonsense, and, when clothed in phrases which now admit one sense now another, Avhat so difficult to refute? "Nothing," says Sir Humphrey Davy, " has so much checked the progress of philosophy, as the confidence of teachers in delivering dogmas as truths, which it would be presumptuous to question. It was this spirit which, for more than ten centuries, made the crude physics of Aristotle the natural philosophy of the whole of Europe. It was this spirit which produced the imprison- ment of the elder Bacon and the recantation of Galileo. It is this spirit, notwithstanding the example of the second Bacon assisted by his reproof, his genius, and his influence, which has, even in later times, attached men to imaginary systems,—to mere abstracted combinations of words, rather than to the visible and living world; and which has often induced them to delight more in brilliant dreams than in beautiful and grand realities." Imposed upon by these abstracted combinations of words, we find it difficult to divest ourselves of the erroneous and mystical distinctions by which our teachers have too often endeavored to conceal their own igno- rance:—for in the "physical sciences,"—I again quote Sir Humphrey Davy, " there are much greater obstacles in overcoming old errors, than in discovering new truths—the mind in the first case being fettered; in the last, perfectly free in its progress." " To say that any class of opi- nions shall not be impugned—that their truth shall not be called in ques- tion, is at once to declare that these opinions are infallible, and that their authors cannot err. What can be more egregiously absurd and presump- tuous ? It is fixing bbunds to human knowledge, and saying men cannot learn by experience—that they can never be wiser in future than they are to day. The vanity and folly of this is sufficiently evinced by the history of religion and philosophy. Great changes have taken place in both, and what our ancestors considered indisputable truths, their pos- terity discovered to be gross errors. To continue the work of improve- ment, no dogmas, however plausible, ought to be protected from investi- gation." In the early history of every people, we find the priest exercising the functions of the physician.—Looking upon the throes of disease as the workings of devils, his resource was prayer and exorcism; the maniac and epileptic were termed by him demoniacs, and when a cure was accom- plished, the demon was said to be cast out.—Even now, the traces of clerical influence on our art are not extinct in England; for though our churchmen have long ceased to arrogate to themselves the exclusive right, as well as the exclusive power of healing, an Archbishop of Can- terbury is still permitted, by the laws of his country, to confer degrees in. physic! nor does he fail even in these days to avail himself occasionally of his prerogative."* We are told by the ingenious John Brown that he " wasted more than twenty years in learning, teaching, and diligently scrutinizing every part of medicine. The first five passed away in hearing others, studying what he had heard, implicitly believing it, and entering upon the pos- session as a rich and valuable inheritance. His mode of employment the next five years was to explain more clearly the several particulars.__to refine and give them a nicer polish. During the next equal space of •time, because no part of it had succeeded to his mind, he became cold upon the subject, and with many eminent men, even with the vulgar themselves, began to deplore the healing art as altogether uncertain and in- • * The present Sir Charles Mansfield Clarke, Bart., &c, after practising for many years as a London apothecary and accoucheur, was dubbed Doctor of Medicine bv the late Archbishop Manners Sutton. I know not if that be the reason he is some- times called by his lady-patients the divine doctor. LECTURE I. 15 comprehensible. All this time passed away without the acquisition of any advantage, and of that which of all things is most agreeable to the mind—the light of truth; and so great, so precious a portion of the fading and short-lived age of man was lost. It was only betwixt the fif- teenth and twentieth year of his studies that, like a traveller in an un- known country, wandering in the shade of night, after losing every trace of his road, a very obscure gleam of light, like that of the first break of day, dawned upon him." Gentlemen, it was my fortune to be more early staggered with the ina- dequacy of received doctrines either to explain Disease or cure it. I there- fore determined to read anew the Book of Nature, and study it by the light of such common sense as God in his goodness had given me, rather than trust any longer to the reports of fallacious commentators. To this investigation I came with a different spirit from that with which I enter- ed the schools of physic. In my noviciate I yielded implicit faith to my teachers; in my later researches after truth, I have often had to guard myself as much against a too rigorous scepticism of their facts as a too great contempt of their opinions. With Lord Bolingbroke, I can truly say, "few men have consulted others, both the living and the dead, with less presumption and in a greater spirit of docility than I have done ; and the more I have consulted, the less I have found of that inward conviction on which a mind that is not absolutely implicit can rest. I thought for a time that this must be my fauR; I distrusted myself, not my teachers— men of the greatest name, ancient and modern; but I found at last it was safer to trust myself than them, and to proceed by the light of my own understanding, than to wander after these ignesfatui of philosophy." After a long and diligent scrutiny of Nature in this spirit, 1 have at last been enabled to place before the profession a Doctrine of Disease, which, when its unity of principle and universality of application have been fairly tested, will not only contrast somewhat curiously with the contra- dictory opinions and pretensions of the schools, but will, I hope, by the superiority of its practical results, tend to rescue physic and physicians from the obloquy and contempt with which the more thinking part of the public have too long looked upon both. In the course of these Lectures, gentlemen, it shall be my business to prove to you the unity or identity of all morbid action, and the unity and identity of the source of power of the various agencies by which disease of every kind maybe caused or cured. "The universe," says an emi- nent foreigner, " to him who should have sufficient comprehension to be- hold it at a single view, would only appear one great fact—one mighty truth." And in the same spirit, Sir James M'Intosh observes, "the com- preliensive understanding discovers the identity of facts which seem dis- similar, and binds together into a system the most apparently unconnected and unlike results of experience." Beware then of differences—of divi- sions ; for " divisions," as Lord Bacon well observes, " only give us the husks and outer parts of a science, while they allow the juice and kernel to escape in the splitting." And from this you may learn not only the ab- surdity of nosological distinctions and divisions, but also the utter nothing- ness and vanity of the many disputes that daily occur in practice, whe- ther disorders resembling each other, and amenable to the same treatment, should be called by one name or another. In the language of Hobbes, " words are wise men's counters,—they do but reckon by them, but they are the money of fools, that value them by the authority of an Aristotle, a Cicero, a Thomas Aquinas, or any other doctor whatsoever." More than twenty-three centuries have elapsed since Hippocrates dis- tinctly announced the Unity of Morbid Action,—" Omnium morborum unus et idem modus est." The type of all diseases is one and identical. These are his words, and that is my Case. That is the cause upon which 16 LECTURE I. unprejudiced and disinterested posterity will one day pronounce a verdict in my favor—for the evidence I am prepared to adduce in its support will be found to be as perfect a chain of positive and circumstantial proof as ever was offered to human investigation. Gentlemen, what Johnson said of poets is equally applicable to physicians : " The first, whoever they be, must take their sentiments and descriptions immediately from knowledge —their descriptions are verified by every eye, and their sentiments acknowledged by every breast. Those whom their fame invites to the same studies copy partly them and partly nature, till the books of one age gain such authority as to stand in the place of nature to another; and imitation, always deviating a little, becomes at last capricious and casual." It is in this manner that the descriptions of disease in our nosological systems have become a mere tissue of unnatural divisions, not to say of the most obvious contradictions ; if the words in which they be conveyed have, in many instances, any meaning at all What, then, shall we say of reasoning founded upon facts which are no facts—upon mere assump- tions which have no foundation hi nature ! The schools of Egypt and Arabia, the eminent men of Greece and Rome, the great anatomical teachers and philosophers of the middle ages, knew not the circulation of the blood. How wild were their theories, how fanciful their hypotheses, may be gleaned from the fact of their naming certain blood-vessels, arteries, or air-vessels ;—tubes which you have only to wound, to see them pour out the living* current in jets, were for ages supposed to contain not blood, but air! What innumerable fallacies must have entered mto reasoning founded on such premises! Yet it was not till the seventeenth century that the illustrious Harvey demonstrated the true nature of the arteries, and the manner in which the blood circulates through the body. The more immediate reward of his discovery was calumny, misrepresentation, and loss of his professional practice. The same College of Physicians who, in after years, opposed the improvements of Montague and Jenner, made the circulation of the blood the subject of their bitterest satire. Not content with slandering the character of its discoverer, the more vile and venal of his medical brethren made it a pretext for declining to meet him in consultation. Harvey lived, neverthe- less, to neutralize the malice of his enemies, and became successively the physician of the two first English kings of the Stuart race, James and Charles. The more you can explain and facilitate the attainment of any science, the more you will find that science approach perfection. The true philosopher has always studied to find out relations and resemblances in nature, thus simplifying the apparently wonderful;—the schools, on the contrary, have as invariably endeavored to draw fine-spun distinctions and differences, the more effectually to perplex and make the most simple things difficult of access. " In universities and colleges," says Lord Bacon, " men's studies are almost confined to certain authors, from which if any dissenteth or propoundeth matters of redargution, it is enough to make him be thought a person turbulent." Any exposition of the singleness of prin- ciple which pervades a particular science will be sure to meet the censure of schools and colleges; nor will their disciples always forgive you for making that easy which they themselves, after years of study,? have declared to be incomprehensible. The most perfect system has ever been allowed to be that which can reconcile and bring together the greatest number of facts that come within the sphere of the subject of it. In this consists the sole glory of Newton whose discovery rests upon no higher order of proof. How was this dis- covery received on its first announcement ? In the words of Dr. Chalmers " authority scowled upon it; and taste was disgusted by it; and all the beauteous speculation of former days was cruelly broken up by this new LECTURE L 17 announcement of the better philosophy, and scattered like the fragments of an aerial vision over which the past generations of the world had been slumbering their profound and their pleasing reverie." For upwards of ten centuries had the false philosophy of Aristotle enslaved the minds of civilized Europe, thus at last to perish and pass away! So that Time itself is no sure test of a doctrine, nor ages of ignorance any standard by which to measure a system. To Nature, eternal Nature, must truth ever make her first and last appeal. By this, and this only, am I willing that the new fabric of medicine which I have presumed to erect upon the ruins and reveries of the past, should be tested and tried. Till the world shall detect one real—one indubitable fact militating against the Views I am now about to develope, let not innovation be charged against me as a crime. Hippocrates, Galen,? Boerhaave, Cullen, were all innovators in their day, nay, revolutionists in physic. The revolution I meditate, unlike those of some of my predecessors, is at least free from the imputation of being either painful or sanguinary in its character. The only agents it rejects are the leech, the bleeding lancet, and the cupping instrument. Let us now enter upon the development of this new, but natural system. Gentlemen, in the higher powers of Observation, Comparison, Compre- hension, and Direction, termed Mind or Intellect, Man stands pre-eminent above all animals; in so far as regards the more immediate observation of certain things around him, he is nevertheless excelled in some respects by many. The eagle has a finer and farther sight; the hearing of the mole is more acute; the dog and the vulture distinguish odors wholly inappreciable by him; not a few of the wilder denizens of the forest have even a keener sense of taste and touch. In mere perceptive power, then, the beasts of the field are in some things permitted to surpass us—while the sagacity of the elephant and the dog, the courage and emulation of the horse, the foresight of the ant, the cunning of the fox, and the social and building habits of the beaver, declare to us—however unpleasing the announcement—that others of God's creatures besides ourselves, possess the elements, at least, of that reason, upon which we so highly pride our- selves. To the greater degree of complexity, perhaps I should rather say, completeness of our cerebral organization—to our more perfect develop- ment of that source of all reasoning power—the Brain, we assuredly owe this corresponding increase in the number and force of our reasoning faculties. To this completeness of his cerebral development, Man then, is indebted for his great mental superiority over every other thing that lives ; just as certainly as that by the more complete mechanism of his prehensile organ—the Hand, his power of physically executing what his Head mentally conceives, places his works and his ways so far above the works and the ways of the whole animal kingdom united. Look at " man's full fair front;" it is a superadded—not a superfluous part—a part that the more it diminishes and recedes, the nearer is its possessor akin to the brute.* But, Gentlemen, the rudiments of this instrumental part of man's reasoning faculties variously developed, may be de- * Dr. Abercrombie of Edinburgh holds another opinion—and one in which, with the single exception of Lord Brougham—he probably stands alone in the world; for he maintains that the Brain is not in the very least necessary for thought, intel- lect, genius;—and he gives facts (!) to prove that the whole intellectual faculties may be perfect when the substance of the Brain is all but disorganized throughout! Yes, Dr. Abercrombie graTely assures us of this—Dr. Abercrombie, so long the leading physician and medical giant of Edinburgh. If Dr. Abercrombie leads the modern Athenians in philosophy as well as in physic, surely it must be by the nose ! Instead of swallowing open-mouthed such insane drivellings of mental im- becility, why don't these good people take an enlightening lesson in phrenology from their fellow-townsman, Gombe? It is only in the dark that pigmies are mistaken for giants. 18 LECTURE I. tected in numerous links of the great chain of animated beings of which he is confessedly the chief. To every variety of race that ani- mates the globe, whether in external or internal configuration, we have undeniably many features of relationship; nor let us spurn even the mean- est and most shapeless as beneath our notice—for of every organic pro- duction of their common Maker,—Man, while yet in the womb of his parent, has been the type !—his foetal form successively partaking of the nature of the worm, fish, and reptile, and rapidly traversing still higher grada- tions in the scale of organized existence, to burst at last upon the view in all the fullness and fairness of the perfect infant. But it is not his outward form only that passes through these various gradations of animal life. From Comparative Anatomy we also learn that each of his separate inter- nal organs, on first coming into festal existence, assumes the lowest type of the same organ in the animal kingdom; and it is only by successive periodic transformations that it gradually approaches to the degree of completeness hi which we find it in the new-born child. The heart of the embryo-infant is a mere canal, nearly straight at first, and then slightly curved, corresponding exactly with the simplicity of heart of insect life,— that of the snail, and other insects of the lowest Crustacea tribe, for exam- ple. And not the heart alone, but each and all of the several organs and systems of the body are brought to their perfection by periodic additions and superadditions of the simpler and more complex parts of the same organs and systems of the several orders of animals, from the least noble to the highest class of all—the Mammalia, of which Man is the head. Man, proud man, then, commences his foetal life in reality a worm !—and even when he has come into the world, and has breathed and cried, it is long before the child possesses the mental intelligence of many of the adult brutes ; in this respect man is for a period lower than the monkey— the monkey he so hates and despises for its caricature likeness of himself. Between the same Man in his maturity, and his animal fellow-creatures,* we perceive many differences ; the resemblances, being infinitely more nu- merous, too often escape our memory! Are not the higher order of ani- mals, and most of the very lowest, propagated by sexes ? Does not the female endure her period of travail like woman, and produce and suckle her young in a similar manner? Have not all of them eyes, noses, mouths, and ears,—senses to see, hear, smell, taste, and touch, and each its respective language of sounds and signs by which it conveys its mean- ing to the other individuals of its race ? Nay, have not Animals many of Man's passions and emotions—most of his sympathies—his power of choice and resistance—the knowledge, by Comparison, who is their friend, and who their foe,—Reflection, whom to conciliate, whom to attack; where to hide, and when to show themselves—the Memory of injury and kindness—Imitation, and consequent docility—in some instances, simula- Hon and dissimulation, each pursuing its own mode of artifice ? Do not their young, too, as in the instance of the child, gambol and play, and leave off both as they grow older, for other pleasures ? And yet there are persons of a temper so unphilosophical as to deny them Mind !—Who will tell me that man is so far superior to the dog in this respect as the dog is to the oyster! Of mental as of physical power, there are gradations. If we have stupid and weak men, so have we stupid and weak animals, according to their respective races. But there are dogs that will observe! calculate, and act more rationally than some human fools you may see every day. When did you find the dog prostrating himself before a figure of his own making, asking it questions, supplicating it, and howling, and tearing his hair, because it answered him not ? Which of all the Brutes quarrels with his fellow-brute for going his own road, whether circuitous or otherwise, to a town or village that does not concern the other in the least ? Or which of all the animal tribes manifests such a paucity of intel- LECTURE I. 19 lect as, more than once, to mistake the same false signs for real sense,— imposture for integrity, gravity for wisdom, antiquity for desert ? Never in my life, Gentlemen, did I see the dog or monkey implicitly submitting himself to another of his race in matters that especially interested himself. On the contrary, in the case of the monkey, instead of trusting to the au- thority of his fellow-monkey, in a spirit of laudable curiosity he has always handled with his tiny fingers, and examined with his quick prying eyes, everything that took his fancy; in no single instance that I remem- ber did he ever allow himself to be taken by the ears. Even in his lan- guage of chatter and gibber, he never seems to mistake the meaning of his comrades, never takes one sign in two or more senses,—senses the most opposite,—so as to get confused and bewildered in his manner or his actions. Can you always say this of man ? Have you never heard him, even in his discussions on this very subject, one moment charging every thing of animal intellect to Mind, at another to Instinct,—instinct which, to have a meaning at all, must mean this—right action without experience, —such as the infant taking its mother's breast as soon as born, or the chick picking up grain the moment it leaves the shell. True, the chick may mistake a particle of chalk for. a grain of wheat, even as the infant may mistake his nurse's thumb for the nipple of his mother. Experience corrects the error of both; and this correction of error is one of the first efforts of the three mental faculties, Observation, Comparison, and Reflec- tion. It is with these identical faculties that both men and animals per- ceive a relationship betwixt two or more things, and act in regard to such things according to their respective interests,—rightly in some instances, wrongly in others. The correction to-day of the errors of yesterday is the chief business of Man. As he grows in years, his experience of things enlarges, and his judgment as to their true value and relationship to him- self becomes more and more matured. The Brutes, then, have the very same intellectual faculties variously developed, which, when stimulated to their utmost in Man, and with the assistance of his higher moral facul- ties, become Genius,—if by genius is meant the discovery of relationships in nature hitherto undiscovered, and leading, as all such discoveries do, to practical results beyond cotemporary anticipation. Newton's system and Watt's steam-engine are examples. Gentlemen, you now clearly see that in the power of gaining knowledge by experience,—call it Mind, Rea- son, Intellect, or what you please,—the Beast of the field partakes in com- mon with man, though not in the same degree ; yet both partake of it in a degree equal to the particular position and exigencies in which they are individually or socially placed. For animals, like men, have their cities and sentinels—their watchwords of battle, siege, and defence: nature, too, has given them all their respective weapons of offence and defence. Man, less gifted in either of these respects, first fashioned his sword, and his shield, and his armor of proof. It was only after the experience of centuries, he reached, by higher mental efforts, to the knowledge neces- sary for the construction of the musket, the cannon, and the other muni- tions of modern warfare. Necessity was the mother of his invention here, as, indeed, in every other instance; but by this also the lower animals profit. What but necessity enables our domestic animals to change their habits so as to live in peace, harmony, or /slavery with man !—even as necessity obliges man enslaved to do and bear for his fellow-man things the most repugnant to his nature. How different the habits of the domes- tic dog from the dog or wolf of the prairie, from which he originally sprung! In the wilderness, the one would all but perish for want, till stern necessity should teach him to hunt down his prey ; the other would require stripes and blows through successive generations, before he could be taught like the shepherd's dog to come at his name, and to drive the sheep at his master's call, or arithmetically to single out from the herd two, 20 LECTURE L three, or more, and to watch or urge them on at his bidding. To deny animals mind is to deny them design, without which, putting mere instinct apart, neither men nor animals act in any manner or matter. The great Designer of the Universe, in the creation of the first crystal, showed this. He proclaimed it when he made the sexes of the vegetable king- dom ;—when he united the plants to the lowest link of the animal world, the Zoophyte or plant-animal, he made his design still more manifest. When he further progressively developed his plan of insect, fish, and rep- tile life, and added the higher animals last of all, before he completed the chain with Man their master, he showed not only design, but Unity of Design; and when to men and animals he gave a power neither the crystal nor the vegetable possesses,—the power of following out designs of their own making,—he imbued them both with a part of his Spirit— varying in degree, but to each he gave it in a portion equal to their respec- tive wants and necessities. Deny this, and you deny God,—you deny God's works and words—words upon which the question of interpolation can never arise; for every leaf of every plant is a letter of his alphabet,—every tree a combination of the letters composing it, and every hill, valley, and stream —every tribe of men and animals—so many sentences by which we may perceive his will, and deduce his law. The stars, and constellations of stars, and their many motions, teach, even to our frail senses, the periodic maimer in which all the motions of nature, like all the motions of man's body, take place. In their harmony of design, they give us an insight into the Unity of the Eternal. And we find embodied in them a principle by which we not only may know the past and present, but to a certain ex- tent read the future, in its dim outline of twilight and shadow. In all humility, then, let us inwardly prostrate ourselves before the Omnipotent: but beware of that outward mock humility which too often leads to reli- gious pride, and engenders everything but a Christian charity; and let it rather be our pleasure to trace resemblances and harmonies, than to see in Nature only discords and differences. The whole world is a Unity ; and in no single instance do we find a perfect independence in any one thing pertaining to it. Betwixt man and the lower animals, we have traced link by link the chain of contiguity—mental as well as corporeal. Like them, he comes into the world, and like them, his body grows, decays, and dies. When injured in any of its parts, it has similar powers of re- pair and reproduction. I know not why such powers should be greater the further we descend the scale; but in the crab and lobster, whole limbs may be severed and reproduced; in the worm, the regeneration of half the body may take place; while in man, the highest of the chain, only limit- ed portions of a tissue can be materially injured and recover. Disease, like death, is the destiny of all. To understand either aright, we must first know what Health is. In the state of Health, an equable and medium temperature prevails throughout the frame. The voluntary and other muscles obey with the requisite alacrity the several necessities that call them into action. The mind neither sinks nor rises but upon great emergencies; the respiration, easy and continuous, re- quires no hurried effort,—no lengthened sigh. The heart is equal in its beats, and not easily disturbed; the appetite moderate and uniform. At their appointed period, the various secreting organs performed their office. The structures of the body, so far as bulk is concerned, remain to appear- ance, though not in reality, unchanged; their possessor being neither en- cumbered with obesity, nor wasted to a shadow. His sensorium is nei- ther painfully acute nor morbidly apathetic; he preserves in this instance, as in every other, a happy moderation. His sleep is tranquil, dreamless.' LECTURE L 21 If we analyze these various phenomena, we shall find that they all con- sist in a series of alternate motions,—motions, for the fulfilment of which various periods of time are requisite; some being diurnal, some recur- ring in a greater or less number of hours,—while others exhibit a minu- tary or momentary succession. At morn, man rises to his labor; at night, here turns to the repose of sleep; again he wakes and labors—again at the appointed period he " steeps his senses in forgetfulness" once more. His lungs now inspire air, now expel it—his heart successively contracts and dilates—his blood brightens into crimson in the arterial circle of its ves- sels—again to darken and assume the hue of modena in the veins. The female partner of his lot,—she who shares with him the succession of petty joys and sorrows, hopes and fears, which made up the day-dream of life, has yet another revolution, the Catamenial; and Parturition, or the process by which she brings their mutual offspring into the world, is a series of periodic pains and remissions. Every atom of the material body is constantly undergoing a revolution or alteration;—liquid or aeriform one hour, it becomes solid the next— again to pass into the liquid or aeriform state; and ever and anon varying its properties, colors, and combinations, as, in brief, but regularly peri- odic succession it assumes the nature of every organ, tissue, and secre- tion entering into, or proceeding from, the corporeal frame. " It is every- thing by turns, and nothing long." The phenomena of the human body, like every other phenomena in na- ture, have all a three-fold relation,—a relation to Matter, Space, Time, and there is another word—Motion, which may be said to bring all three to a unity; for without matter and space, there can be no motion, and motion being either quick or slow, must also express time or period. Moreover, there can be no motion in matter without change of tempera- ture, and no change of temperature without motion in matter. This is so indisputable an axiom in physics, that Bacon and others supposed mo- tion and change of temperature to be one and the same. You cannot, for example, rotate a wheel for a few seconds without heat being produced, and the iron that binds it becoming expanded; in other words it exhibits a motion outwards; when the same wheel is allowed to stand still, the temperature falls, and the iron hoop decreases in size. There is in that case motion inwards. By the same law, if, even in the middle of winter, you run for any length of time, you shall become heated and bloated; and you again shrink in size when you stand still to cool yourselves. To the mind's eye, extremis probatis media presumuntur. Having shown the truth in extremes, we presume the rest; for as there are motions both of quick- ness and slowness that elude the eye, so are there changes of tempera- ture that the thermometer may not reach. Those, then, who ascribe the source of animal heat exclusively to the lungs, seem to have forgotten these facts; they have forgotten, that in the constant mutation of its atoms, every organ, nay, every atom of that organ, being ever in motion, must equally contribute to this end ; for to this common law of all mat- ter, every change in the body is subjected. The powers by which the corporeal motions are influenced, are the same that influence the motions of every kind of matter, namely, the electric, mechanical, and chemical forces, and the force of gravitation. When rightly considered, the whole of these powers resolve themselves into attraction and repulsion. It is by attraction that the fluid matter of the blood first assumes the solid con- sistence of an organ; again to pass by repulsion into the fluidity of secre- tion. From the earth and to the earth, the matter composing our bodies comes and goes many times even in the brief space of our mortal exist- ence. In this, the human system resembles a great city, the inhabitants of which, in the course of years, are constantly changing, while the same city, like the body, betrays no other outward appearance of change than 22 LECTURE L what naturally belongs to the periods of its rise, progress, maturity, or tendency to decay. , . . , , ,., The last, and one of the most important of the revolutions of the healthy state, is Sleep. Philosophers of all ages have made this an object of their most anxious study, its relation to death perhaps being their chief inducement to do so. " Half our days," says Sir Thomas Browne, " we pass in the shadow of the earth, and sleep, the brother of death, extracteth a third part of our lives." In the state of perfect sleep, the pupil of the eye will not con- tract on the approach of light—the skin has no feeling—the ear no sense of hearing—the taste and smell are not to be roused by any of the ordi- nary stimuli. What is this (figuratively speaking) but a periodic half- death—speaking truly, but a periodic palsy or cessation of internal mo- tion of the nerves by which we maintain a consciousness of existence, and perceive our relationship to the world around us ? Broken sleep consists either in brief remissions of the whole sleeping state, or in a wakefulness of one or more of the five senses. There are individuals, for example, who always sleep with their eyes open, and who should see you, were you to enter their chamber with the most noiseless tread. These tell you they are always half awake. In the condition of body termed nightmare, there is a consciousness of existence with a wakeful- ness of the nerves of sight or feeling; but with a total inability to influ- ence the voluntary muscles by any effort of the will. The subject of it can neither sleep nor turn himself. The dreamer, portions of whose brain think, and therefore act or move, is partially awake. The somnambulist and sleep-talker, are dreamers, who, having portions of the brain in a state of action, and others torpid, perform exploits of deed or word, that bring you a mirid of the maniac and the drunkard, whose powers of judging are defective. A man may be entirely awake with the exception of a single member; and this we still refer to a torpid state of some portion of the brain. Such a man will tell' you his arm or leg is asleep or dead. But, as this is a soporific subject, and may have a soporific influence on some of you, I may as well wake you up with an anecdote, a brother medical officer of the army once told me of himself: While serving in the East In- dies, Dr. C----one night awoke, or I should rather say half awoke sud- denly, when his hand at the instant came in contact with a cold ani- mal body. His fears magnifying this into a cobra eapel, he called out most lustily, " a snake, a snake." But before his drowsy domestics had time to appear, he found he had mistaken his own,sleeping arm for this most unwelcome of oriental intruders 1 Gentlemen, the human body in health is never asleep throughout, for when volition is paralysed—when we are everything but dead to all that connects us with the external world, the heart still continues to beat, the lungs perform their office, and the other internal organs, over which' vo- lition has no control, keep on their usual harmony of motion__in other words, the digestion of the food, the circulation of the blood, and the other lesser motions of organic life, proceed as in the waking state. The more important motions of the heart and lungs could not cease for many minutes without endangering the entire life in the higher animals__ though these organs in the bat, dormouse, and snake, appear to be inac- tive for months. Nevertheless, even in those animals, they are not en- tirely so—as we can easily analogically conceive. The state termed a fainting fit, it is true, comprehends even in man a temporary palsy or death of the whole body; but such state prolonged to a very brief period passes into death perpetual. Catalepsy or trance, being a sleep of all the organs, internal as well as external, though not of their atoms, has so great LECTURE I. 23 a resemblance to death, as to have been frequently mistaken for it. The subject of this condition of body, by something like the same inexplicable power which enables the dormouse to hybernate, may remain apparently dead for days and yet recover. More inexplicable still, is the recovery to life of fish, that for months, as travellers tell us, have been frozen as hard as a chip. We now pass to the consideration of Disease. Till the hour of sickness comes, how few non-medical persons ever think of a subject which ought to be of interest to all. The same men who discuss with becoming gravity the artificial inflections of a Greek or Latin verb, neglect to inform themselves of the natural laws that govern the motions of their own bodies ! No wonder that the world should be so long kept in darkness on medicine and its mode of action,—no wonder that even educated persons should still know so little of the proper study of mankind—man ! In the throes of disease, the early priests, as I have already told you, imagined they detected the workings of demons. The medical theorists, on the contrary, attributed them to morbid ingredients in the blood or bowels. One age bowed the knee to an " acrimony" or " putridity ;" another acknowledged no cause but a " crudity," an " acid- ity," or a " humor." The moderns hold the notion that a mysterious process, which they term " inflammation," is the head and front of all offending. How absurd each and all of these doctrines, will appear in the sequel! Disease, Gentlemen, is neither a devil to " cast out," an acrimony or crudity to be expelled, nor any fanciful chemical goblin to be chemically neutralized—neither is the state erroneously termed in- flammation, so commonly the cause as a coincident part of general disorder. Disease is an error of action—a greater or less variation in the motion, rest, and revolutions of the different parts of the body—reducible, like the revolutions of Health, into a systematic series of periodic alternations, in the course of which the matter of a structure occasionally by its atomic changes alters its natural character and chemical relations, so much so in some cases, as to become even completely decomposed and disorgan- ized. Whatever be the cause or causes of corporeal aberration, in obe- dience to the law of all matter, the first effects are change of motion and change of temperature. The patient accordingly has a feeling of heat or cold. His muscular motions, less under the control of their respective in- fluences, become tremulous, spasmodic ; or wearied, palsied, the func- tions of particular muscles cease. The breathing is hurried on slight exertion, or it is maintained slowly and at intervals, and with a long oc- casional inspiration and expiration—familiar to you all in the act of sigh- ing. The heart is quick, palpitating; or languid, or remittent in its beats; the appetite craving, capricious, or lost. The secretions are either hurried and increased in quantity; or sluggish, or suppressed. The body shows a partial or general waste ; or becomes in part or in whole preternaturally tumid and bloated. Alive to the slightest stimulus, the patient is easily impassioned or depressed ; his mind, comprehending in its various rela- tions every shade of unreasonable sadness or gaiety, prodigality or cu- pidity, vacillation or pertinacity, suspicious caution or too confident se- curity ; with every color of imagination, from highly intellectual concep- tion to the dream-like vagaries and reveries of hallucination. His sensa- tions are perceptibly diminished or increased. Light and sound, for example, confuse or distract him; like the soft Sybarite, a rose leaf ruffles him. With the smallest increase in the medium temperature of the atmosphere, he becomes hot and uncomfortable, and the slightest breeze shivers and discomposes him; or, as you may sometimes observe in the case of extreme age and idiotcy, he becomes equally insensible to excess of light, sound, heat, and cold. 24 LECTURE I. Contrast, if vou please, these simpler forms of Disease with ^atJJ have said of Health, and you will at a glance perceive that the ddTerence betwixt the two states consists in mere variation of the ^m or amount o particular corporeal motions, and m a dto.ce o^^^^Jf ao-encv on the matter and functions of the body. Structural cnanbe, or tSLTtTd™mposition of any part of the frame, so frequently but erroneouslyAssociated with disease as a cause, is not even a necessary element in a fatal result. What are Toothache, Consumption, Rheumatism, buTaeveSpments of constitutional change .'-they are phenomena which Slav or may not arise out of general corporeal disturbance, according to particular habits and predispositions. By predisposition, I mean the readiness or fitness of one part of the body more than another to be acted upon by influences from without,—occasioned by a weakness m the co- hesive power of the atoms of that part to each other. We have all our particular predispositions. Let us now inquire into the Causes of Disease. What are the agencies that give rise to -Maladies Of ghastly spasms, or racking tortures, qualms Of heart-sick agony, all feverish kinds, Convulsions, epilepsies, fierce catarrhs,} Intestine stone, and ulcer, colic pangs, Demoniac phrenzy, moping melancholy And moon-struck madness, pining atrophy, Marasmus, and wide-wasting pestilence, Dropsies and asthmas, and joint-racking rheums V Milton. Gentlemen, the Causes of all these various diseases—Various in name, place, and degree—One only in their real nature—may be found either in a deprivation or wrong adaptation of the identical forces which continue life, in health,—the same natural agencies, in a word, by which every motion or event is produced throughout the universe. They comprise, therefore, everything that connects us directly or indirectly, with the ex- ternal world ; and most, if not all of them, act upon us, in the first place, through the different modifications of nervous perception. The causes of disease, then, never originate in any one organ of the body,—except in so far as that organ may be predisposed by an inherent weakness of the attractive power of the atoms of its parts to receive grave impressions from outward agencies that affect the more stable portions of the same body in a slighter manner. I conceive with Hobbes, that " nothing taketh beginning from itself, but from the action of some immediate agent with- out itself." If this be true, how delusive the idea of those professors who look for the Causes of disease in the bodies of the dead ! In the schools we constantly hear that Anatomy is the foundation of medical science. Sydenham, on the contrary, held it so cheap, as to say, " Anatomy is a fit study for painters ;"—he might have added, and also for surgeons ; but so far as Medicine is concerned, the best anatomists have been seldom good physicians. They have been all too mechanical in their notions. Do not, Gentlemen, for a moment suppose that I mean to condemn the study of Anatomy, or that I would desire to leave it out in any system of medical education. Cultivated in a proper spirit, I would rather, on the contrary, make it a part of the useful education of the people. By surgeons Anatomy must be studied minutely, and few men in these days would care to practise Physic without possess- ing a competent knowledge of the various organs of the body on which LECTURE I. 25 medicines operate. But let the student keep in mind that a dead body is one thing and a living body another—and that a man may know anatomy as well as the best professor whoever taught it, and yet be utterly ignorant what medicines to prescribe if he wished to alter the motions of any one organ of a living body. To Physic, anatomy is a mere accessory—and the Physicians of some countries, India and China for example, practise their profession with wonderful success, though they never saw the inside of a dead body. Sydenham is called to this day the English Hip- pocrates, and yet see how little he prized anatomy. And, certainly, in his own words, it is a knowledge " easily and soon attained, and it may be shortened more than other things that are more difficult, for it may be learned by sight in human bodies, or in some animals, and that very easily by such as are not sharp-witted" [meaning thereby that any blockhead with a tolerable memory may easily master it]. " But in acute diseases," he continues, " which kind contains more than two-thirds of diseases? and moreover, in most chronic complaints, it must be confessed there is some specific property" [depending, as I shall afterwards show you, on the electrical condition of the living brain] which no contemplation re- duced from the speculation of the [dead} human body can ever discover: —wherefore, that men should not so place the main of the business upon the dissection of carcases, as if thereby the medical art might be rather pro- moted than by the diligent observation of the natural phenomena, and of such things as do good and hurt"—such as the action of medicine and other external agency upon the living. How different this from the language of Dr. Baillie, who says, " The dead body is that great basis on which we are to build the knowledge that is to guide us in distributing life and health to our fellow creatures." Here, then, so far as mere authority goes, you have the opinions of two celebrated men in direct opposition. But in the course of these lectures I will give you somethmg better than any human authority, however respectable. The too exclusive spirit in which professors have urged the necessity of investigating the bodies of the dead, not in England only, but through- out Europe, has given rise to a class of medical materialists, who, hoping to find the origin of every disease made manifest by the scalpel, are ever mistaking effects for causes. Loth to believe that death may take place without even a palpable change of structure, these individuals direct their attention to the minutiae of the dead—and finding, in their search, some petty enlargement, some trifling ulceration, or, it may be, some formidable tumor or abscess, hastily set this down as the first cause of a general dis- ease of which it was only a development or coincident part. " These people," in the words of a late physician, Dr. Uwins, " put consequence for cause, incident for source, change in the condition of blood-vessels for powers producing such change. It is an error which has its origin in the blood and filth of the dissecting room, and which tends to degrade medi- cine from the dignity of a science to the mere detail of an art." What has practical medicine gained at the hands of anatomical professors ? The greater number of their pupils have been sceptics in Physic; and no wonder, since they have been so constantly accustomed to hear, ex cathedra, that anatomy is the foundation of all medical science. That were true enough, if by the word " foundation" was meant that anatomy is the lowest part of it. The fact is, this kind of language is the natural result of a too great preponderance of surgical influence in the schools. It is the effect of a too great influence of your " great operators,"—tending to make young men expert anatomical mechanics, but nothing more. These leave their universities, not only with a contempt for Physic, but without a single correct idea of the action of medicine on the living system : and yet to these the people of this country chiefly entrust the treatment of their diseases, which, in ninety-nine cases out of the hundred, demand medical, 3 26 LECTURE L not surgical knowledge. Beware, then, of trusting to great operators, to men whose art Shakspeare truly says has " no honor in if—for were Physic better cultivated, there would be little need of such an opprobrium as operative mutilation. It is an art, too, that hardens the heart, and in- clines the professors too often to use the knife, more to gratify their own love of display than to give relief to their suffering fellow-creatures. No " great operator" should be permitted to perform any capital operation without the previous consent of one or more physicians. In its present mechan- ical and degraded state, who can wonder that those who practise Medi- cine should so frequently cut the sorry figures they do when examin- ed as witnesses in our courts of law, or that their evidence in most instances should appear to both the bench and bar a tissue of incoherency and inconsistency throughout ? At an inquest medical practitioners seldom get beyond the appearances of a post mortem examination, though in a great many instances such appearances, as I shall afterwards show you, have been produced by their own bad practice ! It is somewhat strange that their too numerous opportunities of dissecting dead bodies should not long ago have opened their eyes to their paucity of resource for the ailments of the living ! So great and universal has the prevalent delusion upon the subject of dissection become, that almost everybody, from the peer to the peasant, shares in it. Lord Brougham, in a speech he once made, declared that " the only good medical education is to be got in the dis- secting room." The same nobleman, in his work on Natural Theology, speculates upon the power of mind apart from matter, proving himself to be equally superficial in mental as in medical science. But what advan- tages, let me ask, have centuries of dissection contributed to the healing art ? We hear of a great many, truly; but lungs decomposed, livers enlarged, bone, muscle, and intestine in various stages of corruption, would seem to comprise the whole. These are, nevertheless what modern professors put up in bottles and cases, and exultingly show off as " beautiful specimens '." «' superb collections !" pointing them out at the same time to their credulous pupils as the trophies of science, when they might better describe them as the triumphs of death over their own want of skill; or,—in the words of Gray, " Rich windows that exclude the light, And passages that lead to nothing!" Now, what has the most patient study of these done for Physic ? Has it given us one new remedy, or told us better how to use our old ? Where were the virtues of bark and opium ascertained ? In the dead house ? No certainly! The one was discovered by a Peruvian peasant who cured' himself of the ague by it: what had anatomy to do with that ? For the other we may thank the Brahmins of Hindustan, who hold the dissectiii" room in great horror. Antimony, rhubarb, mercury,—whence got Ave our knowledge of these ? From the quack and the old woman—individuals who will ever successfully compete with physicians, while the latter busy themselves with the dead'bodies, to the neglect of the powers and princi- ples that affect the living. " A cripple in the right way," says Lord Bacon, "will beat a racer in the wrong." So great a stumbling-block to a proper knowledge of medicine has been this exclusive and too minute attention to dissection, that Dr. Baillie, its greatest patron, after retiring from practice, confessed, as I have already told you, his total want of faith in physic. The*experience of his whole life was equally a satire on anatomical knowledge, and the value too often attaching to a medical reputation. To return to the causes of disease,—are they not infinite ? The earth and its emanations—the air and its electrical conditions—the degrees of tern- LECTURE I. 27 perature, dryness and moisture of both, the nature and extent of our food and drink,—the passions by which we are agitated, with all the other changes and chances of our social and individual position; these are the elements to which we must look, not only for the causes of disorders, but for the causes of health itself. Having alluded to the great error of the " anatomical," or as it is some- times called, the " pathological," school, we may now glance at the doctrines of another class of particularists, those who, with the quantity or quality of our food or air, associate every disorder,—as if passions, burns, blows, wounds, &c, were mere words ! The late Mr.Abernethy, to whom science nevertheless owes something, was an example of the first. To the bowels, he almost invariably pointed as the first cause of every dis- turbance. He forgot his own observation, that a passion or a blow will alter the secretions of both. He ascribed the first link in the chain of causes to a feature, which could only be improved by an agent affect- ing the nervous or perceptive system, in which that and every other symp- tom could alone have their origin. But what shall we say of those who, like M'Culloch and others, attri- bute every disorder in which remittency of symptom takes place, to marsh-miasma or malaria,—to exhalations from the fens, marshes, &c,— when, as we shall shortly show, every disease which has obtained a name, may not only admit of this phenomenon; but that none, by what- ever caused or characterized, are in the first instance without their remis- sions or intermissions, all more or less periodic and perfect. Man is not an isolated being; without air and food he cannot exist—and a partial deprivation or depravity of either, will give rise to almost every affection to which he is liable ; but his success in life, his reception from friend and foe, the state of his family or finances, will equally excite, depress, and disorder his various organs and functions, as a deprivation or depravity of the food he eats, or the air he breathes. An unexpected reverse of for- tune, good or bad, may lay the foundation of a thousand maladies; nay, examples are on record, where individuals have instantly expired from intensity of sudden joy. Of sudden grief many have been the victims. " It has been too much the fashion in philosophy," says Sir Humphrey Davy, " to refer operations and effects to single agencies, but there are in fact in nature two grand species of relationship between phenomena; in one an infinite variety of effects is produced by a single cause,—in the other, a great variety of causes is subservient to one effect." This observation applies with particular force to everything pertaining both to the causes of disease and its cure. The single agency of thermal change, for exam- ple, has given rise to cough, catarrh, rheumatism, dropsy, and a host of other disorders in one class of individuals; while in another class, to call forth any one of such states, it would require the united influence of intemperance, domestic trouble, and deprivation of food, in addition to rhat thermal change, which of itself singly produced all these diseases in the former. Physicians are in the habit of dividing diseases into two classes, namely, constitutional and local, and they treat them as such ac- cordingly ; but, properly speaking, there never was a purely local disease. You will doubtless ask me if toothache, consumption, and ulcers, are not local diseases? So far from this, it is impossible for such states to take place (unless where they happen to be produced by outward injury), without the previous condition of entire constitutional disturbance,—of which instead of being causes, as many suppose and teach, they are only effects or features. Let the physician recur to nature, he will find that the subjects of all such diseases labored under a general derangement of the whole habit, previously to the development of the local consequences, from which these diseases take their designations. Now, some will call this disturbance by one name, and some by another; for, myself, I am 28 LECTURE I. satisfied with the phrase, " loss of health," but as many of you, Gentle- men, may not be content without a medical term, I will call it, to please you, Fever ; and as remissions or periods of comparative ease are enjoyed by the subjects of all these diseases, I will go father, and call it Remit- tent Fever. Yes, Gentlemen, all diseases have remissions, and " this," says John Hunter, " is an attribute belonging to life, and shows that life cannot go on the same continually, but must have its hours of rest and hours of action." We have already analyzed the Life of Health;—we have seen that it consists in a periodic alternation of harmonious movements, some long, some short,—greater and lesser movements, otherwise fits; in Sliaks- peare's language, Life is a " fitful fever." If so, what can the morbid modifications of that Life be, but modifications of Fitful or Intermittent Fever? "All diseases," says Hippocrates, "resemble each other in their form, invasion, march, and decline." " The type of all diseases," he adds, " is one and the same." What, then, is that type ? If we succeed In proving to you that toothache, asthma, epilepsy, gout, mania, and apo- plexy, all come on in fits; that all have febrile chills or heats; that inter- missions or periods of immunity from suffermg, more or less complete, are common to each; and that every one of these supposed different diseases may, moreover, be cured by any one of the agents most generally suc- cessful in the treatment of Intermittent Fever, popularly termed Ague ; to what other conclusion can we possibly come, but that this same Ague is the type which pervades, and the bond which associates together every one of these variously named diseases ? If, in the course of these Lec- tures, we further prove that what are called "inflammations" also come on in fits; that the subjects of them have equally their periods of immu- nity from pain, and that these yield with equal readiness to the same remedial means;—who can be so unreasonable as to doubt or dispute that Ague is the model or likeness—the type of all disease ! But here let me be clearly understood;—let me not be supposed to say that every disease is an ague and nothing more. A canoe is the model of all sea-vessels,—the type of every brig, barque, frigate, sloop, and so forth, nautically termed ship. But, a ship is a canoe, and something more —a canoe enlarged and variously modified. Here, then, you have unity of type with variety of development,—simplicity of principle with nu- merous modifications of form. That is what I wish to impress upon you nvfehe case of Disease. Let that, then, be your motto and your mark, and do not forget it in the practical application. Remember the constantly changing phenomena of Health,—their fever-like jfafulness,—the slow manner in one case, the rapid manner in another, in which these healthy fitful motions run into motions unhealthily fitful,—run into the true ague or agueish fits, with which I shall hereafter prove to you all diseases com- mence. And beware of mistaking the end for the beginning;—the con- sequence or coincidence for the cause; beware of that all but univer- sal medical error—that fallacy in many mstances so fatal—of mistaking the decay, or tendency to decay, of a part for the primary cause of the febrile disturbance of the whole,—when, as by numerous proofs, I shall bring it home to your conviction that such local disease, in the majority of instances, is a mere consequence or development simply,—a termination or effect, though sometimes a coincidence from the beginning, of repeated constitutional febrile attacks. Health and Disease, Gentlemen, are conver- tible states;—else why should the aid of the physician be asked ? The same moving matter of the body, when influenced by one agency, may become Disease, and acted upon by another while in the diseased 'state, may return again to the condition of Health. The human body, whether in health or disorder, is an epitome of every great system in nature. Like the globe we inhabit, it has in health its LECTURE I. 29 diurnal and other variations—its sun and its shade—its times and seasons —its alternations of heat and moisture. In disease, we recognize the same long chills and droughts,—the same passionate storms and outpourings of the streams, by which the earth at times is agitated,—the matter of the body assuming in the course of these various alterations, changes of char- acter and composition, such as abscesses, tumors, and eruptions, typical of new formed mountain masses, earthquakes, and volcanoes; all these, too, like the tempests and hurricanes of nature, intermitting with longer or shorter periods of tranquillity, till the wearied body either regains, like our common mother, its wonted harmony of motions; or, like what we may conceive of a world destroyed, becomes resolved into its pristine ele- ments. In the language of the schools, the phases of Disease are termed the Paroxysm and Intermission,—the first, or period of suffering, being synony- mous with exacerbation, throe, fit;—the second, as we have already seen, meaning the period of comparative freedom from disorder;—though when less complete, Intermission is termed Remission. For my own part, I shall occasionally be compelled to use Remission and Intermission synony- mously. But as I have already explained to you, so far from having been recognized as a law of universal occurrence, and harmonizing with every- thing which we know of our own or other worlds, periodic intermission and return have been vaguely supposed to stamp the disorders where they were too striking to be overlooked, as the exclusive offspring of a malarious or miasmatic atmosphere ! Gentlemen, there can be no greater error than this. The actions of life in health are all, as you have seen, periodic; and however, or by whatever caused, their morbid modifica- tions, termed disease, are periodic also. What are the remedies most influential in preventing the return of an Ague-fit ? The profession will answer, and rightly answer, the Peruvian bark—or its better substitute quinine, in fact, its essence—arsenic, and opium ; to which you will permit me to add Hydrocyanic Acid, better known as Prussic Acid,—Iron, Silver, Copper, Strychnia, Musk, Assafe- tida, Valerian, Colchicum, Zinc, Bismuth;—and there are others, doubt- less, in nature, which time and accident may yet discover. These agents, Gentlemen, are generally all most effective when taken during the intermis- sion. From the relation which their influence must thus bear to Time or peri- od, and Temperature (cold and heat), I term them chrono-thermal—xp6v°s (Chronos) being the Greek word for time—Qtpfir, (Therma) for heat or tem- perature. But as some of you, in common with many in the profession, and not a few out of it, may possibly be sceptical in regard to the cura- tive power of any medicine in any disease, I will here tell you the way I lately settled this matter with a certain young barrister of my acquaint- ance who thought he should be able to prove to me that physic is all nonsense. " Do you mean to tell me," said the gentleman in question, " that putting little bits of pounded stick or stone mto a man's stomach, will cure any disease whatever ?" " Oh ! certainly not," said I; for when you find people obstinate, it is better to humor them a little at first; " but perhaps," contmued I, " you may just be disposed to admit, that little bits of pounded stick and stone may cause disease, and even death;—other- wise you must be ready to swallow hemlock and arsenic in any quantity required of you." To this the man of law at once put in a demurrer. The causing and killing part of the bushiess he could not by any sophis- try get rid of. So I then thought it time to explain to him, as I now do to you, that the principle upon which these substances can cure and cause disease is one and the same ; namely, their power, for good or for evil, as the case may be, of Electrically altering the motive state of certain parts of the body, and of altering at the same time their thermal condi- tions. 30 LECTURE II. Gentlemen, turn over the history of medicine, and mark well the reme- dies upon which authors dilate as being most beneficial m any form ot disease; you will find them to be, one and all, agents having the power of controlling temperature—of exalting or depressing this in the stages of exacerbation, or of continuing and prolonging the more healthy and mo- derate degrees of it, characteristic of the period of remission;—thereby at the same time controlling motion, or vice versa. For this latter indication, the most generally efficient of all remedies is the Peruvian Bark, or Quinine; but it is not specific, nor is there such a thing as specific, for this or any other purpose, in physic; arsenic, opium, hydrocyanic acid, all proving better or worse than another in particular cases of disease, and this less with reference to the disorder and its cause, than to the constitution or peculiarity of system of individual patients.* This peculiarity, we shall afterwards prove, depends upon certain Electri- cal conditions of the Brain. But upon the nature and the mode of action of all Remedies, we shall enter at length at a more advanced period of the course. In our next lecture we shall consider the phenomena of ague, and show you its relation to Spasmodic disease,—Asthma, Epilepsy,—to Palsy, Curved Spine, Squint, &c. These disorders we shall prove are merely so many developments occurring in its course,—analytically, by rigidly scrutinizing their symptoms; synthetically, by detailing to you cases of each cured on chrono-thermal principles. LECTURE II. AGUE—SPASMODIC AND PARALYTIC DISEASE—DISORDERS OF SENSATION. In our former Lecture, Gentlemen, you will remember that after a brief allusion to a few of the many errors which, from time to time, have pre- vailed in the schools, we took a more simple, though, at the same time, a much more bold and sweeping view of the subject of Medicine than would appear to have hitherto come within the grasp of teachers and professors. The nature of Health and Sleep, of Death and Disease, we in some measure explained;—and we proposed, as matter for future argu- mentation, that intermittent fever or ague is the likeness or type of all the maladies to which man is liable,—referring, at the same time, to cer- tain natural analogies in the world around us; and hazarding the state- ment (which until we prove, we by no means wish you to take for grant- ed) that the chrono-thermal or ague medicines are the most generally in- fluential in the treatment of every kind of disease. Let it not, however, be supposed that in our high estimate of this particular class of remedies, we reject, in practice, any earthly agent which God has given us; for there is no substance in nature which may not be turned to good account by the wise and judicious physician. Besides the chrono-thermal reme- dies, which we chiefly use as remedies of prevention, we possess a multitude * This opinion of Dr. Dickson is frequently and forcibly repeated in these pages. The etudent of that most valuable work of Professor Dunglison of Philadelphia, " New Remedies," is struck at almost every page with the conflicting and opposite views expressed by practitioners in reference to the effect? of the various medicines treated of. By some, a particular remedy is extolled in high terms—by others it is declared to be of little value. Does not our author furnish the key to the cause o f these conflicting opinions .—T. LECTURE 11. 31 of powers which have all more or less influence upon the human body, both in health and disease: and though few or no substances can act upon any part of the frame without implicating every other part, yet do we find that certain medicines have relations of affinity to particular or- gans of the body greater than to others—some affecting one organ, some another. Of this class, Vomits and Purgatives (as their names import), Mercury, Creosote, Cantharides, and the various Gums and Balsams, are the principal: Iodine, Lead, the Earths and Acids, are also examples. But while, in the more simple cases of disease, the chrono-thermal medicines, singly, will answer every purpose,—particular cases of disorder will be more efficiently treated with alterations and combinations of both classes, than by the exhibition of either simply. Of the action of remedies of every kind, we shall speak more particularly when we come to treat of individual substances. For the present, we shall content ourselves with repeating what we stated in our former Lecture, in connection with this subject, that the action of remedy and cause, in every case, comes at last to the common principle of their capacity Electrically or Galvanically to affect temperature or motion—change in one never taking place without the other. It will be a subject of gratification to pursue disease through all its modifications and varieties, step by step, and to show you the source and the extent of our influence over it,—for which purpose we shall call our different witnesses before you in the shape of Cases,—tak- ing these, as often as possible, from the experience of others, and when this fails us, from the results of our own practice; leaving to you, of course, to compare and cross-examine these last at our leisure, with such facts and cases of a similar description, as may come before you during your attendance at the various hospitals with which you are respectively connected. Of this we feel assured, that whether or not you individually pronounce a verdict in our favor upon all counts, you will at least col- lectively admit that we have compelled you to alter your sentiments most materially upon many measures which you previously supposed to be as unquestionable in practice as they were orthodox in precept. But if, ac- cording to Lord Bacon, " disciples do owe unto masters only a temporary belief, and a suspension of their own judgment until they be fully instructed, and not an absolute resignation or perpetual captivity," you will not be sorry to escape from the thraldom of men who, when asked for bread, gave you a substance which, in the darkness of your ignorance, you could not by any possibility tell was a stone ! No longer mocked by mys- tic gibberish, you will now take your places as judges of the very doc- trines you formerly, as pupils, implicitly and without examination be- lieved ; and according to the evidence which I shall bring before you, you will pronounce between your teachers and me—whether the infinity of distinctions and differences, upon which they so pride themselves, be founded in nature and reason,—or whether, hi the words of the same great philosopher, " all things do by scale ascend to unity, so then, always that knowledge is worthiest which is charged with least multiplicity." Gentlemen, there was a time when the greater number of people imagined that the only thing worth acquiring in this life, was a knowledge of the dead languages. A new era has since sprung up, and mankind have begun to appreciate the advantages to be obtained from an acquaint- ance with the chemical and physical sciences. They now prefer the study of the natural bodies around them, to pedantic discussions about Greek articles and Latin verbs. It is only in the cloisters of Oxford and Cambridge, that men sneer at " utilitarianism," or in that antiquated off- shoot of these monkish institutions—the College of Physicians. Railroads, steam-boats, galvanism, and gas, have all come to light within the last half century. A revolution hi thought and action has been the result; petty objects have given way to comprehensive views, and petty interests 32 LECTURE II. have been destroyed by the general improvement that has already been accomplished. Is Medicine the only branch of human knowledge des- tined to stand still, while all around it is in motion ? Is the inarch of intellect to sweep on and on, and leave behind it this so-called science, untouched and unimproved in its progress ? When the monarchs who have successively wielded the medical sceptre—who each in their day were looked upon as demigods in physic, have in turn declared that all they knew of it was that " they nothing knew," shall blame be attached to him who would attempt to rescue his profession from this worse than darkness visible ? If, by their own confession, the Knightons and Baillies were ignorant of the first principles of correct practice, surely it were but charitable to suppose that men so intelligent and sagacious on most other matters may, in this instance at least, have pursued a deceptive mode of investigation ? Like the racer on the wrong road, how could they in that case get to the end of their journey ? Pursuing their professional studies chiefly in the dead house, these physicians forget that medicine has no power over a corpse. Gentlemen, the reflections which I shall have the honor to submit for your consideration, were the result of observations made on the ever-shifting motions of the living. Who will tell me that this kind of study is only proper for medical persons ? Who shall say that this description of knowledge may not be made interesting to the world at large ? Greek, Latin, High Dutch, and Hebrew,—are these repetitions of the same signs more important than an enlarged knowledge of the sense—more instructive to those who pursue them as a study, than a consideration of the revolutions and constantly changing relations of the matter of their own bodies ? Without a proper knowledge of the laws of your own organization, how can you possibly put in practice the Greek maxim, " Know yourselves ?" Having promised this much, I now come to consider in detail the phenomena of Intermittent Fever or Ague ; for ague being the type of every other modification of disease, it is neces- sary you should be well acquainted with its principal system. I have already told you there can be no disease, no morbid motion without change of temperature. The subject of ague, then, among other sensations and changes, successively experiences a Chill and Heat, followed by a profuse Perspiration. These three stages, commonly called the Cold, Hot, and Sweating stages, constitute the Paroxysm or Fit. The patient, during each stage, is consequently in a different condition of body from either of the others; his sensations, moreover, differ during each of them. To the state of Perspiration, which terminates the fit, an Intermission, or interval of comparative health, succeeds; and this interval of immunity from suffering usually lasts one, two, or more days (giving rise to the terms, tertian, quartan, and other agues, according to the interval of duration), before the recurrence of another similar fit;—such fit generally making its invasion with a wonderful degree of exactness at the same hour of the clock as the former, and lasting about the same time,—when it is again followed by a similar periodic intermission of the symptoms as before. In all the stages of the fit, every function of the body is dis- turbed—some more, some less. During the cold stage, the face becomes pale, the features shrink, and the muscles are tremulous or even spas- modic: the patient, in other words, shivers, has cramp, and his strength is prostrate. The breathing and circulation are variously altered,—his urine, if he passes any, is generally pale and plentiful, and his other secretions are similarly changed in quantity and quality. The senses and mental powers are for the most part depressed, or even curiously vitiated LECTURE II. 33 though sometimes they are preternaturally exalted. A gentleman, who was recently my; patient, informed me, that during the cold stage his intellectual powers were more than usually clear, and his sensations throughout highly pleasurable; he felt as if under the pleasurable feeling produced in some people by opium; but this kind of feeling is more frequently an accompaniment of the hot stage. The patient has nausea and loss of appetite, sometimes sickness; less frequently looseness of bowels,—or he has hunger amounting to voracity,—and sometimes thirst. A reaction now comes on. The patient gradually becomes warmer and warmer—the face changes from pale to red—his cheek is now flushed— his eyes are suffused, and he suffers from headache, more or less agoniz- ing. This is the Hot stage. The thirst, whether it existed before or not, is now a most prominent symptom; the appetite is thoroughly lost; the patient having, in most instances, a repugnancy to the very name of food. If you inspect the tongue, you will find it comparatively dry and loaded, and of a brown color; and though the skin feel to your hand like a burning coal, so to speak, the patient himself may complain of such excessive coldness, as to induce the attendants to cover him with numerous blankets;—more generally, however, he has a sensation of heat equally severe. Every muscle of his body in this stage is more or less painful and enfeebled ; though, in some instances, he may appear to have a greater command over them than in health; and if delirium supervene, which it may do, his strength will appear almost superhuman. During the excitement of this stage, individuals have been known to become musical, poetical, oratorical, and have exercised other talents which they never were known to manifest in health. The heart now beats violently, and the pulse is full and bounding ; the urine, instead of being pale, as in the preceding stage, is scanty and high colored. The secretions generally are sluggish, and in some instances they are altogether suppressed. A long Sweat suc- ceeds, during which the greater number of the suppressed secretions gradually re-appear. As with a feeling of languor, lassitude and a disposi- tion to yawn and stretch the various members of the body, the fit is usually preceded; so with the same symptoms does it usually end. Then comes the state of comparative health, which may either again pass into the Fever-fit, or continue for an indefinite period, so as eventually to be- come Health. As every individual has, from birth, some part of his body less strongly constructed than the other parts, it would be wonderful indeed, if, during this terrible tempest of body, termed an Ague-fit, that weak point were not very often discovered ; but discovered, more or less, in every instance it usually is. Is the Brain the least strongly constructed point ? Then, according to the part of the organ most implicated, and the degree of im- plication, will you have Epilepsy, Apoplexy, Insanity, Imbecility of Mind, or Palsy, superadded. Is the original weakness of conformation seated in the lungs ? Look, then, for spitting of blood, asthma, or consumption. In the heart ? how it palpitates or remits in its beats !—it may even stand still for ever ; and more than once hi my life have I known it to do this during the ague-fit. But the joints may be the weak points of the patient's body ?—then, as a matter of course, the joints swell and become more or less hot and painful. And if, just at this epoch, some wiseacre of the profession chance to drop in,—with the usual scholastic sagacity, he dis- covers the disease is not Fever, but Rheumatism. The lancet, of course, is immediately bared—the leech and the blister are ordered;—from this moment, the entire treatment is directed, not to the beginning, but to the end—not to the Fever, but to its termination! The state of the joints is the sole subject of thought and action; the Brain—that Pandora's box of the whole—that organ upon which every motion of the body, wrong or 34 LECTURE IL right, depends,—never once enters into the wonderfully wise man's head; —he never once dreams of influencing this key to all the corporeal actions, in any manner whatever. And what is the result of this treatment? Daily promises, and daily disappointments—hope deferred and the heart sick—the health, the happiness, and the home of the patient too often made desolate for ever. Thus far, Gentlemen, I have detailed to you the beginning, the progress, and some of the more important terminations of what is usually called a perfect ague-fit. I must now tell you that all agues are not equally per- fect ; the stages of the fit in particular cases may vary in duration—the bolder features or symptoms may be all more or less subdued—the inter- mission, or immunity from suffering, instead of extending to a day or days, may be only an hour or two in duration. This disease is now no longer Ague ; Physicians change its name to Remittent Fever. Remittent fever may be either the primary disease, or the Fever may, in the com- mencement, be a veritable ague,—recurring and re-recurring, in the first instance, at perfectly periodic intervals of a day or more; yet slide by degrees into a fever of the Remittent form. And this Remittent Fever again, whether it be the original or secondary disease, from its periods of access and interval becoming still less obviously marked, may assume the shape and shade of disease incorrectly termed Continued Fever; which last, from long duration and other circumstances, may terminate in that most terrible state of mental and corporeal prostration, by the schools denominated Typhus Fever,—from a Greek word signifying stupor or un- consciousness, that being one of the most common symptoms. What, then, are all these Fevers, but varieties or shades of each other! During the course of all or any of these so-called different fevers, every organic affection, every possible local change you can name or imagine, may, with more or less quickness, be developed,—giving occasion, of course, to the attending practitioner to baptize the disease anew; and this he may either do, according to the locality of such organic change, or according to the locality in which the symptoms may induce him to sus- pect its existence. Should a new doctor chance at this particular time to be asked to see the patient, what a fine opportunity for a very pretty quarrel! And the practitioner who attended from the beginning, though he may have practised the right, shall very likely be dismissed, while the other for advising the wrong may as certainly be retained, and be es- teemed, at the same time, as an angel, or an oracle at least. You are doubtless curious to know the wherefore of this. But there is nothing so very curious in the matter after all. For if you only reflect how few peo- ple in this world can get further than the surface of things,—how few can see beyond present signs and present symptoms, you will not be astonished that the new doctor who shall place his finger on the organ most implicated, and wrongly set that down, not as the end, but as the beginning—not as the consequence or effect, but as the origin and cause of the totality of disturbance, will be preferred to him whose experience of the whole case led him rightly to look upon the local disease as the gradual development of repeated febrile attacks. But the new practition- er will seldom be content with merely seizing upon the local termination as the cause or beginning of the mischief, and proceed to treat it accord- ingly ; for he will very often drop a hint, at the same time, that but for neglect of this the case might have ended far more favorably. Suppose, for example, Pulmonary Consumption to be the after result of the original fever. " What a pity," the learned man will say, " I was not called in at first, for then I should have at once attacked the seat of the disease—the chest." Then, Gentlemen, when no consumptive symptom existed,__ then, when the weak point of the patient, for all you, I, or any other doctor knew, or could know, might have been the liver, stomach, or anything LECTURE II. 35 else ! And by that pretty speech of his, nine times out of ten, such new doctor will succeed in securing the esteem of the persons who employ him. Now this is a hard case for the honest and more able practitioner; but so the world wags ! Until the publication of my Work, the Fallacy of the Art of Physic as taught in the Schools, and long after, it was the almost universal belief of medical professors that Ague could only be caused by emanations from the fens, the complaint being very common in fenny countries ; and I am not sure that this belief is not even now one of the numerous fallacies still taught in our schools and universities. But, Gentlemen, there is no agent in nature which may not cause ague, from a blow to a passion. Lord Byron's mother, according to Mr. Moore, died of a " fit of ague brought on by rage or vexation, caused by reading her upholsterer's bill." The close analogy subsisting between ague and the passions has not es- caped the observation of the poets. Shakspeare, as I shall afterwards show you, often alludes to it; and Coleridge, in his usual playful manner, gives us to understand, There's no philosopher but sees That Rage and Fear are one disease, Though this may burn and that may freeze, They're bothalike the Ague. You see, then, there can be no corporeal agitation, no constitutional revolution, without a change of temperature of some kind. Butler in his Hudibras, tells us, Love's but an ague fit reversed,. The hot fit takes the patient first. Seriously, you will do well to ponder on the relations which the effects of the various passages bear to ague. Throughout them all you may ob- serve the same tremor and thermal changes ; and in many cases the dis- eases which they may cause become equally periodic and recurrent. A young lady was to have been married on a particular day; but on the very morning of that day the bridegroom was accidentally killed. The grief of the lady ended in insanity. The fit, in this case, came oneveiy day at the same time; but during the remainder of the twenty-four hours, she had, in scholastic phrase, a "lucid interval." She was then perfectly sane. Gentlemen, may I ask what are the lucid intervals of mania but intermissions ? Prolong them to an indefinite period and you produce sanity ! Prolong the intermission of any disease to an indefinite period, and you have Health. Your own common sense will tell you that. What are the constitutional effects of a fall or a severe blow ? Do we not perceive the same tremor in the first instance—the same pallor and loss of strength so remarkable in the cold fit of ague ? Have we not the same hot or febrile fit succeeding ? " The fevers," says Abernethy, " pro- duced by local disease (local injury?) are the very identical fevers which physicians meet with when there is no external injury." How can they be otherwise, since it is only by the matter of the body changing its motive relations and consequent thermal conditions in an identical man- ner in both cases, that we obtain the group of symptoms included by physicians under the abstract word " Fever ?" The agents which cure fever from a blow, are the same agents which cure fever from a passion, a poison, or a viewless and unknown cause. When a man is hot, and his skin dry all over, no matter what the cause be, you may bring his condition to the state of health by throwing cold water over him. You may do the same by an emetic. Oh! an emetic has a wonderful power in the case of fever; and the old physicians treated all fevers in 36 LECTURE II. the first instance by emetics. They did not trouble themselves much about the cause. The state of the patient was what they cared most about. When he was cold, they warmed him, sometimes with one thing, sometimes with another. When hot, they cooled him—not in the San- grado fashion of these days, by draining him of his life's blood; but by the employment of an emetic, or by sponging him over with cold water! By bleeding a man in the hot stage of fever, you may cool him certainly; but unless you cool him to death, you cannot thereby keep the fit from returning. When it does return, you may bleed him again, it is true; but how often may you do this safely ? So far as my experience of medical matters goes, few people in these times are permitted to die of disease. The orthodox fashion is to die of the doctor! Gentlemen, we daily hear of the terms constant and continued fever, but there never was, nor can there be a fever without a remission, without a period of compara- tive immunity from suffering, more or less marked. Every writer of name from Cullen downwards admits this; but what does it signify whether they admit it or not ? use your own eyes, and you will find it to be the truth. You have only then to prolong that period of immunity to an in- definite time, and you have health. By bark, opium, and the various chrono-thermal medicines, you may in most cases succeed. But instead of trying to prevent recurrence, practitioners now-a-days only temporize during the fit; and this is the most profitable practice; for a long sickness makes many fees! The honest physician will do his best to keep the fit from returning. Now if blood-letting were certain to do that, how could we possibly hear of people being bled more than once for fever ? Do we not hear of repeated applications of the lancet, and of the patient dying notwithstanding ? When I come to speak of Inflammation, you shall find how little that instrument is to be relied on in fever, or rather you shall find that its employment at all is one of the greatest and most terribly fatal of medical mistakes! How then is it, that this practice has so long maintained its ground? By the same influence that for thirty centuries determined the Indian widow to perish on the funeral pile of her husband—the influence of authority and custom simply. In physic, gentlemen, 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 super- ficial, and both are commonly false." [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 under- stand ; for the whole doctrines of the schools are a tissue of the most glaring and self-evident absurdities. At a future period of this course I shall prove my assertion; but before you can detect error you must first know truth, and this it shall be my endeavor to point out to you. To re- turn 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 disturbance shall first fall—whether directly upon theT>rain 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 symp- toms. Why, after these symptoms 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 LECTURE II. 37 yet recur, is a thing not more inexplicable than that the various habits of Health should in certain instances with our knowledge, and in certain in- stances without it, all have a tendency periodically to repeat themselves. Upon this subject I will touch more at large at an after period of the course. Meantime as the symptoms of an uncomplicated Ague fit stand out boldly in relief—and as in every other form of disease, however named or by whatsoever 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 as- sume every disease to be in the first instance 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 prelude to every disease—the precursor of every kind of local mis- chief—though in numerous cases, if not in all—more especially after re- peated 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 symp- toms for a time altogether into 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—functionally, if tthe 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 muscle, or the suspension or too great flow of a secretion. Of the second I can give you no better instances than that disorganizing disease of the knee-joint termed " white-swelling," and that too common termination of chest dis- ease in this country—Phthisis as it is termed by medical men—Consump- tion or decline by the vulgar. The propriety of adopting any remedial measure has in every case more or less relation to time and temperature. But the beneficial influ- ence of the Peruvian bark, and its preparation Quinine, would appear, more than any other agent, to depend upon the period in which we adminis- ter it. The proper period for its exhibition is during the remission. With the exception of opium, it is more strictly a preventive than any other known agent. So generally, indeed, has it been found to answer this purpose in the treatment of Ague, that many teachers of medicine have vaunted it as a Specific for this distemper; but as we stated to you in our former lecture, 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 Cromwell to die of it ? What- ever be the agency by which this or any other disease has been cured, you shall find in the course of these lectures, 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 medi- cal friends—Bark among the number. One day when riding out, he was seized with a paroxysm. The inmate of a little shop where he dismount- ed till the fit should be over, suggested to him to try the barber-surgeon of his neighborhood. Willing to be cured by anybody or by anything, 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! Gentlemen, to what, but to the improvement of the temperature of the spine, must we attribute the success of that plaster ? The general good effect of Quinine in keeping off the ague-fit, when it proceeds from view- less 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 produced by local injury. Of this, however, I will give you a proof. A gentleman shortly after having had a bougie passed, 3S LECTURE II. 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 paroxysms ; then for the first time he took quinine, and he had no repetition. He never had ague before that occa- sion, nor ever afterwards, unless when compelled to use the bougie. I do not know that I could better commence my proof of the intermit- tent nature of Disease generally, than by entering into a short considera tion 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 meaning of the term 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 warming the part, you may sometimes succeed, and there are a great many medicines by which, when taken in- ternally, 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. The difference of locality in which spasm takes place in different persons has afforded professors an excellent opportunity of mystifying the whole sub- ject. When it happens in the membranous lining of the lachrymal duct, you shall see the tears accumulating at the inner angle of the eye, the passage to the nose being closed up by the contracting spasm. This dis- ease is called Epiphora, and sometimes, though not quite correctly, Fistu- la Lachrymalis. Sneeze, Hiccough, and Yawn, are also effects of spasmodic action. Occurring in the muscular apparatus of the windpipe, or its di- visions, spasm is familiar to you all in the word Asthma ; and it is also termed Dyspnaa, 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 convulsions of the face and limbs, there is usually loss of consciousness, 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 color of his skin to spasm —spasm of the gall-ducts—though any other obstruction 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 Eiac Passion ; in the colon or great intestine, Colic; in the urethra, Spasmodic Stricture. The Lockjaw affords yet another example of spasm. That all these vari- ous 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 individuals. They are all capable of producing inverse motion; in one case curing or alleviating, in another causing or aggravating 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 remissions. A girl took a large dose of arsenic (sixty-four grains) for the purpose of suicide; her design was discovered in sufficient time to prevent her death • LECTURE II. 39 but a periodic epilepsy ushered in by chills and heats was the result. A man of the 30th Foot, after a course of hard drinking, became epileptic; his disease 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 pro- duced inverse motions, causing epilepsy 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 epilepsy may cure either. In truth, I scarcely know a disease which the passions Rage and Fear have not cured and caused, according to their attractive or re- pulsive mode of action in particular cases. I have said that Asthma is an intermittent disease. " The fits of con- vulsive Asthma," according to Darwin, " return at periods, and so far resemble the access of an intermittent fever." Had his physician's know- ledge 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 ague and asthma there is something more than a resemblance—that Asthma, in fact, is an ague, with the further development 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 seldom been compelled to complain of ill-success in its treatment. 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 until 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 attention to temperature: the spine, in this case, was always chilly, but became warm and comfortable under the use of the plaster. Many medical writers have detected the analogy which sub- sists betwixt 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 " trembling," and you will find it to be merely a rapid sue cession of incomplete spasms. In St. Vitus's dance, or as it is sometimes termed, " the leaping Ague," which is also a periodic disease, you may see every variety of spasmodic and tremulous action a muscle can take. It is a disease which I am very often consulted for in children, and in most cases I 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 em- ployed.* You all know the beneficial 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 Qui- nine over stricture is not so generally known. It is unnecessary for me to give any instance of my own evidence of this, Sir Benjamin * In the summer of 1838, a gentleman applied to me with stricture, and a large tumor in the perineum, the effects of a false passage caused by a bougie, which he had had eighteen years. He had palliated his sufferings by copious dilution with water. The perineum was as hard as a board. As he was going into the countiy, I recommended him to carry with him a quantity of capsules of copaiva, of which he was to take some half a dozen daily, and to prevent their purging him by taking small quantities of laudanum. At the end of two months, he returned cured. The tumor had subsided, the perineum was in its natural state, and his urine passed in a free stream.—T. 40 LECTURE II. Brodie having published at length the case of a gentleman affected witn 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 ui cases where this is less strikmg you have only to ask the patient if there are times when he passes his water better than others ; and if he answers in the affirmative, you may be sure the stricture depends less on a permanent thickening of the mucous membrane of the urethra, 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—hi pro- ducing spasm; and hence too the benefit to be derived from the warm bath in the treatment of spasm generally. In the great maj ority of stricture- cases, the surgeon may save himself the trouble, and his patient the tor- ture, 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 instances affected or " struck," this disease is known to everybody under the name of " Paralytic Stroke," or more familiarly still, " a Stroke." It consists either in a partial or complete inability to use the affected muscles—for there are degrees 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, gentlemen, Paralytic disease has often been produced by a purge, and oftener still by loss of Blood; * and many weakly persons, on suddenly rising from then chair, have all at once lost the use of a leg or arm. Most cases of Paralytic disease, if properly sifted, will be found to be only the termination of previous 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 the proper temperature of the body. How can you reconcile the idea of permanent pressure with such phenomena ? I now hold in my hand the Dublin Journal, in which I find a case of paralysis of some of the muscles necessary for the proper performance of the functions of speech—Aphonia, as it is called by professional men. This case will show you that Palsy, like every other form of disorder, may exhibit the most perfect periodic intermissions. It is taken from a foreign journal [#ec£er's]. " A peasant girl was attacked in the follow- ing manner:—Speechlessness came on every day at four o'clock, p. m., accompanied by a feeling of weight about the tongue, which remained 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 * The recent case of Sir William Geary must be still fresh in everybody's mind. That gentleman met with a sudden loss of blood from an accidental wound of the carotid artery. Palsy of the left side ensued. LECTURE II. 41 to a feeling of weight in the tongue. The paroxysm went off with a large evacuation of watery urine, accompanied by perspiration and sleep. Ten such attacks had occurred, when Dr. Richter of Wiesbaden was 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 the reporter of this case, but the periodic manner in which it came on and went off, together with the mode of its cure, sufficiently illustrate its nature. Not long ago, I was consulted in a similar case, which was moreover compli- cated 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 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.t I shall now give you the details of a case of palsy which I treated successfully after it had been long considere d hopeless :— Mrs. Sargent, aged 40, a married woman, and the mother of several chil- dren, 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 of the Cheltenham dispensary, Dr. Cannon, and Mr. C. T. Cooke among others. Such at least was the woman's own statement, confirmed to me by many people of respectability, who had visited her fromthe commencement of her illness. When I firstsaw 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 dispensary medicine, mer- cury, 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 remedies, the principal of .which were hydrocyanic acid and tincture of cantharides. Under this treatment, her voice returned in about a week; her recovery from everything was com- plete in six weeks, and she had no return in three years after she was under my care. Charles Overbury, 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 * " Mr. Earle found a paralyzed limb to indicate only 70°, the sound one 92°. By electricity, the former was raised to 77°."—Lefevee, Apology for the Nerves, London, 1S44.—T. t " Dr. Baillie said in his day, that palsy was upon the increase. It is not im- probable that the universal system of blood-letting upon all such attacks, and even threatening of them, has converted remedial into incurable diseases. Paralysis has sometimes immediately followed the depletion intended to prevent apoplexy; and when this plan has been persevered in for the relief of flow of blood to the head, it is not an uncommon consequence. Dr. Holland has commented very freely upon this having known cases of this kind, when bleeding has been immediately follow- ed by convulsions of epileptic character, occasionally by amaurosis, or deafness, more frequently still, by rambling delirium, and where wine or other cordials have as speedily abated these tendencies."—Lefevre.—T. 4 42 LECTURE II. labored under complete loss of speech the entire night, and nearly the whole day. About the same time daily—noon—he could utter the mono- *vllables ves 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 calomel 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 transformation as it is possible to imagine. Yon marked, I hope, the periodic, though im- perfect, remissions which this case exhibited. The case of the celebrated Madame Malibran may still be fresh in some of your minds. It was completely the converse of this boy's disease, for at particular times every muscle of that actress became stiff and rigid throughout the entire 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 differ- ent muscles of the same person,—sometimes they are complicated with imbecility of mind or insanity. A young girl was lately carried into my room by two of my servants. Her mother brought her to me, at the request of the Rev. Edward Murray, brother of the Bishop of Rochester. 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 copper, 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 the Rev. Edward jkurray." 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, aud she was then the monitor of her class ! Now, this girl, Mr. Murray informed me, had been ill four years, and had been dismissed the Middlesex Hospital " incurable." I was suddenly called to see Mrs. T----, of Clarges Street, 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 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 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, con- tinued 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. Case 1.—Mary Boddy, 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 in-patient of the Gloucester Infirmary, in Avhich establishment her mother held the situation of nurse. But cupping, bleeding, leeching, blistering, were ineffectual. The patient complained of having suffered from shivering fits, followed by heats, and sometimes perspiration. The same mode of treatment as in Mrs. Sargent's case, with the addition of a galbanum plaster to the loins, in which she complained of coldness, was LECTURE II. 43 adopted, and followed with like success. She had scarcely been a fort- night under my care, before she completely recovered the use of her paralytic limb, and she has had no relapse during the first four or five years. Case 2.—Esther Turner, aged 30, when in the service of Mr. Ward, the master of a respectable Boarding School, at Painswick, fell down stairs, and from that moment lost the use of her left leg. After a period of eleven years, during which she had been ineffectually under treatment in various hospitals and infirmaries, she came on crutches to my house. She ex- plained that she was subject to severe shivering, with occasional convul- sions. Her leg, she said, had more feeling on certain days than others After trying her for some time with a combination of hydrocyanic acid and tincture of cantharides, without any improvement, I prescribed a pill, containing a combination of quinine, silver, and colchicum, night and morning. She progressed from that day; and in about six weeks, I had the satisfaction to see her hi possession of the complete use of her limb • nay, she returned to her service at Mr. Ward's, which she only left to set married. Case 3,—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 assistance whatever, without even the support of the ban- nisters, she could run up and down stairs nearly as well as myself. Should this case be considered to require better confirmation than my word, I am permitted privately to give Miss M----'s name and address to any party who may take an interest in the case, the particulars of which she will readily communicate. Miss M----is the daughter of an accom- plished clergyman, and is the niece of one of the judges of the supreme court of Scotland, who, being in town all the time she was under my care, saw her the day after she arrived, and had the satisfaction to witness the whole progress of her cure. 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 tiling, 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 hi Mechanics, but not in Medicine. I could here give you numerous other cases, all more or less explana- tory of the manner in v/hich palsy of almost every muscle of the body may be developed and cured. For the present, I shall content myself with recording my experience of a disease, which, until I explained its nature in 1836, was never supposed to depend on Palsy, namely the Curved or Crooked Spine.* By most authors, this disorder had been sup- posed to be, under all circumstances, an affection of the bones. Some vaguely referred it to peculiarity of nervous action; while others hypo- thetically traced it to looseness of the ligaments. When the late Mr. *When I first published my views of the nature of Curved Spine, their correctness was called in question. When Stromeyer and others, without noticing my labors afterwards adopted them as their own, they were admitted by the whole profession to be true. What a reward to the real cultivators of science,—first to have their dis- coveries denied, then pilfered ! The reader will find as he proceeds that this is not the only instance of plagiarism I have to complain of. 44 LECTURE II. Abernethy said it was owing to a " rancor in the muscles," he only used an unmeaning phrase to conceal his ignorance of the entire matter; for what meaning can there in reality be in the word " rancor," when ap- plied to a subject like this ? Rancor is an old English word for malignity or ill-temper; but how can that apply to a state of perfect muscular re- pose,—to a palsy ! Nevertheless, to Mr. Abernethy's surgical care, almost every case of spinal curvature, among the higher ranks, was at one time entrusted. What the disease really is, I shall now proceed to demon- strate. . The mast of a ship is kept erect by the stays and shrouds; if you divide or loosen these on one side, the mast falls more or less in an opposite di- rection. The human Spine is kept upright by a similar apparatus—the muscles. If any of these muscles from bad health become we aliened 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 vertebra—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 muscles so weakened or paralyzed. This disease, or " deformity" (for Mr. Abernethy would not allow it to be anything else), under all its uncomplicated variations of external and lateral curvature, is the result of muscular weakness or pal- sy ; which palsy, for the most part, is a feature or termination of long re- mittent 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 remit- tent fevers; but whether complicated with vertebral disease or not, curv- ed spine is no more to be influenced by issues, setons, moxas, &c, except in so far as these horrible measures almost invariably confirm it by further deteriorating the general health of the patient. In the commencement of most cases of this kind, the patient is taller one day than another,—a proof that it depends upon the state of health of the hour; and never do I remember 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. Case 1.—A young lady, aged 16, had a lateral curvature of the vertebrae of the upper part of the backA(that is, a curvature to one side), causing the inferior angle of the shoulder-blade to protrude. I prescribed for her calo- mel and quinine, in small doses, and directed her to have her spine rub- bed night and morning with soap liniment. In less than a month the pa- tient had gained three inches in height, and in two months more she was erect. Case 2.—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 " hip grew out." This case came on suddenly. I ordered a warm plas- ter to be applied to the spine, and prescribed hydrocyanic acid and qui- nine. 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, gentlemen, 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 depend on a loss of Health of the general system. The mere weight of the body will in some cases produce waste, or more 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 sub- stance of the vertebrae—a process by which one or more of these small bones fall into a state of ulcerative decay. Still, even in these cases there LECTURE II. 45 is at the same time a greater or less loss of power in particular muscles- tor the same general bad health that weakens the bones must weaken them also. I will give you two cases illustrative of this last complication. Case 1.—Mrs. Craddock, aged 25, had, for upwards of eighteen months, great weakness m the upper third of the back, where a sweUing made its appearance, gradually increasing in size. According to the statement of this woman, she had been an in-patient of the Gloucester 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 considerable ezcuryature, involving the third, fourth and fifth vertebrae of the back, —which vertebrae were also painful and enlarged, and the skin which covered them was red and shining. The patient was extremely dispirit- ed, shed tears upon the most trifling occasion, and was subject to trem- blings 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 hydrocyanic acid and tincture of cantharides, to be taken three times a day. These medicines she had scarcely continued a fortnight, when the improvement m her general appearance was most decided; the protube- rant part of her spine had in that period considerably diminished—her health daily became better, and, in less than a month, her cure was ac- complished. A permanent curve, slight when compared with her former state, still remains. Case 2.—A young gentleman, 9 years of age, had external curvature of the upper vertebrae of the back; one or more of which were in a diseased and even ulcerated state, as was obvious from the discharge which pro- ceeded from an openhig 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 for- mer case, having been productive of no good, I ordered to be discon- tinued. Keeping in view the remittent and constitutional nature of the disease, I prescribed small doses of calomel and quinine. The very next day the discharge was much diminished, and a cure was obtained in about six weeks. The ulcer hi that time completely healed up, but a per- manent angular curve, of course, remained—trifling, however, when com- pared 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, gentlemen, are sufficient to show you the nature 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 incipi- ent 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 internalli/, till it reaches the groin, where it forms a tumor; this tumor is called by the profession lumbar, or psoas abscess. With the ex- ception of opening the tumor to allow the collection of purulent or other matter to escape, this disease, like the cases just detailed, should be treat- ed almost entirely by constitutional measures—by such 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 harvest makers of all kinds of beds and machines have derived from the practice. In the greater number of cases this treatment is erro- neous from beginning to end. Constant confinement to one posture is 46 LECTURE II. 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.* . . , c Equally effectual have I found the chrono-thermal principle of treat- ment in that particular palsy of one or more muscles of the eyeball, which gives 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 commence- ment at least, is in most instances an intermittent disease. Can the inter- mission 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 charge, 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 medicines 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 calomel and quinine cured him of both. The subject 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 constitutional signs, they would not, I am sure, leech, blis- ter, and cup away at localities, as they are in general too fond of doing. If properly treated at the commencement, Squint is very generally cura- ble 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 natural 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 complete squint, should the paralytic muscle upon which it depends recover its power after the ope- ration, 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 sudden 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 nyctalopia, or day and night blindness. There, then, are examples of intermittent amaurosis ; and they have been cured and caused, like the ague, by almost everything you can name. You will find them frequent in long voyages,—not produced in that case by exhalations from the fens of marshes, as many of the profession still believe all intermittent diseases to be,—but by depraved and defective food, with exposure to wet, cold, and hard work, perhaps, besides. In the Lancet [8th Dec, 1827], you will find the case of a girl, twelve years of age, who had in- termittent blindness of both eyes, palsy of the limbs, phrenzy, and epilep- * Among the numerous causes of spinal disease named in books, much stress is laid on the improper use of Stays, and other articles of female dress—but what in Heaven's name is the use of reasoning with the English people on such a subject__a people who imitate everybody, fear everybody, and in all things attempt to rival everybody—not so much as regards truth and excellence, but as regards the stark staring abandonment of both! The doctors at least have reason to thank them! We laugh at the Chinese for diminishing the size of the female foot, which is not a tritaZpart. The chest is, if you take its contents into account; but see how we diminish it with stays! &c. LECTURE II. 47 sy, from all of which she recovered under the use of ammoniated Copper —a chrono-thermal remedy. This case fully establishes the relations which these various symptoms all maintain to each other; and their re- mittent character, together with the mode of cure, explains the still greater affinity they bear to ague. The remedies which I have found most efficient in permanent nervous blindness have been the chrono-thermal, or ague medicines, occasionally combined with mercury, or creosote. I will give you a case which I treated successfully by an internal remedy. Charles Emms, aged 25, stat- ed 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 subsist- ence. He had been previously an in-patient in the Worcester Infirmary, under Mr. Pierrepoint, but left it without any benefit. Some days he per- ceived 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 upon 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 trem- blings ; his spirits were depressed. My first prescription, quinine, dis- agreed ; my second, silver, was equally unsuccessful; with my third, hy- drocyanic acid, he gradually regained his vision—being, after an attend- ance 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 appetite, accord- ing to him, having become too good for his circumstances. In confir- mation of the value of hydrocyanic acid hi nervous blindness, I may men- tion 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 apply- ing the vapor 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 majority 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 certain, from chills and heats to which the great body of patients affected with it, acknowledge they are subject. Deafness 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 princi- ple, 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 consulted me for his case ; he recovered com- pletely 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 hi the ears; sometimes so great as to cause partial deafness. Cases of loss of the sense of Touch, and also those of partial or gen- eral numbness, will, in the greater number of instances, be found to exhi- bit remissions hi their course. So also will almost every instance of that exalted degree of sensibility known by the various names of Ticdouloureux, Sciatica, &c, according to the locality of the various nerves supposed to be its seat. Look at the history of these diseases. What have your sur- gical tricks done for their relief,—your moxas, your blisters, your divi- sion of nerves ! The only measures to which these diseases have yielded, 48 LECTURE II. have been the chrono-thermal remedies, bark, arsenic, iron, prussic acid, &c, the remedies, in a word, of acknowledged efficacy m ague. I shall here present vou with a case from the London Medical and Surgical Jour- nal, illustrative of the nature of Tie when involving the nerves of the face. The pain first supervened after a fright; it returned every day at two 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 sul- phate of quinine given every two hours for three days produced in so short a period a complete cure. The same prompt and favorable 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 neuropathy, 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 confusion. 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 constitutional dis- turbance, and so is Depraved Appetite. An example of what is called Bulimia or excessive appetite, occurs in the lectures of Mr. Abernethy: " There was a woman in this hospital, who was eternally eating ; they gave her food enough, you would have thought, to have disgusted any- body, 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 tem- perature—the Fever under which she labored ? 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 different 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 sensation. If we have mtermittent 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 wetted, the relief, though not at first apparent, positively destroys the pain of thirst." We have, hitherto, Gentlemen, confined ourselves, as much as possible, to simple or " functional" diseases,—those forms of disorder in which there does not appear any tendency to local disorganization or decay. In our next Lecture, we shall enter into a consideration of those disorders which manifest more or less change of structure in their course. Such dis- eases 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 special local bearing. I have necessarily, on occasion, combined reme- dies 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 treatment. A charge of unchemical knowledge has been occasionally 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, methodists, or cliemists ?" This charge, then, LECTURE III. 49 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 modifying theactionof every substance submitted to it. And here I may mention, that the late Sir Astley Cooper, when I sent him my work, entitled " The Unity of Disease," with that candor and gentleman-like feelmg by which he was not less distinguished, than by his high eminence as a surgeon, wrote to me as follows: " Dear Sir, I thank you most sincerely for your valuable work. I have not the least objection to being unchemical, if I can be useful; and I agree with you, that the living stomach is not a Wedgewood mortar. Yours truly, Astley Cooper." "Dr. Dickson, Clarges Street, Piccadilly." LECTURE III. hereditary predisposition—apoplexy—hemorrhages—heart disease- pulmonary CONSUMPTION—GLANDULAR COMPLAINTS—CONSUMPTIVE DISEASES of joints. Gentlemen, 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 uncomplicated 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 medical acceptation of that term—disease in which one or more constitutional paroxysms occur before organic change becomes developed. Inquire the Sequela 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?— haemorrhage, or rupture of blood-vessels wherever situated,—diseased lungs by whatever termed ; with all the various visceral 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 scirrhous. 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 indura- tion 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 "constitutional disturbance," are the results. But this phrase, in most instances, they use without any very definite idea of its meaning—and when questioned 50 LECTURE IIL 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 impart to others. Gentlemen, " constitutional disturbance," when analyzed, will be found to be neither more nor less than an excess or diminution of the healthy temperature and motions of various parts of the body,—amount- ing, when the disease is recent (or " acute") to the bolder features of in- termittent fever—and incases of longer standing (or " chronic") coming at last to the more subdued symptoms of that universal disease. Betwixt 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 subject of it a predisposition to disease of one locality or tissue of the frame rather than another; but many per- sons, from accidental causes, have also their weak points. Of this kind are such parts of the body, as after having been externally injured, get so well, that while you continue in health, you 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 accidents 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 frac- tures. Now, Gentlemen, this is what you ought to be prepared to expect; —the atoms of repaired parts must 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 ex-> ternal agency—by everything, 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 ofthose parts of individual bodies, which, by here- ditary 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 prin- ciple 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 configuration. Such similitude we see extend- ing 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 genera- tions, and others, where the same members have been hereditarily reduced beneath the correct human standard. Then in regard to hereditary mental resemblances, you will see children, whose father died before they were born, manifesting the same facility or stubbornness of temper, the same dis- position to moroseness or jocularity, which characterized the author of their being. Friends and relatives will sometimes hold up their hands with astonishment at this mental likeness of children to their parents; " 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 pro- fession 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 depend upon circum- LLECTURE III. 51 stances, whether or not such predisposition be actually and visibly developed in the individual members composing a given family. A per- son, 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 individual 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 these islands, I may mention, Spitting of Blood, Consumption, and Glandular Disorders. The rapid transitions of temperature, so character- istic of this climate, certainly predispose us to these complaints ;—for while in the warmer countries of the East, Dysentery and Abscess of the Liver carry off the greater number of the various races that compose the popula- tion,—the natives of India, who have died on our shores, have generally fallen victims to Glandular and Chest Disease. Even the monkey acknow- ledges the baneful effects «f such rapid thermal transitions on his respira- tory organs. More than one half of this class of animals that come to England, die of consumption of the lungs. Diseases 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 con- trolled as the breeding of our domestic animals, incalculable 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 characterize nations and families, might, in this man- ner, be as certainly diminished, as the beauty of the face and form might be exalted in its standard:—for both depend greatly upon hereditary con- figuration, or upon that particular atomic association of certain parts of the body, which you find prevailing in families—other external modifying circumstances being, at the same time, kept in view,—such as climate, temperature, social and political relationship, &c. But be this as it may, whatever will agitate the whole frame of an individual,—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 shortly to apply 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 tissue of the skeleton, the Cartilaginous and Liga- mentous tissues of the joints; the Glandular tissue, different in different systems of glands, but without which there could be no secretion—no saliva—no bile—no perspiration, and the like; the Musculur and Tendi- nous tissues, so necessary to locomotion; 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 hi 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 prin- 52 LECTURE IIL cipally compounded of the others; so, also, are the lining membranes of the various cavities and canals that convey the secretions—mucous mem- branes, 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 Cutaneous, or Skin tissue, performs the part of an out- ward envelope to all. Now, as there is seldom such a thing 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 in all its parts,—so, in the internal configuration of all bodies, will there be parts, as we have already seen, inferior to other parts in strength and so forth. Some tissue, or portion of a tissue, may be at fault. Well, then, suppose the fabric of the Bbood-vessels of a part to be the least strongly constructed tissue of a given individual, can you doubt that anything which might injure that individual's health generally, 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, Gentlemen, 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 mis- management, were put upon a diet from which animal 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 color, 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, Gentlemen, this is not my statement—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 deputed 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 apothecary 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. Gentlemen, you]seem startled at this, and no wonder —for some of you have, doubtless, lost relatives by the practice. How then, you have a right to demand, must apoplexy be treated ? That apoplexy, like every other disease, is a development of general constitutional disturb- ance,—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. But there is a case in the Medical Gazette, which bears so strongly on this very point, that I will give it to vou at length. It is from the pen of Dr. Graves of Dublin, and the subject of it was a gentleman living in the neighborhood of Donnybrook. Thi« gen- tleman, 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, shortlv after which he complained of chillness, some nausea, and headache [Here LECTURE III. 53 then was the cold stage.] After these symptoms had continued about an hour, his skin became extremely 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 laboring un- der 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 con- tinues, " that I could not explain in a satisfactory manner the perfect free- dom from all cerebral and paralytic symptoms after two such violent at- tacks of Apoplexy. But when a third attack came on, I then saw it was a case of the Tertiana Soporosa of nosologists [what jargon!] and I pre- vented the return of the fit by the exhibition of Quinine." The quinine, you see, proved at once an efficient preventive of the returning fits, while re- peated blood-letting, whatever might have been its effect in shortenhig them, had not the slightest influence in that more salutary respect. 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 re- mission of the disease,—may he not have mistaken this natural phenome- non of all disorder for the effect of his remedies ? However that be, lean say this much for myself, that since 1 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. Mr. Smith of Cheshunt lately informed me that he had cured several cases of apoplexy simply by dashing cold water over the patient's head, with- out drawing a drop of blood. Mr. Walter, a surgeon of Dover, has suc- cessfully treated apoplexy by the same practice. " The application of your theory," he writes to me, " has lately saved me from bleeding in two cases of apoplexy, both of which did well,, without it." Now apoplexy, as it happens, is the great stumbling-block of the vulgar. How mad Dr. Dickson must be not to bleed in apoplexy!—that is the language of every blockhead who, knowing* nothing of the subject but what he has picked up "in conversation or in his schools," very wisely fancies himself an oracle. But what say the oracles of the schools—what say the men who for years and years have been preaching up blood-letting as an infallible reme- dy for all diseases ! Dr. Clutterbuck, as you all know, throughout a long life, has advocated that kind of practice; what does Dr. Clutterbuck say of its* success in cases of apoplexy ? I almost fear you will not believe I quote him rightly—but his name assuredly stands as the author of the article Apoplexy in the Cyclopadia of Medicine, from which I quote—and this is what he says under that head and upon that subject:—"As mere matter of experience there is reason to believe that blood-letting does much less good, and the omission of it less injury, than is generally sup- posed." Only imaghie my feelings when, in the course of my desultory reading, I first stumbled upon this passage. Such confession from such a quarter ! Gentlemen, I laughed most heartily, and made an extract on the instant, keeping to the exact words which I have now given you for your edification.* That you may cure the disposition to * " Sir Chas. Bell has stated, I think, that when a man is taken up in the streets apparently lifeless from the concussion of a fall, the nurse gives him a dram, and the surgeon bleeds him ; but the nurse is right. In St. Petersburgh, I was requested to bleed a gentleman who had fallen from his desk in a fit. * * A cordial was ad- ministered, which soon revived the patient, who had been long in a nervous state of health."—Lefevre.—T. 51 LECTURE III. Ruptured Blood-Vessel 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 bleed- ing from the nose ? To put a cold key down your back, and thus by the suddenness of the shock change hi a moment the whole corporeal tem- perature. The principle is the same in both cases, and the good effects of that measure ought long ago to have suggested to medical practition- ers a better practice in apoplexy and other haemorrhages than is at pres- ent the fashion with fashionable doctors. Cold water, Gentlemen, has MANY VIRTUES, BUT A GREAT DEAL DEPENDS ON THE MODE OF ITS APPLICA- TION.* The suddenness of the dash is the chief thing to be attended to in cases of this nature. 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? English practitioners almost to a man bleed and purge you. The follow- ing case may open their eyes; and as it is not taken from my own expe- rience, but from a German Medical Journal of repute, it may perhaps carry more weight with it on that account. " A strong man aged 27, suf- fered on alternate days from very violent bleeding at the nose, which con- tinued 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 bleeding, the treatment was changed for a large dose of sulphate of qui- nine 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. In the case of a young lady afflicted with periodical Vomiting of Blood, for which she had been repeatedly bled without the smallest advantage,— or rather to the great injury of her general health,—I effected a rapid cure with a combination of Quinine and Alum. The same disease I have again and again cured by Arsenic, Opium, and Prussic Acid. A captain of the royal navy, whom I lately attended along with Mr. Henry Smith of Cheshunt for vomiting of blood, got well by small doses of copper. You will now, I have no doubt, be prepared to question the propriety of the usual murderous treatment adopted for Spitting of Bloodt—Pul- *Much is said now-a-days of Hydropathy, which, whether a novelty or not, ought rather to be called Hydro-BATH-y. When the words I have placed in capitals in the text were first printed, Hydropathy, or the Gold-water Cure, was not even known by name in England. Hydropathy on the right principle is only afragmen- tal part of chrono-thermal means. Practised as it is by Priessnitz and his followers, on the old erroneous humor-zl doctrine, it must occasionally injure those who sub- mit 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 establish- ment, 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 ori- ginal power of the affected muscles. This patient was recommended to me by Major Eyles, Coleshill House, Amersham. t C. T., Jr., aged 17, in 1837, in the summer, Westchester county, having a pain in the bowels, undertook to treat it by swallowing a country remedy for the complaint, viz.: a draught composed of powdered cayenne pepper and cider. In his haste, he inhaled into his wind-pipe a portion of the pepper which had floated unmoistened on the surface of the cider. The consequences, as may be supposed, were of the most violent kind—extreme irritation in the throat, great pain, and increased action of the heart and arteries of the most prodigious character. I arrived an hour or two after the affair, and found a physiciam in attendance. On consultation, actu- ated by the only light we possessed, copious bleeding was resorted to and repeated during the night, until the patient lost some forty to fifty ounces. The next mor- ning, the symptoms were found to have entirely subsided, the patient was pale and LECTURE III. 55 monary 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 in- variable 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 medicine, " 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 former case, bleeding does no good; and in the latter, by an unnecessary waste of the patient's strength, it will do harm. But if the opening of a vein be intended to stop a haemor- 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, prepared 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 disposition to haemorrhage. Gentlemen, these practitioners deceive themselves ; they are deluded into this false and fatal practice by the returning 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 frequent will this febrile fit come on, and with it, the very haemor- rhage which it is the object of their solicitude to prevent. Does it not stand to reason, that the more you debilitate the whole, body, the more certainly must you weaken at the same time the already too weak tissue of the vascular coats, that tissue whose original feeble; and in a few weeks he got about, but he never was himself again. On the approach of every winter since, he has been the subject of some form of disease, dropsy, ague or haemorrhage. In the latter end of October last, 1844, he was seized with spitting of blood, but refused to be bled. At the end of a fortnight, getting no better, he came to town and arrived at my door at midnight drenched with rain. I found him with a hurried circulation and respiration, an anxious countenance, and every few moments coughing up a mouthful of a frothy mixture of mucus and ar- terial blood. I had him put into a warm bed, between blankets, and gave him a powerful opiate, following it the next day with quinine. He coughed but once during the night. In the morning I found him comfortable, and his skin moist from head to foot; but he had some pain on taking a long inspiration, until the middle of the next or second day, when all the symptoms subsided; on the third day he dressed himself and took his seat at the dinner-table. On the eighth day, against my advice, he went into the country to vote at the election, had a relapse, but did not return to me for ten days; when the treatment was repeated with the like result, his appearance at the dinner table, free from all symptoms but weakness, on the third day. He was rather more prudent this time, and at the end of a fort- night he was enabled to resume his business, and by continuing the chrono-thermal treatment, he actually gained in mid winter, seven and a half pounds in weight more than he had ever weighed in his life. At the end of two months, thinking himself beyond danger of another attack he underwent great exposure in the open air, nearly the whole of the coldest day of the last winter. This temerity brought him for the third time into my hands with an attack more violent than either of the two preceding. The chrono-thermal treatment again proved his friend, and he is now, April 8, in the prosecution of his business, free from disease, with a reasona- ble prospect of continuing so, with proper care, at least until the recurrence of another winter. On the 4th of January, 1845, I was called to see W. W., aged 25, who was spit- ting blood. The chrono-thermal remedies in a few days removed his disease; and on the twelfth day, he returned to his occupation perfectly well, and has so contin- ued throughout the winter.—T. 56 LECTURE III. weakness constitutes 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 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 centuries been putting in force, for the cure of the ha3morrha°ic diseases, 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 exsanguined countenances of the unfortunate individuals, 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 circumscribed flush of the face, that this patient is actually dying of hectic or inanition. What fatal mistakes have not originated 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 ! Gentlemen, 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 produced 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 having a hereditary predisposition to spitting of blood or apoplexy, is the most certain method to develope these dis- eases in their worst forms !—Yet this is the daily practice of the most eminent physicians! one among many proofs, that in the medical pro- fession, eminence is less frequently attained by successful results in prac- tice, than by the dexterous employment 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 concerned, 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, 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 mankind 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 ill- ness, what you refuse to a speedy recovery ! Do you think medical men angels, that you thus tamper 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 sub- ject:—" 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 the public or the profession .'—When you call in the physician recommended by your apothecary, how can you be sure that he is not a confederate ? or that, when the farce of a " Consultation" is gone through, you are not the dupes of a petty intrigue to pick your pockets ? Uncharitable man ! some of you may possibly say, how can LECTURE IIL 57 you thus malign the members of your own profession ?—Gentlemen, when so many of my profession, and those not always of the lowest class, de- scend to practices which degrade medicine into the vilest of trades; when, like the Thugs of India, numbers of them silently and secretly enter into systematic collusions and conspiracies for the purpose of inveigling and plundering under friendship's garb, the unfortunate victims who too confidingly repose on their honor and integrity; when the editors of the Medical Journals even are forced to notice the letters they receive in their exposure,—is it not time that the too credulous public should be put upon their guard ?* If any medical practitioner of your acquaintance has the hardihood to deny the existence of this terrible state of collusion now so prevalent, both in town and country, look upon that man with sus- picion,—or rather set him quietly down at once in your own mind, as one of the most deeply implicated of the corruptionists. " A monarch," says Dr. Forth, " who should free his state from this pestilent set of phy- sicians and apothecaries, and entirely interdict the practice of medicine, would deserve to be placed by the side of the most illustrious characters who have ever conferred extensive benefits on mankind. There is scarce- ly a more dishonest trade imaginable titan the Art of Medicine in its present state."—[Rhapsodien uber Medizen.'] But to return to the subject of Ruptured Blood-vessel. You will find that in every case, except where it has been produced 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 e •rery case,—in one being bold and well marked, in ano- ther, so softened and subdued, as almost to escape the patient's own ob- servation ; 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 treatment during the interval of remission. One case will yield to opium or arsenic, another to copper, quinine, or prussic acid, and some will trouble you to cure them at all—for what will agree with one constitution, may, as we have too often seen, disagree with another. I could give dozens of cases of every kind of constitutional haemorrhage cured in this manner; but the details of one would be the details of all, Yes, Gentlemen, I repeat, by the early use of emetics, the proper appli- cation 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 remission, I have successfully treated every kind of hemorrhagic disease. The same system of treatment has enabled me effectually 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 lace stockings. Well, then, I have said all I mean to say upon the subject of Haemorrhage, and I have anticipated something of what naturally belongs to the treatment 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 pene- trate 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 enlighten upon it, so far as their own reputation is con- cerned, they are doubtless right! The great millstone of the present day * See the London Medical and Surgical Journal and Lancet, passim,—particularly the former,—for a full exposure of those nefarious practices. 5 58 LECTURE III. is the Chest, and Laennec's bauble, the divining rod by which our modem 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 instrument must it be—that stetho- scope ! The enchanter's wand was nothing to it! Aaron's rod perhaps came the nearest to it! But, seriously speaking, just observe how grave- ly your hospital tyros hood-wink and hocus each other with the phrases "hypertrophy" here, and " atrophy" there; " caverns" in this place, and " congestions" in that—to say nothing of " rhoncus" and " rale," " ego- phony" and " sybilus"—and heaven knows what other sounds and signs besides—sounds and signs which, in the greater number of cases, have as much of truth and reality as the roar of the sea with which the child deludes his fancy when holding a shell to his ear ! Let me first speak to you of Diseases of the Heart Do not the subjects of every kind of Heart-affection tell you they are one day better, another worse ? How shall we speak of diseases of this organ.' —of palpitation and temporary cessation or remission of its action .'—dis- orders constantly misunderstood, and as constantly maltreated. Complain but of flutter or uneasiness in any part of the Chest, the stethoscope—the oracular stethoscope—is instantly produced. Astonished—in many instances terrified—the patient draws his breath convulsively—his heart beats rapidly—and the indications obtained by means of this instrument, at such a moment of doubt, anxiety, and fear, are registered and recogniz- ed as infallible. •' Have we not had too much talk of Heart-Disease since the stethoscope has come so generally into vogue ?" was a question asked some years ago by the late Dr. Uwins. Dr. James Johnson shall answer it; and for reasons which I shall by and bye make you acquainted with, I prefer his evidence here to that of any other physician. In one of the numbers of The Lancet, Dr. James Johnson is stated to have said at a Medical Society:—" It was a common error in young practitioners to con- sider the heart as organically diseased when its functions only were much interfered with, and this error has become more general, he was sorry to say, since the stethoscope has come into use." Dr. Johnson confines his observation to young practitioners—himself not coming under that head, —but I have seen men as old as he, make the same mistake, and those, too, enjoying a great reputation for stethoscopic sagacity. Patient after patient—medical as well as non-medical,—have come to me with the fatal scroll of the stethoscopist—their hearts palpitating, their limbs trembling, as they gazed in my face, expecting to read nothing short of a confirmation of their death-warrants;—yet of these patients, many are now living and well, and laugh, as I hope to make you laugh, at both the instrument and its responses. How little must that man know of his duty as a physician, who would deprive a fellow-creature in distress of the balm of hope—how little can he appreciate the influence of the de- pressing passions on the bodily sufferings of the sick! Yet with these eyes have I seen, in the hands of the patient, the written announcement of his doom, an announcement which afterwards turned out to be utterly unprophetic and false. How unwarrantable in any case to intrust the pa- tient with such a document! Let the practitioner withdraw his eye, for a time, from a mere symptom; let him observe how other muscles of his patient palpitate at times, like the heart, and act, like that, convulsively—finding these symptoms to be LECTURE III. 59 remittent in every case, and complicated with others, all equally remittent, would he still persist in his small bleedings, his repeated leeches, his pur- ges,—measures, of themselves sufficient for the production of any and every degree of organic change he already fancies he has detected ! Would he not rather reflect with horror on the past treatment, and endeavor, by another and a better practice, to enable his patient to escape the sudden death to which, in his imagination, he had devoted him ? How many a physician, by such a prognostic, has obtained unmerited credit for fore- sight and sagacity, while he only taught the patient's friends to be pre- pared for an event, he himself was materially contributing to hasten! Truly, in this case at least, prophecies do tend to verify themselves! Gentlemen, I have seen two stethoscopists examine a patient with sup- posed Heart-disease, and come to the most opposite conclusions,—one declaring the organ to be enlarged, the other assuming with equal confi- dence, that it was the reverse ! The utter absurdity of attempting to dis- tinguish, during life, one form of Heart-affection from another by any par- ticular sign or symptom, is sufficiently proved by this one fact, that a mere functional variation of its motions will produce every symptom of a real change in the structure of the organ itself. But even could such dis- tinction be effected to the nicety of a hair, the knowledge of it would not be worth a rush for any practical purpose—inasmuch as the remedies for every kind of chest-disease come at last to the same agency, whether that agency be directly applied to the surface of the body in the shape of cold or heat; or be externally or internally administered in the form of medi- cines that electrically influence the corporeal motions through the medium of the brain and nerves. By the chrono-thermal system of practice, I have successfully treated every kind of Heart-disease which ever came, or could come, under the notice of the physician—setting aside, of course, original malformation of the organ. I will give you some cases in illus- tration :— A gentleman, aged 30, had been ill for a long time, particularly com- plaining of his heart, the action of which organ was generally below the healthy standard, and it also palpitated occasionally. So great was his mental depression, that the smallest trifle produced tears. The tempera- ture of his body generally was below that of health, and he suffered much from coldness of feet—remissions he of course had, being better at par- ticular times. As he did not improve in the country, he thought he would try a London doctor; so he came to town, and consulted the late Dr. Hope, a gentleman, who, though he wrote a thick tome, entitled " Diseases of the Heart," was, I am sorry to say, altogether wrong in his treatment of them! The stethoscope in this case was as usual applied to the chest, and its annunciation was sepulchral. Hope here told no " flattering tale," for not only was the heart pronounced to be enlarged, but a fatal result was prophetically expressed. The treatment prescribed was not ill calculated to verify this prediction—cascarilla and ammonia,—with aperients ! and a bleeding every month, or six weeks !! The patient's health, as you may readily suppose, got worse and worse daily,—he became much emaciated in his person, and completely prostrate in mind. To sum up all, he had a tendency to fainting fits ; in which state, by the advice of Dr. Selwyn of Ledbury, he came to me. You already guess the practice I adopted— chrono-thermal, of course. Yes, gentlemen, I ordered, him first a combi- nation of prussic acid and creosote, which I afterwards followed up by arseihc and quinine. I also prescribed a generous diet, with wine. Well, what was the effect of this.'—Why, notwithstanding the depletion to which he had been subjected, he improved daily, and in about six weeks had become so well as to be able to resume his profession—the law, which profession, at the hour I speak, he follows with ardor, and with- out a complaint of any kind. Indeed, a letter which I recently received 60 LECTURE III. from Dr Selwyn, gave me the news of his marriage. Yet this patient, ac- cording to the stethoscope, should have been dead and buried long 2^0*0 J °Gentlemen, in confirmation of the value of Arsenic in disease of the heart, the details of a case from Darwin, who wrote, be it remembered, in the last century, may not be deemed unimportant:—" A gentleman. 65 years of age, had for about ten years been subject to an intermittent pulse, and to frequent palpitations of his heart. Lately the palpitations seemed to observe irregular periods, but the intermission of every third or fourth pulsation was almost perpetual. On giving him four drops of a saturated solution of Arsenic about every four hours, not only the palpitation did not return, but the intermission ceased entirely, and did not return so long as he took the medicine." The cases I shall now give you are three of many such which have oc- curred in my own practice :— Case 1.—A young lady was afflicted with palpitation of the heart, occa- sional cough, and so great a difficulty of breathing as to be unable to sleep, except when supported with pillows. She had frequent shivering fits; her abdomen and legs were much swelled, and her symptoms alto- gether so distressing, as to leave her friends with scarcely a ray of hope. Nevertheless, by the employment of silver, quinine, and prussic acid, she did eventually recover, to the surprise of all who knew her. Remissions were well marked in this case. Case 2.—A young gentleman aged 16, had violent palpitation of the heart, much headache, craving appetite, and some thirst, with great de- pression of spirits. He was much emaciated, and had a tendency to eruption of the skin. His hands and feet, which were generally cold by day, became during the night so hot, as frequently to keep him from sleeping. By a course of cold-plunge baths, alternated with the shower bath, and by the use at the same time of quinine and iron in combination, the young gentleman was completely restored to health—every one of the above symptoms having disappeared in a few weeks. He is now serving with his regiment in India, having reached the rank of lieutenant. Case 3.—Major M'P----'s heart palpitated so violently at times, that you could see the motions in a distant part of the room. This was the case when I asked to see him. I ordered him prussic acid and musk, which stopped the palpitation hi about two minutes after he took it. In the middle of the night he had a threatening of the complaint, but it was at once arrested by the same medicines. A continuation of them for about six weeks cured him completely. * Before dismissing affections of the heart, I must tell you that all of them, or almost all, depend upon weakness of the Brain—as you may convince yourself by putting this question to your patient—How do you feel when anything disturbs your mimd ? The answer will almost invariably be, " Oh, it brings on the palpitation at once," or the pain, as the case may be. Gentlemen, strengthen the brain, and in few instances will you have any trouble about the heart. The brain is the great controller of every func- tion—it is the true key to all good treatment. We now come to consider, Pulmonary Consumption, or Decline. When you see a person harassed with a cough, and losing his flesh, * J. S. came to me with palpitation of the heart. He had been examined with the stethoscope and pronounced incurable. On inquiry, the palpitation proved to be intermittent; there was also a great flatulence. I gave him some pills of silver and cyanide of potassium. At the end of a week he returned, and on my asking him how he was, he laughed and replied, " I hope I may never be worse." At the end of a month, the palpitation had wholly disappeared and he has had no return of it—T. LECTURE III. 61 and if, at the same time, he complain of shortness of breath and pain of the chest, and begin to expectorate a mucopurulent-looking matter, you may certainly set his disease 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 tissues? what does it signify whether it be their mucous membrane, their glands, or their interstitial substance. If his general health, from the time he be- comes your patient, improve, he will naturally live as long as it continues to do so,—if not, and if it as progressively continue to get worse, he must die! Any further discussion of the matter, quoad hoc, resolves itself into the interminable question of Tweedle-dwm and Tweedle-dee / " Can Consumption be cured?" asked Mr. Abernethy, adding 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 tubercles were healed, and the lungs otherwise sound, the patient 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 pur- pose, 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 you to consider it well, for it is, or, I should rather say it was, until I took the liberty of enlightening the profession, totally at variance with their notions; some of them even now believing tubercles to be parasitical animals ! Gentlemen, for the requisite lubrification of the mucous membrane of the cells and other air-passages of the lungs, there must be a certain amount of secretion. To supply this secretion, I need not tell you, there must be a glandular apparatus; and accordingly a num- ber of minute and almost imperceptible Glands in reality intersperse the entire tissue of the lungs—the pulmonary tissue, as it is called—but abound more particularly in the upper portion of it—that identical portion in which pathologists imagine they have detected the commencement of Consumption. But what they call the commencement is nothing more than an effect or development of general constitutional disorder. If it be the beginning, it is the beginning of the end—the end of previous repeated febrile par- oxysms of greater or less intensity. During such constitutional disorder, and particularly during the course of severe fevers—such as a long re- mittent fever, the fevers termed small-pox, measles, and the like, these minute pulmonary glands become diseased, there being a previous predis- position of course; in other words, these glands being the original weak point of individuals having the consumptive tendency. Tubercles then are diseased pulmonary glands. How many, people have traced the con- sumption of their children to the small-pox or measles—but would any man in his senses say the consumption 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 dis- ease 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, but as the disease advances, it swells and becomes of a reddish grey color, 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 be- coming an abscess at all—the function of the affected lung in this case being, nevertheless, 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 62 LECTURE III. 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 gradually produced in the course of repeated paroxysms of general remittent disorder. The matter expectorated by the patient consists of the contents of the tuberculous abscess, and more or less mucus, sometimes mixed with blood; while the cough is at one moment produc- ed 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 dis- eased lungs, though almost every patient has it periodically spasmodic. 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, ex- posure to cold, or the abuse of mercury, and what do you find? Why, these very glands gradually enlarge and form tumors, which tumors, as in the case of tubercles of the lungs, are sometimes of a solid kind, and when examined after death have the same reddish grey 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 vomica, as these tubercles are sometimes called. In the one case, the patient is said to have the " Evil" or " Scrofula," in the other Phthisis or Consumption;—the difference of place, and the de- gree of importance of this in the animal economy, making the only differ- ence between them. In still farther proof of the correctness of this ex- planation, I may mention, that Louis and others have detected tuberculous matter in various other Glandular parts of the body of patients who have died consumptive. 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 schoolmen, I shall try to explain my meaning to you by similitudes; for similitudes, in the words of Fuller, are indeed "the windows that give the best light."— Many of you 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 re- maining 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 Cheltenham, some time ago, detailed to me two cases in which he suc- ceeded 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 attention 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 graver symptoms of consumption, and only commence to expectorate during some change of weather, when they have slight febrile attacks, but these will leave them again on the return of warm weather. LECTURE III. 63 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 you, 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 correct one. The same power that may set a ship on the right course, improperly ap- plied 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, according 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 remedies 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 read; 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 occasionally to spitting of blood; his maternal grandfather died of con- sumption under thirty years of age, and his mother fell a victim to this dis- ease, with which she had been long threatened, in her 43d year, and im- mediately after she had ceased to have children. In the severe winter of 1773-4, he was much afflicted with cough, and being exposed to intense eold in the month of February, he was seized with peripneumony [inflam- mation of the pleura, now called pleurisy]. The disease 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 restlessness took place, succeeded towards morning by general perspiration. The patient, having formerly been sub- ject to Ague, was struck with the 'resemblance of the febrile paroxysms to what he had experienced under the disease, and was willing to flatter himself it might be of the same nature; therefore he took Bark in the interval of the fever, but with an increase of his cough." This patient eventually recovered by change of air and horse-exercise,—the last, a remedy held in high re- pute by Sydenham. What first induced Sydenham to prescribe horse- exercise for pulmonary consumption .' Was it any knowledge he had obtained in the dissecting-room.' No such thing;—it was the same kind of experience that first taught the Peruvian peasant the value of Bark, as a remedy for ague—the observation of its good effects upon the living. You might dissect diseased bodies all your life, without ever once guessing that either the one agency or the other could beneficially influence any kind of disorder. See, then, the difference betwixt watching the action of ex- ternal influences on living bodies and dissecting and hair-splitting the bro- ken down organs of dead ones! " Whatever philosopher or projector," says Dean Swift in his Tale of a Tub, " can find out an art to solder and patch up the flaws and imperfections of nature, will deserve much better of mankind, and teach us a more useful science than that so much in pres- ent esteem, of widening and exposing them, like him who held anatomy to be the ultimate end of physic." Persons of this stamp we have seen are not yet extinct. The relationship existing between Consumption and Ague is not only established by the remissions and exacerbations of the above case, but also by the remedies that proved successful in its treatment,—horse-exer- cise, and change of air having cured agues, which had resisted every 64 LECTURE III. kind of internal treatment, Bark among the number;—so that Bark is no more a specific for ague, than for any other disease. Were you to judge solely from the experience of the case I have just read, in which the Bark not only faded, but actually aggravated the symptoms, you might be led to conclude, that it ought never to be exhibited in consumption; but you will please to remember that the same is every day the effect of its em- ployment in ague,—in which latter disease, we therefore dismiss it for arsenic, opium, iron, or some other chrono-thermal agent, which may better answer the peculiar habit of the patient, and which we cannot know till we try. Never, like weak-minded persons, take your estima- tion of any medicine or system of medicine from its success or failure in one or two cases. In the 13th volume of the Medical Gazette, you will find the detailed case of a man laboring under Consumption, for whom Mr. Maclure, the gentleman who narrates it, prescribed generous diet and quinine. Dr. Marshall Hall examined the patient with the stethoscope, and pronounced an unfavorable prognostic. Even after commencing the quinine, and when a considerable improvement had taken place in the appearance of the patient, Dr. Hall still held that the case would be fatal;—" again the stethoscope was consulted—again it uttered the same sepulchral re- sponses ; and according to it, the poor patient ought by this to have been moribund, his pulse, good looks, muscular firmness, appetite, and his high spirits notwithstanding. I need hardly add," says the narrator of this case, " that our judicious friend, the doctor, was much surprised, as well as gratified, to witness his appearance"—alluding to the change after the cure had taken place. Justice to Dr. Marshall Hall compels us to say, that he was anything but gratified with the result; for in another number of the same journal, not only does he speak daggers at Mr. Maclure for publishing the case, but he goes into a very learned discussion as to whether the cessation of symptoms were not a Suspension rather than a Cure. For our present purpose, it is quite enough that he admits suspen- sion ; and if this suspension continued for a series of years, it is scarcely worth while inquiring whether the patient was cured or not. In fact, the matter would resolve itself into a mere dispute about words. By Emetics frequently repeated, and alternated with Quinine, and other chrono-thermal medicines, I am satisfied I have cured or arrested many cases of consumption,—some of them, too, hi apparently very advanced stages. The stethoscopists will of course question this, and ask how I could know, without using their instrument. I shall therefore give you a case of this kind in which it was employed, not by myself, but by men who have the reputation at least of being wonderfully quick in the use of it:—A pianoforte maker, aged 36, came to me much emaciated : he complained of shiverings, chills, and heats, night sweats, cough, and ex- pectoration of matter, tinged with blood occasionally; he informed me that he had been a patient at the provincial dispensary, from which, after having for some months taken much medicine, and been repeatedly blis- tered, he was discharged as incurable. The stethoscope, he informed me, had been consulted in his case by Drs. M. and A., both of whom told his wife he was in the last stage of consumption, and there was no hope. I prescribed hydrocyanic acid, three times a-day, and ordered him to take a pill, containing a combination of opium and quinine, atthatperiod of the day when he should find himself most free from the symptoms of his disease. From that day, he began to recover his flesh and spirits ; his pulse, which was 120, gradually fell to 80, his appetite improved daily,1 his expectoration diminished in proportion, and in about three months he returned to his work, without any complaint whatever. I must not omit to add that I ordered him to apply a galbanum plaster to his spine, in which he had suffered from chills, and which it effectually stopped. A year afterwards LECTURE III. 65 I saw him again, when, in the presence of Dr. Selwyn of Ledbury, he told me he was quite well, and was still at his work, and he expressed to me his gratitude for my successful efforts in his favor. Now, some will say this case was consumption, and some not,—for when the patient dies, nobody disputes it, but when he gets well, everybody does;—some again may say that the disease might break out again at some future period, say five or six years after,—which I am ready to grant; and what is more, to admit, may happen after a cure in any disease whatever: and so may a fractured bone that has united and been cured in the best manner, become, in the course of years and constitutional change, disunited again; as you may find, if you will read the accounts of the diseases of the sailors who accompanied Lord Anson in his Voyages. A maid-servant, 25 years of age, the subject of consumption, had been an out-patient at the same dispensary for several months, during which she had been bled, leeched, and blistered, but as she found herself daily getting worse, she came to me; she was then spitting blood and much muco-purulent matter; her pulse was quick and small; she had chills and heats, and night sweats, with severe cough. I prescribed hydro- cyanic acid, as in the above case, with opium and quinine during the remission; with this treatment she recovered completely, and though several years have now elapsed, she has had no return of her disease. When I first entered into private practice in this country, I was much abused for giving prussic acid, and that too by individuals who afterwards ordered it in their own prescriptions! " We old practitioners," I have been told by some of those very enlightened persons, " don't like your iodine,— your prussic acid,—your creosote—and your new medicines.—We have known injury to follow their use."—And what remedy in the world, in the hands of blockheads, may not do the same! Iodine, prussic acid, and the new medicines, are only valuable in the hands of those who know the principle of their application;—like fire or hot water, they are not to be left at the mercy of fools or children; inasmuch as, like either of these agents, they may warm you in one degree, and destroy you in another. Moreover, they will not agree with all patients in any dose; but who they are to agree with, you cannot of course know till you try, and therefore you will suit your patient's constitution as best you can—for, in the words of Lord Bacon, " a wise physician doth not continue still the same medicine to a patient, but he will vary if the first medicine doth not apparently suc- ceed—for of those remedies that are good for the jaundice, stone, ague, &c, that will do good in one body which will not do good in another—accord- ing to the correspondence the medicine hath to the individual body." Is not this matter of every day's experience .' How can we tell before we try, wheth- er opium will set a person to sleep, or keep him awake all night ? Or that prussic acid will aggravate consumption in one case, and cure or amelio- rate it in another? Gentlemen, I shall afterwards prove that the reason of the difference of effect of all remedies, is the difference hi the electric con- dition of the brain of different patients. But whatever be the true expla- nation of the facts, they show, at least, the utter impossibility of foretelling in numerous cases, by what remedial agency you can accomplish a given object—and they must also demonstrate to all who have even the very least pretension to common sense, the imposture daily practised by the charlatan, when he puffs his nostrum as a universal and infallible reme- dy. But so far as regards prussic acid, its good effects in numerous cases of consumption are unquestionable. On the Continent, Magendie, among others, " asserts and maintains," that with this acid he has cured individuals " having all the symptoms of incipient phthisis (consumption), and even those in a more advanced stage." Dr. Frisch, of Nyborg, in Denmark, has also employed the remedy successfully in Consumption. But prussic acid is equally influential as a remedy for Ague, and I have 66 LECTURE III. administered it with the most perfect success in cases of that disease, after they had resisted quinine and arsenic. Dr. Brown Langrish, too, with laurel-water (the virtues of which depend upon the prussic acid it con- tains), cured many cases of obstinate ague. The principle upon which this acid acts in both diseases I need not say is one and the same— namely, by its power electrically to influence the motion and temperature of certain parts of the body, through the medium of the brain and nerves. People who have accidentally taken an over-dose will tell you how they felt as if they had had an electric shock. Whatever produces a sudden im- pression upon the whole frame causes such a shock. Whatever acts upon it more slowly does the same in effect as galvanism or electricity slowly and gradually applied. How otherwise can you influence the body in disease With drugs or minerals That waken motion!—Shakspeare in Othello. The action of such substances, I do not require to tell you, is anything but mechanical. What, then, can it be but electrical or galvanic ? To call it chemical or magnetic is only an admission of my position, for these have been proved by Mr. Faraday to be mere modifications of the same great principle. We can now understand how galvanism and electricity may be directly and advantageously employed in every disease which has obtained a name, ague and consumption among the number. But there is another mode of favorably influencing consumption, which is seldom or never resorted to —namely, the cold-shower and plunge baths. In the case of a gentleman whom I saw about eighteen months ago, with Dr. Watson of the Middlesex Hospital, I stopped the shivering fits at once by the employment of the coW-shower bath, after a hot bath and a warm plaster to the spine had been tried in vain. The gentleman who was the subject of it was otherwise much improved, but he afterwards died of the disease at Madeira. But in another case, which I also saw with Dr. Wat- son, and which I shall now detail to you, a perfect cure was obtained. Mr. L------, an artist of eminence, was suddenly taken with a very malignant Fever, in the course of repeated paroxysms of which every organ of his body was more or less painfully affected—he had constant coughs, with severe pain in the chest, side, and back, and he with diffi- culty expectorated a tough mucus, which every moment threatened to suffocate him. His pulse was very quick, and sometimes remitted, and his skin became jaundiced all over; his urine at the same time being almost black. For some days he was in the most imminent danger, but by chrono-thermal treatment, and without the loss of a drop of blood, the severer symptoms began to give way, the fever diminished in intensity, and the pulse came down to 80. Our hopes were now high, when sud- denly one morning he expectorated muco-purulent matter, having exactly the appearance of what consumptive people cough up. His fever now returned—his pulse rose to 140—he was harassed by constant cough, and every day from that time he expectorated at least half a pint of muco- purulent matter. I had now little hope of saving this gentleman's life. However, by steady perseverance—and in the right course what will not perseverance do .'—by steadily persevering, I say, in the use of quinine, copaiba, and other medicines which I prescribed for him, together with the cold-shower bath, and (when he could bear to be moved) with coun- try air and horse exercise, in somewhere about six months his health gradually became re-established—the cough and expectoration at the same time kept diminishing until it finally ceased altogether. For the last twelve months and more, I am happy to say, this patient has not had a single consumptive symptom—his general health also is now as good as ever it was in his life. LECTURE IIL 67 Before I quit the subject of consumption, I may mention that, in many cases of the disease, I have derived great benefit from arsenic and silver, and also from sub-carbonate of potass. In four or five cases which re- sisted many remedies, a combination of stramonium and belladonna arrested for a time, though it did not ultimately cure, the complaint. In many cases about which we are consulted, the disease may have pro- ceeded so far as to make cure impossible—in other cases, which might seem to admit of this desirable end, circumstances, over which we have no control, will prevent it. Do you think it possible to cure a person of any grave disease if he were everlastingly on the eve of bankruptcy, or who lived in an atmosphere which disagreed with his health generally,— or who had a wife continually scolding him and making him miserable ? In such cases, need I say it will be difficult to give even a temporary bene- fit in consumption ? There is a phrase at present so much in fashion, that were I all at once to tell you it was absolute and indisputable nonsense, you would, in all probability, stare with astonishment. Gentlemen, did any of you ever hear of .Bram-cough—or .Ear-cough—or Eye-cough .'—No !—But you have, of course, heard two doctors discussing with the greatest gravity im- aginable, whether a particular complaint was incipient consumption or " Stomach-cough;" as if people in these days coughed with their stomachs instead of their lungs ! Only let a fashionable physician give currency to this kind of false coin, and it will pass for genuine till some suspicious character like myself shall submit it to analysis at the mint of Common Sense,—and then—what then.'—Why, people will scarcely even then believe the evidence of the whole of their five senses put together,—for, as some one says, when the gullible public once get hold of a lie, they become so enamored of it, that nothing but death will make them part with it. Who first introduced the phrase " stomach-cough," I do not know; but Dr. Wilson Philip, at all events, insists that " indigestion or dyspepsia is the remote Cause of a variety of Consumption;" and in proof of this he tells us he has cured it with minute doses of mercury. Now, if that were any proof of the Origin of a disease, every disease in existence might be termed a "stomach affection;" for I know very few chronic complaints, however grave, which I have not myself cured by the same medicine ;— aye, and have seen aggravated by it too. In the latter case, of course, the complaint could not be a " stomach disease." Direct your attention, says Dr. Philip, to the digestive organs, and you will improve the subject of " dyspeptic-phthisis." And so you may, if you direct your attention to any other part of the body of a consumptive patient,—for what part of the body of such a patient performs its functions correctly ? In this disease the feet and hands feel cold and hot by turns; the skin, one moment harsh and dry, is at another bedewed by a cold and clammy sweat. Are these causes or coincidences ? May you not as well say, Cure the consumption, and the digestive powers will improve, as, Cure the indigestion, and you will stop the consumption ? Medical men constantly talk of indigestion as an essence or entity having' features separate and distinct from all other disorders. Can any person, Task, be the subject of any disease without his digestion being more or less implicated ? What becomes of your digestion in fever?—or when you get bad news just as you are about to eat your dinner ? Though you were as hungry as a hawk a moment before, your appetite would leave you then. Gentlemen, have we a Brain, or have we not.' Give a man a blow on that, and see what becomes of his digestion ? How much the workings of this organ have to do with the functions of the stomach, we have a lesson in the play of Henry VIII. Mark what the fiery monarch says to Cardinal Wolsey when surprising him with the proofs of his treachery— 68 LECTURE III. -----Read o'er this, And after, this; and then to breakfast With what appetite you have. Do you doubt that the breathing of a man thus suddenly and uncere- moniously surprised would be as much affected at such a moment as his appetite' See, then, the absurdity of placing naturally coincident circum- stances in the light of cause and effect! Shakspeare knew the influence of a passion upon the totality of the body better than half the faculty; and I am not sure that he could not have prescribed to better purpose than them all put together. Do you think that in cases of this kind he would have troubled his head about the digestive organs, or that he would have said, like many of the great doctors of the day, " we must put the stomach and bowels to rights !" Certainly not; he would have made the Brain his first care;—he would have first tried to soothe and comfort that, and then he would have expected the appetite to return. Now, that is what ought to be done in all complaints, indigestion and consumption included. Every organ of the body is of importance in our economy,—but the Brain is so important an organ that people cannot live a moment without it ;• and whatever affects it, for good or for evil, equally for good or for evil affects every other part of the body,—the lungs as much as the stomach. Through the medium of the Brain and nerves only, can mercury or any other medi- cine influence the diseases of these two last-mentioned organs, whether advantageously or the reverse; and, as I have already told you, mercury can do both,—according to the correspondence and fitness it hath for indi- vidual bodies, and the scale or degree in which it may be administered. But upon the subject of appetite the greatest nonsense prevails, even in the profession. You hear that such a one is ill—very ill,—but, thank Heaven! his appetite still keeps " good." How, then, is it that the patient continues day by day to waste and become skeleton-like ? Is it because that man's appetite, so far from being " good—nay excellent," is morbidly voracious and craving, having as much resemblance to the appetite of health as the diabetic flow of urine has to a useful—that is, a moderate secretion —from the kidneys ? No man can possibly be the subject of disease of any kind without his digestive organs partaking in the general totality of derangement. Whatever can improve the general health in one case may do the same in the other. Now, though the chrono-thermal remedies, judiciously administered during the remission, may of themselves singly cure almost every kind of disease,—yet it is my custom to combine and alternate them, as I have already said, with such medicines as experience proves have more or less affinity to the particular parts of the body most implicated in a given case,—mercury, iodine, and emetics, for example— inasmuch as the cure may thereby, in many instances, be at least accele- rated. The well-ascertained influence of mercury and iodine on the glandular and assimilative nerves, naturally points to those two medicines as being the most proper for consumption; and I feel it my duty to state to you that I have often availed myself of their beneficial influence in that disease. That they can produce it in cases where they prove constitu- tionally injurious, you will scarcely doubt, when you consider that what- ever may injure the health of persons predisposed to chest-disease, may as certainly bring out that weak point of their frame. Instances produced by both, more particularly mercury, I have too often been compelled to witness. Medical practitioners, when detailing the most strikingly remittent phenomena, in general manage so to word them that you cannot distin- guish whether they be remittent or not. The more intelligent non-medical writer will often convey in his unsophisticated English the precise bearings of a case. Take an instance from Captain Hall's narration of the illness of the Countess Purgstall:—" Our venerable friend," he says, LECTURE III. 69 " though she seemed to rally, and was certainly in as cheerful spirits as ever, had gotten a severe shake; her nights were passed in coughing, high Fever, and sharp rheumatic pains,—but in the day-time she appeared so well, that it was scarcely possible to believe her dying, in spite of her constant assertions to that effect." [Schloss Hainfield.] Now, in such a case as this, would not the responses of the stethoscope differ materially accord- ing to the time they were taken ? The indications obtained through its medium could not possibly be the same by night as by day. Connected with this subject, I may mention that when in 1836 I first published in this country my sketch of the chrono-thermal doctrines, the Fallacy of the Art of Physic as taught in the Schools, in which it appeared, was pretty severely handled by the medical critics. Dr. James Johnson, hi his Medico- Chirurgical Review, and Drs. Forbes and Conolly, the editors of the British and Foreign Medical Review, sounded their respective tocsins of scurrility. Not content with misstating and misrepresenting the matter of my volume, they resorted to personal abuse of myself; and the open contempt hi which I held their wooden idol, the stethoscope, fired them with a common indignation,—for, while Drs. Conolly and Forbes, with rare courtesy, made this a reason for pointing out to me " the advantages of common sense over the want of it," Dr. James Johnson, in an equally polite manner, charged me with "profound ignorance and inveterate prejudice." This language, I at once determined to treat with silence; but when I reflected how few, comparatively speaking, are aware of the manner in which the medical criticism of our metropolis is managed, and that the Reviews in question are only part of the corrupt machinery by which Mediocrity and Mendacity have been too often enabled to usurp the place and grasp the emoluments which of right should belong to Genius, I took an opportunity of answering the conductors of both publications, through the medium of the Lancet.* To that answer one only of the parties, Dr. James Johnson, put in a replication, but whether he gained or lost by the line of conduct he pursued, I leave to his own warmest advocates to decide. Drs. Forbes and Conolly to this hour have never attempted to invalidate either my facts or reasoning, though in a recent num- ber of their periodical, they have taken care to repeat their abuse of me—. a sure sign that they still smart under the effects of the castigation they received at my hands. Having already proved the utter inutility of the stethoscope m diseases of the heart, as confessed by Dr. James Johnson himself, I shall now enter into some investigation of its merits, in the detection of pulmonary con- sumption. Permit me, I said to my very polite critics, to ask you a very plain question. Since this instrument first came into fashion, have you or any other physician been able to bring this or any other disease of the chest to a more favorable termination than formerly.' Hitherto, I never could obtain but one answer to this question, and that answer was always a ne- gative. But softly, you will say—has it not taught us to discriminate and distinguish one disease from another ? Admitting, for the present, that such is the fact (which, however, I shall shortly disprove), of what use, I again ask, is such discrimination, such change of one kind of verbiage for another, if it lead to no difference or improvement in practice—if our remedial measures, for all shades and variations of pectoral disorder, come at last to the same agency ? What is it but a vain waste of time in splitting straws, to attempt to distinguish by some nice auricular sign, * For an exposure of the profligacy of these and other London Medical Reviews, Bee the various London Medical Periodicals,—the editors of which, in their hatred of each other, very often disclose the secret tergiversation of their respective colleagues. 70 LECTURE III. severe disease of one tissue of the pulmonary substance from another, if the proper treatment of every kind of lung disorder be the same .' If you reply, it is a satisfaction to know whether the disease be Curable or not, I give you for rejoinder the fact, that where the symptoms are so grave as to be with difficulty distinguished from tuberculous consumption, the disease, in that case, may either, like consumption, under certain circum- stances'admit of cure, or, like the same disorder in its very advanced stages, as certainly terminate in death. " Rush, Portal, and the most judicious physicians," says Dr. Hancock, " have constantly regarded Consumption to be a disease of the constitu- tion, not consisting merely of ulceration or loss of substance in the lungs— of course not to be disposed of by stethoscopes or any oracular mum- mery. Hence too, we see the reason that consumption formerly, in the times of Morton, Sydenham, Bennet, and others, was not regarded as an incurable disease." Let us, however, for argument's sake, allow that a knowledge of the exact amount of lung-decomposition could be turned to some useful or practical account; are my critics so certain that the ste- thoscope is adequate to the detection of this ? Andral, an authority to whom " pathologists" on all occasions implicitly bow, candidly admits its deficiency. " Without other signs," he says, " the stethoscope does not reveal with certainty consumption and inflammations of the heart." And Dr. Latham, who has taken no small pains to advocate its employ- ment, admits that the best Auscultators even—the technical term for those who use it—have been led to a wrong prognostic by it. " To most pa- tients," he adds, " I fear it is a trouble and distress." Now this is just the reason why I repudiate its assistance; whatever troubles and dis' tresses the patient must not only alter all the movements of the heart and lungs, so as to neutralize the whole indications presented by them ; but must actually aggravate the state of his system throughout, and, by consequence, instead of tending to the relief of the part most implicated, must further increase its diseased state. Well, then, as the information obtained from the stethoscope must, from the nature of things, be as hol- low and empty as the toy through which it proceeds—and as the dis- covery of the degree of organic change, even could it be known to a nicety, can in no instance lead to practical improvement, I am content to judge of it from the patient's general appearance, the number of his re- spirations, and the sounds emitted, when he speaks,breathes, and coughs, as appreciable by the naked ear. From an instrument whose employ- ment troubles and distresses the majority of patients, I look for no superior information ; for I repeat, whatever troubles and distresses peo- ple's brains, will assuredly trouble and distress their bodies, particularly the weaker parts of them. Gentlemen, we are all liable to trust too much to our Ears. Depend upon it, it were better, in Diseases of the Chest, as on most other occa- sions, to examine things with our Eyes. When we are consulted about disorders of that cavity, our business is to watch well the countenance of the patient, to mark whether his breathing be hurried, or the reverse, whether he has lost flesh or begins to gain it; and from whatever part of the lungs the matter expectorated may proceed, we can be at no loss for the proper principle of treatment; our eyes will soon tell us whether he gets better or worse, and whether a particular medicine should be con- tinued or changed for another. In the case of any very material change in the lungs, such as an abscess, cavern, or solidification of a part of their substance, if large, such local disease will get smaller as the general health improves,—if small, it will grow larger should that get worse More than this, LECTURE IIL 71 There need no words, nor terms precise— The paltry jargon of the Physic Schools, Where pedantry gulls folly;—we have Eyes. With these, then, let us recur to Nature, and we shall have no need to ask of professors and other great persons whether consumption and other Chest-affections be remittent disorders or not. When once satisfied of that, we may be sure that quinine and opium will be of infinitely more avail for their cure than all the discussion and discrimination of all the doctors that ever mystified disease by their vain nosologies ! What cares the pa- tient about the alphabetical combination, by which we baptize his dis- ease, if we cannot make him better; and if we succeed in curing him, what does it signify, whether we call it one name or another ? Is it not enough to know that the worst feature of the disease was in the chest, and that our treatment was judicious .' So far as result is concerned, the wise physician, even when despairing of success, will do well to guard himself against a too decided prognostic in any case. How often have I heard patients, who had formerly suffered from chest-disease, boast that they had lived to cheat their doctor of the death to which he had theoreti- cally doomed them,—aye, and that doctor a stethoscopist! It is truly amusing to find men playing the critic, without the smallest pretension to the knowledge requisite for such an office. So ignorant was my Medico- Chirurgiccl Reviewer, Dr. James Johnson, of one of the most universal laws, both of Health and Disorder, as to accuse me of a lim- ited grasp of my profession, for making Fever,—" not Fever in the large sense of the word, but only Remittent fever,"—my primitive type of all diseases. He chuckled that he could confront me with the school-boy term, " Continued Fever," " Fever in the large sense of the word ;" but according to a living professor, whom I should quote more frequently did he write better English (Dr. A. T. Thompson), in " Continued, Fever, in almost every case, there is an Exacerbation towards mid-day, and the Remission towards morning." Another contemporary, Dr. Sherman, says, " an Intermittent is the most perfect form of fever, having the most com- plete periods of accession and intermission. The Continued Fever, as it is called, differs from this only in its periods being less perfect and the stages of its curriculum less obvious." Cullen long ago said the same thing in nearly the same words, and almost every other writer on Fever since his time has noticed it. But so great a blunder was my preference of the perfect rather than the imperfect form of fever, for my type of all disease, in the eyes of Dr. James Johnson, that he not only condemned my doctrine in toto, as a Pyrexy-Mania, or fever-madness, but he assured his readers, my madness had a method in it. Gentlemen, whether or not Dr. Johnson's own practice does better deserve to come under the head of madness, savoring too of a rather sanguinary and homicidal type of it —I shall bye-and-bye have an opportunity of showing you. Meantime I may cibserve, that— ----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, Nor 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 starch decree, And break him on the wheel he meant for me; To spurn the rod a scribbler bids me kiss, Nor care if courts or crowds applaud or hiss.—Byron. Having already adverted to 72 LECTURE III. Glandular Disease, I will just shortly observe, that complaints of this kind, whether involv- ing some large Gland, such as the Liver, Pancreas, or Spleen,—if the last mentioned viscus be hideed a gland,—or taking place in the glandular apparatus of canals, the lachrymal and biliary ducts, the eustachian, salivary, and urinary passages, for example,—such disorders may all be advantageously treated by the various Chrono-thermal Medicines, and more certainly so, if combined with minute doses of Iodine, Mercury, and other remedies which have a well-known glandular affinity. Dis- orders 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 practitioners 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 tumors, 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 charac- ter, perfectly cured by a combination of these remedies with mercury or iodine. 1 could give cases innumerable in proof of this, but as I have so well established the principle in cases of structural disease, and have still further to illustrate it in the disorders we are about to enter upon, I shall not detain you further on this matter, than to state the fact as I have fotmd it, a fact which your own after-experience will enable you to con- firm, with only a common-place share of observation and sagacity. Consumptive Diseases of Joints^ Very much akin to Consumption of the Lungs and various diseases which, from their external manifestations, have been too long left under the exclusive dominion of the Surgeons, namely, those destructive affec- tions of the joints, which so often bring the subjects of them to the ampu- tating 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 sav- ing 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 mechani- cal dexterity of hand unenviably obtained by an equally unjustifiable waste of human blood. It is truly atrocious in the legislature of this country to permit the present hospital system,—a system that only encour- ages ignorance, presumption, and heartless cruelty. No man in his senses would put himself under the care of an " Hospital Surgeon," if he knew that scarcely one of those self-conceited creatures is in the very least ac- quainted with physic. What would some of these supercilious mechanics say to the following cases ? Case 1.—Harriet Buckle, seven months old, had what is called a scrofu- lous elbow. The joint was much enlarged, red, painful, and pervious to the probe, with discharge. The patient was the subject of diurnal fever Notwithstandmg the assurances 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 calculated 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. LECTURE HI. 73 Case 2.—A young gentleman, aged 11 years, had enlarged knee, with great pain and heat, which came on in paroxysms. Leeches, blisters, and purgatives had all been ineffectually tried by his " hospital surgeon," who then proposed amputation; the boy's mother hesitated, and I was called in. I prescribed minute doses of calomel and quinine. From that time the knee gradually got better, but stiff joint was the result,—anchylosis or adhesions having taken place before I was consulted. 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; ab- scesses 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 remain- ing. 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 com- plain 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 simi- lar treatment as in the above case, and the child rapidly recovered his health, with the complete use of his limb. He had been previously seen by a surgeon, who rightly pronounced the case to be one of Hip-disease. Case 5.—A girl, aged 12, had enlarged ancle, with an open ulcer lead- ing into the joint. Amputation, according to the mother, was looked upon as the inevitable termination of the case by two " Hospital" surgeons, un- der whose care the patient had been for twelve months previously to my seeing her. With small doses of quinine and calomel, the girl regained 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 these various affections. Will they be content with the simplicity of joint consumption ? 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, I leave to more learned heads than mine to decide. There is not a disease, Gentlemen, however named, or by whatever caused, of which the most perfect periodic examples might not be given, and the only difference between diseases in this type, and the more ap- parently 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 phy- sician will doubt that a purely periodic disease, whatever be its nosologi- cal 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 continued Fever, since all disorders like it have remissions and exacerbations, more or less perfect hi character, throughout their whole course ? What are such diseases but varieties of the more purely inter- mittent type ? And what are the remedies found to be most beneficial in their treatment, but the remedies of the 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 sur- geon who has remarked this :—" Exacerbations," he says, " are common to all constitutional diseases, and would often appear to belong to many local complaints." Gentlemen, they belong to all. You may observe them even in the case of disease from local injury; and here I may give you 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 im- proved method of treating fractures. Mr. Radley writes thus:—" Many 6 74 LECTURE IIL 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 you a case strikingly illustrative of the truth of your new doctrine, and one that was presented to me in my own favorite 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, I 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 simple fracture with much contusion. To soothe the pain, he had solution of morphia after the limb had been laid on a pillow. When three days had elapsed, he still complained of pain, and on my inquiring when he suffered most, ' Why, zur, '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 frac- tured bones in particular constitutions,—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 constitutional mode of treating such cases; but it was confined to one medicine, mer- cury, 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 result, in the case of a soldier of that regiment, by the exhibition of Quinine. The man had remittent fever,—the true constitutional reason why fractured bones refuse to unite under ordinary means. Gentlemen, inquire of the subject of Goitre or other tumor; question the unfortunate persons who ask your advice in cases of cancer; such as suffer from abscess or ulcer, or those even who consult, you for the true aneurismal tumor of an artery, and each and all will admit that they are one day better, another worse; that their swellings at intervals decrease; that their ulcers become periodically 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 influenced by a pas- sion, or by good or bad news ; that in the commencement, at least, there are days, nay, hours of the same day, when they have a certain respite from their pain and suffering: and that they all experience in their bodies the 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. Gentlemen, can you doubt the advantage 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 LECTURE IV. 75 LECTURE IV. INFLAMMATION—blood-letting—abstinence. Gentlemen, When medical men hear that I am in the habit of treat- ing all kinds of disease without Blood-letting, they generally open their eyes with a stare, and ask me what I do in Inflammation. Inflamma- tion !—who ever saw any part of the body on fire, or in flames ? for the word, if it means anything at all, must have something like that signifi- cation. To be sure, we have all heard of " spontaneous combustion," but I confess I never saw it, and what is more, nobody, that ever did ! What, then, is this inflammation—this term which our great modern doc- tors so dogmatically assure us is the head and front of every corporeal disorder ? It is a metaphor merely—a theoretical expression, which, tor- ture it how you please, can only mean a quicker motion and a higher temperature in the moving atoms of a given structure, than are compati- ble 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 approaching 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 inflammation, then, very closely resemble, if they be not indeed identical with, the chemical phe- nomena which take place preceding and during the decomposition of inorganic substances. Now, when this kind of action proceeds uncheck- ed, the result in most cases is a tumor, containing purulent matter, which matter being a new fluid product, differs entirely in its appearance and consistence from the original tissue, in which it chanced to become de- veloped. This tumor we call Abscess. 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 he'althy 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 system, and 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 originally formed. How analogous all this to the operations of the chemist, who, by means of the galvanic wire, having first reduced water into its elemental gases, again converts these, by electrical means, into the water from whose decomposition they pro- ceeded ! Such, and many more chemical operations, Nature daily per- forms 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 unquestionable of cerebral actions), large abscesses, and even solid tumors, have often completely disappeared in a single night. Gentlemen, there is not a passion,—Grief, Rage, Terror, or Joy,—which has not as effectually cured abscesses and other tumors, 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 76 LECTURE IV. the inflammatory process. For example, after having proceeded, to a certain extent, in the way of change, but still falling short of actual puru- lent decomposition, the atoms of the inflamed part, by the renewal of a healthy condition of the body generally, or 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 inflam- matory action is more than usually rapid, the result may be the complete death of the part implicated,—a black morganic mass being left in the place of the tissue which it originally composed. This last we term Mortification or Gangrene. But, Gentlemen, medical men extend the term inflammation to some other morbid processes,, "which, under the various names of Gout, Rheu- matism, and Erysipelas, we shall, in another lecture, have the honor to 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, in almost every instance, use language which they do not themselves 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 enor- mously 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.] Gen- tlemen, 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 phenomenon of disease, it is a development of pre- vious constitutional disturbance. I do not speak of immediate local in- flammation produced by a chemical or mechanical injury, leaving that to the surgeons to elucidate or mystify, according to their particular inclina- tions ; 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 widely 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, (techni- cal terms for inflammation 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 inflammation in such parts equally inter- mittent with the diseases of which we have already treated ? Listen to Lal- lemand:—" In inflammation of the brain," he tells you, " you have spas- modic symptoms, slow and progressive paralysis, the course of the dis- order being intermittent." So that inflammation, like almost every Other morbid action, is for the most part a feature or development of intermit- tent fever. Dr. Conolly, in his Cyclopaedia of Medicine, says " diurnal re- missions are distinguished in every attack of inflammation." Now if you prefer the evidence of another man's eyes to your own, this statement LECTURE IV. 77 ought to be more than convincing, for it comes from the enemy's camp. Gentlemen, it is the language of an opponent, the Editor of the British and Foreign Medical Review—the same individual who lately told his read- ers that the Unity of Disease was a silly book. If it was so silly as he says, why was he so silly as to abuse it ? But against his authority,—if authori- ty, in these days, be still permitted to take the place of examination—you have the opinion of Sir Astley Cooper, who, with his usual candor and good feeling, at once pronounced it to be a " valuable work." Now, who in his senses would think of comparing these two men together,—Astley Cooper, the father of English surgery, and John Conolly, the Mad-doctor ? —" Hyperion to a satyr!" But, Gentlemen, you have no idea what tricks these medical Reviewers are in the habit of playing. Some time ago I showed up one of them in a way he will not soon forget. Dr. James Johnson, were he here, would know the person I mean ; for he, Gentle- men, as I have already told you, reviewed my Fallacy of the Art of Physic as taught in the Schools, in the Medico-Chirurgical Review. A most unlucky business it turned out for him, for were I to tell you how I replied to his criticism, you never could again hear his name mentioned without laugh- ing. Why has he not, in revenge " cut up" the Unity of Disease ? The editor of the Medical Gazette, not long ago, pretended to review that work. He did not, however, like Dr. Conolly, call it a silly book;—he admitted, on the contrary, that it had " both pith and point," but he contended that it was only a straw thrown up at a lucky moment when the wind of medical opinion was turning against the " bleeding mania,"—a mania which he said he also reprobated. I wrote to him to ask, if that were really the case, why he, Mr. Editor, had never reprobated that mad practice before, and knowing it to be so murderous in itseffects, as he said he did, how in common humanity he allowed my strictures upon it to remain so long unnoticed in his pages ; while all the years that these strictures had been before him, he not only continued to fill his journal with cases treated after the sanguinary fashion, but had even held them up to the world as mo- dels of practice ! True, in one or two instances, where the person he quoted was his enemy, he had certainly hinted that the treatment was bad. But these were very sorry exceptions. So far from my book being a straw that showed which way the wind blew, I was the first (I maintained) who had the courage, alone, and in the face of much opposition, to set that wind a-blowing; and I added, that before I died I hoped to raise such a stormy one as would purify the medical atmosphere of some of its present corruption and foulness ! But of that letter my good friend the Editor took no notice whatever ,• nor was I surprised at it, for the Medical Gazette, as some of you may know, is a mere organ and supporter of the College of Physi- cians ; and so much the slaves of that body are the booksellers who pub- lish it, that when about two years before, I sent them the MS. of this very Unity of Disease, they actually refused to bring it out for me on any terms ! —the editor of the Gazette can best tell at whose instigation,—for he is, or was then at least, the examiner of all their medical manuscripts, and there- fore perfectly acquainted with that particular secret. Like a good servant, doubtless, he had too much regard for his employers to permit them to usher into the world such a terrible exposure of their professional patrons. Before quitting this matter, 1 may mention, that I am frequently-asked why my writings have never been taken up by the Lancet, the Lancet which talks so constantly and so grandiloquently of its reforming and liberal politics! I can suggest a reason;—that Periodical is now the organ of the Apothecaries. Mr. Wakley, its proprietor, was, in early life, a medical reformer, and much good he certainly at one time did in that character. Now—but I shall say no more of him on this occasion except Cave canem ! To return to inflammation. Whether the particular condition so called, 78 LECTURE IV. be termed erysipeloid, gouty, rheumatic, scrofulous, 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 inflammation, then, yield to Bark—to Quinine ? The late Dr. Wallace of Dublin maintained the affirmative, dwelling more paiticularly on its good effects in that disorganizing inflammation of the Eye, termed Iritis, in which disease he preferred it to all the routine measures which, on the strength of the theory, medical men have from time to time recommended as antiphlogistic. During an attack of Ague, he tells us, Iritis with inflam- matory affection of other parts of the eye, occurred in the person of a patient under his care. " For the former complaint, namely, the inter- mittent fever, he administered 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 inflammation of the Eye. Now I shall tell you what first led me to entertain similar doubts of its efficacy. A medical officer of one of Her Majesty's regiments serving in India, couched a woman 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 re- covering her from this; but it was not till four longhours 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 other- wise call up the attention of the brain by the application of stimulants to the nose, mouth, &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, Gentlemen, the blood-letting did not cure the inflamma- tion ; for the next day the eye was more painful and inflamed 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 I 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. You see, then, that blood-letting, even to the point of death, is no cure for inflammation; and that it cannot prevent its development, I shall furnish you with ample evidence before I finish this lecture. Mean- time, I will tell you 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;—aud 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 ap- peared much more plausible when taught in the schools of physic, than pro- bable, when I attended to fact and experience. The unquestionable safety and acknowledged use of the Bark, in the worst stage of inflammation, when it is tending to a mortification, affords a sufficient answer to the' first of these objections; and I have several times seen it given plentifully LECTURE IV. 79 in the confluent small-pox, without lessening in any degree the expecto- ration." Some time ago, I was called to see a young gentleman, who had a swelling under the arm-pit, extending to the side. The skin was red and hot, and the tumor so painful as to have deprived him of all rest for the three previous nights. Though suppuration appeared to me to have com- menced, I at once ordered Quinine, and begged him to poultice the tu- mor. By these means, he was perfectly cured in three days, the swel- ling having, in that period, completely disappeared. The subject of this case was, in the first instance, attacked with shivering and fever, which had repeatedly recurred, but disappeared under the use of the quinine. Matter, I have no doubt, was absorbed in this instance, but so far from this absorption producing shiverings,—which, according to the doctrine of the schools, it ought to have done, the very reverse took place. I shall now give you one of many instances of indubitable and palpa- ble inflammation—if the word have a meaning at all—as a proof of the value of Opium in the treatment of this affection. Case.—An old officer, Major F., 89th Foot, who had previously lost one eye by acute Ophthalmia, notwithstanding a vigorous antiphlogistic disci- pline, 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 indicative 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 re- mitted principally in the afternoon. Three grains of opium, which I di- rected 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 up on the activity of his treatment. But how, you may ask me, can Pleurisy and Pneumonia be cured with- out Blood-letting ? What are Pleurisy and Pneumonia ? Any rapid ten- dency to atomic change in the substance of the lungs, from the real pain and presumed increase of temperature at the same time developed, is termed Pneumonia—vulgo inflammation of the lungs. A similar tendency to change in the atomic relations of the membrane {pleura) which covers the outer surface of the lungs, or that portion of it which is continued over the inner suiface of the chest, is called the Pleurisy. Now, authors have thought it a fine thing to be able to tell pleurisy from pneumonia, but the thing is impossible ; and what is more, if it were possible, so far as treat- ment is concerned, it would not be worth the time you should spend in doing it. Such distinctions only lead to interminable disputes, without in the least tending to improvement in practice. This much, however, I do know,—both diseases are developments of intermittent fever, and both may often co-exist 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 illus- trates the chrono-thermal doctrine and treatment in both, I shall give to you in the words of its narrator.—" The patient's symptoms were difficult respiration, dry cough with stringy expectoration, pulse full. The disease 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 shiverhig, 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 very next day the fit was scarcely perceptible; the day after, there was no fit at all. An observation worthy 80 LECTURE IV. 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 parox- ysms—disappeared completely, and in a very short time, by the effect of the sulphate of quinine." Who are the persons most subject to inflammatory diseases of the chest ? Medical theorists answer, " strong healthy laborers, and people much ex posed to the air." How these gentlemen deceive themselves ! If I know anything 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 confined to badly ventilated rooms, and the greater number broken down by starvation, blood-letting, or previous disease. Some of you may have heard of M. Louis of Paris, a physician, who for many years has made chest-disease his study. Speaking of his consumptive patients, who became the sub- jects of inflammatory disease, he has this observation :—" As we have al- ready remarked in speaking of Pneumonia, the invasion of Pleurisy coin- cides in a large proportion of our patients with the period of extreme weak- ness and emaciation."—Dr. Cowan's translation of Louis. Now, what is the usual treatment of Pleurisy and Pneumonia ? Does it not almost entirely consist in blood-letting, starving, and purging—with blisters and mercury sometimes ? But what are the results ?—relapse or repetition of the paroxysm from time to time,—long illness,—weakness ever after, and death too often. Even in these cases of extreme emacia- tion, 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 setting a theatre in a roar may be still fresh in the recollection of many of you—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 your laughter, very much wanted your sympathy. " Monday, the 9th of October," says Mr. Charles Dickens, " was the day fixed for his benefit, but on the preceding Saturday, he was suddenly seized with severe illness, originating in a most distressing impediment 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 sin- gle day of perfect health." If you reflect that medical relief was im- mediately called in, you may be inclined, like myself, to ascribe poor Gri- maldi's damaged constitution, not so much to the effect of the original dis- order, as to the sanguinary 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 this continued ill- ness was owing to the neglect of this very excellent 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 White Chapel Work-house. " 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 diseases of the chest—whether involving the pleura simply, the interstitial substance of the lungs, or the mucous or muscular apparatus of their air-tubes, your first duty is to premise an emetic. So far from acting exclusively on the stomach, medicines of this class have an influence pri- marily cerebral, and they therefore act powerfully upon every member and matter of the body. By emetics you may change the existing relations of LECTURE IV. 81 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 re- lieve 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 medicines can alter the state of an inflam- ed part may be actually seen by their effects on the eye, in the inflamma- tory 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 you have occasionally seen 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 salulary influence, as a present means of relief, blood-letting may produce, it is infinitely inferior to what you may obtain by emetics—a class of reme- dies which possess the additional advantage of giving that relief, without depriving the patient of the material of healthy constitutional power. Their influence, moreover, as a preventive against return of the paroxysm, is very considerable,* while blood-letting, so far as my experi- ence goes, has only, on the contrary, appeared to render the patient more liable to a recurrence. Lord Bacon tells us in his Works, that if disciples only knew their own strength, they would soon find out the weakness of their masters. What led him to this conclusion ? What but the fact that, with all his ability, even Lord Bacon himself had been duped by his teachers ?—and why did Des Cartes say, that no man could possibly pretend to the name of phi- losopher who had not at least once in his life doubted all he had been previously taught ? He too had been hood-winked by his pretended mas- ters in philosophy. But you, perhaps, will say all this took place in old times—the world is quite changed since then; professors are now the most enlightened and respectable men alive; they go to church, where they are examples of piety; they never were found out in a lie; are not subject to the passions of other men ; have no motives of interest or ambi- tion,—in fact, they are all but angels. Now, I only wish you knew the manner in which most of these very respectable persons get their chairs— the tricks, the party-work, the subserviency, meanness, and hypocrisy practised by them for that and other ends—and you would not so tamely submit your judgment to their theoretic dreams and delusions. Young men, be men,—and instead of taking for gospel the incoherent and incon- sistent doctrines of the fallible puppets whom interest or intrigue has stuck up in Academic Halls,—use your own eyes, and exercise your own rea- son ! Here, then, I give you a test by which you may know the best practice in inflammatory diseases of the chest—a test that cannot possibly deceive you. Take a certain number of pleuritic and pneumonic pa- tients—bleed, blister, and physic these after the most orthodox fashion, so that you shall not be able to tell, whether the continued disease be the effect of the primary cause, or the heroic measures by which your pa- tients have been worried during their illness. Take another equal number similarly afflicted, and treat them chrono-thermally,—that is to say, pre- mise an emetic, and when, by means of this, you have obtained a remis- sion of the symptoms, endeavor to prolong such period of immunity, by quinine, opium, or hydrocyanic acid, and then compare the results of both modes of practice. If you do not find an immense saving of suffer- * This statement, when I first published it, was denied by Physicians, but it has been since confirmed by Dr. Seymour of St. George's Hospital, who recently made 6ome remarks upon the power of Emetics in " altering the Periodicity of Disease." 82 LECTURE IV. ing and mortality by the latter mode of treatment, I will consent to be stigmatized by you as an impostor and deceiver—a cheat—a quack—a person, hi a word, who would rather teach error than vindicate truth. Remember, however, before you begin, that the Chrono-Thermal System professes, as its chief feature of superiority over every other, to make short work with disease,—a circumstance not likely to recommend it to those whose emolument, from the manner in which things are now or- dered, arises principally from long sickness and much physic ! I am often asked how I treat Enteritis,—Inflammation of the Bowels,— without the lancet.' Before I give my answer, I generally ask—Can medi- cal men boast of any particular success from depletion in this disease? If so, why have they been always so solicitous to get the system under the influence of calomel,—or why do they prescribe Turpentine in its treat- men ? Is it not because the nature of the relief afforded by the lancet has either been temporary or delusive, or, what I have myself found it to be, absolutely hurtful in the majority of cases .' " The symptoms of Enteritis," says Dr. Parr, " are a shivering, with an uneasiness in the bowels, soon increasing to a violent pain,—occasionally at first remitting, but soon becoming continual. Generally, the whole abdomen is affected at the same time with spasmodic pains, which extend to the loins, apparently owing to flatulency. The pulse is small, frequent, generally soft, but sometimes hard, and at last irregular and intermittent—the extremities are cold—the strength sinks rapidly." " Perhaps," he adds, " bleeding is more seldom-necessary in this disease than in any other inflammation; for it rapidly tends to mortification, and should it not at once relieve, it soon proves fatal." In a letter which I received from staff-surgeon Hume, he says : " I am satisfied that Pneumonia and Enteritis, diseases which are at present the bugbears of the faculty, are indebted for their chief existence to the remedies employed in ordinary ailments, namely, bleeding and un- necessary purging. I never saw a case of either (and I have seen many), of which the subject had not been the inmate of an hospital previously, | where he had undergone the usual antiphlogistic regimen,—or had been otherwise debilitated, as in the case of long residence in a warm climate." Now, Gentlemen, this is the language of an experienced Medical Officer of the Army, one "who, having no interested end to serve, and who would not take private practice if offered to him, is at least as worthy of belief as those whose daily bread depends upon the extent and duration of dis- ease around them. My own practice in Enteritis I will illustrate by a case. I was one evening requested by the Dowager Duchess of Roxburgh to see her butler; 1 found him with severe pain of abdomen, which would not brook the touch, furred tongue, hard pulse, and hot skin; he told me he had shivered repeatedly, that the pain was at first intermittent, but at last constant. He had been seen in the morning by a gentleman, who had ordered him Turpentine and Calomel—a proof that he also considered the case as one of inflammation of the bowels. The patient having obtained no relief, I was called in. I gave him an emetic, and went up stairs to await the result. In about twenty minutes, I again saw him. The vomit had acted powerfully, and with such relief that he could then turn him- self in bed with ease, which he could not before do. 1 then prescribed prussic acid and quinine. In a few days he was as well as ever. Instead of bringing theoretic objections to this method of treating inflammation of the bowels, let practitioners only put it to the proof. Is it possible that they can be less successful with the new practice than with the old, under which, when they save a patient in this disease, they are fain to boast of it as a wonder ! I shall now enter at some length upon the subject of LECTURE IV. 83 Blood-Letting. While with one class of practitioners, Medicine is reduced to the mere art of purgation, with another class it consists in the systematic abstrac- tion of blood ; every means being resorted to in the mode of doing this, from venesection, arteriotomy, and cupping, to the basest application of the leech. In the remarks, Gentlemen, which I am now about to make on the subject, instead of discussing the preferable mode of taking blood away, I shall bring before you some facts and arguments that may con- vince you of the perfect possibility of dispensing with the practice altogether. " The imputation of novelty," says Locke, " is a terrible charge among those who judge of men's heads as they do of their perukes, by the fashion —and can allow none to be right but the received doctrine." Yet, in the words of the same acute writer:—" An error is not the better for being common, nor truth the worse for having lain neglected; and if it were put to the vote anywhere in the 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. In the same spirit Lord Byron asks : " What from this barren being do we reap ? Our senses narrow, and our reason frail, Life short, and truth a gem that loves the deep, And all things weighed in Custom's falsest scale. Opinion an omnipotence—whose veil Mantles the earth with darkness—until right And wrong are accidents—and men grow pale Lest their own judgments should become too bright, And their free thoughts be crimes, and earth have too much light!" 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 ignorance; but this we know, that its intro- duction could only have been during the hifancy 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 little for the after-dis- coveries of ages, or for the boasted progress of medical science. Like every other lucrative branch of human knowledge, the Practice of Medi- cine at one time was 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 disease. I am the rather inclined to this idea from the fact that when 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 afterwards burnt hi public by the common hangman. Of what is the body composed ? Is it not of Blood, and Blood only ? What fills up the excavation of an ulcer or an abscess ? What repro- 84 LECTURE IV. duces the bone of the leg or thigh, after it has been thrown off dead, in nearly all its length ? What but the Living Blood, under the electrical influence of the brain and nerves! How does the slaughtered animal die ? Of loss of blood solely. Is not the blood then, in the impressive language of scripture, " 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 practised by the Jews, why this omission ? Will the men who now so lavishly pour out the Blood, dispute its importance in the animal economy.'—will they deny that it forms the basis of the solids,—that when the body has been wasted by long disease, it is by the Blood only it can recover its healthy volume and appearance ? Has not nature done everything to preserve to animals of every kind, " The electric Blood with which their arteries run!" Byron. She has provided it with strong resilient vessels—vessels which slip from the touch, and never permit their contents to escape, except where their coats have been injured by accident or disease. Misguided by theory, man, presumptuous man, has dared to divide what God, as a part of crea- tion, united—to open what the Eternal, in the wisdom of his omniscience, made entire ! See then what an extreme measure this is ! It is on the very face of it a most unnatural proceeding. Yet what proceeding so common, or what so readily submitted to, under the influence of authority and custom .' If, in the language of the Chemist Liebig, the blood be indeed " the sum of all the organs that are being formed," how can you with- draw it from one organ without depriving every other of the material of its healthy state ?—Yet enter the crowded hospitals of England—of Europe —and see how mercilessly the lancet, the leech, and the cupping-glass, are employed in the diseases of the poor. Look at the pale and ghastly faces of" the inmates. What a contrast to the eager pupils and attendants thronging around their beds—those attendants with bandage and basin, ready at a moment's notice to take from the poor creatures whatever quantity of life-blood, solemn Pedantry may prescribe as the infallible means of relieving their sufferings. Do that, I say, and refrain, if you can, from exclaming with Bulwer, " when Poverty is sick, the doctors mangle it!" What are the causes of the disorders of this class of people .' In the majority of cases, defective food, and impure air. By these has their blood been deteriorated—and for what does the (so termed) man of science abstract it ? To make room for better .' No !—goaded on by the twin-goblins, "congestion" and " inflammation,' to deteriorate it still further by starvation and confinement. Gentlemen, these terms play in physic much the same thing 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 party-phrase by cunning caught and spread, That guilt may reign, and wolves and worms be fed ! Byron. The first resource of the surgeon is the lancet—the first thing he thinks of, when called to an accident, is how he can most quickly open the floodgates of the heart, to pour out the stream of an already enfeebled exist- ence. Does a man fall from his horse or a height, is he not instantly LECTURE IV. 85 bled .'—has he been stunned by a blow, is not the lancet in requisition ?— Nay, has an individual fainted from over-exertion or exhaustion, is it not a case of fit—and what so proper as venesection ! You cannot have forgotten the fate of Malibran—the inimitable Malibran —she who so often, by her varied and admirable performances, moved you to tears and smiles by turns. She was playing her part upon the stage—she entered into it with her whole soul, riveting the audience to the spot by the very intensity of her acting. Just as she had taxed the powers of her too delicate frame to the uttermost—at the very moment she was about to be rewarded by a simultaneous burst of acclamation, she fainted and fell—fell from very weakness. Instantly a medical man leapt upon the stage—to administer a cordial?—No—to bleed her!—to bleed a weak, worn, and exhausted woman! And the result ?—she never rallied from that unfortunate hour.—But, Gentlemen, Malibran was not the only intellectual person of the thousands and tens of thousands who have prematurely perished by the lancet.—Byron and Scott—those master-spirits of their age—those great men who, like Ariosto and Shak- speare, not only excited the admiration of contemporary millions, but whose genius must continue, for generations yet unborn, to delight the land that produced them—they too fell victims to the lancet—they too were destroyed by hands which, however friendly and well-intentioned, most undoubtedly dealt them their death-blows. Is not this a subject for deep reflection ? To the cases of these great men we shall recur in the course of this lecture ; but for the present, we must turn to other matters —to events that have just passed before our eyes. The affair of Newport, in Wales, is still the topic of the hour. You must therefore remember it to its minutest detail—the attack by the rioters upon the town—the gallant and successful stand made by Captain Gray and his little detachment of the 45th regiment—the prisoners captured, and the investigation which afterwards took place. In the course of that inquiry, a prisoner, when under examination, fainted.—What was done with him ?—he was carried out of court and immediately bled! On his return, the newspapers tell us, an extraordinary change had come over his countenance. From being a man of robust appearance, he had become so wan and haggard, so altered in every lineament, the spectators could scarcely recognize him as the same prisoner. Yet, strange to say, not one of the many journals that reported this case, introduced a single word in condemnation of the utterly uncalled for measure, which brought the man to such a state;—so much has Custom blunted the sense of the public to this the most danger- ous of all medical appliances ! Gentlemen, a coroner's inquest was held upon a person who died sud- denly. I shall read to you what followed from the Times newspaper, of the 20th December, 1839, suppressing, for obvious reasons, the name of the witness. " Mr------, surgeon, stated that he was called upon to attend deceased, and found him at the point of death. He attempted to bleed him, but ineffectually, and in less than a minute from witness's arrival, deceased expired. Witness not being able to give any opinion as to the cause of death from the symptoms that then exhibited themselves, he afterwards, with the assistance of Dr Ridge, 37, Cavendish Square, made a post-mortem examination, and found that a large cavity attached to the large vessel of the heart, containing blood, had burst, and that that was the cause of death." So that while the man was actually dying of inanition from internal bleeding, the surgeon, utterly ignorant, according to his own confession, of the nature of the symptoms, deliberately proceeded to open a vehi!—How happens it that the lancet should be so invariably the first resort of Ignorance ! In every case of stun or faint, the employment of this instrument must be a superadded injury;—in all, there is a positive enfeeblement of the 86 LECTURE IV. whole frame, evidenced by the cold surface and weak or imperceptible pulse; there is an exhaustion, which loss of blood, so far from relieving, too often converts into a state of utter and hopeless prostration. True, men recover though treated in this manner, but these are not cures—they are escapes! How few the diseases which loss of blood may not of itself produce ! If it cannot cause the eruptions of small-pox, nor the glandular swellings of plague, it has given rise to disorders more frequently and more imme- diately fatal than either. What think you of cholera asphyxia—Asiatic cholera? Gentlemen, the symptoms of that disease are the identical symp- toms of a person bleeding slowly away from life ! The vomiting, the cramps, the sighing, the long gasp forbreath—the leaden and livid coun- tenance which the painter gives to the dying in his battle-pieces—these are equally the symptoms of cholera and loss of blood! Among the nu- merous diseases which it can produce, Darwin says—" a paroxysm of gout is liable to recur on bleeding."—John Hunter mentions "lock-jaw and dropsy," among its injurious effects,—Travers,'' blindness,"—and " Palsy," Marshall Hall, " mania,"—Blundell," dysentery,"—Broussais, " fever and convulsions!" " When an animal loses a considerable quantity of blood," says John Hunter, " the heart increases in its frequency of strokes, as also in its violence." Yet these are the indications for which professors tell you to bleed ! You must bleed in every inflammation, they tell you. Yet is not inflammation a daily effect of loss of blood ! Magendie mentions "pneumonia" as having been produced by it, completely confirming the evidence of Mr. Hume upon that point. He further tells us that he has witnessed among its effects " the entire train of what people are pleased to call inflammatory phenomena; and mark," he says, " the extraordinary fact, that this inflammation will have been produced by the very agent which is daily used to combat it!" What a long dream of false security have mankind been dreaming! they have laid themselves down on the laps of their medical mentors, they have slept a long sleep ;—while these, like the fabled vampire of the poets, taking advantage of a dark night of barbarism and ignorance, have thought it no sin to rob them of their life's blood during the profoundness of their slumber! Gentlemen, the long shiver of the severest ague, the burning fever, the fatal lock-jaw, the vomiting, cramps, and asphyxia of cholera, the spasm of asthma and epilepsy, the pains of rheumatism, the palpitating and tumultuous heart, the most settled melancholy and madness, dysentery, consumption, every species of palsy, the/ami* that became death, these,— all these—have I traced to loss of blood. Could arsenic, could prussic acid, in their deadliest and most concentrated doses, do more ? Yet T have heard men object to use the minutest portions of these agents, me- dicinally,—men who would open a vein, and let the life-blood flow until the patient fell like an ox for the slaughter, death-like, and all but dead, upon the floor ! Do these practitioners know the nature of the terrible power they thus fearlessly call to their aid ? Can they explain its man- ner of action, even in those cases where they have supposed it to be beneficial ? The only information I have been able to extract from them upon this point, has been utterly vague and valueless. Their reasoning, if it could be called reasoning, has been based on a dread of " inflamma- tion" or " congestion." From the manner in which they discuss the sub- ject, you might believe there was no remedy for either but the lancet. Ask them why they bleed in ague, in syncope, in exhaustion or col- lapse ? they tell you it is to relieve congestion. After a stun or fall.'__it is to prevent inflammation. Bleeding, in all my experience, I have already stated to you, never either relieved the one, or prevented the other ! Gen- tlemen, did you never see inflammation of a vein after bleeding—inflam- mation caused by the very act! I have known such inflammation to end LECTURE IV. 87 fatally. Did you never know the wounds made by leech-bites become inflamed, after these reptiles had exhausted the blood of the part to which they were applied ! And how came that about.' Simply because, however perfectly you exhaust any part of its blood, you do not thereby prevent that part from being again filled with it—or rather, you make it more liable to be so, by weakening the coats of the containing vessels! Hun- dreds, thousands have recovered from every kind of disease, who never were bled in any manner; and many, too many have died, for whom the operation, in all its modes, had been most scientifically practised ! Have I not proved that every remedial agent possesses but one kind of influ- ence, namely, the power of changing temperature ? Let the school-man show me that the lancet possesses any superiority in this respect—any specific influence more advantageous than other less questionable mea- sures ; and I shall be the last to repudiate its aid in the practice of my profession. The beneficial influence of blood-letting, where it has been beneficial in disease, relates solely to temperature. To this complexion it comes at last, and to nothing more—the equalization and moderation of temperature. In the congestive and non-congestive stages of fever, the cold, the hot, the sweating, the lancet has had its advocates. Blood-letting, under each of these circumstances, has changed existing temperature. Why, then, object to its use ? For this best of reasons, that we have remedies without number, possessing each an influence equally rapid, and an agency equally curative, without being, like blood-letting, attend- ed with the insuperable disadvantage of abstracting the material of healthy organization. I deny not its power as a remedy, in certain cases ; but I question its claim to precedence, even in these. Out of upwards of twelve thousand cases of disease that have, within the last few years, been under my treatment, I have not been compelled to use it once. Re- sorted to, under the most favorable circumstances, its success is anything but sure, and its failure involves consequences which the untoward ad- ministration of other means may not so certainly produce. Have we not seen that all diseases have remissions and exacerbations—that mania, asth- ma, apoplexy, and inflammation, are all remittent disorders ? From the agony or intensity of each of these developments of fever, you may ob- tain a temporary relief by the use of the lancet; but what has it availed in averting the recurrence of the paroxysm .' How often do you find the patient you have bled in the morning, ere night with every symptom in aggravation. Again you resort to bleeding, but the relief is as transitory as before. True, you may repeat the operation, and re-repeat it, until you bleed both the blood and the life away. Venesection, then, in some cases, may be a temporary though delusive relief. The general result is depression of vital energy, with diminution of corporeal force! Dr. South wood Smith, physician to the London Fever Hospital, has published a book purposely to show the advantages of bleeding in fever. One of his cases is so curiously illustrative of his position, that I shall take the liberty of transcribing it from the Medical Gazette, with a running commentary by the Editor of that periodical:—" The case of Dr. Dill de- mands our most serious attention, and deserves that of our readers. It is adduced as an example of severe cerebral affection, in which cases, Dr. S. affirms, ' the bleeding must be large and early as it is copious.' ' I saw him,' says Dr. Smith, * before there was any pain in the head, or even in the back, while he was yet only feeble and chilly. The aspect of his countenance, the state of his pulse, which was slow and laboring, and the answer he returned to two or three questions, satisfied me of the inor- dinate, I may say the ferocious attack that was at hand.—p. 398.' " Whatever may be the opinion of our readers, as to the above signs indicating a ferocious cerebral attack, they will one and all agree with us, that the ferocious attack was met with a ferocious treatment; for an 86 LECTURE IV. emetic was given without delay, and • blood was taken from the arm, to the extent of twenty ounces.' This blood was not inflamed. Severe pains in the limbs and loins, and intense pain in the head, came on during the night—and early in the morning blood was again drawn to the extent of sixteen ounces, ' with great diminution, but not entire removal of the pain.' Towards the afternoon, he was again bled to sixteen ounces. 4 The pain was now quite gone—the blood from both these bleedings intensely in- flamed.' [Inflamed, according to Dr. Smith's notions—but mark, in his own words—the first blood drawn was " not inflamed." Were the lancet a preventive of inflammation, how came the blood to be inflamed after so many bleedings ?] " During the night the pain returned, and in the morning, notwith- standing the eyes were dull, and beginning to be suffused, the face blanched (no wonder!) and the pulse slow and intermittent, and weak, twelve leeches were applied to the temples—and as these did not entirely remove the pain, more blood, to the extent of sixteen ounces, was taken by cupping. The operation afforded great relief—but the following morn- ing, the pain returned, and again was blood abstracted to sixteen ounces. ' Immediate relief followed this second operation; but, unfortunately, the pain returned with great violence towards evening; and it was now im- possible to carry the bleeding any farther.' Typhoid symptoms now be- gan to show themselves ; ' the fur on the tongue was becoming brown, and there was already slight tremor in the hands. What was to be done.' Ice, and evaporating lotions were of no avail; but happily for Dr. Dill, the affusion of cold water on the head, ' the cold dash,' was thought of and employed, and this being effectually applied, the relief was ' instan- taneous and most complete.' So that this case, announced as a severe cerebral affection, and treated, in anticipation, by copious blood-letting, before there was any pain in the head, while the patient was yet only feeble and chilly, which grew worse and worse as blood-letting was repeated, until, after the abstraction of ninety ounces of blood, the patient had become in a ' state of intense suffering,' and ' imminent danger,' and was relieved at last by the cold dash—this case, we say, is brought forward as a speci- men of the extent to which copious blood-letting may sometimes be re- quired !! Most sincerely do we congratulate Dr. Dill on his escape, not from a dangerous disease, but from a dangerous remedy."—Medical Gazette. Could any case more forcibly exemplify the utter inefficiency of blood- letting, in almost all its forms, either as a certain remedy, or a preventive of fever .' Yet such is the force of custom, prejudice, education, that this case, and I have no doubt, thousands like it, so far from opening the eyes of the physician to the London Fever Hospital, only served to confirm him in his error. He had this methodus medendi, and he pursued it; and notwithstanding the total inefficiency of his vaunted remedy, he gives the case at length, as a perfect specimen of the most perfect practice—Mark the result of that practice !—but for the " cold dash," the patient must have perished. It is even now a question whether he ever recovered from those repeated blood-lettings,—for he died not many months after. Hap- py would it have been for mankind, that we had never heard of an Anatomical or " Pathological School,"—happier for Dr. Hill, for to that school, and its pervading error of imputing effect for cause, may we fairly attribute all this sanguinary practice.* * " Dr. Rutherford of Edinburgh said, active treatment may relieve the symptoms, but long convalescences follow, and the constitution is shattered and impaired by such abstraction of its powers. Patients who have been apparently cured by large bleed- ings which have conquered pain in the first instance, remain eventually longer in the hospitals than those who have not been so speedily relieved; moreover, you will find them return again, after their dismissal, with dropsy and chronic affections."__ Lefevre,—T. LECTURE IV. 89 Lord Byron called medicine " the destructive art of healing." How truly it proved to be so in his own person, you will see, when I give you the details of his last illness :—" Of all his prejudices," says Mr Moore, " he declared the strongest was that against Bleeding. His mother had obtained from him a promise, never to consent to be bled, and whatever argument might be produced, his aversion, he said, was stronger thau 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 instrument of mighty mischief!' On Mr. Millengen observing that this remark related to the treatment of nervous, but not of inflammatory complaints, he joined, in an angry tone, ' Who is nervous, if I am not?— and do not those other words of his apply to my case, where he says, that drawing blood from a nervous patient, is like loosening the cords of a musical instrument, whose tones already fail, for want of a sufficient tension! Even before this illness, you yourself know how weak and irrita- table I had become; and bleeding, by increasing this state, will inevitably kill me. Do with me what else you like, but bleed me you shall not. I have had several inflammatory fevers in my life, and at an age when more robust and plethoric ; yet I got through them without bleeding. This time also, will I take my chance.'" After much reasoning, and repeated en- treaties, Mr. Millengen at length succeeded in obtaining from him a promise, that should he feel his fever increase at night, he would allow Dr. Bruno to bleed him. " On revisiting the patient early next morning, Mr. MUlengen 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 to put aside all considera- tion of his feelings, and to declare solemnly to him how deeply I lamented to see him trifle thus with his life, and show so little resolution. His per- tinacious refusal had already, I said, 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 for ever to deprive him of reason ! I had now hit at last on the sensible chord : and partly annoyed by our importunities, partly persuaded, he cast at us both the fiercest glance of vexation, and throwing out his arms, said, in the angriest tone, ' There you are, I see, a d—d set of butchers,—take away as much blood as you like, but have done with it!' We seized the moment (adds Dr. Millengen), and drew about twenty ounces. On coagulating, 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 patient spoke several times in an incoherent manner.'" Surely, this was sufficient to convince the most school-bound of the worse than inoperative nature of the measure. Far from it. "On the following morning, the 17th April, the bleeding was repeated twice, and it was thought right also to apply blisters to the soles of his feet!" Well might Mr. Moore exclaim : " it is painful to dwell on such details." For our present purpose, it will be sufficient to state, that although the " rheumatic symptoms have been completely removed," it was at the expense of the patient's life ; his death took place upon the 19th, that is, three days after he was first bled—[Moore's Life of Byron.] Now I ask you, what might have been the termination of this case, had an emetic been substituted for the lancet, and had the remission been prolonged by quinine, opium, or arsenic ! I solemnly believe Lord Byron would be alive at this moment; nay, not only is it possible, but probable, that a successful result might 90 LECTURE IV. have ensued, without any treatment at all. When describing the effects of a former fever, Lord Byron himself says : " After a week of half deli- rium, burning skin, thirst, hot headache, horrible pulsation, and no sleep, by the blessings of barley water, and refusing to see my physician, I re- covered." Facts like these are indeed stubborn things ! I have preferred to give these two instances of what I conceive to be de- cided malpractice, to any of the numerous cases which have come under my own observation, as the first named gentleman was well known to many of the medical profession, while the death scene of the noble poet will arrest the attention of all who take an interest in his genius. In the generality of cases of disease, Gentlemen, it matters little what may have been the primary Cause. The disease or effect, under every circumstance, not only involves change of temperature, but produces more or less interruption to the two vital processes,Digestion and Respiration. In other words, it impedes sanguification, or the necessary reproduction of that Living fluid, which, throughout all the changes of life, is constant- ly maintaining expenditure. This being in the nature of things one of the first effects of disorder, let us beware how we employ a remedy, which, if it succeed not in restoring healthy temperature, must inevitably hasten the fatal catastrophe—or, in default of that, produce those' low chronic fevers, which, under the names of dyspepsia, hypochondria, hysteria, mania, &c, the best devised means too often fail to alleviate, far less to cure. With the free admission, then, that the lancet is capable of giving tempo- rary relief to local fullness of blood, and to some of the attendant symp- toms, I reject it generally, upon this simple and rational ground, that it cannot prevent such fulness from returning—while it requires no ghost from the grave to tell us that its influence upon the general constitution must, in every such case, be prejudicial. If the source of a man's income is suddenly cut off, and he still continue to spend as before, surely his capital must, as a matter of course, diminish.—Beware then how, under the exact same circumstances of body, you allow a doctor to take away the little capital of blood you possess when disease comes upon you,— remember there is then no income—all is expenditure. And I care not whether you take inflammation of any considerable internal organ,—the Brain, Liver, or Heart, for example,—or of any external part, such as the knee or ankle joint—with the lancet, you can seldom ever do more than give a delusive relief, at the expense of the powers of the constitution. The man of routine, who has not heard my previous lectures, giving up Fever, perhaps, and a few disorders, which the occasional obstinacy of a refractory patient, contrary to " received doctrine," has taught him may yield to other means than blood-letting—will ask me what I should do without the lancet in apoplexy ? Here the patient having no will of his own, and the prejudices of his friends being all in favor of blood-letting, the school-bound member of the profession has seldom an opportunity of opening his eyes. Mine were opened by observing the want of success attending the sanguinary treatment; in other words, the number of deaths that took place, either in consequence or in spite of it! Was not that a reason for change of practice ? Having in my Military Hospital no preju- dices to combat; and observing the flushed and hot state of the patient's forehead and face, I determined to try the cold dash. The result was beyond my best expectations. The first patient was laid out all his length, and cold water poured on his head from a height. After a few ablutions, he staggered to his feet, and stared wildly round him, and then walked to the hospital, where a smart purgative completed his cure. While in the army, 1 had a sufficiently extensive field for my experiments ; and I seldom afterwards lost an apoplectic patient. But, Gentlemen, since I embarked in private practice, I have improved upon my Army plan. With the purgative given after the cold dash, I LECTURE IV. 91 have generally combined quinine or arsenic—and I have also, upon some occasions, at once prescribed hydrocyanic acid without any purgative at all. This practice I have found highly successful. The Quinine may pre- vent the apoplectic fit, I have proved to you, by the case given by Dr. Graves. The value of Arsenic in apoplexy has also been acknowledged, even by members of the profession; but whether they have been ac- quainted with the true principle of its mode of action, in such cases, is another thing. Dr. A. T. Thomson recommends it " in threatened apoplexy, after Cuppings and Purgings, when the strength is diminished and the com- plexion pale;"—that is, you must first break down the whole frame by depletion—you must still further weaken the already weak vessels of the brain, before you take measures to give their coats the degree of strength and stability, necessary to their healthy containing power! Upon what principle would you, Gentlemen, prescribe arsenic in threatened apoplexy ? Surely, upon the same principle that you would prescribe it during the remission in ague—to prolong the period of immunity—to avert the paroxysm. Long after the Bark came into fashion for the cure of Ague, practitioners still continued to treat that distemper, in the first instance, by depletion, till the complexion became pale. Do they treat it so now ?— No; they become wiser!—why then do they go on from day to day, bleeding in threatened apoplexy ? In the case given by Dr. Graves, deple- tion,—repeated depletion, did not prevent the recurrence of the apoplectic fit—but quinine was at once successful. Sir Walter Scott had a series of fits of apoplexy. What did the bleeding and starving system avail in this case ? It gave him, perhaps, a temporary relief, to leave him at last in a state of irrecoverable prostration. Mr. Lockhart, his biographer, tells us how weak the bleeding always made him. But how could it be other- wise, seeing that I have proved to all but mathematical demonstration, that whatever debilitates the whole body, must still further confirm the original weakly condition of the coats of the blood-vessels, which consti- tutes the tendency to apoplexy. Had the cold dash been resorted to during the fit, and had quinine, arsenic, or hydrocyanic acid been given during the period of immunity, who knows but the Author of Waverley might still be delighting the world with the "wonderful productions of his pen ! Shall I be told there are cases of apoplexy, where the face is pale, and the temperature cold .' My answer is—these are not apoplexy, hut faint; —cases which the cold dash or a cordial might recover, but which the lancet, in too many instances, has perpetuated to fatality! If the prac- titioner tells me that the cold dash by no possibility can cure an apoplexy, where a vessel is ruptured with much effusion of blood on the brain; my reply is, that in such a case he may bleed all the blood from the body, with the same unsuccessful result! In the case of effusion of blood in an external part, from a bruise for instance, could any repetition of venesec- tion make the effused blood re-enter the vessel from which it had escaped ? No more could it do so in the brain, or any other part. Why, then, resort to it in this case ?—If it be said, to stop the bleeding, I answer, that it has no such power. Who will doubt that Cold has ? Surely, if the mere ap- plication of a cold key to the back very often stops bleeding from the nose, you can be at no loss to conceive how the far greater shock of the cold dash may stop a bleeding in the brain.' When, on the contrary, there is no vascular rupture, but only a tendency to it, the cold dash will not only contract and strengthen the vascular coats so as to prevent them from giving way ; but will moreover rouse the patient from his stupor, by the simple shock of its application. But from theory and hypothesis, I appeal to indubitable and demonstrative fact. Let the older members of the profession seriously reflect upon the ultimate injury which may accrue to their own interests, by opposing their school-follies and school-prejudices to palpable and demonstrative 92 LECTURE IV. truth So long as colleges and schools could mystify Disease and its nature, any treatment that these proposed—no matter how cruel or atrocious— would be submitted to in silence ; but, when people find out that every kind of disorder, inflammation included, may be conquered, not only by external, but by internal means, they will pause before they allow them- selves to' be depleted to death, or all but death, by the lancet of either sur- geon or physician. The world will not now be deluded by the opposition of men, who stick to their opinion not so much because they have long sup- ported it, as that it supports them—men who, in the words of Lord Bacon, would dispute with you whether two and two make four, if they found the admission to interfere with their interests. Will any practitioner be so bold as to tell me that inflammation of any organ in the body is beyond the control of internal remedies ? For what, then, I ask, do we prescribe mercury for inflammation of the liver and bowels ? Why do we give colchicum for the inflamed joints termed gout and rheumatism ? Do not these remedies, in numerous instances, lessen the temperature, pain, and morbid volume of these inflammations, more surely and safely than the application of leech or lancet ? If, for such inflammations, then, we have influential internal remedies, why may we not have medicines equally available for diseases of the lungs ? Have I not shown you the value of prussic acid in such cases ? But I shall be told of the danger of such a remedy in any but skilful hands. In the hands of the ignorant and injudicious, what remedial means, let me ask, have not proved, not only dangerous, but deadly ?—Has not mercury done so .' —Are purgatives guiltless.' How many have fallen victims to the lancet! With prussic acid properly diluted and combined, I have saved the infant at the breast from the threatened suffocation of croup ; and I have known it in the briefest space of time relieve so called inflammation of the lungs, where the previous pain and difficulty of breathing were hourly expected to terminate in death. True, like every other remedy, it may fail—but have we no other means or combination of means for such cases ? With emetics and quinine I have seldom been at a loss; and with mercury and turpentine I have cured pneumonia. But will the inflamed heart yield to anything but blood-letting! Fear- lessly I answer, yes! and with much more certainty. With emetics, prussic acid, mercury, colchicum, silver, &c, I have conquered cases that were theoretically called inflammations of the heart, and which the abstraction of half the blood in the body could not have cured. So also has Dr. Fosbroke, physician to the Ross Dispensary, a gentleman who had the felicity to be associated with Dr. Jenner in his labors, and one in whose success and fortunes that illustrious man took the warmest interest [See Baron's Life of Jenner.] In some of the numbers of the Lancet Dr. Fosbroke has given several cases of Heart-Disease, which he treated successfully without blood-letting, and, with a rare candor, he admits that a lecture of mine on the heart and circulation had no small influence in leading him to dismiss blood-letting in the treatment of them. The human mind does not easily turn from errors with which, by early education, it has been long imbued: and men, grey with years and prac- tice, seldom question a custom that, fortunately for them at least, has fallen in with the prejudices of their times. For myself, it was only step by step, and that slowly, that I came to abandon the lancet altogether in the treat- ment of disease. My principal substitutes have been the various remedies which, from time to time, I have had occasion to mention; but in a future lecture I shall again enter more fully into their manner of action. That none of them are without danger in the hands of the unskilful, I admit;__ nay, that some of them, mercury and purgatives, for example, have, from their abuse, sent many more to the grave than they ever saved from it, is allowed by every candid and sensible practitioner. But that was not the LECTURE IV. 93 fault of the medicines, but of the men, who, having prescribed them with- out properly understanding the principles of their action, in the language of Dr. Johnson, " put bodies, of which they knew little, into bodies of which they knew less !" Gentlemen, I have not always had this horror of blood-letting. In many instances have I formerly used the lancet, where a cure, in my present state of knowledge, could have been effected without; but this was in my noviciate, influenced by others, and without sufficient or correct data to think for myself. In the Army Hospitals, I had an opportunity of studying disease, both at home and abroad. There I saw the fine tall soldier, on his first admission, bled to relief of a symptom, or to fainting. And what is fainting 1 A loss of every organic perception—a death-like state, which only differs from death, by the possibility of a recall. Prolong it to perma- nency, and it is death ! Primary symptoms were, of course, got over by such measures—but once having entered the hospital walls, I found that soldier's face become familiar to me. Seldom did his pale countenance recover its former healthy character. He became the victim of consump- tion, dysentery, or dropsy ; his constitution was broken by the first deple- tory measures to which he had been subjected. Such instances, too numerous to escape my observation, naturally led me to ask—Can this be the proper practice ? It was assuredly the prac- tice of others—of all. Could all be wrong ? Reflection taught me that men seldom act for themselves; but take, for the most part, a tone of bias from some individual master. By education most have been misled; So they believe, because they were so bred. But, Gentlemen, I had the resolution to think for myself—aye, and to act, and my conviction, gained from much and extensive experience, is, that all diseases may not only be successfully treated without loss of blood, but that blood-letting, however put in practice, even where it gives a tem- porary relief, almost invariably injures the general health of the patient. Englishmen! you have traversed seas, and dared the most dangerous climes to put down the traffic in blood ;—are you sure that in your own homes there is no such traffic carried on—no Guinea Trade ? In connection with Blood-letting in the treatment of inflammation, we generally find Abstinence or Starvation recommended. Beware of carrying this too far!—for " Abstinence engen- ders maladies."* So Shakspeare said, and captain. " Pay me your fee, and I'll tell you," replied the doctor. The money was pro- duced, and this advice given, " Instead of squirting your saliva over my carpet, keep it to masticate your food with." Now, upon my word, he could not have given him better advice. Gentlemen, I shall conclude this lecture by reading to you a few of many communications I have received from medical men of repute, since I first published my doctrines in 1836. Dr. Fosbroke of Ross began his medical career as the associate of the immortal Jenner; he lived in his house, and materially assisted to propagate his great doctrine of Vaccination. You will therefore fully appreciate the evidence of a gentleman so distinguish- ed in the history of medicine. From a letter which I received from him in January, 1840,1 shall read to you a passage or two:— '* In April, 1835, our acquaintance and free communication commenced; LECTURE IV. 97 and though I pricked up my ears, like one thunderstruck, at your whole- sale denunciation of blood-letting, and your repeated asseverations, that in a practice embracing the treatment of several thousands of patients per annum, you never employed a lancet or a leech,—your assertions made an impression, though it was slowly and reluctantly received." That it strengthened by time, Gentlemen, you will see by the next extract. " Nothing can be more striking than the great disparity between the pro- portion of persons who were bled in the two first years of my Ross prac- tice, 1834 and 1835 (in which latter year I first became acquainted with your views), and the three following years, 1836, 1837, and 1838. In the former two years, I bled one in seven, in the fourth only one in twenty- eight—and in the fifth year I bled none ! The year 1839 is now concluded, and again in all that time I have not bled a single individual!" " Your crime is, that you are before the age in which we live. If yOu had done nothing else but put a bridle upon Blood-letting, you would de- serve the eternal gratitude of your race, instead of the calumny and op- pression of the two-legged fools—the Yahoos, who persecute their great- est benefactors. But how can you expect to be more fortunate than your predecessors in this respect? The health of Sir Humphrey Davy was affected by the ingratitude of his country. ' A mind,' said he, ' of much sensibility might be disgusted, and one might be induced to say,—why should I labor for public objects only to meet abuse ? lam irritated more than I ought to be, but I am getting wiser every day,—recollecting Galileo and the times when philosophers and public benefactors were burnt for their services.' Whence is all this? Pride, poverty, disappointment, difficulty, and envy—and ' envy,' said Jenner to me in his last days, * is the curse of this country.' These are kept up by the canker of party and the taint of corruption. " One of the greatest obstacles to reform of blood-letting and blistering, will be the prospective loss of guineas, half-guineas, five shillings, and half-crowns. I saw a farmer last summer come into a druggist's shop. Some one had told him ' he must be cupped ;' so he drove a bargain, and stepped into a back room. ' That fool,' said I, ' does not want cupping.' ' He does not look as if he did,' said the druggist, ' but we can't afford to let him go without.'" Gentlemen, the next two communications are from an army medical officer, Staff-surgeon Hume, a gentleman who, from the nature of his du- ties, has the very best opportunity of testing any particular practice—and one who, were he to give a false report, must be at once contradicted by regimental records. His statements may therefore be relied upon with somewhat greater confidence than the Reports which annually emanate from Medical Officers of Civil Hospitals and Dispensaries throughout Eng- land. From the Tables of Mr. Farr, we learn, that these officers make the deaths at their Institutions infinitely less than the average number of deaths of sick and well throughout the country ! so that, if their reports be correct, sickness would appear to be actually a protection against death! Mr. Hume first writes from Dover, 6th December, 1838, " My object in writing, is to congratulate you on the moral courage you have evinced in your last two works. I have'been now nearly thirteen years in the service—mostly in charge of an hospital, and it will be gratifying to you to know that an old fellow-student adopts and carries out your principles in his daily practice. I have not used the lancet these last two years. My cases yield readily to "warm baths, cold affusions, emetics, and quinine. You may ask me where I have been ? Four years in Jamaica, the rest in North America and Home Service. If you had seen Marshall's Digest of the Annual Re- ports of the Army Medical Officers since 1817, you might have quoted itas a proof of your startling fact—the Unity of Disease. The more I read your book, the more I am convinced it is based on truth, and consistent equally 98 LECTURE V. with common sense and nature's laws. However little this age may appreciate your labors, and the persecution you are likely to sutler from a certain class of doctors, every liberal mind must do justice to your un- wearied zeal. Your holding up to ridicule the most fatal of all medical errors—bleeding a patient into a temporary calm and incurable weak- ness, ought to stamp you as the benefactor of mankind." The same gentleman again writes to me from Naas Barracks, Ireland, 5th Dec, 1839. " It isnow twelve months since I wrote to you, saying that I had not used the lancet for the two previous years ;—and I am now more convinced than ever of its utter inutility in the treatment of disease. Every day's experience confirms me in the truth of your doctrines. During the last year, I have not had a single death of man, woman, or child. The depot was never more healthy—and I attribute this principally to my abstain- ing, during the last three years, from every kind of depletion in the treat- ment of disease. I am satisfied that Pneumonia and Enteritis (inflamma- tion of the lungs and bowels), which are at the present the bugbears of the faculty, are indebted for their chief existence to the remedies used for ordinary ailments—namely, bleeding, starvation, and unnecessary purging. I never saw a case of either (and I have seen many) in* which the patient had not been the inmate of an hospital previously, where he had undergone the usual antiphlogistic regimen, or had been otherwise de- bilitated—as in the case of long residence in a warm climate. I am not surprised at the opposition you meet with. It has ever been the lot of those who have done good to humanity to be offered up as sacrifices at the altars of ignorance, prejudice, and obstinacy. It is a fact related by Harvey, he could not get a physician above the age of forty to believe in the Circulation of that Blood whose value in the economy you have so forcibly proved. Although I yield to you, as your just due, the origin of the improved principle of treating disease, I take creditto myself for being one of the first to carry it into effect, and I am doubtful whether a person in private practice could ever so far overcome prejudice as to use the cold bath with the confidence I do in every kind of fever. Its power, together with a warm one, is truly wonderful in equalizing the temperature of the body. When I compare the success of my treatment during the last few years, with that of my previous experience, I feel inclined to curse the professor who first taught me to open the vein with a lancet. "Yours most truly, T. D. Hume." LECTURE V. medical doctrines, old and new—gout—rheumatism—cutaneous disease —small-pox—plague—yellow fever—dysentery—dropsy—cholera. Gentlemen, When a young man has run the usual course of study at a university, he thinks he has learned everything worth knov/ing. But herein he grievously mistakes; for if we may trust Lord Bacon who had no interest in the matter, rather than the professors who have, we shall find that " in the universities all things are found opposite to the advance- ment of the sciences ; for the readings and exercises are here so managed, that it cannot easily come into any one's mind to think of things out of the common road; or if here and there one should venture to use a liberty LECTURE V. 99 of judging, he can only impose the task upon himself without obtaining assistance from his fellows; and if he could dispense with this, he will still find his industry and resolution a great hindrance to his fortune. For the studies of men in such places are confined and pinned down to the writings of certain authors; from which, if any man happens to differ, he is presently represented as a disturber and innovator." Gentlemen, in this passage you at once see the reason why Medicine has progressed so little from the time of Hippocrates to the present. Every person who has in any way improved the practice of physic has had to repent it. Harvey lost his business by discovering the circulation of the blood ; Lady Mary Montague suffered in her reputation for intro- ducing the small-pox inoculation; and Jenner for a long period of his life was victimized for the still greater improvement of the Vaccine. His moral character was for years at the mercy of the most venal and corrupt members of the profession. " Such," in the words of Milton, " are the errors, such the fruits of misspending our prime youth at schools and uni- versities, as we do, either in learning mere words, or such things chiefly as were better unlearned." So far as they relate to Medicine, the doctrines of the schools have been a succession of the grossest absurdities. Let us briefly review a few of the most prominent. For several ages the state of the Blood was held to be the cause of all disease—no matter how the disorder originated. Had you a shivering fit from exposure to cold or damp, the " Blood" required to be instantly pu- rified,—a fever from a bruise or fall, the only thought was how to sweeten " the Blood;" nay, wereyoupoisonedbyhemlock or henbane," the blood" or its blackness, was the cause of all your sufferings—and the chief anxie- ty was how to get rid of it. It never occurred to the physicians of that day that the blood was an indispensable part of the economy, or that " black blood" was better than no blood at all,—so on they bled and con- tinued to bleed while a drop would flow from the veins. When their patients died, it was all owing to the cursed " black blood" that still re- mained in the system! How to get the whole out, was the great subject of scholastic disputation, and treatises innumerable were written to prove that it might be done. In progress of time, another doctrine arose, name- ly, that all diseases first originate in the Solids, and many were the parti- zans that took it up; so that several centuries the fluidists and solidists di- vided the schools, and, like Guelph and Ghibelline, ranged themselves under their respective leaders. What medical man is ignorant of the wars they waged, the ink they shed, and the eloquence they wasted upon the still unsettled point whether the solids or the fluids ought to bear the blame of the first imparting disease to the constitution! But to turn from these to the doctrines of more modern schools. The chief feature in the professional notions of the day, is the assumption that all diseases may be traced to the " inflammation" or other theoretical state of a given portion of the body, one School taking one organ—another, ano- ther ; but why should I say organ ? seeing there are professors who ex- clusively patronize a given tissue, and others a given secretion even;— which One thing, after they have wrapped it round in mummery and mys- ticism, they gravely proceed to magnify into the very Daniel O'Connell of every corporeal disturbance! Exposure to cold and heat, the midnight revel, and the oft-repeated debauch—any, or all of these may hayivinjur- ed your constitution. This, of course, you already know and" feel; so you wish to have the sense of your physician upon it. And what does he do.' Why, he takes you by the hand, counts, or affects to count, your pulse, looks at your tongue perhaps, and then, with a seriousness becom- ing the occasion, he tells you, your " Stomach is wrong;"—and so far, so true, as your own want of appetite and sensation of nausea abundantly testify. But as if this were not enough, and more than enough, he must 100 LECTURE V. proceed to tell you the cause of your disease; and what does he say that was ? Being a " stomach doctor," of course he says, " the stomach" again. " The stomach," he tells you, is the cause of all;—your headache, tremor, and blue devils, all proceed from " the stomach !" But herein, if I mis- take not, the doctrine falls into the same error as the man who, on seeing a house in ruins, should point to one of the broken bricks, and saddle it with the whole amount of mischief; when, in reality, it was only one of many coincident effects produced by agency from without, such as accident, time, or tempest. For a considerable space, the Stomach held undisputed sway in the medical schools,—John Hunter having contributed much to bring it into fashion. His pupil Abernethy afterwards coupled the whole alimentary canal with it, under the name of the " digestive organs;" and for a time nobody dared to dispute his dictum that derangement of the digestive organs is the cause of all disease. Some other partialist would have it, however, that "the Liver" is the great source of all ailments—and a very convenient substitute this organ became, for not only did it save the phy- sician the trouble of thinking, but the patient, by constantly directing his mind to it, very soon found out that the liver was the only organ of the body worth a moment's cogitation. Oh! " the liver" has put a great many fees into the pockets of the faculty, and might continue to do so still, but for Laennec's invention, the stethoscope.—Adieu, then, to the liver, and adieu to the stomach and digestive organs ! for, from the mo- ment people heard of this instrument, the Heart and Lungs eclipsed them all. We have no liver and digestive organs in these days,—we have only "J" the heart" and " lungs;" and these, as the world wags, are always in such a state—in such a deplorable condition of disease and danger, that heaven only knows for what end they were given us, unless it be that our bodies were -----intended For nothing else but to be mended! —in other words, were expressly created for the benefit of our next-door neighbor the apothecary ! Never was such a catalogue of disease as these organs have entailed upon us;—but the curious thing is, that nobody knew it until Laennec made the discovery by means of the stethoscope. Since then, leech, lancet, cupping-glass and purge, have followed each other with unexampled rapidity ;—but whether the " fits" and " sudden seizures," which now-a-days carry off so much mortality, be the effect of these very safe and gentle remedies, or of the " Heart-disease," under which the doctors, in their innocence, are pleased to class them, I leave to persons of common sense and common discrimination to decide. One thing is certain, physicians have made a great professional stride since the days of Moliere—for whereas in his time the only organ they ever thought or theorized about was the lungs ; now, thanks to the stethoscope, they have got the heart, with its valvular and vascular apparatus, to the bargain.—So much for organs, Gentlemen ;—let us now speak of tissues. To be chronologically correct, we must first take the " Skin"—for of skin, and nothing but skin, our bodies at one time would appear to have been entirely constructed. The skin was the medical rage, and the doctors were very certain they had made a great discovery, when they turned their attention to it. Derangement of the skin explained everything in existence, and many other things besides ; whatever your sufferings, the answer was always the same, " The skin, Sir, the skin !"—The skin solved every possible difficulty, and if patients were pleased, why un- deceive them ? Sick men do not reason—you must therefore treat them like children; and he who can best impose upon their credulity is sure LECTURE V. 101 to become the popular physician. The skin, however, had a pretty long run: but, like its predecessors, it was destined to fall in its turn—to be supplanted by another tissue, " the Mucous Membrane."—In the hands of Broussais the mucous membrane first rose to eminence. Bustling, active, ready, he first pushed it into notice ; and so skilled was he in all the arts of scholastic juggling, that not only did he parry every blow aimed against his favorite theme by the skin supporters, but he at last obtained for it so great an influence in the sick-room, that no patient of importance could be put to death legitimately till he had first been called in to pre- scribe something for the " mucous membrane." Broussais thus became the French medical dictator—and the " mucous membrane" the French ruling doctrine. Carried by his numerous partizans and disciples into every commune in France, the " mucous membrane" at last found its way into England, where it was taken up by the late Dr Armstrong—and an excellent stepping-stone it proved to him in practice. Everybody came to hear what he had to say of the "mucous membrane" You could not have an ache in your back, or a cramp in your leg, but the " mucous mem- brane" was at fault;—nay, had you a pimple on your nose, or a pain in your great toe, it was still the " mucous membrane !"—Nor is this doctrine even now quite exploded. How many of the various secretions have run this gauntlet of accusation, it would be unprofitable to do more than allude to. The Perspiration was at one time much in vogue—and " checked perspiration" the reply to every inquiry—our grandmothers use the phrase occasionally still; though some of them betray a leaning to the system of the Jfater-doctors—a class of persons who only needed to inspect your urine to find out a cure for your complaint. Many curious stories come to my mind in connection with this ;—but the subject is too grave to be trifled with—let us therefore pass from that to the Bile"—the mysterious cause of so much offending. How many difficulties has not this secretion mastered ? How many has it not made where none existed before ? You derange every organ and function of your frame by intem- perance—" the bile," not the wine, is the criminal! You have headache from hard study, it is still " the bile ;"—the palpable and obvious agencies going for nothing—while one of many effects produced by a common cause, is absurdly singled out as the father and mother of the whole! I have still to notice another school of physicians, who ring the same changes upon a word, which having no very definite signification itself, may therefore signify anything they have a mind, without in the least commit- ting them in the opinion of the public. Rheumatism, Gout, Scrofula, Scurvy —what is the meaning of these terms! They are synonyms simply, having all a common import, fluidity or humor. In Rheumatism, we have merely a derivation from the Greek verb ^a> (Rheo, I flow), and Shak- speare used it in its proper sense when he said, Trust not these cunning waters of his eyes, For villany is not without such Rheum. Then, as regards Gout, what is it but a corruption of the French word goutte, a " drop." And this perhaps some of you may think not so bad a name for a class of symptoms which frequently proceed from " a drop too much"—but that is not what doctors mean by the term. Gout with them is merely a fanciful " humor." Scrofula in Latin, Scurvy in Saxon, have the same signification, namely, a " dry humor." Only think of dry-Ait- midity, Gentlemen,—and the confusion of tongues during the building of Babel, will readily occur to you as a type of the language in which Medi- cine is even now taught in most of our schools ! Some German physi- cians of the present day tell us that scrofula has taken the place of scurvy in the European constitution. But this is only one of the many modes in 102 LECTURE V. which professors play at " hide and seek" with words. The Diseases Continental doctors formerly termed Scurvy, they now term Scrofula, and Heaven only knows what the doctors of after times will call the same cor- poreal variations before the world comes to an end ! So much, Gentle- men, for the " Humoral school,"—a school that impressed upon its disci- ples a doctrine of purgation scarcely less fatal than the sanguinary practice of the present pathologists. In fact, it is the identical system of " Mor- rison, the hygeist," and all those quacks, who, by their determined per- severance in purging away a fancied " impurity of the blood," have too often purged away the flesh and the lives of their credulous victims. 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 min- eral, you may so disturb every action of the body—may so alter every corporeal structure and secretion, that no one shall be of natural consis- tence 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 in the course of this lecture ex- plain to you, the disease termed " Ship-Scurvy." See, then, the effect of that humoral doctrine ! But even this kind of folly appeared too simple to some teachers, and these taxed their invention to make nonsense com- pound. Who has not heard of Rheumatic-Gout ?—and who will be so bold as to deny its existence? Yet, what is it but a self-evident absurdity ! Its literal meaning is " fluid-fluidity." You might as well call an injury from fire, " a ignes-eous burn !" Gentlemen, does such jargon convey to your minds the most distant idea of the true motions which take place in the body in the course of any one disease ? How then can you 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 Stowell was right when he hinted a man might be both at fortyj " When youth made me sanguine," says Horace Walpole, " I hoped man- kind 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 pur- pose 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 statement 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 complained 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 fear- ed or talked of as rickets among children, and consumption 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 patients knew well what to make of; and to all these succeeded va- pors, which serve the same turn, and furnish occasion of complaint among persons whose bodies or minds ail something, 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 humor such pa- tients 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 LECTURE V. 103 the cause of diseases or care in advising remedies, which neither they nor their patients find any effect of, besides some gains to one and amuse- ment to the other. As Diseases have changed vogue, so have Remedies, in my time and observation. I remember at one time the taking of tobacco, at another, the drinking of warm beer, proved universal remedies—then swallowing of pebble-stones, in imitation of falconers curing 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 spoonful 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 excus- ed, 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 questions whether purging ever be so, and from many ingenious reasons. The Chinese never let Blood." Gentlemen, you now see the correctness of a remark of the late Dr. Gregory, that medical doctrines are little better than " stark-staring absur- dities." And God forgive me for saying it, but their authors, 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 Jour- nals and Reviews, by which the masters are enabled to keep down truth, and mystify and delude the student and country practitioner at their pleas- ure, in physic, now as formerly, the very clever world ----bows the knee to Baal, And hurling lawful Genius from his throne, Erects a shrine and idol of its own,— Some leaden Calf— who, by virtue of this 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 swollen bubble bursts and all is air! 104 LECTURE V. But, Gentlemen, 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 anything you please; for according to received opi- nion, 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 tell you, 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 shop-keeper 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 !—Byron. In sober seriousness, is there such a disorder as Gout ? Gentlemen, 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 per- suade you that it is in itself anything but a piece of hypothetical gibberish, invented by men who knew as little of Disease and its natnre as the tyros they pretended to illuminate. When a lady or gentleman of a certain 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 the Gout. If the same kind of swelling should appear in the knee or Azp-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 betwixt them. But as neither this kind of disquisi- tion, 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, Gentlemen, you wdl find this fit in one case perfectly periodic and regular in its recurrence; in another less determinate as to the time of its approach. The result of repeated paroxysms, as in other disease* where great heat and swelling take place, must be a tendency to decomposition, and hi 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 matter or ichor, instead of chalk or earth,—which neither you nor anybody else can know beforehand,—you must not be astonished if a rival practitioner be called in to give the disease another sobriquet,— 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 becoming a whit the wiser! You see, then, that the only difference betwixt what is called " Gout," and what is called " Inflammation," is, that the result of LECTURE V. ■105 the morbid action in the former case is earthy instead of purulent deposit, a solid instead of a fluid product. Now, this difference may be accounted 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 principles as that of infancy and youth, from these being in different pro- portions, the results of decomposition must, mutatis mutandis, be different. What are the Causes of Gout? One writer says one thing; another, another. Dr. Holland, 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 dictum, 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 anything and everything 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 authority of Parr and Darwin. What, then, is the remedy ? If you ask me for a Specific, I must again remind you that 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 as 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 ex- planation 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 man- mer you must treat the disease purely as an ague. With quinine, arsenic opium, and colchicum, I have cured it scores of times, and truth obliges me to say I have in some cases 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 simple or single to which you may specially refer in the midst 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 treatment, there is as little doubt. What, then, are all your school-divisions but " flocci, nauci, nihdi, pili!" I shall now give you a case or two which may perhaps suffice to show you my treat- ment of Gout. Case 1.—Colonel D---, aged 60, had a fit of Gout which came on every night, and for which leeches and purgation had been ineffectually pre- scribed, 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. Case 2.—Captain M---, aged 56, had a fit of Gout which recurred every night during his sleep. I prescribed arsenic without effect; I then 8 106 LECTURE V. gave him quinine, which acted like magic. The same gentleman, twr~'lve months after, had a recurrence, but was much disappointed, on resun ling the quinine, to obtain no relief. I then prescribed arsenic, which, tho ugh it failed the year before, this time perfectly succeeded !—a lesson to s uch 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 severe 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 gentleman eyed the animal with a look of terror, sprung out of bed, and complained of his foot no more! Now, Gentlemen, 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 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 immunity .'—and how comes it that arsenic, quinine, and colchicum so often neutralize its effects—while purgation and blood-letting, in too many instances, produce a recurrence ? In a word, is not this " morbid ingredient in the blood" a mere crotchet of Dr. Holland's brain—a goblhi—a phantom—that, like other goblins and phantoms, disappears the moment the daylight comes in.' Having stated my reasons for dissenting from Dr. Holland's hypothetic view of the cause of Gout, it may not be out of place here to request your attention to some points of infinitely greater importance, upon which that physician and myself, by some curious fatality, maintain a remarkable Coincidence of opinion. I quote the following passages from his Medical Notes and Reflections. " Has sufficient weight been assigned in our pathological reasonings to that principle which associates together so many facts in the history of dis- ease, namely, the tendency, in various morbid actions, to distinct inter- mission of longer or shorter duration, and more or less perfect in kind.'" " The subjection of so many diseased actions to this common law, estab- lishes relations which could not have been learned from other sources, and which have much value even in the details of practice." Again, he says, " It will probably be one of the most certain results of future research, to associate together, by the connection of causes of com- mon kind, diseases now regarded as wholly distinct in their nature, and arranged as such in our systems of nosology. This remark applies very widely throughout all the genera of disease." " We can scarcely touch upon this subject of Fever (particularly that which our present knowledge obliges us to consider as of idiopathic kind), without finding in it a Bond with which to associate together numerous forms of disease, but withal a knot so intricate, that no research has hitherto succeeded in unravelling it." Now, what does Idiopathic mean ? It means peculiar or primary—in opposition to symptomatic disease, or disease of long standing. The pro- fession, then, according to Dr. Holland—and he is quite right—have been all perfectly in the dark in regard to the beginning of any disease. The " knot" they have for so many centuries been trying to unravel, I hope he, they, and everybody else will now consider as completely united, but not, as I shall in a few minutes prove, in consequence of Dr. Holland's prediction. When speaking of the Influenza and other Epidemics, Dr. Holland says: " I may briefly notice the singular analogy to the milder forms of Typhus and Intermittent Fever which these epidemics have occasionally pre- LECTURE V. 107 sented." Why he puts Typhus before Intermittent Fever, I know not; but this I do know, that except where badly treated, the Influenza sel- dom takes the typhoid shape. However, Dr. Holland admits he has pre- scribed Bark in influenza with very great advantage. On the subject of Temperature, the same physician thus speaks :— " The patient may almost always choose a temperature for himself, and inconvenience in most cases, positive harm in many, will be the effect of opposing that which he desires—his feeling here is rarely that of theory, though too often contradicted by what is merely such. It repre- sents in him a definite state of the body, in which the alteration of tem- perature desired is that best adapted for relief, and the test of its fitness usually found in the advantage resulting from the change. This rule may be taken as applicable to all fevers, even to those of the exanthematous kind." By which term medical men understand small-pox, chicken-pox, measles, and scarlet-fever. Some include the plague. Dr. Holland asks: " Is not depletion by blood-letting still too general and indiscriminate in affections of the Bram, and especially in the differ- ent forms of Paralysis ? I believe that the soundest medical experience will warrant this opinion. The vague conception that all these disorders depend upon some inflammation or pressure which it is needful to remove, too much pervades and directs the practice in them—and if the seizure be one of sudden kind, this method of treatment is often pursued with an urgent and dangerous activity." "Theory might suggest that in some of these various cases, the loss of blood would lead to mischief. Ex- perience undoubtedly proves it, and there is cause to believe that this mischief, though abated of late years, is still neither infrequent, nor small in amount." It is now the fashion of the Eminents and their herd of followers to say, " Oh, there has certainly been too much bleeding," and " Oh, we don't bleed as we used to do;" but it is not so convenient for them to tell who opened their eyes to their errors. Now, Gentlemen, if any of you be disposed to question by whose influence this abatement of mischief "was principally brought about, I may suggest that, from numerous letters I have received from medical men, long before Dr. Holland's volume first appeared, my writings must at least have in something contributed to it. Dr. Holland's work, from which I quote, was publishsd by Messrs Longman and Co., in 1839. Mark that date, and mark also, if you please, that it was in the year 1836 —three years before—that the same Publishers brought out the Fallacy of the Art of Physic as taught in the Schools,—wherein I stated:— 1. " We hope to prove even to demonstration, that Fever, remittent or intermittent, comprehends every shape and shade which Disorder can assume." 2. " That many cases of Disorder have been observed to partake of the nature of Remittent Fever, and to derive benefit from the modes of treat- ment adapted to that periodic distemper, we are sufficiently aware. But we have yet to learn that any author, ancient or modern, has detected that type and advocated that treatment in every shade and variety of disease." 3. " That Attention to Temperature is the end of all medicine. 4. " That Blood-letting might be advantageously dispensed with in all diseases, even in Apoplexy." Gentlemen, some of you may have read an anecdote of Dennis the Critic. Having invented a new mode of producing theatrical thunder, he submitted his discovery to the managers; but their high mightinesses only affected to laugh at it. Some weeks afterwards, he went to see a play, in which there was a thunder-scene. " Now," thought Dennis, " is my turn—now I can afford to laugh at their thunder as much as they laughed at mine;" but judge his surprise, when, instead of the farcical squall he expected, his ears were saluted with a thunder as terrible and true as 108 LECTURE V. the " hurly-burly" of his own invention. Perceiving, in an instant, the trick that had been played him, he cried aloud, " By G— ! that's my thun- der!" This or something like this—always excepting the irreverent adjuration__was the sentiment that escaped me when I first perused the passages I have read to you from the Medical Notes and Reflections. " These are my doctrines," I said; "aye—the identical doctrines which Dr. James Johnson, physician-extraordinary to the King deceased, two years before, stigmatized as a Pyrexy-mania, or Fever-madness. How will he receive them now—now that they are patronized at second-hand by an F.R.S. and a physician extraordinary to the Queen that reigns?" That was my exclamation—and how did he receive them, Gentlemen ? Oh! he praised Dr. Holland to the skies; said he was this, and said he was that; and concluded by telling us that " it is impossible to lay down his book without an acquiescence in the decision of the public, which has placed him in the first rank among the practical physicians of the capital;" adding, moreover, that " his bearing toward his brethren is fair and open, and his candid mind, instructed by liberal reading and polished by society, is willing to allow their meed of merit to all." But not a sylla- ble did Dr. James Johnson say in condemnation of Dr. Holland's pro- phecy, that " Fever" would one day be found to be " the Bond with which to associate together numerous forms of disease;'"—nor did he remind him that when that prophecy was actually fulfilled by me to the letter years before Dr. Holland took the trouble to make it, he, Dr. James Johnson, ridiculed it as a Fever-MADNEss! - Gentlemen, if, in the course of his " liberal reading," the Author of the Medical Notes and Reflections never saw the Fallacy of the Art of Physic as taught in the Schools!—nor the Review of it by his patron Dr Johnson ;—nor Dr. Conolly's equally honest criticism of it!—nor the controversy in the Lancet, to which the former gave rise!—nor heard in " society" the remarks made by the laughter-loving part of the profession, when that controversy was con- cluded !—nor met with the Unity of Disease !—nor the many Reviews that were written upon it! !— you must acknowledge the coincidence to be curious—startling ! ! ! And, further, you must admit that this coincidence affords another of many proofs of the truth of a discovery, which, when Dr. Holland—with the candor, I am willing, in common with Dr. John- son, to allow him—takes into account dates, facts, and other similar trifles, I hope he will, in return, permit me now, henceforth and for ever, to call MINE ! Meantime, I have much pleasure in availing myself of the testimony of a physician so eminent, in favor of its " value, even in the details of practice." [Shortly after the above observations made their appearance in print, Dr. Holland addressed to me a letter in "explanation." The correspondence which followed I am not quite at liberty to give, as the doctor expressed a wish that his communications should be kept " private." This much I may, however, state, that though couched in very polite, very diplomatic language, the explanation afforded by his letters did not appear to me to be any explanation at all. His observation might apply to this, that, or the other, or anything else ! How green Dr. Holland must have thought me when he imagined he would tie up my hand with his " private" letters ! But seriously, if he intended to do more than shuffle me out of my discoveries, why did he send a " private" answer to my published charge,—or insinuation, if he like it better ? The concluding paragraph of his last letter is so adroitly worded, that with or without his leave I must quote it. " It gives me pleasure to know that you find anything of truth or useful suggestion in what J have published. And I shall be gratified by any opportunity which may hereafter occur of talking with you on these subjects, of common interest to us, out of print [no doubt! ] Ever, my dear Sir, yours faithfully, H. Holland." Now I should like to know LECTURE V. 109 which is the " suggester" here—I who first published the discovery—or Dr. Holland, who three years afterwards printed it in a phraseology only slightly altered ? " New truths of a higher order," says an enlightened physiologist, " and of which the connection is not seen with common and hackneyed doctrines, are scouted by all, and especially sneered at, denied, and abused by the base creatures who have just sense enough to see there really is somethmg in them,—who have just ambition enough to make them hate one who appears to know more than they do,—and who have just cunning or skill enough to bias minds yet weaker than their own. To crown suitably such procedure, the doctrines at first denied are subsequently pilfered with all the little art of which such minds are capable." Alexander Walker on the Nervous System, " to which is pre- fixed some account of his earlier discoveries, of which the more recent doctrine of Bell, Magendie, &c, is shown to be at once a plagiarism, an inversion, and a blunder."] From this digression I now turn to Rheumatism. Like Gout, the word Rheumatism conveys nothing beyond the expression of the false theory, which first gave rise to it. But as we are compelled, by long custom, to retain this among other equally unmeaning terms, I may tell you, that the profession of the present day class under it nume- rous affections of the great joints, particularly such as have come on sud- denly, and are attended with much pain and swelling. You will find that these, in every case, have been ushered in by fever fits. The young and middle-aged are more liable to rheumatism than the extreme old. Like the gout, it is a remittent disorder, and Dr. Haygarth, long ago, wrote a work illustrative of the value of Bark in its treatment. My own prac- tice is to premise an emetic; this I follow up with a combination of qui- nine and colchicum If that mode of treatment fad, I have recourse to opium, arsenic, guiac, mercury, silver, turpentine, copaiba, arnica mon- tana, aconite or sulphur, 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 standing, you may have to run from one medicine and combination 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 depletion, 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 mus- cular pains, which occur in various parts of the body, but which are un- attended 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 you two examples. Case 1.—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' ancles were much swelled and exquisitely pain- ful ; his heart labored, 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 hi operating, but when it did, the relief was signal. I followed this up with pills containing a combi- nation of quinine, blue pill, and colchicum, and in two days he was sit- ting up with scarcely any swelling remaining in the affected joints; in two days more he had no complaint. Not a drop of blood was taken in this case. 110 LECTURE V. Case 2.—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, before 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, Gentlemen, like every other disease incident to man, Rheumatism may not only be cured without loss of blood, but without any physic at all; and in evidence 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 weak- ly constitution, he is most commonly rendered more obnoxious to other diseases for some years, when, afterwards, the matter that causes the Rheumatism [Sydenham, like Hippocrates, was a disciple of the Humoral School] falls upon the lungs, the latent indisposition in the blood being put into motion by taking cold, or upon some slight occasion. For these reasons, I endeavor to try for some other method different from Bleeding, so often repeated, to cure this disease; therefore, well considering that this disease proceeded from an inflammation, which is manifest from other phenomena, but especially from the color of the Blood, which was exactly like that of Pleuritis, I thought it was probable that this disease might be as well cured by ordering a simple, cooling, and moderately nourish- ing diet, as by bleeding repeated, and those inconveniences might be avoid- ed which accompanied the other method; and I found that a whey-diet, used instead of Bleeding, did the business. After last summer, my neigh- bor Matthews, the apothecary, an honest and ingenious man, sent for me; he was miserably afflicted with a Rheumatism, accompanied with the following symptoms. He was first lame in the hip for two days, after- wards 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 whol- ly vanquished; especially the summer being so far spent, it was to be feared winter would come before he could recover his strength, weaken- ed by frequent bleeding, and therefore I ordered 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 in bread at supper too; he daily drank eighteen pints of whey, made at home, wherewith he was sufficiently nourished. After these days, when the symptoms did no more vex him, and when he walked abroad, t 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 contemn this method because it is plain and inartificial, I would have such a one 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 LECTURE V. HI not for common prejudice, 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 dying, as if they were to be sacri- ficed like beasts."—But The Stone ?— You will doubtless, Gentlemen, 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 morbid 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 subject 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 calcu- lary diseases, state, that 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 temperature and action, termed fever, wobody 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 both first-cousins to ague, and by treating them as such, the practi- tioner may save himself a world of trouble, and the patient a world of pam, which neither might escape, in adopting the doctrine of the " patho- logists," and these are inflammatory diseases, and only to be subdued by leech, lancet, and mercury to salivation. Gentlemen, laugh at the patho- logists, and laugh too at their disputations, which, being all about non- sense, can never possibly come to a satisfactory conclusion. The calculary {gritty) or stony concretions which are occasionally de- posited in the different joints during Gout, suggested to medical men, even at an early period, the analogy subsisting betwixt that disease and stone. During constitutional disorders, calculus may be developed in any tissue or structure of the body. Salivary concretions are common; pulmonary calculi I have seen in two instances: in one case they were expectorated by a consumptive female, who died ; in the other by a gentleman whose lungs being otherwise organically uninjured, recovered his health com- pletely 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 employed 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^ showed in this instance, at least, their good opinion of attention to tempera- ture. 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 ossification. 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 112 LECTURE V. 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 relationship which subsists betwixt all " the various genera of disease." What a fine thing to be able to master the cloud of ridiculous distinctions and definitions by which Drs. Willan and Bateman have contrived to dis- guise the whole subject of Cutaneous 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—Erysipelas, 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 accu- racy 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 disease 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 candor of Mr. Travers entitles his evidence to a preference. At a meeting of the Medico-Chirur- gical 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 patients 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 particular time to a greater or less extent among a particular people or class of people. Wherefore it seems to depend upon a peculiar constitution of atmosphere; for during the time it is prevalent in camps or 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 I remember, when in Edinburgh Castle with the Royals, I was obliged to tell the officer commanding 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 any one of the thousand things that daily occur in life. Cold and wet are frequent causes ; and there are individuals who cannot take mercury in any shape or dose without being liable to an attack of it—nevertheless, I have my- self cured many cases with mercury. The best practice, however, is to treat it like other acute fevers. Begin with emetics, and follow them up with arsenic or quinine ; this practice will apply to all acute diseases of the skin, by whatever names they may be known or distinguished. What are the causes of cutaneous disease generally ? Everything that can set up Fever,—and what agent in nature, when abused, may not do LECTURE V. 113 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 bougie 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 dis- eases to a " morbid ingredient of the blood," and they look upon eruptions as an effort of nature to expel the " peccant humor." Be careful, they tell you, not to drive it in ! Now, what is an eruption but the effect of a ten- dency 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 and motions 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 chrdnic 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 " scro- fula," and the " gout," "Scurvy" in process of time came to perform the part, not of a sign merely, but of a corporeal something—an indefinite entity or essence,—or anything 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 professor made his pupils suppose that he had detect- ed it in the Blood even; and from that moment not only did people believe that scurvy was a specific disease, but the whole faculty were anxious to discover a specific remedy for it. A specific for what, Gentlemen.' for an " airy nothing," that only existed in the theoretic visions of their own most mystified brains. You may stare as you please—but this, after all, is the truth. What, then, you will demand, is the disease which doctors call " ship-scurvy !" Now to this most rea- sonable question, I "will endeavor 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 closed and consequently unven- tilated decks—what from being obliged to watch and work hard upon a short allowance of food and water—together with the anxiety and depres- sion 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 petechia 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 upon a something noxious in the blood, but upon a positive want of something essential to its healthy reproduction. And how, think you, is this disease to be cured ? By wholesome food and pure air, you will naturally reply. No such thing, Gentlemen; nothing so simple would do for scientific people. It can only be cured by Lemon-juice! Lemon-juice, according to the greatest medical professors, is not only a preventive of the bad effects of starvation—but a substitute for pure air and proper food hi 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 improve- 114 LECTURE V. ments began to be made in navigation, as also in ship-building, and in the ventilating and victualling of fleets ; voyages that formerly took up a year, can now be completed in a month or two, and the natural good effects of all this upon the habits and constitution of the seamen are, up to this moment, very modestly claimed by the doctors as the result of their employment 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 everything I could think of. I may here, nevertheless, state in regard to cutaneous disease generally, that I have not very often been at loss, while I had at my disposal quinine, 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 complete cure in about a fortnight. The disease, in this in- stance, 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 afterwards speak, I have also found of great service in diseases of the s"kin—and what, Gentlemen, do all these rem- edies 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 attention, is only one of the many fea- tures of universal disturbance. So far from being the causes of such dis- turbance, the local tendencies to disorganization are merely hereditary or accidental developments occurring in its course—developments expres- sive, 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 viscera of the chest are the organs which chiefly suffer—while hi the East and West Indies, the liver and other con- tents 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 producing the same constitutional disturbance with every kind and degree of organic change to which the subjects of them may, by original weakness of con- figuration, 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, according to the predisposition of the patient. Even in the course of the Contagious or Pustular Fevers, 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 swellings, rheumatism, and palsy, just as I have seen the same localisms developed hi the course of a common remittent fever,—such sequela 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 constitution. And how should it be otherwise, when we come to reflect that the Small- Pox Fever, like every other fever, consists in a succession of paroxysms so exactly resembling ague, that, before the appearance of the eruption, it cannot possibly be distinguished from it!—Nor, so far as individual LECTURE V. 115 treatment 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, you may resort to the nearest cordial you can get. 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, you may easily do ; and when that and the sweat- ing 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 physicians 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 1828, a great many instances of the disease occurred in Edinburgh, and I remember two cases which, from the difference of the practice employed, and from the difference of the results, 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 antimonial, and an opiate about seven in the evening, which had the effect of either entirely preventing the anticipated paroxysm, or of rendering it so trifling as to pass without observation. On two occasions it was neglected, and a night of fever and restlessness was each time the result. I was out of the house in ten days, and, as you see, I have not a perceptible mark on my countenance, while the other gentleman was con- fined 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 unsuccessful was the treatment employed, bleeding, leeching, and pur- gation, that the dissecting-rooms of Paris were literally 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! Vacci- nation is only the artificial introduction into the human system of an animal poison; and it was first practised by Dr. Jenner of Berkley, in Gloucester- shire. 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 Gloucestershire 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 discovered it to be the truth; and, in spite of the greatest opposition 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 Latin for cow. Jenner, then, was the first who artificially introduced cow-pox as a preventive of small-pox ; and that it is indeed a preventive you will have no difficulty in believing, if you choose to recall to memory the number of persons whose faces were fretted and seamed by the small-pox in your younger days, and the few instances of a similar kind you meet with in 116 LECTURE V. these times, since vaccination has been practised. Do you doubt the pre- ventive effect of small-pox against a recurrence of small-pox .'—No more can you doubt the effect of vaccination—for though small-pox does occa- sionally attack individuals 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 dis- ease 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 recent- ly proved by a very simple experiment. He first inoculated a cow with the matter of a Small-vox 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 valuable preventive against the severer form. What is the nature of the specific agent which produces and repro- duces, through such an infinity of individuals, an effect so generally spe- cific ? Can it be, as Linnseus thought, of an animalculine character? or, is it at all analogous to the influence produced by the magnet on iron ? which metal, you 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 the subject, which I confess myself unable to answer. Perhaps the ingenuity of some of you may solve them for me. 1. Why is Small-pox, when directly inoculated, more generally 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—seeing 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-vox afford to the constitution against recurrence, any analogy to agricultural exhaus- tion—to the impossibility to obtain more than a given number of successive crops of a particular herbage, from a particular soil, in a given period of years ? But the small-pox fever is not the only fever which once having attack- ed an individual during his life, for the most part renders him unsuscepti- ble of recurrence;—all the truly contagious fevers have this effect—Chick- en-pox, Measles, Scarlet-fever, Hooping-cough, seldom affect the consti- tution 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 re- markably small-pox becomes 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 cer- tain, that every one of the contagious diseases has the most perfect ana- logy 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, however, possess such specific influence over them, as to be exclusively 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 remedial agency, how can we possibly expect to find suchfor LECTURE V. 117 any one of the great family of disorders which may be produced by any- thing and everything that can derange the general health ? Yet, Dr. Hol- land hopes that medical men may one day find a specific for Gout, and another for Consumption—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 detailed by Dr. Calvert [Medico-Chirurgical Transactions], will be a sufficient answer to the question:—" This man had been standing in the sea on the 10th of No- vember, upwards of an hour, to wash and purify his clothes, 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 skin, and afterwards by sweating, which alleviated the distressing symptoms. On the follow- ing 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) arising in the groin, while the seat of the pain seemed to be suddenly transferred from the head to that part. The paroxysm was again followed by an intermissi on or remission. Bnt 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 whichever side truth lies, there can be no difficulty as to the proper treat- ment. 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, ami 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 practice. " In all our cases," says Dr. Madden, " we did as all other practitioners did,—we continued to bleed, and the patients continued to die !"—[Madden's Constantinople.] From the same candid author, I find that the Yellow Fever of the West Indies is not less remarkable for its periodic remissions and exacerbations than for the shiverings and alternations of temperature char- acteristic of every other disorder. The yellow appearance of the patient, like the milder jaundice of our own climate, is a mere effect of spasm of the gall ducts. Jaundice, then, is a symptom, not a disease ; it is the re- sult 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 gen- tleman been bled, after the fashion of the country, I think in all probability he would have died; or had he survived, that he wouldhave had left a debilitat- ed 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 army, I read Dr. James John- son's work on the " Diseases of Tropical Climates." Impressed when a boy with his pretty style, I put his sanguinary treatment and his twenty- grain doses of calomel to the test. But so far from confirming his asser- tions, my own after-experience led me to adopt conclusions much the same as Dr. Madden. Captain Owen of the Royal Navy, too, who could neither have a theory to support nor any interested end to serve, one way 118 LECTURE V. or the other, details at great length the mortality which took place among his people while employed in surveying the Afncan coast. " It may, m factf be questioned," says this intelligent navigator, " whether our very severe losses were not, in some measure, 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." Captain Owen farther states, that he him- self recovered without either bleeding or calomel, while the ship-doc- tor 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 Com- mittee on the Western coast of Africa, appeared in the Times newspaper, wherein, among other things, is the following : " The bleeding system has fortunately gone out of fashion, and the frightful mortality that attended its practice, 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 ex- actly what is meant by the word Dysentery ? I shall say nothing of its etymology, but rather give you the symptoms included by Sydenham under the name.—" The patient," he tells us, " is attacked with a chil- liness and shaking, which is immediately succeeded by a heat of the whole body. Soon after this gripes and stools follow." What, then, Gentlemen, is this dysentery but an agu«, with increase of sectetion from one surface instead of another—from the mucous surface of the bowels instead of the skin, and the skin, remember, is only a continuation of the mucous membrane of the bowels. Now, Dr. Cumming, late of the East India Company's medical service, informs us, that while ascending the Nile in 1836, he was attacked with dysentery. After suffering for a week with " intervals of remission," he fairly gave himself up, and so did his at- tendants, for he had nothing in the shape of medicine with him. As a forlorn hope, however, he ordered his guide to sponge him with warm water. And this simple remedy (attention to temperature), with fomen- tation of the abdomen, was the only treatment employed. He took a lit- tle wine and water, which remahied upon his stomach; he then became drowsy, slept for a short time, felt his skin less hot and burning, and, in brief, began to recover, and that rapidly. In about a week afterwards, he writes in his journal: " My recovery is almost complete, and the ra- pidity 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 applied to the abdomen, and during the first four days of the disease, in addition to ex- tensive mercurial frictions, I swallowed two hundred and sixteen grains of calomel. True, I recovered ; or, rather I did not die ! whether in conse- quence, 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 con- stitution received a shock from which it never fairly recovered, and I was obliged to come to Europe on furlough. On the present occasion, fortu- nately for me, the vis medicatrix natura was my sole physician, (he for- got the sponging part!) and I am now almost as well as before the attack commenced. British medical practice, in my humble opinion, deals too MUCH IN HEROICS." That opinion, Gentlemen, I hope, is now yours also—it has many years LECTURE V. 119 been mine. Such a case, from such a quarter, must doubtless be more than sufficient to warn you against the sanguinary and mercurial practice introduced 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 savor of mania, or does it not? and that too, as I hinted before, madness of rather a homicidal kind ? Dropsy. How can there be a morbid superabundance of any secretion without a corresponding change of temperature ? He who 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 pa- tient and physician on such days being excited by general improvement throughout. How should this 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 acknowledged effica- cy in that most perfect type of all disease, the ague. Of cases success- fully treated by me in this manner, I could give you hundreds, but to what purpose ? The recital would only comprehend the symptoms of ague with increase of the natural secretions of the various cavities even to effu- sion (in cellular substance) instead of perspiration by the skin; and the remedies, as you may guess, 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-Sergeant of the Royals had dropsy, which, notwithstand- ing the usual treatment by diuretics, purgatives, &c, was daily getting worse, when Dr. Stephenson, of the 13th Dragoons, suggested the appli- cation of poultices of lichen vulgaris to the loins. From that day the amendment was rapid, and the patient subsequently got well. Now, Gentlemen, everybody believed that there must have been some magical virtue in the lichen. But Mr. Brady, the surgeon of the regiment, think- ing that the plant had less to do with the cure than the heat which, in the form of a poultice, it produced, determined to try poultices made with 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 prac- tice, I have repeatedly applied poultices to the loins with advantage, and have also, with the assistance of plasters of pitch, galbanum, &c, suc- ceeded in curing cases of dropsy, that resisted every kind of internal remedy. Cholera,— the scourge of nations—will cholera be found to partake of the same uni- versal type of disease, the ague? You will be the best judges, Gentle- men, when I draw my parallel. While in India I had ample opportuni- ties for ascertaining its nature. Tremulous and spasmodic action belong equally to ague and to cholera; vomiting or nausea characterizes both. The ague patient has sometimes diarrhoea or looseness; oppression at the chest, and coldness of the whole body are the primary symptoms of each. The increased flow of pale urine, so often remarked in ague, is an occa- sional symptom of the epidemic cholera. In more than one instance of cholera, which came under my observation while serving in the East, that secretion passed involuntarily from the patient a short time before 120 LECTURE VI 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, with hot skin and bounding pulse, a state analogous to the mUder forms of cholera, in which you remark the same phenomena. When not fatal, cholera, like ague, has a hot and sweating stage. More- over, 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. Cholera, then, is an extreme of the cold stage of ague. WJiat are the remedies most beneficial in Cholera ? Attention to tem- perature comprehends everything 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 anything contained hi 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 Dis- eases of India, I have proved that death, in the great majority of instances of cholera, takes place from a palsy of the pneumo-gastric nerves,—those nerves that influence the functions of the lungs and stomach. If you di- vide 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 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 of cholera. Shortly after my return from India, Dr. Wilson Philip read a paper at the Westminster Medical Society, in which he took the very same view of Cholera, but wherein he forgot to say that his views of the disease had been every one of them anticipated in my Remarks upon it, published in the Lancet some months before I quitted India. LECTURE VI. present state of medical practice in england—dyspepsia—hysteria and hypochondria--insanity--effect of ligatures--faint--congestion, its nature--infantile convulsions. Gentlemen, After a long intercourse with the world, and a rigid exami- nation of what, in his day, was called its wisdom, the great Lord Bacon, musing doubtless over his own philosophical discoveries, thus writes:— " It is a view of delight to stand or walk upon the shore-side, and to see a ship tossed with tempest upon the sea, or to be in a fortified town, and to see two 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, labors, and wanderings up and down of other men." But, Gentlemen, however exciting this kind of pleasure be to him, who should be content with merely making a discovery to himself— the making of it public has its drawbacks; for "whoever," in the words of Johnson, "considers the LECTURE VL 121 revolutions and the various questions of greater or less importance, upon which wit and reason have exercised their power, must lament the un- successfulness of inquiry, and the slow advances of truth, when he reflects that great part of the labor of every writer, is only the destruction of.those that went before him. The first care of the builder of a new system, 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 rep- tiles and insects that so long rejoiced in the darkness and secrecy these cobwebs afforded—the bats and spiders, to whom the daylight is death! Truth, like a torch, does two things; for not only does it open up to man- kind a path to escape from the thorns and briars 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 ex- pect from these.'—What, but to be whispered away by the breath of cal- umny, to be scouted and lied down by the knaves and fools, whom inter- est or intercourse has leagued with the public robber as his partizans ? Who will talk to me of conciliation ? Who will tell me that mild and moderate measures ever brought over such implacable enemies to the ranks of their destroyer; or that robbers rioting in the spoils of their vic- tim, will listen to the voice of the charmer, charm he never so wisely ? Surely people must be out of their senses, who imagine that any exposi- tion 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 possible promise to their schools, and, when once in their net, keep him there by every possible artifice and pre- text which collusion and corruption can devise ! one day entangling him in a web of unmeaning sophistry—another, stimulating him to waste his time and labor in splitting straws, or in magnifying hairs—now encour- aging him in a butterfly chase after shadows—now engaging him in a wordy and worthless disputation with his fellows ! Gentlemen, I appeal to you, if this is not the mode in which, in most cases, from four to six years of the best part of a young man's existence are passed in our medi- cal schools—passed in the fruitless endeavor to know a profession, upon the exercise of which he is too often compelled to enter with no other pretensions to a knowledge of its principles than the trumpery certificates and diplomas for which 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 igno- rance of the public?—in one case inflicting visits too numerous to be ne- cessary ; in another, employing draughts, mixtures, or measures, too ex- pensive, too frequently and too fruitlessly repeated, to be all for the bene- fit of the patient! Think you, that the members of the medical profession are different in their feelings from every other human being—that then- 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 threat- ens so many of their order with ruin ? Is it in the nature of things that they will welcome a practical improvement, by which the practitioner may, in a few hours, cut short cases and chances, which, by daily visita- tions, or by three draughts a-day, might be profitably protracted to a month, if the system on which it is based, were only advocated in calm, melliflu- ous, and complimentary language ? As soon may you expect a needy 192 LECTURE VL attorney to be prevailed upon 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 superiority of rail- road over coach conveyance, when estimating each the losses they shall respectively sustain by the too general 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 protec- tion,—annually to lure, by misrepresentation and lying promises, thou- sands of credulous and unsuspecting youths into a path strewed, even in the very best of times, with thorns and briars innumerable ? Better far that one half of these should at once abandon a walk of life, where the competition is so keen and close, that comparatively 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 honor, and their patients' interests. Who will tell me half- measures can be of any avail, under circumstances like these ? Gentle- men, in corrupt and difficult times, half-measures, so far from succeeding, have either been taken as a sign of weakness in the cause, or as a symp- tom of timidity on the part of the advocate. Away then, with half-meas- ures !—away with the idea of conciliating men, the already rotten tree of whose sustenance you sap—the long-cemented system, whose existence depends, not on a virtuous adherence to nature and truth, but upon a col- lusive and fraudulent perversion of both ! When persons little versant with the present state of medical affairs, see men of established name sup- porting 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 re- spectable, and so amiable in private life .'"—But tell these simpletons, that Dr. So-and-So's Bread depends 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 which he had so long supported, and which supported him"—and you bring an argument which, though not quite convincing in itself, will at least compel a closer investigation of the system it is your wish to expose and crush.—Gentlemen, I have been blamed for the tone and spirit in which I have spoken of my 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 par- va, I have followed in his wake—I hope soon to add passibus aquis. Think you, the Reformation of the Church could have progressed with the same rapidity, had its most forward champion been honey-mouthed—had his lip been all smiles, and his language all politeness—or had he been con- tent, in pointless and unimpassioned periods, to direct attention solely to the doctrinal errors of Rome ? No—he thundered, he denounced, he heap- ed invective upon invective, and dealt in every form of language which could tell best against his enemies, whether 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 which, in the eyes of the vulgar, they had been too long invested. Had he done otherwise, he might have obtained the posthumous praise of moderation, at the price of defeat and the stake. Gentlemen, let it not for a moment be supposed that in thus sweepingly arraigning the present system of medical polity, I can have the remotest wish to degrade the profession of the physician. On the contrary, it has been my endeavor throughout to improve his morale, and to elevate his condition,—to render him a useful, honorable, and honored person,—to LECTURE VL 123 make him what neither the mere lawyer nor the mere churchman can pos- sibly be—a student of nature, and an intellectual expounder of his Maker's works;—one from whose ranks kings may still, as they once did, choose their counsellors. 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 wish to insinuate that among the individual members of the profession, there are not nume- rous exceptions to the line of conduct pursued by these creatures. In every one of its grades and conditions,—apothecary, surgeon and physi- cian,—I have had the pleasure to meet practitioners who not only heartily join me in deploring the present shameful state of practice, but who aid me with their best efforts to expose and correct it. One and all of these honorable persons 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 physic 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 bub- ble reputation, to be blown me by their breath;—while by exposing the intrigues of the schools, and the collusions and corruptions of the pro- fessional world, not only do I stand as one man to a host, but I lay my- self 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 honorable practitioners who 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 1 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 this 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 know, that my enemies have done everything 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 corruption have usurped the profes- sor's chair, and placed themselves 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 have ever heard of. Now, Gentlemen, to the more orthodox mat- ter of this lecture. 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 two-fold. We have two eyebrows, 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 therefore 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 become diseased, and the subject of it shall appear 124 LECTURE VI. to reason very fairly to the last. But that must be a shallow observer in- deed, who from such a possible fact should draw the fictitious inference that even one hemisphere of the Brain may be disorganized throughout its entire substance, without the intellectual powers being at all disturbed! If you read of such facts set them down as false facts. The Brain then, like the body, in some of its parts is double, yet like the body in its integ- rity, the Brain is a unity, and like the same body it has a diversity of parts. That the scalpel has hitherto failed to trace any well marked divisions betwixt the various cerebral portions to which phrenologists have ascrib- ed variety of function, is no argument against this doctrine. Do not all the different parts of Ae frame merge into each other—the elbow 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 the weakness of one or more of its joints or muscles an inability on the part of its possessor to do a particular work, though he may still accomplish many others by means of it.' It is the same thing with the head. Partial disease of the Brain produces partial intellectual injury, and you see the effects of such injury in those persons who 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 foetal 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 organs of the body, one or more of the superadditions are never properly developed. The result you can anticipate. Idiocy, according to the degree of the defect; and yet there are medical twad- dlers 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 Consumption, at a former meeting, I explained to you, that no individual could possibly suffer from any complaint whatever, without his digestion being more or less impli- cated. The patient who labors under any severe form of disease, such as Gout, Consumption, or Erysipelas, has all/the symptoms or shades of symp- tom, 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 disease 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 parti- cular tendency to decomposition in any organ or locality, but from every function being more or less wrong, he very naturally turns his attention to the stomach or bowels, the errors of which come more particularly under the immediate cognizance of his feelings. Such a patient will 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 eating," or it is positively " excellent"—which 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 what he desired most, the moment it come before him. Perhaps he has thirst. He is wearied 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 indolent in body; and he has often a great dis- position to sleep, especially after meals. Others again will just be quite the LECTURE VI. 125 reverse of all this, these perpetually harp upon some particular topic—fidget themselves and everybody else about trifles, 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 sleepless or broken and disturbed by unpleasant dreams. One moment, they dream of rob- bers, from whom they cannot escape; or they are on the eve of tumbling down a precipice; dreaming sometimes within a dream—asking them- selves, even in the very act of dreaming, whether they dream or not—and they will satisfy themselves by a process of unreason, that they are actu- ally awake and walk the air. Even during the day many of these pa- tients 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 unnatural. Phantoms may even pass before them at mid-day, phantoms such as they see in their dreams of the night. The very colors of things may be altered to their eyes—red appearing to them green, and vice versa. Even the shapes and dimensions of bodies may be quite changed to their sight—though the greater number have sufficient judgment remaining, 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 own 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 common 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, his feelings so sensi- tive, that he shrinks with pain if you merely touch him. Occasionally, 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 most frequently,—headache, for which, on the hypothetical assumption of fullness of blood in the brain, the leech, lancet, and cup- ping-glass are so frequently in requisition. But to what end ? In the words of Abernethy, supposing such assumption to be correct—" Does blood-letting cure diseases in which there is a fulness of blood in the head ? It must be granted, that in many instances, it temporarily allevi- ates 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 sensations, but the effects of a great instability of Brain, now brought on by one thing, now by another ? I have known the most se- vere and distressing headaches arise from loss of blood, and I have known them originate in a long fast. Surely for such diseases, the leech and the lancet are not the proper remedies. But, Gentlemen, there are many other ways by which the brain may be weakened. You may as certainly exhaust it by prolonging literary or other mental labor, as by starvation or loss of blood; for there are times to think, and times to cease thinking; 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 organ painfully revolve again and again the occurrences of the external world, and give the proper attention to the internal economy, over which it presides? When you listen to an orator or a preacher whose discourse powerfully affects you, the brain 126 LECTURE VI. becomes so engaged, that it cannot at the same time attend to the breath- ing—and you are, therefore, compelled ever and anon to draw a long breath—you must take a deep sigh, to make up for the ordinary suc- cession of short inspirations and expirations, which constitute the natural art of breathing. Now, Gentlemen, if the function of the lungs be so easily disturbed in this way, can you doubt that the heart, stomach, bow- els, and other parts, may be similarly influenced? What are the com- plaints of men who have much on their minds, of bankers, merchants, and great lawyers ?—what the diseases of aged persons—persons whose brains become weaker and weaker by the slow but certain operation of time ?—Do not these patients 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, Gentlemen, this giddy sensation, this disposition to fall, is most common- ly felt upon suddenly raising the head, or in rising from a chair. What surer sign of cerebral weakness ? Yet, not long since, two gentlemen, each upwards of seventy, informed me, they had been bled and leeched by their respective apothecaries for this disease of pure cerebral ex- haustion. 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, whether 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 everything he could think of, and among others hot water. The ease which this gave him, led him to extend its use to his dyspeptic patients; and my own experience of its virtues enables me to bear him out in the encomiums he has passed upon it. To this simple means, palpitations, spasms, head-aches, wind and acidity will all sometimes 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 very frequently gives the same immediate re- lief in every one of these affections, we at once see that its medicinal power must depend upon the change of temperature which it electri- cally produces. Of the various cordials to which you may have re- course 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 remedies with which I am ac- quainted, 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 of the side, produced by cramp of the muscles of the ribs. How correctly Shakspeare described the nature of these pains, when he made Prospero say to Caliban in the Tempest, * " I had not been absent from home above half an hour when I was seized with violent spasms of the stomach and was obliged to return. I was bent almost dou- ble with the pain. I took, upon going into the house, a basin of hot tea. It was scalding hot, and as soon as I had swallowed it my spasms ceased, and with them the cough entirely left me. It had lasted eleven months." Lefevre.—T. LECTURE VL 12*. 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 the 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, prussic 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 promi- nent features as the Cause of all the others. In one instance they will blame wind—in another acid. But as it happens, these, instead of being causes, are only the common and coincident Effects of the great cerebral weakness, and not the product, as many imagine, of fermentation of the food—they are morbid secretions from the lining membrane of the alimenta- ry canal. And of this you may be assured, not only by the mode of their production, but by the manner of their cure, when that happens to be accomplished. Just watch a dyspeptic patient when he receives a sud- den or unexpected visit; his " heart-burn," as he calls his acidity, comes on in a moment, and his bowels 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 sud- denly 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, Gentlemen, is not every tissue of the body the result of secretion ?—are not the hair and the nails as certainly secret- ed as the saliva or the bile .' Only place your naked arm for a few min- utes 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 conceive 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 medi- cines, will often do away for months, and even years, with every symp- tom of wind and acidity—"while cordials, alkalis, and mild laxatives, sel- dom 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 dyspectic patient is more or less disordered. In every case of this kind there is an unnatu- ral 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 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 " appearances are deceitful." 128 LECTURE VI. The dyspeptic patient is either torpid, and .with difficulty roused to ex- ertion, whether corporeal or mental, or he is acted upon by everything 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 straw or a feather. Then, as regards his actions or his promises, you can scarcely depend upon anything 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 mo- ment all confidence, the next all suspicion. Now, is not this one of the strongest of many striking proofs how much our mental workings are the effects of our material state, the result of our brain's condition, and its atomic relations and revolutions ? It is in perfect accordance with what we ob- serve in all our corporeal motions. If the muscles be tremulous, can you wonder that the mind should be vacillating and capricious ?—or when these are cramped and spasmodic, why should you be astonished to find a corresponding wrong-headedness, and pertinacious and perverse ad- herence to a "wrong opinion ?—mens sana in corpore sano. You may argue for hours to no purpose whatever with some patients ;—for how can you expect the 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 then minds sooner than the most powerful and persuasive arguments of a Cicero or Demosthenes. Lady Mary Montague held the notion that the whole world hate 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 best 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 re- lieve it from the weight of its panniers ! Never yet did I attempt to open the eyes of a person imposed upon, but he was sure to abuse me. The poet was therefore right when he said, The pleasure surely is as great, Of being cheated, as to cheat. In all my experience, the more unscrupulous and unprincipled the im- postor has been, the more certainly he appeared to fascinate his dupes. All he had to do was to hold out an impossibility to them, and they were sure to dance attendance at his door for months. Taking advantage of a popular but puerile prejudice against Mineral medicine, the medical char- latan is very careful to prefix the word Vegetable to his nostrum ; and this, he tells the public, is safe in every form, dose, and degree—which being in utter repugnance to every other thing in nature, is greedily swal- lowed 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 yourselves with any weight of clothes, or swallow any measure of food .' Or can you retain any part of the body in perpetual motion or repose without that part suffering .' No, truly ! re- sponds the same dyspectic, who 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 what they are taking; but should they chance to find out that you have been giving them arsenic, prussic acid, or nitrate of silver, you will be sure to be worried to death by questions, dictated sometimes by their own timidity, and sometimes by the kind feeling of some " damned good-natured friend" secretly set on by some equally damned good-natured apothecary. Now, as these patients are for the most part great sticklers for authority, your only course is to tell the truth—which, after all, in nine cases out of ten, will make no imp res- LECTURE VI. 129 sion—and that is the reason why the quack and the subordinate practi- tioner who can keep their medicines secret, have an advantage over the honorable physician—an advantage 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 patients them- selves, will at least appear reasonable to their friends—that the medicines you ordered are all contained in the pharmacopcoiae of the three Colleges of Edinburgh, London, 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 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 naught 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 accordingly 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, hydrocyanic acid, or nitrate of silver, Math aniseed or cardamoms. In acidity, either of the two first remedies will often answer very well with soda or potash. Where the bowels are slow and torpid, rhubarb, aloes, or both, are very good medicines with which to combine any of 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 guiac—and so proceed in a similar manner with other symptomatic remedies for other local indications ; keeping in mind, however, that these symptomatic medicines are merely a means of secondary importance in the treatment of a great constitutional totality of derangement. In addition to these measures, plaster to the back or stomach may be very beneficially resorted to hi 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 a bet- ter guide to you in your choice and continuance of any bath than all the theories of all the doctors that ever wrote or reasoned upon disease and its treatment. " How do you think me now, doctor ?" is a question I am asked every day, and every day I give the same answer: " How do you feel ?" If the patient is better, he says so ; if worse, he will be sure to tell me he is not so well; 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 * My experience in this form of disease, so common in America, is fully confirma- ■ tory of the truth of Dr. D.'s views. I have in no instance failed to give relief. One gentleman gained eight pounds in weight, in six weeks.—T. 130 LECTURE VI. 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— which I need not tell you is a lie—or more politely 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 apothecary, attend him, but Dr. Such-a-one, the great physician, was 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 per- haps have been nearer the mark—but, in that case, what apothecary would either call him in again himself, or let him in again when request- ed, where he could by a little gentlemanly trickery keep him out ? In my own particular case, the custom of the apothecary has been secretly to play upon the fears of the patient of his friends against " strong me- dicine," to shrug his shoulders and smile contemptuously. " Oh I can tell you something of Dr. Dickson," he has said, " but you must not give up me as the author;"—whereupon he has proceeded to lie Dr. Dickson's life away; and when he had thus, to his own thinking, sufficiently poisoned the ear of his patient, he has turned .round in this manner 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 the people like him, call in to conceal their bad work—men, who would as soon think of differing with the opinion of their supposed subordinates but real patrons, as of quarrelling with their break- fast because it was purchased with the shilling of a dead man's guinea ! What a just observation was 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 paradoxical, that the rapid recovery of the one usually depends upon the procrastinated disorder of the oilier. Some persons will tell you with an air of the miraculous, that they re- covered although they were given over, when they might with more rea- son have said, they recovered because they were 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, whose dishonest practices they are so constantly decrying ! Now, this, you will say, is a startling statement—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 attention. Gentlemen, the man who 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 asseveration on the part of individuals interested in declaring the contrary, weigh with you one straw against the evidence of your own senses, when 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 rea- son of suspecting the person who has attained to it, of a complete con- tempt 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 imper- sonation 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, LECTURE VI. 131 however, I maintain it to be—but not the whole truth; for the world must have its eyes a little more open before it can believe all I happen to know upon the subject. By and bye I shall tell the English people something will make their ears tingle ! To return to the consideration of Disease. You now see that in all the cases of which we 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 diseases. With every case of Dyspepsia, depression of spirits, and more or less mental caprice, with hasty or erroneous notions upon one or more points, will be found to be as- sociated. When such depression amounts to despondency, medical men, according to the sex of the patient, change the word dyspepsia into Hypochondria, or Hysteria ; and some professors are very particular in their directions how to dis- tinguish the one from the other! Gentlemen, what is the meaning of Hysteria ? It is a corruption of the Greek word ivrcpn (Hystera) the womb; and it was a name given by the ancients to the particular symptoms we are now considering, from a hypothetical idea that in such cases the womb was the principal organ in fault. From the same language we also derive Hypochondria, a compound word formed of i™ (Hypo) under, and xnvi90i (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 when a female suffers from low spirits and despondency, with occasional involuntary fits of laughing, crying, sobbing, or shrieking, you must call her state hysteria; and when a male is similarly affected, you must say he has hypochondria. Now it so happens, that medical men sometimes pro- nounce even their male patients to be hysterical! And this brings me in mind of an honest Quaker of the profession, who 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 owing to the state of the " digestive organs." Dr.------, being a stethoscope man, maintained 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 should be 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 ! Gentlemen, that the Brain is the principal organ implicated in all disorders, which come within the physician's province, more especially in such as are termed Hysteria or Hypochondria, the smallest reflection will convince you. Suppose a per- son of either sex had been accidentally debilitated by the loss of blood— a person who previously was strong in nerve as in muscular fibre ; sup- pose 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! Another class of practition- ers, scarcely less unreasonable than those to whom we have just alluded, will have it, that patients coming under the head of hysteria and hypochon- dria, are not ill at all.—" Oh ! there is nothing the matter with this man;" they will say, " he is only hipped!" and if the female, " she is only hysteri- 132 LECTURE Vt cal." Dr. Radcliffe, when he refused to come to Queen Anne, declared he would not stir a foot, " for there was nothing the matter with her but the Vapors!" Such was the term by which the doctors of that day charac- terized the shifting shades of symptom now called Hysteria. Gentlemen, do I require to tell you that no man or woman suffers from melancholy, or indulges in whims and fantasies, without being positively ill ? Who- ever labors under mental delusion or despondency has alternate chills and heats; and remissions and exacerbations of all the more prominent symptoms characterize the disorder in every form. The late Lord Dudley, in a letter to the Bishop of Landaff, relates his own case, and it is so like what you will daily meet in practice, that I shall give it to you in his own words:—" It is in vain," he says, " that my reason tells me that the view I take of any unpleasant circumstances in my situation is exaggerated. Anxiety, regret for the past, apprehensive 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 constantly 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 my general condition. It is a dismal contrast; for you will remember that I was naturally gay and cheerful." Now, although Lord Dudley recovered per- fectly 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 disorder gradually deepened hi their hue, until they amounted to the most complete Insanity,— a proof to you that the hypochondriac whim, and the hysteric 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 nothing but degree. Had 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 malfor- mation, instead of being the consequences 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 causes of an mtermittent living action, for the origin of hypochondria and mania,—dis- eases which they have even themselves, perhaps, traced to hard study or a passion ! External agencies, then, were the real causes, not the struc- tural deviations detected within after death by the scalpel. Students of medicine ! young men honorably ardent in the pursuit of knowledge, for the sake of your profession and your future patients, learn to think for yourselves. Pause, examine, weigh, before you give a slavish assent to the dicta of your teachers. When these tell you that madness with a lucid interval is an inflammatory essence, or that it depends upon some cerebral malformation or tumor, 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 unfortunate. 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 compatible with a LECTURE VI. 133 defective cerebral organization 1 How can the cause of an intermittent dis- ease be a corporeal entity, or something permanently fixed? Let no sounding words, no senseless sophistry, cheat you of a reply to this ques- tion. The maniac who has lucid intervals is curable in the greater num- ber of instances—the hypochondriac who at any time of the night or day enjoys the very briefest immunity from his miserable feelings, may be equally susceptible of improvement from well-devised remedial means. The modern medical 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 opprobria of medi- cine ! What has been the result of the antiphlogistic 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 treatment in this disease, I will read a short extract from a letter I received from Dr. Hume, the same staff-surgeon whose successful practice I have already had occasion to detail to 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 inquired 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 observation is, that the usual practice of bleeding, leeching, cupping, &c, only aggravates the condition of the patients. Of those who were 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 medical profession, might not perhaps have been so candid in his remarks." Dr. Conolly, in his Report of the Hanwell Lunatic Asylum, is obliged to admit that great numbers die shortly after their admission into that establishment. The large abstraction of blood which he so lauds in his work on Insanity, will easily account for the unsuccessful termination of his cases. Well then, Gentlemen, Hysteria, Hypochondria, Mania, are merely 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 contrast somewhat strongly with the poor opinion I entertained of the resources of our art, and the vexation I ex- perienced when first entering upon my professional career. This much you should know, however, that in all such disorders you will be obliged to change your remedies frequently—for in chronic disease 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 everything in life. The toy that will stop the cry of the weeping 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 properly, then, consists in the frequent change and right adjustment of the chrono-thermal and other remedies, to particular cases ; —and this also explains the good effects of Travelling upon many of these patients, for to the constantly shifting scenes and to the frequent repetition of novel cerebral excitement produced by these scenes, we must ascribe the chief advantages of such a course; clearly proving that the Brain hi this instance, as in every other, is the true key to all good medical treat- 134 LECTURE VI. ment. Whatever, then, be the name by which you choose to designate your patient's complaint, you will be sure to meet with nothing but dis- appointment, if you pin your faith exclusively to any one medicine. To- day a mdd 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 divine remedy; the next, having lost its power, you may dismiss it for prussic acid, valerian, creosote, strychnine, or silver. In regard to silver, the nitrate is the preparation which 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 " nervous complaints." Cullen, Pitcairn, every medical man but the 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 readily bear testimony to its safety and value as a medicine. Like every good thing, however, the nitrate of silver has been abused in practice, and in some half-dozen instances it has been pushed to so great an extent as to give the patient a permanent blueness of skin for life; but, Gentlemen, in these cases, the practitioners who em- ployed it committed the double error of giving it too long and in too great quantities; and that people should entertain a prejudice against it on that score, is just as reasonable as that a man should be afraid to warm him- self when cold, because his next-door neighbor 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 igno- rant 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 patient; for if you have no remedy for rascality, he may have no relief for his sufferings. So much then for one of many annoyances every prac- titioner must experience when his patient happens to be ----"the tool That Knaves do work with, called a Fool." But, Gentlemen, we must not suppose that medicine is the only profession where able and honorable men experience such annoyances. Doctors of divinity, and doctors of law, are equally obnoxious to intrigue and preju- dice,—aye, and State doctors too, as Dr. Peel and Dr. Melbourne, could tell you if you would ask them. To return. The shifting shades of men- tal distress, and the various vagaries and wrong thoughts—to say nothing of wrong actions—of persons whose diseases come under the head we have just been considering, are so many and so multifarious, that to attempt to describe them all would be a mere waste of time and labor—inasmuch as however greatly they may appear to differ from each other in shape and hue, they all depend upon a similar totality of corporeal infirmity, and yield, when they yield at all, to one and the same system of corporeal treatment. A few instances in proof may suffice to show you this:— Case 1.—A married lady consulted me under the following circumstan- ces: Every second day, about the same hour, she had an unconquerable wish to kill her children, and when she happened to look at a knife, her terror, lest she should do so, was extreme. I\ow, as every function of this lady's frame was more or less wrong, I prescribed for her quinine with sulphuric acid. From that day she had no return of the homicidal feeling. Case 2.—A gentleman, every second day, took a fit of suspicion and jealousy of his wife, without the slightest cause w hatever, as he confess- LECTURE VI. 135 ed 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. Case 3.—Another gentleman, after a hard contest at his university for prize honors, suddenly became moody and sullen ; lost his flesh and ap- petite, 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 learnt that her brother had not had the slightest symptom of return. Whoever, in his progress through life, takes the trouble to study indi- vidual 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 of you may possibly remember the case of Moscati, a per- son singularly 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, who was once a patient of mine, told me that every time she became pregnant she caught herself frequent- ly telling lies, for no end or purpose whatever. I knew a gentleman, with high feelings of honor, who was occasionally in the habit, when un- der 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, when he packed up the articles to return them to their owners. From these cases, you now see how much the morale of every one must depend upon his physique; for if I know anything in the world, I know that attention to corporeal temperature will be found of more avaU 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 it may, like many other bad dispositions, be cured by medicine, I could give you a great many proofs. However, as our time will not now permit me to enter into these subjects so fully as 1 could wish, I shall content myself with reading to you a part of a let- ter I some time ago received from Dr. Selwyn, formerly of Ledbury, now of Cheltenham. Speaking of Mr. Samuel Averill, of the Plough Inn, Dyn- ock, Gloucestershire, Dr. Selwyn says:—" Before he came to me he had consulted Mr.------, of Ledbury, and other medical men, to- no good purpose, as you can easily understand, when I tell you they principally went over the old routine of cupping, purging, &c. Mr. Averill's symp- toms were depression of spirits to crying—thoughts of Suicide, fears of be- coming 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 particu- lar organ in a worse state than another, I thought this a good case for your doctrines; and accordingly 1 rang the changes on the nitrate of silver, strychnine, musk, prussic acid, creosote, iron, quinine, and opium—vary- ing and combining these according to circumstances with valerian, harts- horn, blue pill, &c. In a fortnight you would have been astouished at the improvement 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 suc- cessfully, by attending to the intermittent principle, and I had lately a case of Tic Douloureux, which, after having been under the successive treat- ment of several eminent practitioners with no perceptible improvement, 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 136 LECTURE VI. 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^ist or pathologist to name or classify; and as 1 am still consulted 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 puz- zled what to do, I now proceed at once to act upon the intermittent prin- ciple, and I have every reason to be satisfied with my success. Believe me, yours faithfully, "Congreve Selwyn." Gentlemen, that the numerous diseases which medical men group to- gether under the head of Dyspepsia, Hysteria, and Hypochondria, are caused by circumstances from without, acting upon an atomic instability of brain within, might be proved by an affinity of facts. But this instability may be produced or rather put in action by different influences in different individuals—one patient being only susceptible to one agent, while an- other may be acted upon literally by every wind that blows. General O'Hara, when he commanded the troops on the Mediterranean, was so sensible of the Levant wind, that before 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 servant kept out of his way on these occasions. The different effects of the winds on the human sys- tem, Shakspeare well 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." And in confirmation of Shakspeare's truthfulness to nature in this as in most of his other observations, Sir Woodbine Parish, in his publication 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 hand- some, and his disposition frank and generous; but when the north wind set in, he appeared to lose all command of himself, and such was his extreme irritability, that during its continuance, he could hardly speak to any one hi the street without quarrelling. In a conversation with my informant, a few hours before his execution, he admitted that it was the third mur- der 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 wounds, 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 head- ache first, and 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 became worse, a heavy weight seemed to hang over his tem- ples—he saw objects, as it were, through a cloud, and was hardly con- scious where he went. Such was the account the wretched man gave of himself, and it was corroborated afterwards by his relations, who add- ed, that no sooner had the cause of his excitement passed away, than he would deplore his weakness, and he never rested till he had sought out, and made his peace with those whom he had huit 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 who could never indulge in lea without experiencing a disposition to commit suicide, and nothing could arouse him from this state of morbid excitement but the pleasure of de- LECTURE VL 137 stroying something—books, papers, or anything within his reach. Under no other circumstance than this influence of tea were these fearful aber- rations observed." Coffee affects many people with fever. But if coffee, tea, and other things so apparently trifling sometimes set up severe dis- order—things equally trifling will sometimes cure it—indeed there is nothing, perhaps, in the whole history of disease more curious than the readiness with which the paroxysm of many complaints 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 d 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 words over the morbid motions of the body, we 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, volun- tarily claimed admission to a madhouse in the Faubourg St. Antoine, on account of a desire to commit homicide, with which he was tormented. He threw himself at the foot of the altar, and supplicated the Almighty to deliver him from the horrible propensity. Of the origin of his 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 Establishment, and re- questing 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 desperate attempt upon one of his keepers, and perished, at last, in a paroxysm of fury."—[Annates d' Hygiene Publique, et de Medecine Legale.] Now, every man of any information in the profession, knows that the application of a ligature to the arm or leg will frequently stop the commencing ague-ht. 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 with his hand. Putting aside, then, all consideration of the re- mittent nature of the case of homicidal mania I have just read, all con- sideration 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, Gentlemen, 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 was unex- pectedly seized with severe cramp in his back and loins. Observing him to become pale and shiver all over, I caught him suddenly 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 suffer- ing from cold feet and general malaise. Mania, epilepsy, asthma, cramp, ague, then completely establish their fraternal relationship by means of the ligature; for had we no other facts, no other bond of association than that which the ligature furnishes us, we should still be led to the irresisti- ble conclusion, that those particular diseases, at least, amid all their ap- parent diversity, have yet some principle in common which determines their unity. When I come to explain to you the manner in which the ligature acts, you will find that the connecting link of the whole is the 10 138 LECTURE VI. 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 sup- posedly any Congestion orfullness of its blood-vessels. That,you know, was his doctrine of the cause of 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 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 would say; " behold how the shiverings cease the very moment you open the vein—what can be a more trium- phant 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 was 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 his lancet, the fit was at once arrested. But, Gentlemen, 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 word, of diminished cerebral power. But when we come to consider that, in every instance in which the causes of the diseases now under consideration have been known, the Brain has been suddenly and prima- rily 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 dis- eases—they are all the effect of cerebral weakness, and have all more or less analogy to faint. Faint, in fact, may be the premonitory symptom of them all; and the Walcheren ague, in particular, generally began with a fainting fit, which faint was sometimes so alarming as to cause the greatest possible anxiety 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 pulseless;—the blood, having thus suddenly left the arteries and external vessels of the body, must go somewhere else. Had we never dissected a person who had died of 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 what first misled Dr. Mackintosh. On opening the heads of subjects who had died in the cold fit of ague, he almost invariably found the veins of the brain gorged with blood. This constant Effect of every kind of exhaustion he had once pre- sumed was the Cause of such exhaustion. Gentlemen, he did not know that the very same internal vascular fullness may be seen on opening the bodies of those who die of 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 reahty the invariable Effect, of sudden exhaustion, I shall LECTURE VI. 139 now read to you one of several experiments in which Dr. Seeds bled healthy dogs to death. The editor of the Medical Gazette will pardon me for reading 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 great 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 [flatulent 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 were frequently examined; they became gradually less obedient to the influence of light, and at length ceased to contract altogether. [That is, they became dilated.] Slight spasmodic con- tractions took place, first in the femoral and abdominal muscles ; then the head, neck and fore-legs, were likewise powerfully affected with spasms [or convulsions]. At this time a deep sleep seized the animal: he breathed slowly and with difficulty, and, for a little time before death, re- spiration 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." Now for the dissection :—" The Dissection of the Head was first begun. The membranes of the Brain were loaded with turgid vessels, the larger of which were of a very dark color. A bright red spot was observed near the cornua, 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, were inundated with water. 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 degree 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, Gentlemen, if anything in this world could open the eyes of "pathological" professors,—if facts or reasoning of any kind could possi- bly move those mechanical-minded persons, who plan their treatment of living men from what they see on dissecting 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 was 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 kthe 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 * We constantly hear of children dying of " Water on the Brain " I scruple not to declare, that in ninety-nine of every hundred of such cases, the water in the Brain is produced by the lancet or leeches of the doctor. 140 LECTURE VL master about his wages, " turned suddenly pale, and fell speechless and insensible for a time, breathing heavily untd 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 soak through a thick mat on the 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 possibly imagine was the treatment which this wise man of Gotham put hi practice the moment he was called to a person who had fallen down in a faint, and who from the injury occasioned by the fall, had lost blood " enough to soak through a thick mat ?" Why, to bleed him again! And what do you think was the quantity of blood he took from him? More than Three pints ! The landlady of the house,—and she was corroborated by other witnesses,—swore that " she thought that about Three and a fifth pints of blood was taken besides what was spilt on the floor. The bleeding, she calculated, occupied twenty minutes. The bandage also got loose in bed, and some blood, not much, was lost there be- fore its escape was discovered. He had convulsions on Saturday, after which 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, without having once recover- ed his sensibility to surrounding objects, he died." Remember, Gentle- men, he did recover his sensibility after he left his master's shop, and only lost it again on repeated bleeding. And now could he possibly survive such repeated bleeding ? That he died from loss of blood was the opinion of every person who heard the evidence, 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 loss of blood, Mr. Wakley and the jury were 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 was thus received as evidence of the best possible treatment under the circumstances,—and a verdict pro- nounced 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 everything goingon 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 no conceivable circumstances could justify, only shows the lamentable state of darkness in which the profession are at this very moment on everything connected with the proper treatment of disease! When St. John Long, or any other unlicensed quack, by an oyer 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 oc- casion by practitioners who kill their man every day with the lancet,— not from a strong powerful man, but from a person so weakly that during the excitement of a trifling dispute with his master, he 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 an error, it was on the safe side ! If such things be permitted to be done in the heart of the metropolis, not only without censure, but with something like praise, even homicide may henceforth cease to be looked upon as a reproachable act. The oidy thing required of the perpetrator is, that he should do it under the sanction of a diploma and secundum artem ! LECTURE VL 141 But, Gentlemen, to return to Ague, and the other morbid motions which led to this digression. Some of you may be curious to know how so simple a thing as the Ligature can produce such a salutary effect in these disorders. I will tell you how it does this—and the explanation I offer, if re- ceived 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 par- ticular portion 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 mentally insane. In all these diseases, the atomic movements 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 withdrawn from the various nerves through which it influenced the entire economy. The consequence of all this is, that 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 associated 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 beyond the control of the Brain, resemble so many race-horses that have escaped from the control of their riders—one stands still alto- gether, another moves forward in the right course perhaps, but with va- cillating and uncertain step, while a third endangers itself and everything 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 cere- bral actions, must with equal celerity influence the previous motive condi- tion 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 around the arm of a healthy person, you would to a dead cer- tainty excite his Alarm or Surprise. Now, as both of these are the effects of novel cerebral movements, should you not thereby influence in a novel manner every part of his economy ? 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 palpitate—they would change color, 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 proportionally long. But in the case of a person already trembling and pale from another cause, the very natural effect of suddenly tying a liga- ture 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 reversing every previously existing movement of the body. The face that before was pale, would now become redder and more life-like ; the trem- bling and spasmodic muscles would recover their tone; the heart's palpita- tions would become subdued into healthy beats; and a corresponding improvement would take place in every other organ and function of the body. The ligature, then, when its application is successful, acts like every other remedial agency; and a proper knowledge of its. mode of action affords us an excellent clue to the mode of action of medicinal sub- stances generally,—all of which, as you have already seen, and I shall still 142 LECTURE VI. further show, are, like the ligature, capable of producing and curing the various morbid motions for which we respectively direct their administra- tion. 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, Gentlemen, is the principal organ to which, in most cases, you should direct your reme- dial 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 throw cold water on his face, put harts- horn, 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 recall 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 would endeavor to screen any of its members from the contempt they merit, when they have so far outraged everything like decency and com- mon 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-in- formed midwife, in the case of children that are still-born—children 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 mid- wife wants. And if you 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 crying, 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 weep and have a convulsion fit of the epileptic or fainting kind at the same moment. Convulsive sobbing is a phenomenon perfectly incom- patible with these movements—for it depends upon a reverse action hi 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. Gentlemen, these persons do not know how difficult it is to get a child in convulsions to feel at all;—and in proof of this, I may tell you, that 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 what- ever 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 gravely requested to meet an old woman' in consultation—a nurse or midAvife, I forget which, who being much with children, must necessarily be wonderfully clever in the cure of their diseases. You smile, doubt- less, that I should be asked to do anything of the kind; but it was in the case of the child of a relative; and relatives, you know, sometimes take strange liberties with each other. Still it was not altogether to tell you this, that I reverted to the case in question—it was, on the contrary, to show you what a wise person she proved, the female doctor who, on this occasion, was proposed for my coadjutor. On being asked by the mother what should be done in the case of a return of the convulsion fits, the old lady answered, " 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 LECTURE VII. 143 in which, if you were to roar till your lungs cracked, you could not by any possibility make the subject of it hear at all. What is the present routine treatment of an infant taken with convul- sion fits ? That I can scarcely tell you ; but when I settled in London, some four years ago, the Court doctors, who, of course, give the tone to the profession in the country, 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 cases, repeatedly! In addition, they were in the habit of leeching, purging, and parboiling the poor little crea- tures in warm baths! If mothers will really suffer their children to be treated in this manner, surely they only deserve to lose them. The strong- est and healthiest child in existence, far less a sick one, could scarcely survive the routine practice. But whether you believe me or not, there is nothing more true than what the Duke says in the play of The Honeymoon, such fits are ----seldom mortal, Save when the doctor's sent for. In the case of adult epilepsy, especially at the commencement 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 continuance. 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, everything depends upon the suddenness and unexpectedness of the particu- lar 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 circum- stances which surprised the person who heard it, has charmed away a paroxysm of the severest pain. In the army, the unexpected order for a march or battle will often empty an hospital. The mental excitement thereby produced, has cured diseases which had baffled all the efforts of the most experienced medical officers. In the words of Shakspeare, then, you may positively and literally Fetter strong madness with a silken thread. Cure ache with air, and agony with words! LECTURE VII. unity of all things—diseases of women—cancer—tumor—pregnancy— parturition--abortion--teething—hereditary periodicity. Gentlemen, Many of you have doubtless read or heard of Dr. Charming 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 bear- ing so strongly upon the subject of these lectures, that I cannot resist the temptation to read them at length. How far they go to strengthen the view I have thought it right to instil into your minds, you will now have 144 LECTURE VII. an opportunity of judging for yourselves:—" Intellectual culture," says thin justly eminent person, " consists, not chiefly, as many are apt to think, in accumulating information—though this is important; but in building up a 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 concen- tration 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 philosophical 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 different distances;—thus giving us a grand principle, which we have reason to think extends to, and controls the whole outward Creation. One man reads a history, and can tell you all its events, and there stops. Another combines these events, brings them un- der one view, and learns the great causes which are at "work on this or another nation, and what are its great tendencies—whether to freedom or despotism—to one or another form of civilisation. So one man talks con- tinually about the particular actions of this or that neighbor,—while an- other looks beyond the 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 harmony, connection, unity of all." That such Unity, Gentlemen, does actually and visibly pervade the whole subject of our own particular branch of science—the History of human diseases,—is a truth we have now, we hope, placed equally be- yond the cavil of the captious and the interested. In this respect, indeed, we find it only harmonizing with the history of every other thing in na- ture. 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 con- stantly in view the innumerable diversities of shade and period, which different intermittent fevers may exhibit in their course. It has been said of Faces, ---Facies non omnihus una, Nee diversa tamen— And the same may with equal truth be said of Fevers—all have resem- blances, yet all have differences. For, betwixt the more subtle and slight thermal departures from Health,—those scarcely perceptible chills and heats, which barely deviate from that state,—and the very intense cold and hot stages characteristic of an extreme fit of ague, you may have a thousand 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 motive condition of the muscles of particular patients. One man, for example, may have a tremulous, spasmodic, or languid 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 LECTURE VII. 145 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 perspira- tion outwards, there may be,) a vicarious superabundance of some other secretion within: of this you have evidence 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 re- mission, differs with every case. The cold stage, which in most instances takes the patient'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 its paroxysms and periods of return; passing in one case into a fever apparently continued—in anoth- er, reverting by successive changes of shade into those happier and more harmonious alternations of temperature, motion, and period, which Shaks- peare, with his usual felicity, figured as the " fitful fever" of healthy life. If you take Health for the standard, everything above or beneath it—whether as regards time, temperature, motion, or rest, is Disease. When care- fully and correctly analyzed, the symptoms of such disease, to a physical certainty, will be found to resolve themselves into the symptoms or shades of symptom, of intermittent fever. Fever, instead of being a thing apart from man, as your school doctrines would almost induce you to believe, is only an abstract 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 " en- tities" to combat—they are simply variations in the phenomena of the cor- poreal movements ; and in most cases, happily for mankind, may be con- trolled without the aid either of physic or physicians. The same repara- tive power by which a cut or a bruise, in favorable circumstances, 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 where the physician had been only too busy with his interference! It is in these cases of Escape that the gen* erality of medical men arrogate to themselves the credit of a Cure. "Itwas 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, Gentlemen, that everything on this earth which can be weighed or measured, is Matter—Matter in one mode or an- other. What is the difference betwixt a piece of gold and a piece of sil- ver of equal shape and size ? A mere difference of degree of the same qualities,—a different specific gravity, a different color, a different ring, a different degree of malleability, a different lustre. But who in his senses would deny that these two 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 sub- stance 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 we 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 everything in turn change into some- thing else,—the organic passing into the inorganic, solids into liquids, liquids into gases, life into death, and vice versa ? The more you reflect 146 LECTURE VII. upon this subject, the more you must come to the opinion, that all things at last are only modes or differencs 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. But the approaches to unity may be traced throughout everything in nature. Betwixt the history of man's race, for example—the revolutions of em- pires, 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 connection of time and place. All events which happen in that portion of space and period of time, are compre- hended in his design, though, in other respects, different and unconnected. They 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 economy, 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 corporeal and intellectual power. The girl, the boy, the woman, 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 with everything else in nature; for all things in the beginning approach more nearly to simplicity. The early foetus of every animal, man included, has no sex,—when sex appears it is hi the first instant 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 preservation 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 long time even after birth, 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 foetal 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 hi its mother's womb, converts more and more the unity of sex of the infant into diversity. But such diversity, 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 puberty the difficulty has altogether vanished. Then the boy becomes 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 LECTURE VII. 147 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 Catamenw 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 develop- ments of an Intermittent Fever simply,—as various in its shades, it is true, as a fever from any other cause may become,—producing, like that, every wrong 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 the body. Before 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 when women can bear children, to the period when this reproductive power ceases. As with a fever it comes into 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 anything analogous been observed. 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, espe- cially as they have every opportunity of settling the question definitively. 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 recurrence of the phenomenon. It is therefore without question 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 catamenia is too profuse 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 impaired. Then, indeed, as in the case of other secretions imperfectly performed, pain may be an accompaniment of this particular function. Need I tell you that no female of a certain ag§ can become the subject of any Fever without experiencing more or less change in this catamenia.' or that during any kind of indisposition, 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 of prescribing astrin- gents 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 whole economy, very frequently puts the catamenia, in common with every other function, to rights,—when the practitioner who prescribes them has no idea that he is doing more than attending to the derangement of a part. He accordingly places pro- fuse menstruation in his list of local diseases! when deficiency or sup- 148 LECTURE VII. pression of this secretion, on the contrary, chances to be the co- incident feature of any general constitutional change,—a thing which 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 corporeal derangement! And under the formidable title of " obstruction," 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, with just the same reason, laugh at the fashionable practitioners of the day, when you find them leeching their patients for [defective or suppressed menstruation,—a derangement of function which a Passion might produce, 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 water" 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 treatment is obvious—at- tention to temperature; for, in every case of catamenial irregularity, whether as regards quantity, quality, or period, the temperature of the loins must be more or less morbid,—one patient acknowledging to chill, ano- ther to 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 remedies singly, you may produce the most perfectly salutary results in numerous cases. In both instances, cold, -warm, and tepid baths may also be advantageously employed, ac- cording to the varying circumstances of the case. The majority of women who suffer from any general indisposition short of Acute Fever, are more or less subject to a particular discharge which, by the patients themselves, is very often termed Weakness, but which is more familiar to the profession under the name of Leucorrhaa 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 acknowledged that the local flow was one day more, another less, and that she had, besides, the chdls, heats, and other symp- toms of general constitutional derangement. But of that derangement, the discharge so often supposed to be the cause, is, in the first instance, 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 superadded cause or aggravant. In cases of this kind I am in the practice of prescribing quinine, iron, or alum, 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 remarka- ble for their professional eminence, as for their utter want of high profes- sional knowledge, had been previously treating by leeches, some apply- ing these to the loins, which, in every case, whether of whites or irregular 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 ob- LECTURE VII. 149 tained, more delusive? Bark, iron, opium,—these are the remedies for cases of this description; and the general constitutional improvement which, for the most part, follows their use, together with the disappear- ance of the more prominent local irregularities for which 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—and you will find it useful in most—is a plaster to the spine to warm and support it; though cold, hot, or tepid fomentation to the loins or womb 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. Now, what is Cancer ? What but a slow and painful decomposition,—a Canker or blight of the particular organ affected. The manner in which Cancer of the breast generally commences is this :—A tumor, at first smaller than a nut, pos- sessing more or less hardness, and to a certain extent circumscribed, 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, which soon deepens into a " pricking," " darting," or " shooting" pain,—for such are the various phrases by which different patients describe their pain. The tumor slowly but gradually increases in size and hardness, whde the pain becomes more and more intolerable and "lancinating." The disease, in every case, is intermittent, and in most instances, this intermission is periodical, the tumor being one day perceptibly diminished, another as obviously enlarged. The pain, in like manner, disappears 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 tumors, after removal by the knife, were usually, from motives 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 appearance, the tumor had a resemblance to the substance of the brain, or to lard, jelly, or was of a mixed character, disputes 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 ! Oh ! it matters very little what that 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 ? Gentlemen, 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 dis- ease ; or, to express myself 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 when the catamenial secretion is about to terminate for life. Can such termina- tion take place without a new corporeal revolution? Certainly not: every female at such time suffers more or less from constitutional dis- 150 LECTURE VII. order. Analyze this disorder, and you will find that it resohos 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 difficulty to cure it simply—the difficulty in most instances— the absolute impossibdity 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 lun^s, an organ of the least importance to her own vital economy. It is a part superadded for the preservation of the race. Rudimental, or all but absent in the child, this organ only reaches its full maturity of de- velopment when the girl becomes the woman. After the woman ceases to bear children, or whether 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 generally more or less absorbed, though you occasionally meet with instances where it becomes enlarged be- yond its previous size. In fewer cases still it takes on a pro- cess of decay—in other words, it becomes Cancerous. But nature in this instance, 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 now, not only so far as the individual economy is concerned, but so far also as regards the race, has become a useless 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 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. Gentlemen, 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 affect- ed. I lately attended the sister of a Fellow of the Royal College of Physicians, who was first induced to consult me, from hearing that I look- ed 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 whole progress of the disease she suffered more or less from aguish feelings. Previously to my seeing her, she had been visited by a surgeon of eminence, who 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 " inflamma- tion," which doubtless suggested their employment, the breast in that in- stance was generally cold ! Would not a warm plaster under these cir- cumstances have been of more service? You, Gentlemen, may try at least, and if you do not find it produce more or less relief 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 advantage in this or any other disease, without attending to the chrono-thermal principles of paroxysm and remission. Arsenic, quinine, opium, copper, prussic acid, may be all successively 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 cases of chronic disease, namely, that no medicine will produce its beneficial effect for any great continuance in LECTURE VII. 151 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 when tried in the first in- stance. No medicinal agent had a greater reputation at one time, in the treat- ment of cancer, than arsenic; arsenic in fact was supposed to be a wonder- ful specific in cases of that nature. What was the consequence ? Like every- thing else in the world, whether person or thing, physician or physic, that ever enjoyed the temporary distinction of infallibility, after a few 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 appetite im- proved, and the general health increased. Unfortunately," he continues, " these good effects have not been permanent. By increasing the dose we 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 will the best medicine cease, after a time, to do the work it did at first. But a physician who should, on that score, despise or decry a power that had, for a given time, proved decidedly advantageous in any case, would be just as wise as the travel- ler who, on reaching his inn, instead of being thankful 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 circum- stances mentioned 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 constitutional power, and change and change until you find improvement to be the result; and when such result no longer fol- lows 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 you had formerly tried with benefit; for when (if I may speak so metaphorically) the constitution has been allowed time to forget a remedy that once beneficially influenced it, such remedy, like the re-reading of a once-admired, but long-forgotten book on the mind, may come upon the corporeal economy once more with much of its original force and freshness. In all such cases, then, you must change, combine, and modify your medi- cines and measures in a thousand ways to produce a sustained improve- ment. Arsenic, gold, iron, mercury, creosote, iodine, opium, prussic acid, &c, may be all advantageously employed, both as internal 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 tumor, gradually increasing in dimension. And so exceed- ingly weak do the atomic attractions of the matter of the breast become during the change produced by the disease, that scarcely has the atmospheric air been allowed to come in contact with the tumor, than it commences to mortify and die—falling away in most cases (asit did indeed in the case of the lady to which I have already alluded), after a certain time, in a dead corrupted mass. The ulcer which it leaves behind, is, in all such cases, extremely foetid, and shows a great disposition to spread; the reason of which 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 152 LECTURE VII. power 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 when 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 mush- room-like and other excrescences springing from the sides and bottom of the ulcerous and decaying part, and that too with a rapidity truly astonish- ing. A case of this kind I lately attended with Mr. Farquhar of Albemarle Street. Unless every portion of these fungoid bodies be completely re- moved, you must not hope to arrest the progress of the disease. The whole surface of the ulcer should be cauterized and completely destroyed with a burning iron, nitrate of silver, ammonia, or potass. All four may, in some cases, be resorted to with advantage. Nor must you here spare any part that shows even a symptom of weakness; but cauterize, and cauterize again and again, until you get red, small, healthy granulations to appear. The dressings which you will now find most successful, are ointments or other preparations of the red oxide of mercury, iodine, arsenic, creosote, 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 now 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 Stuart, while practising in the West Indies, where the disease is more frequent than in England, had many opportunities of making him- self acquainted with every one of the various states and stages of cancer —and since I settled in London, where he also now practises, he has shown me cases of this kind, which he has treated with the greatest suc- cess. 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 generation. How many women at one time remarkable for a large full breast, in the course of years lose every appearance of bosom by the slow but imperceptible process of interstitial absorption;—what inconvenience do these suffer in conse- quence ? But for the tendency to spread, and the accompanying pain, cancer would 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 produce that extreme sensibility of nerve, or that intolerance of external impression, that con- verts the merest touch into the stab of a dagger. Strong people seldom complain of pain: it is bloated and emaciated persons who mostly do so. Keep up your patient's health, then, by every means in your power, and she may live as many years with a cancer of the breast, as if she had never suffered from such a disease. Sir B. Brodie mentions the case of a lady who lived twenty years with Cancer, and died at last of an affection of the lungs, with which it had no necessary connection. What shall I say in regard to amputation of the breast ? Will amputation harmonize the LECTURE VII. 153 secretions ? Will it improve the constitution in any way whatever i Those patients who, in the practice of others, have been induced to under- go operations, have seldom had much cause to thank their surgeons,—the disease having, for the most part, reappeared at a future period in the cicatrix of the wounded part. Gentlemen, you have only to look at the pallid, bloated, or emaciated countenances of too many of the sufferers, to be satisfied that something more must be done for them than a mere sur- gical operation,—a measure doubtful at the best in most cases, and fatal in not a few. Shiverings, heats, and sweats, or diarrhoea, or dropsy,— these are the constitutional signs that tell you you have something more to do than merely to dissect away a diseased structure, which structure, so far from being the cause, was in reality but one feature of a great totality of infirmity. That the knife may sometimes be advantageously employed I do not deny, but instead of being the rule, it should be the exception; for the majority of honorable and enlightened surgeons will admit how little it has served them in most cases beyond the mere pur- pose of temporary palliation. When you hear a man now-a-days, speak- ing of the advantage of early operating, you may fairly accuse him of ignorance, with 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 was a European, the other a native of India. Let me now say a few words on Tumors generally; premising that the term tumor is merely the Latin word for any Swelling, though we 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 tumor in this or that situation. Now, such prac- titioners by this very expression show how much they have busied them- selves with artificial distinctions—distinctions which have no foundation in nature or reason—to the neglect of the circle of actions which consti- tute the state of the body termed health. Never did a tumor spring up in a perfectly healthy subject. In the course of my professional career I have witnessed tumors 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 tumor was alternately more and less voluminous. Every individual, we have already shown, has a predisposition to dis ease of a particular tissue. Whatever shall derange the general health may develope the weak point of the previously healthy, and this mav be a tendency to tumor in one or more tissues. The difference in the organic appearance of the different textures of the body, will account for anv apparent differences betwixt the tumors themselves ; and where tumors appear to differ in the same tissue, the difference will be found to be onlv m the amount of the matter entering into such tissue, or in a new arrange ment of some of the elementary principles composing it It is a law of the animal economy, that when a given secretion becomes morbidlv deficient, some other makes up for it by a preternatural abundance If you do not perspire properly, you wdl find the secretion from thekidnevs or some other organ increase in quantity. I was consulted some time ago by a female patient, whose breasts became enormous from excess 154 LECTURE VII. of adipose or fatty deposit. Now, in the case of this female, the urine was 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, gentlemen, this chemistry is of a higher kind than the chemistry of the laboratory;—it is Vital Chemistry under the influence, as I shall afterwards show you, of Vital Electricity. Secretion of every kind is the effect of this vital chemistry; and Tumors, instead of being produced, as Mr. Hunter supposed, by the " organization of extra- vasated blood," are the results of errors of secretion. They are principally 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 composition. If you search the records of medicine upon the subject of tumors, you will find that the medicinal agents by which 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 favorably of the bark; the natives of India prefer arsenic; while most practitioners have found iodine and mercury more or less serviceable in their treatment. Gentlemen, do you require to be told that these substances have all succeeded and failed in ague I Wonder not, then, that each has one day been lauded, another decried, for every disease which has obtained a name, tumors of every description among the number. We now 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 catalogue 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 we find it in the case of pregnancy. Can the seedling become a herb in the frost of winter, or the sapling grow up into maturity without a series of changes in the temperature and motion of the surrounding earth.'—No more can the infant germ become the foetus without a succession of febrile revolu- tions 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-lips, 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 instance, some of the parts or divisions of the mother's brain must act in associ- ation or simultaneously, while others act independently or in alternation, for otherwise you could not understand 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 want 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 LECTURE VII. 155 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 which she is then liable—more particularly in the periodic vomitings which 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 who has been much bled ? It appears to me probable that the infant's growth must take place principally during the period of maternal sleep. For it is chiefly in the morning, just as she awakes, that the mother experiences those vomitings and other symp- toms from which I infer the brain has been too long neglecting her own economy. But even as a natural consequence of the more favorable alternations of cerebral movement which take 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 unu- sual manner—she becomes at certain times pale and flushed alternately, and, as in the case of other fevers, frequently complains of headache. When blood-letting—the usual refuge of the ignorant—is in such cases tried, the blood drawn exhibits the same identical crust which, under the name of " buffy-coat," "inflamed 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" natu- ral 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 everything in Nature a natural process, from the fall of an apple to the composition of the Iliad! Everything 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 certainly an Intermittent Fever?—What dis- orders have not originated in pregnancy ? What, in cases where they previously existed, has it not like every other fever cured? If it has produced Epilepsy, Apoplexy, Tooth-ache, 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 mar- riage, squinted to perfection. But when she became pregnant her Squint diminished, and long before the period of her confinement it was cur- ed ;—never did I see such an improvement in the face of any person. Still, if pregnancy has cured squint, I have known cases where it pro- duced 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 resemblance of 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 anything with me; for wherever I have had an interest in knowing the truth, I have generally appealed from the decree of that unsatisfactory court to the less fallible decision of the Court of Fae" And what does Fact say in this instance ? Fact says that child-labor, 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 156 LECTURE VII. guessed it; for I could not suppose that parturition, unlike every other great revolution of the body, could be either a yam-less or an unperilou.s state, or that it could be free from the chills, heats, and remissions, which I had always observed in cases of that character. Still not being a per- son easily satisfied with guess-work, I took the trouble, in this particular instance, to interrogate Nature. And as sure as the sun ever shone on this earth, Nature completely verified the fact of my anticipation, that parturition, in every instance, is an intermittent fever. In some of my medical books, too, I found shiverings among the numerous other symp- toms 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 complains 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 revolu- tions take place in the same manner as ague, but, like ague, they may both be influenced by medicines as well as by mental impressions. Indeed, in most cases of parturition, the labor-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 conse- quences ensue. When the foetus is fairly developed in the case of preg- nancy, and the labor 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 occasional 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 symptoms or shades of symp- toms of ague. Moreover, when a woman gets into a habit of miscarry- ing, such miscarriage, like an ague, recurs periodically, and takes place almost to a day at the same month as the first. A lady who 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 pregnant to let me hear from her within a fortnight of the time she might expect to miscarry. She did so, telling me at the same time she knew she should soon be taken ill, as she had already had shiverings. I directed her to use an opium suppository 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 smce, 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 de- cidedly disagree, will be found the most generally useful of our medi- cines in checking the habit of miscarriage. Need I tell you that in no case should it be continued 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 accidents. A lady, who from fright during a storm, miscarried of her first child, a boy, never afterwards when, pregnant with boys, could carry them beyond the time at which she miscarried of the first. On the other hand, she has done well with every oue of her daughters, five in number, all of whom are at this moment living. LECTURE VII. 157 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 certam degree of anxiety, if not with fear. Why is this.' Why, but because, as in the case of pregnancy, 6e/ore the dormant germ can be called into action—before the embryo tooth can be developed—there must be a complete corporeal revolution, an intermit- tent 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 proper study of nature. The embryo tooth, like the em- bryo infant, 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 womb. 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 conse- quently be less painfully accomplished; just as under the same circum- stances the parturient mother will more surely bring forth her young in 6afety. In those cases, on the contrary, where the child is weakly »r out of health, the fever will be proportionally 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 which its increasing growth produces in the gum, to aggravate and prolong the constitutional disorder. It is first an effect, and then a superadded cause, or aggravant. Gentlemen, in this fever we have a fresh illustration of the unity of dis- ease—a fresh proof that Intermittent Fever, in some of its many shades, is the constitutional 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—convulsions, apoplexy, lock-jaw, squint, curved spine, with all the family of structural disorders, from cutaneous rash and eruption 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 with 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, with a little dill or aniseed to comfort and warm it—having recourse also to friction with hot flannel, or to the warm bath. During the period of remission, the exhibition of small doses of calomel, quinine, or opium, with prussic acid occasionally, will often anticipate the subsequent fits, or render them trifling in comparison with those that preceded them. But, Gentlemen, I should explain to you that you may sometimes be met with considerable opposition on the part of the wiseacres of the profession, when you propose Quinine or Prussic Acid in infantile disease. I was once requested to see the infant son of a gentleman living in Hertford Street, which had been suffering from convulsions and 15S LECTURE VII. flatulence. You remember what I told you of this disease—that infantile convulsion depends in every instance upon cerebral exhaustion. It is often the effect of cold, and frequently follows upon a purge ; I have known the disease come on after the application of a leech. " No fact," says Dr. Trotter, " is better known to the medical observer, than that frequent convulsions 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 pro- duced by the evacuation. But to return to the child in question. Before I saw it, the poor little thing had been the subject of thirteen distinct convulsive fits, with an interval of remission of longer or shorter duration between each. Whaf do you think was the treatment to which this infant had been in the first instance subjected by the practitioner, then and previously in attendance.' Though its age was 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 bug- bear, 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 attending Sangrado, I suggested quinine as a possible preventive. The man of cups and lancets stared, but acceded. The quinine, 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 weeks,—when the convulsive paroxysm again recurred—from "what cause, I know not, unless it might be from a Purge which its mother injudiciously gave it on the morning of recur- rence. The flatulence, too, with which 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 resembles everything in nature. Take colors, 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, in his design, a trace of either one or the other. In the case of the infant just mentioned, the dose of prussic acid was about the twenty fourth part of a drop, and its good effects were very immediate and very obvious. Nevertheless, when the attending prac- titioner came in the morning to see the little patient, then completely out of danger, he was 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! Gentlemen, though I will not condescend to name the individual who having so heroically, in this instance, swallowed the camel, found such a difficulty afterwards in approaching the gnat, I may state for your diversion thathe is a very great little man in his way—being no less than one of Her Majesty's principal accoucheurs—a proof to you that " Court-/oo/s" are as common as ever. Indeed, the only difference I see in the matter is this,—that LECTURE VII.] 15s) whereas in the olden times such persons 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 prac- titioners of midwifery. For by means of that introduction, numbers of badly educated persons not only contrive to worm themselves into the confidence of families, but by the vde arts to which they stoop, and the collusions and conspiracies into which they enter with 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." Notwithstanding the howl and the scowl with which that letter was received by the apothecaries, it is pleasing to see that the public are now beginning to be aware of the fact that more children perish by the meddlesome interference of these persons, than have ever been saved by the aid of their instruments. How many perish by un- necessary medicine common sense may form some notion—for the fashion of the day is to commence with physic the moment the child leaves the ■womb—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 sug- gested such a custom.' \Vho but a creature with the mind of a mechanic and the habits of a butcher would think of applying a cupping instrument behind an infant's ear to stop wind and convulsions ? The nurses and midwives of the last age knew better. Their custom in such cases was to place a laurel-leaf upon the tongue of the child. The routinists laughed at what they called a mere old woman's remedy, and declared that it could have no effect whatever; they little knew that its strong odor and bitter taste depended upon the prussicacid it contained! Gen- tlemen, you may get many an excellent hint from every description of old women 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 medi- cine upon which its virtues 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! Gentlemen, there is such a thing as Hereditary Periodicity. If you take a particular family, and, as far as practicable, endeavor to trace their diseases from generation to generation, you will find that the greater number die of a particular disease. Suppose this to be pulmona- ry 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 which they become its victims is equally determinate—in one this disease appearing only during childhood, in another restricting itself to adult life or old age. By dili- gently watching the diseases of particular famdies, and the ages at which they respectively reappear, and by directing attention in the earliest stages of constitutional disorder to those means of prevention which I have in the course of these lectures so frequently had occasion to point out to you, much might be done to render the more formidable class of disorders of 160 LECTURE VII. less frequent occurrence than at present—mania, asthma, epilepsy, and consumption might thus, to a certain extent, be made to disappear in families where 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 was in the course of printing I received the three following letters, which, 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 graduated in 1824, and immediately after- wards received an appointment to the Medical staff of the army. I con- ceive that, phrenologically speaking, my head is a fair sample of the com- mon run; and during my period of pupilage I had the very best opportu- nity 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 in 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 ob- servations I made on the practice of my comrades mend the matter. The Sangrado system was in full operation. Like my neighbors, I did as Iliad been taught, but, the more I considered the result of our practice, the more convinced I became that we were all in the dark, and only tamper- ing with human life most rashly, in a multitude of cases. Still 1 thought it my duty to do as my superiors 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 mar- ried man has no business to be in the army, I resolved to embark in private practice, expecting that with the excellent opportunities of becoming ac- quainted with disease in every form which I had possessed in the army, and aided by numerous friends, I might rise easily in my profession. I settled in Edinburgh, and became a Fellow of the College of Physicians. I soon found, however, that in leaving the army for private practice, I was ' out of the frying-pan into the fire;'—there were obstacles to success that I had never even dreamt of. In the military hospital I had only to say ' do,' and it was done ; and I knew to a nicety the effect of my reme- dies, for in every instance they were faithfully administered. In private practice all this was changed. There, in order to live like other men by labor, I found it absolutely essential to practise 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 was 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 patients. I endeavored to trace the career of these favored 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 was compelled to believe that these qualities often were a bar to a phy- sician's rise, and that flattery and humbug were far more valuable quali- ties in the eyes of the world, and, if skilfully practised, would ensure first-rate eminence. Lower down I found a certain number who, like myself, did their best to retain practice, and preserve the vultus ad sidera. But when I looked to the bottom of the tree, I saw around it a host of creatures, void of any scruples, determined to acquire wealth, and to act on that ancient maxim, rem si possis recte; si non, quocunque modo rem [Make money,—honestly if you can; if not make money] ; men who, void of integrity and all honorable self-respect, looked upon such as differed LECTURE VII 161 from them in this point as insane. I certainly 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 dissatisfied 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 would 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, who thought me ' getting on so nicely,' but who were unable to read my real feelings, and at the expense of being ridi- culed by many who supposed me actuated 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 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 lancets, I grow very rusty. Perhaps you will say so much the better. And now, why have I troubled you with 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 know- ledge of the principles of its application. Most sincerely do I congratulate you on your discoveries, and most confidently do I look forward to the day, not distant, when they will be duly appreciated. I have myself been all but a martyr at the shrine of Sangrado, but nothing will ever 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 with 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, with perfect succes. Should time permit, I "will furnish you with various instances. I have no doubt the public will eventually appreciate the superiority of your views, and take its leave of the nefarious apothecary, whose existence seems to depend upon the deluging of his patient with 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 with the profession and the public, the evidence of a country practitioner as to the result of their application 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 simplicity of your views, as there detailed, and we determined to put them to the test. You will be gratified to hear, that neither 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 con- firmed us in the truth of your opinions by our increased success. I have treated cases of Apoplexy with the most perfect success with no other means than the application of cold water dashed over the head and face, —following that up after the fit had gone off, with quinine, ammonia, and 162 LECTURE VII. 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 children have been apparent- ly 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. My 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 practice 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 which medicine was formerly so much en- veloped by its professors.—Yours, my dear Sir, very faithfully,— " Henry Smith." Since the publication of the second edition of this work, Mr. Smith confirms his previous statement by a further experience 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 follow- ing :— From H. C. Deshon, Esq. Surgeon:—" Shroton, Blandford, 10th Novem- ber, 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 your care, and I am now glad to hear that she considers herself better. * * I have cured palsy and epilepsy by hydrocyanic acid, quinine, arsenic, &c, and have also found these medicines of avail in convulsions and dropsies. Indeed, I am confident that most diseases may be cured (1 refer to chronic diseases chiefly) by medicines useful in ague, and on your principles, with reference to Periodicity and Temperature. Dear Sir, very truly yours,—Henry Deshon." From Charles Trotter, Esq., Surgeon:—" Holmfirth, near Huddersfield. —Dear Sir,—Having read your Second Edition, Fallacies of the Faculty, 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 what are termed inflamma- tions without the patient 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 favorable result without 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 medicine without any bleeding whatever. And I may at the same time observe, the recovery was in every case quicker, and the con- sequent 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 word ought to be written in letters of gold. Yours faith- fully,—M. Fogarty." From H. W. Bull, Esq., Surgeon, R. N.:—" Workingham, 5th February, 1843.—Dear Sir,—I beg to forward to you a statement of my own case, and one or two cases of others treated on your plan, all of which are evidence of the value of the chrono-thermal system. I was attacked by paralysis on the 28th October, 1841, which deprived me of the use of my right arm LECTURE VII. 163 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 weak,—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 afterwards to state by letter, the particulars of my case to you. The first prescription you were 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 followed the plan laid down by you with very great advantage,—changing the different medicines from time to time as occasion required; and I can now walk two miles without assistance. 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, Royal Navy." Cases alluded to in the above letter. " Case 1.—Mr. C------was attacked with rheumatism in almost every joint, great difficulty of breathing, and violent pain in the chest. I pre- scribed 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 was prevailed on to take the emetic. Tt ope- rated soon and gave him instant relief. I followed it up with quinine and colchicum : he is now 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 from Binfield in convulsive fits. The pupils of her eyes were much dilated, and the fits followed each other in rapid succession. I first gave her a purgative, and followed it up with prussic acid;—this was on a Monday. The fits became less and less frequent, and from the following Friday they entirely ceased. I also lately used the prussic acid with the best effect in the case of a child seven weeks 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 sixpowders containing quinine and a little calomel; no other medicine wasprescribed. There has been no squint since the powders were 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 doctrines on dis- ease. 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 Faculty with 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 164 LECTURE VII. 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 decided Pleurisy and Pneumonia according to the Chrono-thermal 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 eme- tics, 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, Member of the Royal College of Surgeons, and Licentiate of the Apothecaries' Company, London." 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 practice. I was 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 superficial thinking as the present. Those prejudies, 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 woman 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 compared effects with then supposed causes, believing nothing upon the mere assertion or ipse dixit of any authority, however high. It was 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 was also common to place consumptive patients in cow-houses, to breathe the odor of the animal, then believed to be a specific for that complaint. Beddoes, however, prescribed digitalis (fox-glove); maintaining that he could cure consumption with that drug, as certainly as he could cure an ague with bark. Yet all these things are now candidly allowed to be only specious fallacies. Soon after this originated 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 Guy's Hospital, promulgated to the world as true, in his attrac- tive 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 was generally known at the druggists' shops in London by the name of Curry powder! How many thousands of lives have been destroyed by the mercurius dulcis, or sweet mercury, as calomel was once called ! On the subsidence of the Hepatic mania, Mr. Abernethy appeared upon the medical stage with his LECTURE VII. 165 blue pill and black draught, which, with decoction of sarsaparilla, were 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 few exceptions, has up to the present time been zealously advocated by the whole medical fraternity. < The Sanguinary Science,' as you have most appropriately named it, has been, and is still taught and inculcated in all the English schools of medicine ; and sanctioned 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 word was ' You must be bled !' Or if the operation had been performed, the next most important question 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 nature—so much poisonous ditch-water. I re- collect a spruce young surgeon, of the 12th Regiment of Foot, with whom I was in garrison in the Island of Jersey, who made it his boast, that ' when the battalion was 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 with the Director-General of the Army Medical Department, I was of course obliged to follow at an humble dis- tance this terrible practice; for had not the letters V. S., or Vena? 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 was the operation considered to be ! But even at this early period of my life, by a judicious use of Emetic Tartar and other medicines, which I now call Chrono-thermal remedies, I was much more successful in my practice than those who trusted almost exclusively to the lancet. A few years after the time I refer to, a perusal of the excel- lent practical treatise of Dr. Balfour led me to adopt the Antimonial treat- ment. 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 pro- duced not by disease, but by the doctor. But of all the sanguinary projects ever had recourse 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 neighborhood where the patient has rapidly sunk from the 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 red hot iron! What an idea, to call the practice of illiterate quacks in question, when medical men are permitted to perform operations so unprofitable ! Lord Ellenborough's Act for ' cutting and maiming' surely applies to these tor- turers of their fellow-creatures. A very clever physician, whom 1 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 advice, where his case was treated by two medical men, a physician and an oculist, as Inflammation of the Brain. This patient, by their directions, was unmercifully leeched and then cut and hacked, as I have described to you, and he returned 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 which blood-letting has been so universally urged, and that, too, in the face of the great destruction of human life indubitably produced by it, to you, Sir, belongs the honor of 166 LECTURE VII. 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 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 inflamma- tory, which I have lately cured by the chrono-thermal treatment, without the loss of a single drop of blood. With a deep sense of obligation to you for the information I have derived from your various writings, especially the ' Fallacies of the Faculty,' I remain, my dear Sir, yours very faithfully, " J. H. Sprague, M. D." Cases referred to in Dr. Sprague's letter:— Case 1.—I was suddenly called upon to see the butler of Sir C. A. El- ton, Bart., Clevedon Court, who, I was told, had brain-fever, and was " 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 state, when I saw him, was one of great danger. He looked wild and agitated,—his head at intervals being intensely hot, succeeded by a low sinking pulse, and his skin be- dewed with clammy perspiration; he had not slept for seven nights. The case was evidently Delirium tremens. I immediately ordered the cold dash to the head, which was repeated at intervals in the course of the day. Mulled port to be taken occasionally with some cordial medicine and an opiate. The next day he was effectually relieved, having had six hours' oomfortable sleep. A remission of symptoms being thus established, I prescribed quinine, and other chrono-thermal medicines; and at the end of a fortnight he was so far recovered, as to be able to walk a distance of two miles, much to the surprise of all who had 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 mad-house. He is now doing his duty as butler in good health. Case 2.—A girl, aged four, who had been ill four days, was brought to me, with intense pain of head, and the peculiar scream that generally attends inflammatory brain affection. She had much fever, with hard and incompressible pulse—the pupil of her eye was contracted—she was in- tolerant of light, and she had repeated fits of vomiting. Having had her head shaved, cold applications in various forms were employed, and her feet, at the same time, were kept warm with hot water bottles. An emetic was also given, with other medicines, to subdue the fever. In the course of three weeks, this severe case of cerebral inflammation was completely cured, without 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 fever- ish, had great difficulty in breathing and cough, with the metallic sound peculiar to that disease. By an emetic twice repeated, followed up with quinine, and sulphate of copper, in minute doses, to say nothing of warm applications to the throat and other chrono-thermal means, the child re- covered rapidly. Under the old system of leeching, bleeding, and blister- ing, such cases, if the subjects of them survive at all, which is seldom, generally end hi a long protracted weakness 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 as repeatedly bled and leeched. When called upon to see her, she was bringing up LECTURE VIII. 167 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 stopped the haemorrhage. This I followed up with 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 weeks, her health was very greatly improved. In six weeks more, she left Clevedon quite an altered person, and without any apparent tendency to return of the haemorrhage. Case 5.—Mrs. S----, age about 38, applied to me for a lancinating pain of the left side, cough, and difficulty of breathing, increased by inspira- tion, with the other common symptoms of Pleurisy. I prescribed an emetic, and having, by means of this, and antimonials in small doses, sub- dued 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 witnessed, 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 wet, was seized with severe shiverings, followed by violent fever, in course of which the elbow, wrist, and the ankle joints became so swollen, painful, and agonizing, as to prevent his moving in any manner. Emetics, opium, bark, and warm 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 /.—H----D----, age about 50, had for years suffered 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, guiac, and small doses of turpentine, 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. LECTURE VIII. the senses--animal magnetism--the passions—baths--exercise-- homoeopathy. Gentlemen, The Causes of Disease, we have already said and shown, 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 without it. Who ever heard of a corpse taking the Small- pox ? or of a tumor 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 paralysed, the most potent agents have not their usual influence over the parts which such nerves supply. If you divide the pneumo-gastric nerves of a living dog—nerves which as their name imports, connect the Brain with the Lungs and Stom- ac^__arsenic will not produce its accustomed effect on either of these or- gans. Is not this one of many proofs that an external agent can only influ- ence 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 168 LECTURE VIII. manner, do the greater number of our remedial forces exert their salutary influence on the human frame. But whether applied for good or for evil, all the forces of nature act simply by attraction or repulsion. The Brain and Spinal Column—the latter a prolongation of the former—are the grand centres upon which every medicine sooner or later tells, and many are the avenues by which these centres may be approached. Through each of The Five Senses, the Brain may be either beneficially or banefully influenced. Indeed, take away these, where would be the joys, sorrows, and more than half the diseases of mankind ? We shall first speak of Sight. The view of the varied and pleasant country may, of itself, improve the condition of many invalids—while a gloomy situation too often has the reverse effect. There are cases, never- theless, in which pleasant objects only pain and distract the patient by their multiplicity or brightness. Night and darkness, in such circumstan- ces, have afforded both mental and bodily tranquillity. The presence of a strong light affects certain people with headache; and there are persons to whom 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. Laennec mentions the case of a gentleman who, when pursuing a journey on horseback, suddenly arrived at an extensive plain. The view of this apparently interminable waste affected him with such a sense of suffoca- tion that he was forced to turn back. Finding himself relieved, he again attempted to proceed; but the return of the suffocative feeling forced him to abandon his journey. The common effects of gazing from a great height are giddiness, dimness of sight, and a sense of sickness and terror; yet there are individuals who experience a gloomy joy upon such occa- sions ; and some become seized with a feeling like what we suppose inspiration to be—a prophetic feeling that leads them to the utterance and prediction of extravagant and impossible things. Others again, under such circumstances, have an involuntary disposition to hurl them- selves from the precipice upon which they stand. Sir Walter Scott, in his Count Robert of Paris, makes Ursel 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. Everything 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 with some. Many people become giddy, and even epileptic, from looking for a length of time on a running stream; with others, this very scream-gazing induces a pleasurable reverie, or a disposi- tion 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 consists 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 mental ascendency. On no account must you allow your features to relax into a smile. If you perform your trick 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-gazei, one person will become dreamy and entranced; another, LECTURE VIIL 169 sleepy; a third, fidgetty, or convulsed. Who are the persons that, for the most part, submit themselves to this mummery ? Dyspeptic men, and nystenc women—weak, curious, credulous persons, whom you may move tW 7 -m J **. straw or a father. Hold up your finger to them and tney win laugh; depress it, and they will cry ! So far from being astonish- ed W1111^ 1 hear of these people, I only wonder it has not killed hOO* t .the+r?.ou1t^ht—Poor fragile things ! A year ago I took it into my rtwT ff J7}, ■ d 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 nave otten done the same thing with a stamp of my foot. In a case of cancer upon which I tried the « passes," as these manipulations are called, tne lady got so fidgetty, I verily believe, if I had continued them longer, sne would have become hysterical or convulsed ! That effects remedial and the reverse, however, may be obtained from them, I am perfectly satisned. INor do I mean to deny that in a few—a very few instances, tnese or any other monotonous motions, may produce some extraordinary ettects—effects which, however, are the rare exception instead of the general rule. Whatever any other cause of Disease may produce on the numan body these manipulations may by possibility occasion—Somnam- bulism, Catalepsy, or what you please. There is no more difficulty in be- lieving this than there is in believing that the odor of a rose, or the sight of a cat will make certain people swoon away. This much then I am dis- posed 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 with 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 with 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 waistcoat, boddice, and hea- ven knows what all!—I reply, that the charlatans of all countries every day perform their tricks with a swiftness that altogether eludes the un- practised eye. Thousands of persons have seen the Indian juggler plant a mango-stone in the ground, and in the course of a few minutes do what nature can only do in the course of years, make it successively produce a plant with leaves, blossoms, and lastly fruit! How this trick is done, the "witnesses who describe 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 transformations with which their eyes have been cheated. Gentlemen, the transposition of the senses, is only an old whimsy, newly dressed up under the name of " clairvoyance." We read in Hudibras of Rosicrucian 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 advantages, while the' other's only care is not to make 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 move from his place—not a countenance shall change its cast or hue, while lash follows lash, and the blood flows in streams from the back of the culprit. The same scene enacted before a body of newly enlisted lads of equal numeri- cal strength, will alter the expression of every face; nay, a dozen or more 12 170 LECTURE VIII. will drop, some fainting, some vomiting, some convulsed and epileptic. A medical student of my acquaintance, the first time he saw an amputa- tion, 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 steadhiess with which he performed his amputations. To use a vulgar phrase—familiarity breeds contempt. How awkward most persons feel when, 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 convince you of the neces- sity of changing your remedies in disease; 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 work wonders. Do you require to be told that you can influence the whole corporeal motions through the organ of Hearing ? I have stopped the commencing epdeptic 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 a medicine. Certain sounds, on the contrary, set the teeth on edge. The influence of melody upon the diseases of mankind was so fully be- lieved by the ancients, that they made Apollo the god both of medicine and music: but sweet sounds, like other sweets, are not sweet to every- body. Nicano, Hippocrates tells us, swooned at the sound of a flute; what would he have done had he been obliged to sit out an opera i Many people are melancholy when they hear a harp ; yet the melancholy of Saul was assuaged by David's harping. Some persons become furious when a fiddle plays, And others when the hagpipe sings i' the nose Cannot contain their urine,—for Affection, Mistress of Passion, sways it to the mood Of what it likes or loathes.—Shakspeare. Everybody has heard of the wonderful effects of the Ranz 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 with 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 which 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 hound.—Byron. How strangely some people are affected by Smell. Who that had never seen or experienced it, would believe that the odor of the rose could pro- duce Fainting ? or that the heliotrope and the tuberose have made some men asthmatical ? There are persons who cannot breathe the air of a room containing ipecacuan, without suffering from asthma. The smell of musk, LECTURE VIIL 171 so grateful to many people, sickens some. An odor, 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 gushbus non est disputandum. Might not the Red Indian, when taunted for devouringver- min, retort upon the " Pale-face" for his mite-eating propensity ? The Esquimaux, who 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 whisky as any Irishman among us—that is, before Father Matthew and Temperance Societies became the rage. How you would stare if you saw a man, in his senses, chewing quick-lime; yet I have seen some hundreds at a time doing that. I allude to the practice of the Asiatics, who first wrap up a little portion of lime in a betel-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 wonder that fine ladies have sickened at the sight of a quid. Was there ever such a fancy as that of the Chhiese, who eat soup made of birds' nests',! Morbid in the first in- stance, 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 whole sensa- tions then are, doubtless, more or less deranged. What extraordinary likings and longings ladies in the family way generally take ! Some will eat cinders, some have a fancy for fats and mice, and some, like French- men, 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 bite, at any price. If you smile, and look incredulous at this, how will you receive what I am now going to tell you ? WhUe I was myself studying at Paris, some fourteen or fifteen years ago, a woman was tried for decapitating a chfld. When asked her motive for a crime so horri- ble, she replied, " I'envie d'unefemme grosse." Well now, I think we have had quite enough of Tastes—We shall there- fore say something of Touch. You wdl tell me, perhaps, not to trouble you on that subject;—no great good or ill can happen from a touch, you wdl say But here you are mistaken: many curious and even dangerous affections may originate in touch simply, provided it be of a novel or unu- sual 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 appli- cation of either the one or the other to the throat or fauces may vomit vou 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 what other medical men have seen, but I have over and over again witnessed 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. You all know the effect of tickling. Now what is tickling but a succession of short touches ' And see how wonderfully it affects most people !-oh, you may 1 memen mad by it. Though it has been carried so far, m some cases as To have produced convulsions and even death itself Mr. Wardrop actually found it efficacious in some convulsive affections. I have already actually luuim application of a ligature to the arm oHe^sTel"^fit of manTa' ?pileps??&c. Now the influence of that a™a°rentlvX application depends upon the cerebral attention which ftTcTtesVrough the double influence of sight and touch. As I hinted o vou 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 occa- 172 LECTURE VIII. sions, have aided its efficacy. How many virtues were, at one time, attri- buted 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 deceived 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, which your mummery inspired, 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, impos- ture may succeed ! In what does the adult differ from the infant—gullible man, who gives his gold for an echo, from the chdd who caresses its nurse when telling lies to please it? Ignorance in degree makes the only difference. Gentlemen, let us now inquire into the manner in which 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 va- riations 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 together ? Are not the resemblances, in many instances, so very close that you could not tell one from another? A person is pale in the face, his lips quiver, his whole frame trembles or becomes convulsed. Is this fear, rage, love, or hate ? May it not be the effect of a change of temperature simply ? Bailly when on the scaffold, was taunted by the bystanders for trembling. Yes, he replied, but " It is with Cold." " You are pale, Sir, your fears be- tray you." " If I am pale, it is with astonishment at being accused of such a crime !" " You blush, Madam, you are ashamed of yourself." " Pardon me, Sir, it is your audacity brings the redness of rage to my cheek." You see, then, how 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 corporeal actions so called, have all been asso- ciated 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-bde." Envy or Spite we still call the " Spleen," and when a person is enraged, we say " his Bfle is up." Europeans place courage, benevolence, and fear in the heart,—the heart which 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 benevo- lence with the liver : " White-liver" is their term for a coward. Shaks- peare uses the word lily-livered hi the same sense. People often speak of Temperament, and professors of philosophy 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 temperament is phlegmatic—a word somewhat difficult to translate, inasmuch as it origi- nated in a fanciful phantom, which the ancients believed to be an element of the body, and which they termed " phlegm." Some add another tem- perament which they call leuco-phlegmatic, or white phlegm. I wonder they never took the saliva to distinguish a temperament; surely the " sali- LECTURE VIIL 173 vous 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 gibberish ?—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 into a moody and moping wretch? When the doctrines of the Humoral School prevailed, the word temperament gave way to humor, and good and bad humor took the place of cheer- ful and sulky temper. We are in the daily habit of speaking of "the spir- its." We say " low spirits," and high spirits; which forms of expression may be traced to the period when physicians were so ignorant as to sup- pose that the arteries, instead of carrying blood, contained air or" spirits," from Spiritus the Latin for breath or air. That was the reason why these blood-vessels were first called aer-teries. The confusion which pervades all language has materially impeded our knowledge both of the physical and moral man. Locke must have felt this when he said, " Vague and insignificant forms of speech, and abuse of language, have so long passed for mysteries of science, and hard or misapplied words, with little or no meaning, have, by prescription, such a right to be mistaken for deep learning and height of speculation, that it will not be easy to persuade either those who speak or those who 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 accompanied with some cor- responding change in the organic matter of the body." Through the medi- um of one or more of the five senses must some external circumstance first operate on that part of it called the Brain, so as to change the existing relations and revolutions of its atoms, before there can be what 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 laugh may enrage another. What are the features common 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 fever'd 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 in all these passions the " hot fit 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 another. Moreover, there is no constitutional affection which these passions may not excite or cure. In this respect, also, they resemble the Aoth; a reason why you should watch its effects, for where it fails to improve, it commonly aggravates. Like all other medicinal agents, it is a motive power, and if it fail to move matter the right way, it must occa- sionally move it the wrong. The mildest remedial substance, when laken by a person in perfect health, if it act at all, must act prejudicially. What is the action of colchicum, in such cases ? According to the jour- nals of the day, pains of the joints and feet were among the symptoms produced by it, when accidentally taken in poisonous quantities by pre- vious healthy persons—the very pains for which we find it available in practice! Squill, Digitalis.—Are physicians aware that both of these substances f^e the power of suspending as well as of increasing the secretion from LECTURE IX 205 the kidneys ? They are often continued too long in dropsy, to the preju- dice of the patient, from practitioners being ignorant of their double action. But in this respect they only harmonize with all known agents. The electrical state of the body, which cannot be known but by an experience of their effects upon it, determines whether squill or digitalis prove aggra- vant or remedial. Stramonium, or Thornapple is used by the Asiatics, in their treatment of mania-—a disease which it has produced. It can also produce eruptions of the skin, a fact which led me to try its effects in cutaneous disease. Combined with belladonna, I have cured some very obstinate eruptions with stramonium. I have also employed the same combination advan- tageously in the treatment of pulmonary consumption. The genera! action of both remedies in small doses, is mildly febrile. Their use some- times produces a temporary dimness of sight, which goes off when the remedies are stopped. Tobacco, Lobelia Inflata.—Tobacco is a valuable remedy, when properly prescribed, and it may be administered internally, as well as externally. I have found its internal use, in the shape of tincture, effica- cious in dropsy and asthma. Heberden cured a case of epilepsy, by applying a cataplasm of tobacco to the pit of the stomach. The lobelia inflata, or American tobacco, is a good diuretic, and has cured asthma. Like the common tobacco, it produces sickness, in large doses. The Balsams and Gums.—Copaiba, turpentine, and guaiac, powerfully influence mucous surfaces, in one case increasing secretion, in another suspending it. They have all produced and cured rheumatism. With turpentine, I have cured cases of Iritis, which resisted mercury and quinine. Copaiba in some constitutions produces a cuticular eruption so like small-pox, that even medical men have supposed it to be that dis- ease. Others putting this rash down to a fanciful cause called Syphilis, have gravely proceeded to ruin their patients' constitutions with mercury, to cure what they were pleased to call " secondary symptoms !" Cantharides or Spanish Fly.—This is principally used as a blister; but the tincture of Spanish fly is an admirable internal remedy for gleet and leucorrhcea, and it is also among our best diuretics; remember, however, it can produce strangury, an opposite effect. I am in the habit of com- bining it with quinine and prussic acid, in the treatment of dyspeptic cases, and I find it useful also in cuticular disease ; though in the case of a gentleman—a colonel of the army—a blister to the side had twice the effect of blistering him all over ! The Earths and Alkalis have all particular effects upon the body, according to the mode and degree in which they are administered. Besides their constitutional influence, e*ach has more or less affinity to special organs. Lime and Barytes influence the secretions of the stomach; Soda and Potash those of the lungs, kidney, and bladder; Ammonia or hartshorn affects the salivary glands—each for good or for evil, according to its dose and fitness for particular constitutions. The earth called Alum is a favorite with the common people, in the cure of ague. What is its mode of action ? Its power of astringency or attraction simply—the same power by which it arrests the morbid increase of secretion, called leu- corrhcea. How does it do that ? By its attractive influence over the atoms of the spine and the nerves proceeding from the spine. Well, then, that is the way in which it cures the ague. The greater number of The Acids have been usefully employed in medicine. Acetic acid, or vinegar, is an old remedy for hiccup, and might be efficacious in other spasmodic diseases. Dilute sulphuric acid has cured the ague, among other disorders. With dilute nitric acid, I have arrested and increased almost every secretion of the body, according to varying circumstances. For a gentlemen who was affected with vertigo and tremor, I prescribed 206 LECTURE X dilute nitric acid, which cured him; his wife, by mistake, took his medi- cine for her own, and in a few minutes afterwards she was affected with a tremor, that lasted for nearly an hour! You see, as a general rule, then, that whatever can move one wray, can move the other. Gentlemen, the medicines of which I have given you some account to- day, are the principal symptomatic medicines which I employ in my own practice, combining or alternating them, as I have already stated, with the chrono-thermal remedies. But there are thousands of other agents, which may be usefully employed in this manner, and a great numbei are mentioned in our books of Materia Medica. What I have said on the action of remedies generally, will apply to all. At our next lecture, I shall give you some account of the principal chrono-thermal agents—and conclude the course, by a general summary of the chrono-thermal doc- trine. LECTURE X. principal chrono-thermal remedies—summary of the chrono-thermal doctrine of disease. Gentlemen, We now come to consider the mode of action of the Chrono-Thermal agents—or those substances so generally effectual in prolonging that remission of symptom which we have proved, beyond question, is a law of all disease. Whatever be the nosological name of a distemper—Ague, Epilepsy, or Eruption—the physician will more surely accomplish his purpose of cure by taking advantage of this period of immunity than by any measures to which he may resort during the paroxysm. The more perfectly periodic the paroxysmal return, the more amenable will the disease for the most part be to the chrono-thermal medicines; but however imperfect, irregular, or brief the remissions, there is no case of disorder that may not be beneficially influenced by these remedies—whether they be alternated with baths and emetics, or be prescribed in combination with such symptomatic medicines and local measures as the features of the case, from place or prominence, may appear to demand. Let us commence the consideration of the Chrono- Thermal agents with a few observations on The Peruvian Bark.—To the value of this Bark as a remedy for many diseases, the celebrated Cullen, among others, bears his unequivocal tes- timony : what does he say are the ailments in which he found it most useful ? Rheumatism, Gout, Scrofula, Scurvy, Small-pox, Dysentery, Gangrene, Diseases of the Bones, Convulsions, Hysteria, Hypochondria, Haemorrhages. Is not this a pretty comprehensive association of appa- rently different diseases, all cured or relieved by a single substance ! And yet it never seemed to enter the head of any previous medical writer, that these diseases have each something in common—each some principle of continuity which, amid all their apparent variety, establishes their Unity of type. One remedy alleviates or cures them all—and yet physicians either cannot or will not see that the action of that remedy is one and one only, viz., motive power. What better evidence of the absurd- ity of Cullen's own Nosological System—a system that so far from explaining the perfect continuity that pervades the chain of all morbid LECTURE X. 207 motion, separated the links so widely asunder that the student could not for the life of him believe them to be anything else but so many distinct and unlike disorders, each of which, forsooth, required a separate treatise to understand it! What a beautiful piece of work for the quacks ! what an admirable method of darkening the world, that bad men might the better pursue their game of imposture ! An accomplished French physician, Baron Alibert, speaks thus of the Bark and its influence in disease,—" I have been able to pursue and appreciate the salutary results of the employment of this substance in Cancerous affections, in Scrofulous tumors of the Glands, according to the recommendation of Fordyce, in many Cutaneous diseases, and prin- cipally in Lepra, Elephantiasis, and in certain cases of Jaundice, arising from diminished tone in the secretory organs of the bile—in the altera- tions affecting the Osseous system, such as Ricketts, Spina Bifida, &c. With the bark we may also advantageously combat certain disorders of the Nervous system, such as Epilepsy, Hypochondria, Hysteria, &c. Many authors recommend it in Hooping-cough, and the various convul- sive coughs. No remedy, according to them, is so efficacious in strength- ening the organs of respiration, and in preventing the state of debility induced in the animal economy by the contractile and reiterated move- ment of the lungs. The most part of those who employ it in like cases are, nevertheless, of opinion, that the administration of it is imprudent without some previous preparation, according to the particular stage of disease. These practitioners [influenced, doubtless, by their hypothesis of a humor in the blood] would in some sort mitigate the ferocity of the paroxysms by sweeteners and temperants—often even by evacuants, such as emetics and bleedings. To prevent irritation, they wait until the strength has been absolutely struck down. But upon this point, the cele- brated Murray differs from these practitioners in toto. The Peruvian Bark, according to that physician, is equally adapted to the cure of Con- vulsive and Periodic Coughs as to the cure of Intermittent Fevers. He witnessed an Epidemic in which these maladies were efficaciously met by this powerful remedy from the commencement. He has therefore proved that there is no advantage in retarding its administration; and that to permit, in the first place, so great a waste of the vital powers, only renders the symptoms more rebellious, and their consequences more fatal !" Gentlemen, I am not now giving you opinions,—I am not now dealing in hypothetic disquisitions—I state facts simply, facts powerfully attested; for Murray in his day was celebrated over all Europe, and Alibert, only a few years ago, was second to no physician in France. Both have now passed from the scene of life ; but their writings may be still read with advantage by every one who takes any interest in medicine. The yalue of the Bark in all diseases, both authors distinctly state. You have also heard what they say of the sanguinary practice. Nothing can be stronger than the expression of their united evidence against that prac- tice ; yet in the teeth of that evidence—in the teeth of common sense even, which says that whatever reduces the vitality of the whole, must more surely confirm the hereditary or other weakness of a part,—the medical herd of this country still go on like their ignorant fathers before them, bleeding, leeching, and purging to death, or all but death, every unfortunate creature who falls into their hands. Did the disciples of Malthus only know how admirably their master's system has been car- ried out by the great body of English practitioners, what encomiums would they not heap upon the schools to whose regiments of lancers and Jeechers the world is so indebted for keeping down a surplus population! But let not people suppose that, possessed of a remedy so powerful, and, go far as nomenclature is concerned, one so almost universally applicable 208 LECTURE X as the Bark, the physician has an infallible elixir—a remedy adapted to all constitutions. The most perfect ague-fit within my own remembrance, appeared to me to be the effect of two grains of quinine, prescribed for an asthmatic patient. Dr. Thomson mentions the case of a patient of bis, in whom this medicine brought on an attack of asthma: " When he was getting well, after seven or eight days, I again," he says, " began the sulphate of quinine, and the same attack was the result." A lady, after taking it, became subject to intermittent-fits. Now, some would be glad to lay hold of this as a reason why you should never use quinine. But the smell of the rose has produced fainting-fits—the smell of ipeca- cuan asthma;—must we, therefore, never smell a rose, or keep ipecacuan in our houses ? What agent in nature is absolutely innocuous:—Rhu- barb, in a very minute dose, has produced convulsions with some people —but, according to some people, should we never prescribe rhubarb ? When quinine disagrees, the common complaints are tremor, faintness, headache, vertigo, nervousness, cramps, and " all overishness." Ratier, in his Hospital Reports, among its deleterions effects mentions " nervous agitations," which 1 fancy, might be as well translated " shivering fits,"— or—what say you to " ague," Gentlemen ? Oh ? you may depend upon it, whatever can correct a morbid motion may cause it! Like many other medicines, the Peruvian Bark is termed by writers on Materia Medica, a tonic. All medicines are tonics, when they" improve the health of the patient; but when, on the contrary, weakness or ner- vousness is the result of using them, who will say that in that case they are anything but debilitant ? Bark, like an emetic, or a purge, may cause both one and the other. To go on, then, day after day, prescribing this substance, and what are termed " strengtheners," without manifest amelioration, or with positive retrogression, is not giving a course of " tonics," but a succession of exhausting or debilitating agents ;—it is to prescribe a name for a name. What, then, is the mode of operation of the Peruvian Bark when its action proves salutary ? This I conceive to be the true explanation. Whether it be administered during the Remission or Paroxysm, the bark, like every other medicinal agent capable of influencing the corporeal totality, must, if it act at all, do one of two things, namely,—Being a superadded power, it must either, with more or less force, continue, or with more or less force reverse the direction of the existing order of corporeal movement, according to the attractive or repulsive manner in which it may exercise its motive influence. Now, as this difference of result depends upon whether the patient's brain be negatively or positively electric, a thing which can only be known by trial, it must be clear to every reflecting person, that where the chances are equal in favor of the presence of either electrical state, it is better to prescribe the medicine during the remissional movement of body, when so far as continuance goes, it must act to a certain extent at an obvious advantage. In com- mon with every material agent capable of influencing matter in motion, the power of the bark, under ordinary circumstances, must be more effective in continuing than in reversing existing motion. To reverse generally suggests opposition, difficulty, disadvantage. To continue what is already begun as generally implies a course of action that can be advantageously undertaken. The chances, then, being so much in favor of continuance, it no longer remains a question, which state of body should be selected for the exhibition of the bark,—the Paroxysm or the Remis- sion. Which of these two periods has most resemblance to Health ? The term Remission at once suggests the answer; that then is the proper. period for the administration of this particular remedy. And experience has confirmed what exact reasoning might have anticipated ; for when exhibited to the patient during the Paroxysmal movement, the bark, for LECTURE X. 209 the most part, not only renders that movement more intense, but prolongs with equal frequency the duration of its period. A like effect follows its administration during the movement of Remission, for not only in most instances does it prolong this period, but adding force to the existing order o£ movement, it brings it at last to that desirable standard which it only previously approached, namely, the standard of Health. Numerous instances, of course, have occurred where a contrary effect has followed the exhibition of the bark, both in the case of the paroxysm and remis- sion. But the general result of its employment determines us in the line of practice we should, under ordinary circumstances, pursue. So long, then, as we can, by the bark or any other agency, keep up the movement of remission in as great, or even greater force than before, so long do we secure our patient from a recurrence of the previous paroxysmal move- ment, involving, as the latter must do, the identical corporeal matter of the movement of remission. Whatever be the name or nature of the disease, the remissional movement, in most instances, though a shade or two beneath that of health, may, as we have already said, by the increase of force effected by the bark, be brought at last to the healthy standard; nay, in some cases, by a too long continuance or an excess of the medici- nal force applied, it has itself been actually converted into a new febrile paroxysm of more or less intensity. But in that case the paroxysm of the old disease has, with equal certainty, been prevented from recurring. Still, however mild and subdued the movement kept up by the bark may appear, in comparison with that of the previous paroxysm, if it only be continued for a sufficient time, it generally becomes at last so habitual as entirely to supersede the original disease, and to destroy, as a matter of course the constitutional memory upon which the recurrence of the old paroxysm depended. Such constitutional memory French writers term " memoire machinale." It is by this that all the motions of health are periodically reproduced—and by the same law, all morbid motions take on a habit of return. Whatever will put the brain on a new course of thought or action, will confuse this memory. Hope, joy, faith, and enthu- siasm act in that manner. What are these—what are all passions but mild fevers?—and, as no two fevers can affect the body at one and the same time, inasmuch as no given corporeal atom can move in opposite directions at the same moment—these fevers, however mild in themselves, are sufficiently powerful, in many cases, to avert the return of the more dangerous morbid motions. Like the fevers of pregnancy, puberty, &c, they may cure or arrest every kind of disease you can name, from tooth- ache to pulmonary consumption ;—like the same fevers, they have pro- duced all!—according to constitutional predisposition. The Chrono-thermal medicine next in value to the Bark, is— Prussic Acid.—The College of Physicians have given a formula for the preparation of this acid for medicinal purposes; but I prefer that of Scheele, and I believe most other practitioners do the same. The con- centrated acid cannot be prescribed in practice. It must, then, be given in a diluted state. " Diluted prussic acid," says Magendie, " is employed with success, in all cases of morbid irritability (weakness.') of the pul- monary organs. It may be advantageously used in the treatment of nervous and chronic coughs, Asthma and Hooping-cough; and in the palliative treatment of Pulmonary Consumption ; indeed, a great number of observations induce the belief, that it may effect a cure in the early stage of the latter disease. In England it has been administered with suc- cess in Dyspepsia, and also in Hectic cough sympathetic of some other affection. [Why sympathetic of another affection ? When a man's health is wrong throughout, some prominent symptom is seized upon, and con- sidered to be the cause of all the others !] Dr. Elliotson, both in hospital and private practice, has frequently employed medicinal prussic acid, 210 LECTURE X. prepared after the manner of Vauquelin. He has recorded more than forty cases of Dyspepsia, with or without vomiting, and accompanied with considerable pain in the epigastric region, and with pyrosis (water- brash), which were cured by this acid. The same physician quotes a case of colica pictonum (spasm of the colon) in which Dr. Prout gave the acid, and procured instantaneous relief. Dr. Elliotson also administered hydrocyanic acid, in a great number of Pectoral affections ; and has almost invariably succeeded in allaying the troublesome cough. [Why will people use this 'word " invariably?"—what agent in the Materia Medica acts invariably in the same manner?—such medicine would be, indeed, a specific! but that we shall never discover !] Applied externally in lotions, in different diseases of the skin, it has not, in Dr. Elliotson's practice, produced any decided effect. Dr. Thomson, however, asserts, that he has employed it in lotions with constant success [here again, " constant success !"] in diminishing the itching and the heat so annoying in Cutane- ous diseases, and has cured several species of herpes. " M. J. Bouchenel has published an interesting memoir on the employ- ment of prussic acid in the treatment of chronic Pulmonary Catarrh. He mentions four cases in which this remedy proved effectual. He concludes by urging that prussic acid, when given in a small dose, is not more inconvenient than an ordinary cough mixture. M. Bouchenel has also employed prussic acid in a case of consumption, but he only succeeded in allaying the cough for a time, which leads him to doubt the fact of its having really effected the cure of confirmed consumption. I do, however, assert and maintain," says Magendie, " that with prussic acid 1 have cured individuals, having all the symptoms of incipient phthisis; and even those in a more advanced stage. " In Italy, the medicinal hydrocyanic acid has been used to. allay ex- cessive irritability of the womb, even in cases of Cancer." " Professor Brera extols its happy effects in pneumonia: he recommends it also in Rheumatic cases, and as a worm-medicine. Since this professor has employed it in diseases of the Heart, Dr. Macleod has administered it in the same diseases. He has found it allay nervous Palpitations, especially those which seemed to depend on derangement of the digestive organs. [How common this error of accusing one symptom of being the cause of another!] He has also employed it in some cases of Aneurism of the Heart, Dr. Frisch, of Nybourg, in Denmark, has allayed the intolerable pain caused by Cancer of the Breast, which had resisted all the anti- spasmodics, by washing the ulcerated surface with diluted prussic acid. He has also successfully employed the remedy in several cases of Phthisis. Dr. Guerin, of Mamers, has obtained beneficial results from its employ- ment in two cases of Brain Fever." Thus far I have given you the experience of others, with this acid, as detailed in Magendie's Formulary;—let me now add a few observa- tions of my own in its favor. Combined with the tincture of lobelia inflata I have found it one of the most generally effectual remedies for Asthma, with which I am acquainted. The same combination has enabled me to cure Spasmodic Stricture of the urethra; and generally speaking, I have obtained successful results from the administration of prussic acid in cramp and spasms wherever developed. In the low, habitual Fever, whether misnamed dyspepsia, hysteria, or hypochondria, I have found it particularly valuable. I have also experienced its curative influence in the treatment of Dropsy; more especially when complicated with difficult breathing. In Palsy, I have found prussic acid more generally successful than strychnia. I may here again, however, mention that it is my custom, in the treatment of disorder generally, to combine one or more chrono-ther- mal powers—quinine, hydrocyanic acid, or arsenic—with one or more LECTURE X 211 symptomatic, medicines, possessing marked local influence. Thus, one or more of the chrono-thermal agents maybe advantageously combined with iodine, in glandular and skin affection,—with colchicum or guaiac in rheumatism—squill or digitalis in dropsy—cantharides or copaiba in leucorrhcea and gleet—with squill in catarrh—with purgatives where cos- tiveness is a symptom; and so in like manner, according to the most prominent feature of a case. Combined in this way with tincture of gin- ger, cardamoms, &c, I have found prussic acid extremely valuable in the treatment of flatulency and acidity of the stomach. In all these disorders, however, this and all other remedies wdl be found to be advantageous only in so far as they contribute to improve the temperature, and, conse- quently, the circulation of the subjects of them. Your patients, when ob- taining their beneficial effects, will tell you, " I have not had those heats and chills which used to trouble me,"—or, " my hands and feet are not so cold or so burning as formerly." If you poison a certain number of rabbits with prussic acid—say a dozen, and pour cold water in a stream over six of them, these six will recover, while all the others will die. This has been done over and over again with the same result. You see, then, how clearly the influence of this agent depends upon its power of controlling temperature. We have seen that prussic acid may be successfully employed in the most obstinate agues; yet I remember the case of an Irish barrister, who, from the same medicine, experienced severe shivering and chillness, with cramp, pain of the stomach, and slight difficulty of breathing; the very symptoms, you will remark, Gentlemen, for which it is so often available in practice. The electric condition of the cerebral part influenced, deter- mines whether a given remedy shall produce attractive or repulsive mo- tions ; and this, we have repeatedly stated, can only be known by trial. From such trial, no greater harm than a little temporary inconvenience can take place, when prussic acid disagrees, if prescribed and watched by a judicious physician. Rhubarb or magnesia may do the same, for, like prussic acid, both act electrically.* From Prussic acid, I now pass to Opium, and its salts of Morphia.—These, like the Bark, may be ad- vantageously employed, as Ave have already stated, in prolonging the in- terval of remission in every form of disease. Opium, indeed, like every other remedy, possesses more or less influence over the whole system, but its more obvious effect is the control which it exercises over the nerves of sense. With these we associate Memory—and as every part of the body has, through the brain, a power of remembrance, whatever will con- fuse or suspend the action of the senses, will often equally suspend and confuse memory, and consequently conduce to the suspension or inter- ruption of any habitual or periodic action of any part of the body. A minute dose of opium generally heightens the perceptive powers, while a large dose as generally diminishes them. But a large dose, after all, is only a relative term—for the quantity that would poison a horse, may be a moderate dose to the habitual opium eater! I do not know a disease in which I have not found opium useful. In dropsical cases, when administered at that particular period of the day when the patients have confessed to amelioration of their feelings gene- rally, it has, in my experience, been frequently followed by a copiousfiow * I have been in the habit of using the cyanide of potassium in place of prussic acid, with good results. It seems to me more constant and safer than the other—is not so alarming to the patient, and is easily administered in the form of pill. I have found a weak solution of great use in itchings of the skin—as of the pudenda in wo- men. Alternating the cyanide with silver, in two cases of piles with prolapsus ani after stools, the patients were cured with a celerity which astonished as well as de- lighted them.—T. 212 LECTURE X of urine after every diuretic had completely failed. By giving it in a large dose during the remission, I have kept several consumptive; patients alive for months, and some for years even, whose existence must assuredly have been shortened but for the beneficial influence of this drug. There are persons, however, whom Not poppy, nor mandragora, Nor all the drowsy syrups of the world, would medicine into slumber—but upon whom the cold affusion would instantly produce that effect. Behold again, how much all things depend on temperature ! With some people opium, as I have already mentioned, acts like ipecacuan—who can tell what may be the effect of any remedy till it be tried ? It is only impostors who never fail! As a proof of the in- fluence of opium as a preventive against disease, we are informed by Dr. M'Pherson, of the Madras army, in his book oii China, that " the peculiar active principle in opium, the narcotic, has of late been employed with considerable success in Bengal, as a substitute for Quinine. It may also be mentioned, that at the time fevers prevailed so extensively among our troops at Hong-Kong, but comparatively few of the Chinese suffered, though exposed throughout to the same exciting causes." And this Dr. M'Pherson attributes to their habit of opium smoking. Travellers, who have witnessed the effects of this drug in the East, mention tremor, fever, dropsy, delirium, and restlessness, as the consequences of the habitual use of opium. It has, nevertheless, contributed to the cure of all these symptoms when produced by other causes. In practice, we find it give repose in one case and preclude all sleep in another. It has caused mania, and cured it. Very analogous to opium in their mode of action are Alcohol, Wine, and Malt Liquors; but like every other medicinal agent, they act upon the body, beneficially or the reverse, in no other manner than by changing the existing temperature of the brain. If a glass of brandy has arrested the ague-fit and its shudder, the army surgeon will bear testimony to the " horrors" and tremblings which the abuse of strong liquors too frequently induces in the previously healthy. Are not the chill, the shiver, the fever-fit, the epileptic, asthmatic, icteric, strictural, and other spasmodic paroxysms daily produced by potation ? How often have we known dropsy brought on by gin-drinking;—yet is not gin daily prescribed with the best effect for the dropsical ? See how differently alcohol affects different men! One it renders joyful or gentle—another sullen and morose—in a third, it gives rise to wit, while the fourth, under its influence, loses the wit he previously possessed. I remember the case of a man of the 1st Regiment of Foot, who grew mighty religious, and took to psalm-singing every time he got drunk. But this spurious kind of godliness, as you might have expected, generally evaporated with the fumes of his liquor. That excess of religious feeling or veneration (as the Phrenologists call it) does, however, depend on the temperature or motive condition of some cerebral part, there cannot be a doubt; and that it takes place by fits or periods, Shakspeare well knew, for he makes one of Clarence's murderers say: " I hope this holy humor of mine will change ; it was wont to hold but while one would tell (count) twenty." Wine will make the brave man timid and lachrymose—the coward ca- pable of actions, the mere thought of which, in his sober moments, would have inspired him with terror. One man will first show the effects of drunkenness in his speech—another in his diminished powers of prehen- sion—some individuals will not betray the influence it has obtained over them until they try to walk; their limbs may then fail them, though nei- ther hand nor tongue shows any sign of inebriety. Now all this is done LECTURE X. 213 by the change of temperature which wine induces on various parts of the cerebrum of particular individuals. It throws them into a state of fever ; and the same phenomena may be witnessed in the course of fevers pro- duced by cold or a blow. Dr. Jenner, in describing the effects of excessive cold on himself, says, " I had the same sensations as if I had drunk a considerable quantity of wine or brandy, and my spirits rose in proportion to this sensation. I felt, as if it were, like one intoxicated, and could not forbear singing," &c—[Baron's Life of Jenner.] Take the converse of this —A man shall get as " drunk a6 a lord," and immediately become sober under the influence of a cold shower, or plunge bath. Does not thisunity of result argue unity of mode of action ? We prove, then, by every pos- sible manner, that the effect of wine, whether for good or for evil, like that of every other power in nature, relates to the influence it exerts over the temperature of one or more portions of the Brain. Musk, Valerian, Camphor, A9SAF would dare to rave against As now practised in England, medicine is little better than a copy of the exploded navigation of the ancients. Taking his bearings, less by the observation of the fixed stars, than by every little eminence and promi- nent locality, the ancient mariner, cautiously, if not timidly, crept along shore. With the unerring compass for his guide, the seaman now steers his bark boldly upon the boundless ocean. Despising the localism that formerly guided his sail, he now completes his voyage to the distant port, m as many days as it formerly occupied him weeks or months. Keep- ing in view the principles here laid down, the physician may, in like manner, with a few rare exceptions, entirely dispense with the common anatomical landmarks of his art—if he be not startled with the novelty of the light by which we have endeavored to dispel the darkness that has hitherto clouded the field of medicine. Taking corporeal unity and totality for his rudder and compass—the brain and nerves for the ocean and seas on which he is to act—temperature and remittency for his tide and season—constitution and habit for the rule by which he must occa- sionally change his tack—he may now rapidly accomplish ends which, by groping among the intricacies of nomenclature, or by a vulgar atten- tion to mere localities, he can only imperfectly attain by the reiteration of long and painful processes;—he may thus, with ease, obviate difficul- ties which he previously believed to be insurmountable. Let him not question whether or not the adoption of this will best serve his own in- terest. As physic is for the public, not the public for physic, he may rely with certainty, that notwithstanding the present over-crowded state of the profession, the supply of medical aid will, sooner or later, adjust itself to his own, as well as to the general weal. It was one of the boasts of the eccentric Radcliffe, that he could write the practice of physic on half a sheet of paper: the whole might be com- prised in half a line—attention to temperature ! This, you may be sure, was Radcliffe's chief secret—for he was one of the earliest physicians who first introduced what is called the cooling system of fever. When the Duke of Beaufort was taken ill of the small-pox, " the doctor," says Pottis, " was sent for, and found his grace's windows shut up in such a manner, by the old lady duchess, his grandmother's order, that not a breath of air could come into the room, which almost deprived the duke of the very means of respiration. This method had been observed by the physicians (!) in her grace's youthful days, and this she was resolved to abide by, as the most proper in this conjuncture, being fearful that her grandson might otherwise catch cold, and, by means of it, lose a life that was so precious to her and the whole nation. She had also taken a re- solution to give her attendance upon the duke in person during his sick- ness, and was in the most violent consternation when Radcliffe at his first visit ordered the curtains of the bed to be drawn open, and the light to be let in, as usual, into his bed-room. ' How,' said the duchess,' have 220 LECTURE X. you a mind to kill my grandson ?—Is this the tenderness and affection you have always expressed for his person—'tis most certain his grandfather and I were used after another manner, nor shall he be treated otherwise than we were, since we recovered [escaped, truly!] and lived to a great age without any such dangerous experiments' ' All this may be,' replied the doctor, with his wonted plainness and sincerity, ' but I must be free with your grace, and tell you that unless you will give me your Avord that you'll instantly go home to Chelsea and leave the duke wholly to my care, I shall not stir one foot for him; which if you will do, without inter- meddling with your unnecessary advice, my life for his, that he never miscarries, but will be at liberty to pay you a visit in a month's time.' When at last, with abundance of difficulty, that great lady was persuaded to acquiesce and give way to the entreaties of the duke and other noble relations, and had the satisfaction to see her grandson, in the time limited, restored to perfect health, she had such an implicit belief of the doctor's skill afterwards, that though she was in the eighty-fifth year of her age at that very time, she declared it was her opinion that she should never die while he lived, it being in his power to give length to her days by his never-failing medicines." Well, Gentlemen, the proper medical treatment of all diseases comes, at last, to attention to temperature, and to nothing more. What is the proper practice in Intermittent Fever ? To apply warmth, or administer cordials in the cold stage; hi the hot to reduce the amount of temperature, by cold affusion and fresh air; or, for the same purpose, to exhibit, according to circumstances, an emetic, a purgative, or both in combination. With quinine, arsenic, opium, &c, the interval of comparative health—the period of medium temperature, may be prolonged to an indefinite period; and in that manner may health become established in all diseases— whether, from some special local development, the disorder be denominated mania, epflepsy, croup, cynanche, the gout, the influenza ! In the early stage of disease, to arrest the fever is, in most instances, sufficient for the reduction of every kind of local development. A few rare cases ex- cepted, it is only when the disorder has been of long standing and habitual, that the physician will be compelled to call to his aid the vari- ous local measures, which have a relation to the greater or less amount of the temperature of particular parts. The Unity of Disease was first promulgated by Hippocrates, and for centuries it was the ancient belief. In modern times it found an advocate in the American physician Rush—but except in this instance of unity, betwixt the respective doctrines of both authors and my doctrine of disease there is not a single feature in common. For while the first, from his observation of the resemblance of disorders one to another, inferred that one imaginary humor must be the cause of all complaints—the doctrine of the second was that all disorders consisted in one kind of ex- citement. The principle of Hippocrates led him to purge and sweat;— that of Rush to bleed, leech, and starve. In practice and in theory I am equally opposed to both. Other physicians doubtless have held the idea of a unity of disease, but neither in the true theory of the nature of mor- bid action, nor in the principle of the practical application of medical re- sources, have I as yet found the chrono-thermal system anticipated. The opponents of my doctrines, and those who embrace them by stealth, have alike searched the writings of the ancients in vain to discover a similarity to them in either respect. If it be urged against the author of the chrono- thermal system of medicine, that he has availed himself of facts collected by others—and that therefore all is not his which his system contains—I answer, Facts when disjointed are the mere bricks or materials with which the builders of all systems must work. And to deny to any man the merit of being the architect of a great Edifice of Truth on that account, LECTURE X. 221 would be just as reasonable as to ascribe the merit of St. Paul's Cathedral to the donkeys and other beasts of burden Sir Christopher Wren neces- sarily employed in fetching the marble and mortar composing it. " Mere- ly to collect facts is an easy and mindless task, that any common being can perform; it requires eyes and hands, and almost dispenses with a brain ; it is the work of a toiling wretch, who, like the miser, is incapable of using what he possesses. Mere facts lie around even the savage, but he knows not what he sees—and such, precisely such, is the case with the mere learners of the names of things, the collectors of little facts, the undiscriminatmg triflers, who think they are cultivating the sciences."— [Alexander Walker.] It is of these, nevertheless, that our medical clubs and coteries are chiefly composed, and it is with the conglomerating ef- fusions of these that the editors of the medical press chiefly contrive to keep the daylight of medical truth from the eyes of the student. " Micro- scopical observations," straw-splittings, and other little facts you have from their hands in abundance—but facts properly arranged and systematized into a whole or great fact, not only do you never find in their writings—but when you present such great facts to their eyes, they either comprehend them not, or if they do so, they immediately endeavor to steal or stifle the discovery. Out upon such contemptible creatures, fit only to Suckle fools and chronicle small beer! What was the first reception of the chrono-thermal system by medical men ? I do not speak of its reception by the canaille of the profession— the twaddling intriguing sycophants of country towns—I mean its re- ception by the medical aristocracy, as the Court doctors call themselves. Immediately after its publication, one of these court gentry (James John- son) misrepresented, ridiculed, and denied it—three years after that an- other court physician (Holland) attempted, as you have seen, by a side- wind to steal it—three years more passed away and a third court doctor (Forbes) by those meanest arts, misstatement and misquotation, did his little endeavor to stifle it. If such was the candid and gentleman-like conduct of the town doctors, what had the chrono-thermal system of medicine to expect at the hands of the physic-selling profession in the country ? What could these intriguing little gossips do but follow hi the wake of their town masters, and court physicians ? Now they ridiculed it—-now they denied it—but all the while they had no hesitation to practise it by stealth, some in one, some in another of its fragments. This moment it was partially true, but not new;—the next, the newness was admitted, the truth denied. But, Gentlemen, up to 1836, when I first published the heads of that system, the profession to a man were utterly ignorant of the very nature of disease. Its periodicity in the case of ague, and a few other disorders, they knew—the periodicity of all animal movement, whether in health or disease, they knew nothing at all about —and of the mode in which remedies act they were just as ignorant. As to blood-letting, which the great majority of them now admit they did carry too far,* the exclusion of it from the chrono-thermal system, so far * The following is the official report of the physicians who attended General Harrison, in his last illness, as published in Niles's National Register. The italics are mine. Comment is needless. " On Saturday, March 27,1841, President Harrison, after several days'previous indisposition, was seized with a chill, and other symptoms of fever. The next day, pneumonia with congestion of the liver, and derangement of the stomach and bowels, was ascertained to exist. The age and debility of the patient, with the immediate prostration, forbade a resort to general blood-letting. Topical depletion (i. e. leeching and cupping), blistering and appropriate internal remedies, subdued in a great measure the disease of the lungs and liver, but the stomach and intestines did not regain a healthy condition. Finally, on the 3d of April, at 3 o'clock P. M., profuse diarrhoea came on, under which he sank, at 30 minutes to 1 o'clock, on the morning of the 4th." The above was accidentally omitted under the head of blood-letting.—T. 222 LECTURE X. from being its principal feature, as some of them pretend, is only a fragmental part that of necessity followed its discovery. I have never taken credit for being the first opponent of the lancet. But one thing in regard to this matter I do claim credit for—I claim credit for being the first man who, by a strong array of facts, and some force of reasoning, produced an impression on the public that all the facts and all the argu- ments of former opponents of the lancet never before produced on the Pro- fession—namely, an impression of the dangerous nature of the remedy; and whether they like to be told of it or not, I claim to have either convinced or compelled the profession materially to alter their practice * In all the late medical reviews of my writings, the subject of blood- letting, which afforded so much mirth to my early critics, has either been kept entirely in the back-ground, or, if noticed at all, my strictures on it are declared to be a mere echo of the present opinions of the profession! —but whether they be so or not, the astute editors of these publications determine that no merit attaches to me for my endeavors to put it down, inasmuch as it had been equally opposed and decried by somebody of some place or another in Greece, who lived before the time of the Mes- siah ! Gentlemen, to Say blood-letting is a bad remedy is one thing—to Prove it to be bad is another—to force the world to believe and act upon your arguments against it, in the teeth of the opinion of the world, is a still greater achievement. That merit I distinctly claim. The silence and admissions of the medical press on that head equally attest the fact— while the recent barefaced attempt of Dr. Laycock, under the disguised (?) name of " Vital Periodicity," to purloin my doctrine of the Periodic movement of all Vitality, whether in health or disease, is as much a com- pliment to the genius of its real discoverer as it is a proof of the worth of the discovery. On that discovery is based the whole chrono-thermal system of medicine. Before concluding, I will just make a remark upon the subject of the doses of all medicines. Perceiving, as you must have done by this time, the utter impossibility of foretelling, in many cases, especially of chronic disease, the particular agent by which you are to obtain amelioration or cure,—and as in almost every case where an agent does not act favor- ably, it does the reverse—you must see the necessity of commencing your treatment with the smallest available doses of the more potent reme- dies ; of feeling your way, in short, before you venture upon the doses pre- scribed by the schools. Let me not, for a moment, be supposed to counte- nance the homoeopathic nonsense.—The twelfth part of a grain of calomel, for example, is a proper medicine to give to an infant; but such dose has no more relation to the millionth or decillionth part of a grain of the same substance, than the twelfth part of a bottle of wine—one glass—has to a drop of that liquid. The one has power to influence the whole body;—the other is utterly inappreciable beyond the taste it may impart to the tongue, the only organ it can, by any possibility, even momentarily influence.—Gentlemen, pity the Homceopathists !—shun the Pathologists and Bloodsuckers—and follow only that best guide of the physician— Nature! not in the confined sense of our mortal economy, but in every department of her works.—One great principle binds them together— God, in his Unity, pervades them all! * Even upon the subject of Apoplexy it is amusing to see the manner in which those who formerly advocated the lancet in that disease now endeavor to get out of their difficulty. Sir C. Bell, Dr. Clutterbuck, Dr. Marshall Hall, Mr. Wardrop, &c, in recent remarks upon the treatment of apoplexy, give so many doubts, cautions, and reservations, as all but to amount to a complete prohibition of the lancet in this disease—not one of them, however, having the boldness to oppose it entirely in direct words, or virtue enough to acknowledge to whom he owes the new light that has so lately come upon him in this matter.—" Awful is the duel between Mas and the Age in which he lives!"—Bulwer. APPENDIX. No. I. Medical Section of the British Association. To the Editor of the Medical Times. Clarges Street, July 8,1842. Sir,—In a Report under the above head, inserted in the last number of your Journal, I find the following passage :—" A very lengthened communication from Dr. Laycock, on Vital Periodicity, was read by the secretary (Dr. Sargent), in which a vast number of facts were related establishing periodicity net only in dis- eases, but in sound health, and not only in man, but in the lower order of animals. Such facts had been noticed very particularly by the ancient writers on medicine,— Hippocrates, Celsus, &c,—which led to the establishment of critical days in the treatment of various diseases, often rendering their prognostications very certain. Indeed, Dr. Laycock stated, that in many instances certain periodic changes took place in health as well as disease, establishing the same law, that he, Dr. L., felt little doubt that the time of birth had reference to the time of death." Whether or not the facts in question bear out Dr. Laycock in this last proposition,—a proposition I have taken the liberty to place in italics,—I am not in a condition to determine; but it is highly gratifying to me to find that the Periodical doctrine of col animal Life, whether in health or disease, is now beginning to claim the attention of the profession, after having for so many years since its discovery by me, been assailed and cried down at their hands ! In the Second Edition of the " Fallacies of the Faculty" (a copy of which accompanies this letter) will be found not only the whole doctrine of Vital Periodicity (i. e. the intermittent and periodic nature of every animal movement), but a new doctrine of the mode in which it may be turned to account in the treatment of all human diseases. At home, the Chrono-ther- mal System of Medicine is already widely appreciated ; in the country it is openly embraced by numerous members of the medical profession; in London, too, it has its supporters,—among others, one or two eminent practitioners, who, by a side-wind, have attempted to pirate it! To our continental neighbors, the French, it is under obligations; they have done its author the honor to translate his work into their language, with a laudatory acknowledgment of its value to the world. I am, Sir, your most obedient servant, S. Dickson. No. II. British Association.—Vital Periodicity. To the Editor of the Medical Times. Sir,—I beg to express to you my obligation for your early insertion of my letter on the subject of " Vital Periodicity ;" and I would further beg to tender my very best thanks to the numerous friends who, in your pages, have so kindly and 224 APPENDIX. readily come forward to vindicate my claim to the discovery of the doctrine in question. That fragmentary parts of the doctrine of Vital Periodicity should from time to time have attracted the attention of medical thinkers will excite the wonder of nobody,—nobody, at least, who had ever counted a pulse, or witnessed in his life the outward phenomena of an ague,—nobody even who knows so much of man and his many diseases, as to be aware that his toothache_ and his tic,—his gout and his epilepsy, come on in fits only, and do not in any case last for ever!—Hippocrates, Celsus," Boerhaave, Darwin, aye, and hundreds of others knew this much at least, —some trying to explain it one way, some another. M'Culloch more recently and more fully handled the subject, and he endeavored to prove what, for a time, scarcely one professional man in Europe doubted, that every intermittent action depends on malaria or marsh emanations. This doctrine of M'Culloch, neverthe- less, if I am not in error, I was the first to impugn. But be that as it may, I have yet to learn that any author, ancient or modern, in England or elsewhere, has pre- ceded me in the discovery, that all the movements of all animal bodies—thegr ater and the less—the atomic, functional, and organic—whether in health or disease— disease however caused,—like all the movements of all the systems, minor and major, —of the universe at large—are equally intermittent and periodic ! And that there can no more be an eternal or continuous disease (i. e. a disease without intermission) than there can be an eternal earthquake, or an eternal tempest. Six years ago and more I brought this forward—this doctrine of the periodic and intermittent nature of all animal movement—not as a Whole, but as a part; for with it I also published the Elements of the New System of Medicine which necessarily grew out of the discovery, viz., the Chrono-thermal System. And how were my discov- eries then received at the hands of the professional public? How! how, Mr. Edi- tor, did the professional public ever receive any discovery that improved the prac- tice of physic ? Mine they received as they have received every other. So far back as 1836, I demonstrated that Life in health is in reality, and not figuratively, a " fitful fever;" a thing of alternate motion and rest, alternate chill and heat, depres- sion and excitement; and that intermittent fever or ague is the type or model of every one of the many modifications of life termed disease. Then the doctrine was scouted and ridiculed by all. Doctors, surgeons, apothecaries, all flew to arms. The reviewers, in the language of Dr. James Johnson their chief, denounced it as a FEVER-madness, or PYREXY-mania. Nobody then dreamed of calling its authorship in question—no, it was false, fanciful, and fatuous throughout—so utterly insane that nobody ever was mad enough to put such madness on paper before! How stands the question now ?—why it makes one laugh at the turn-coat world ; for who could dream that the same men who, six years ago, denounced the author as a madman, and his system as an absurdity, would now meanly attempt to annihilate and cast aside the one, while adopting as their own the principles of the other! This, nevertheless, has been done. But you, Mr. Editor,—of you I demand why you only do me partial justice? "Whoever," you say, "preceded Dr. Dickson, Dr. Dickson long preceded Drs. Holland and Laycock. In publishing the doctrine in England, and having done much to revive and propagate it, he was fairly entitled to some notice by more recent writers adopting his views on so important a subject." Of whose doctrines, Sir, permit me to ask, are mine a revival ?—who before me maintained the doctrine of the periodicity of all animal life ? I speak of life in its totality—its abstract—not in its fragments! It is only in the nature of things that a doctrine when reluctantly admitted to be true should be whispered away as not new; and you doubtless, in my case, have unwillingly caught up the echo. The same thing happened to Harvey. When his enemies found it impossible any longer to deny the truth of his discovery, they accused him of having stolen it from the writ- ings of the ancients. A\ncient or modern, what author have J stolen from ?—who taught me that all diseases, however named, and by whatever eaused, are intermit- tent in their character, or that, like the ague, all may be cured on the principle of prolonging the intermission, by bark, arsenic, &c.! To whom am I indebted for the hint, that each and all of these medicinal agents, like every other medicinal agent in nature, cause and cure by their Electrical influence solely—in one case electri- cally producing, in another electrically reversing, every morbid motive condition of the body ?—that whether opium produce sleep or wakefulness—whether copaiba aggravate or cure discharges,—whether prussic acid or strychnia cause or relieve palsy, spasms, &c,—depends upon the positive or negative electrical state of the brain of the individual selected for their demonstration?—that change of tempera- ture and change of motion are equally the law of Disease, Remedy, and Cause! APPENDIX. 225 Who, I again demand, taught me these ? Of these, nevertheless, and many other matters, which have never entered the head of the pathological professors, the " Unity of Disease," and " Fallacies of the Faculty," treat at length. Under the title of Erreurs de Mdecins, ou Syst me Chrono-thermal, the latter work is now busily agitating the medical circles of France and Germany. Permit its author to ask why you have not yet reviewed it? In the expectation that you will still do your duty in this respect to your readers, he looks forward to a just and candid criticism at your hands. Your very obedient servant, S. Dickson. This letter the editor of the Medical Times declined to insert.—But shortly after- wards a " Review" of the " Fallacies of the Faculty" appeared in his pages,—which review, while it nibbled at certain fragmentary matter, discreetly postponed sine die, all notice ofthe doctrine of the Unity of Disease—and more particularly omitted to answer the question, Who have I Revived! A letter to the following effect was nevertheless obligingly inserted in the Medi- cal Times. No. III. Dr. Dickson and Dr. Forbes. To the Editor of the Medical Times. Sir,—Will you allow me through the medium of your pages to administer a little wholesome castigation to Dr. John Forbes, of British and Foreign Medical Review notoriety ? In the present January number of that periodical, Dr.-Forbes pretends to review the second edition of my " Fallacies of the Faculty." The very first quotation from the volume, in his first page, is a misquotation! The second quotation in the same page is a misquotation ! The first quotation in the next page is a misquotation !! At the bottom of his third page is the following false insinuation—" Curved spine, which Stromeyer and a few other insignificant schoolmen, have attributed to Para- lysis of certain sets of muscles is also, in the opinion of Dr. Dickson, a remittent affection." Certainly, at the commencement it is a remittent affection; but in the very volume my critic pretends to review, not only do I take much pains to prove its paralytic nature, but I claim to myself the discovery of that fact; and if Dr. Forbes chooses to appeal to dates, I will make it clear to the world that Stromeyer and his other schoolmen have only followed in my wake ! As a specimen of the misquotations I have noticed in this pretended Review, take the following:—In the original the passage stands thus, "Like every other remedial agent it (iodine) cuts two ways—atomically attracting or lessening volume and secretion in one case, atomically repelling or increasing both in another, accord- ing to the electric state ofthe individual body for which it may be prescribed." In the misquotation the word " anatomically'' is substituted in both instances for "atomically!" Dr. Forbes asks if this be not stark staring nonsense?—Most cer- tainly; but it is his nonsense, not mine.— Perhaps Dr. Forbes will ascribe these and his other misquotations to the printer's devil—six misquotations at least in a review of as many pages!—Such a course was worthy ofthe plagiarist of Dr. Payne [for a full account of which disgraceful transaction, see the various Medical Journals.] Yet he, Dr. Forbes, has the impudence to tell his readers, " We have done justice to his (Dr. Dickson's) doctrines by giving them and the proofs in his own language." He concludes his review by asking, " has not Dr. Dickson made an ass of himself V In return for which piece of politeness, [ ask you, Mr. Editor, if Dr. Forbes has not made a knave of himself! Dr. Forbes is a Court Physician, " Physician Extraordi- nary," &c, so is his friend and coadjutor Dr. Holland. Perhaps it is by way of re- venge for my having defeated Dr. Holland's ingenious attempt to steal my discove- ries, that Dr. Forbes now does his best by an equally ingenious device to stifle them. The world will doubtless cry " Arcades ambo!" 1 am, Sir, your most obe- dient servant, S. Djckson. 3d January, 1S43. APPENDIX, No. 2. Scarcely was the People's Edition published, when the same individual, who in June, 1842, enlightened the British Association with his "discoveries" on Vital Period- icity—Dr. Laycock of York—ventured to put forth something more in the same original vein in the Lancet—and among other things to ;lprevent (provoke?) con- troversy" he claims to have " discovered the periodic movement of all Vitality!" Im- mediately on seeing this, I wrote to the Editor of the Lancet, charging Dr. Laycock with Piracy; sending at the same time a copy of the People's Edition, Fallacies of the Faculty, that the respective dates of his and my papers might be compared. In- stead of printing my letter, Mr. Wakley, the Editor, in a note to Correspondents, in- formed me " The Pamphlet [Fallacies of the Faculty, a pamphlet!] of Dr. Dickson, will be examined in connection with the paper of Dr. Laycock, and our opinion ofthe question raised by Dr. Dickson given in another number." I immediately wrote to say, I would dispense with his, Mr. Editor's opinion, if he would do me the favor to print my letter. But to such a course, this most just judge, this " second Daniel," had the most invincible objection,—as my readers may perceive from the tone of his next announcement: " We have received the second note of Dr. Dickson—who may adopt any course that he thinks proper,though he maybe assured that we shall not allow him to make use ofthe columns of this journal for promulgating a charge of piracy against a highly respectable physician, unless he accompanies that charge with proofs of the accuracy of his allegation—[the first time he asks for proofs!] The subject is in process of investigation, and a perfectly fair and just decision shall be the result." Knowing pretty well the sort of investigation Mr. Wakley intended. I immedi- ately dispatched the following to his address, taking care, at the same time, to send a copy to the Medical Times, where it was in due time inserted :— to the editor or the "lancet." Do not Sir, imagine that any trick, or artifice, however ingenious, can juggle me out oi a discovery which it has been the labor of my life to establish—the discovery ot the Periodic movement of all Vitality—of the Periodicity of life in health-the periodicity of life m disease—of the Periodicity of movement of universal nature ! lou wi.l not, you say, allow me to make use of the columns of your Journal " for rnZElTw urge of P'Facy a?ainst a hiShly respectable physician unless I ac- sameP breath von S^u™ V"?-8 °f 2"* aCCUraCy °f m? Ration," and in the f^andTust IZ ft lubjtCt 1S mft V^ess ^investigation, and a perfectly fair and just decision shall be the result." What! an investigation and deci- sion without proofs! Not Mr. Thomas Wakley surely but soiS WnrtS T,„ underling, must have penned that absurdity. Proofed Wha Toof"dvon llnrf -words? dates? or both? words, or dates, that the papeS re^en^tlv Snttrf »^ eulogized by you under the head of" Vital Periodicity, W Dr Lavcocl?' arPIf mean attempts to plagiarize my doctrine of the periodic movement of all vh^"7, Sir, the proofs aie already in your possession, they are contoS ?n mv will htI! Fallacy of the Art of Ph/sic, L.; ?he Unity of ofseaL STaltaJle^f ^e FacS" ty, 1st, 2d 3d, and foreign editions; nay they are stamped on your own na„ , Look to the Lancet for 23d Sept., 1837, and you will there find, what Dr Lav8^8.' now so modestly puts forth as his, the whole doctrine of vital periodicity .Hv v myself. Let me quote it.—" The principal aim of my volume {Fallacy 0f ,/Je" hY Phy.-v; fife, published in 1836) has been to demonstrate that the corporeal acti rt°f man in hisjfiealthy state constitute the basis or standard of every kind of T of LIV1NG APPENDIX, No. 2. 227 action (all vitality ?) In health he rests from his labor—he wakes to sleep again—his {ungs now inspiring air, now expelling it; his heart successively dilating and contract- ing; h!s blood brightening in one set of vessels only again to darken in another—his lood and drink nutritious one hour to become excrementitious the next—in a word all appetites and necessities periodically alternating with each other." Nor do I connne this doctrine of periodicity to health—for in the same number of the Lancet you will nnd the following: " Is it not strange that the profession should still couple remittency (periodicity ?) exclusively with miasma or malaria as a cause. Every water who has professedly treated the subject, refers to this (malaria), seeming to be totally and absolutely unconscious of the universality of remission (periodicity ?) as a law ol all Disease." Thus far I have ouoted from what I have written and publish- ed in your own pages. From the Unity of Disease, first published in 1838, I extract the following: " The body under disease exhibits revolutions analogous to those in health, it shows a similar tendency to alternate motion and repose, for periods more or less regular, are observed to mark the approach, duration, and interval of recurrence of the morbid phases." And in the first edition of the Fallacies of the Faculty, pub- lished in 1839, is the following : " So far, however, from having been recognized as a law of universal occurrence, harmonizing with everything which we know of our own or other worlds, periodic return has been vaguely supposed to stamp the disorder where it was too striking to be overlooked as the exclusive offspring of a malarious or miasmatic atmosphere." " The human body, whether in health or disorder, is an epitome of every great system in nature. Like the globe we inhabit, it has in health its diurnal and other revolutions, its sun and its shade, its times and seasons, its alter- nations of heat and moisture. In disease we recognize the same long chills and droughts, the same passionate storms and outpourings of the streams by which the earth at times is agitated; the matter of the body assuming in the course of these various alternations, changes of character and composition, such as tumors, abscesses, and eruptions, typical of new formed mountain masses, earthquakes, and volcanoes ; —all these, too, like the tempests and hurricanes of nature intermitting with lon- ger or shorter pe ri od s of tranquillity, till the wearied body either regains, like our com- mon mother, its wonted harmony of motion, or like what we may conceive of a world destroyed becomes resolved into its pristine elements." In these extracts not only have I given the doctrine ofthe periodicity of health and disease in all vitality, but the doc- trine of universal periodicity—of the periodicity of all nature ! Further proofs, if further proofs be wanted, you will find in the volumes I have already placed in your pos- session, although in the list of your " books received" you have not thought it politic to include their names. Under these circumstances, to refuse to print my charge against Dr.Laycock in the journal that contains his piracies, would be to refuse me common justice. It would be the act of one who has received stolen goods knowing them to be stolen. By such a course you would reduce your periodical to the level of the Brit- ish and Foreign Medical Review, the editor of which, Dr. Forbes, first misquoted, mis- represented, and then endeavored to divide the honor of my discovery between your protege' Dr. Laycock and his Court colleague Dr. Holland—Dr. Holland whose pla- giarisms I had so fully exposed in the volume Dr. Forbes pretended to criticise. In his number for January, 1843, Dr. Forbes damns the doctrine of periodicity and re- mittency when it comes from me. Three short months afterwards (April) he has the effrontery to print the following:—" The intermittent nature of disease must most certainly be better understood before we can practise medicine scientifically." " Dr Holland has an interesting essay on the subject in his Medical Notes and Reflec- tions and more recently Dr. Laycock has attempted to demonstrate a general law of rjeriodicity "—" If his researches prove to be correct, a considerable change must necessarily take place in both the theory and practice of medicine." Such base- ness Sir is perhaps unparalleled in the history of any science. It has proved to me that'I had neglected to make myself acquainted with one element of penodicity- Periodical rascality—an element, however, I am pretty well prepared to encoun- ter, with the little monosyllable Dates. To these and to the public—if not to the profession-I appeal. i ^ ^ ^ ^ obedi(mt( S. Dickson. Clarges-Street, Piccadilly, April 22,1843. This letter not having appeared in the Lancet on the next day of publication, I again wrote to the Editor, Mr. Wakley, as follows: 228 APPENDIX No. 2. r Sir,—I herewith convey to you the Medical Times of t^dav^ic^c""Sns'a let- ter, I addressed and sent to you on the day of its date bv nost As you have taken no notice of that letter in this day's-Lancet, I infer that you sunnose the Conductor ot a Medical Journal may dispense with the common feelines of honor and justice, mat every man pretending to the rank of a gentleman is careful to evince when appealed to, in your position. Therefore, I accuse you, Mr. Thomas Wakley, of having in the case of Dr. Laycock, received stolen goods knowing them to be stolen—of being a party to a scandalous and contemptible swindle—get out of the matter how you can. I am, Sir, your most obedient S. Dickson. TT ■"W^-:W^^^ *w ■ + + '. KBsaHi! HB98BB9 ^rai^ra H9