LHJ f f3A II ol^ Ifi)? W? YQDMUlrS, OF NEW YORK . Av/r/'/rau A'c/ifor &/' /J/: Dwkio/tlr '/'////anr-r o/'///? ''ontt/y wit/i i/te f///-fMv '/7ier//tu/ Jyjlem of Mechcute- -„ ( Voune/ /'/n ■■!■//■. ) Onward /« itlo rcJ__ Dijraj'i' arid 2Jtni/i retire.. .4ne/ Piiutn 'rt/tQ Jjgmeus /tute/utti _ and (/rh'fi/'e / THE PRINCIPLES CHRONO- THERMAL. SYSTEM OF MEDICINE, /V*' WITH THE FALLACIES OF THE FACULTY, IN A SERIES OF LECTURES, BT SAMUEL DICKSON, M.D. < FORMERLY A MEDICAL OFFICER ON THE BRITISH STAFF. CONTAINING ALSO, AN INTRODUCTION. AND NOTES BT WILLIAM TURNER, M.D., | EX-HEALTH COMMISSIONER FOR THE CITY AND COUNTY OF NEW YORK, FELLOW OF THE SCIENTIFIC AND MEDICAL-ECLECTIC COLLEGE OF VIRGINIA, ETC. SECOND AMERICAN, FROM THE FIFTH LONDON EDITION. NEW YORK: H. LONG & BROTHER, 46 (Late 32) ANN STREET. 1848. W67 " Look at these two men about t6 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, ne- vertheless, are, as you see, on their 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 veiy embarrassing!" said Leandro. " What, in such a case, Friend Asmodeous, 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 doctor!"—Le Sage's Diablc Boiteux. John Douglas, Stereotyper and Printer, No. 11 Spruce Street, N. Y. TO MRS. GENERAL GAINES. Madam, It is related of the heroic and patriotic Mary Wortley Montague, who introduced into England a great medical improvement for her day—the small-pox inoculation—such was the malice of its ene- mies, that, though supported, in addition to the prestige of aristocra- tic rank, by a Princess of the Blood, she all but sunk under the dif- ficulties of her undertaking. How far, under our simpler institu- tions, the liberality manifested by you, whose chief distinction con- sists in your faithful and exemplary discharge of the duties apper- taining to the endearing relations of daughter, wife and mother, in permitting me to dedicate to you this edition of a work subversive of the entire fabric of " established medicine," may neutralize the sa- vage rancour of persecution, I am unable to predict. If, however, it shall be the means of attracting the attention of the women of our country filling the delightful domestic offices to which I have advert- ed, to a system calculated to enable them, under judicious advice, to disarm, in innumerable instances, pain of its intensity, disease of its severity, and to put the King of Terrors himself at bay, they will agree with me, that your sagacity, courage, and patriotism are wor- thy of a nation's gratitude. I have the honor to be, Madam, With profound respect, Your obliged and obedient servant, Wm. Turner. CONTENTS. Preface - - - - Dr. Turner's Introduction Sketch of Dr. Dickson - LECTURE I. Introduction - Phcenomena of Health - of Sleep Disease Causes of Disease - LECTURE II. Intermittent Fever, or Ague - Spasmodic Complaints - Palsy or Paralysis - Disorders of Sensation - Page LECTURE III. Hereditary Predisposition - - 55 Apoplexy.....57 Haemorrhage, or ruptured Blood- vessels ..... 59 Diseases of the Heart 62 Pulmonary Consumption, or Phthisis 64 Glandular Disease 75 Consumptive Diseases of Joints - 75 LECTURE IV. Inflammation- .... 77 Blood-letting. 84 Abstinence, or Starvation - - 94 LECTURE V. Medical Doctrines, Old and New - 99 Gout......104 Rheumatism - - - - - 109 The Stone.....Ill Cutaneous Disease - - - - 112 Variola, or Small-pox - - - 114 Plague......116 Yellow Fever - - . - 117 Dysentery ..... ng Dropsy......H8 Cholera...... jjg LECTURE VI. Present state of Medical Practice in England.....120 Dyspepsia, or Indigestion - - 123 Hypochondria, or Hysteria - ,- 130 Insanity - - - - '- 131 Effect of Ligature - 136 Faint -.....137 Congestion - - - . . 137 Infantile Convulsions - - - 140 LECTURE VII. Unity of all things - - - - 142 Diseases incidental to Women - 145 Cancer of the Breast - - - 147 Page Tumors ------ 151 Pregnancy - - - - - 152 Parturition.....153 Abortion, or Miscarriage - - 154 Teething.....154 Hereditary Periodicity - - - 157 LECTURE VIII. The Five Senses - - - - 157 Animal Magnetism ... 158 The Passions.....162 Baths......170 Exercise.....171 Plasters, Blisters, Ointments, &c. - 173 Homoeopathy .... 173 LECTURE IX. Physic and Poison Identical - - 179 Remedial Means - - - - 183 Action of Medicinal Substances proved to be Electrical - - 185 Particular Remedies, and why they affect particular parts - - 18G Emetics.....187 Purgatives.....189 Mercury -....<< Todine ..... 191 Lead -.--..« Tar—Creosote - - - « Sulphur - - - - - 192 Colchicum, or Meadow Saffron - " Squill, Digitalis " Stramonium, or Thornapple - " Tobacco, Lobelia Inflata " The Balsams and Gums - - 193 Cantharides, or Spanish Fly - " The Earths and Alkalis - - <■ The Acids « LECTURE X. The Chrono-Thermal Remedies :— The Peruvian Bark - - . 194 Prussic Acid - - . - 197 Opium, and its Salts of Morphia - 198 Alcohol, Wine, and Malt Liquors 199 Musk, Valerian, Camphor, Assa- foetida - - - . . . 200 Strychnia ---._« Silver.....2d Copper ----- 202 Iron ---... „ Zinc and Bismuth - . . « Arsenic - . . „ Summary of the Chrono-Thermal . D°ct™e.....204 Appendix:— Letters to the Author . . oiq Dr. Forbes' Trickery - . ,215 Dr. Laycock's ditto - . - 215 Dr. Copland's ditto - 220 Dr. Turner's Notes « PREFACE TO THE FOURTH BRITISH EDITION. " What have the physicians been about the last four thousand years ? The an- swer to that question will be found in the following pages .'" Such is the question—such the reply with which the eminent Health Commission- er for the City and County of New York introduces the Chrono-Thermal System of Medicine to his countrymen in the new West. The flattering terms with which Dr. Turner has expressed his acknowledgements to me in his Introduction to the Ame- rican Reprint of my labours, contrast somewhat curiously with the reception they have met nearer home. To the author of the Chrono-Thermal System he thus writes: "New York, MayUth, 1845. " Dear Sir,—This note will be handed to you by my friend Mr. Richard Burlew, a merchant of this city, who, visiting England on business, and intending to pass a few days in vour metropolis, has kindly undertaken to place in your hands a copy of an edition of your ' Fallacies of the Faculty,' which I have had reprinted here. He has also been good enough to undertake another commission for me, viz. to make an arrangement with some Daguerreotypist in London to take your likeness for me, if you will do me the great favour to sit for it. " The reprint of your book is too recent to enable me to inform you as to the re- sult. But I think the obstacles to a full reception of your beautiful System in Ame- rica, are not so great as they have been with you. The daily press here takes cogni- zance of such works. And thus far I have no reason to complain in this respect. My edition consists of 1000 copies. " I hope to communicate further with you hereafter, and would be pleased to re- ceive any hints or suggestions you may have to offer to your new disciple in this Western Hemisphere. Let me add, that, if I can in any way promote your views or wishes in this quarter, I shall be most happy to receive your commands. With unfeigned regard, " Your friend and obedient servant, " Wm. Turner. " Dr. Dickson, Bolton Street, Piccadilly, London." On a suggestion which the reader will find in Dr.Turner's Introduction, the " Fal- lacies of the Faculty" is now again presented to the public under its second title__ The Chrono-Thermal System of Medicine. In the face of much opposition, this system has already made its way pretty well in the world. Reprinted in America, it has had the further honour to be translated into three of the continental languages -^■French, German, and Swedish; while the sale of nearly six thousand copies of former editions in this country speaks favourably for its reception among the British people. When I come to relate how it has been received by the Medical Profession, the great body of them, I fear, will not feel much flattered, either by the matter or the manner of the relation. Fifteen years ago it was my fate—I can scarcely call it my fortune—to make two most important discoveries in Medicine,—namely, the Periodicity of Movement of every Organ and Atom of all Living Bodies—and the Intermittency and Unity of All Diseases, however named, and by whatever produced- To these I added a third —the Unity of Action of Cause and Cure,—both of which involve Change of Tern- vi PREFACE TO THE FOURTH LONDON EDITION. perature. Such is the groundwork of the Chrono-Thermal System—so called from Ckronos, Time or Period; and Therma, Temperature or Heat. This I gave to the public in 1836. Then, for the first time, I announced the appalling fact, that up to that hour the Professors of the Healing Art had been, to a man, in all but utter darkness on the subject they pretended to teach. From the days of Hippocra- tes, I indisputably proved, that when the Physician succeeded in the Cure of Di- sease, he did so—in Irish phrase—by accident, on purpose ! Thirty centuries and upwards the Blind had been leading the Blind in Medicine—the right way some- times—more frequently the wrong! Was it wonderful that a revelation so startling should come upon the Profession like a thunderbolt ? Silently, secretly, however, it has been gaining converts ever since from their ranks. Like the Religion of the Reformation in its earlier struggles, the Chrono-Thermal System has been embraced and practised by thousands who have neither the courage nor the honesty to dare the avowal. To those gallant men, who have openly come forward to bear tec timony to its worth, I want words to express my gratitude. How but for them could I have so long stood against the organised opposition of the Schools—the Bro- dies, the Chambers', the Clarks,—who, with their clique of pedantic, sycophantic supports, conspired to cry me down for my efforts to cleanse the Augean Stable of British Medical Practice of its filth and corruption 1 Could the London world but know the arts by which certain men have got a name, with what astonishment would it stare to find itself precisely in the position of a deluded savage, when, for the first time, he discovered the utter worthlessness of the red and green glass, for which, year after year, he had been unsuspiciously bartering his wealth ! In the dark, pigmies seem giants; Britain only knows her great men when they are dead. On Harvey and Jenner, while they lived, the beams of her warming sun never shone;—she all but deferred to acknowledge their merits till she saw them on their deaths, surrounded with that halo of immortality which all the nations of the earth united to bestow on them. The Chrono-Thermal System of Medicine has shared the fate of every truly great discovery. Translated, reprinted, and lauded abroad, it was first denied, decried, then plagiarised at home. And now, at the eleventh hour, (or year!) when France, Germany, Sweden, and America, have each come forward to speak to its worth, I, its author, find myself here in England exposed to the hourly abuse of men who gain their bread by practising in secret, or under some paltry disguise, the very principles they have surreptitiously pilfered from me! Who does not remember the London Practice of Physic only ten years ago—the barbarities practised under the name of medicine 1 Leech, lancet, and calomel—where are they now—those so-called sheet-anchors of the Medical Art 1 The change that in that short time has been accomplished in Physic, is not less great than what has taken place in our mode of locomotion through the agency of steam. Ten years ago, where was the madman so foolhardy as to declare that the Lancet could be dispensed with in Apo- plexy 1 Nearly ten years it is, however, since I first had to run the moral gauntlet for explaining, not only that this could be done, but that the employment of the Lancet is the most certain course to render that disease fatal! And here have we now in 1845, Books, Pamphlets, and Reviews all corroborating the fact, but studiously con- cealing the name of him who first announced it! The Editor of the Medical Times for one, will not deny, that when he first printed, as a marvel, a case of Apoplexy that had been successfully treated without Bleeding by Mr. Baldy, of Devonport, such was his dread of the professional conspiracy against me, he was obliged to draw his pen through the passage in the narration that alluded to Dr. Dickson as the first teacher of the new treatment! Nothing can more forcibly show the value of an article, than attempts to steal it. Would a pickpocket risk detection for an empty purse ? The first who committed PREFACE TO THE FOURTH LONDON EDITION. Vll himself in this manner was Dr. Henry Holland, a physician of the Court. In 1839, Dr. Holland, for the first time, hazarded as & prophecy, what I had not only proved, but printed as a fact in 1836,—namely, the Intermittency of all disease. Then, too, for the first time, he suggested as a probable danger, the employment of the Lancet in Apoplexy. Successively and under new disguises, new plagiarisms followed. Sir C Bell, Hood, Copeman, Dr. Searle and others, pretending to repudiate the Chro- no-Thermal principle, adopted the Chrono*Thermal practice. I know not if Dr. Searle be the same person who sent me his pamphlet about the Gases, " with the author's respectful compliments and admiration" inscribed on the title-page. Some such similar expression in the body of the book he lately printed, " On the Tonic Treatment of Diseases of the Brain," would have spared me the necessity of telling the world that the practice he advocates in those diseases is borrowed entirely from me. Sir George Lefevre, I regret to find, has followed in the same slippery track —quoting Dr. Holland, instead of me, on the subject of Apoplexy. " Dr. Baillie said in his day that Palsy was upon the increase. It is not improbable (remarks Sir George) that the UNIVERSAL system of blood-letting upon all such attacks, and even threatenings of them, has converted remedial into incurable diseases. Pa- ralysis has sometimes immediately followed the depletion intended to prevent Apo- plexy." Here the practice he condemns is admitted to be "universal." To whom must we attribute this universality of a bad practice ? To whom but to the teach- ers in the various medical schools—the so-called leaders of the medical world—the Brodies, the Chambers', and others of that stamp, who have so long led the Profes- sion by the nose, and the Public by the ear! Winter after winter in their Lectures at St. George's Hospital, did Sir Benjamin Brodie and Dr. Chambers assure their worshipping pupils that the Lancet and the Leech are the sheet-anchors of Apo- plexy. "Bleed! bleed! bleed!" was their cry—and bleed, bleed, bleed! was their practice. Of what slaughter have not these men been the cause ? Said I not truly, The Blind have been leading the Blind in Medicine 1 By the terrible doc- trines they have so long taught, must Sir B. Brodie and Dr. Chambers now stand or fall. Among the multitude of fools they may still find patients. The clique of sy- cophants who professionally support them, already begin to turn with the turning stream. One word to Sir George Lefevre, who has so unconsciously helped to this exposure. Why, when this good travelling physician was so elaborate on the new treatment of Apoplexy, did he omit to name the real author of that treatment in his work? and how came he to call his treatise "An Apology for the Nerves?" His nerves only require an apology, who conspires to rob genius of its due. The next book Sir George indites, may possibly be—An Apology for Himself! The Chrono-Thermal Principle is denied, disguised, plagiarised, and whispered away—the Chrono-Thermal Practice secretly triumphs in every hand! Dr. Cop- land, it is true, in his peculiar fashion, has admitted the correctness of both; but to account for it, he contends, that within the last five and-twenty years Disease has changed its type—that the physical constitution of man has changed its character j Pity he did not sooner announce his discovery! For something like five-and-twenty years has this very Dr. Copland been ever and anon favouring the public with his notions about Medicine. But not till the year of Grace 1844, did he tell the be- nighted world, that the diseases of mankind had ceased to be continual, and had all [to gratify Dr. Dickson ?] taken on the Intermittent Type—that the Lancet and the Leech must, henceforth, give way to Bark and Tonics " even in Inflammation of the Chest!" Ah! Dr. Copland, why not confess at once you had just been taking a peep at Disease through Dr. Dickson's spectacles ? As it is, you have unwittingly paid him a compliment at the expense of your integrity, your honour, and your understanding. The Type of Disease change! Forms change; Types are immuta- ble ! A Continual Disease! Who ever heard of an eternal tempest or an eternal viii PREFACE TO THE FOURTH LONDON EDITION. storm ? From the beginning of Time there never was a continual disease—a conti- nual tempest of the human body! How degrading these piratical attempts to take my Bark, and throw its owner overboard ! They afford an index, however, to the present morale of the Profession. Vain will be its calls upon any government to re- form it, till its members shall have first individually learnt to reform themselves. Among the pitiful persons who have been thus amusingly employing themselves, I must not forget to notice a country practitioner, of the name of Laycock, who figures as a member of the British Association for the Advancement of Science. " The British Association," we are told by the Times newspaper, " began at York; —what it has brought forward, of new, is not true—what, of true, is not new!" From this sweeping condemnation of the Times I wholly dissent. The Herschells, the Bucklands, the Sedgwicks, the Murchisons,—Faraday, Brewster, Airey, have laboured too successfully in science, not to rebut with all sensible people, this lan- guage of the Times. These, with other illustrious names, belong to the British Association. But, unfortunately, connected with it also, is a rather noisy class of people—principally of the Doctor tribe—who hope to emerge from obscurity, by clinging to the mantles of the truly great men who belong to it. Of this excep- tional class is Doctor Laycock. To him and to his doings, the censures of the Times completely apply. He began at York. At York, in 1842, by means of a false tail and other Yorkshire tricks, he disfigured and disguised my hobby, Vital Periodi- city, to pass it off afterwards as his own at one of the meetings of the British As- sociation. Not content with this, he did the same in the Lancet; and, some time after, he repeated the offence in Forbes' Medical Review—that well-known recep- tacle of stolen property. Blush! Messrs. Chambers, for having allowed him to do the same iu your respectable Edinburgh Journal. As a specimen of the false tail he tacked to my hobby, let me give the first joint:—" A day of twelve hours," quoth Laycock, " is the basil unit of Vital Periodicity." The merest schoolboy could tell him, that a day, being the measure of one full revolution of the Earth, takes twenty-four, instead of twelve hours, for its accomplishment; and that the basil unit of all Periodicity must necessarily be the smallest portion of Time the mind can imagine—a second being sufficient for every practical purpose. My let- ters iu the Medical Times very speedily stripped this jackdaw of his borrowed fea- thers. With a perseverance, however, worthy of a better cause, I find him again at his tricks with the British Association. Only within the last few weeks, the Bo- tanical Zoological Section of that body—all doctors, of course—appointed a com- mittee to inquire into the " Periodicity of Plants and Animals,"—got up, I happen to know, at the instance of Mr. Laycock, to shield him and his delinquencies from the scorn and contempt of a profession he, and so many people like him, have de- graded. Oh, for the report of this precious Committee ! The Periods of sowing, planting, flowering and reaping,—" annuals," " biennials," " septennials," and so forth,—taken for the nonce from the Gardener's Chronicle, when prettily dressed up with a certain imposing technicalityof manner will furnish forth a highly origi- nal dish on the Periodicity of Plants. While the plundered contents of my volume, variously distorted, and mixed up with the history and habits of Birds and Beasts, —not forgetting the nidification, egg-hatching, and breeding of the genus " Goose" and class " Reptile,"—the cackling and slimy creatures with which they are so fa- miliar,—will be reproduced as a scientific novelty on Animal Periodicity. On this particular occasion the pilfering Magpie, by desire, will be left out; so also, per- haps, will be the mare's nest of " a day of twelve hours." The whole performance, however, to conclude with a handsome compliment to the talented author of the discovery—Doctor Laycock, the quondam York apothecary. Alas ! for the learned Laycock—to have his name and his fame withered in a moment by a slight com- parison of the little word, Dates. For these and some amusing facts, I refer the reader to the correspondence in the Appendix. , 28, Bolton Street, Piccadilly, September, 1845. DR. TURNER'S INTRODUCTION TO THE FIRST AMERICAN EDITION. This work was published in London under its second title, " Fallacies of the Fa- culty," a phrase which does not convey a proper idea of the important character of the production; like the " Curiosities of Literature," and so forth, it might rather 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 author, I have given promi- nence* to what he had made the second branch of its title, as best calculated to indi- cate 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 et 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 posterity will one day pronounce a verdict in my favour,—for the evidence I am prepared to ad- duce in its support, will be found to be as perfect a chain of positive and circum- stantial 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 at diminution of the amount of the same motions or events, and being universally alter: native with a Period of comparative Health, strictly resolves itself into Fever—Re- mittent or Intermittent, Chronic or Acute;—every kind of structural disorganization, from Tooth-Decay to Pulmonary Consumption, and that decomposition of the knee- joint, familiarly known as White Swelling, being merely developments in its course: —Tooth-consumption, Lung-consumption, Knee-consumption. 3. The tendency to disorganisation, 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 characterised 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 x INTRODUCTION TO THE AMERICAN EDITION. 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 Tempera- ture, (cold and heat,) Chronos being the Greek word for Time, and Therma for Heat or 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 bleeding-lancet, and the cupping instrument." The subject of blood-letting occupies a considerable portion of these Lectures. What first caused the author to peroeive 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 Hos- pitals I had an opportunity of studying disease, both at home and abroad. There I *w the fine tall soldier, on his first admission, bled to relief of a symptom, or to fainting. 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 permanency, 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 consumption, dysentery, or dropsy; his con- stitution was broken by the first depletory measures to which he had been sub- jected." y/ 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. 1 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. Resorted to under the most favourable circumstances, its success is anything but sure, and its failure involves consequences which the untoward administration of other means may not so certainly produce. I have never taken credit for being the first opponent of the Lancet. But one thing in regard to this matter I do claim cre- dit 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 argumenfc of former opponents of the lancet never before produced on the profession,—namely, an impression of the dangerous nature of the remedy; and whe- ther they like to be told of it or not, I claim to have either convinced or compelled the profession materially to alter their practice. To say blood-letting is a bad thing 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." 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, a source of great dread—especially in the treatment of acute diseases. I could not see my way clearly—I was not satisfied—I revolted from a system of practice to which my understanding could not give its full and entire sanction. In that year 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. INTRODUCTION TO THE AMERICAN EDITION. xi Disease being thus simplified, according to the system of Dr. Dickson, it follows that it is, to use his own words, amenable to a Principle of treatment equally sim- ple. 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 distemper. To apply warmth, or administer cordials in the Cold stage; in the Hot, to reduce the amount of temperature, by cold affusion and fresh air; or, for the same purpose, to exhibitraccording to circumstances, an emetic, a purgative, or both in com- bination. 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, the influenza! In the early stages of disease, to arrest the fever is, in most instances, sufficient for the reduction of every kind of local develop- ment. A few rare cases excepted, it is only when the case has been of long stand- ing 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 tempera- ture 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 this, 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 by violent chills, followed by darting pains in the lungs, severe headache, a rapid pulse, hurried respiration, and all the symptoms of Inflammation (so called) of the Lungs. Added to this, owing to conpunction 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. Peruvian 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 fort- night, 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 parti- cularly valuable and eligible. Other distinguishing features of the Chrono-Thermal System of Medicine are— First, A demonstration of the fallacious character of the ideas entertained by the Profession and the Public in reference to Inflammation and Congestion, those fruit- ful sources of error. Second, 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. Third, That the Chrono-Thermal Medicines are to be used generally in minute doses, and that hence but little medicine is required. Fourth, The doctrine that all remedies act primarily upon the Brain, and thence, electrically or magnetically, through the system. Writers on Medicine, pursuing a false mode of analysis, have for a long time been engaged in dividing and subdividing the subject until it reached its acme in the ela- borate and ponderous tomes of the learned and classical Dr. Good; in which such is the extent of subdivision and subtilty attained by the author, that the recollection 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 seizing upon the question with the true analytical grasp of his genius, reduced the whole to a xii INTRODUCTION TO THE AMERICAN EDITION. 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 think, from its subject, that it is a dull, dry, and tedious disquisition upon matters of interest to the medical fraternity alone. This would be a great error. The au- thor has-adapted it to popular use; on which account, he has discarded as much as possible all technical terms. He has also enlivened his production by the introduc- tion 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- sicians and Surgeons of Great Britain in favour of the system of Dr. Dickson; among the rest, a letter from Sir Astley Cooper, who, on receiving a copy of a previous edi tion, 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 translated into French, German, and Swedish, for the use of the people of those nations. Wm. Turner. New York, 269 Tenth Street. P. S. While this reprint 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 corrobora- tive of the truth of the Chrono-Thermal System, and indicative of the progress that benign and salutary system is making among active and scientific minds in the Bri- tish metropolis, I have thought it would not be unprofitable to devote a little extra space to their examination. The first, entitled Practical Observations on the Diseases most fatal to Children, is by Mr. Hood. The chief object of this gentleman's work, is to call the attention, not of medical men only, but of all persons who may be interested in the matter, to the investigation of the mode of treatment which may be most appropriate 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 in- flammation, if not properly checked by bleeding and the administration of active antiphlogistic medicines, speedily causes death. Now," he proceeds, " without en- tering here into any pathological discussion respecting the symptoms and conse- quences of inflammation, but supposing that it exists, or is 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 men- tioned is improper." , After discussing certain tables constructed from that report, he concludes 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 in- dicating an opposite course of treatment. Having so frequently witnessed the benefi- cial effects of his 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 especially to the subject." INTRODUCTION TO THE AMERICAN EDITION. The subjects treated of are inflammation, irritation, teething, bronchitis, and inflam- mation of the lungs, whooping-cough, croup, measles, scarlet-fever, small-pox, con- vulsions, and inflammation of the brain, scrofula and cachectic diseases, constipation, and, lastly, the effects of calomel on children. Under the head of inflammation 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 sub- due the disease by abstraction of the blood." In discussing inflammation on the brain, he remarks, " In looking over several cases which I have known treated by bleeding or leeches, when the brain was suffering from congestion in infants, I am unable to point out one in which the treatment was successful. There was usually an abate- ment in the violence of the symptoms for a short period when blood had been drawn, but they invariably returned with redoubled vigour; and death appeared to be has- tened by the use of blood-letting as a remedy." The other work is entitled, " A Collection of Cases of Apoplexy, wtth an Explana- tory Introduction. By Edward Copeman, Surgeon." The author has transcribed from various authentic works and journals, and from his own note-book, no less than 250 cases of Apoplexy, in order to convince himself of the correctness of an opinion he had long entertained, that the popular and professional prejudice in favour of bleeding in affections of the brain, is not justifiable by the results 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 favour of the latter; and should be considered sufficiently correct, from the number of cases re- ported, to neutralize the far too prevalent idea that bleeding is the only remedy to be depended on in Apoplexy. The practice of 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 Apo- plexy. 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 ap« peared 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 following 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 cases." The following are tables of the cases above alluded to :— Number not bled, 26, cured, 18, died, 6. Number bled, 129, " 51. " 78. Number of cases in which the treatment is specified, 155. Proportion of Cures in cases treated by Bleeding,...........................1 in 3}. Proportion of Deaths in ditto, about........................................1 in 1J. Proportion of Cures in Cases not bled,.....................................1 in 1}. Proportion of Deaths in ditto,..............................................1 in 3i. Behold, then, the answer to the question which, above all others, is asked by tho 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 ?' W. T. PREFACE TO THE SECOND AMERICAN EDITION. "Like causes," philosophers assure us, "produce like effects." The reader, therefore, will be prepared to hear that the appearance three years ago of this work in this city, created as great an uproar in the medical camp on this side the Atlantic, as that sr crudity to be expelled, nor any fanciful chemical goblin to be chemically neutralised ;—neither is the state erroneously termed inflammation, so com- moniv the cause as a coincident part of general disorder. Disease is an error "£ 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. Whatever be the cause or causes of corporeal aberration, in obedience 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 movements less under the con- trol of their respective influences, become tremulous, spasmodic ; or wearied, palsied, the functions of particular muscles cease. The breathing is hurried on slight exertion ; or it is maintained slowly and at intervals, and with a long occasional inspiration and expiration—familiar to you all in the act of sighing. 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 preternatu- rally tumid and bloated. Alive to the slightest stimulus, the patient is easily impassioned or depressed ; his mind, comprehending in its various relations every shade of unreasonable sadness or gaiety, prodigality or cupidity, vacil- lation or pertinacity, suspicious caution or too confident security ; with every colour of imagination, from highly intellectual conception to the dream-like vagaries and reveries of hallucination. His sensations are perceptibly dimi- nished or increased. Light and sound, for example, confuse or distract him; like the soft Sybarite, a ruffled rose-leaf frets him. With the smallest in- crease 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 or idiocy, he becomes equally insensible to excess of light, sound, heat, and cold. Contrast, if you please, these simpler forms of Disease with what we have said of Health, and you will at a glance perceive that the difference betwixt the two states consists in mere variation of the sum or amount of particular corporeal motions, and in a difference of effect of external agency on the matter and functions of the body. Structural change, or tendency to decomposition of any part of the frame, so frequently but erroneously associ- ated with disease as a cause, is not even a necessary element in a fatal result. What are Toothache, Consumption, Rheumatism, but developments of consti- tutional change ?—they are phenomena which ma^y or may not arise out of general corporeal disturbance, according to particular habits and predisposition. 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 in the cohesive 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 moonstruck madness, pining atrophy, Marasmus, and wide-wasting pestilence, Dropsies and asthmas, and joint-racking rheums 1" MlLTON'. Gentlemen, the Causes of all these various diseases—Various in name, 32 LECTURE I. place, and, degree—One only in their real nature—may be found either in a deprivation or wrong adaptation of the identical forces which con- tinue Life in health,—the same natural agencies, in a word, by which every motion or event is produced throughout the universe. They comprise, there- fore, everything that connects us, directly or indirectly, with the external world; and most, if not all of them, act upon us, in the first place, through the dif- ferent 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 con- ceive with Hobbes, that, "nothing taketh beginning from itself, but from the action of some immediate agent without itself." If this be true, how de- lusive 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 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 possessing a competent knowledge of the various organs of the body on which 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 who ever 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 accessary—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 Hippocrates, and yet you have seen 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 block- head with a tolerable memory may easily master it.] " Butin 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 elec- trical condition of the living brain,] " which no contemplation deduced 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 carcasses, as if thereby the medical art might be rather promoted, than by the diligent observation of the natural phenomena, and of such things as do good and hurt,"—the action of medicine, for example, 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 opi- nions of two celebrated men in direct opposition. But in the course of these lectures, I will give you something better than any human authority, how- ever respectable. The too exclusive spirit in which professors have urged the necessity of investigating the bodies of the dead, not in England only, but throughout Europe, has given rise to a class of medical materialists, who, hoping to find LECTURE I. 33 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 disease of which it was only a development or coincident part. " These people." in the words of the late 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 medicine from the dignity of a science to the mere detail of an art." What has practical medicine gained at the hands of ana- tomical 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 cathedrd, that anatomy is the foundntion of all medical science. That were true enough, if by the word " foundation" be meant that anatomy is the lowest part of it. The fact is, this kind of language is the natural re- sult 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 dis- eases, which, in ninety-nine cases out of the hundred, demand medical, not surgical knowledge for their cure. Beware, then, of trusting to great opera- tors, to men whose art Shakspeare truly says has " no honour in it,"—for were Physic better cultivated, there would be little need of such an oppro- brium in medicine as operative mutilation. It is an art, too, that blunts the feelings and inclines its professors too often to use the knife more to gratify their own love of display, than to give relief te their suffering fellow-crea- tures. No "great operator" should be permitted to perform any capital operation without the previous consent of one or more physicians. In its present mechanical and degraded state, who can wonder that those who practise Medicine should so frequently cut the sorry figures they do when examined 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 dissec- tion 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 dissecting-room." The same no- bleman, 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 advantages, let me ask, have cen- turies of dissection contributed to the healing art ? We hear of a great many, truly; but lungs decomposed, livers enlarged, bone, muscle, and in- testine 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 •'" 34 LECTURE I. 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 him- self 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 dissecting-room in horror. Antimony, rhubarb, mercury,—whence got we our knowledge of these ?—From the quack and the old woman—individuals who will ever suc- cessfully compete with physicians, while the latter busy themselves with dead bodies, to the neglect of the powers and principles 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 attach- ing to a medical reputation. To return to the causes of disease,—are they not infinite ? The seasons and the sidereal influences; the earth and its emanations ; the air and its electrical conditions; the degrees of temperature, dryness, and moisture of surrounding media; 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 partialists, those who, with the quantity or quality of our food or airs, associate every disorder,—as if passions, burns, blows, wounds, &c, were mere words. The late Mr. Abernethy, to whom science, never- theless, owes something, was an example of the first. To the stomach and bowels, he almost invariably pointed as the first cause of every disturbance. He forgot his own observation, that a passion, or blow, will alter the secre- tions of both. He ascribed the first link in the chain of causes to a feature, which could only be improved by an agent affecting the nervous or percep- tive system, in which that and every other symptom could alone have their origin. But what shall we say of those who, like M'Culloch and others, attribute 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 whatever caused or characterised, are in the first instance without their remissions or intermissions, all more or less periodic and perfect. Man is not an isolated being; without air or 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 re- ception from friend and foe, the state of family or finances, will equally excite, depress, and disorder his various organs and functions, as a deprivation or de- pravity of the food he eats, or the air he breathes. An unexpected reverse of fortune, good or bad, may lay the foundation of a thousand maladies; nay, examples are on record, where individuals have instantly expired from in- tensity of sudden joy. Of sudden grief many have been the victims. " It has been too much the fashion iii 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 LECTURE I. 35 and its cure. The single agency of thermal change, for example, 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 that 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 accordingly; but, properly speaking, there never was a purely local disease. You will doubtless ask me if toothache, con- sumption, and ulcers, are not local diseases ? So far from this, it is impossi- ble 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 laboured 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 satisfied with the phrase, " loss of health," but as many of you, Gentlemen, 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 farther, and call it Remittent 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 con- tinually, but must have its hours of rest and hours of action." We have already analyzed the Life of Health ;—we have seen that it con- sists in a periodic alternation of harmonious movements, some long, some short,—greater and lesser movements, otherwise fits ; in Shakspeare's lan- guage, 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 apoplexy, all come on in fits; that all have febrile chills or heats ; that intermissions or periods of immuni- ty from suffering, 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 successful in the treatment of Intermit- tent Fever, popularly termed Ague ; to what other conclusion can we pos- sibly 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 Lectures, we further prove that what are called " inflammations" also come on in fits ; that the subjects of them have equally their periods of immunity from pain, and that these forms of disorder yield with equal readiness to the same remedial means ;—who can be so unreason- able 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 developement,—simplicity of principle with numerous modifications of form. This is what I wish to impress upon you in the 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 pheno- mena of Health,—their FEVER-like ^-fulness,—the slow manner in one case, the rapid manner in another, in which these healthy fitful motions run into 36 LECTURE I. motions unhealthily fitful,—run into the true ague or agueish fits, with which I shall hereafter prove to you all diseases commence. And beware of mis- taking the end for the beginning,-the consequence or coincidence for the cause ■ beware of that all but universal medical error—that fallacy in many instances 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 developement simply,—a termination or effect, though sometimes a coincidence from the be- ginning, of repeated constitutional febrile attacks. Health and Disease, Gentlemen, are convertible 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 dis- eased 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 diur- nal and other revolutions; its sun and its shade ; its times and seasons ; its alternations of heat and moisture. In disease, we recognise 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 abscesses, tumours, 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 motion ; or, like what we may conceive of a world destroyed, becomes resolved into its pristine elements. 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 access, exacerbation, throe, fit; the second, as we have already seen, meaning the period or interval of comparative freedom from disorder ; though when less completely periodic, Intermission is usually termed Remis- sion. For my own part, I shall occasionally be compelled to use Remission and Intermission synonymously. But as I have already explained to you, so far from having been recognised as a law of universal occurrence, and harmonising 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 acie, better known as Prussic Acid, iron, silver, copper, strychnia, musk, assafe- tida, valerian, colchicum, zinc, bismuth, turpentine; and there are others, doubtless, in nature, which time and accident may yet discover. These agents, Gentlemen, are generally most effective when taken during the intermission. From the relation which their influence must thus bear to Time or Period, and Temperature (Cold and Heat,) I term them chrono- thermal—xQOvog (Chronos) being the Greek word for Time—deo/xt) (Ther- ma) for Heat or Temperature. 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 curative power of any medicine in any disease, I will here tell you how I lately settled this matter with a certain young barrister, who thought he should be able to prove to me that physic is all nonsense. " Do you LECTURE I. 37 mean to tell me," said the gentleman in question, " that putting little bits of pounded stick or stone into a man's stomach, will cure any disease whatever ?" " Oh ! certainly not," said I; for when you find people obstinate, it is better to humour them a little at first; " but perhaps," I continued, " you may just be disposed to admit, that little bits of pounded stick and stone may cause disease, and even death;—otherwise 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 business he could not by any sophistry get rid of. So I then thought it time to ex- plain to him, as I now do to you, that the principle upon which these sub- stances 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 conditions. Gentlemen, turn over the history of medicine, and mark well the remedies upon which authors dilate as being most beneficial in any form of 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 moderate degrees of it, characteristic of the period of remission ; thereby at the same time control- ling 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 a specific, for this or any other purpose, in physic ; arsenic, opium, hydro- cyanic 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 peculiari- ty, we shall afterwards prove, depends upon certain Electrical conditions of the Brain. But upon the nature and the mode of action of all Remedial sub stances, 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 de- velopements occurring in its course,—analytically, by rigidly scrutinising 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 prevailed 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 na- ture of Health, Sleep, and Disease, we in some measure explained ; and we proposed, as matter for future argumentation, that intermittent fever or ague is the type, model, or likeness of all the maladies to which man is liable,—referring, at the same time, to certain natural analogies in the world around us ; and hazarding the statement, (which, until we prove, we by no means wish you to take for granted) that the chrono-thermal, or ague medi- cines, are the most generally influential in the treatment of every kind of dis- ease. 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 38 LECTURE II. 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 remedies, which we chiefly use as remedies of Prevention, we possess a multitude of powers which have all more or less influence upon the human body, both in health and disease : and though few or no substan- ces 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 organs of the body greater than to others ; some affecting one organ, some an- other. Of this class, Vomits, Purgatives, and Diuretics, (as their names im- port,) 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 medi- cines, singly, may answer every purpose, particular cases of disorder will be more efficiently treated with alternations 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 connexion with this subject, that the action of remedy and cause, in every case, comes at last to the common principle of their capacity to affect temperature or motion—change in one never taking place without change in the other. It will be a subject of in- terest 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; taking 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 your 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 favour upon all counts, you will at least collectively 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, according to Lord Bacon, " disciples do owe unto masters only a temporary belief, and a suspension of their own iudgment 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 dark- ness of your ignorance, you could not by any possibility tell was a stone ! No longer mocked by mystic gibberish, you will now take your places as iudges of the very doctrines you formerly, as pupils, implicitly and without examination believed ; and according to the evidence which I shall bring be- fore 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, in 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 acquaintance 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 institu- tions—the College of Physicians. Railroads, steamboats, galvanism, and o-as, have all come to light within the last half century. A revolution in thought and action has been the result; petty objects have given way to comprehen- LECTURE II. 39 Rive views, and petty interests have been destroyed by the general improve- ment that has already been accomplished. Is medicine the only branch of iiuman knowledge destined to stand still, while all around it is in motion ? Is the march 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 in their day were looked upon as demigods in physic, have in turn declared that all that they knew of it was that " they nothing knew," shall blame be attached' to hivn 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 successful in their worldly pursuits, may, in this instance at least, have followed 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 forgot that medicine has no power over a corpse.— Gentlemen, the reflections which I shall have the honour to submit for your consideration, were the result of observations made on the ever-shifting mo- tions 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, Hebrew, — are these representations 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 good old maxim, " Know yourselves ?" Having premised this much, I now come to consider in detail the pheno- mena of Periodic Fever commonly called Intermittent Fever or Ague ; for Ague being the type of every other modification of disease, it is necessary vou should be well acquainted with the principal shades of suffering so de- nominated. I have already told you there can be no disease, no morbid mo- tion 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 in a different condition of body from either of the others; his sensations, consequently, differ during each of them. To the state of Perspiration, which terminates the fit, a periodic Intermission, or regular interval of comparative health, succeeds ; and this interval of immunity from suffering usually lasts one, two, or more days (giving rise to the terms, Ter- tian, Quartian, and other agues, according to the duration of the interval), 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 every stage of the fit, all the functions of the body are more or less disturbed. During the cold stage, the face becomes pale, the features shrink, and the muscles are tremulous or even spasmodic : the patient, in other words, shivers, has cramp, and his strength is prostrate. The breathing and circu- lation are variously altered,—the urine, if any passes, is generally pale and plentiful, and the other secretions are similarly changed in quantity and quality. The senses and mental powers are for the most part depressed, or even curiously vitiated ; sometimes, though seldom, they are preternaturally exalted. The patient has nausea and loss of appetite; occasionally sick- 40 LECTURE 11. ness ; less frequently looseness of bowels ;—or he has hunger amounting to voracity,—thirst more seldom. A reaction now comes on. The tempera- ture of the body gradually changes from cold to hot—the pallor of the face gives place to redness—the cheek is now flushed—the eye suffused, and the patient suffers from headache, more or less agonising. This is the Hot stage. The thirst, whether it existed before or not, is now a most prominent symp- tom ; the appetite is thoroughly lost; the patient manifesting, in most in- stances, a repugnance to the very name of food. If you inspect the tongue, you will find it comparatively dry and loaded, and of a brown •colour; 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 in- duce 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 be- ing pale and plentiful, as in the preceding stage, is scanty and high coloured. The secretions generally are sluggish, and in some instances they are alto- gether suppressed. A long Sweat succeeds, during which the greater num- ber of the suppressed secretions gradually reappear. As with a feeling of languor, lassitude, and a disposition to yawn, and stretch the various mem- bers 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 periodically pass into the Fever-fit, or continue for an inde- finite space, so as eventually to become 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 some of the repetitions of this terrible tempest of body, termed an Ague-Ht, that weak point were not very often discovered; but discovered, more or less, in most instances, it is. Is the brain the least strongly constructed point ? Then, according to the part of the organ most implicated, and the degree of implication, will you have vertigo, epilepsy, apoplexy, insanity, imbecility of mind, palsy, or their shades superadded. Is the original weak- ness 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 in 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 chances to drop in—with the usual scholastic sagacity, he discovers 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 be- ginning, but to the end—not to the fever, but to its development. The state of the joints is the sole subject of thought and action ; the Brain—that Pan- dora's box of the whole—that organ upon which every motion of the body, wrong or 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 made 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, LECTURE II. 41 and some of the more important terminations of what is usually called a per- fect ague-fit. I must now tell you that all agues are not equally perfect; 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 intermission, or immunity from suffering, instead of extending to a day or days, may be only an hour or two in duration. The disease is now no longer Intermittent Fever or 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 de- grees 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 or 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 Ty- phus Fever ; from a Greek word signifying stupor or unconsciousness, that being one of the most common symptoms. What, then, are all these fevers but varieties or shades of each other 1 What can a sick man be but the alteration of a healthy man ; his tem- perature altered, his movements altered? the periodicity of most of his functions altered, the material of his body in both states must be the same ! During the course of all or any of the fevers we have mentioned, every or- ganic 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 loca- tity in which particular symptoms may induce him to suspect its existence. Should a new doctor chance, just at this 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 detained, and be esteemed, 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 people in the world can get further than the sur- face 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 for the time 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 prac- titioner will not always be content merely to seize upon the local termination as the cause or beginning of the mischief, and proceed to treat it accordingly; he will very often drop a hint, at the same time, that but for neglect of this the case might have taken a more favourable turn. 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 know, I, or any other doctor knew, or could know, might have been the liver, stomach, or anything else ! And by that pretty speech of his, nine times out often, 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 Physic as taught in the Schools, it was the almost universal belief of medical professors that ague 42 LECTURE II. could only be caused by emanations from the fens ; the complaint being very common in fenny countries ; indeed I am not sure that this belief is not even now one of the numerous absurdities still taught in our schools and univer- sities. 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 from 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 escaped the observation of the poets. Shakspeare, as I shall afterwards show you, often alludes to it; and Coleridge, if I mis- take not, says, " There's no philosopher but sees That Rage and Fear are one disease, Though this may burn and that may freeze, They're both alike the Ague." You see, then, there can be no corporeal agitation, no constitutional revolu- tion, without a change of temperature of some kind. Butler, in his Hudi- bras, 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 passions bear to ague. Throughout them all you may observe the same tremor and thermal changes; and in many cases the diseases 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 on every day at the same time; but during the remainder of the twenty-four hours, she had, in scholastic phrase, a "lucid interval;" in other words, an intermission amounting to sanity. 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 stage of ague ? Have we not the same hot or febrile fit succeeding ? " The fevers," says Mr. 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 manner in both cases, that we obtain the group of symptoms included by phy- sicians 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 Fever • and the old physicians treated all fevers in 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 m the Sangrado 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 feve^ou 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 s true ; but how often may you do this safely ? So far as my experience of medica 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 wL nor can there be, a fever without a remission or period of comparative immunity from suffering, more or less marked. Most writers of name, from Cullen down- LECTURE II. 43 wards, admit 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 indefinite time, and whatever be the name of the disease, you have health. By Bark, Opium, and the va- rious chrono-thermal medicines, you may in most cases succeed. But in- stead of trying to prevent recurrence, practitioners now-a-days only tempo- rise during the fit; and this is the most profitable practice ; for a long sick- ness 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 notwith- standing ? When I come to speak of Inflammation, you shall see 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 In- dian 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 superficial, 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 be- lieve one-half the rubbish propounded by medical teachers, I cannot now un- derstand ; 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 endeavour to point out to you. To return, then, to Fever. From the facts and observations already stated, you at once per- ceive that during each paroxysmal stages of an ague, the entire economy is more or less altered and revolutionised. 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 the brain in the shape of a Passion, a poison, or a blow on the head ; or more remotely, as in the case of a sudden chill of the whole body, 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 paroxysmal symptoms. Why, after these symptoms have once completely passed away, and the economy has been comparatively re- stored to its usual healthy motive condition, periodical repetitions of the dis- eased motions should yet recur, is a thing not more inexplicable than that the various habits of Health should,—in certain instances with our conscious- ness, in certain other instances without it,—all have a tendency periodically to repeat themselves. Life after all, both in Health and Disease, is a series of periodic repetitions, whether we regard it in the minor movements of the organs, or in the greater alternations, remarkable in the Unity of the Body. To most of us, the day of to-day is but a repetition of the day of yesterday ; modified, it may be, by a little more repose or a little more stir ; hope, fear, joy. and sorrow, alternating. Upon this subject I will touch more at large at an after period of the course. Meantime, as the symptoms of an uncom- plicated Ague-fit stand out boldly in reljef; and as in every other form of disease, however named, or by whatever caused, these symptoms or shades of them may readily be traced, I take Ague for the type of the whole. But while with this explanation I assume every disease to be in the first instance an ague—do not suppose for a moment that I employ the term in any con- fined0 sense. Call the symptoms ague, fever, or what you please, consti- tutional disturbance is the prelude to every disease—the precursor of 44 LECTURE II. every kind of local mischief not immediately produced by chemical or me- chanical agency. In numerous cases, if not in all—more especially after re- peated paroxysmal recurrence, superadded local phenomena appear, and these last, in some instances, may be of a kind so grave and important, as to throw the constitutional symptoms 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 the atomic movements only be altered—organically, if the part in question be threatened with a change in its structure tending in any way to its destruc- tion 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 disorganising disease of the knee- joint, termed " white-swelling," and that too common termination of chest disease in this country—Phthisis, as it is termed by medical men—Consump- tion or Decline by the vulgar. The propriety of adopting any remedial measure has, in every case, more or less relation to Time and Temperature. But the beneficial influence of the Peruvian Bauk, and its preparation Quinine, would appear, more than any other agent, to depend upon the period in which we administer it. The proper period for its exhibition is during the 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 disease whatever. For, did there exist a specific—did there exist a remedy that could certainly cure all cases of a given disease, man, so far as that disease is concerned, would be immortal! Had there been a specific for ague, do you think the court doc- tors would have permitted Oliver Cromwell to die of it ? Whatever be the agency by which this or any other disease has been cured, you shall find, in the course of 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 medical friends; Bark among the number. One day, when riding out, he was seized with a paroxysm. The inmate of a little shop, where he dismounted till the fit should be over, suggested to him to try the barber-surgeon of his neigh- bourhood. Willing to be cured by any body, 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 suc- cess of that plaster ? The general good effect of Quinine in keeping off the ague-fit, when it proceeds from viewless causes, is sufficiently well known to every member of the profession ; but it is not so generally understood that the same agent may be equally serviceable in cases produced by local injury. Of this, however, I will give you a proof. A gentleman, shortly after hav- ing had a bougie passed, was seized with ague of the most perfect kind ; two days after, at the same hour, he had a return, and every alternate day it re- curred, 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 occasion, nor at any time afterwards, unless when compelled to use the bougie. v I do not know that I can better commence my proof of the intermittent nature of disease generally, than' by entering into a short consideration of what are termed Spasmodic Complaints. Such complaints being unattended with any structural change, are termed by the profession functional ; a word, as we have seen, expressive of their LECTURE II. 45 simplicity. What is the meaning of the term Spasm ? It means an irre- gular 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 suc- ceed, and there are a great many medicines by which, when taken internally, the same effect may be produced ; but what will answer in one case may not answer in another. The disease is sometimes termed Convulsion, and Cramp also ; more especially if the spasms be painful. The difference of locality in which spasms take place in different persons has afforded professors an excellent opportunity of mystifying the whole subject. When it happens in the membraneous fining of the lachrymal duct, the tears accumulate at the inner angle of the eye, from the passage to the nose being closed up by the contracting spasm. This disease is called Epiphora, and sometimes, though not quite correctly, Fistula Lachrymalis. Sneeze, Hiccough, and Yawn, are also effects of spasmodic action. Occurring in the muscular appa- ratus of the windpipe, or its divisions, 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 convul- sions of the face and limbs, there is usually loss of consciousness, with a sud- den 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 Jaun- dice, in ninety-nine cases out of a hundred, owes the yellow colour of his skin to spasm—spasm of the gall-ducts—though any other obstruction of these passages—a gall-stone for example, may give rise to the same effect. Taking place in the ilium or small intestines, spasm is termed the Iliac Pas- sion ; in the colon or great intestine, Colic; in the urethra, Spasmodic Stric- ture. The Lockjaw affords yet another example of spasm. That all these various diseases are merely effects of the same action in different parts, is proved by each and all of them having been known to assume the most per- fectly periodic type in individual cases, and by all being more or less ame- nable to the same class of remedies most generally influential in keeping off the ague-fit. Like every other Force in nature, our remedial powers all act by causing Attraction or Repulsion; and for a reason to be afterwards given, every remedy can act both ways in different individuals. All medicinal agencies have the power of producing inverse motion; and, in this way, they cure or alleviate in one case, while in another they cause or aggravate disease. Opium, for example, will set one man to sleep, and keep another wakeful. Arsenic has cured the tremor, chill, and heat of ague, and produced them in a previ- ously healthy person. The same results have followed the exhibition of opium, bark, and copper. Moreover, to all four have I traced 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; 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. %n these two cases, then, arsenic produced inverse motions, causing epilepsy in the first, and curing it in the second. When I come to treat particularly of the pas- sions, I shall show you that the same passion which has caused an ague or an epilepsy, may cure either. In truth, I scarcely know a disease which the passions, Rage and Fear, have not cured and caused, according to their at- tractive or repulsive mode of action in particular cases. I have said that Asthma is an intermittent disease. " The fits of convul- sive asthma," according to Darwin, " return at periods, and so far resemble the excess of an intermittent fever." Had this physician's knowledge of the nature of asthma been sufficiently complete, he would have told us that be- 46 LECTURE II. tween ague and asthma there is something more than a resemblance ; that the asthmatic patient, in fact, has an ague, with the further development ot spasm of some of the muscles of the windpipe. But call the disease what you please, 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, how- ever,—that of a gentleman who had the disease every second night,—1 had the greatest difficulty in effecting a cure, for it was not till I had nearly ex- hausted all my best resources, that I at last obtained success 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. The analogy which subsists betwixt Spas?n and Tremor, has not been unnoticed by medical writers. Analyze " tremor," " shivering," " shak- ing," and you will find the motions so termed to be merely a rapid succession ofincomplete spasm. In St. Vitus's dance, or as it is sometimes called, " the leaping Ague," which is also a periodic disease, you may see every variety of spasmodic and tremulous action a muscle can exhibit. It is a frequent disease of children, and in most cases you may obtain success with minute doses of one or more of, the chrono-thermal remedies; one remedy of course answering better in one case, another in another. With the same agents, prescribed upon the same principle, I have been equally fortunate in the treatment of Urethral Stricture—a disease for which the bougie, in general practice, is far too indiscriminately employed. You all know the beneficial influence of the warm bath in this affection, and some of you may have heard of the same good result from the internal use of Iron. But the influence of Quinine over stricture is not so generally known. It is unnecessary for me to give any instance of my own in evidence of this, Sir Benjamin Brodie having published at length the case of a gentleman afflicted with spasmodic stricture of the tertian type—that is to say, a stricture which came on every alternate night about the same hour,—and which yielded, in the hands of that surgeon, to quinine. The marked periodicity of this case, doubtless, suggested the proper treatment; but in cases where this is less striking, you have only to ask the patient, if there are times when he passes his water better than 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 mus- cular apparatus. Such a patient, on coming out of a warm room into a cold one, will find himself, all in a moment, unable to pass a drop of water.— See then the effect of thermal change—of change of temperature—in producing spasm ; and hence, too, the benefit to be derived from the warm bath in the treatment of spasm generally. In the great majority of strictures, the surgeon may save himself the trouble, and his patient the torture, of passing the bougie at all, by treating the disease chrono-thermally ; that is, if he prefers the in- terest of the public to his own; but this mode of preventing the return of the disease is obviously less lucrative than that which enables him to give tem- porary relief at the expense of a long attendance. We now come to that particular form of disease termed Palsy or Paralysis : an affection in which, when complete, there is an absolute loss of muscular power. From the suddenness with which the patient is, in most instances, affected or " struck," this disease is known to every body 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—an inability to excite their action in any manner whatever by the will. Now it is a common error of the schools LECTURE II. 47 to teach that such disorder is always dependent on some pressure on the brain or spine. There is no doubt that pressure on these parts can cause palsy ; but much more frequently this disease is the effect of a weakness of the brain or spine, produced by exhaustion, the cause of such exhaustion be- ing various of course. Paralytic disease has often been produced by a purge, and oftener still by loss of blood. The recent case of Sir William Geary must be still fresh in every body's mind. That gentleman met with a sud- den loss of blood from an accidental wound of the carotid artery; palsy of the left side ensued. Weakly persons, on suddenly rising from their chair, sometimes all at once lose the use of a leg or arm. Most cases of paralytic disease, if properly sifted, will be found to be only the termination of pre- vious constitutional disturbance ; previous threatenings of such loss of power having been more or less frequently felt by the subjects of every case. More- over, 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 intermittent phenomena ? In one of the numbers of the Dublin Journal, 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 per- fect periodic intermissions. It is taken from a foreign journal [Hecker's]. "A peasant girl was attacked in the following manner:—Speechlessness came on every day at four o'clock, p.m., 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 hiss- ing noise. Consciousness did not seem impaired during the fit. She ascribed her inability to speak to a feeling of weight in the tongue. The paroxysms went off with a large evacuation of watery urine, accompanied by perspira- tion and sleep. Ten such attacks had occurred, when Dr. Richter of Wies- baden 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 com- ing on." The corporeal temperature is not stated by the reporter of the case, but the periodic manner in which it came on and went off, to say nothing of the mode of its cure, sufficiently illustrates its nature. Not long ago, I was consulted in a similar case, which was moreover complicated with palsy of one side. Sarah Warner, aged 25, married, had suffered periodically from loss of speech, and also an inability to move the leg and arm of one side. Various remedies had been ineffectually prescribed by her medical attend- ants, who all looked upon her disease as Apoplectic—in other words, they supposed it to be caused by pressure on the brain. One of them, indeed, proposed to bleed her, but she would not consent. When she applied to me, I ordered her a combination of Quinine and Iron, after which she never had another fit. I shall now give you the details of a case of palsy which I treated suc- cessfully, after it had been long considered hopeless:—Mrs. Sargent, aged 40, a married woman, and the mother of several children, had kept her bed for eight years, on account of paralysis of the lower extremities ; during which period she had been under the treatment of eight or nine different physicians and surgeons of the Cheltenham dispensary, Dr. Cannon and Mr. C. T< Cooke among others. Such at least was the woman's own statement, con- firmed to me by many people of respectability, who had visited her from the commencement of her illness. When I first saw her, she could not move either leg; her voice was an almost inaudible whisper; she was liable to frequent retchings, and she complained of spasms with much pain of the loins and limbs. Her last dispensary medicine, mercury, which she believed had 48 LECTURE II. been given her by mistake, had produced salivation, but with decided aggra- vation of her symptoms. In tbfS case, I prescribed a combination of reme- dies, the principal of which were hydrocyanic acid and tincture of cantharides. Under this treatment, her voice returned in about a week; her recovery from every symptom was complete in six weeks, and she had no return in three years after she was under my care : nor, so far as I know, since that time. Charles Overbury, aged 10, had been in a curious state for six 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 diffi- culty he swallowed his food, but the heart and respiratory muscles performed their respective offices with tolerable correctness. The patient laboured under complete loss of speech the entire night, and nearly the whole day. About the same time daily, noon, he could utter his monosyllables, yes and no; but this power remained with him for half-an-hour only. The remedies to which I resorted in this case were minute doses of calomel, quinine, and hydrocy- anic acid, all of which improved him, but the last proved 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. You marked, I hope, the perio- dic, though imperfect, 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 the muscles of that actress became stiff and rigid throughout the entire body. When taken together, these cases show the analogy which subsist between paralytic and spasmodic affections ; indeed, in many cases, both affections co-exist at the same time in different muscles of the same person ; sometimes they are complicated with idiocy or insanity. A young person was some time ago brought to me by her mother, at the request of the Rev. Edward Murray, brother of the bishop of Rochester__ This girl had not only complete mental imbecility, or paralysis of the mental brain, but she had also lost the use of one side, so as to be utterly helpless in every way. Every night also when she was put to bed, she had an epileptic attack. In this case, I prescribed a combination of copper, silver, strychnia, and quinine. About six weeks afterwards, an intelligent-looking young per- son walked into my room with a letter, "from the Rev. Edward Murray." I could scarcely believe I saw before me the same girl; yet she was speak- ing and walking as well as she ever did in her life. Her epileptic fits had become faint, few, and far between, and she was then the monitor of her class! Now, this patient, 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, continued for about six weeks, with country air she recovered the use of her side so far as to be able to walk without a stick • the use of her arm also returned. Had this lady been bled or leeched she would not have survived many days. ' . l j™1.1 now ^ve y°u a case or two exemplifying the cure of palsy of a LECTURE II. 49 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 which establishment her mother held the situation of nurse. But cupping, bleeding, leeching, blistering, were all ineffectually tried. The same mode of treatment as in Mrs. Sar- gent's case, with the addition of a galbanum plaster to the loins, in which she complained of coldness, was adopted by me, and followed with like success. She had scarcely been a fortnight under my care, before she completely re- covered the use of her paralytic limb; and she has had no relapse during the last 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 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 explained that she was subject to severe shivering, with occasional convulsions. 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 in. possession of the complete use of her limb ; nay, she returned to her service at Mr. Ward's, which she only left to get 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 of several professional persons of eminence, 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 treat- ment, 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 balusters, she could run up and down stairs nearly as well as myself. Should this statement be considered to require better confirma- tion than my word, I am permitted 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 English 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 mv care, saw her the day after she arrived, and had the satisfaction to wit- ness the whole progress of her cure. I could here give you numerous other cases, all more or less explanatory of the manner in which Palsy of almost every muscle of the body may be developed and cured. For the present, I shall content myself" with record- ing my experience of a disease, which, until I explained its nature, was never once imagined to depend on Paralysis, namely, the Curved or Crooked Spine.* By most authors, this disorder had been supposed to be, under all circum- stances, an affection of the bones. Some, indeed, vaguely referred it to pe- culiarity of nervous action; while others hypothetically traced it to loose- ness of the ligaments. When the late Mr. Abernethy said it was owing to a " rancour 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 * When 1 first published my view of the nature of Curved Spine, in 1836, its correctness was called iu question. When Stromcycr and others ou the continent, without noticing my labours, afterwards adopted my explanation as their own, it was admitted by the whole profession to be true. What a reward to the real cultivators of science,—first to have their discoveries denied, then pilfered' The reader will find as he proceeds that this is not the only instance of plagiarism I have to com- plain of. 50 LECTURE II. in the word " rancour," when applied to a subject like this ? Rancour is an old English word for malignity or ill-temper ; but how can that apply to a state of perfect muscular repose,—to a palsy ? Nevertheless, to Mr. Aber- nethy'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 demonstrate. 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 direc- tion. The human Spine is kept upright by a similar apparatus—the muscles. If any of these muscles from bad health become weakened or paralysed on any side, the spine, from the want of its usual supporting power, must ne- cessarily, at that particular place, drop to the other side. But being com- posed 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 'ocality of muscles so weakened or paralysed. This disease or " deformity," (for Mr. Abernethy would not allow it to be anything else,) under all its un- complicated variations of external, internal, and lateral curvature, is the result of muscular weakness or palsy ; which palsy, for the most part, is a feature or termination of long remittent febrile disorder. It is often a more or less rapid developement of the usual diseases of children,—Scarlet fever. Chicken-pox, Measles, and so forth ; all of which, as I shall afterwards show you, are purely remittent fevers ; but whether complicated with vertebral disease or not, Curved Spine is no more to be influenced by issues, setons, moxas, &c, except in so far as these horrible measures almost 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 the curvature then very much 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 versd. 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 back, (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 rubbed night and morning with soap liniment. In less than a month the patient 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 plaster to be applied to the spine, and prescribed hydrocyanic acid and quinine. In three weeks she stood erect. 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 palsv 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, professionally to speak, " interstitial absorption" of particular ver- tebras 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 is at the same time a greater or less loss of power in particular muscles—for the same general bad health that weakens the bones must weaken the muscles 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 in the upper third of the back, where a swelling made its ap- LECTURE II. 51 pearance, 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 mea- sures, but with no good effect. When I first saw her, she could not walk without assistance. Upon examination, I found a considerable ex-curvature, 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 dispirited, shed tears on the most trifling occasion, and was subject to tremblings and spasms. She was gene- rally 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 in her general appearance was most decided; the protuberant part of her spine had in that period considerably diminished— her health daily became better, and in less than a month her cure was accom- plished. A permanent curve, slight when compared with her former state, still remains. Case 2.—A young gentleman, nine years of age, had external curvature of the upper vertebras 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 opening connected with the spine. His mother.observed that he stood more erect some days than others. When I was first consulted he had an issue on each side of the spine: but these, as in the former case, having been productive of no good, I ordered to be discontinued. Keeping in view the remittent and constitutional nature of the disease, I prescribed small doses of calomel and quinine. The very next day the discharge was much diminished, and a cure was obtained in about six weeks. The ulcer in that time completely healed up, but a permanent angular curve, of course, remained—trifling, however, when compared with the state in which I first found him, I might give you many other such cases, but my object is to illustrate a principle, not to confuse you with too much detail. These two cases, 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 incipient state, the other fully developed. It occasionally happens that the matter proceeding from a diseased verte- bra, instead of making its way out by the back, proceeds down in front of the loin internally, till it reaches the groin, where it forms a tumour; this tumour is called by the profession Lumbar, or Psoas, abscess. With the ex- ception of opening the tumour to allow the collection of purulent or other matter to escape, this disease, like the cases just detailed, should be treated 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 patients with spinal disease to a horizontal posture ; and a rich harvest makers of all sorts of beds and machines have derived from the prac- tice. In the greater number of cases this treatment is erroneous from begin- ning to end. Constant confinement to one posture is sufficient of itself to keep the patient nervous and ill; while his own feelings and wishes are, for the most part, the best guide as to whether he should rise, walk, sit, or lie down. In this he has no theory—the doctor too often has nothing else. Among the numerous causes of spinal disease named in books, much stress is generally laid on the improper use of Stays, and other articles of female dress. To these, however, I attribute but a very small share in the produc- tion of such disorder. You meet with every kind of spinal disease in boys, —in girls, more frequently, it is true ; but this greater frequency depends 52 LECTURE II. upon the artificial lives girls are compelled to lead-their domestic occupa- tions confining them more to the house, and allowing them less freedom ot general movement, and fewer opportunities ot enjoying the exercises and in- vigorating sports of the open air. _ Equally effective have I found the chrono-thermal principle ot treatment in that particular palsy of one or more muscles of the eye-ball, which gives rise to Squint, or Strasbismus, 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 commencement at least, is in most instances an intermittent disease. Can the intermission here, like that of the ague, be prolonged to an indefinite period by bark, opium, &c. ? Oh, I could give you half-a-hundred instances where I have pro- longed it to a cure by these remedies ! In a case lately under my care, the squint came on regularly every alternate day at the same hour, and lasted an hour. The subject of it, a boy of eleven, after taking a few minute doses of quinine, never squinted more. In another case, as nearly as possible the same, I ran through almost all the chrono-thermal 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 developements of remittent fever. Were medi- cal men only to attend a little more to constitutional signs, they would not, I am sure, leech, blister, and cup away at localities, as they are in general too fond of doing. If properly treated at the commencement, Squint is very generally curable by internal remedies; but when, from long neglect or ill-treatment, it has become permanent, the position and appearance of the eye may be made all but 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 operation, a new squint would follow of course. There is yet another paralytic affection of the Eye which I must explain to you. I allude to what is called Amaurosis, or Nervous Blindness. In this case, a non-medical person could not tell that 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 Hemeralo- pia and Nyctalopia, or day and night blindness. These, then, are examples of intermittent amaurosis; and they have been cured and caused, like the ague, by almost every thing you can name. You will find them frequent in long voyages,—not produced in that case by exhalations from the fens or marshes, as many of the profession still believe all intermittent diseases to be,—but by depraved and defective food, with exposure to wet, cold, and hard work, per- haps, besides. In the Lancet, [8th December, 1827,] you will find the case of a girl, twelve years of age, who had intermittent blindness of both eyes, palsy of the limbs, frenzy, and epilepsy ; 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 remittent 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 com- bined with mercury, or creosote. 1 will give you a case which I treated suc- cessfully by an internal remedy. Charles Emms, aged 25, stated to me that he had been completely blind of both eyes for upwards of nine years, four of which he passed in the Bristol Asylum, where, after having been under the LECTURE II. 53 care of the medical officer of that establishment, he was taught basket-mak- ing, as the only means of earning his subsistence. He had been previously an in-patient in the Worcester Infirmary, under Mr. Pierrepoint, but left it without any benefit. Some days he perceived flashes of light, but could not even then discern the shape or shade of external objects. Before he became com- pletely 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 de- scribed himself as being very nervous, subject to heats and chills, palpita- tions and tremblings, with great depression of spirits. My first prescription, quinine, disagreed; my second, silver, was equally unsuccessful; with my third, hydrocyanic acid, he gradually regained his vision—being, after an at- tendance 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, according to him, having become too good for his circumstances. In confirmation of the value of hydrocyanic acid in nervous blindness, I may mention, that Dr. Turnbull, in a recent work, has detailed some cures which he made in simi- lar cases by applying the vapour of this acid to the Eye. If patients, who are subject to Deafness, be asked whether they hear better upon some days than others, the great majority will reply in the affirma- tive ;—so that deafness is also for the most part a remittent disease. That it is a feature or developement of general constitutional disorder, is equally certain, from the 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 principle, I have been enabled to im- prove 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 completely by a short course of hydrocyanic acid. The like good effects may also be obtained by chrono-thermal treatment in ringing of the ears, &c. Indeed, very few people get much out of health without suffering more or less from noise in the ears ; sometimes so great as to cause partial deafness. Cases of loss of the sense of Touch, and also those of partial or general numbness, will, in the greater number of instances, be found to exhibit re- missions in their course. So also will almost every instance of that exalted degree of sensibility known by the various names of Tic doloureux, 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 surgical tricks done for their relief,—your moxas, your blisters, your division of nerves ? The only measures to which these diseases have yielded, have been the chrono-thermal remedies, bark, arsenic, iron, strychnia, prussic acid, &c, the remedies, in a word, of acknowledged efficacy in ague. I shall here present you with a case from the London Medical and Surgical Jour- nal, illustrative of the nature of Tic when involving the nerves of the face. The pain first supervened after a fright; it returned every day at two o'clock, commencing at the origin of the suborbital nerve, extending along its course, and lasted from half an hour to an hour. Two grains of sulphate of quinine given every two hours for three days, produced in so short a period a complete cure. The same prompt and favourable effects were observed in another case of frontal tic, that appeared without any known cause. Now, this frontal tic is commonly known by the name of brow-ague. Why, then, mystify us with 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. 54 LECTURE II. Loss of the sense of Taste is an occasional effect of constitutional distur- bance, 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 anybody, but she cram- med it all down ; she never ceased but when her jaws were fatigued. She found out that when she put her feet into cold water, she ceased to be hungry." What could be this woman's inducement to put her feet in cold water in the first instance ? What, but their high temperature—the Fever under which she laboured ? A gentleman, who was fond of play, told me, that when he lost much money he was always sure to become ravenously hungry; but that when he won, this did not happen. The condition of his body, as well as his brain, must have been different at these different times. To the state of corporeal temperature, we must also refer the various de- grees of Thirst, from which so many invalids suffer. This, like Hunger, when extreme, is a depraved sensatipn. If we have intermittent fever, so also must we have intermittent hunger and thirst among the number of mor- bid phenomena. Colonel Shaw, in his Personal Memoirs and Correspon- dence, 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." As yet, Gentlemen, we have 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 disorganisation 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 diseases are termed " organic," by medical writers, and to a certain extent they are more com- plicated 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-ther- mal influence, with one or more having a special local bearing. I have necessarily, on occasion, combined remedies which may partially decompose each other. In continuing still to do so I am justified by successful results, the only test of medical truth—the ultimate end and aim of all medical treat- ment. A charge of unchemical knowledge has been 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 Chemists ?" This charge, then, I am willing to share, with numerous medical men, whom the world has already recognised 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 the action of every sub&tance submitted to it. And here I may mention, that the late Sir Astley Cooper, when I sent him my work, " The Unity of Disease," with that candour and gentle- man-like feeling 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. LECTURE III. 55 LECTURE III. hereditary predisposition--apoplexy--hemorrhages--heart dis- ease—pulmonary consumption--glandular complaints--con- sumptive di3eases of joints. Gentlemen, We have hitherto derived our illustrations of the unity and intermittent nature of disease, almostly 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 immedi- ate etfect of mechanical or other direct injury. 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 consequences of those agues for which the usual 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 espe- cially of the liver, as also the spleen, and from induration of the mesenteric glands." It is only of late years that the better informed members of the profession have begun to suspect that these structural alterations, instead of being the causes of the "constitutional disturbances," are the results. But this phrase, in most instances, they use without any very definite idea of its meaning ; and when questioned in regard to it, they either confuse the matter with the mixed-up jargon of incompatible theories, or frankly confess that they entertain notions which they feel themselves unable by any form of speech to impart to others. Gentlemen, " constitutional disturbance," when analyzed, will be found to be neither more nor less than a morbid excess or diminution of the body's temperature, with corresponding errors in the various func- tional powers and periods—amounting, where the disease is recent (or " acute"), to the bolder features of intermittent"Fever—and in cases of longer standing (or " chronic"), coming at last to the more subdued symp- toms of that universal disease. Betwixt these two extremes, you have every kind of intermittent 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 persons, 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 56 LECTURE III. 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 morn- ing. They obtain their knowledge of this from the experience of their feel- ings in the'ir old wounds and fractures. 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, therefcre, in the very nature of things, be more liable to be influenced by external agency—by every thing, in a word, that has the power to put the matter of the body in motion. Whatever, under ordinary circumstances, shall slightly shake or affect the whole body, must, under the same circumstances, be a subject of serious import to its weaker parts ; and this argument also applies with equal force to the atoms of those parts of individual bodies, which, by hereditary predisposition, manifest a similar weakness in the attractive power of their atoms to each other. As the child is but an extension of the living principle of the parents, its frame must naturally, to a certain degree, partake of the firmness and faults which characterized its progenitors, whether mental or corporeal; resembling them, not only in external features, but copying them even in their inward configu- ration. Such similitude we see extending to the minutest parts, whether such parts be fully developed, or defectively, or even superfluously constructed. As instances of these last, I may mention, that I have known particular fami- lies, where the frequent repetition of six fingers to the hand has taken place in successive generations, and others, where the same members have been as hereditarily reduced beneath the correct human standard. Then in regard to hereditary mental resemblances, you may see children, whose father died before they were born, manifesting the same facility or stubbornness of temper, the same disposition 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 old father over again," is a common and correct mark 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 whe- ther 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 circumstances, whether or not such predisposition be actually and visibly developed in the '.ndividual members composing a given family. A person, for example, in whose family the heart or lungs is the weak point, by guarding himself against too rapid changes of temperature, and availing himself of a fortunate position in society, as to pecuniary and other means, may so control numerous excit- ing 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 recog- nize as the most prominent and important that affect the inhabitants of these islands, I may mention, Spitting of Blood, Consumption, and Glandular dis- orders. The rapid transitions of temperature, so characteristic of this climate certainly excite 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 population, the natives of India, who have died on our shores, have generally fallen victims to Glandular'and Chest Disease. Even the monkey acknowledges the baneful effects of such rapid thermal changes on his respiratory organs. More than one-half of this class of animals th&t come to England, die of consumption of the lungs. Diseased LECTURE III. 57 of the chest and glands certainly become hereditary; but under that head, you may include a great many others—epilepsy, apoplexy, palsy, mania— and, perhaps, every purely constitutional complaint which has obtained a name. Could the breeding of mankind be as closely watched, and as easily controlled as the breeding of our domestic animals, 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 characterise nations and families, might, in this manner, be as certainly diminished, as the beauty of the face and form might be exalted in its standard; for both depend^ greatly upon hereditary configuration, or upon that particular atomic 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 in- dividual; whatever will in any manner touch the strength and stability 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 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. Bv anato- mists, these various fabrics are termed the Tissues. Thus we have the Osseous or Bony tissue of the skeleton; the Cartilaginous and Ligamentous tis- sues 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 perspira- tion, and the like ; the muscular and tendinous tissues, so necessary to loco- motion ; 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. Besides these, there are certain nerves which influence growth, termed the ganglions or organic nerves. Then there is the vascular tissue, partly mus- cular in its nature, comprising the heart and its infinity of blood-vessels ; to say nothing of the cellular tissues, which, like a web or net, invests and insinuates itself into the whole tissues of the body. The tissue of the lungs and that of the intestinal tube are principally compounded of the others ; so, also, are the lining membranes of the various cavities and canals that convey the secretions—-mucous membranes," as they are termed—for the membranes that line such cavities, such as the cavities of the chest and abdomen, are dis- tinguished by the term " serous." The Cutaneous, or Skin tissue, performs the part of an outward envelope to all. Now, as there is nowhere to be found 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 Blood- 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 gene- rally, would, among other phenomena, develope such original weakness in that part of his vascular tissue, even where it had not been before suspected } Suppose you were to starve a person slowly, or to bleed him day by day, would you not in that case be sure to break down his whole health ? Would you not also weaken the coats of the blood-vessels generally, by what so palpably weakened every tissue of the frame ? Now, suppose one or more vessels of the Brain to be the least strongly constructed parte 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 thai 58 LECTURE III. conclusion. But, Gentlemen, I will give you a fact, or rather a host of facts, which you will be glad to take in change fo% a thousand theories. The inmates of the Penitentiary Prison, by very gross mismanagement, 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 sometime, they lost their colour, flesh, and strength, and could not do as much work as formerly." " The affections which came on during this faded, wasted, weakened state of body, were headache, vertigo, delirium, convulsions, Apoplexy." Remem- ber, Gentlemen, this is not my statement—no distortion or corruption of words made by me as a party advocate. It is a quotation literatim etverbatim from the official report of Dr. Latham, the physician who was deputed by Govern- ment to inquire into the cause of the great mortality of the Penitentiary. If you place any confidence in the accuracy of that report; if you believe Dr. Latham to be an honest man, there is only one conclusion you can come to, which is this, that the universal practice of starving and bleeding to prevent or cure Apoplexy, is the most certain mode of producing this disease in per- sons predisposed to it, and of confirming it in such as have already shown the apoplectic symptoms. Gentlemen, you seemed startled at this, and no wonder, for some of you have, doubtless, lost friends or relatives by the practice. How then, you #emand, must apoplexy be treated ? That apoplexy, like every other disease, is a development of general constitutional disturbance ; that it is in the first instance a remittent disease, aud in many instances cur- able, 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 you at length. It is from the pen of Dr. Graves of Dublin, and the subject of it was a gentle- man living in the neighbourhood of Donnybrook. This gentleman, Dr. Graves tells us, " Had slept well till four o'clock in the morning, when he was awakened by a general feeling of malaise, shortly after which he com- plained of chilliness, some nausea, and headache. [Here 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 labouring under a violent apoplectic fit. He seemed to derive much advantage from bleeding, and other remedies, and to my sur- prise was perfectly well when I visited him in the evening. The day but one after, at the" very same hour, the very same symptoms returned, and were removed by the very same remedies. [So at least the doctor thought.] I must confess," he continues, " that I could not explain in a satisfactory man- ner the perfect freedom from all cerebral and paralytic symptoms after two such violent attacks of Apoplexy. But when a third attack came on, I then saw it was a case of the Tertiana Soporosa [mere jargon] of nosolo- gists, and I prevented 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 repeated blood-letting, whatever might have been its effect in shorten- ing them, had not the slightest influence in that more salutary respect. But when Dr. Graves supposed that his bleedings did actually shorten the dura- tion of the fits, may he not have been deceived by the approaching intermis- sion ? may he not have mistaken this natural phenomenon of all disorder for the effect of his remedies ? However that be, this much I may be permitted to say for myself, that since I gave up the practice of bleeding in apoplexy. I have found that disease in the young as generally curable as any other, and in the old much less fatal than when treated by the lancet. Mr. Smith, of Cheshunt, lately informed me that he had cured several cases of apoplexy simply by dashing coli water over the patient's head, without drawing a drop LECTURE III. 59 of blood. Mr. Walter, a surgeon of Dover, has successfully treated apoplexy by the same practice. " The application of your theory," he writes to me, " has lately saved me from bleeding in turn 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. Dixon must be not to bleed in apoplexy ! —that is the language of every blockhead who, knowing nothing of the sub- ject 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 men who for years and years have been preaching up blood-letting as an infallible remedy 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 the word " Clutterbuck" assuredly stands at the foot of the article Apoplexy in the Cyclopaedia of Medicine, from which I quote—and this is what we there find 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 supposed." Only imagine the delight I felt when, in the course of my desultory reading, I first stumbled upon this passage. Such a confes- sion from such a quarter ! Gentlemen, I laughed most heartily, and made an extract on the instant, keeping to the exact words which 1 have now given you for your edification. That you may cure the disposition to 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 bleeding from the nose ? To put a cold key down your back, and thus by the sudden- ness of the shock change in a moment the whole corporeal temperature.— The principle is the same in both cases, and the good effects of that measure ought long ago to have suggested to medical practitioners a better practice in apoplexy "and other haemorrhages, than is at present the fashion with fashion- able doctors. Cold water, Gentlemen, has many virtues, but a great DEAL DEPENDS ON THE MODE OF ITS APPLICATION.* The Suddenness of the dash is the chief thing to be attended to'in cases of hemorrhage disease. So much, then, for the proper treatment of the patient during the fit of bleed- ing ; but what is to be done to prevent its return ? English practitioners almost to a man starve, bleed, and purge you. The following case may open their eves ; and as it is not taken from my own experience, but from a German medical journal of repute, it may perhaps carry more weight with it on that account. " A strong man, aged 27, suffered on alternate days from very violent bleeding at the nose, which continued from four to six hours, and could neither be stopped nor diminished by the usual styptics, nor by any of the other means commonly employed in similar cases. Taking into account the remarkable periodicity of the bleeding, the treatment was changed for a lar°e dose of sulphate of* quinine with sulphuric acid. During the twenty- one5 days following, the bleeding recurred but twice, and was then readily stopped. The patient subsequently continued quite well." — [Medical 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 com- * When the words I have placed in capitals in the text were first printed, Hydropathy, or the cold water cure was not oven known by name in England. Practised on a right principle. Hydropathy is onlv a fra-'mcntul part of Chrono-'i'liermal means. But while Priesmtz and h:s lollower. reject all remedies that God has given ..shut cold water ; 1, on the contrary, avail >n.v*eltol every good thing iu nature, cold water included. Fertility, not paucity, of resource, shoulu be the aim ot the enlightened practitioner. 60 LECTURE III. bination of quinine and alum. The same disease I have again and again cured by arsenic, opium, and Prussic Acid. A captain ot the royal navy, whom J lately attended alone with Mr. Henry Smith, of Cheshunt, for vomiting ot blood, got well by small doses of copper and the application of wet cloths to his stomach. . c You will now, I have no doubt, be prepared to question the propriety ot the usual murderous treatment adopted for spitting of blood—pulmonary apo- plexy, as it has been called. Is not the lancet in almost every such case the first thing in requisition, and death the almost as inevitable result of the measure ? What say the older authors upon this matter ? Listen to He- berden, 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 haemorrhage, by deprivation or revulsion, may it not be questioned whether this doctrine be so clearly established, as to remove all fears of hurt- ing 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 frequently will this febrile fit come on, and with it, the very haemorrhage which it is the object of their solicitude to prevent. Does it not stand to reason, that the more you debilitate the ichole body, the more must you, at the same time, weaken the already too weak tissue of the vascular coats—that tissue whose original weakness con- stitutes 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 non- sense, but the measures which medical men have for centuries been puttino- in force, for the cure of haemorrhage diseases generally, 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 exsanguine countenances of the unfortunate indi- viduals, who, whether for spitting of blood, apoplexy, or other haemorrhages, have been subject 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 the patient is actually dying of hectic or inanition. What fatal mistakes have not originated in this 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 th*, 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, that the coats of the blood-vessels, like every other tissue of the body, must be implicated in the general debility produced by whatever abstracts from, or prevents the LECTURE III. 61 entrance of, the material necessary to the healthy organisation of every part of the human frame ? To bleed or starve a person having a hereditary pre- disposition to spitting of blood or apoplexy, is the most certain method to de- velop these diseases in their worst forms ! Yet this is the daily practice of the most eminent physicians ! one among many proofs, that, in the medical profession, eminence is less frequently attained hy'successful results in prac- tice, than by the dexterous employment of all those arts and intrigues with which mediocre but unscrupulous minds' too often beat men of genius in the race. So far as practice is concerned, the eminent physician generally con- fines himself to the fashion of the day—the more especially, if that fashion be profitable to the apothecary ; for in such cases 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 suppose that any class of man- kind will put the interests of the public in competition with their own !— Benighted and misguided people ! you call upon men to relieve you from your sufferings, while you hold out to them the most powerful of temptations to keep you on your sick beds ! You pay for time, what you deny to talent; for a long illness, 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 almost forces them to be corrupt—and that, too, at a moment when their numbers are so great, it is utterly impossible for one half of them to live honestly on their mere professional gains. Hear Mr. Aber- nethy on this subject:—" There has been a great increase of medical men, it is true, of late years ; but, upon my life, diseases have increased in propor- tion." He might have added,—" And they are longer of being cured." 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 developement of general intermittent fever; the symptoms of which fever vary in their degree of severity with every case,—in one being bold and well marked ; in another, so softened and subdued, as almost to escape the patient's own observation ;—curable, too, like the simplest ague, by the cold dash or an emetic given during the hot fit;— and to be prevented from recurring by chrono-thermal treatment during the interval of remission. One case will yield to opium or arsenic, another to copper, quinine, or prussic acid, and some few 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 application of heat and cold in the different morbid con- ditions 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 haemorrhagie disease. The same system cf 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 sur- gical mechanic may learn that there are other and better modes of treating " varicose veins," than by bandages and laced stockings. Well, then, I have said all I mean to say upon the subject of Haemorrhage, and I have antici- pated 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 penetrate farther into a millstone than their pupils; and, seeing that for the most part such professors know as little of their particular subject as those they pre- 62 LECTURE III. tend to enlighten upon it, so far as their own reputation is concerned, they are doubtless right! The great medical millstone of the present day is the Chest,—and Laennec's bauble, the divining rod by which our modern sages pretend to have obtained their knowledge of it. If you believe them, a hollow piece of stick they have nicknamed " the Stethoscope," is the greatest invention of these times ! By means of it you may discover every motion and change of motion that ever took place in the organs within the cavity of the chest, and some that never could take place in them at all. What an invaluable instrument must it be, that stethoscope ! The enchanter's wand was nothing to it! But, seriously speaking, just observe how gravely 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," " egophony" 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 ?—disorders constantly misunderstood, and as constantly maltreated. Complain but of flut- ter or uneasiness in any part of the Chest, the stethoscope—the oracular stetho- scope—is instantly produced. Astonished—in many instances terrified—the patient draws his breath convulsively—his heart beats rapidly—and the in- dications obtained by means of this instrument, at such a moment of doubt, anxiety, and fear, are registered and recognised as infallible. " Have we not had too much talk of Heart-Disease since the stethoscope has come so gene rally into vogue ?" That was a question asked some years ago by the late Dr. Uwins. Let Dr. James Johnson answer it. 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, he is stated to have said at a Medical Society :—" It was a common error in young practi- tioners to consider 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 con- fines 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 there 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 instru- ment 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 depressing 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 announce- ment which afterwards turned out to be utterly unprophetic and false. How unwarrantable in any case to intrust the patient 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 remit- tent in every case, and complicated with others, all equally remittent, would LECTURE III. 63 he still persist in his small bleedings, his repeated leeches, his purges—mea- sures 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 his past treatment, and endeavour, 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 foresight and sagacity, while he only taught the patient's friends to be prepared for an event, he himself was materially contributing to hasten I 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 de- claring the organ to be enlarged, the other assuming with equal confidence that it was the reverse ! The utter absurdity of attempting to distinguish, during life, one form of Heart-affection from another by any particular sign or symptom, is sufficiently proved by this one fact, that mere functional va- riation of its motions may produce every symptom of a real change in the structure of the organ itself. But even could such a distinction 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 in- ternally administered in the form of medicines 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 phy- sician—setting aside, of course, original malformation of the organ. I will give you some cases in illustration :— A gentleman, age 30, had been ill for a long time, particularly complain- ing of his heart, the action of which organ was generally below the healthy standard, and it also palpitated occasionally. So great was his mental de- pression, that the smallest trifle produced tears. The temperature 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 particular times. As he did not improve in the country, he thought he would try a London doc- tor ; so he came to town and consulted the late Dr. Hope, author of a work on " Diseases of the Heart." The stethoscope in this case was as usual ap- plied to the chest; its annunciation was sepulchral. Hope here told no 4 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 the prediction—carscarilla and ammonia,—with aperients ! and a bleeding every month, or six weeks ! ! The patient's health, as vou 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 combination of prussic acid and creosote, which I afterwards followed up by arsenic 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 be- come so well as to be able to resume his profession—the law, which he had been obliged to leave off. Indeed, a letter I afterwards received from Dr. Selywn, gave me the news of his marriage. Yet this patient, according to the stethoscope, should have been dead and buried long ago ! 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, 64 LECTURE III. had for about ten years been subject to an intermittent pulse, and to frequent palpitations of his heart. Lately the palpitations seemed to observe irregu- lar 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 intermis- sion "ceased entirely, and did not return so long as he took the medicine." The cases I shall now give are three of many such which have occurred 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 altogether so dis- tressing, 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, headache, craving appetite, and some thirst, with great depression 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, this young gentleman was completely re- stored 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 was asked to see him. I ordered him prussic acid and musk, which stopped the palpitation in 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 the greater number of these complaints depend less on any defect in that organ than upon a weakness or want of power in the Brain to control the motions of the heart —and of this you may easily convince yourselves by putting the question to the patient: How do you feel when anything disturbs your mind ? 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 function—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 cough, and losing his flesh, and if, at the same time, he complain of shortness of breath and pain of the chest, and begin to expectorate a muco-purulent-looking matter, you may certainly set down that man's disease as Consumptive; for not only is the general health in that case manifestly wrong, but the 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 sub- stance? Should the patient's general health improve under your treatment he will naturally live as long as it continues to do so; if not, and if it as pro- gressively continue to get worse, he must die! Any further discussion of the matter, quoad hoc, resolves itself into the interminable question of Tweedle- dum and Tweedle-a!ee / LECTURE III. 65 '« Can consumption be cured ?" asked Mr. Abernethy, adding in his own sarcastic manner, " Odd bless me ! that's a question which a man who 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 purpose, for there is no case of any disease which, when it has proceeded to a certain extent, can be cured." The next question is, what are tubercles ? I take this to be the true answer :—For the requisite lubrication of the mucous membrane of the cells, and other air-passages of the lungs, there must be a certain amount of secre- tion. To supply this secretion, I need not tell you, there must be a glandular apparatus. A number of minute and almost imperceptible Glands, accord- ingly, do intersperse the entire tissue of the lungs—'the pulmonary tissue, as it is called—and abound more particularly in the upper portion of it—that identical portion in which pathologists imagine they have detected the com- mencement 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 paroxysms of greater or lesser intensity. During such con- stitutional disorder, and particularly during the course of severe fevers—such as a long remittent feve* the fevers termed small-pox, measles, and the like —these minute pulmonary glands become diseased, there being a previous predisposition 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 consumption 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 disease may in the course of time aggravate and keep up the febrile state. The affected gland is in this instance at first almost microscopically minute; but as the disease advances,' it swells and becomes of a reddish grey colour, or it may at once take on a suppurative action—-it may become an abscess varying from the size of a pea or less to that of a walnut or more ; or it may go on enlarg- ing to any extent without suppuration or becoming 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 suppurative state ; but 'in most cases of con- sumptive disease, both kinds of disorganization go on at the same time, one gland or cluster of glands suppurating, and sooner or later bursting and dis- charging 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 stated, 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 may be either pro- duced by a lodgment of matter in the air-passages, or be a spasmodic effect of the cold air coming, in contact with the ulcerated surface of the diseased lungs ; almost every patient, however, has it periodically more or less severe. 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 or felt; but apply any general influence that shall excite Fever in an individual 66 LECTURE III. predisposed to glandular disorder'—such as starvation, exposure to cold, or the abuse of mercury—and what do you find ? Why, these very glands gradu- ally enlarge and form tumours ; which tumours, 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 " Vomicae," as these tuber- cles 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 degree of importance of this in the animal economy, making the only difference between them. In still farther proof of the correctness of this explanation, I may mention, that Louis and others have detected tuber- culous matter in various other Glandular parts of the bodies of patients who have died consumptive. If it be objected that they have also detected it in the Bones, I answer, the bones, like every other part, have a glandular appa- ratus ; and this more particularly in the neighbourhood of their cartilaginous or secretive surfaces—the joints. In the joints, accordingly, we often find tuberculous matter developed. The shafts of bones, having fewer glands, are seldom affected with tuberculous disease. 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 consider- able portion of the lungs is destroyed—it cannot possibly be cured, though even in this case, the disease, by proper management, may sometimes 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." Some of you, doubtless, have had a certain portion of tooth slowly consumed by disease, which disease (tooth- consumption ?) by some change in your manner of living, or otherwise, has all of a sadden stopped, and the remaining sound portion of that identical tooth has continued to be useful to you for years! Such arrest of the consumption of a tooth, I have often myself obtained by quinine internally administered ; and Dr. Irving, of Cheltenham, some time ago, detailed to me two cases in which he succeeded with that remedy. Well, then, with medicines of this class, and sometimes even without any medicine at all, the same thing may take place in the lungs ; and I have known persons reach a good old age, who had portions of their lungs destroyed, but who, by proper medicine, and atten- tion 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 com- mence 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. But Consumption, in many instances, is curable—curable in stages even considerably advanced. The reparative power inherent in a living body is so great, that if you break the bone of your leg or arm, nature, without any physic at all, will reunite the broken parts—provided the system be kept free from fever, and nature will repair the broken lung as surely as it will cure the broken leg. Oh ! but, say the men who decide this question in the negative —how can that be, seeing the lungs are always in motion ?—that of itself would prevent such a desirable end. That of itself, Gentlemen, would do no such thing. Many and many persons have had a small sword or a pistol-ball passed through their breast, so that it has come out again at the back, and have yet perfectly recovered. Perhaps the lung in such cases was not wounded ? So I have heard people say ; but my answer was ready. The patient spit blood immediately on the receipt of his wound ! That, I fancy, you will call pretty conclusive evidence of the lungs being wounded. Well, then, people LECTURE III. 67 so wounded have recovered, though all the time their lungs were in motion. Cure the consumptive fever, I repeat, and the lungs will cure themselves as certainly as any other injured parts of the body. Those who deny the cura- bility of consumption are generally ignorant, conceited creatures, who know nothing but what they have picked up in books, or in the dissecting-room— they argue of the beginning from what they have seen of the end—of the liv- ing from their dissections of the dead. 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 prin- ciple 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—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 grand- father died of consumption under thirty years of age, and his mother fell a victim to this disease, with which she had been long threatened, in her 43rd year, and immediately 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 cold in the month of February, he was seized with Peripneumony, [inflammation of the lungs, now called Pneumonia]. 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 subject to Ague, was struck with the resemblance of the febrile paroxysms, to what he had experienced under that 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 repute by Syden- ham. What first induced Sydenham to prescribe horse-exercise for pulmon- ary 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 observa- tion of its good effects upon the living. You might dissect dead 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 external influences on living bodies, and dis- secting and hair-splitting the broken-down organs of dead ones ! " What- ever philosopher or projector," says Dean Swift in his Tale of a Tub, "can find out an art to solder and patch up the flaw and imperfections of nature, will deserve much better of mankind, and teach us a more useful science than that so much in present 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 estab- lished by the remissions and exacerbations of the above case, but also by the remedies that proved successful in its treatment; horse-exercise and change of air having cured agues, which had resisted every kind of internal treat- ment, bark among the number; so that bark is no more a specific for ague, than for any other disease. When you judge solely from the expe- 68 LECTUKE III. rience of the case I have just read-, in which the bark not only failed, 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 employment 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 f your estimation of any medicines 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 labouring under consumption ; for whom Mr. Maclure, the gentle- man who narrates it, prescribed generous diet and quinine. Dr. Marshall Hall examined the patient with the stethoscope, and pronounced an unfavour- able prognostic. E ven 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 responses ; 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 your 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 this 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 chrono-thermal medi- cines, I am satisfied I have cured ot arrested many cases of consumption— some of them, too, in apparently very advanced stages. The stethoscopist 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 tome much emaciated: he complained of shiverings, chills, and heats, night sweats, cough, and expectoration of matter, tinged with blood occasionally ; he informed me that he had been a patient at a provincial dispensary, from which, after having for some months taken much medicine, and been repeatedly blistered, 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 pre- scribed hydrocyanic acid three times a-day, and ordered him to take a pill, containing a combination of opium and quinine, at that period 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: his expectoration dimin- ished in proportion; and in about three months he returned to his work, with- out 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 these it effectually stopped. A year afterwards, 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 suc- cessful efforts in his favour. Now, some will say this was consumption, and some not—for when the patient dies, nobody disputes it; but when he gets well, every body does; some again may say that the disease might break out LECTURE III. 69 again at spme 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 possible manner, become, in the course of years and constitutional change, disunited again—as you may find, if you will read the acccount 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 muco-purulent matter ; her pulse was quick and small; she had chills and heats, and night sweats, with severe cough. I prescribed hydrocyanic 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 re- turn 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 these 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 ot blockheads may not do the same ? Iodine, prussic acid, and the new medi- cines, 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, a,nd 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 succeed ; for of those re- medies that are good for the jaundice, stone, agues, &c, that will do good in one body which will not do good in another—according 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, whether 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 ameliorate it in another ? Gentlemen, I shall afterwards prove that the reason of the difference of effect of all remedies, is the difference of the electric condition of the brain of differ ent patients. But whatever be the true explanation of the facts, they show, at least, the utter impossiblity of foretelling, in numerous cases, by what re- medial agency you can accomplish a given object—and they must also demon strate 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 remedy. But so far as regards prussic acid, its good effects in numerous cases of consumption are unquestionable. On the Con- tinent, 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 con- sumption. But prussic acid is equally influential as a remedy for Ague, and I have 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 contains,) 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 70 LECTURE III. accidentally taken an over-dose, will tell you how they felt as if they had had an electric shock. Whatever produces a sudden impression upon the whole frame causes such 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. The action of such substances, I need not tell you, is anything but mechanical. What, then, can it b& but electrical or galvanic ? To call it chemical or mag- netic 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 consump- tion among the number. But there is another mode of influencing consumption, which it would be well for the patient were it more frequently resorted to; namely, the em- ployment of cold shower and plunge baths. In the case of a gentleman whom I saw some time ago, with Dr. Watson of the Middlesex Hospital, I stopped the shivering fits at once by the employment of the coZrf-shower bath, after a hot bath and a warm plaster to the spine had been tried in vain. The gentle- man who was the subject of it was otherwise much improved. His friends, however, persuaded him he could not live the winter in England, so he went to Madeira and died. 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---r» au artist of eminence, aged 60, was suddenly taken with a very malig- nant Fever, in the course of which every organ of his body was more or less painfully affected ; he had a fearful cough, with severe pain in the chest, side, and back, and he expectorated (with much difficulty) a tough mucus, which every moment threatened to suffocate him. His pulse was very quick, and sometimes remittent, 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 dimin- ished in intensity, and the pulse came down to 80. The hopes of his friends were now high, when suddenly 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 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. How- ever, by steady perseverance—and in the right course what will not perse- verance do ?—by steady perseverance, 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 removed) with country air and horse exercise, in somewhere about six months his health gradually became re-established ; the cough and expectoration, at the same time, kept diminish- ing, until it finally ceased altogether. For the last two years 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 it ever was in his life. 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 the sub-carbonate of potass. In four or five cases, which resisted 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 proceeded 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 everlast- ingly on the eve of bankruptcy, or who lived in an atmosphere which dis- LECTURE III. 71 agreed 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 diffi- cult to give even temporary benefit to a consumptive patient. 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 auy of you ever hear of .Bram-cough, or .Ear-eough, or -Eye-cough? No! But you have, of course, heard two doctors discussing with the greatest gravity imaginable, 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 himself shall submit it to ana- lysis 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 enamoured 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, how- ever grave, which I have not myself cured by the same medicine ; ay, 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 coincidents ?— 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, I ask, 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 Wol- sey, when surprising him with the proofs of his treachery— ----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 unceremo- niously surprised, would be as much affected at such a moment as his appe- tite ? See then the absurdity of placing naturally coincident circumstances 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 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 72 LECTURE III. 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 medicine 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 individual 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 ? It is 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 diges- tive 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 particu- lar parts of the body most implicated in a giv^h case,—mercury, iodine, and emetics, for example, inasmuch as the cure may thereby, in many instances, be at least accelerated. 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 whatever may injure the health of persons predisposed to chest-disease, may as cer- tainly 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 pheno- mena, in general manage so to word them that you cannot distinguish 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, " 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 assertion to that effect." [Schloss Hainfield.] Now, in such a case as this, would not the responses of the stethoscope differ materially according to the time they were taken ? The indications obtained through its medium could not possibly be the same by night as by day. When I first published my sketch of the Chrono-Thermal System of Medicine, I had the misfortune, among other things, to find myself at issue with certain medical critics on this very subject of trie stethoscope. My un- disguised contempt for their wooden idol fired two of them, at least, with a common indignation ; for while Dr. Forbes, in his Review, made this a rea- son for pointing out to me " the advantages of common sense over the want of it," I found myself charged, on the same score, in the pages of Dr. James Johnson, with " profound ignorance and inveterate prejudice." To the strictures of both reviewers I replied in the Lancet. The utter inutility of LECTURE III. 73 the instrument in diseases of the Heart having, as you have seen, been since acknowledged by Dr. James Johnson himself, I will only now detain you with a few remarks as to its value in Pulmonary Consumption. Permit me, I said to my very polite critics, to ask you a very plain ques- tion.— Since the stethoscope 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 favourable termination than formerly? Hitherto, I never could obtain but one answer to this question, and that answer was always a negative. 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 discrimina- tion, 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 varia- tions 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 auri- cular sign, severe disease of one tissue of the pulmonary substance from an- other, 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 true tuberculous consumption, the disease, in that case, may either, like such consumption, under certain cir- cumstances, 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 constitution, not consisting merely of ulceration or loss of substance in the lungs—of "course not to be disposed of by stethoscopes or any oracular mummery. Hence, too, we see the reason that consumption formerly, in the times of Morton, Syden- ham, 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 stethoscope is adequate to the detection of this 1 Andral, an authority to whom "pathologists" on all occasions implicitly bow, candidly admits its deficiency. -Without other signs," he says, "the stetho- scope does not reveal with certainty consumption and inflammations of the heart." And Dr. Latham, who has taken no small pains to advocate its em- ployment, 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 patients," he adds, " 1 fear it is a trouble and distress." Now this is just the reason why I repudiate its assistance; whatever troubles and distres- ses the patient must not only alter all the movements of his heart and lungs, so as to neutralise the whole indications presented by them ; but must ac- tually 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 stetho- scope must from the nature of things, be as hollow and empty as the toy through which it proceeds—and as the discovery of the degree of organic change, even could it be known to a nicety, can, in no instance, lead to prac- tical Improvement, I am content to judge of it from the patient's general ap- pearance, the number of his respirations, and the sounds emitted when he 6peaks. breathes, and coughs, as appreciable by the naked ear. From an in- strument whose employment troubles and distresses the majority of patients, I look for no superior information; for, I repeat, whatever troubles and distresses people'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. In Diseases ot the Chest, as on most occasions, we should do well to examine things with our eyes. When consulted about disorders of that cavity, our business is to 74 LECTURE III. 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 continued or changed for another. In the case of any very mate- rial change in the lungs, such as an abscess, cavern, or solidification of a part of their substance, if targe, such local disease will get smaller as the general health improves,—if small, it will grow larger should that get worse. More than this, ----°— There need no words, nor terms precise— The paltry jargon of the 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 processors and other great persons whether consumption and other chest- affections, be remittent disorders or not. When once satisfied of that, you, Gentlemen, may be sure that quinine, opium, and the other Chrono-Thermal medicines, will be of infinitely more avail for their cure than all the discus- sion and discrimination of all the doctors that ever mystified disease by their vain nosologies! What cares the patient about the alphabetical combination, by which you baptize his disease, if you cannot make him better; and if you succeed in curing him, what does it signify, whether you call it one name or another ? But the name, it may be said, has to do with the prognostic. To that I reply.—Even when despairing of success, you will do well to guard yourselves 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 theoretically doomed them,—ay, and that doctor a stethoscopist! It is truly amusing to find men playing the critic, without the smallest pre- tension to the knowledge requisite for such an office. So ignorant was my Medico-Chirurgical Reviewer, Dr. James Johnson, of one of the most uni- versal laws, both of Health and Disorder, as to accuse me of a limited 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, Dr. A. T. Thompson, in Continued Fever, in almost every case, there is an Exacerbation towards mid-day, and the Remission towards morn- ing. Another contemporary, Dr. Shearman, says, " an Intermittent is the most perfect form of fever, having the most complete 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, in the eyes of Dr. Johnson, was my preference of the perfect rather than the imperfect form of fever, for my type of all disease, 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. James Johnson's own practice does better deserve to come under the head of madness,—savouring, too, of a rather sanguinary and homicidal type of it—I shall by-and-by have an opportunity of showing you. Mean- time I may observe, that— -----Though I hope not hence unscathed to go, Who conquers me shall find a stubborn foe I The time hath been when no harsh sounds 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; LECTURE III. 75 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 Glandular Disease, I will just shortly observe, that complaints of this kind, whether involving some large gland such as the Liver, Pancreas, or Spleen,—if the last men- tioned viscus be indeed 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. Disorders of the smaller glands, whether situated in the neck, arm-pit, or groin, or in the course of the mesentery, are for the most part termed "scrofula," and by some 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 tumours, and the purgatives so unsparingly employed by many in their treatment. All these various diseases are features or effects of Re- mittent Fever; by controlling which with the chrono-thermal agents, they may all, in the earlier stages, be at once arrested ; and some, even of a chronic character, perfectly cured by a combination of these remedies with mercury or iodine. I could give cases innumerable in proof of this, but as I have so well established the principle in 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. Consumptive Diseases of Joints. Very much akin to Consumption of the Lungs, are various diseases, which, from their external manifestations, have been too long left under the exclusive dominion of the Surgeons; namely, those destructive affections of the Joints, which so often bring the subjects of them to the amputating table. I forget the particular operative eminent who thanked God he knew nothing of physic! Such a confession was very proper for a butcher—for the barber- surgeons of former ages; but the medical man who, by well-directed reme- dies, prefers the honest consciousness of saving his patient from prolonged suffering and mutilation, to the spurious brilliancy of a name for " Opera- tions," will blush for the individual whose only title to renown was the bliss of his boasted ignorance, and a mechanical dexterity of hand unenviably ob- tained 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 encourages 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 acquainted with physic. What would some of these superci- lious 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 previous to the probe, with discharge. The patient was the subject of diurnal fever. Not- withstanding 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 contain- ing 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. 76 LECTURE III. Case 2.—A young gentleman, aged 11 years, had enlarged knee, with great pain and heat, which came on in paroxysms. Leeches, blisters, and purga- tives 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 adhesion having taken place before I was consulted. Case 3.—Another young gentleman, aged seven years, son of Lord C----, was brought to me from Brighton, with his knee as large as a young child's head ; abscesses had formed about the joint, and were still discharging when I first saw him. I prescribed chrono-thermal treatment; and notwithstand- ing that his limb had been condemned to the knife, by his Brighton " hospital surgeon," I obtained a complete cure ; a partial anchylosis only remaining. He had also been a patient of Sir B. Brodie before I was consulted. Case 4—A boy, aged six, 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 similar treatment as in the above case, and the child rapidly recovered his health, with the com- plete use of his limb. He had been previously seen by a surgeon, who, though the knee was the painful part, rightly pronounced the case to be one of jffip-disease. To the knee, as you know, instead of the hip, the little pa- tient constantly refers his complaint, a circumstance which occasionally deceives the attending practitioner, as to the nature and locality of this destruc- tive disease. Case 5.—A girl, aged 12, had enlarged ankle, with an open ulcer leading into the joint. Amputation, according to the mother, was looked upon as the inevitable termination of the case by two " hospital" surgeons, under whose care the patient had been for twelve months previously to my seeing 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 cause, of which the most perfectly periodic examples might not be given; and the only difference between diseases in this type, and their more apparently con- tinued forms, is, that the periods of the latter are less perfect, and the stages of their curriculum less marked than in the former. No physician will doubt that a purely periodic disease, whatever be its nosological name, partakes of the nature, and is more or less amenable to the treatment successfully fol- lowed 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 per- fect in character, throughout their whole course ? What are such diseases but varieties of the more purely intermittent type ? And what 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 dis- eases, as of the more general symptoms which are supposed to be the ex- clusive province of the physicians. John Hunter seems to be the only surgeon 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. Etadley, of Newton LECTURE IV. 77 Abbot, Devon, a gentleman well known for his improved method of treating fractures. Mr. Radley writes thus :—" Many thanks to you for the ' Unity of Disease,' which contains in it more of the true philosophy of medicine than any book I have ever yet seen. There are some passages that threw me into an extacy 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 favourite 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 2nd instant. It was a simple fracture, with much contusion. To soothe the pain, he had a solution of morphia, after the limb had been laid on the 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 pain comes every twelve hours quite regular, about mid- night, 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 the fractured bones in particular constitutions; of the setons which have been passed be- tween their ends, and of the knives and saws by which they have been scraped and pared—these horrible local means for constitutional effects. Dr. Colles, of Dublin, indeed, introduced a constitutional mode of treating such cases; but it was confined to one medicine, mercury, and that failing in other hands, it has not been generally followed. Several years ago, while in medical charge of Her Majesty's 30th Foot, in the East Indies, it was my fortune to obtain the most satisfactory 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. Inquire of the subject of Goitre or other tumour ; 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 tumour 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 varia- tions of heat and cold, damp or moisture of the weather ; that their diseases are often materially influenced by a passion, 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. INFLAMMATION—BLOOD-LETTING—abstinence. Gentlemen, „ . „ ,. , f When medical men hear that I am in the habit of treating all kinds ot disease without blood-letting, they generally open their eyes with a stare, and ask me what I do in Inflammation. Inflammation! who ever saw any 78 LECTURE IV. part of the body on fire, or in flames ? for the word, if it means anything at all, must have something like that signification. To be sure, we have all heard of" spontaneous combustion," but 1 confess I never saw it, nor what is more, anybody that ever did ! What, then, is this inflammation—this term which our great modern doctors so dogmatically assure us is the head and front of every corporeal disorder? It is a metaphor merely—a theoretic expres- sion, which, torture it how you please, can only mean a quicker motion and a higher temperature in the moving atoms of a given structure, than are com- patible with the healthy organisation of that structure. When you find a con- siderable degree of heat and swelling, with pain and redness in any part, that part, in medical language, is "inflamed." Now, what are these phenomena out 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 decompo- sition, this thermal change is sure to be one of the most prominent features. The phenomena termed inflammation, then, very closely resemble the chemi- cal phenomena which take place preceding and during the decomposition of inorganic substances. Now, when this kind of action proceeds unchecked, the result in most cases is a tumour, containing purulent matter ; which mat- ter being a new fluid product, differs entirely in its appearance and consist- ence from the original solid tissue, in which it chanced to become developed. This tumour we call Abscess. And how is it to be cured ? In most in- stances, the matter, after working its way to the surface, escapes by an ulce- rated opening of the integument; while in others, an artificial opening must first be made by the knife of the surgeon. In either case, the part in which the abscess was situated, generally recovers its healthy state by the repara- tive 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 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, by electrical means, converts them into the water from whose decomposition they proceeded ! Such, and many more chemical operations, Nature daily performs in the animal body ; and that she does all this through the vito-electric 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) abscesses of considerable size, and even solid tumours, 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 tumours, as the most powerful agents in the materia medica. The writings of the older authors abound in instances of this. But there are yet other terminations to the inflammatory process. For example: after having proceeded, to a certain extent, in the way of change, but still falling short of actual purulent decomposition, the atoms of the inflamed part, by the renewal of a healthy condition of the body generally, or by the direct application of cold or other agency, may again, with more or less quickness, subside into the degree of motion and tempera- ture characteristic of their natural revolutions. This termination is called Resolution. When the inflammatory action is more than usually rapid, the result may be the complete death of the part implicated,—a black inorganic 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, Rheumatism, and Erysipelas, we shall, in another lecture, have the honour to explain to you. A great many books have been written upon this subject of Inflammation, but LECTURE IV. 79 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 in- stance. A carpenter had his thumb severely bitten by a rattlesnake; and the effects of the venom are thus described by Mr. Samuel Cooper, in his lectures, published in the Medical Gazette: - The consequence was, that in ten or eleven hours, the whole limb, axilla, and shoulder became very cold and enormously swollen up to the neck ; in fact, the surface of the whole body was much below the natural temperature. The swelling, you know, is produced by that kind of inflammation which is called diffuse inflammation of the cellular tissue." Gentlemen, 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, redness, 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 developement of pre- vious constitutional disturbance. I do not speak of immediate local inflam- mation produced by a chemical or mechanical injury—leaving that to the surgeons to elucidate or mystify, according to their particular inclinations ; I talk of inflammation from a general or constitutional cause. Has an individual, for example, exposed himself to a cold draught, or to any other widely inju- rious influence, he shivers, fevers, and complains of pain, throbbing, and heat in the head, chest, or abdomen,—phenomena gradually developed according to the patient's predisposition to organic change in this or that locality. Phrenitis, Pneumonia, Peritonitis, (technical terms for inflammation of the Brain, Lungs, and membraneous covering of the Bowels,) are consequences or features, not causes of the constitutional disorder. But do the symptoms of inflammation in such parts become as perfectly intermittent as the diseases of which we have already treated ? Listen to Lallemand : " In inflamma- tion of the brain," he tells you, " you have spasmodic symptoms, slow and progressive paralysis, the course of the disorder being intermittent." Dr. Conolly, in his Cyclopaedia of Medicine, says, " Diurnal remissions are dis- tinguished in every attack of inflammation." Now, if you prefer the evi- dence of another man's eyes to your own, this statement ought to be more than convincing, for it comes from the enemy's camp. It is the language of a gentleman who was formerly one of the editors of the British and Foreign Medical Review, a publication that first opposed my doctrines, and afterwards attempted to give the credit of them to another. Whether the particular condition called Inflammation be termed erysipe- loid, 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 ac- companied 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 particularly on its good effects in that disorganis- ing inflammation of the Eye, termed Iritis, in which disease he preferred it to all the routine measures which, on the strength of a theory, medical men have from time to time recommended as " antiphlogistic." During an attack of Ague, he tells us, Iritis, with inflammatory affection of other parts of the eye, occurred in the person of a patient under his care. " For the former complaint, namely, the Intermittent Fever, he administered Bark; by the exhibition of which, he was surprised at seeing the inflammatory affection ot 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 m inflammation of 80 LECTURE IV. 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 recovering her from this state; but it was not till four long hours had passed, that he felt he could safely leave her with ordi- nary attendance; for during the greater part of that time, when he ceased to chafe her temples, or otherwise call up the attention of the brain by the ap- plication 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 inflammation ; 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 ?—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 ; that it is equally powerless in pre- venting the development of inflammation, I shall furnish you with ample evidence before I finish this lecture. Meantime, 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 inflam- mation after it has come on; and their beneficial influence will be more gene- rally 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, be- yond 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 in- ♦ flammation; and its astringency has been judged to be the likely means of checking or putting a stop to expectoration." All this appeared much more plausible when taught in the schools of physic, than probable, when I attended to fact and experience. The unquestionable safety and acknowledged use of the bark, in tne 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 in the confluent small-pox] without lessening in any degree the expectoration." Some time ago, I was called to see a young gentleman, who had a swell- ing under the armpit, extending to the side. The skin was red and hot, and the tumour so painful as to have deprived him of all rest for the three pre- vious nights. Though suppuration appeared to me to have commenced, I at once ordered quinine, and begged him to poultice the tumour. By these means, he was perfectly cured in three days, the swelling 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 shivering —which, according to the doctrine of the schools, it ought to have done__tfie very reverse took place. I shall now give you one of many instances of indubitable and palpable inflammation—if the word have a meaning at all—as a proof of the value of opium in the treatment of this affection. An old officer, Major F., 89th Foot, who had previously lost one eye in acute ophthalmia, notwithstanding LECTURE IV. 81 a vigorous " antiphlogistic" discipline, had the other attacked in a similar man- ner 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 de- gree, and remitted principally in the afternoon. Three grains of opium, which I directed him to take half-an-hour before the recurrence of the expected paroxysm, procured him a whole night of profound sleep, and his eye, in the morning, to his astonishment, was free from pain, and only slightly vascular. He had been repeatedly bled, leeched, purged, and blistered, without even temporary benefit—indeed, the gentleman who attended him, in the first place, plumed himself upon the activity of his treatment. But how, you may ask me, can Pleurisy and Pneumonia be cured with- out blood-letting ? What are pleurisy and pneumonia ? Any rapid tendency to change in the substances 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 sub- stance of the membrane (pleura) which covers the outer surface of the lungs, or of that portion of it which is continued over the inner surface of the chest, is called 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 the treatment is concerned, it would not be worth the time you should spend in doing it. Such distinctions only lead to inter- minable disputes, without, in the least, tending to improve 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 illustrates 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 and 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 symp- toms, commencing with very great shivering, cough, and intolerable pain in the chest, a fit of suffocation, and finally & perspiration ; at the end of an hour the paroxysm terminated. Ammoniacal mixture was first given, then two grains of quinine every two hours. The very next day the fit was scarcely perceptible ; the day after, there was no fit at all. An observation worthy of remark is, that the symptoms of pleuro-pneumonia—which continued throughout in a very slight degree, it is true, in the intervals of the par- oxysms—disappeared completely, and in a very short time, by the effect of the sulphate of quinine." Who are the persons most subject to inflammatory disease of the chest ? Medical theorists answer, " strong healthy labourers, and people much 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 subjects of inflammatory disease, he has this observation :—" As we have already remarked, in speaking of Pneumonia, the invasion of Pleurisy coincides in a large proportion of our patients with the period of extreme weakness and emaciation."—Dr. Cowan's translation of Louis. Now, what is the usual treatment of pleurisy and pneumonia 1 Does it not almost entirely consist in blood-letting, starving, and purging, with blisters 82 LECTURE IV. 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 emaciation, M. Louis ap- plies 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 nis benefit, but on the preceding Saturdays he was suddenly seized with severe illness, originating in a most distressing impediment in his breath- ing. 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 suffici- ently 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 occur- rence, he never had a single day of perfect health." If you reflect that medical relief was immediately called, you may be inclined, like myself, to ascribe poor Grimaldi's damaged constitution, not so much to the effect of the original disorder, as to the sanguinary treatment adopted in his case. Whe- ther or not he had the additional medical advantage of being starved at the same time, I do not know; but lest it might be inferred that his continued illness was owing to the neglect of this very 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 Whitechapel Workhouse. " 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 workhouse. In acute disease of the chest, whether involving the pleura simply, the interstitial substances 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 primarily oerebral, and they, therefore, act powerfully upon every member and matter of the body. By emetics, you may change the existing relations of the whole corporeal atoms more rapidly and effectually than by any other agency of equal safety in the Materia Medica. Every kind of chest-disease being a mere feature or development of fever, whatever will relieve the latter will equally relieve the former. The value of emetics in the simpler forms of fever, few will be sufficiently bold to deny ; and the quickness with which the same medicines can alter the state of an inflamed part may be actually seen by their effects on the eye, in the inflammatory affections of that organ, You have only to try them in chest-disease, to be satisfied of their inesti mable value in cases of this kind. Instead, therefore, of talking of the tem- porary good you have occasionally seen done by the lancet in inflammation 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 escaped the united bad effects of chest-disease and loss of blood. Whatever salutary influence as a present means of relief, blood-letting may produce, it is infinitely inferior to what you may obtain by emetics—a class of remedies which possess the additional advantage of giving that relief, without depriving the patient of the material of healthy constitu- tional power. Their influence, moreover, as a preventive against return of the paroxysm, is very considerable ;* while blood-letting, so far as my ex- * This statement, when I first published it, was denied by physicians, but it bag been since con firmed by Dr. Seymour, of St. George's Hospital, who recently made some remarks upon the Dower of emetics in " altering the Periodicity of Disease." v LECTURE IV. 83 perience goes, has only, on the contrary, appea/ed to render the patient more liable to a recurrence. Lord Bacon tell 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 he, Lord Bacon, had been duped by his teachers? and why did Des Cartes say, that no man could possibly pretend to the name of philosopher, 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 masters in philo- sophy. 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 ambition ; in fact, they are all but angels. Now, I only wish you knew the manner in which most of these very respect- able 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 inco- herent and inconsistent doctrines of the fallible puppets, whom interest or intrigue has stuck up in academic halls, use your own eyes, and exercise your own reason ! 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 pos- sibly deceive you. Take a certain number of pleuretic 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 patients have been worried during their illness. Take another equal number similarly afflicted, and treat them chrono-thermally ; that is to say, premise an emetic, and when, by means of this, you have obtained a remission of the symptoms, endeavour to prolong such period of immunity, by quinine, opium, or hydro- cyanic acid ; and then compare the results of both modes of practice. If you do not find an immense saving of suffering and mortality, by the latter mode of treatment, I will consent to be stigmatised by you as an impostor and de- ceiver, a cheat, a quack, a person, in 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 ordered, 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 always been so solicitous to get the system under the influence of calomel—or why do they prescribe turpentine in its treatment 1 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 remittent, 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, 84 LECTURE IV. diseases which are at present the bugbear of the faculty, are indebted for their chief existence to the remedies employed in ordinary ailments, namely, bleed- ing and unnecessary 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 pre- viously, 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 in 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 exterit and duration of disease around them. My own practice in Enteritis, I will illustrate by a case. I was one evening requested to see a person very ill; I 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 in about twenty minutes I again saw him. The vomit had acted powerfully, and with such relief that he could then turn himself in bed with ease, which he could not before do. I then prescribed prussic acid and quinine. In a few days he was as well as ever. Instead of bringing theo- retic 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 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 abstraction of blood ; every means being resorted to in the mode of doing this, from vene- section, arteriotomy, and cupping, to the basest application of the leech. In the remarks, Gentlemen, which I am about to make on the subject, instead of discussing the preferable mode of taking blood away, I shall bring before ^ou some facts and arguments that may convince you of the perfect possi- ility of dispensing with the practice altogether. " The imputation of novelty," says Locke, "is a terrible charge amongst those who judge of men's heads as they do of their perukes, by the fashion__ and can allow hone 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 any- where 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 examina- tion 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 f" 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 Eur&pe to the other LECTURE IV. 85 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 introduction could only have been during the infancy of Medicine, when remedial means were yet few, and the mode of action of remedies totally unknown. It was the invention of an un- enlightened,—possibly, a sanguinary age ; and its continued use says but little for the after-discoveries of ages, or for the boasted progress of medical science. It was once a question whether or not the blood be alive. That question is now definitely settled. John Hunter, to the conviction of everybody, proved that the Blood lives; and every drop that artificially leaves the sys- tem is admitted, even by those who take it away, to be a drop of life. He who loses a pint of blood loses a pint of his life. Of what is the body com- posed ? Is it not of Blood, and Blood only ? What fills up the excavation of an ulcer or an abscess ? What reproduces 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 vito-electrical influence of the Brain and Nerves ! Hovy 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," "physics,"—"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? wiJl 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 every thing to pre- serve 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, pre- sumptuous man, has dared to divide what God, as a part of creation, 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 withdraw 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 mer- cilessly the lancet, the leech, and the cupping-glass, are employed in the dis- eases 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 exclaiming 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) 86 LECTURE IV. 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 com- mon affairs of the world— Religion, Freedom, Vengeance, what you will, A word's enough to raise mankind to kill,— Some party-iphrase 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 flood-gates of the heart, to pour out the stream of an already enfeebled existence. Does a man fall from his horse or a height, is he not instantly 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 en- tered 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 re- warded with a simultaneous burst of acclamation, she fainted and fell; fell from very weakness. Instantly a medical man leapt upon the stage,—to ad- minister a cordial ? No—to bleed her! to bleed a weak, worn, and ex- hausted 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 Shakspeare, not only excited the admiration of tempo- rary 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-inten- tioned, 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 35th regiment—the prisoners captured, and the investigation which afterwards took place. In the course of that inquiry, a prisoner, when under examina- tion, 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 ap- pearance, he had become so wan and haggard, so altered in every lineament, the spectators could scarcely recognise him as the same prisoner. Yet, strange to say, not one of the many journals that reported this case, intro- duced 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 dangerous of all medical appliances ! Gentlemen,-a coroner's inquest was held upon a person who died suddenly. 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 in- effectually, 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 LECTURE IV. 87 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 symp- toms, deliberately proceeded to open a vein ! 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 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 immediately fatal than either. What think you .of cholera asphyxia—Asiatic cholera 1 Gentlemen, the symptoms of that disease are the identical symptoms of a person bleeding slowly away from life ! The vomiting, the cramps, the sigh- ing, the long gasp for breath—the leaden and livid countenance which the painter gives to the dying in his battle-pieces—these are equally the symp- toms of cholera and loss of blood ! Among the numerous 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 in- jurious 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 Dr. Hume upon that point. He further tells us that he has witnessed among its effects, " the en- tire 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 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 faint that became death, these—all these—have I traced to loss of blood ! Could arsenic, could prussic acid, in their dead- liest and most concentrated doses, do more ? Yet I have heard men object to use the minutest portions of these agents, medicinally,—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 prac- titioners know the nature of the terrible power they thus fearlessly call to their aid ? Can they explain its manner 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 value- less. Their reasoning, if it could be called reasoning, has been based on a dread of " inflammation" or " congestion." From the manner in which they 88 LECTURE IV. discuss the subject, you might believe there was no remedy for either but the lancet. Ask them why they bleed in ague—in syncope—in exhaustion or collapse? 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 vou, never either relieved the one, or prevented the other ! Gen- tlemen, did you never see inflammation of a vein after bleeding—inflamma- tion caused by the very act? I have known such inflammation end 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 rattler, you make it more liable to be so, by weakening the coats of the containing vessels! Hundreds, 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 influence,—namely, the power of changing Temperature ? Let the schoolman show me that the lancet possesses any superiority in this respect—any specific influence more advantageous than other less questionable measures ; 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 com- plexion it comes at last, and to nothing more—the equalisation and modera- tion 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 the 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, attended with the insuperable disadvantage of abstracting the material of healthy organisation. 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 com- pelled to use it once. Resorted to, under the most favourable circumstances, its success is anything but sure, and its failure involves consequences which the untoward administration of other means may not so certainly produce. Have we not seen that all diseases have remissions, and exacerbations—that mania, asthma, apoplexy, and inflammation, are all remittent disorders! From the agony or intensity of each of these developements 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 too often a delusive, relief. The general result is depression of vital energy, with diminution of corporeal force ! Dr. Southwood Smith, physician to the London Fever Hospital, published a book purposely to show the advantages of bleeding in fever. One of his cases is so curiously illustrative of his position, 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 demands our most serious attention, and deserves that of our readers. It is adduced as an ex- ample of severe cerebral affection, in which case, Dr. S. affirms, ' the bleed- ing 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 fee was yet only feeble and chilly. The aspect of his countenance, the state of his pulse, which was slow and labouring, and the answer he returned to two or three LECTURE IV. 89 questions, satisfied me of the inordinate, 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 indi- cating a ferocious cerebral attack, they will one and all agree with us, that the ferocious attack was met with a ferocious treatment; for an 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 grpat diminution, but not entire removal of the pain.' Towards the afternoon, he was again bled to sixteen ounces. ' The pain was now quite gone—the blood from both these bleedings intensely inflamed.' [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, notwithstanding the eyes were dull, and beginning to be suffused, the face blanched (no won- der !) and the pulse slow and intermittent, and weak, twelve leeches were ap- plied 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 opera- tion afforded great relief; but the following morning, the pain returned, and again was blood extracted to the amount of sixteen ounces. ' Immediate relief followed this second operation; but, unfortunately, the pain returned with great violence, towards evening; and it was now impossible to carry the bleeding any further. Typhoid symptoms now began to show them- selves : ' 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 'instantaneous and most complete.' So that this case, announced as a severe cerebral affection, and treated, in anti- cipation, 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 the blood-letting was repeated, until, after the abstraction of ninety ounces of blood, the patient had become in a state of' intense suffering' and ' immi- nent danger,' and was relieved at last by the cold dash—this case, we say, is brought forward as a specimen of the extent to which copious blood-letting may sometimes be required !! Most sincerely do we congratulate Dr. Dill on his escape, not from dangerous disease, but from a dangerous re- medy."—Medical Gazette. What could more completely 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 his methodus medendi, and he pursued it; and notwithstand- ing the total failure of his vaunted remedy, he gives the case at length, as a perfect specimen of the most perfect practice. Mark the result of that prac- tice ! 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. Happy would it have been for mankind, that we had never heard of a " Pathological School;" happier for Dr. Dill, for to that school and its pervading error of imputing effect for cause—of arguing from the end as if it were the beginning—may we fairly attribute all this sanguinary practice. Lord Byron called medicine " the destructive art of healing." How truly it proved to be so in his own person, you shall see, when 1 give you the de- tails of his last illness:—" Of all his prejudices," says Mr. Moore, " he 90 LECTURE IV. 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 than reason. ' Be- sides, 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 rejoined, in an angry tone, ' Who is nervous if I am not ? and do not those other words of his (Dr. Reid's) 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 sufficient tension ! Even before this illness, you yourself knew how weak and irritable I had become ; and bleed- ing, 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 m 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 entreaties, 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. Millengen 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 consideration 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 pertinacious 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 disorganisation 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 arm, 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 Mr. Millengen,) and drew about twenty ounces. On coagulation, the blood presented a strong buffy coat; yet the relief obtained did not corres- pond to the hopes we had formed ; and during the night the fever became stronger than it had been hitherto, the restlessness and agitation in- creased, 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 had 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 remis- sion 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 pro- bable, that a successful result might have ensued, without any treatment at all. When describing the effects of a former fever, Lord Byron himself says: " After a week of half delirium, burning skin, thirst, hot headache, horrible pulsation, and no sleep, by the blessings of barley-water, and refusing to see my physician, I recovered." Facts like these are indeed stubborn things! LECTURE IV. 91 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 circum- stance, 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 constantly maintain- ing 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 re- storing 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 ofteii fail to alleviate, far less" to cure. With the free admission, then, that the lancet is capable of giving temporary relief to local fulness of blood, and to some of the attendant symptoms, 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,—re- member there is then no income—all is expenditure. And I care not whether vou 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- ioint—with the lancet, you can seldom ever do more than give a delusive re- lief, 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 other 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 Apo- nlexy 1 Here the patient having no will of his own, and the prejudices of his friends being all in favour 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, bother 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 prejudice to combat, and observing the flushed and hot state of the patient's forehead and face, I determined to try the cold dash. The St was beyond my best expectations. The first patient was laid out all his entth, android water poured on his head, from a height. After a few ablutions he staggered to his feet, stared wildly rcmnd.hi*.then walked to the hospital, where an aperient completed his cure. While in the army, I had a sufficiently extensive field for my experiments; and I seldom ^ter- ^al^^^^trW.in private practice, I have> improved noon mv Army plan. With the aperient given after the cold dash, 1 have geCraTy combined quinine or arsefc-and I have also, upon someoccasions at once orescribed hydrocyanic acid without any aperient at all. 1 his prac ricelha^e found hfghly "successful That Quimne -ay prevent the apo- plectic fit, I have proved to you, by the case given by »r- Graves 1 he value of Arsenic in Apoplexy has also been acknowfejged, by members ot the profession ; but whether they have been acquainted with the ™grm ciple of its mode of action, in such cases, is another thing. Dr. A. 1. 1 horn 92 LECTURE IV. son recommends it " in threatened apoplexy, after Cuppings and Purgings, when the strength is diminished and the complexion 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 contain- ing 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 Peruvian 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 ! Why, then, do they go on from day to day, bleed- ing in threatened Apoplexy ? In the case given by Dr. Graves, depletion,— 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 his 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 otherwise, seeing that I have proved to all but mathematical demonstration, that whatever debili- tates the whole body, must still further confirm the original weakly condition of the coats of the blood-vessels, which constitutes 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, but Faint; cases which, with the cold dash or a cordial, might recover, but which the lancet, in too many instances, has perpetuated to fatality ! If the practitioner 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 venesection 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 application 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 hypo- thesis, 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 fol- lies and school prejudices to palpable and demonstrative truth. So long as colleges and schools could mystify disease and its nature, any treatment that * M. Coperaan, in 1845, gives the statistics of the bleeding and non-bleeding practice in Apoplexy. In 1836, when I first repudiated the lancet iu this disease, the statistics were all on one side, the only cases of the non-bleeding side of the argument being my own. The following is from Mr. Copeman's table :— Number bled. ... 129 Cured, ... 51 Died, . . 78 Number not bled, . . 36 Cured, ... 18 Died, . . 8 showing that in the cases where bleeding was practised nearly two out of three died ; wherens in the cases treated without blood-letting, more than two out of three recovered ! What is the worth of general assertions in the face of such evidence ? LECTURE IV. 93 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 themselves to be depleted to death, or all but death, by the lancet of either surgeon 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 supported 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 rheum-1 atism 1 Do not these remedies, in numerous instances, lessen the tempera- ture, pain, and morbid volume of these inflammations, more surely and safely than the application of leech or lancet? If, for such inflammation, 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 injudi- cious, 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 suf- focation 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 1 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 ? Fearlessly I answer yes ! and with much more certainty. With emetics, prussic acid, mercury, colchicum, silver, &c, I have conquered cases that were theoreti- cally 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 labours, 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 candour 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 practice, 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 treatment of dis- ease. 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 fault of the medicines, but of the men, who, having prescribed them without properly understanding the principles of their action, in the language of Dr. Johnson,lt put bodies of which they knew little, into bodies of which they knew leas!" 94 LECTURE IV. 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 my- self. In the Army Hospitals, I had an opportnnity 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 ? A loss of every organic perception—a death-like state, which only differs from death by the possibility of recall. Prolong it to permanency, 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 consumption, dysentery, or dropsy ; his constitu- tion was broken by the first depletory 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 practice 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 or bias from some individual master. By education most have been misled; So they believe, because they were so bred. Gentlemen, I had the resolution to think for myself—ay, and to act, and my conviction, gained from much and extensive experience, is, that all dis- eases may not only be successfully treated without loss of blood; but that blood-letting, however put in practice, even where it gives a temporarj' 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 connexion with blood-letting, in the treatment of inflammation, we generally find Abstinence or Starvation recommended. Beware of carrying this too far ! for " abstinence engenders maladies." So Shakspeare said, and so nature will tell you, in the teeth of all the doctors in Europe ! Abstinence, Gentlemen, may produce almost every form of disease which has entered into the consideration of the physi- cian ; another proof of the unity of morbid action, whatever be its cause.— You remember what I told you of the prisoners of the penitentiary ; but I may as well re-state the facts at this lecture. In the words of Dr. Latham, then, " An ox's head, which weighed eight pounds, was made into soup for one hundred people ; which allows one ounce and a quarter of meat to each person. After they had been living on this food for some time, they lost their colour, flesh, and strength, and could not do as much work as formerly. At length this simple debility of constitution was succeeded by various forms of disease. They had scurvy, diarrhoea, low Fever, and lastly, diseases of the brain and nervous system. "The affections," Dr. Latham continues, "which came on during this faded, wasted, weakened state of body, were headache, vertigo, delirium, con- vulsions, apoplexy, and even mania. When blood-letting was tried [why was it tried ?] the patients fainted, after losing five, four, or even fewer ounces of blood. On examination, after death, there was found increased vascularity of the brain, and sometimes fluid between its membranes and its ventricles." Is not this a proof of what I slated to you in my last lecture that the tendency to haemorrhagic development does not so much depend upon fulness of blood, as upon weakness of the coats of the containing vessels?__ starvation, you see, actually producing this disease—in the brain at least. LECTURE IV. 95 In all the higher animals, man included, the substances composing the food are converted into blood in precisely the same manner. Crushing and com- minuting it with their teeth, they reduce it by the aid of their saliva to a pulp, and by the action of their tongue and other muscles, convey it in that state to the gullet; the Epiglottis, or valve of the windpipe, shutting simultaneously, so as to prevent all intrusion in that quarter—though some of you, when at- tempting to speak and eat at the same time, may have had the misfortune to let a particle enter the " wrong throat;" I need say nothing of the misery of that. When the food reaches the stomach, into which it is pushed by the muscular apparatus of the gullet, a new action commences. Pooh, pooh ! I hear you say, all this we know already ; but, Gentlemen, what you know may be news to somebody, and as I see strangers listening with apparent at- tention. Twill proceed as I have begun. Well, then, to continue. Once in the stomach, the food becomes mixed with the gastric juice, a fluid peculiar to that organ ; and this fluid works so great an alteration upon it, "that it is no more the same thing. It is now what medical men term " Chyme"—but this is not the only change it has to undergo ; for scarcely has the chyme left that great receptacle of gluttony, and entered the small intestines, when it receives a supply of another fluid from a gland called the pancreas ; and yet another from the ducts of the liver, a still larger gland ; and this, under the mysterious name of Bile, some of you may possibly have heard of before !— By this last fluid it is turned to a white colour, and from Chyme its name is now changed to " Chyle." Why, upon my word, I do not know, both words signifying precisely the same thing—"juice !" But as nothing in nature will go on constantly the same without change, the " Chyle" must needs separate into two parts ; one nutritious, the other the reverse ; one portion enters into the formation of every part of the body, the other is excremen- titious, and must be expelled from it. For the nutritious portion a million of mouths are ready. These belong to a system of vessels, called, from the milky appearance of their contents, the Lacteals, and they pervade the entire alimentary canal. A great viaduct termed the Thoracic duct, receives them all, and this again, under a new name (the receptaculum Chyli), passing up- wards along the front of the spinal column, drops its contents—namely, the nutritious portion of the Chyle, into the left subclavian vein, a large blood- vessel leading under the left collar-bone to the heart. Here the chyle is no longer chyle ; meeting and mixing with the blood, it becomes Blood in fact, to be sent first by the right chamber of the heart through the lungs, and then by the left chamber circulated to all parts of the body. In that now living state, it successively takes the shape of every organ and atom of the body; again, in the shape of the excrementitious secretions, to pass in due time to the earth, from which its elements were first derived. The food of animals supports them only in so far as it offers elements for assimilation to the matters of the various organs and tissues composing their frames. While a single secretion still continues to be given off from the body ; while the kidneys or bowels, for example, continue to perform their office, however imperfectly, it must be manifest to you, that, without some corresponding dietetic increment, the elemental atoms of the animal organism must sooner or later be so far expended, as to leave it in a state incompatible with life. How, then, let me ask, can you reconcile healthy organisation with starvation-practice ? How can you expect to find even the appearance of health, after having practised the still more barbarous and unnatural pro- ceeding of withdrawing by blood-letting a certain portion of the sum of all the organs that are being formed ? The quantity of food which animals take, diminishes or increases in the same proportion as it contains more or less of the substance which chemists term azote or nitrogen. This, as you well know, is most abundant in animal food, but all vegetables possess more or less of it. Rice, perhaps, contains less than any other grain, and that is the reason why the Asiatics can devour such quantities of it at a time, as they 96 LECTURE IV. are in the habit of doing. You would be quite surprised to see the natives of India at meal-time. Sitting cross-legged on their mats, a great basin of rice before them, with mouth open and head thrown back, they cram down handful after handful, till you wonder how their stomachs can possibly con- tain the quantity they make disappear so quickly. The most cursory examination of the human teeth, stripped of every other consideration, should convince any body with the least pretension to brains, that the food of man was never intended to be restricted to vegetables exclu- sively. True, he can subsist upon bread and water, for a time, without dy- ing, as the records of our prisons and penitentiaries can testify ; but that he can maintain a state of health under such circumstances, is as utterly and physically impossible as that the lion and the panther should subsist on the restricted vegetable diet of the elephant. The dental organisation of man partakes of the nature of the teeth of both gramnivorous and carnivorous animals ; his food should, therefore, be a mixture of the elements of the food of both ; and with this mixed nourishment, the experience of centuries tells us, he supports life longest. How wretched, on the contrary, is the person doomed, however briefly, to an exclusive diet! Sir Walter Scott thus de- scribes the effects of what he terms " a severe vegetable diet," upon himself. " I was affected," he says, " while under its influence, with a nervousness which I never felt before or since—a disposition to start upon slight alarms; a want of decision in feeling and acting, which has not usually been my fail- ing; an acute sensibility to trifling inconveniences, and ah unnecessary ap- prehension of contingent misfortunes rise to my memory as connected with vegetable diet." How can a dietetic system which so shakes the entire frame, by any possibility give strength and stability to the weaker parts of the body—those parts whose atomic attractions are so feeble, that every breath that blows upon the whole organism shakes them to pieces ? Must it not, in the very nature of things, make the man predisposed to consumption more certainly consumptive—and so on, throughout the whole catalogue of hereditary disease ? Observe the various operations Of food and drink in several nations. Was ever Tartar fierce or cruel Upon the strength of water gruel ? But who shall stand his rage and force, If first he rides, then eats his horse ? Salads, and eggs, and lighter fare, Tune the Italian's gay guitar; And if I take Dan Congreve right, Pudding and beef make Britons fight.—Prior. That abstinence is proper, in the commencement of most acute disorders, nobody will doubt. The fact is proved by the inability of the patient to take his accustomed meal; his stomach then is as unfit to digest or assimiliate nutriment, as-his limbs are inadequate to locomotion. Both equally require rest. But to starve a patient who is able and willing to eat, is downright madness. No animal in existence can preserve its health, if fed on one kind of food exclusively. The dog, when restricted to sugar alone, seldom sur- vives the sixth week ; and the horse, if kept entirely upon potatoes, would waste away day by day, though you were to give him as much of that par- ticular diet as he could devour; he would die of a slow starvation. How many persons, even in the upper walks of life, are every day starved to death ! The doctor has only with a mysterious shrug to whisper the word "inflam- mation," and it is quite astonishing to what miserable fare people of all con- ditions will submit. Instead of an exclusive vegetable diet being a cure fof all complaints, as your medical wiseacres assure you, I know no complaint, except that of small-pox, and the other contagious diseases, that it has not of itself produced. The only thing it is good for, in mv view of the matter. LECTURE IV. 97 is to keep the patient to his chamber, and the doctor's carriage at the door. You see what a profitable practice it must be for the apothecary—and I'll bet you my life, the physician who first brought it into fashion made his fortune by it. Not a nurse or nostrum-vender in the kingdom, but would be sure to cry him up to the skies ! Not an apothecary from Gretna Green to Land's- End, but could tell you of some miracle worked by him ] and the world, hearing the same thing eternally rung in its ears, how could it possibly doubt the greatness of " Diana of the Ephesians!" I am every day asked by my patients what diet they should take. I gene- rally answer by the question, " How old are you ?" Suppose they say, Forty^- Forty !" I rejoin : " you who have had forty years' experience of what agrees and disagrees with you—how can you ask me, who have no experience of the kind in your case whatever ?" Surely, Gentlemen, a pa- tient's experience of what agrees and disagrees with his own particular con- stitution, is far better than any theory of yours or mine. Why, bless my life! in many chronic diseases the diet which a man can take to-day would be rejected with disgust to-morrow ; under such circumstances, would you still, according to common medical practice, tell a sick person to go on taking what he himself"found worried him to death ? Gentlemen, I hope better things of you. The only general caution you need give your patients on the subject of diet, is moderation ; moderation in using the things which they find agree with them- selves best. You may direct them to take their food in small quantities at a time, at short periodic intervals, intervals of two or three hours, for exam- ple ; and tell them to take the trouble to masticate it properly before they swallow it, so as not to give a weak stomach the double work of mastication and digestion,—these processes being, even in health, essentially distinct. Unless properly comminuted and mixed with the saliva, how can you expect the food to be anything but a source of inconvenience to persons whom the smallest trifle will frequently discompose ? I remember an anecdote of the late Mr. Abernethy which is so apropos to what I have just been telling you, that I do not know I can better finish what I have to say upon the! subject of the diet than by letting you hear it, even at the risk of its proving to some of you a twice told tale : An American captain, on being one morning shown into his consulting-room, immediately, in Yankee fashion, emptied the con- tents of his mouth upon the floor. The man of medicine stared, keeping his hands in his pockets, according to his custom, until the patient should explain. " What shall I do for my dyspepsy ?" asked the American 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 distinguished in the history of medicine. From a letter I received from him in January^ 1840, I shall read to you a passage or two :— " In April, 1835, our acquaintance and free communication commenced; and though I pricked up my ears, like One thunderstruck, at your wholesale denunciation of Blood-letting, and your repeated asseverations, that in a prac- tice embracing to my knowledge the treatment of several thousands of pa- tients 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. '• No- thing can be more striking than the great disparity between the proportion 98 LECTURE IV. of persons who were bled in the first two years of my Ross practice, 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 you live. If you had done nothing else but put a bridle upon Blood-letting, you would deserve the eternal gratitude of your race, instead of the calumny and oppression of the two-legged fools—the Yahoos, who persecute their greatest 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 ingrati- tude of his country. ' A mind,' said he, ' of much sensibility might be dis- gusted, and one might be induced to say,—Why should I labour for public objects only to meet abuse ? I am irritated more than I ought to be, but I am getting wiser every day,—recollecting Galileo and the times when philo- sophers 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 duties, has the very best opportunity of testing any particular practice—rand 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 the Medical Officers of Civil Hospitals and Dispensaries throughout England. From the Tables of Mr. Farre, we learn that these officers make the deaths at their Institu- tions 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! Dr. Hume first writes from Dover, 6th of December, 1838 : " My object in writing is to congratu- late 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-stu- dent 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 Reports of the Army Medi- cal Officers since 1817, you might have quoted it as 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 with common sense and nature's laws. However little this age may appreciate your labours, and the persecution you are likely to suffer from a certain class of doctors, every libe- ral mind must do justice to your unwearied zeal. Your holding up to ridicule the most fatal of all medical errors—Bleeding a patient into a temporary calm and incurable weakness, ought to stamp you as the benefactor of man- kind." The same gentleman again writes to me from Naas Barracks, Ireland, 5th December, 1839. " It is now twelve months since I wrote to you, saying LECTURE V. 99 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 neither bled, leeched, nor cupped in any case—and 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 abstaining, during the last three years, from every kind of depletion in the treatment of disease. I am satisfied that Pneumonia and Enteritis, (inflammation of the lungs and bowels) which are at 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 anti- phlogistic regimen, or had been otherwise debilitated—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 credit to 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 equalising 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 knowing. But herein he grie- vously 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 uni- versities all things are found opposite to the advancement 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 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 per- son 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 introducing the small- 100 LECTURE V. pox inoculation ; and Jenner for a long period of his life was victimised 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 misspend- ing our prime youth at schools and universities, 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 succes- r sion of the grossest absurdities. Let us briefly glance at a few of the most promineht. 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 purified, —a fever from a bruise or fall, the only thought was how to sweeten " the blood ;" hay, were you poisoned by hemlock or henbane, " the blood," or its blackness, was the cause of all your sufferings—and the chief anxiety 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 continued to bleed while a drop Would flow from the veins. When their patients died, it was all owing to the accursed "black blood" that still remained 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, namely, that all diseases first originated in the Solids, and many were the partisans that took it up ; so that, for several centuries, the fluidists and solidists divided the schools, and, like Guelph and Ghibellirie, ranged themselves under their respective leaders. What medical man is ighorant of the wars they waged, the ink they shed, and the eloquence they wasted upon the still unsettled point, whether the solids or fluids ought to bear the blame of 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 dis- eases may be traced to the " inflammation" or other theoretical state of a given portion of the body—one school taking one organ—another, another; but why should I say Organ ? seeing there are professors who exclusively patronise a given Tissue, and others a given Secretion even ; which One thing, after they have wrapped it round in mummery and mysticism, 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 have injured 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 per- haps, and then, with a seriousness becoming the occasion, he tells yon, your " Stomach is wrong;" and so far, sb true, as yoUr own want of appetite and Bensation of nausea abundantly testify. But as if this were not enough, and more than enough, he must 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 mistake not, the doctor falls into the same error as a man who, seeing a house in ruins, should, point to one of the broken bricks, and saddle it with the whole amount of mischief; when, in really, 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 undisputable 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 no- LECTURE V. 101 body dared to dispute his dictum that derangement of the digestive organs must be the cause of all disease. Some other partialist would have it, how- ever, that the " Liver" is the great source of all ailments; and a very con- venient substitute this organ became ; for not only did it save the physician 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 moment people heard of this in- strument, the " Heart and Lungs" eclipsed them all. We have no liver and digestive organs in these days ; we have only 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, Heaven only knows for what end they were given us, unless our bodies were -----------intended For nothing else but to be mended! —in other words, were expressly created for the benefit of our next-dopr neighbour, 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 unex-; ampled 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 inno- cence, are pleased to class them, I leave to persons of common sense and com- mon discrimination to decide. One thing is certain, physicians have made a great stride since the days of Moliere—for whereas in his time, ^e only organ they ever thought or theorised 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 Tis? sues. 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 pos- sible difficulty ; and if patients were pleased, why undeceive them? Sick men do not reason, you must therefore treat them like children ; and he who can best impose upon their credulity, is sure 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 favourite 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 legitimately put to death till he had been first called in to prescribe something for the " Mucous Membrane." Broussais thus be, came the French medical dictator—and the " Mucous Membrane" the French ruling doctrine. Carried by his numerous partisans 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 excel- lent stepping-stone it proved to him in practice. Every body 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 Membrane was at fault; nay, had you a pimple on your nose, or a pain in your great toe, it 102 LECTURE V. was still the " Mucous Membrane !" Nor is this doctrine even now quite exploded. How many of the various Sf.cretions 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 Water- doctors__not the Water-^doctors of the present day, Priesnitz and his followers, to wit,__no, quite a different class of persons. The persons I speak of only needed to inspect your water to find out a cure for your complaint. Many curious stories come to my mind in connexion with this ; but the sub- ject 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 intemperance—" the Bile," not the Wine, is the criminal! You have head- ache 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 synonymes simply, having alia common import, fluidity or humour. In Rheumatism, we have merely a derivation from the Greek verb feu (Rheo, I flow), and Shakspeare used it in its proper sense, when he said, Trust not these cunning waters of his eyes, For villany is not without such RJieum. 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 occasionally proceed from " a drop too much"—but that is not what the doctors mean by the term. Gout with them is merely a fanciful " humour." " Scrofula" in Latin, and " Scurvy" in Saxon, have the same signification,—namely, a " dry humour." Only think of dry-humidity, Gentlemen, and the confusion of tongues during the building of Babel, will readily occur to you as a type of the language in which even now medicine is taught in most of our schools ! The German physicians 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 which professors play at " hide and seek" with words. Diseases which the Con- tinental doctors formerly termed scurvy, they now term scrofula; Heaven only knows what the same corporeal variations will be called before the world comes to an end ! So much, Gentlemen, for the " Humoral school" —a school that impressed upon its disciples a doctrine of purgation scarcely less fatal that the sanguinary practice of the present pathologists. In fact, theirs is the identical system of "Morrison the hygeist," and all those quacks, who, by their determined perseverance 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, whe- ther vegetable or mineral, you may so disturb every action of the body—may so alter every corporeal structure and secretion, that not one shall be of natural consistency 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 LECTURE V. 103 state of inanition which constitutes, as I shall in the. course of this lecture explain 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, an igneous 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 Stowel was right when he hinted a man might be both at forty. " When youth made me sanguine," says Horace Walpole, " I hoped mankind might be set right. Now that I am very old, I sit down with this lazy maxim, that unless one could cure men of being fools, it is to no purpose to cure them' of any folly, as it is only making room for some other." This, I believe, was said in regard to religious doctrines ; but that it applies equally well to medical doctrines, may be seen from a 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 season, and disappeared at another, and.commonly succeeded by some of a very different kind. When I was very young, nothing was so much feared or talked of as Rickets among children, and consumptions among young people of both sexes. After these, the spleen came into play, and grew a formal disease. Then the scurvy, which was the general complaint, and both were thought to appear in many various guises. After these, and for a time, nothing was so much talked of as the ferment of the blood, which passed for the cause of all sorts of ailments, that neither physicians nor pa- tients knew well what to make of; and to all these succeeded vapours, which served the same turn, and furnished 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 indisposition of any other parts. Yet these employ our physicians more than any other diseases, who are fain to humour such patients in their fancies of being ill, and to prescribe some remedies, for fear of losing their practice to others that pretend more skill in finding out the cause of diseases, or care in advising remedies, which neither they nor their patients find any effect of, besides some gains to one and amusement to the other. As Diseases have changed vogue, so have Remedies, in my time and observation. I remem- ber 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 heatsand fevers by drinking as much spring-water as the patient could bear; (Priesnitz'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 maybe the better excused, since both are so transitory, so subject to be spoiled with common use, to be torn by accidents, and at last to be so worn out. Yet the usual practice of physic among us runs still the same course, and turns in a manner wholly upon evacuation, either by blood- 104 LECTURE V. 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." Sensible people those Chinese ! Gentlemen, you now see the correctness of Dr. Gregory's remark, that medical doctrines are little better than " stark-staring absurdities." 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 mankiud 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 hebdomadal Journals and Quarterly Reviews, by which the masters are enabled to keep down truth, and mystify and delude the student and country practitioner at their pleasure. In physic, now as formerly, the very clever world -------Bows the knee to Baal, * And, hurling lawful Genius from his throne, Erects a shrine and idol of its own— Some leaden €!alf— who, by virtue of his puppet-position, maintains a reputation and a rule in matters medical, to which neither his merits nor his learning in the very least entitle him ; nevertheless he reigns the Esculapius of the day, and it is only in the next age that -------the vulgar stare, When the swollen bubble bursts, and all is air! 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. Accord- ing to Crabbe, who studied physic, but left the profession in early life to take orders, Some to the Gout contract all human pain, They view it raging in the frantic brain, Find it in fevers all their efforts mar, And see it lurking in the cold catarrh. _ Gout, then, may be anything you please; for if the received opinion be right, this offspring of Nox and Erebus, this vox etpreterea nihil, takes shapes as many and Protean as there have been authors to treat of it. This much I may venture to assure 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 shopkeeper better than by telling him his disease is " Gout"—" Gout suppressed"—" Gout retrocedent"__" Gout in this place," or " Gout in that!" And what is Gout ? ——<---Of all our vanities the motliest— The merest word that ever fooled the ear, From out the schoolman's jargon !—Btron. In sober seriousness, is there such a disorder as Gout ? 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 persuade you LECTURE V. 105 that it is in itself anything but a piece of hypothetical gibberish, invented by men who knew as little of disease and its nature as the tyros they pretended to illuminate. When a lady or gentleman of a certain age complains to you ^©f^a.|>ainful swelling in some of the joints of the hand or foot, you may say, if you please, that such patient has got the gout. If the same kind of swell- ing should appear in the knee or hip-joint, or take the shape of an enlarged gland or a rubicund nose, you must then change your phrase; and you may easily exhaust a volume in pointing out the difference betwixt them. But as neither this kind of disquisition, nor the baptizing your patient's disease by one name or another, can in the very least help you to cure it, I may just as well explain to you that this swelling, like every other malady incident to man, is not only a development of constitutional disease, but comes on in fits or paroxysms :—you have all heard of a " fit of the Gout." Gentlemen, you will 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 diseases where great heat and swelling take place, must be a tendency to decomposition; in this instance, the pro- duct for the most part is a deposit of chalky or earthy matter. When this happens, nobody will dispute the name you have given to the disorder; but should the result of the decomposing action be purulent matter or ichor, in- stead of chalk or earth—which neither you nor any body else can know beforehand—you must not be astonished if a rival practitioner be called in, to give the disease another soubriquet; to christen it anew by some other phonic combination full as indefinite as the first; and which may thus serve you both to dispute about very prettily from one end of the year to the other, without either of you becoming a whit the wiser! You see, then, that the only dif- ference betwixt what is called " gout," and what is called " inflammation," is, that the result of 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 we find the same elemental principles as that of infancy and youth, from these elements being in different propor- tions, the results of decomposition must, mutatis mutandis, be different.— What are the Causes of Gout? One writer says one thing; another, an- other. 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 his dictum, but I challenge him to bring forward a tittle of proof in support of it. His whole doctrine of gout, I ap- prehend, 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 got Wet; or had been exposed to the East Wind ; or had been Vexed by some domestic mat- ter. 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 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 what- ever. 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 given by Syd- enham, who was half his life a martyr to it—to say nothing of Dr. Samuel Johnson's explanation in his dictionary. That it comes on like the ague with 106 LECTURE V. 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 fg,c^ for yourselves, I will give it to you in black and white in the words ot Dat* win. Speaking of some cases of the disease, he says : " The patients^tfter a few days, were both of them affected with cold fits like ague-fits, and iheir feet became affected with gout." To meet it in a proper manner, you must treat the disease purely as an ague. With quinine, arsenic, opium, and colchicum, 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 mids-t of ah apparently conflicting variety. tThat 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, nihili, pili!" I shall now give you a case or two which may perhaps suffice to show you my treatment 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 prescribed, before I was called in. I ordered a combination of quinine and colchicum, but as this did not stop the fit, I changed it for arsenic, after taking which, the patient had no return. _ 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 gave him quinine, which acted like magic. The same gentleman, twelve months after, had a recurrence, but was much disappointed, on resuming the quinine, to obtain no relief. I then prescribed arsenic, which, though it failed the year before, this time perfectly succeeded! a lesson to such as would vaunt any remedy as a specific for any disease. The influence of the passions in causing or curing gout is well known.— One of many cases so cured comes just at this moment to my mind. A country 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 fear- fully 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 that the cause of ague is ? Still, let us suppose for a moment that it is the effect of a "morbid ingredient in the blood ;" What, then, allow me to ask, is this morbid ingredient doing all the time of remission ? Does it sleep or wake during this interval of immunity ? and .how comes it that arsenic, quinine, and colchicum so often neutralise 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 goblin—a phantom—that, like other goblins and phantoms, disap- pears the moment the daylight comes in ! Having stated my reasons for dissenting from Dr. Holland's hypothetic view of the case of gout, it may not be out of place here to request your at- tention to some points of infinitely greater importance, upon which that phy- sician and myself, by some curious fatality, maintained a remarkable coin- cidence of opinion. The following passages occur in 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 disease, namely, the tendency, in various morbid actions, to distinct intermission LECTURE V. 107 of longer or shorter duration, and more or less perfect in kind ?" " The sub- jection of so many diseased actions to this common law, establishes rela- tions 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 connexion of causes of common kind, diseases now regarded as wholly distinct in their nature, and arranged as such in our systems of nosology. This remark applies very widely through- out 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 to- gether 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 op- position to symptomatic disease, or diseases 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 the disease. The " knot" they have for so many centuries been trying to unravel, I hope he, they, and every body else will now consider as completely untied ; 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 presented." Why be puts typhus before intermittent fever. I know not; but this I do know, that except where badly treated, the influenza seldom takes the "typhoid" shape. However, Dr. Holland admits he has prescribed 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 inconve- nience 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 represents in him a definite state of the body, in which the alteration of temperature desired is the 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 exanthemateous kind." By such terms, medical men understand small-pox, chieken-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 brain, and especially in the different 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 per- vades 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. Experience undoubtedly prove's 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 fashionable practitioners 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 published by Messrs. Longman and Co., in 1839. Mark that date, and mark also, if you 108 LECTURE V. please, that it was in the year 1836, three years before, that the same pub- lishers brought out my work The Fallacy of Physic as taught in the Schools, wherein I stated :— . . 1. "We hope to prove, even to demonstration, that Fever, RemiafSit 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 treatment 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 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 thunder !" 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 ; " ay—the iden- tical doctrines which Dr. James Johnson, physician-extraordinary to the King deceased, two years before, stigmatised as a PYREXY-mania, or Fever- madness. How will he receive them now—now that they are patronised 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 ? Why, 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 syllable did Dr. James Johnson say in condemnation of Dr. Holland's prophecy, 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 pro- phecy was actually fulfilled by me to the letter years before he, Dr. Holland, took the trouble to make it, he, Dr. James Johnson, ridiculed it as a Fever-MADNF.ss ! Gentlemen, if, in the course of his " liberal reading." the Author of the Medical Notes and Reflections never saw the Fallacy of Physic as taught in the Schools—nor the review of it by his patron Dr. Johnson ! nor Dr. Forbe'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 concluded !—nor met with the Unity of Disease—nor the many reviews that were written upon it! !—you must acknowledge the " coinci- dence" 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. Johnson, to allow him—takes into account dates, facts, and other similar trifles, 1 hope he will, in return, permit me now, henceforth, and for ever, to call MINE! Mean while, I have much pleasure in availing myself of LECTURE V. 109 the testimony of a physician so eminent, in favour 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 communication 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 ex- planation at all. His observations might apply to this, that, or the other, or anything else ! But seriously, if Dr. Holland intended to do more than shuffle me out of my discoveries, why did he send a " private" answer to my pub- lished charge—or insinuation, if he like it better ? The concluding para- graph 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 [suggestion!] in what I 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." " New truths of a higher order," says an enlightened physiologist, " and of which the connexion 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 something in them—who have just am- bition 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.] From this digression I now turn to Rheumatism. Like Gotit, the word " Rheumatism" conveys nothing beyond the expression of thefalse theory which first gave rise to it. But as we are compelled, by long custom, to retain this among other etqually unmeaning terms, I may tell you, that the profession of the present day class under it numerous affections of the great joints, particularly such as have come on suddenly, 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 practice is to premise an emetic; this I follow up with a combination of quinine and colchicum. If that mode of treatment fail, I have recourse to opium, arsenic, guiaic, mercury, silver, turpentine, copaiba, arnica montana* aconite, or sulphur—or combinations of them — all of which remedies have succeeded and failed in ague as well as in rheumatism. In most instance 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 mer- cury, or both, have been employed—as I grieve to say, they too often are in the primary treatment-^you may fail with every means you may devise. . Under the head of rheumatism* medical men also Include Certain muscular pains, which occur in various parts of the body, but which are unattended by any apparent morbid structural development. With nitrate of silver and prussic acid, I have often cured these pains; and with the cold plunge-bath, I have sometimes succeeded after every other means had failed. Of my mod* of treating acute rheumatism, I will give you two examples. 110 LECTURE V. Case 1.—A young man, aged 25, had been suffering severely from rheu- matism for four or five days before I saw him. At this time, the joints of his wrists and ankles were much swelled and exquisitely painful; his heart laboured, and was in such pain as to impede his breathing; his tongue was foul and furred, and he had been occasionally delirious. I offered an emetic, which was some time in operating, but when it did, the relief was signal. I followed this up with pills containing a combination of quinine, blue pill, and colchicum, and in two days he was sitting 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. 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 weakness, 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 Syden- ham : " As to the cure of rheumatism," he says, " I have often been troubled, as well as you, that it could not be performed without the loss of a great deal of blood; upon which account the patient is not only much weakened for a time, but if he be of a weakly constitution, he is most commonly rend- ered more obnoxious to other diseases for some years, when, afterwards, the matter that causes the rheumatism (Sydenham, like Hippocrates, was a dis- ciple 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 endeavour 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 colour 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 nour- ishing diet, as by bleeding repeated, and those inconveniences might be avoided, which accompanied the other method ; and I found that a whey- diet, used instead of bleeding, did the business. After last summer, my neighbour Matthews, the apothecary, an honest and ingenious man, sent for me ; he was miserably afflicted with rheumatism, accompanied with the fol- lowing symptoms. He was first lame in the hip for two days ; afterwards he had a dull pain upon his lungs, and a difficulty of breathing, which also went off in two days' time (both remittent), after which his head began to pain him violently, and presently the hip of the right side which was first seized ; and afterwards, according to the usual course of the disease, almost all the joints, both of the arms and legs, were afflicted by turns. He being of a weak and dry habit of body, I.was afraid that by taking away much blood, his strength, before but infirm, would be wholly vanquished ; especially the summer being so far spent, it was to be feared winter would come before he could recover his strength, weakened by frequent bleeding, and therefore I 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, where- with he was sufficiently nourished. After these days, when the symptoms did no more vex him, and when he walked abroad, I permitted him to eat flesh, namely, of boiled chickens, and other things of easy digestion • but LECTURE V. Ill 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 condemn 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 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 sacrificed 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 ./einte) change ? Certainly not; then, without such change, how could stone become developed at all ? moreover, are there not times of tl^e 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 calculary 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, nobody but such as prefer books of nosology to the book of nature and com- mon 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 practitioner may save himself a world of trouble, and the patient a world of pain, which neither might escape, in adopting the doctrine of the " pathologists," that these are in- flammatory diseases, and only to be subdued by leech, lancet, and mercury to salivation. Gentlemen, laugh at the pathologists, and laugh, too, at their disputations, which, being all about nonsense, can never possibly come to a satisfactory conclusion. The calculary (gritty) or stony concretions which are 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 completely by attending to the temperature of his chest, and by the occasional use of hydro- cyanic acid and quinine, which I prescribed for him. This patient had pre- viously 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. Chambers 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 temperature. How often the liver, gall- bladder, and kidney are the seat of stone, I need not tell you. Taking place in the course of an artery, calculus is erroneously termed " ossification." I wonder it never occurred to authors to call it " the gout!" seeing there is, at 112 LECTURE V. least, this resemblanee betwixt them, that both generally become developed during or after middle age. There are not wanting authors, who have traced an analogy betwixt rheu- matism and Cutaneous or Skin Disease— 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 integ- rity 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 Mackintosh says, when describing his own case ; and the accuracy of his description will scarcely be questioned, if it be remembered, that previously to entering upon his legal career, Sir James had not only studied, but taken his degree in physic: " We had an unusually cheerful day," he says, " but just as I was going to bed I was attacked by a fit of shivering, which in the morning was followed by a high fever, and in two days by an erysipelas in the face. The 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 candour of Mr. Travers entitles his evidence to a preference. At a meeting of the Medico- Chirurgical Society, he is reported to have stated, that in "a great many in- stances [of erysipelas] he had found the most decided benefit from the use ot 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 epi- demic ; 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 particular 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 remem- ber, 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 epi demic, 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 myself 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 t Everything that LECTURE V. 113 can set up fever ; and what agent in nature, when abused, may not do that 1 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 partisans of that school trace all such diseases to a " morbid ingredient in the blood," and they look upon eruptions as an effort of nature to expel the " pec- cant humour." Be careful, they tell you, not to drive it in ! Now, what is an eruption but the effect of a tendency to decomposition of the matter enter- ing into a detached portion of the cuticular tissue, so as to produce an arrange- ment 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! When that doctrine was more prevalent than it is at present, cutaneous diseases were very generally classed under the head of " Scurvy," or Scor- butic ; whoever had eruptions on his skin of a chronic character was said to have the scurvy. Now, if this phrase had been used simply as a sign, or " counter to reckon by," no great harm could have ensued; but, like " scrofula" and the " gout," -Scurvy," in process of time, came to perform the part, not of a sign merely, but of a corporeal something—an indefinite entity or essence —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 sup- pose that he had detected 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 ?-rfor 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 ?" Having myself been 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 conse- quently unventilated decks—what from being obliged to watch and work hard upon a short allowance of food and water—together with the anxiety and depression of spirits produced by " hope deferred," the men gradually begin to show signs of a constitutional " break-up." You will find them with faces pale and bloated; their skins rough, rugged, and exhibiting pete- chia and haemorrhage 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 depend- ing upon a something noxious in the blood, but upon a positive want of some- thing essential to its healthy reproduction. And how, think you, is this dis- ease°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 in the cure of diseases produced by a deprivation of both ! Now, it is a curious fact in the history of ship-scurvy, that just about the time that *lemon-juice came into fashion, as a cure for it, great improvements began to be made in navigation, as also in ship-building, and in the ventilating and victualling of fleets; voyages that formerly took up a year, can now be completed in a month or two, and the natural good effects of all this upon the habits and constitutions ot the sea- 114 LECTURE V. men 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 seen cured by quinine; and I have met with examples of every kind of skin-dis- eases, that have baffled me with every thing I could thing of. I may here, nevertheless, state in regard to cutaneous disease generally, that I have not very often been at a loss, while I had at my disposal quinine, arsenic, oxy- muriate 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 instance, had been upwards of twelve months' standing, and had resisted the prescriptions of some of the ablest men of Dublin and London. Baths, of which I shall afterwards speak, I have also found of great service in diseases of the skin ; but what, Gentle- men, do all these remedies come to at last, but to the various forces that pro- duce thermal change ? In the great majority of instances, then, the local disorder from which phy- sicians almost invariably name disease, and to which they almost as invari- ably confine their attention, is only one of many features of universal disturb- ance. So far from being the cause of such disturbance, the local tendencies to disorganisation are merely hereditary or accidental developments occur- ring in its course—developments expressive, for the most part, of the weak points of individual constitution—though sometimes determined by climate or other speciality of cause. In England, for example, the viscera of the chest are the organs which chiefly suffer—while in the East and West Indies, the fiver and other contents of the abdomen become more frequently implicated. Remittent fever, I need not say, is the parent of both. Injuries, passions, poisons, then, are each capable of producing the same constitutional disturbance with every kind and degree of orgafiic change to which the subjects of them may, by original weakness of configuration, be predisposed. To use a homely phrase—"when the whole house shakes, the worst-built room suffers most"—and this, of course, differs with every house. A blow on the head; nay, an injury to so minute a member as the finger, may produce a general febrile disorder, ending in abscesses 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 sorts 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 in the course of a common remittent fever; such consequences 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 treatment is concerned, does that matter one straw ; for, however perfectly specific the cause of the disorder undoubt- edly is, the disease admits of no specific 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 endeavour to break it by an emetic' which, in nine times out of ten, you may easily do ; and when that and the sweating stage are ended, endeavour to prolong the interval of remission bv LECTURE V. 115 opium, hydrocyanic acid, or quinine. Such, I believe, comprehends nearly the whole duty of the physician in this, as in every other acute disorder. By a reverse course, the most perfectly curable case of small-pox may be very speedily rendered malignant. During the spring of 1824, a great many in- stances 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 fre- quently visited the former gentleman daring 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 even- ing, which had the effect of either entirely preventing the anticipated par- oxysm, 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 confined to his room for more than a month, barely escaping with his life ; and when he made his appearance in the streets, his face was so disfigured by scars, his most intimate friends did not know him when he addressed them. During the autumn and winter of 1825, while I attended the Pari- sian Hospitals, the small-pox was raging fearfully in France. But so un- successful was the treatment employed—bleeding, leeching, and purgation— that the dissecting-rooms of Paris were 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 ? Vaccination is only the artificial introduction into the human system of an animal poison ; and it was first practised by Dr. Jenner, of Berkeley, in Gloucestershire. Now Jenner was a man of great observation—great penetration—a man upon whom facts were never lost—not a mere collector of facts—not one of those poor creatures who cry, " Facts, facts, give me facts—I never think"—men who might as wisely 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 many people connected with dairies had their hands attacked with an eruptive dis- ease, 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 super- stition. Not so Jenner ; who, on setting about an investigation, 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 these times, since vaccina- tion has been practised. Do you doubt the preventive effect of small-pox against a recurrence of small-pox ? No more can you doubt the effect of vaccination ; for, though small-pox does occasionally 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 disease but a modification of small-pox? It is small-pox in a milder form, a fact which Jenner suspected, and which Mr. Ceely, of Aylesbury, has recently proved by a very simple experiment. He first inoculated a cow with the matter of a small-pox pustule. From the 116 LECTURE V. new pustules which were in due time produced in that animal, he took mat- ter 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 reproduces, through such an infinity of individuals, an effect so generally specific? Can it be, as Linnaeus thought, of an animal-culine character ? or, is it at all analogous to the influence produced by the magnet on iron ? which metal, you all know, may, from the contact of a magnet, be- come itself magnetic. These are the most probable relations in which the subject may be viewed ; if, indeed, it have not some analogy to the continua- tion and reproduction of all animal life. There are a few questions connected with this subject, which I confess myself unable to answer. Perhaps the ingenuity of some 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 pus- tule 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-pox afford to the constitution against recurrence, any analogy to agricultural exhaustion—to the impossibility to obtain more than a given number of successive crops of a particular herbage, from a particular soil, in a given period of years ? But the small-pox fever is not the only fever which once having attacked an individual during his life, for the most part renders him unsusceptible of recurrence—all the truly contagious fevers have this effect—chicken-pox, measles, scarlet-fever, hooping-cough, seldom affect the constitution above once in life ; though sometimes, like small-pox, they make their appearance twice, and even three times in individuals. By some authors, the chicken- pox has been supposed to be a modification of small-pox—an opinion to which I myself lean—for when we consider how remarkably small-pox 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 certain, that every one of the contagious dis- eases has the most perfect analogy to the ague; seeing that all have remis- sions 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, possessing such specific influence over them, as to be ex- clusively relied upon in the treatment of any case. Is not this the best of all proofs that there is no " specific" in physic? If for a most decidedly specific disease we have no specific remedial agency, how can we possibly expect to find such for any one of the great family of disorders which may be produced by anything and everything that can derange the general health ? Yet Dr. Holland 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 Farrell, as detailed by Dr. Cal- vert, in the 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 LECTURE V. 117 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 sweat- ing, which alleviated the distressing symptoms. On the following day the paroxysm was repeated. He was permitted to remain in the barracks from a belief that his complaint was intermittent fever. The next day his fever returned as usual, but it now declared itself to be the plague by a bubo (glandular swelling) 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 intermission or remission. But the next morning, while dress- ing himself to go to the lazaret, he dropped down and expired." Disputes still exist as to whether plague be contagious or not. From a perusal of the evidence laid before the House of Commons, as well as from analogical reasoning, my belief is, that it is not contagious ; but on whichso- ever side truth lies, there can be no difficulty as to the proper treatment.— The indications in plague as in, simple intermittent fever, or the small-pox, are to regulate the temperature in the cold and hot stages, by the means already pointed out, and to prolong the remission by quinine, opium, arsenic, &c, according to particular constitutions. Treated in this manner, the dis- ease 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 ex- acerbation than for the shiverings and alterations of temperature character- istic 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 result of spasm developed in the course of a febrile paroxysm. People will say, " You would not give quinine or bark in jaundice." But wherefore not ? seeing I could muster a good half-hundred instances, where I myself have cured the disease by one or the other. Dr. Madden details a case of yellow fever cured by quinine, a case in which he says, " had the gentleman been bled, after the fashion of the country, I think in all probability he would have died; or had he survived, that he would have had left a debilitated constitution and a dropsical diathesis to encounter in his convalescence." Previous to my embarkation for the East Indies, where it was my chance to serve five years as a medical officer of the 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 assertions, my own after-experience led me to adopt conclusions much the same as Dr. Mad- den. Captain Owen of the Royal Navy, too, who could neither have a theory to support nor an interested end to serve, one way or the other, details at great length the mortality which took place among his people while employed in surveying the African coast. " It may, in fact, be questioned," says this intelligent 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 further states, that he himself recovered without either bleeding or calomel; while the ship-doctor fell a martyr to his medical faith ; he bled himself, took calomel, and died ! [The above remarks were first printed in 1840. Two years afterwards, 12th November, 1842, Extracts 118 LECTURE V. from the Report of the Select Committee on die Western Coast of Africa, ap- peared in the Times newspaper, wherein, among other things, is the follow- ing : " The bleeding system has fortunately gone out of fashion, and the fright- ful mortality that attended its practice, is now no longer known on board our Bhips."—Dr. James Johnson, are you satisfied ?] But the eastern practitioner will tell me possibly, that Dysentery cannot be safely treated in any other fashion. Is he sure he knows exactly what is meant by the word dysentery ? I shall say nothing of its etymology, but rather give you the symptoms included by Sydenham under the name.— "The patient," he tells us, "is attacked with a chilliness and shaking, which is immediately succeeded by a heat of the body. Soon after this, gripes and stool follow." What, then, Gentlemen, is this dysentery but an ague, with increase of secretion from one surface instead of another ; from the mucous surface of the bowels instead of the skin ; and the skin, remember, is only a continuation of the mucous membrane of the bowels. Now, Dr. Ciimming, 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 attendants, 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 little wine and water, which remained 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 rapidity of my conva- lescence leads me to contrast my late attack with a precisely similar one which I had at Cawhpore 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 extensive mercurial frictions, I swal- lowed two hundred and sixteen grains of calomel. True, I recovered ; or rather, I did not die ! whether in consequence, or in spite of the above heroic treatment, I will not venture to say. My face was swollen to an enormous size ; every tooth was loose in my jaws; and for six or eight weeks I could eat no solid food ; my constitution received a shock from which it never fairly recovered, and I was obliged to come to Europe on furlough. .On the present occasion, fortunately for me, the vis medicatrix natura was my sole physi- cian, (he forgot the sponging part!) arid I am now almost as well as before the attack commenced. British medical practice, in my humble opi- nion, DEALS TOO MUCH IN HEROICS." That opinion, Gentlemen, I hope, is now yours also—it has many years been mine. Such a case, from such a quarter, must doubtless be more than sufficient to warn you against the sanguinary and mercurial practice intro- duced into the East, by the influence of Dr. James Johnson's work on the Diseases of India. What an idea, to break down by the lancet and mercury, to salivation, the attractive power of every atom of the body, in the expec- tation of thereby strengthening its weakest parts ? Does this savour of madness, 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 scrutinise 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 LECTURE V. 119 disease may be seen by the palpable diminution of the swelling on particular days ; to say nothing of the hopes both of the patient and physician on such days being excited by general improvement throughout. How should the disease be treated ? Not, according to modern practice, by diuretics and su- dorifics solely ; but by a combination and alternation of these remedies with the medicines of acknowledged efficacy in that most perfect type of all di- seases, the ague. Of cases successfully treated by me in this manner, I 1 could give you hundreds—but to what purpose ? The recital, after all, would amount to little more than a mere repetition of the paroxysmal symp- toms of ague, minus the sweating stage;—that stage being typified, never- theless, by the cellular watery effusion, or by the morbid increase of the natural secretion, which lubricates the various shut cavities of the body. The remedies and the results were such as I have already stated, to you. What other proofs do you want of the unity of all disorder? The Pay- master-Sergeant of the Royals had Dropsy, which, notwithstanding the usual treatment by diuretics, purgatives, &c, was daily getting worse, when Dr. Stephenson, . f the 13th Dragoons, suggested the application 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, thinking 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 practice, I have repeatedly prescribed poultices to the loins with advantage', and I have, also, with the assistance of plasters of pitch, galbanum, &c, succeeded 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 univer- sal type of disease, the ague ? You will be the best judges, Gentlemen, when I draw my parallel. While in India I had ample opportunities for ascertaining its nature. Tremulous and spasmodic action belong equally to Ague and to Cholera; vomiting, or nausea, characterises 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 in- creased flow of pale urine, so often remarked in ague, is an occasional symp- tom 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 death. Suppression of urine, so common in the late epidemic, was a frequent symptom of the Wal- cherin 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 bound- ing pulse, a state analogous to the milder forms of cholera, in which you re- mark the same phenomena. When not fatal, cholera, like ague, has a hot and sweating stage. Moreover, when ague terminates life by a single par- oxysm, you find the same appearances after death in the bodies of both. Lastly', frenzy, 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. What 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 moretoa bottle of brandy than to anything contained in the Materia Medica. While serving in the East Indies, I saw many hundred cases of the disorder, but I never could convince myself of the superioritytff any one kind of active medical treatment over another. In my work upM the Diseases ot India, i 120 LECTURE V. 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 divide these nerves in the dog, you have the essential symptoms of Cholera, viz. loss of voice, vomit- ing, and difficult breathing always—cramps and flatulence frequently ; and the'animal seldom survives the third day. On dissection, you find the ves- sels of the head, lungs, and intestines, filled with black blood. That is ex- actly 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 every one of them been anticipated by me, in a paper which I published in the Lancet before I quitted India. LECTURE VI. present state of medical practice in england—dyspepsia--hys- teria, and hypochondria--insanity--effect of ligatures--faint —congestion, its nature--infantile convulsions. Gentlemen, After a long intercourse with the world, and a rigid examination 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 de- light to stand or walk upon the shore-side, and to see a ship tossed with tem- pest upon the sea, or to be in a fortified town, and to see two battles join upon a plain ; but it is a pleasure incomparable, for the mind of man to be settled, landed, and fortified, in the certainty of truth; and from thence to descry and behold the errors, perturbations, labours, and wanderings up and down of other men." But, Gentlemen, however exciting this kind of plea- sure be to him, who should be content with merely making a discovery to himself—the making of it public has its drawbacks; for in the words of Johnson, " whoever considers the revolutions and the various questions of greater or less importance, upon which wit and reason have exercised their power, must lament the unsuccessfulness of inquiry, and the slow advances of truth, when he reflects that great part of the labour of every writer, is only the destruction of those that went before him. The first care of the Builder of a new 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 reptiles and insects that so long rejoiced in the darkness and secrecy these cobwebs afforded ?—the bats and spiders, to whom the day- light is death ! Truth, like a torch, does two things ; not only does it open up to mankind 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 calum- ny, to be scouted and lied down by the knaves and fools whom interest or intercourse has leagued with the public robber as his partisans ? Who will talk to me of conciliation ? Who will tell me that mild and moderate mea- sures ever brought over such implacable enemies to the ranks of their des- troyer ; or that robbers, rioting in the spoils of their victim, will listen to the voice of the charmer, charm he never so wisely ? Surely people must bo out of their senses, who imagine that any exposition of Truth will be accept- able to men whose emoluments are chieflv derived from a course of studied LECTURE VI. 121 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 pretext which collusion and corruption can devise! one day entangling him in a web of unmeaning sophistry—another stimulating him to waste his time in splitting straws, or in magnifying hairs —now encouraging him in a butterfly chase after shadows—now engaging him in a wordy and worthless disputation with his fellows! 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 pas- sions and prejudices—the hopes, fears, and ignorance of the public?—in one case inflicting visits too numerous to be necessary ; in another, employing draughts, mixtures, or measures, too expensive, too frequently and too fruit- lessly repeated, to be all for the benefit of the patient! Think you, that the members of the medical profession are different in their feelings from every other human being—that their minds are so constituted, that, under the most terrible temptations, they can so far set at defiance the stern law of necessity, as, in their present crowded and starving state, to receive with open arms a sys- tem that threatens so many of their order with ruin ? Is it in the nature of things that they will welcome a practical improvement, by which the prac- titioner may, in a few hours, cut short cases and chances, which, by daily visitations, or by three draughts a-day, might be profitably protracted to a month, if the system on which it is based were only advocated in calm, mel- lifluous, and complimentary language ? As soon may you expect a needy 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 railroad over coach conveyance, when estimating 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 au- thority—professors, enjoying the sanction of its protection—annually to lure, by misrepresentation and lying promises, thousands of credulous and unsus- pecting 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 honour, and their patients' interests. Who will tell me half-measures will be of any avail, under circumstances like these ? Gentlemen, 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 symptom of timidity on the part of the advocate. Away, then, with half-measures !—away with the idea of conciliating men, the already rotten tree of whose sustenance you sap—the long-cemented system, whose exist- ence depends, not on a virtuous adherence to nature and truth, but upon a collusive 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 respect- able, 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 must fall 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 122 LECTURE VI. /jjm"—and you bring an argument which, though not quite convincing in it- self, will at least compel a closer investigation of the system it is your wish to expose and crush. "To abandon usurped power," says Robertson, in his History of Scotland, " to renounce lucrative error, are sacrifices which the virtue of individuals has, on some occasions, offered to truth ; but from any society of men no such effort can be expected. The corruptions of so- ciety, recommended by common utility, and justified by universal practice, are viewed by its members without shame or horror ; and reformation never proceeds from themselves, but is always forced upon them by some foreign hand." 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 parva, I have followed in his wake—I hope soon to add, passibus aquis. Think you, the Reformation of the church could have pro- gressed 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 content, in pointless and unimpassioned periods, to direct atten- tion solely to the doctrinal errors of Rome ? No; he thundered, he denounced, he heaped invective upon invective, and dealt in every form of language which could tell best against his enemies, whether in exposure or attack.— Too vise to leave them the moral influence of a presumed integrity, 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 in- vested. 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 arraighing the present system of medical policy, I have the remotest wish to degrade the profession of the physician. It has ever, on the contrary, been my object to improve the social position of my order; to render it useful, honourable, and honoured, that kings may still, as they once did, choose their counsellors from it. Nor is it my wish for an instant to insinuate that, among the individual members of the profession, there are not numerous exceptions to the line of conduct too generally pursued. In every one of its grades and conditions—apothecary, surgeon, and physician—I have had the pleasure to meet gentlemen%ho not only heartily join me in deploring the present shame- ful state of practice, but who aid me with their best efforts to expose and correct it. One and all of these honourable persons acknowledge, that, un- less 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 con- science and principle on the part of the physician. How often have I been told, in my own case, that by courting the apothecary, and offering up incense at the false shrine of the professors, I might easily and cheaply obtain the bubble reputation, to be blown me by their breath ; while, by exposing the intrigues of the schools, and the collusions and corruptions of the profes- sional world, not only do I stand as one man to a host, but I lay myself 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. The daily increasing number of upright and honourable 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 I feel as secure of victory, as at any one period of my life I feared defeat! As yet, I have only assailed the system— LECTURE VL 123 carefully avoiding individual attack. True, I have repelled the attacks of others, somewhat strongly, too ; but that was in self-defence. If in tearing away the veil of iniquity, I have not altogether remained unscathed, I have, at least, the satisfaction to know, that my enemies have done everything but laugh at the blows I dealt them. If it be said, 1 have used language too strong for the occasion, I answer in the words of Burke : " When ignorance! and corruption have usurped the professor's chair, and placed them- selves in the seats of science and virtue, it is high time to speak out. We know that the doctrines of folly are of great use to the professors of vice. We know that it is one of the signs of a corrupt and degenerate age, and one of the means of insuring its further corruption and degeneracy, to give lenient epithets to corruptions and crimes." What reformer has not been called a " violent person ?" none that I ever heard of. Now, Gentlemen, to the more orthodox matter 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 also say in the Jldult. 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 possihle that a small part of one of the hemispheres of the brain may, in like manner, be- come diseased, and the subject of it shall appear to reason very fairly to the last. But that must be a shallow observer, indeed, 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 intel- lectual 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 integrity, the brain is a unity, and like the same body it has also a diversity of parts. That the scalpel has hitherto failed to trace any well-marked divisions betwixt the various cerebral por- tions to which phrenologists have ascribed variety of function, is no argument against this doctrine. Do not all the different parts of the frame merge into each other, the 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 6uch 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 com- mences its foetal existence in the lowest type of the same organ of those ani- mals 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 these superadditions are never properly developed. The result you can anticipate :—Idiocy, according to the degree and locality of the defect; and yet there are medical twaddlers who have the audacity to deny that the brain is the organ of intellect! Were their statements correct, why confide the treatment of mental derangement to the physicians—to men who, for the cure of mental derangement, employ the identical material agency by which they profess to cure a diseased limb, or other injured mem- ber of the material body ? You might as weli talk of " walking" apart from the matter of the legs, as of mind or thinking power apart from the matter of brain ! 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 124 LECTURE VI. 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 implicated. The patient who labours under any severe form of disease, such as gout, consumption, or erysipelas, has all the symptoms, or shades of symptom, that medical men group together under the head of Indigestion ; but the superadded symptom which, from its prominence or locality, 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 particular tendency to decomposition in any organ or locality; but from every function being more or less wrong, he very naturally turns his attention to his stomach or bowels, the errors of which come more parti- cularly under the immediate cognisance of his feelings. Such a patient will complain to you of flatulency and acidity, or of that distressing symptom termed "water-brash." If you ask him about hi| appetite, he will tell you it is " so-so ;" or " he cares nothing about eating;" or it is positively " excel- lent"—which last, I need scarcely tell you, means that it is morbidly craving. Ten to one, if* is capricious—the patient now wishing for this, and now for the other, and rejecting what he desired most, the moment it comes 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 in- dolent, and dawdles his time away. He is apathetic in mind as he is indolent in body ; and he has often a great disposition to sleep, especially after meals. Others, again, will just be the reverse of all this; these perpetually harp upon some particular topic—fidget themselves and every body 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 robbers, from whom they cannot escape ; or they are on the eve of tumbling down a precipice ; dreaming sometimes within a dream —asking themselves, 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 actually awake and walk the air. Even during the day, many of these patients have their dreams or reveries—pleasurable sometimes, but more often the reverse ; they see things either as " through a glass darkly," or their perceptions are all exaggerated and unnatural. Phantoms may even pass be- fore them at mid-day, phantoms such as they see in their dreams of the night. The very colours of things may be altered to their eyes—red 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 the ears of others are so sensitive, they complain of the tick- ing of the clock. The sense of touch is very often similarly vitiated; one patient having partial or general numbness; another, his feelings so acute, 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 per- LECTURE VI. 125 haps most frequent—headache, for which, on the hypothetical assumption of fulness of blood in the brain, the leech, lancet, and cupping-glass, are so fre- quently m requisition. But to what end ? In the words of Abernethy, sup- P°s.lr)g 8Uch 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 alleviates them, but in others, it fails to relieve, and even aggravates them." What are those headaches, those night and day dreams, all those various signs and sensations, but the effects of a great instability of brain, now brought on by one thing, now by another ? I have known the most severe and distressing headaches arise from loss of blood, and I have known them originate in a long fast. 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 prolonged literary or other mental labour, as by star- vation or loss of blood ; for there are times to think, and times to cease think- ing ; and if the brain be eternally harassed by an over anxiety in any of the Sursuits of life ; if it be always at work on one subject, not only will there be eadache, or confusion of head, but the constitution must be injured. How can this organ painfully revolve again and again the occurrences of the exter- nal 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 becomes so engaged, that it cannot at the same time attend to the breathing; 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 succession 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, bowels, and other parts, may be similarly influenced ? What are the com- Jilaints of men who have much on their minds, bankers, merchants, and great awyers ? 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 stomach 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 commonly 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 cere- bral exhaustion. Bless my life, you may bleed or purge a healthy man into this state any day ! In these diseases, one patient will tell you, he is troubled by a feeling of sinking and pain of stomach, which is only relieved by eating. Another suf- fers 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 some- times 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 pos- sibly drink it. This point of practice we owe to John Hunter, who, having frequently suffered from spasm of the stomach, tried every thing he could think of, and among others hot 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, palpitation, spasm, headache, 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 hy- drocyanic acid very frequently gives the same immediate relief in every one of these affections, we at once see that its medicinal power must depend upon 136 LECTURE VI. the change of temperature which it electrically produces. Of the various cordials to which you may have recourse, for spasmodic pain of the heart or stomach, there is none so good as Noyeau ; and the virtue of this " strong water" depends very much upon the prussic acid it contains. Of all the re- medies with which I am acquainted, there is none equal to this acid, in con- vulsions 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 affec- tion 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— For this be sure, to-night thou shalt have cramps, Side-atitehes, 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 profitable 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 de- pletion, with all the usual routine of blisters, black draught, and blue pill to the bargain. The great error of both patient and practitioner, in dyspeptic cases, is to seize upon some of the most prominent features as the cause of all the others. In one instance, they will blame wind ; in another, acid. But these, as it happens, instead of being causes, are only the common and coin- cident effects of a great cerebral weakness ; they are not the product, as many imagine, of fermentation of the food—they are morbid secretions from the lining membrane of the alimentary canal. And of this you may be assured, not only by the mode of their production, but by the manner of their cure, when that happens to be accomplished. Just watch a dyspeptic patient when he receives a sudden or unexpected visit; his " heart-burn," as he calls his acidity, comes on in a moment, and" his bowels commence tumbling and tossing about, and will often guggle so audibly, as to make even the by- standers feel sorry for him ; showing you clearly that this acidity, as well as the gases so suddenly extricated, are the effects of a weakened nervous system ; that they are, in a word, the common effects of wrong secretion.— Now, the term secretion is so constantly associated in the mind of the student with the notion of a liquid, that some of you may not all at once comprehend how gas can be secreted ; but, Gentlemen, is not every tissue of the body the result of secretion ? are not the hair and the nails as certainly secreted as the saliva or the bile ? Only place your naked arm for a few minutes under water, and you 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 of treatment by quinine, nitrate of silver, or alter- nations and combinations of these medicines, will often do away for months, and even years, with every symptom of wind and acidity; while cordials, alkalis, and mild laxatives, seldom do more than give a temporary relief!— Oh ! I never saw much good done by that placebo mode of practice ; nor is this at all to be wondered at, if you reflect, that every part of the constitution of a dyspeptic patient is more or less disordered. In every case of this kind there is an unnatural temperature of body; some patients complaining to LECTURE VI. 127 you of chills or heats, or alternations of both in the back, stomach, hands, 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 condi- tion, from the increase of either in the minute cells of the investing membrane of the whole 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." The dyspeptic patient is either torpid, and with difficulty roused to exer- tion, whether corporeal or mental, or he is acted upon by every thing he hears. The last person that speaks to him is the man for him. His spirits are depressed by the merest trifle, and raised again by a 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 moment 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 re- Bult of our brain's condition, and its atomic relations and revolutions ? It is in perfect accordance with what we observe 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 adherence 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 brains of wrong bodies to reason rightly ?— These persons are like the inebriated, who see two candles when there is only one; their perceptions being false, so also are their reasonings. The plunge bath, or a short course of chrono-thermal treatment, will make them alter their minds sooner than the most powerful and persuasive arguments of a Cicero or Demosthenes. Lady Mary Montague somewhere says, It is the nature of the world to hate truth. She came to this opinion, doubtless, from observing how badly the public had, for the most part, treated its best benefactors. The first dis- covery of anything useful generally meets with the fate of him who attempts to open the eyes of a person imposed upon—namely, to be called bad names for his pains. How forcibly this reminds us of the jackass that kicked the good-natured man, when trying to relieve the stupid brute from the weight of its panniers! The pleasure surely is as great, Of being cheated as to cheat. The more unscrupulous and unprincipled the impostor, the more certainly he has appeared to fascinate his dupes. Let him only hold out an impossi- bility to them, and they will dance attendance at his door for months. Tak- ing advantage of a popular but puerile prejudice against mineral medicine, the medical charlatan 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 swallowed by the multitude, as an indisputable truth! Can weight, measure, heat, cold, motion, rest, be so applied to the human body with impunity? Can you without injury cover 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 ! responds the same dyspeptic, who believes that such and such a medicine is safe in every form, 128 LECTURE VI. 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 often, will make no impression—and that is the reason why the quack and subordinate practitioner, who can keep their medicines secret, have an advantage over the honourable 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 themselves, will at least appear reasonable to their friends—that the medicines you ordered are all contained in the pharmacopeiae of the three colleges of Edinburgh, London, and Dublin, and they are therefore recognised as medicines of value by all the physicians who have a name to make, or a character 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 incon- venience ; 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 not 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 sometimes by action dignified. Within the infant rind of this small flower, Poison hath residence, and Medicine power !" So that physic and poison, whether vegetable or mineral, are physic or poison according as they are rightly or wrongly 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, with aniseed or cardamons. In acidity, either of the two first re- medies 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 ape- rient effervescing draughts are also useful. Should the patient complain of muscular or other pains, you may add colchicum or guaiac—and so proceed in a similar manner with other symptomatic remedies for other local indica- tions ; keeping in mind, however, that these symptomatic medicines are merely a means of secondary importance in the treatment of a great constitu- tional totality of derangement. In addition to these measures, plasters to the back or stomach may be very beneficially resorted to in many cases of dyspepsia, and you may also run the changes upon various kinds of baths. The cold plunge and the shower baths are my favourites; though I need not tell you that the feelings of the patient, after he comes out of it, are a better guide to you in your choice and continuation 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, whe- ther this be common sense or not, I leave you to judge. Heaven only knows LECTURE VI. 129 it is not science, or what very learned people call science ; for when the pa- tient says he gets worse and worse every day, science generally tells him to continue his medicine, for that he has not taken enough of it, and that he will be worse before he be better—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, who also called in, and he said all was right, and that noth- ing 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 requested, where he could by a little gentlemanly trickery keep him out ? In my own parti- cular case, the custom of the apothecary has been secretly to play upon the fears of the patient or his friends against " strong medicine," to shrug 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 ;" where- upon 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 lead- ing men, you know !" Now that only means, that the physicians in question are the fashionable puppets whom he, and people like him, call in to conceal their bad work—men who would as soon think of differing with the opinion of their supposed subordinates, but real patrons, as of quarrelling with their breakfast, because it was purchased with the shilling of a dead man's guinea ! What a just observation was that of the author of Lacon : " The rich pa- tient 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 tbe procrastinated disorder of the other. Some persons will tell you with an air of the miraculous, that they recovered, althoughihey were given over; when they might with more reason have said, they re- covered, because they were given over." " 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 mortality of many legalised practitioners, even of the highest grade, is not one removed 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 your- selves ? So far as my own experience goes—that is, from what I have seen of the profession in London and the English county towns—eminence in medi- cine is less a test of talent and integrity than a just reason of suspecting the person who has attained to it, of a complete contempt for both ! I say sus- pecting—for I have met with exceptions, but not many, to the rule. Could you only see as I have seen, the farce of a medical consultation, I think you would agree with me, that the impersonation of physic, like the picture of Garrick, might be best painted with comedy on one side and tragedy on the other. In saying this much, not only have I acted against everything like medical etiquette, but I shall be sure to be roundly abused by the medical profession for it. The truth, however, I maintain it to be, but not the whole 130 LECTURE VI. truth ! for the world must have its eyes a little more open before it can be- lieve all I happen to know upon the subject. By-and-by 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 cases of which we have been speaking, the constitution is, for the most part, pri- marily 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, such as hasty or erroneous notions upon one or more points, will be found to be associated. When such depression amounts to despondency, medical men, according to the sex of the patient, change the word dyspepsia into Hypochondria, or Hysteria; and some professors are very particular in their directions how to distinguish the one from the other ! Gentlemen, what is the meaning of Hysteria ? It is a corruption of the Greek word voregr] (Hysteria, the womb ;) and it was a name given by the ancients to the particular symptoms we are now consi- dering, from a hypothetical idea that in such cases the womb was the prin- cipal organ at fault. From the same language we also derive Hypochondria, a compound word formed of vno (Hypo, under,) and %o\i(j$os (Chondros, car- tilage,) the supposed seat of the disease being the liver or stomach ; which organs are both situated under the cartilaginous portions of the lower ribs. So that when a female suffers from low spirits and despondency, with occa- sional 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, 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 had his own notion of the disease : the last men- tioned, having put a stethoscope to the chest, at once declared the " Heart" to be the seat of mischief. Mr. Abernethy, on the contrary, with a sarcastic '■'• pooh, pooh !" muttered something about the " stomach and digestive or- gans,"—while Dr. Blundell, in the true spirit of a man-midwife, decided 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 his stethoscope physician, and to Dr. Blundell his Womb, if he could find one ! Genrlemen, that the Brain is the principal organ implicated in all disor- ders 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 person of either sex has been accidentally debilitated by loss of blood—a person who previously was strong in nerve as in muscular fibre ; suppose a letter comes with a piece of bad news—the patient, in that case, bursts into tears, laughs and cries time about, and then sinks into a state of dismal and gloomy despondency. And all this, forsooth, you must put down to the state of the womb or digestive apparatus, according to the sex of the patient, instead of placing it to the account of the brain and nerves, without which the ill-timed letter, the cause of all, could not, by any possibility, have affected the mind in the least! Another class of practitioners, scarcely less unreasonable than those to whom we have just alluded, will have it, that patients, coming under the head of hysteria and hypochondria, are not ill at all.—" Oh ! there is nothing the matter with this man," they will say ; " he is only hipped !" and if the female, " she is only hysterical." Dr. Radcliffe, when he refused to come to Qneen Anne, declared he would not stir a foot, LECTURE VI. 131 "for there was nothing the matter with her but the Vapours !" Such was the term by which the doctors of that day characterised 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 phan- tasies, without being positively ill ? Whoever labours under mental delusion or despondency has alternate chills and heats ; and remissions and exacer- bations of all the more prominent symptoms characterise the disorder in eve- ry form. The late Lord Dudley, in a letter to the Bishop of Landaff, re- lates 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 un- easiness 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. J 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 re- member that I was naturally gay and cheerful." Now, although Lord Dud- ley recovered perfectly from this particular attack, his disease, at a later pe- riod of his life, returned ; but this time he was less fortunate ; for the symptoms of his disorder gradually deepened in 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. Has not the maniac, in every form of his delusion, lucid intervals—remissions ? Your schoolmen, your " patho- logists," your profound medical reasoners, speak of madness and other di- seases, as if they were the effects of some fixed cerebral malformation, in- stead 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 intermittent living action—for the origin of hypochondria and mania—'diseases which they have even themselves, perhaps, traced to hard study or a passion ! External agencies, then, were the real causes, not the structural deviations detected within after death by the scalpel. Students of medicine ! young men hon- ourably 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 es- sence, or that it depends upon some cerebral malformation or tumour, ask them how they reconcile days, or even hours of sanity and sense with a cer- ebral structure thus partially, but permanently malformed or disorganised ! That medical men, mystified from boyhood by their teachers, should fall into such errors, is not so astonishing as that the leaders of our periodical litera- ture should be equally uufortunate. What, for example, can be more egre- giously 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 or- ganic malformation of the brain." How can intellectual power even for one moment be compatible with defective cerebral organization ? How can the cause of an intermittent disease be a corporeal entity, or something per- manently fixed ? Let no sounding words, no senseless sophistry, cheat you of a reply to this question. The maniac who has lucid intervals is curable 132 LECTURE VI. in the greater number of instances—the hypochondriac who, at any time 01 the night or day, enjoys the very briefest immunity from his miserable feel ings, 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 medicine ? 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 pro- duced 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 re- ceived 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 Paymaster 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, 1 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 pro- fession, might not, perhaps, have been so candid in his remarks." Dr. Con- oily, 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 mo- difications or developements 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 experienced 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 reme- dies frequently—for in chronic diseases what will often succeed to admiration one day, may as often have an opposite effect the next; and this is strictly in accordance with what you find in every thing in life. The toy that will stop the cry of the 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 va- rying. The great secret of managing chronic diseases properly, consists in the frequent change and right adjustment of the chrono-thermal and other remedies, to particular cases ; and this also explains the good effect of Tra- velling upon many of these patients ; for to the constantly shifting scenes and to the frequent repetition of novel cerebral excitement produced by those scenes, we must ascribe the chief advantages of such a course ;__clearly proving that the Brain, in this instance, as in every other, is the true key to all good medical treatment. Whatever, then, be the name by which you choose to designate your patient's complaint, you will be sure to meet with nothing but disappointment, if you pin your faith exclusively to any one me- dicine. To-day a mild emetic will give relief—temporary only if you do not follow it up to-morrow, with iron, opium, musk, quinine, or the bath. One week, arsenic will be a divine remedy ; the next, having lost its power, LECTURE VI. 133 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 most highly of its remedial powers in " nervous complaints." Cullen, Pitcairn, every medical man but the most ill-educated apothecary, or the equally ill-educated puppet, who enjoys, at the mercy of his breath, the reputation of being par excellence a physician, will 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 employed 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 himself when cold, because his next- door neighbour had burnt his fingers at the fire. For myself. I can truly say, that though I haVe prescribed the nitrate of silver in some thousand cases of disease, I never had the misfortune to give the slightest tinge to the skin of a single individual. But should objections to the use of this medicine still continue to be urged, after a proper explanation on your part, you may be pretty sure that some ignorant or interested rival has been secretly play- ing 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 suffering. So much, then, for one of many annoyances every practitioner must experience when his patient happens to be -------" the tool That Knaves do work with, called a Fool." Bnt, Gentlemen, we must not suppose that medicine is the only profession where able and honourable men experience such annoyances. Doctors of divinity, and doctors of law, are equally obnoxious to intrigue and prejudice ; ay, and state-doctors, too, as Sir Robert Peel and Lord Melbourne could tell you, if you would ask them. To return. The shifting shades of mental distress, and the various vagaries, and wrong thoughts—to say nothing of wrong actions—of persons whose dis- eases come under the head we have just been considering, are so many and so multifarious, that to attempt to describe thern all would be a mere waste of time and labour ; 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 circumstances : 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. Now, 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 jeal- ousy of his wife, without the slightest cause whatever, as he confessed to me, on the day of remission, when he called to consult me; and however absurd and unreasonable the idea which haunted him, he found it impossible to drive it from his mind. Prussic acid and the plunge bath cured him completely. Case 3.—Another gentleman, after a hard contest at his university for prize honours, suddenly became moody and sullen ; lost his flesh and appetite, and fancied himself Judas Iscariot. Such was his belief one day—to be laughed at even by himself the next! I saw him six times, at the end of m LECTURE VI. which he was perfectly cured by chrono-thermal treatment. Two yearg afterwards, his sister consulted me for " nervousness," when I learned that her brother had not had the slightest symptom of return. Whoever in his progress through life, takes the trouble to study individual character, must be struck by the perversities, inconsistencies, and other bizar- reries 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 person singularly gifted with talent, but who, at the same time, had such an invincible disposition to lie, that no one would believe him, even when by accident he spoke the truth. A ladv, who was once a patient of mine, told me that every time she became pregnant, she caught herself frequently telling lies, for no end or purpose whatever. I knew a gentleman, with high feelings of honour, who was oc- casionally in the habit, when under the influence of wine, of pocketing the silver forks and spoons within his reach ; you can easily imagine his distress of mind the next day, 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. Attention to corporeal temperature will be found of more avail in mending the morals of some individuals than a well- written homily. How many pretty things have been said for and against, the morality of suicide ! I wish it were always in a person's power to abstain from it. But that the disposition to commit 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 I could wish, I shall content myself with reading to you a part of a letter I some time ago received from Dr. Selwyn, formerly of Ledbury, now of Cheltenham.— Speaking of Mr. Samuel Averill, of the Plough Inn, Dynock, Gloucester- shire, Dr. Selwyn says : " Before he came to me, he had consulted Mr.----, of Ledbury, and other medical men, to no purpose, as you can easily under- stand, when I tell you they principally went over the old routine of cupping, purging, &c. Mr. Averill's symptoms were depression of spirits to crying, thoughts of suicide, fears of becoming a lunatic, sleepless nights, and, generally speaking, the greatest possible state of mental wretchedness. He passed immense quantities of urine, as pale and pellucid as water from the pump,— » Finding no particular organ in a worse state than another, I thought this a good case for your doctrines : and accordingly I rang the changes on the nitrate of silver, strychnine, musk, prussic acid, creosote, iron, quinine, and opium—varying and combining these according to circumstances with vale- rian, hartshorn, blue pill, &c. In a fortnight you would have been astonished at the improvement effected upon him. In about six weeks more, he had no complaint, and he was wir.h me about a month ago, when I considered his cure complete. I have treated a great many cases of dyspepsia successfully, by attending to the intermittent principle, and I had lately a case of tic dou- loureux, which, after having been under the successive treatment 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 hold that, in chronic diseases, by keeping your principles in view, we have a great help in many of those ano- malous cases, which I would defy a nosologist or pathologist to name or classify.; and as I am still consulted in 6uch cases, I do not, I assure you, lose sight of them. Often, indeed, when I should, under the scholastic sys- tem, have been completely puzzled what to do, I now proceed at once to act upon the intermittent principle, and I have every reason to be satisfied with my success." Gentlemen, that the numerous diseases which medical men group together under the head of dyspepsia, hysteria, and hypochondria, are caused by circumstances from without, acting upon an atomic instability of brain within. LECTURE VI. 135 might be proved by an infinity of facts. But this instability may be pro- duced, or put in action rather, by different influences in different individuals -—one patient being only susceptible to one agent, while another may be acted upon literally by every wind that blows. The late General O'Hara, for example, 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 con- quer ; by his own desire, his servants kept out of his way on these occasions. The different effects of the winds on. the human system, 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 6f Shakspeare's truthfulness to nature on this, as on most other occasions, we read in Sir Woodbine Parish's Book about Buenos Ayres, that " not many years back, a man named Garcia, was executed for murder. He Was a person of some education, esteemed by those who knew him, and, in general, rather remarkable than otherwise, for the civility and amenity of his manners. His countenance was open and handsome, and his disposition frank and generous ; but when the north wind set in, he appeared to lose all command of himself; and such was his extreme irritability, that during its continuance, he could hardly speak to any one in the street without quarrell- ing. In a conversation with my informant, a few hours before his execution, he admitted that it was the third murder he had been guilty of, besides hav- ing 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, and not he that shed all this blood. When he rose from his bed in the morning, he said he was at once aware of its accursed influence upon him; a dull headache first, and then a feeling of impatience at every- thing 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 head- ache 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 conscious where he went. Such was the account the wretched man gave of himself, and it was corroborated afterwards by his relations, who added, 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 hurt or offended." The same difference of effect upon individuals may take place from any of the common articles of diet.— Dr. Millengen, in his Curiosities of Medical Experience, tells us he " knew a person who could never indulge in tea, without experiencing a disposition to commit suicide, and nothing could arouse him from this state of morbid excite- ment but the pleasure of destroying something—books, papers, or anything within his reach. Under no other circumstance than this influence of tea, were these fearful aberrations observed." Coffee affects many people with fever. But if coffee, tea, and other things so apparently trifling sometimes set up severe disorder—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 seemingly powerless in themselves, it might almost seem puerile to suggest their application. Who, for example, could, a priori, suppose it possible to stop a fit of mania with a thread ? or who would be believed, were they to tell a person that had never heard the like before, that aches and agues had been cured with a song ? Yet in sober truth, such things have been actually done ! 136 LECTURE VI. 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, from the Annates d' Hygiene Publique, et de Medecine Legale. - Mr. R___, a chemist, naturally of gentle disposition, voluntarily claimed admis- sion 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 requesting 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." Now, every man of any informa- tion in the profession, knows that the application of a ligature to the arm or leg will frequently stop the commencing ague-fit. Dr. Davis, in his account of the Walcheren ague, tells us he very often arrested it merely by grasping the leg or arm strongly with his hand. Putting aside, then, all consideration of the intermittent nature of the case of homicidal mania I have just read— all consideration of the thermal and other changes which usher in the fit of every maniacal case, you could not fail to find in the very simple measure, which may equally succeed in preventing or arresting the fit of mania and ague, a new bond, of connexion with which to associate ague and mania to- gether in the same category. But, Gentlemen, these are not the only com- plaints in which the ligature may be thus advantageously employed. In epilepsy, asthma, and other convulsive affections, 1 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 unexpectedly seized with 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 im- mediately afterwards he became warm and comfortable; though for several days previously, he had been suffering from cold feet and general malaise. Mania, epilepsy, asthma, cramp, ague, then, completely establishing their relation- ship by means of the ligature ; for had we no other facts, no other bond of as- sociation than that which the ligature furnishes us, we would still be led to the irresistible conclusion, that those particular diseases, at least, amid all their apparent diversity, have yet some principle in common which determines their unity. When I come to explain to you the manner in which the liga- ture acts, you will find that the connecting link of the whole is the brain.__ They are all the result of a weak and exhausted state of that organ; but not as the late Dr. Mackintosh, of Edinburgh, supposed, produced by any conges- tion or fulness of its blood-vessels. This, 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 in the cold stage of ague,—and then he ap- pealed 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 triumphant answer to the opponents of the lancet!" But mark the fallacy of that fact—mark how the too-confident doctor was deceived by his own practice. The relief of which he boasted—for the most part temporary only,—instead of being produced by the very trifling quantity of blood which LECTURE VI. 137 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, Epi- lepsy,—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 cere- bral 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 primarily affected—as in the case of a blow, a poison, a purge, a passion, we can be at no loss in forming an opinion as to the real nature of these diseases ;—they are all the effect of cerebral weak- ness, 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 ez-ternal vessels of the body, must go some- where else. Had we never dissected a person who had died of faint, we should naturally expect it to settle in the in-ternal veins ; and there accord- ingly, 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 at once presumed was the Cause of such exhaustion. Gentlemen, he did not know that the very same internal vascu- lar fulness 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 bugbear of medical quidnuncs, instead of being the invariable Cause, is in reality the invariable Effect, of sudden exhaustion, I shall now read to you, one of several 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,'r 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, in- deed, 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 gradu- ally less and less obedient to the influence of light, and at length ceased to contract altogether. [That is, they became dilated.] Slight spasmodic contractions 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, respiration at intervals was suspended altogether. [All the symptoms of apoplexy !] Whenever the 138 LECTURE VI. 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, Gentleman, for the dissection : " The Dissection of the Head was first begun. The membranes of the Brain were loader/ with turgid vessels, the larger of which were qf a very dark colour. A,bright red spot was ob- served 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 Jh 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, through- out the whole body the veins were tumid." Now, Gentlemen, if anything in this world could open the eyes of " patho- logical " professors,—if facts or reasoning of any kind could possibly 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. Gentle- men, you constantly hear of children dying of " water on the Brain." I scruple not to declare, that in ninety-nine of every hundred such cases, the water in the Brain is produced by the lancet or leeches of the doctor ! Not long ago, I was shocked with the details of an Inquest which took place before the coroner for Middlesex, Mr. Wakeley, who is also the editor of the Lancet. The Inquest, according to the report iri that paper, was held on the body of a man, who, in the act of disputing with his master about his wages, "turned suddenly pale, and fell speechless and insensible for a time, breathing heavily until his neckerchief was loosed. In falling, his head struck the edge of a door and received a deep wound three inches long, from which blood flowed enough to 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 in practice the moment he was called to a person who had fallen down in a FAINT, and who, from the injury occa- sioned by the fall, had lost blood "enough to soak through a thick matl" 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 were 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 before 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 recovered his sensibility to surrounding objects, he died." Remember, Gentlemen, he did recover his sensibility after be left his master's shop,—he even complained of head- LECTURE VI. 139 ache; but after having been bled by the doctor he relapsed into his former state of unconsciousness. How could he possibly survive such repeated loss of Hood ? That he died from such loss of blood was the opinion of every person who heard the evidence, till Mr. Wakley, the Coroner, luckily for " the doctor," had the corpse opened. Then, sure enough, just as in the case of the dog that was bled to death, the internal veins were found to be turgid and congested throughout.. Deceived by this very constant result of any great and sudden loss of blood, Mr. Wakely 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 ver- dict pronounced accordingly ! That an ignorant coroner and an ignorant jury should be imposed upon in this manner, is nothing very wonderful; but that the Editor of the Lancet, who publishes the case, and who, from his position, knows every thing going on at the present time in t]ie 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 lamen- table state of darkness in which the profession are at this very moment on every thing connected with the proper treatment of disease ! When St. John Lons or any other unlicensed quack, by an overdose, or awkward use of some of our common remedies, chances to kill only one out of some hundreds of his dupes, he is immediately hunted to death by the whole faculty ; but when a member of the profession at one bleeding takes more blood by three times than is taken on any occasion by practitioners who kill their man every day 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 any 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 only thing required of the perpetrator is, that he should do it under the sanction of a diploma, and secundum artcm ! 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 received as iust 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 conse- nuences 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 particular nortion 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 vomif another fall into convulsions; a third shiver, fever, grow deliri- ous and become mentally insane. In all these diseases, the atomic move- ments of the Brain being no longer in healthy and harmonious 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 altogether; another moves forward in the 140 LECTURE VI. right course perhaps, but with vacillating and uncertain step ; while a third endangers itself and every thing near it, by the rapidity or eccentricity of its movements. When the atoms of the various parts of the Brain, on the con- trary, act in harmony with each other, there is an equally harmonious action of every organ of the body—supposing, of course, every organ to be perfect in its construction. Whatever suddenly arrests or puts into irregular motion the whole cerebral actions, must with equal celerity influence the previous motive condition of every member and matter of the body—for evil in one case, for good in another. Were you suddenly and without any explanation to put a ligature round the arm of a healthy person, you would to a dead certainty excite his Alarm or Surprise. Now, as both of these are the effects of novel cerebral movements, would 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 colour, becoming pale and red by turns, according as the Brain alternately lost and recovered its controlling power over the vascular apparatus. If the alarm was very great, the pallor and tremor would be proportionally long. But in the case of a person already trembling and pale from another cause, the very natural effect of suddenly tying a ligature round the arm would be a reverse effect—for if the cerebral motive condition should be thereby changed at all, it could only be by a reverse movement; and such reverse cerebral move- ment 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 trembling and spasmodic muscles would recover their tone ; the heart's palpitation 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 substances generally ; all of which, as you have already seen, and I shall still further show, are, like the ligature, capable of producing and curing the various morbid motions for which we respectively direct their administration. It is in this manner that every one of the various passions may cause or eure every disease you can name; always excepting, as I have said before, the properly contagious dis- orders. The brain, Gentlemen, is the principal organ to which, in most cases, you should direct your remedial means. When a person faints and falls, whatever be the cause of such faint—a blow, a purge, or loss of blood—the first thing to be done is, to rouse the brain. You must throw cold water on his face, put hartshorn, snuff, or burnt feathers to his nose ; and a little brandy, if you can get it, into his mouth. You may also slap or shake him strongly with your hand ; if you can only make him feel, you will be almost sure to recal him to life: but to think of bleeding a person in such a state—ha ! ha ! After all, this is no laughing matter ; for when we see such things done in the nineteenth century, we should rather blush for a profession that would en- deavour to screen any of its members from the contempt they merit, when they have so far outraged everything like decency and common sense. The proper treatment of a fit of fainting or convulsion, should be in principle the same as you may have seen practised by any well-informed midwife, in the case of children that are still-born—children all but dead. You may have seen the good lady place the child on her knee, and beat it smartly and re- peatedly with her open hand on the hips and shoulders, or suddenly plunge it into cold water ; now while this is doing, the infant will often give a gasp or two, and then cry ; that is all the midwife wants. And if you will 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 LECTURE VI 141 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, wlrch, under the rou- tine 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 convulsive fit of the epileptic or fainting kind at the same moment. Convulsive sobbing is a phenomenon perfectly incompatible with these move- ments ; for it depends upon a reverse action in the atoms of the brain. The only thing which may prevent some of you from doing your duty on such occasions, is the fear of offending an ignorant nurse or mother, who will think you a monster of cruelty for treating an infant so. 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 descrip- tion leave no mark whatever after the paroxysm has ceased. During the fit, the child is so perfectly insensible as to be literally all but half-dead. What is the present routine treatment of an infant taken with convulsive fits ? That I can scarcely tell you; but when I settled in London, some six years ago, the court doctors, who, of course, gave 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 ears of infants under six months old ; and that, in some cases, repeatedly ! In addition, they were in the habit of leech- ing, purging, and parboiling the poor little creatures to death in warm baths ! If mothers will really suffer their children to be treated in this manner, surely they only deserve to lose them. The strongest and healthiest child in existence, far less a sick one, could scarcely survive the routine practice. And yet, whether you believe me or not, such fits are -----seldom mortal, Save when the doctor's sent for! In my experience, it is only when the muscles of the wind-pipe become spasmodically involved, that you have any occasion to be anxious ; asphyxia and sudden death being sometimes the result of such cases. In 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 appli- cation of so simple a means as the ligature may then very often do this at once ; but, like every other remedy frequently resorted to, it will be sure to lose its good effect, when the patient has become accustomed to it; for in this and similar cases, every thing depends upon the suddenness and unexpected- ness of the particular measure put in practice, whether you influence the brain of a patient in a novel manner or not. The sudden cry of " fire" or " murder," nay, the unexpected singing of some old song, in a situation, or under circumstances which surprised the person who heard it, has charmed away a paroxysm of the severest pain. In the army, the unexpected order for a march or a battle will often empty an hospital. The mental excitement thereby 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! f 142 LECTURE VII. LECTURE VIL UNITY OF ALL THINGS--DISEASES OF WOMEN--CANCER--TUMOUR--PREG- NANCY — PARTURITION--ABORTION-- TEETHING--HEREDITARY PERIO- DICITY. Gentlemen, Many of you have, doubtless, read or heard of Dr. Channing of Bos- ton, one of the boldest and most eloquent of American writers. In a little essay of his, entitled " Self-Culture," I find some observations bearing so strongly upon the subject of these lectures, that I cannot resist the tempta- tion 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 an opportunity of judging for yourselves :—" Intellectual culture," says this justly eminent person, " consists, not chiefly, as many are apt to think, in accumulating in- formation, 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 concentration of the attention ; in accurate, penetrating observation; in reducing complex subjects to their ele- ments ; 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 princi- ples, constitutes what is called a 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 prin- ciple, 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 under 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 continually about the parti- cular actions of this or that neighbour, while another 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, while another strives to discover the harmony, connexion, 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 beyond the cavil of the cap- tious and the interested. In this respect, indeed, we find it only harmonising with the history of every other thing in nature. But in making intermit- tent fever or ague the type or emblem of this unity of disease, we must beg of you, at the same time, to keep constantly in view the innumerable diversities of shade and period, which different intermittent fevers may ex-, hibit in their course. It has been said offaces, -----Facies non omnibus una, Nee divcrsa tamen— And the same may with equal truth be said of fevers; all have resemblances, yet all have differences. For, betwixt the more subtle and slight thermal LECTURE VII. 143 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 tremu- lous, 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 chills, heats, and sweats, instead of being in all cases universal, may in many instances he partial only. Nay, in place of any increase of perspiration outwards, there may be a vicarious supera- bundance of some other secretion within ; of this, you have evidence in the dropsical swelling, the diarrhoea, 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 remis- sion, 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 gra- dually less and less regular in its paroxysms and periods of return; passing in one case into a fever apparently continued ; in another, reverting by suc- cessive changes of shade into those happier and more harmonious alternations of temperature, motion, and period, which Shakspeare, with his usual felicity, figured as the " fitful fever" of healthy life. If you take health for the standard, every thing above or beneath it, whether as regards time, tempera- ture, motion, or rest, is disease. When carefully and correctly analysed, 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 " entities" to combat; they are simply variations in the pheno- mena of corporeal movements ; and in most cases, happily for mankind, they may return to their normal state without the aid of physic or physicians.— The same reparative power by which a cut or a bruise, in favourable circum- stances, becomes healed, may equally enable every part of a disordered body to resume its wonted harmony of action. How often has nature in this way triumphed over physic, even in cases where the physician had been only too busy with his interference ! It is in these cases of escape that the generality of medical men arrogate to themselves the credit of a cure. " It was a beautiful speculation of Parmenio," remarks Lord Bacon, " though but a speculation in him, that all things do by scale ascend to unity." Do I need to tell you, Gentlemen, that everything on this earth which can be weighed or measured is matter—matter in one mode or another ! What is the difference betwixt a piece of gold and a piece of silver of equal shape and size ? A mere difference of degree of the same qualities—a different specific gravity, a different colour, a different ring, a different degree of mal- leability, 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 trans- formed into the very identical substance from which, at first sight, it so strik- ingly 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, 144 LECTURE VII. 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 something else ; the organic passing into the inorganic, solids into liquids, liquids into gases, life into death, and vice versa ? The more you reflect upon this subject, the more you must come to the opinion, that all things at last are only modes 01 differences of one matter. The unity of disease is admitted by the very opponents of the doctrine, when they give to apoplexy and toothache the same name—disease or disorder. But these approaches to unity may be traced throughout every thing in nature. Betwixt the history of the human race, for example, the revolutions of empires, and the history of the individual man, the strongest relations of affinity may be traced. The corporeal revo- lutions 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 connexion of time and place. All events which happen in that portion of space and period of time, are" comprehended in his design, though, in other respects, different and un- connected. 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 minor 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 succes- sively developed. Such are the periods of teething and 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 harmonises with every thing 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 in the first instance hermaphrodite, just as we find it in the lowest tribe of adult animals—the oyster, for example. In this particular, aswin every other, the organs of the human foetus, internal as well as external, first come into exist- ence 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 tem- perature. 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 ovaries are so perfectly identical in place and appearance, that you could not tell whether they should afterwards become the one or the other.— What in the male becomes the prostate gland, in the female takes the form of the womb. To sum up all, the outward generative organs of both sexes are little more than inversions of each other. Every hour that passes, however, while yet in its mother's 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, this dif- ficulty has altogether vanished. Then the boy becomes bearded, and his LECTURE VII. 145 voice alters ; then the breasts of the girl—which up to this period, in no re- spect different 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, embues them with the power of secreting the first nutriment of the infant. But even before the girl can become a mother a new secretion must have come into play ; a secretion which, from its period being, unlike every other, monthly only, is known to physicians under the name of " Catamenia," or the " Menses." How can such things be done but by a great constitutional change, without a new febrile revolution of the whole body ! Mark the sudden alternate pallor and flush of the cheek and lip, the tremors, spasms, and palpitations—to say nothing of the uncontrollable men- tal 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, Gentlemen, will recognize in them the developments 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 Catamenial secretion, 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 ani- mal 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, especially as they have every opportunity of settling the question definitively. Various specu- lations 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 natu- ral and necessary to females of a certain age, as the saliva or the bile to all people in all times. How absurd, then, the common expression that a wo- man, 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 secre- tions imperfectly performed, pain may be an accompaniment of this particu- lar function. Need I tell you, that no female of a certain age 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 cor- responding 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 astringents and cold appli- cations. 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 146 LECTURE VII. other function, to rights,—when the practitioner who prescribes them hajs no idea that he is doing more than attending to the derangement of a part. He accordingly places profuse menstruation in his list of local diseases ! When deficiency or suppression of this secretion, on the contrary, chances to be the coincident 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 "ob- struction," how do you think some of your great accoucheur-doctors are in the habit of combating it ? By leeching the patient—by applying leeches locally. Now, I only ask you what you would think of a practitioner, who, on finding the same patient feverish and thirsty, should leech her Tongue ? or when she complained of her Skin being uncomfortably dry, should apply leeches to that ? You would laugh at him of course ; and so you may, with just the same reason, laugh at the fashionable practitioners of the day, when you find them leeching their patients for defective or suppressed menstrua- tion,—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 gullet 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—attention to temperature ; for, in every case of catarhenial irregularity, whether as regards Quantity, Quality, or Period, the temperature of the loins must be more or less morbid,—one patient acknowledging to chill, another 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 salutary results in nu- merous cases. In both instances, cold, warm, and tepid baths may also be advantageously employed, according to the varying circumstances of the case. The majority of women who suffer from any general indisposition short of Acute Fever, are more or less subject to a particular discharge which, by the pa- tients themselves, is very often termed Weakness, but which is more familiar to the profession under the name of Leucorrhma or Whites. The usual concomit- ant 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 acknow- ledged that the local flow was one day more, another less, and that she had, besides, the chills, heats, and other symptoms of general constitutional de- rangement. 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 re-act 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 with, and sometimes without, copaiba, catechu, or cantharides— one medicine answering best with one patient, another with another. I have been frequently consulted in cases of painful Whites, and also in cases of painful menstruation, disorders which practitioners, as remarkable for their professional eminence, as for their utter want of high professional knowledge, had been previously treating by leeches ; some applying 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 LECTURE VII. 147 practice can be more erroneous ? What relief, if obtained, 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 disappearance of the more prominent local irregulari- ties for which your aid had been asked, affords the best answer to any hypo- thetic 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, accord- ing 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 mat- ter 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 com- mences is this :—A tumour, at first smaller than a nut, possessing more or less hardness, and to a certain extent circumscribed, is observed in the neigh- bourhood of the nipple ; the patient's attention, in most cases, being 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. This tumour slowly but gradually increases in size and hardness, while the pain becomes more and more intolerable and " lancinating." The disease in every case is inter- mittent, and in most instances, this intermission is periodical, the tumour be- ing 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 tumours, 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 cartilage, the disease was pro- nounced to be " true cancer"—a schirrhus or carcinoma. On the contrary, if, instead of this appearance, the tumour 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 as 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 disease ,• or, to express Zself better, there is hereditary predisposition ; and what is more, the dis- e 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. [t comes on much about the time when the catamenial secretion is about to terminate for life. Can such termination take place without a new corporeal revolution ? Impossible ! at this epoch every female suffers more or less from constitutional disorder. Analyse that disorder, and you will find that it resolves 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 to the 148 LECTURE VII. female ear ? The difficulty to cure it, simply—the difficulty in most instances —the absolute impossibility in many. To understand the reason of this dif- ficulty, we must consider the nature and uses of the organ. However beau- tiful and ornamental, the breast is not, like the heart or lungs, an organ of importance to the vital economy of the individual. 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 development 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 ab- sorbed ; though you occasionally meet with instances where it becomes enlarged beyond its previous size. In fewer cases still, it takes on a process of decay ; in other words, it becomes cancerous. But nature in this 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 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 pro- cure 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 affected. I lately attended the sister of a Fellow of the College of Physicians, who was first induced to consult me, from hearing that I looked upon ague as the primary type or model of all complaints. Her own cancer, she assured me, was preceded by shivering fits, which she traced to a sudden chill; and during the whole pro- gress of the disease, she suffered more or less from agueish feelings. Previ- ously 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 in- crease of her pain. And no wonder; for if that eminent person had only taken the trouble to inquire, he would have found that, instead of the hypo- thetic "inflammation," which doubtless suggested their employment, the breast in that instance was generally cold! Would not a warm plaster, under these circumstances, have been of more service ? You, Gentlemen, may try it 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 all be 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 pro- duce its beneficial effect for any great continuance in those disorders ; 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 instance. No medicinal agent had a greater reputation at one time, in the treatment of Cancer, than arsenic; arsenic, in fact, was supposed to be a wonderful specific in cases of that nature. What was the consequence? Like every thing else in this world, whether person or thing, physician or physic, that LECTURE VII. 149 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 ] 809, " an extensive [cancerous] sore filled with the most healthy granulations, the complexion become clear, the appetite improved, and the general health in- creased. 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 traveller, 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 noC carrying him without resting to the end of his journey ! What, under the circumstances 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 improve- ment to be the result; and when such result no longer follows the employ- ment of your medicine, change it again for some other ; 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 consti- tution has been allowed time to forget a remedy, that once beneficially influ- enced it, such remedy, like the re-reading of a once-admired, but long-forgot- ten 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 medicines and measures in a thousand ways to produce a sustained improvement. Arsenic, gold, iron, mercury, creosote, iodine, opium, prussic acid, &c.,*may be all advantageously em- ployed, 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 tumour, gradually increasing in dimension. And so exceedingly weak do the atomic attractions of the matter of the breast become during the change pro- duced by the disease, that scarcely has the atmospheric air been allowed to come in contact with the tumour, than it commences to mortify and die— falling away in most cases, (as it did indeed in the case of the lady to which I have already alluded,) after a certain time in a dead and 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, be- cause 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 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 mushroom-like and other excrescences springing from the sides and bottom of the ulcerous and decaying part, and that too with a rapidity truly astonishing. A case of this kind 1 lately attended with Mr. Farquhar of Albemarle Street. Unless every portion of these fungoid bodies be com- 150 LECTURE VII. pletely removed, you must not hope to arrest the progress of the disease. The whole surface of the ulcer should be cauterised 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 cauterise, and cauterise 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 pro- duce a temporary action. If that action be of a novel kind, they will pro- duce beneficial results; if, on the contrary, the increased motion from their action be in the old direction, and which cannot be foreseen till tried, the re- sult 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 himself 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 success. You must not then suppose, like most of the laity, 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 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 bosom, have in the course of years, lost every appearance of breast by the slow but imperceptible process of interstitial absorption ;—what inconvenience do these suffer in consequence? 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 strong- est : relieve this in every way you can, but avoid leeches and depletion, which, I need not say, are the readiest means, not only to exhaust the pa- tient's strength, but to produce that extreme sensibility of nerve, that intol- erance of external impression, which converts the merest touch' into the stab of a dagger. Strong people seldom complain of pain ; it is bloated or emacia- ted persons who mostly do so. Keep up the health, then, by every means in your power, and your patient 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 he says it had no necessary con- nexion. What shall I tell you in regard to amputation of the Breast? Will amputation harmonise the secretions ? Will it improve the constitution in any way whatever ? Those patients who, in the practice of others, have been induced to undergo operations, have seldom had much cause to thank their surgeons,—the disease having, for the most part, reappeared at a future period in the cicqtrix 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 surgi- cal operation,—a measure at the best doubtful in most cases, and fatal in not a few. S,hiverings, heats, and sweats, or diarrhoea, or dropsy,—these are the constitutional signs that tell you you have something more to do than merely 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 LECTURE VII. 151 the knife may sometimes be advantageously employed I do not deny, but in- stead of being the rule, it should be the exception; the majority of honoura- ble and enlightened surgeons will admit how little'it has served them in most cases beyond the mere purpose of temporary palliation. When you hear a man now-a-days speaking 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 fee for amputating a breast enters into the calculation of some operators. 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 usually 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 reports of cases, that a " healthy" person presented himself with a particular tumor in this or that situation. Now, such practitioners by this very expression show how much they have busied themselves with arti- ficial distinctions—distinctions which have no foundation in nature or reason —to the neglect of the circle of actions which constitute the state of the body termed Health. Never did a 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 un- healthy 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 or less voluminous. Every individual, we have already shown, has a predisposition to disease of a particular tissue. Whatever shall derange the general health may de- velope the weak point of the previously healthy, and this may 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 any apparent differences betwixt the Tumors themselves ; and where Tumors appear to differ in the same tissue, the difference will be found to be only in the amount of the mat- ter entering into such tissue, or in a new arrangement of some of the elemen- tary principles composing it. It is a law of the animal economy, that when a given secretion becomes morbidly deficient, some other makes up for it by a preternatural abundance. If you do not perspire properly, you will find the secretion from the kidneys or some other organ increase in quantity. I was consulted some time ago by a female patient, whose bosom became enormous from excess of adipose or fatty deposit. Now, in the case of this female, the urine was always scanty, and she never perspired. Every tissue of the body is built up by secretion. The matter of muscle, bone, and skin, is fluid, beibre it assumes the consistence of a tissue, and the atoms of one texture are constantly passing into some otherv. " 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 pro- duced, as Mr. Hunter supposed, by the " organisation of extravasated blood," are the result of errors of secretion. They are principally made up of excess of some portion of the tissue in which |hey appear, or the result of new com- binations of some of the ultimate principles which enter into its composition. If vou search the records of Medicine upon the subject of Tumors, you will Had that the agents by which these have been cured or diminished, come 152 LECTURE VII. at last to the substances of greatest acknowledged efficacy in the treatment of ague. One practitioner (Carmichael) lauds Iron ; another (Alibert) speaks favourably of the Bark; the natives of India prefer Arsenic ; 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 ! Marvel not, then, if 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 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 periods of Teething and Puberty—and so we find it in the case of Pregnancy. Can the seedling become an herb in the frost of winter, or the sapling grow to maturity without a series of changes in the temperature and motion of the surrounding earth ? No more can the foetal germ become the infant without a succession of febrile revolutions in the parent frame ! Once in action, it re-acts 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-lip, distortions, moles, marks, &c, have been traced by the mother to such passions in far too many instances 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 association 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 only guess from analogy. How a too long cerebral neglect of the mother's economy may influence her, we daily see in the numerous dis- orders to which she is then liable—more particularly in the periodic vomit- ings, and also in the swoon or faint which occasionally comes on during the pregnant state. Are not these the very s\'mptoms 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 principal- ly 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 favourable alter- nations of cerebral movement which take place during pregnancy, the mother for the most part experiences Chills, Heats, and Sweats,—she has symp- toms, or shades of symptom at least, of the same disorders that may "arise from any other agency affecting the Brain in a novel or unusual manner__she becomes at certain times pale and flushed alternately, and, as in the case of other Fevers, frequently complains of headache. When blood-letting—the usual refuge of the ignorant—is in sudai 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 great peculiarity of " true inflammatory fever !" LECTURE VII. 153 Pregnancy has been defined by some very great doctors, to be a " natural process." Now, that certainly is a very great discovery ; but they might have made the same discovery in the case of Disease and Death. Is not every thing in Nature a natural process, from the fall of an apple to the com- position of the Iliad ? Every thing that the eye can see or the ear can hear, is natural; miracles only are miraculous ; for they are events that are con- trary to the natural order of things. Pregnancy, then, is a natural pro- cess ; but is it on that account the less surely a febrile state ? Is it for that reason the less certainly an Intermittent Fever ? What disorders have not originated in Pregnancy ? What, in cases where they previously exist- ed, has it not, like every other Fever, cured ? If it has produced Epilepsy, Apoplexy, Toothache, Consumption, Palsy, Mania,—each and every one of these diseases have I known it to ameliorate, suspend, or cure ! I remember .he case of a lady who, before her marriage, squinted to perfection. But when she became pregnant her squint diminished, and long before the period of her confinement it was cured ; 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 produced it. How completely, then, does this harmonise with the Unity which pervades Disease generally ! Parturition, I have already said, is a series of pains and remissions, but it is not an inter- mittent fever ; nor, indeed, has it any resemblance to that affection ! So, at least, I have been assured by very clever doctors : and they have told me the same of pregnancy ! Is this question, then, completely settled in the negative ? Certainly ; it is settled to the satisfaction of all who pin their faith upon mere human authority. But human authority seldom settled any thing with me ; for wherever I have had an interest in knowing the truth, I have generally appealed from the decree of that unsatisfactory court to the less fallible decision of the court of fact. And what does fact say in this in- stance ? Fact says that child-labour, in almost every case, commences with chills and heats, and that these are again and again repeated with longer or shorter periods of immunity during its progress. But how do I know all this ? you will ask—I who hold modern midwifery in horror ! I will tell you truly —I first guessed it; for I could not suppose that parturition, unlike every other great revolution of the body, could be either apain-less or anunperilous state ; or that it could be free from the chills, heats, and remissions, which 1 had always observed in cases of that character. Still, Hot being a person 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, na- ture 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 symptoms mentioned as incidental to women at this period. " Sometimes," says Dr. Ramsbotham, himself a man- midwife, " they are sufficiently intense to shake the bed on which the patient lies, and cause the teeth to chatter as if she were in the cold stage of an ague- fit ; and although she 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 revolutions take place in the same manner as those of ague, but, like ague, both may be influenced by medicines, as well as by mental impressions. Indeed, in most cases of par- turition, the labour-^, mark the word ! will stop in a moment from the new cerebral movement induced by fright or surprise. In some, the fit never returns, and the most terrible consequences ensue. When the foetus is fairly 154 LECTURE VII. developed in the case of pregnancy, and the labour completed in that of par- turition, 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 symptom of ague. Moreover, when a woman gets into a habit of miscarrying, such mis- carriage, 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 abor- tions, 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 had two children since, and all three are well and thriving. I have succeeded in similar cases with the internal exhibition of quinine, iron, hydrocyanic acid, &c. But opium, where the drug does not decidedly dis- agree, will be found the most generally useful of our medicines in checking the habit of miscarriage. Need I tell you, that in no case should it be con- tinued where it excites vomiting. The tendency to return of any action which has once taken place in the constitution, is a law even in some effects of 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 one of her daughters, five in number, all of whom grew to womanhood. To mothers and nurses, next to pregnancy and parturition, there is no sub- ject so interesting as Teething. By both, the birth of the first tooth, like the birth of a first child, is com- monly expected with a certain degree of anxiety, if not of fear. Why is this ? Why, but because, as in the case of pregnancy, before the dormant germ can be called into action—before the embryo tooth can be developed—there must be a complete corporeal revolution, an intermittent fever of more or less intensity, varying according to the varying conditions of particular constitu- tions ? 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 embryo 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, are ushered into the world by fever. The more healthy and vigorous the child, the more sub- dued will the teething fever for the most part be, and the teething itself will consequently be less painfully accomplished; just as under the same circum- stances the parturient mother will more surely bring forth her young in safety. In those cases, on the contrary, where the child is weakly or out of health, the fever will be 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 ag- gravate and prolong the constitutional disorder. It is first an effect, and then LECTURE VII. 155 a superadded cause or aggravant. Gentlemen, in this fever, we have a fresh illustration of the unity of disease; 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 be pro- duced during the intermittent fever of teething ! Every spasmodic and para- lytic distemper you can name ; convulsion, apoplexy, lock-jaw, squint, curved spine, with all the family of structural disorders, from cutaneous rash and eruption to mesenteric disorganisation 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 dis- order, 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. Dur- ing 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,—in the cases of infants suffering from convulsions and 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 fol- lows 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 lar^e loss of blood." And you may recollect that in the experiment of the animal bled to death by Dr. Seeds, flatulence and convulsions were among the symptoms produced by the evacuation. Some years ago, I was requested to visit a child affected with convulsions ; before I saw it, the poor little thing had been the subject of thirteen distinct fits, with an interval of remis- sion of longer or shorter duration between each. What do you think was the treatment to which this infant had been in the first instance subjected by the 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 mechanical bugbear, pressure on the brain. How compatible this doctrine, permanency of cause, with remission of symptom ! The quantity of blood taken was about an ounce, but the convulsions recurred as before. This was the reason why I was called in. The child at that particular mo- ment had no fit—so after taking the trouble to explain the nature of the symp- toms to the attending Sangrado, I suggested Quinine as a possible preventive. The man of cups and lancets started, 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 re- curred__from what cause, I know not, unless it might be from a Purge which its mother injudiciously gave it on the morning of recurrence. _ The flatulence, too, with which the child was all along troubled, began to dimin- ish 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 156 LECTURE VII. every two hours all that day—so that there is no earthly agent, however powerful, even in a small quantity, that may not, by farther diminution, be adapted to any state and strength—to any age or condition of life for which you mav be desirous of prescribing it. In this respect, medicine resembles everv thing in nature. In the case of aolors, 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 practitioner 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 that he 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-fools" are as common as ever. Indeed, the only difference I see in the matter is this—that whereas in the olden times such personages only exhibited in cap and bells at the feast and the revel, they now appear in a less obtrusive disguise, and act still more ridiculous parts on the gravest occasions. One very great obstacle to improvement in medicine has been the very general preference given by Englishwomen to male over female practitioners of midwifery ; for by means of that introduction, numbers of badly-educated persons not only contrive to worm themselves into the confidence of families, but by the vile arts to which they stoop, and the collusions and conspiracies into which they enter with nurses and each other, they have in a great mea- sure managed to monopolise the entire practice of physic in this country. 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 was a natural process, and not a surgical operation." Notwithstanding the howl and the scowl with which that letter was received by the apothe- caries, it is pleasing to see that the public are now beginning to be aware of the fact that more children perish by the meddlesome interference of these persons, than have ever been saved by the aid of their instruments. How many perish by unnecessary 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 suggested such a custom ? Who but a creature with the mind of a mechanic and the habits of a butcher, would think of applying a cupping in- strument behind an infant's ear to stop wind and convulsions ? The nurses and mid wives 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 prussic acid it contained ! Gentlemen, you may get many an excellent hint from every description of old women but the old wo- men of the profession—the pedantic doctors, who first laugh at the laurel-leaf as inert, and yet start at the very medicine upon which its virtues depend, when1 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 LECTURE VIII. 157 at the mention of opium or arsenic, while they dose you to death with pur- gative physic, 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 tkke a particular family, and, as far as practicable, endeavor to trace their diseases from generation to generation, you will I find that the greater number die of a particular disease. Suppose this to be pulmonary consump- tion. Like the ague, which makes its individual revisitations only on given days, you shall find this disease attacking some families only in given gener- ations—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 determi- nate—in one this disease appearing only during childhood, in another restrict- ing itself to adult life or old age. By diligently watching the diseases of particular families, and the ages at which they respectively reappear, and by directing attention in the earliest stages of constitutional disorder to those means of prevention which I have in the course of these lectures so frequent- ly had occasion to point out to you, much might be done to render the more formidable class of" disorders of less frequent occurrence—mania, asthma, epilepsy, and consumption might thus, to a certain extent, be made to disap- pear 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 !" LECTURE VIII. the senses—animal magnetism—the passions—baths—exercise- homoeopathy. Gentlemen, The Causes of Disease, we have seen, can only affect the oody 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 tumour or a sore being healed in a dead body ? A dreamer or a German novelist might imagine such tilings. Even in the living subject, when nerves have been accidentally paralysed, the most potent agents have not their 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 Stomach—arsenic will not produce its accustomed effect on either of these organs. Is not this one of many proofs that an external agent can only influence internal parts banefully, at least, by means of its Elec- tric power over the nerves leading to them ? Through the same medium, and in the same manner, do the greater number of our Remedial Forces exert their salutary 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. Take away these, and where would be the joys, sorrows, or the diseases of mankind? 158 LECTURE VIII. We shall first speak of Sight. The view of a varied and pleasant coun- try may, of itself, improve the condition of ru.oy inlands—while a gloomy situation has too often had the reverse effect. Jvnr.r. are cases, nevertheless, in which pleasant objects only pain and dis^a-cc che patient by their multi- plicity or brightness. Night and darkness, \n such circumstances, have af- forded both mental and bodily tranquillivy. The presence of a strong light affects certain people with headache ; and thore are persons to whom the first burst of sunshine is troublesome, oo account of the fit of sneezing it ex- cites. A flash of lightning has caused and cured the palsy. Laennec men- tions the case of a gentleman who, when pursuing a journey on horseback, suddenly arrived at an extensive plain. The view of this apparently inter- minable waste affected him with such a sense of suffocation, 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, with a sense of sicknerjs and terror; yet there are individuals who ex- perience a gloomy joy upon such occasions ; 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 themselves 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." Any 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. Who of you has not experienced giddiness from a few rapid gyrations ? Everything in the room then appears to the eye to turn round. If for a length of time you look from the window of a coach in rapid motion, 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 stream-gazing induces a pleasurable reverie, or a disposition to sleep. Apply these facts to Animal Magnetism*—compare them with the effects of the manipulations so called, and you will have little difficulty in arriving at a just estimate of their nature and mode of action. What is animal magnetism ? It 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 imperturba- * [Three years ago, viz., in 1845, when I published my first American edition of this work, I was almost as sceptical on this subject as Dr. Dickson. But my scep- ticism has been much shaken since, and I am constrained to think with Hamlet that, " there are more things in heaven and earth than are dreamt of in our phi- losophy." Nor would it be a sound philosopical objection to say that it is liable to be abused; since that is the lot of every gift of Providence—to quote again a pas- sage from Shakspeare, that accurate observer:— " Naught so vile that on the earth doth live, But to the earth some special good doth give ; Nor ought so good, bid. strained from that fair use, Revolts from true birth, stumbling on abuse! Our author admits, which indeed can hardly be denied, that the action of medi- cines, both of the mineral and the vegetable kingdoms, is electric, or, what is the same thing, magnetic. Why should we infer the higher kingdom, the animal, to be deficient in, instead of possessing in a higher degree, a power so subtle and so important ? May it not yet be demonstrated that the two forms of electricity, now known as the positive and the negative, are simply, the one, the motion of the par- ticles of the light of the sun, the other, the motion of the particles of his heat__both together, with their varieties of intercourse, constituting the all of mineral and vege- table power, and the all of physical life, and their disturbance or imperfect adjust- ment m the human body, the all of physical disease, or disorder ? W. T. ] LECTURE VIII. 159 ble gravity, and keep your eye firmly fixed upon the patient, in order to maintain your mental ascendancy. On no account must you allow your fea- tures to relax into a smile. If you perform your tricks slowly and silently in a dimly-lit chamber, you will be sure to make an impression. What im- pression ?—Oh ! as in the case of the stream-gazer, one person will become dreamy and entranced; another, sleepy; a third, fidgetty, or convulsed. Who are the persons that, for the most part, submit themselves to this mum- mery? Dyspeptic men, and hysteric women—weak, curious, credulous persons, whom you may move at any time by a straw or a feather. Hold up your finger to them, and they will laugh; depress it, and they will cry ! So far from being astonished at any thing 1 hear of these people, I only won- der it has not killed some of them outright—poor fragile things ! A few years ago I took it into my head to try this kind of pawing in a case of epilepsy. It certainly had the effect of keeping off the fit; but what hocus-pocus has not done that ? I have often done the same thing with a stamp of my foot. In a case of cancer upon which I tried the " passes," as these manipulations are called, the lady got so fidgetty, I verily believe, if I had continued them longer, she would have become hysterical or convulsed ! That effects reme- dial and the reverse, however, may be obtained from them, I am perfectly satisfied. Nor do I mean to deny that in a few—a very few instances, these, or any other monotonous motions, may produce some extraordinary effects— effects which, however, are the rare exception instead of the general rule. Whatever any other cause of Disease may produce on the human body, these manipulations may by possibility occasion—Somnambulism, Catalepsy, or what you please. There is no more difficulty in believing this than there is difficulty in believing that the odour of a rose, or the sight of a cat, will make certain people swoon away. This much, then, I am disposed to admit. But when the animal magnetisers 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 complete 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 magnetisers 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 waist6oat, boddice, and heaven knows what all!—I reply, that the charlatans of all countries every day perform their tricks with a swiftness that altogether eludes the unpractised eye. Thousands of persons have seen the Indian juggler plant a mango-stone in the ground, and in the course of a few 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 you or I do how the magnetisers perform their juggleries ; but few who have seen the Indian trick believe in the reality of any one of the vari- ous transformations with which their eyes have been cheated. Gentlemen, the transposition of the senses, is only an old whimsey newly dressed up under the name of " clairvoyance." We read in Hudibras of ---------Eoscrucian vhtuosis, 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 oppor- tunity 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, you will not find a man move from his place, no, nor a countenance change 160 LECTURE VIII. 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 equally numerical strength, will alter the expression of every face ; nay, half-a-dozen or more will drop, some fainting, some vomiting, some convulsed and epileptic. A medical student of my acquaintance, the first time he saw an amputation, not only fainted, but lost his sight for nearly half- an-hour ; yet the same student afterwards became celebrated for his manual dexterity, and the coolness and steadiness with which he performed his am- putations. 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 necessity 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 mo- tions through the organ of hearing ? I. have stopped the commencing epileptic fit by simply vociferating in the ear of the patient. The atoms of the brain, like the atoms of other parts, cannot do two things at once; they cannot, at one and the same moment of time, maintain the state of arrest which constitutes attention, and the state of motion on which the epileptic convul- sions depend. Produce cerebral attention in any way you please, and there can be no epilepsy. In this way, a word may be as efficacious as 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 the 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? Many people are melancholy when they hear a harp; yet the melancholy of Saul was assuaged by David's harping. Some persons become frantic when a fiddle plays, And others when the bagpipe sings i' the nose Cannot contain their urine ; for affection, Mistress of passion, sways it to the mood Of what it likes or loathes.—Shakspeare. Every body 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 associa- tion. Captain Owen had more faith in an old song as a remedy for the tro- pical 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're darkly bound.__Byrqr. How strangely some people are affected by smell ! Who that had never seen or experienced it, would believe that the odour of the rose could produce fainting ? or that the heliotrope and the tuberose have made some men asth- matical ? There are persons who cannot breathe the air of a room containing ipecacuan, without suffering from asthma. The smell of musk, so grateful LECTURE VIII. 161 to many people, sickens some. An odour, in certain cases, may be as good a cordial as wine ; every old woman knows the virtue of hartshorn and burnt feathers. I am almost afraid to speak of taste, for, you know, de gustibus non est disputandum. Might not the Red Indian, when taunted for devouring vermin, retort upon the " pale face" for his 'mite-eating propensity ? The Esqui- maux, 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 whiskey as any Irishman among us ; that is, before Father Mathew and temperance so- cieties 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 por- tion 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 others, besides fine ladies, have sickened at the sight of a quid. Was there ever such a fancy as that of the Chinese, who eat soup made of birds' nests? Morbid in the first instance, such tastes, like other diseases, spread by imitation or contagion.. In the West Indies, the negro is liable to a peculiar fever, called, from the avidity with which he devours clay, Mai d'Es- tomac. His whole sensations, during this fever, are, doubtless, more or less deranged. What extraordinary likings and longings ladies in the family way occasionally take ! Some will eat cinders, some have a fancy for rats and mice, and some, like Frenchmen, take to frog-eating! I remember reading of a lady who paid fifty pounds for a bite of a handsome young baker's shoulder ; the same lady went into hysterics because the poor fellow would not permit her to take another bite, at any price. If you smile and look in- credulous at this, how will you receive what I am going to tell you ? While I was myself studying at Paris, some twenty years ago, a woman was tried for decapitating a child. When asked her motive for a crime so horrible, 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 will tell me, perhaps, not to trouble you on that subject; no great good or ill can happen from a touch, you will say. But here you are mistaken : many curious and even dangerous affections may originate in touch simply, provided it be of a novel or unusual kind. Touch the white of the eye, however lightly, with your finger, or a feather, and you shall have pain that may last an hour. The application of either the one or the other to the throat or fauces may vomit you as effectually as tartar emetic or ipecacuan ; every nurse knows that. A bristle introduced, in the softest manner, into the nose or ear, has thrown some people into fits. Then what extraordinary effects may sometimes follow the most painless touch of the bladder by a catheter or a bougie ! I do not know 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 cathetre or bougie ; and I have even traced rheumatism and eruptions to the same ope- ration. You all know the effect of tickling. Now, what is tickling but a succession of short touches ? And see how wonderfully it affects most peo- ple ! you may drive some men mad by it. Though it has been carried so far, in some cases, as to have produced convulsions, and even death itself, Mr. Wardrop actually found it efficacious in some convulsive affections. I have already given you instances where the mere application of a ligature to the arm or leg arrested the fit of mania, epilepsy, &c. Now, the influence of that apparently trifling application depends upon the cerebral attention which it excites through the double influence of sight and touch. As I hinted to you before, the lancet has often got the credit for the good effects produced by the bandage. Fear of the operation may also, on some occa- 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 162 LECTURE VIII. touch of relics ; the bones, rags, and other rattle-traps of saints ! Priests and Princer^uhave by turns governed mankind-justly and well, some times- more freauentlv you have deluded and deceived them. If the credulity and wSSSrfAeia-e. have, in most cases, been your strength, here at least the E has not always been a loser Ijy 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, imposture may succeed ! In what does the adult differ from the infant—gullible man, who gives his gold for an echo, from the child who caresses its nurse, when 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 ot 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 varia- tions caused by impressions from without ? Have not the Passions all some- thing in common, certain 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 lip quivers, 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 Fear betrays 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 the corporeal actions so called—have all been associated with particular organs and secretions. Their very names have changed with the changes in medical doctrine. Who among you would dream of placing Grief in the liver ? That the ancients did so, is evident by the name they gave it—Melancholy literally signifies " black-bile." Envy or Spite we still call the " Spleen," and when a person is enraged, we say "his bile is up." Europeans place Courage, Benevolence, and Fear in the Heart,—the Heart which has enough to do in the performance of its own proper office, namely, that of a vessel to circulate the blood through the sys- tem i__The Persians and Arabs associate Fear, Courage, and Benevolence with the liver : " White-liver" is their term for a coward. Shakspeare uses the word lily-livered in the same sense. People often speak of " Temperament," and professors of 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 Phlegma- tic__a word somewhat difficult to translate, inasmuch as it originated in a fanciful phantom, which the ancients believed to be an element of the body, and which they termed " phlegm." Some add another temperament, which they call Leuco-phlegmatic, or white phlegm! I wonder they never took the Saliva to distinguish a temperament; surely the " Salivous tempera- ment" 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 invented by Pedantry to gull Folly; or, in the words of Home Tooke, " an exemplar of the subtle art of saving appearances, LECTURE VIII. 163 and of discoursing deeply and learnedly on a subject with which we are per- fectly 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 brav- est 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 humour, and good and bad humour took the place of cheerful and sulky temper. We are in the daily habit of speaking of "the spirits." We say "low spirits," and "high spirits;" which forms of expression maybe traced to the period when physicians were so ignorant as to suppose that the arteries, instead of carry- ing 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. 1 his confusion which pervades all language has materially impeded our know- ledge both of the physical and the moral man. Locke must have felt this when he said, " Vague and insignificant forms of speech, and abuse of lan- guage, 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 corresponding change in the organic matter of the body." Through the medium of one or more of the five senses must some external circumstance first operate on that part of it called the Brain, so as to change the existing relations and revo- lutions of its atoms, before there can be what we term a Passion. Whatever alters the cerebral atoms must alter the actions of every part of the body— some more, some less. According to the prominence and locality of one set of actions or another, do we, for the most part, name the Passion. The jest that will make one man laugh, may enrage another. What are the features common to all Passion ?—Tremor, change of temperature, change of secre- tion. Do not these constitute an Ague-fit ? Shakspeare, with his accustom- ed 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, Love, and Anger 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." Such at least is their general effect; 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 sole- ly—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 Ague, that type of every dis- turbed state, whether of man the microcosm, or the globe he inhabits. We have already, to a certain extent, demonstrated the influence of particular Passions in the production of certain diseases. We have further proved that the same morbid actions which we recognise under so many different names, when arising from a blow or a poison, may be equally the result of a mental impression; we have established their absolute identity by curing them with the same physical agents. The history of medicine, on the other hand, pre- sents us with innumerable instances of the beneficial agency of these very Passions in every kind of disorder, whatever may have been the nature of the primary cause. Faith, Confidence, Enthusiasm, Hope,—or rather the various Causes which produce them,—are as powerful agents in the cure of 164 LECTURE VIII. the sick as any remedies we possess. Not only, like Bark, or Wine, do they often give rise to a salutary Excitement, or mild Fever, sufficient to prevent the access of the most malignant diseases—but, like these agents, they have actually arrested and cured such diseases after they had fairly and fully com- menced. A stone, a ring, with a history real or supposed ; a verse of the Koran or the Bible sewn in a piece of silk—these worn, now on one part of the body, now on another, have inspired a mental firmness and induced a corporeal steadiness which have enabled the wearer to defy the united influ- ence of Epidemic and Contagion. If the Arabs have still their talismans, and the Indians their amulets, the Western nations have not ceased to vaunt the cures and other miracles effected by their relics, their holy wells, and holy water. When we boast of the success of a particular measure, we say it acted like a Charm. What is a charm ?—whence its origin ? It is a cor- ruption of the Latin word Carmen, a Song or Verse. In all times and in all countries, there have been men who have found their advantage in play- ing upon the ignorance of their fellow-men ; he that would appear wiser than another has always had recourse to some kind of imposture ; and as priest, poet, prophet, and physician were often united in one person, it was not won- derful that such person should clothe his mummery and mysticism in verse. To be able to read or spell was, at one time, a mark of superior wisdom, and he who could do so, had only to mutter his " spell" to cure or kill. From the earliest antiquity, we find charms a part of medical practice ; Homer, in his Odyssey, introduces the sons of Autolycus charming to stanch blood ; the physicians of Egypt and India are to this day charmers ; the north men com- posed Rhunic rhymes to charm away disease. Indeed, with the Norwegians and Icelanders verse or song was supposed to be all-powerful; one of their poets thus expresses the belief of his time and country in this respect: " I know a song by which I can soften and Enchant the arms of my enemies, and render their weapons harmless. I know a song which I need only to sing when men have loaded me with bonds ; for the moment I sing it my chains fall in pieces, and I walk forward at liberty. I know a song useful to all the children of men ; for as soon as hatred inflames them I sing it, and their hate ceases. I know a song of such virtue, that I can hush the winds with it, and subdue the storm to a breath." Such, Gentlemen, was the origin of Enchantment, or Incantation, terms bor- rowed from the Latin verb Canto, I sing. With the Jews, the simple enun- ciation of their mystical word Abracalan, was sufficient to inspire the confi- dence that baffled disease; nay, Quintus Severinus Samonicus vaunted his success in the cure of the hemitritic or double tertian fever, by pronouncing mysteriously the word Abracadabra, a phonic combination of his own inven- tion ! At this very hour, the Cafire rain-maker, the Cingalese devil-dancer, and the Copper Indian sorcerer, with their charms and chants, are enabled to work changes in the bodies of their several countrymen that put the boasted science of the schoolmen to shame. That these act by inspiring Confidence simply, may be seen from what took place in 1625, at the siege of Breda. " That city from a long siege, suffered all the miseries that fatigue, bad pro- visions, and distress of mind could bring upon its inhabitants. Among other misfortunes, the scurvy made its appearance, and carried off great numbers. This, added to other,calamities, induced the garrison to incline towards a surrender of the place, when the Prince of Orange, anxious to prevent its loss, and unable to relieve the garrison, contrived, however, to introduce let- ters to the men promising them the most speedy assistance. These were accompanied with medicines against the scurvy said to be of great price, but of still greater efficacy ; many more were to be sent to them. The effects'of the deceit were truly astonishing. Three small vials of medicine were given to each physician. It was publicly given out that three or four drops were sufficient to impart a healing virtue to a gallon of water. [Mark this, Homceopa- thists !] We now displayed our wonder working balsams. Not even were the commanders let into the secret of the cheat upon the soldiers. TheY LECTURE VIII. 165 flocked in crowds about us, every one soliciting that part may be reserved for his use. Cheerfulness again appears in every countenance, and an uni- versal faith prevails in the sovereign virtues of the remedies. The effect of this delusion was truly astonishing; for many were quickly and perfectly recovered. Such as had not moved their limbs for a month before, were seen walking the streets with their limbs sound, straight, and whole ! They boasted of their cure by the Prince's remedy."—[Ives' Journal.] And what was this remedy ?—a mere sham medicine, Gentlemen ! After this, do I require to caution you, when you visit your patients, not to put on a lugubrious or desponding look before them ? Such conduct, on the part of a medical man, is unpardonable; yet there are practitioners so base and sordid as to make it a part of their policy to represent the malady of every patient as dangerous. These find their profit in croaking ; for it is a course of con- duct that almost infallibly contributes to keep up disease. To God and their consciences I leave these men. Such of you as might be disposed to question the depressing influence of a long face upon the sick, may read the history of Lord Anson's voyages with profit. There you will find it recorded, " that whatever discouraged the seamen, or at any time damped their hopes, never failed to add new vigour to the distemper, (the Scurvy,) for it usually killed those who were in the last stages of it, and confined those to their hammocks who were before capable of some kind of duty." And this is in perfect accordance with the observation of Solomon, that " a merry heart doeth good like medicine, but a broken spirit drieth the bones." Let me, therefore, counsel you not only to assume a cheerful look in the presence of the sick, but endeavour at the same time To render with your precepts less The sum of human wretchedness, And strengthen man with his own mind. What are all your trumpery Pathology and Dissecting-Room knowledge compared with this ? You may dissect dead bodies for twenty years, and never be one whit the wiser on the mode of influencing the motions of the living. Now, this brings to my mind certain lines of a cotemporary poet, the celebrated Beranger ; but as some of you may not understand the French language, I shall offer no apology for giving his sentiments in my own not over poetical English :— Was ever such an ass as that Who hoped, by slicing mutton-fat, And pulling candle-wicks to pieces, To tell why Light should spring from Greases ? Yes, one—that still more precious fool, Who in the anatomic school Expected with dissecting knife , To learn from Death the laws of Life ! Ha ! ha! when sick myself, I'd rather From some old nurse a " wrinkle " gather, Than trust to such pedantic pate To cure my frame's disordered state ! But, seriously, Gentlemen, I have known a great many first-rate anatomists in my time ; yet there are old women who never saw the inside of a dead body, whom I would sooner consult in my own case than any of these hair- splitting gentry. These men are mere geographers, who will point out rivers and towns, if I may say so,—corporeal hills, and dales and plains,—but who know nothing of the manners, customs, or mode of influencing the animated atoms constantly entering into and departing from them. If any such me- chanical-minded creature presume hereafter to mystify you on this point, tell him to watch the wounded of contending armies ; and ask him to explain to you why the same description of injuries which heal with rapidity when oc- 166 LECTURE VIII. curring in the persons of the victors, too often prove intractable, or even fatal to the vanquished ! He might dissect their dead Nerves as clean as he pleased, and never find out that the living body of man may be either weak- ened or strengthened through the medium of his own Mind.* The depressing power of Grief is familiar to every body ; but there are cases where a reverse effect may take place from it—and Shakspeare, with his usual accuracy explains the reason of this. In Poison there is Physic—and these news Having been well, that would have made me sick, Being Sick, have in some measure made me Well; And as the wretch, whose fever-weakened limbs, Like strengthless hinges buckle under life, Impatient of his fit, breaks like a fire Out of his keeper's arms, even so my limbs, Weakened with Grief, being now Enraged with Grief, Are thrice themselves. The strength imparted to the constitution in cases of this nature, has a re- lation to the novel atomic revolutions caused by desperation ; or that deter- mination to act in an energetic manner, which so often comes upon a man in his extremity. Such reaction resembles the glow that succeeds the sudden shock of a cold shower-bath. There are persons whom a slow succession of petty misfortunes would worry to death ; but who, on sudden and apparently overwhelming occasions, become heroes. It will be readily admitted, by all who have profited by their experience of life, that one-half the world live by taking advantage of the passions and prejudices of the other half. The parent of prejudice is ignorance ; yet there is no man so ignorant but who knows something which you or I may not know. The wisest judges have played the fool sometimes from ignorance; they have allowed themselves to be gulled by individuals of a class they de- spise. Poor, decrepid, ill-educated females, calling themselves witches, have imposed upon the ablest and most learned men of a nation. Lord Bacon and Sir Mathew Hale believed in witchcraft; nay, the latter judge went on so far as to sentence to death wretches supposed to be convicted of it, and they were executed accordingly. Samuel Johnson was a believer in ghosts and the second sight. Where, then, is the country so enlightened that, upon some points, the wisest and best may not be mystified ? If such a country exists, it must be England at the present moment; if there be a profession in which deception is never practised, it must be medicine. Happy England ! happy medicine! where all is perfect and pure—where the public are neither cheated by an echo, nor led by a party for party interests! Here collegiate corrup- tion is unknown, and corporate collusion is a mere name ; here we have no diplomas or certificates to buy—no reviewers to bribe—no humbug schools —no venal professors ; here, having no mote in our own medical eye, we can the better distinguish and pluck out that of our neighbours. Who will doubt our superiority in this respect over all other nations of the earth ? Or who will question me in what that excellence principally consists ? Scape- grace, sceptic, read Dr. Hawkins—read Dr. Bisset Hawkins' Continental Travels—and you will there find it recorded, that the brightest feature of British medicine—the most distinguished point of excellence in English treat- ment—is the copious blood-lettings we practice. " The neglect of copious blood-lettings," quoth Hawkins, " is the great error of the continentalhospitals!" Let us laugh, then, at the do-little "medecine expectante" of the French, ridicule the do-nothing homoeopathy of the Germans, and turn up our lip in derision at the counter-stimulant doctrines of the Italians. What are the * The remarks in the text apply solely to the Morbid Anatomists—to those who argue from the end as if it were the beginning—not to the philosophical Comparative Anatomists, who, by comprehensively comparing the structure of one tribe of animals with another, have arrived at the Unity of Structure of all animals. * LECTURE VIII. 167 greatest medical professors of the Continent, in comparison with our own meanest apothecaries even—to say nothing of our leading surgeons and phy- sicians—presidents and vice-presidents of learned societies ? Only look at the number of scientific -bodies to which these little great men belong, you will find their names enrolled in every (so called !) Literary and Scientific institution throughout the country—astronomical, botanical, geological, anti- quarian, royal! Amiable and respectable persons ! worthy of the carriages in which you ride, and the arms you bear; you are gentlemen—friendly and disinterested gentlemen ; you owe your elevation to your own industry ; you preserve your position by your incorruptible honesty ; you recommend your- selves, and each other, neither by letter nor affection, but upon the score of talent and integrity solely ; you are all honourable men. Unlike the " hon- ourable members" of a certain honourable place, who have been purchased, you, the members of an equally " honourable" profession, are unpurchasable ! This, vour colleges and coteries declare—this, the discriminating world be- lieves and echoes. Who but the reptiles—the few that never think, never reflect—would answer, all is not gold that glitters ! Gentlemen, what is the difference betwixt a guinea and its counterfeit ? Do not both sparkle with equal brightness ? Have they not the same form, the same ex- terior impress ? Can the eye detect the imposture ? No ! it is only by a comparative trial of their respective weight and ring, that you can make out the difference. Do you think mankind are to be judged in any other way than this ? Is it not as necessary, for a person to be a successful cheat, that he should borrow the exterior of worth and integrity, as it is for the counter- feit guinea to bear the name and livery of the coin it purposes to be, before it can pass for genuine ? Be not, then, satisfied with fine names and appear- ances only; do not take men for what they pretend to be s61ely by their manner or title, because they are doctors of this college, or professors of that university. What is a professorship but a place? " He who has the best talents for getting the office, has most commonly the least for filling it; and men are made moral [medical] and mathematical teachers, by the same trick and filthiness with which they are made tide-waiters and clerks of the kit- chen."—Sydney Smith. Depend upon it, professors thus elected will always stand by each other—right or wrong, they will always support the same system. In this, they do no more than the members of the swell-mob, who work together by coterie and collusion. Like these professors, too, they are all very respectable in their appearance, some of them doing business in a carriage even ! Where is the individual that has not his moral as well as his physical weakness ? Upon this point, at least, we are all liable to be overreached.— Here we are every one of us imbecile as the infant; for we are placed as completely at the mercy of the Charlatan, as the child is at the disposal of ihe parent, whose mental ascendancy he acknowledges. Speak to the prat- tler of the "haunted chamber," his countenance instantly falls. With the adult, assume an air of mystery, mutter darkly and indefinitely, and mark how his brain will reel. Is he sane ? he becomes your tool. Has he come to you in his sickness ? you gull him and guide him at your pleasure. But how can you wonder at the effects of this kind of agency on individuals, when you have seen a whole nation similarly hood-winked by a coterie of doctors ? I allude to what was done when the cholera first appeared in England.— The influence of fear, in disposing to spread an epidemic, you know; the effect of confidence in strengthening the body against its attacks, you also know. What was the conduct of the College of Physicians when the cholera broke out ? Did they try to allay the alarm of the masses ? did they en- deavour to inspire them with confidence and hope, that their bodies might be strengthened through their minds ? No ! they publicly, and by proclamation, declared the disease, to be contagious; without a particle of P™of, or the shadow of a shade of evidence, they solemnly announced that, like the small- • 168 LECTURE VIII. pox, it was communicable from man to man ! That was the signal to get up their cholera boards; and cholera bulletins, forsooth, must be published. I had just then returned from India, where, though I had seen more cases of cholera than all the fellows of the college put together, I never heard of cholera- contagion ; no, nor cholera boards. In the far East, the authorities, civil, military, and medical, acted with firmness ; what they could not arrest, they awaited with fortitude ; they placed themselves and those committed to their care at the mercy of the great Disposer of Events ; while in England, enlight- ened England, the leading law-givers, under the influence of the leading medical men, introduced acts that disgraced the statute-book, and permitted medical jobs to be got up that did anything but honour to the medical profession. A new tax was actually levied to defray the salaries of their cholera boards ! The consequences of these measures might have been foreseen. Throughout the country universal panic was spread, and universal gloom prevailed. The rich shut themselves up in their houses, each in terror of his neighbour's touch; the middle classes suffered from the general stagnation which ensued in consequence : every trade, but the drug trade, languished or stood still; and the poor, when taken ill—for the disease was chiefly confined to that class— were, by act of parliament, dragged from their homes, and conveyed to the cholera hospitals, where, if they did not perish of the prostration induced bv their removal, they had salt and water injected into their veins by the medical mad-men in charge! Debarred the society of their nearest and dearest re- latives, and tortured in every possible way by their pedantic doctors, how few of these unfortunates escaped from the pest-houses in which they were so inhumanly immured! All this, the leading men of the country, peers, judges, and members of parliament, saw and permitted, from a puerile dread of the phantom contagion, which the ignorance or cupidity of the College of Physicians had conjured up. To what miseries will not the feeble submit, when under the influence of intimidation, if Even the wisest and the hardiest quail To any goblin hid behind a veil! Is not this a subject for deep reflection ? To some it may suggest a feel- ing like shame. Let me speak of Shame. Generally speaking, this is a depressing passion, and under its influence men sometimes, and women daily, commit suicide. I will give you an instance where it had the reverse effect. The girls of Miletus, a town in Greece, were seized with a mania that led them to believe self-destruction an act of heroism ; and many accordingly de- stroyed themselves. Physic and argument having been alike ineffectually tried, the authorities, to prevent the spread of this fatal rage, ordered the bodies of the suicides to be dragged naked through the streets of the city. From that moment the mania ceased. But everything depends upon a con- tingency, whether a particular passion act as a depressant or a tonic in dis- ease. In the case of Shame, the past and the future make a great deal of difference. Some of you may, perhaps, feel inclined to remind me of the efficacy of Fear in the Cure of diseases; but in this case the fear induced must neither be a dread of the disease nor its event, but a dread of some circumstance com- pletely unconnected with it. Thus, Sir John Malcom, in his History of Persia, tells us of a certain Hakeem who cured ague by the bastinado. In this case the Persian doctor availed himself of the double influence of fear and pain, neither of which was contingent upon the disease. The effect of Terror in removing tooth-ache is familiar to many who have knocked at a den- tist's door. The gout, too, has been cured and caused by every passion you can name. There does not pass a day but we hear of people being frighten- ed into epileptic fits ; yet Boerhaave terrified away an epilepsy from a school where it prevailed, by threatening to burn with a red-hot poker the first bov that should have another paroxysm. I have known asthma cured by Rage, LECTURE VIII. 169 and also by Grief; yet, if we may believe what we hear, people occasionally choke of both ! Few medical men will dispute the influence of a passion in the cure of Ague. Mention any mental impression, such as Faith, Fear, Rage, or Joy, as having succeeded in this affection, and they doubt it not; but superadd to the patient's state a palpable change of volume, or structure, such as an enlarged gland or ulcer, and they smile in derision at the efficacy of a charm. Extremes in scepticism and credulity are equally diseases of the mind. The healthy brain is ever open to conviction ; and he who can be- lieve that the Obi-charm, or the magic of a monarch's touch, can so operate on the nervous system as to interrupt or avert the mutations of motion and temperature constituting an ague-fit, should pause before he deny their in- fluence over an ulcer or a tumor, which can only be developed or removed by or with change of temperature. Indeed, from what we have already said, it is impossible for any individual to be the subject of any mental impression without experiencing a chill or a heat, a tremor or a spasm, with a greater or less change in the atomic relations of every organ and secretion. Baron Alibert gives the case of a Parisian lady, who had a large wen in the neck— a goitre—which, from its deformity, occasioned her much annoyance. That tumor, which had resisted every variety of medical treatment, disappeared during the Reign of Terror—a period when this lady, like many others of her rank, experienced the greatest mental agony and suspense. The agony and suspense in that case referred to a contingency altogether unconnected with her disease. The mere act of dwelling upon sickness will keep it up ; while whatever withdraws the mind from it is beneficial. In my own experience, abscesses of considerable magnitude have been cured both by fear and joy. Few surgeons in much practice have been without the opportunity of satis- fying themselves that purulent swellings may recede under the influence of fear. They have assured themselves of the presence of matter—they propose to open the tumor—the frightened patient begs another day, but on the mor- row it has vanished. Akin to Terror is Disgust, or that feeling which a person naturally en- tertains when, for the first time, he handles a toad or an asp. This passion has worked wonders in disease. The older physicians took advantage of it in their prescriptions; for they were very particular in their directions how to make broth of the flesh of puppies, vipers, snails, and milipedes! The celebrated Mohawk Chief, Joseph Brandt, while on a march, cured himself of a tertian ague, by eating broth make from the flesh of a rattlesnake ! Here the cure must have been altogether the effect of disgust, for in reality the flesh of a rattlesnake is as perfectly innocuous, and quite as nutritious as the flesh of an eel. Mr. Catlin, in his Letters and Notes on the North American Indians, tells us that when properly broiled and dressed he found the rattle- snake to be " the most delicious food of the land.*' But when you come to think of the living reptile and the venom of his fang, who among you could at first feed upon such fare without shuddering, shivering, shaking—without, in a word, experiencing the horrors and horripulations of ague ! Spider-web, srot, moss from the dead man's skull, the touch of a dead malefactor's hand, are 'at this very hour remedies with the English vulgar for many diseases. With the Romans the yet warm blood of the newly-slain gladiator was esteemed for its virtues in epilepsy. Even at this day, in some countries of Europe, the lower orders cure the same disorder by drinking the blood as it flows from the neck of the decapitated criminal. In the last century, a live toad hung round the neck was much esteemed, by the same class of people, for its efficacy in stopping bleeding at the nose. Now that the toad is known to be free from venom, it might not be so successful as it once was in this in- stance. Any temporary benefit, real or supposed, which has accrued from the employment of the Leech, has appeared to me to be in many instances the effect of the Horror the patient very naturally entertained for the reptile. _ A consideration of the power by which the Passions cure and cause dis- 170 LECTURE VIII. eases, affords at once the best refutation of medical error, and the most per- fect test of medical truth. By this test, I am willing that my doctrines should stand or fall. What are the Passions ? Cerebral movements—actions of the internal Brain, produced by external causes—which, by influencing its atomic revolutions, influence every right or wrong action of the body. Take the influence of Fear simply—what disease has not this passion caused ?— what has it not cured ?—inducing right motions in one case, wrong in another. The mode of action of a passion, then, establishes beyond cavil not only the unity of disease, but the unity of action of remedy and cause. What does the proper treatment of all diseases come to at last, but to the common prin- ciple of reversing the existing motion and temperature of various parts of the body ? Do this in a diseased body, and you have health—do the same in health, and you reproduce disease. Whatever will alter the movements of a living being will cure or cause disease. This, then, is the mode in which all our remedies act. Just observe the effect of Baths. In what disease have not Baths been recommended ?—arid in what man- ner can they cure or ameliorate, but by change of temperature—by change of motion ? Put your hand into ice-water—does it not shrink and become di- minished in size ? Place it in water as hot as you can bear—how it swells and enlarges ! You see, then, that change of temperature necessarily implies change of motion ; and that change of motion produces change of tempera- ture, you have only to run a certain distance to be satisfied ; or you may save yourself the trouble, by looking out of your window in a winter morn- ing, when you will see the hackney coachmen striking their breasts with their arms to warm themselves. Depend upon it they would not do that for no- thing. Heat, then, so far from being itself a material substance, as Black and other chemists assert, is a mere condition of matter in motion—it is no more a substance than colour, sound, or fluidity. What can be greater nonsense than an " imponderable" substance—as Heat and Light have been sometimes called ? That only is matter or substance which can be weighed and measured—and this may be done with invisible as well as visible things,—in the case of a Gas for example; however attenuated, a gas can both be weighed and measured. I am often asked, what baths are safest, as if everything by its fitness or unfitness is not safe, or the reverse. The value of all baths depends upon their fitness; and that, in many instances, can only be known by trial. It depends upon constitution, more than upon the name of a disease, whether particular patients shall be benefitted by one Bath or another. Generally speaking, when the skin is hot and dry, a Cold Bath will do good ; and when chilly, a Hot Bath. But the reverse sometimes happens. The cold stage of Ague, may at once be cut short by a cold bath. I have seen a shivering hy- pochondriac dash into the cold plunge bath, and come out in a minute or two perfectly cured of all his aches and whimsies. But in cases of this nature, every thing depends upon the glow or reaction, which the Bath produces; anf) that has as much to do with surprise or shock as with the temperature of the bath. I have seen a person, with a hot dry skin, go into a warm bath, and come out just as refreshed as if he had taken a cold one. In that case the perspiration which it excited must have been the principal means of relief. So far as my own experience goes, I prefer the cold and tepid shower- baths, and the cold plunge bath to any other; but there are cases in which these disagree, and I, therefore, occasionally order the warm or vapour bath instead. In diseases termed " inflammatory," what measure so ready or so effica- cious as to dash a pitcher or two of cold water over the patient__Cold Affu- sion, as it is called ? Whilst serving in the Army, I cured hundreds of inflam- LECTURE VIII. 171 matory fevers in this manner—fevers, that, in the higher ranks of society, under the bleeding and starving systems, would have kept an apothecary and physician—to say nothing of nurses and cuppers—visiting the patient twice or thrice a-day for a month, if he happened to live so long. Gentlemen, with the cold dash you may easily, " While others meanly take whole months to slay," Produce a cure in half a summer's day. That being the case, do you wonder that prejudices should still continue to be artfully fostered against so unprofitable a mode of practice ? Why do not the gullible public examine for themselves ? Why will they continue to bribe their medical men to keep them ill ? In their shops and out of their shops, people generally enact two very different characters. Behind their counters they take advantage of their customers in every possible way; but the moment they get out of doors, the same persons drop the knave and be- come the dupe. The merchant and tradesman, who buy cheap and sell dear —the landowner and farmer, who keep up the corn laws by every possible sophistry—the barrister and attorney, who rejoice and grow fat on the imper- fections and mazes of the law—the clergyman and his clerk, whose gospel knowledge and psalm-singing, are too often in juxta-position with tithes and burial fees—become all perfect lambs when they leave their respective voca- tions ; each giving the others credit for a probity and disinterestedness in their particular line, which himself would laugh at as sheer weakness, were any body to practise it in his own ! With the most childish simplicity, peo- ple ask their doctor what he thinks of this practice, and what he thinks of the other—never for a moment dreaming that the man of medicine's answer, like the answer of every other man in business, will be sure to square with his own interests. Instead of using the Eyes that God has given them, they shut them in the most determined manner, that their Ears may be the more sure ly abused. "What a delightful person Dr. Such-a-one is," you will hear persons say ; "he is so very kind, so very anxious about me." Just as«f all that affected solicitude, all that pretty manner of his, were not part and par- cel of the said good doctor's stock in trade. Silly, simple John Bull! Why will you pin your faith to fallible or fallacious Authority, when you may get the truth so easily by a little personal Examination ! To be able to discrimi- nate in the choice of a physician, aad to guard against medical imposture, would not cost you half the time, nor anything like the trouble, of mastering the inflections of , verbero, or Amo, amare ! Which kind of know- ledge is of most use in life, I leave to pedants and philosophers to settle be- tween them. Meantime, I shall beg your attention to the subject of Exercise. The effects of mere motion upon the body are sometimes very surprising. Only think of iiZbrse-exercise curing people of consumption ! A case of this kind, you remember, I gave you, on the authority of Darwin. I knew a gen- tleman, who was affected with habitual asthma, but who breathed freely when in his"gig. I know, at this moment, another, afflicted with giddiness, who is immediately " himself again," when on horseback. A dropsical fe- male, who came many miles to consult me, not only felt corporeally better when she got into the coach, but her kidneys acted so powerfully as to be a source of much inconvenience to her during the journey. This corporeal change she experienced every time she came to see me. The motion of the circular swing has cured mania and epilepsy. But what, as we have repeat- edly shown, is good for one patient is bad for another. You will not, there- fore, be astonished to find cases of all these various diseases, where aggrava- tion may have been the work of horse exercise, and the other motions we have mentioned. Exercise of the muscles, in any manner calculated to occupy the patient's 172 LECTURE VIII. whole attention, will often greatly alleviate every kind of chronic disease. Dr. Chevne was not above taking a useful hint on this point from an Irish charla- tan." " This person," says Dr. Cheyne, " ordered his (epileptic) patients to walk, those who were not enfeebled, twelve, fifteen, or even twenty miles a- day. They were to begin walking a moderate distance, and they were gra- dually to extend their walks, according to their ability. In some of the patients, a great improvement took place, both with respect to digestion and muscular strength ; and this was so apparent in a short time, that ever since this luminary shone upon the metropolis of Ireland, most of our patients af- fected with epilepsy, have been with our advice peripatetics." Exercise, then, is one of our best remedial means. Moreover, it may be turned to very great advantage in our common domestic matters. Were I to tell you all at once, that you might keep yourselves warm by a single log of wood all the winter over, you would think I was jesting, but really the thing may be done. I believe we owe the discovery to our friends across the water, the Ameri- cans ; and I may as well give you the recipe :—•' Take a log of wood of moderate size, carry it to the upper garret, and throw it from the window into the street, taking care, of course, not to knock any body on the head; this done, run down stairs as fast as you can; take it up again to the garret and do as before. Repeat the process until you are sufficiently warm—when —you may lay by the log for another occasion !" " One of our reverend bishops, (who, Sydenham tells us, was) famous for prudence and learning, having studied too hard a long while, fell at length into a Hypochondriacal disease ; which afflicted him a long time, vitiated all the ferments of the body, and wholly subverted the concoctions. [Such, Gentlemen, was the jargon of the eminents of Sydenham's time.] He (the bishop) had passed through long steel courses more than once, and had tried almost all sorts of mineral waters, with often-repeated purges and antiscorbutics of all kinds, and a great many testacious powders which are reckoned proper to sweeten the Blood (!) and so being in a manner worn out, partly by the disease, and partly by Physic used continually for so many years, he was at last seized with a colliquative looseness which is wont to be the forerunner of death in consumption and other chronical diseases when the digestions are wholly de- stroyed. At length he consulted me ; I presently considered that there was no more room for medicine, he having taken so much already without any benefit; for which reason I advised him to ride on horseback, and that first he should take such a small journey as was agreeable to his weak constitution. Had he not been a judicious man, and one that considered things well, he would not have been persuaded so much as to try such a kind of exercise. I entreated him to persist in it daily, till in his own opinion he was well, going daily far- ther and farther, till at length he went so many miles, as prudent and moderate travellers that go a long journey upon business use to do, without any regard to meat or drink, or the weather, but that he should take everything as it hap- pens like a traveller. To be short, he continued this method, increasing his journey by degrees, till at length he rode twenty or thirty miles daily, and when he found he was much better in a few days, being encouraged by such a wonderful success, he followed this course for a pretty many months, in which, as he told me, he rode many thousand miles ; so that at length he not only recovered, but also regained a strong and brisk habit of body. Nor is this kind of exercise more beneficial to hypochondriacal people than to those that are in a consumption; whereof some of my relations have been cured by riding long journeys by my advice ; for I knew I could not cure them better by medicines of what value soever, or by any other method.__ Nor is this remedy proper only in small indispositions, accompanied with a frequent cough and leanness, but also in consumptions that are almost de- plorable when the looseness above-mentioned accompanies the ni^ht sweats which are wont to be the forerunners of death in those that die of consump- tion. To be short, how deadly soever a consumption is, and is said to be__ LECTURE VIII. 173 two-thirds of it dying who are spoiled by chronical diseases—yet I sincerely assert, that mercury in the French pox, and the Jesuits' bark in agues, are not more effectual than the exercise above-mentioned in curing a consumption, if the patient be careful; and the sheets be well aired, and that his journeys are long enough. But this must be noted, that those who are past the flower of their age, must use this exercise much longer than those that have not yet arrived at it; and this I have learned by long experience which scarce ever failed me. And though riding on horseback is chiefly beneficial to peo- ple that have a consumption, yet riding journeys in a coach is sometimes very beneficial.* The poet Coleridge, while at Malta, was in the habit of attending much to those about him, and particularly those who were sent there for pulmonary complaints. " He frequently observed how much the invalid, at first land- ing, was relieved by the climate, and the stimulus of change, but when the novelty arising from that change had ceased, the monotonous sameness of the blue sky, accompanied by the summer heat of the clime, acted powerfully as a sedative, ending in speedy dissolution." Is not this a proof of the correct- ness of my previous observation, that in chronic disorder remedies require to be frequently changed ? The benefit to be derived from travelling, often great in chronic disorders, is partly to be ascribed to the change of motion, and partly to change of air and scene. Like every mode of treatment pre- senting frequent novelty, travelling, therefore, offers many advantages to the invalid, in every kind of chronic or habitual disease. How often, alas ! do we find it recommended as a last resource, under circumstances where it must inevitably hasten the fatal catastrophe ! The breath that might otherwise have fanned the flame, now only contributes to its more rapid dissolution.— How much the success of a measure depends upon time and season ! I must say a few words about Plasters, Blisters, Ointments, &c. The beneficial influence obtained from all such local applications depends upon the change of temperature they are capable of producing. Their results will vary with constitutions. Most patients, who suffer from chronic disease, point to a particular spot as the locality where they are most incommoded with " cold chills." This is the point for the application of the galbanum or other " warm plaster." A plaster of this kind to the loins has enabled me to cure a host of diseases that had previously resisted every other mode of treatment. The same application to the chest, when the patient complained of chilliness in that particular part, has materially aided me in the treatment of many cases of phthisis. In both instances, where heat was the more general complaint, cold sponging has been followed by an equally beneficial effect. The ingredients of plasters, blisters, ointments, lotions, &c, what are they but combinations of the agents with which we combat fever ? Their benefi- cial influence depends upon the change of motion and temperature which they produce by their electrical or chemical action on the nerves of the part to which they are directed. Cantharides will not blister the dead—they have very little effect even on a dying man ! Every one of the chrono-thermal and other agents may be locally employed in certain cases—sometimes with more and sometimes with less advantage than when given internally. Gentlemen, I shall employ what remains of our time to-day in a brief no- tice of the doctrines of Hahnemann, the founder of the Homoeopathic School. His pamphlet, entitled, " The Spirit of the Homoeopathic Doctrine," com- mences thus :—" To know the essence of Diseases, and the hidden changes which they effect in the body, is beyond the reach of the human understand- ing."—Which proposition he contradicts by the following paragraph : " It is * Two Swedish physicians, Messrs. Erenhoff, and Inde Betou, now settled in London, successfully treat numerous chronic diseases solely by the use of well-directed mechanical means. 174 LECTURE VIII. necessary that our senses should be able clearly to discern what it is in each malady which must be removed in order to restore health, and that each medi- cine should express, in a distinct and appreciable manner, what it can cure with certainty, before we can be in a condition to employ it against any di- sease whatever." From this you perceive that Hahnemann, like Dr. Hol- land and the humoral schoolmen, look upon disease as a fanciful something to be " removed," instead of a state to change ; and as he uses the phrase, " to expel disease " in another part of his work, it is evident he does not know in what Disorder consists. Again, " The material substances of which the hu- man organism is composed, no longer follow, in their living combination, the laws to which matter is subject in the state of non-life ; and they acknow- ledge only the laws proper to vitality—they are then animated and living, as the whole is animated and living. In the organism reigns a fundamental power, indefinable yet every where dominant, which destroys every tendency in the constituent parts of the body to conform themselves to the laws of pressure, of concussion, of vis inertia, of fermentation, of putrefaction, dec, which subjects them exclusively to the wonderful laws of life, that is to say, maintains them in the state of sensibility and activity necessary to the con- servation of the living whole—in a dynamic, almost spiritual state." Gentle- men, what is the sum of all this ? Nothing more nor less than that if you press the soft parts of the body, they will not yield to a resisting substance —that you cannot be shaken by concussion, or have the bone of the leg or arm broken by external agency—that you are in a -dynamic state "—a state "almost spiritual!" What is the meaning of the word dynamic? It sig- nifies " moving power." This you can understand ; but when our author, apparently dissatisfied with his own term, would further explain it by the words " almost spiritual," a phrase perfectly indefinite, you see he has only a vague conception that the various parts of the body are in motion. But that the material atoms of the living frame do follow the laws to which all Matter is subject, under the particular circumstances in which the matter composing them is placed, is undoubted. A piece of amber or sealing-wax, when rubbed, first attracts silk, then repels it; producing alternate motion altogether independent of mechanics. Though not Life, this phenomenon is at least, a type of it; for the organic and other motions of an organism termed Life, even in the highest grade of animals, when analysed, will be found to be mere periodic repetitions of alternate Attraction and Repulsion. What are the successive conversion of the food into blood, of the blood into the matter of tissue and secretions, but so many instances illustrative of this proposition ?—what the alternate inspiration and expiration of the lungs ?__ the equally alternate contraction and dilatation of the heart—sleep and wake- fulness, love and hate, ambition and worldly disgust, but so many modifica- tions or effects of attractive and repulsive influences! When the magnet attracts iron, it does so, not in contrariety to the law of Gravitation, but in obedience to the more comprehensive law of which Gravi- tation is a part—namely, Electricity or Galvanism. But Electricity, like Electrive Attraction, is only a fragment of the great doctrine of LIFE.* The word Life, when applied to animals in their healthy condition, is an abstract term expressive of the sum total of harmonious movements produced by the principal forces in nature, when acting together with perfect Periodicity, in one body. Life, then, is Electricity in its highest sense, even as the attrac- tion of gravitation is Electricity in its lowest sense. The attraction of the magnet is an electrical step in advance of gravitation,—chemical change one step more,—the alternate attraction and repulsion of amber is a still higher link in the electrical chain. Galvanism and Electricity, strictly so called, embrace all the subordinate links, while LIFE or Vital Electricitt comprehends the whole. Mere mechanical motion, though it belongs to all animal life, in reality only grows out of it. There is no mechanical move- ment in the fcetal germ, nor is such movement necessary to the life of the LECTURE VIII. 175 plant. Vital Electricity,then, produces changesin every way analogous to the changes that take place in inorganic bodies, but not the same changes, —for no Electricity short of the highest or Vital kind can produce the elec- trical and chemical changes constantly going on in a living body, any more than the power of gravitation or the magnet could produce the higher move- ments of common chemistry. The chemist who, like Liebig, expects by the destructive chemical analysis of dead organs in his laboratory, to be able to produce or explain the very opposite transformations that take place in the organs of the living, will no more improve medicine than the mere anatomist who separates them tissue by tissue with his scalpel. However similar his chemistry and his electricity may be to vital electricity and vital chemistry, however analogous the results of both be to the attractive and repulsive mo- tions that constitute vitality, yet are the transformations not identical,—curi- ously resembling them certainly, but still so different that they never even approach to organism. The electricity and chemistry of man no more could produce a worm, or a leaf even, than the inferior intellectual power of the dog or the elephant could produce the Iliad. The same harmony of motion that we behold in animal life we equally find in the life of the vegetable ; but the forces employed are fewer in number, and more feeble in their action. The extremes of vegetable and animal life approach each other. In the zoophyte or ^- LECTURE X. 199 vantageously employed, as we have already stated, in prolonging the interval ot remission in every form of disease. Opium, indeed, like every other re- medy, possesses more or less influence over the whole system, but its more obvious effect is the control which it exercises over the nerves of the senses. With these we associate memory ; and as every part of the body has, through the brain, a power of remembrance, whatever will confuse or suspend the action of the senses, will often equally suspend and confuse memory, and con- sequently conduce to the suspension or interruption 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 generally, it has, in my experience, been frequently followed by a copious flow 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 in- stantly 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 influence of opium as a preventive against disease, we are informed by Dr. M'Pher- son, of the Madras army, in his book on 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 restless- ness, 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 an- other. 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 aoent, these act upon the body beneficially or the reverse, in no other man- ner than by changing the existing temperature of the brain. If a glass of brandy has arrested the ague-fiVand 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 a fourth, under its influence, loses the wit he previously possessed. I remember the case of a man ot the * irst Re- __J 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 as kindly and 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 theorists, will excite the wonder of nobody—no- body at least that had ever counted a pulse, or witnessed in his life the outward Shenomena of an ague—nobody even who knows so much of man and his many iseases, as to be aware that his toothache, his tic, his gout, and his epilepsy, come on in fits only, and by no possibility can last for ever! Hippocrates, Celsus, Boer- haave, Darwin, ay, 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 endeavoured to prove what, for a time, scarcely one professional man in Europe doubted—that eveiy intermittent action depends on matana or marshy emanations. This doctrine of M'Culloch I was the first to impugn; and I have yet to learn that any author, ancient or modern, in England or elsewhere, has preceded me in the discovery, that all the movements of all animal bodies—the greater and the less—the atomic, functional, and organic—whether m health or dis- 216 APPENDIX. ease—disease however caused—like all the movements of all the systems, minor and major—of the universe at large—are similarly intermittent and periodic ! And that there can be no more an eternal or continuous disease (i. e. a disease without inter- mission) 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 dis- coveries then received at the hands of the professional public ? How ! How, Mr. Editor, did the professional public ever receive any discovery that improved the !>ractice of physic ? Mine they received as they have received every other. So ar 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—de- pression 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—a PYREXY-mania. Nobody then dreamed of calling its author- ship in question. No! it was false, fanciful, and fatuous throughout—so utterly in- sane, 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 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. Dicksou 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 sub- ject." 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—you, Sir, doubtless, in my case, have unwittingly 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 ancients. Ancient or modern, what author have / stolen from ? Who taught me that all diseases, however named, and by whatever caused, (Ire intermittent in their character; or that all diseases, like the ague, may be cured on the principle of prolonging the intermission, by bark, arsenic, opium, &c. ? To whom am / indebted for the hint, that every and each of these medi- cinal agents, like every other medicinal agent in nature, cause and cure by their electrical influence solely—iu one case electrically producing, in another electrically reversing every morbid motive condition of the body ? That whether opium pro- duce,sleep or wakefulness; whether copaiba aggravate or cure discharges; whether prussic acid or strychnia cause or relieve palsy, spasms, &c., depends upon the posi- tive or negative electrical state of the brain of the individual selected for their admi- nistration ? That change of temperature and change of motion are equally the law of disease, remedy, and cause ? Who, I again demand, taught me these ? Of these, nevertheless, and many other matters which have never entered the head of patho- logical professors, the Unity of Disease and Fallacies of the Faculty treat at length.— Under the title of Erreur de Midecins, ou Systeme Chronothermale, the latter work is now busily agitating the medical circles of France and Germany. Permit its author to ask why you have not reviewed it 1 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 of the doctrine of the Unity af Disease, and more particularly omitted to answer the question—Whom have I Revived ? Scarcely was the People's Edition of this work published, when the same indi- vidual who, iu June, 1842, enlightened the British Association with his "discoveries" on Vital Periodicity—Dr. Laycock, of York—ventured to put forth something more APPENDIX. 217 in the same original vein in the Lancet; and among other things, to "prevent con- troversy" he claimed to have discovered the periodic movement of all vitality! Im- mediately on seeing this, I wrote to the Editor of the Lancet, charging Mr. Laycock with piracy; sending at the same time a copy of the Fallacies of the Faculty, that the respective dates of his and my papers might be compared. Instead of printing my letter, Mr. Wakley, the Editor, in a note to correspondents, informed me that my work would be examined in connexion with the paper of Dr. Laycock, and his [Mr. Wakley's] opinion of the question raised by me, given in another number. I immediately wrote to say, I would dispense with his, Mr. Editor Wakley's opinion, if he would do me the favour to print my letter. What was the reply of this second Daniel—this exquisite expounder of Crowner's Quest law 1 " We have received the second note of Dr. Dickson—who may adopt any course that he thinks proper, though he may be assured that we shall not allow him to make use of the columns of this journal for promulgating a charge of* piracy against a highly re- spectable physician, unless he accompanies that charge with proofs of the accuracy of his allegation—[the first time he asks for what he has already got—proofs!]— The subject is in progress of investigation, and a perfectly fair and just decision shall be the result." Anticipating the sort of investigation Mr. Editor Wakley intended, I immediately 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 of the Lancet. April 22, 1843. Do not, Sir, imagine that any trick, or artifice, however ingenious, can juggle me out of a discovery which it has been the labour of my life to establish—the discoveiy of the Periodic movements of* all Vitality—of the periodicity of life in health—the periodicity of life in disease—of the periodicity of movement of universal nature! You will not, you say, allow me to make use of the columns of your journal " for promulgating a charge of piracy against a highly respectable physician, unless I accompany that charge with proofs of the accuracy of my allegation;" and in the same breath you add, " The subject is in process of investigation, and a perfectly fair and just decision shall be the result." What! an investigation and decision without proofs! Not Mr. Thomas Wakley surely, but some blockhead of an under- ling, must have penned that absurdity. Proof's! What proofs do you demand ? words ? dates ? or both ?—words, or dates, that the papers recently printed and eulogised by you under the head of " Vital Periodicity, by Dr. Laycock," are so many mean attempts to plagiarise my doctrine of the periodic movement of all vitality ! Sir, the proofs are already in your possession; they are contained in my works, the Fallacy of Physic as taught in the Schools; the Unity of Disease, and Fallacies of the Faculty, 1st, 2nd, 3rd, and foreign editions; nay, they are stamped, indelibly stamped, on your own pages! Look to the Lancet for 23rd Sept., 1837, and you will there find, what Mr. Laycock now so modestly puts forth as his, the whole doctrine of Vital Periodicity given by myself*. Let me quote it:—" The principal aim of my volume [Fallacy of Physic, &c., published in 1836] has been to demonstrate, that the corporeal actions of man in his healthy state constitutes the basis or standard of every kind of living action. In health he rests from his labour—he sleeps—he wakes to sleep again—his lungs now inspiring air, now expelling it; his heart succes- sively dilating and contracting; his blood brightening in one set of vessels only again to darken in another—his food and drink nutritious one hour to become excrementi- tious the next—in a word, all'his appetites and necessities periodically alternating with each other." Nor do I confine this doctrine of periodicity to health; for in the same number of the Lancet you will find the following: " Is it not strange that the profession should still couple remittency (periodicity?) exclusively with miasma or malaria as a cause ? Every writer who has professedly treated the subject, re- fers to this, seeming to be totally and absolutely unconscious of the universality of remission (periodicity?) as a law of all disease." Thus far I have quoted from what I have written and published in your own pages. From the Unity of Disease, first published in 1838,1 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 ap- proach, duration, and interval of recurrence of the morbid phases. And in the first edition of the Fallacies of the Faculty, published in 1839, is the following:— «• So far, however, from having been recognised as a Law of universal occurrence, harmonising with everything which we know of* our own or other worlds, periodic return has been vaguely supposed to stamp the disorders where it was too striking 218 APPENDIX. 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 alternations of heat and moisture- In disease, we recognise 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 alternationi, changes of character and composition, such as tumours, abscesses, 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 mo- ther, its wonted harmony of motion, or like what we may conceive of a world de- stroyed, becomes resolved into its pristine elements." In these extracts, not only have I given the doctrine of the periodicity of health and disease in all vitality, but the doctrine of Universal Periodicity—of the Periodicity of all nature ! Further proofs, if further proofs be wanted, you will find in the volume I have already placed in your possession; 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 British and Foreign Medical Review, the Editor of which, Dr. Forbes, first misquoted, misrepresented, and then endeavoured to divide the honour of my discovery between your protege, Dr. Laycock, and his Court colleague, Dr. Holland—Dr. Holland, whose plagiarisms 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 remittency, when it comes from me. Three short months afterwards (April), he has the effrontery to print the fol- lowing :—" The intermittent nature of disease must most certainly be better under- stood before we can practice medicine scientifically." " Dr. Holland has an interesting essay on the subject in his Medical Notes and Reflections, and more recently, Dr. Laycock has attempted to demonstrate a General Law of Periodicity." " If his researches prove to be correct, a considerable change must necessarily take place in both the theory and practice of medicine." Such baseness, 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 periodicity—periodical rascality —an element, however, I am pretty well prepared to encounter, with the little monosyllable, dates. To these and to the public—if not to the profession—1 appeal. I am, Sir, your most obedient, S. Dickson. This letter not having appeared in the Lancet on the next day of publication, I again wrote to the Editor, Mr. Wakley, as follows:— April 29, 1843. Sir, I herewith convey to you the Medical Times of this day, which contains the copy of a letter I addressed and sent to you on the day of its date, by post. As you have taken no notice of that letter in this day's Lancet, I infer that you suppose that the Conductor of a Medical Journal may dispense with the common feelings of honour and justice, that every man pretending fo 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 literary swindle— get out of the matter how you can. I am, Sir, your most obedient, S. Dickson. This letter at last brought a reply from Dr. Laycock, the nature of which will be seen by my rejoinder. In a subsequent number of the Lancet, Mr. Wakley conde- ■oended to denounce me as a quack and a bully! To the Editor of the Medical Times. 15th May, 1843. Dr. Laycock having at last thought it necessary to his character to get up some- thing like a reply to my letters, on the subject of his recent piracies, permit me, Mr. Editor, to beg the favour of your inserting the following rejoinder. Out of his own APPENDIX. 219 "mouth, I have convicted this physician of a mean plagiarism of my doctrine of the periodicity of movement of all vitality ; and out ofhis own mouth I will now pro- ceed to convict him of an equally disingenuous attempt to shuffle out of his discre- ditable position. In the Lancet for 25th March last, in a paper on " Vital Periodicity," Dr. Lay- cock claims to have demonstrated five propositions, which he numbers 1,2,3,4, and 5. With the first and essential one only, do I propose to deal. " 1. That there is a general law of periodicity, which regulates all the vital movements of all animals." This, with the other four propositions, he pretends to have discovered. "To pre- vent controversy," he says, " I would observe that these propositions contain what I claim as my own"—Literce Scriptts Manent. So much tor what he claims: let us now see what he disclaims. " Dr. Dickson," quoth this consistent gentleman, " asserts that it has been the labour of his life to establish the discovery of the periodic movement of all vitality—of the periodicity of life in health—of the perio- dicity of life in disease—of the periodicity of movement of universal nature ! and that he won't be juggled out of it either by Mr. Wakley, Dr. Holland, or Dr. Lay- cock, or any one else. Now the plain truth is, that the unhappy man has spent his life in trying to crack a blind nut, and his charge of plagiarism is all moonshine.— I have never claimed the discovery of the doctrine in question!" What, then, in the name of common sense, does this " respectable physician" claim ? What does he mean by the manifold productions which, under the head " Vital Periodicity," he has been palming upon the British Association and the readers of the Lancet as his discoveries ?—discoveries of such importance, too, as in the eyes of his patron and fellow-plagiarist, Dr. John Forbes, must eventually change the whole face of" physic. " Dr. Laycock," says the immaculate Forbes, " has attempted to demonstrate a general law of Vital Periodicity." " If his researches prove correct, a considerable change must necessarily take place in both the theory and practice of medicine."— His researches! Ay, there's the rub. The value of the discovery of this great na- tural law or principle—the universality of periodic intermission and return—being thus distinctly acknowledged, the next question is, to whom does it belong ? Not to Dr. Laycock assuredly, for Dr. Laycock himself has now abandoned his claim to it; no, nor to Dr. Dickson either, he adds, " for this best of reasons, that it is pro- bablyjust as old as the pyramids." Probably not quite so old, Dr. Laycock—other- wise, why should it only now, for the first time, threaten to work such a change in the theory and practice of medicine 1 Something more satisfactory, however, than your assertion that it is, will be required at your hands before you be permitted to get out of the controversy you have so deliberately provoked—not prevented!— For, keeping to " probabilities" still—as it is just probable that you, Dr. Laycock, may try to cover your retreat with the names of Hippocrates, Aristotle, Celsus, or some other of the ancients, I mnst be so plain as to tell you that names alone will neither satisfy the public nor me. No, Sir, if you still adhere to your latest asser- tion—an assertion the exact converse of the premises with which you set out—tf you still intend to convince the world that not you, but I, am the plagiarist, I now call upon you to'produce the pages and passages of the authors by which you may find it convenient to say my labours have been anticipated! The quibbles of speech to which you have descended, will scarcely provoke the smiles of your friends; for the flippant abuse of me, which you have done me the honour to introduce in your letter, I thank you most sincerely, and for the similar compliment paid me in last week's Lancet, by the publisher of* your piracies, Mr. Thomas Wakfey, I beg to offer that "honourable gentleman" my best acknowledg- ments. " Quack and bully" coming from him, require from me the " retort courte- ous." The next time my " honourable friend," for such I must now certainly style him, does me the favour to publish a letter of mine, I hope he will pursue the exact same course he has done on this occasion, viz., bottle it up for five mortal weeks, then mispoint and misprint it, substitute commas for full stops, full stops for com- mas, capitals for small type, and vice versd; and, in a word, so unsentence the sen- tences, that such letter shall be his production rather than mine. Of course he will take care, at the same time, to suppress any correspondence that may have passed between us in the interval, such as the very unimportant letter you, Mr. Editor, have just printed in the Medical Times, thereby confessing to the world his, Mr. Thomas Wakley's, high sense of my merits—merits so distinguished as, in his view, to entitle me to nothing short of the identical salutations with which certain respectable gab- blers, in times gone by, welcomed the illustrious Harvey and Jenner—the stale cackle of " quack, quack, quack!" Yours, Mr. Editor, S. Dickson. To this letter there was no reply! 220 APPENDIX. Dr. Dickson and Dr. Copland. To the Editor of the Medical Times. 28, Bolton Street, April 22nd, 1844. gmi—In your Journal of last week, Dr. Copland is reported to have made the following observation at a late meeting of the Westminster Medical Society—" That within his recollection, the character of disease in London had changed very much. «■ Iu 1820, and for several years afterwards, as far as 1826 or 1827, disease presented more of the inflammatoiy character; at least, patients bore depletion better. It had, since then, gradually changed, and had assumed the intermittent or remittent type, especially in the outskirts. There is, consequently, less toleration of deple- tion, even in cases of disease of the chest." Allow me, Sir, to put Dr. Copland right on this subject; the type of disease has not changed, neither did patients bear blood-letting better formerly than now; but medical men have changed—they have changed their opinions of the nature of the one, and the value of the other. The type of disease change! Yes, when the types of life and death change. Intermit- tent fever, Mr. Editor, ever has been, and to all eternity will be, the type of all dis- eases, in London, out of London, in Europe, in Asia, in Africa, in America! And, through your pages, I beg to tell Dr. Copland that, if he likes, I will show him let- ters from medical practitioners, which bear the post-mark of every quarter of the globe, expressive of their obligations to me for my discovery of that great fact; many of them army and navy surgeons, and all of them too honest, too ingenuous, and too disinterested, to pretend that disease has changed its character, rather than themselves have changed their views of it! Suum cuique. The day is not distant, when quacks only will resort to the lancet and the leech for any disease—diseases of the chest included. Has Dr. Copland never read the Unity of Disease ?—has he never, in fact, admitted the truth of the doctrine ?—or, like Dr. Holland, will he plead non mi rccordo ? 8. Dickson. To this letter there was no reply! DR. TURNER'S NOTES. Intermittency of Disease—Quinine.—That there are those in our own country who do not think so lightly of Dr. Dickson's views of Disease and its Treatment as some people pretend to do, testimony is at hand. I find it in the leading article of the May number of the Western Lancet, published at Lexington, Ky., from the pen of Dr. Thomas D. Mitchell, the learned professor of Materia Medica and Therapeutics in the Transylvania University. Here are his words : " The doctrine that all fevers, and all diseases are essentially Intermittent, has long been before the public ; and while we are ignorant of the nature and source of Periodicity, the fact of Inter- mittence is as well established as any other in Medicine." Applying this position to Fevers, Dr. Mitchell says, " Well aware that the idolaters of a false diagnosis, based on imaginary lesions, which have no practical bearing in the case, will stand aghast at this announcement, I feel it to be my duty to present the facts, as history —not far off, in Europe, but here in our own land,—exhibits them." Dr. Mitchell then details many wonderful and rapid cures in a variety of violent fevers wrought by a bold and judicious use of that most prominent of the Chrono-Thermal reme- dies—the Sulphate of Quinine, which in his satisfaction he styles " the Samson of the Materia Medica." It has been pretended that Dr. Dickson's views are not so new as he imagines. To this it is answered, that the Doctor has repeatedly de- manded the proofs and the dates, but in vain. Blood Letting.—The following is the Official Report of the Physicians who at- tended General Harrison in his last illness. The italics are mine—comment is need- less. "On Saturday, March 27, 1841, President Harrison, after several days' pre- vious 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 intes- tines did not regain a healthy condition. Finally, on the 3d of April, at three o' clock, f.m., profuse diarrhoea came on, under which he sank, at thirty minutes to one APPENDIX. 221 o'clock on the morning of the 14th." I will not here attempt to discuss the opinion whether or not the Lancet can be altogether dispensed with in medical practice— opinions prove nothing. An opinion was once entertained that rivers could not be navigated by steam—Fulton himself doubted the safety of going round Point Judith by steam. Philosophers are now living who demonstrated the impracticability of traversing the Atlantic by steam. Yet all these are daily done. To suppose wo have learnt all we can learn—that the progress of man in improvement has reached its height, is to suppose that the Providence of the Almighty is exhausted or ex- haustible. Dr. Dickson is not so absurd as to pretend to cure all his patients, as certain par- ties have seemed to require of him. But he claims—and I aver it with him from actual experience—that by his system more are saved ; and that the curable cases are relieved in much shorter time, and consequently with less expense and with greatly less pain and suffering, than by any former mode of treatment.—Is all this nothing ? The Duplex Action of all Medicines.—The student of that most valuable work of Professor Dungleson of" Philadelphia,—New Remedies, is struck at almost every page with the conflicting and opposite views expressed by practitioners in reference to the effects of the various medicines therein treated of. By some, a particular re- medy is extolled in high terms; by others it is declared to be of little value. Does not Dr. Dickson furnish the key to these conflicting opinions in the Duplex Action of all Medicines ? Palsy, Apoplexy, and Diseases of the Brain.—Sir George Lefevre, without acknow ledgment, avails himself largely of Dr. Dickson's writings:—" Dr. Baillie said in his day, that Palsy was on the increase. It is not improbable that the universal system of blood-letting upon all such attacks, and even threatenings 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, Debility of Brain, (erro- neously so called !) is not an uncommon consequence. Dr. Holland has comment- ed very freely upon this, having known cases of this kind, where bleeding has been immediately followed 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."—Apology for the Nerves, London, 1844. Concussion from Fall.—" Sir Charles Bell has stated, I think, that when a man is taken up iu the street 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. Pe tersburg I was requested to bleed a gentleman who had fallen from his desk in a fit—a Cordial was administered, which soon revived the patient, who had been long in a nervous state of health."—Lefevre, in 1844. Inflammation and Spitting of Blood.—C. T., junior, aged seventeen, Westchester County, in the summer of 1837, having a pain in the bowels, undertook to treat it by swallowing a country remedy for the complaint, composed of Powdered Cay- enne Pepper and Cider. In his haste he inhaled into his wind-pipe a portion of the unmoistened pepper; the consequences were of the most violent kind—extreme irritation of 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 Physician in attendance. On consultation, guided by the only light we possessed __I had not then seen Dr. Dickson's work—copious bleeding was resorted to, and repeated during the night, until the patient lost some forty to fifty ounces. The next morning the symptoms were found to have entirely subsided. The patient, however, was pale and feeble; in a few weeks he got about; but he never was him- self again. On the approach of every winter since, he has been the subject of some form of disease. In October last, 1844, he was seized with Spitting of Blood. 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 res- piration, an anxious countenance, and every few minutes coughing up a mouthful of a frothy mixture of mucus and arterial 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 fi-om 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 symp- toms subsided; on the third day, he dressed himself, and took his seat at the din- 222 dr. turner's notes. ner-table. On the eighth day, against my advice, he went into tho country to vote at the election, had a relapse, but did not return to me for ten days, when the treat- ment was repeated with a like result,—namely, his appearance at the dinner-table, free from all symptoms but weakness, on the third day. He was rather more pru- dent this time, and at the end of a fortnight 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 the 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 8th, in the prosecution of his business, free from disease, with a reasonable 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 spitting- 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 conti- nued throughout the winter. Palpitation.—J. S. came to me with palpitation of the heart. He had been exa- mined with the stethoscope, and pronounced incurable. On inquiry, the palpita- tion proved to be intermittent; there was also 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. Fever and Inflammation.—" Patients, who have been apparently cured by large bleedings, which have conquered pain in the first instance, remain eventually lon- ger 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 af- fections."—Lefevre, in 1844. Abstinence.—In the summer of 1843, an eminent citizen of this state laboured un- der that form of Influenza then known by the sobriquet of " Tyler grippe." He conceived the idea that he could starve it out; consequently, he confined himself to a rigorously abstemious diet—a little boiled fish for dinner, with a dessert of wa- ter-melon. At the end of a fortnight, he was seized with Palsy of one side. -------- June 17th, 1847. Dear Sir,—Accident placed in my hands, about one year or fifteen months since, a copy of your edition of Dr. Samuel Dickson's " Chrono-Thermal System of Medi- cine," &c. After a careful perusal of it, you can scarcely imagine the delight which it afforded me. For years I have been gradually losing confidence in the prescribed mode of treatment laid down, and forced on the profession, through the talismanic influence of either fashionable or time-honoured professors, or our medical Bchools; and have for many years past adopted a plan of treatment, in many of its essential features, similar to that so forcibly pointed out by Dr. Dickson. But the happy thought of adopting intermittent fever as the type of disease, so clearly illustrated by the doctor, never once entered my mind; although I had for some years been using the chrono-thermal remedies, from observing the great and benefi- cial effects derived from their use, and had almost ceased to use the lancet, drastic purgatives, &c., from the clearly-demonstrated ill effects which so often followed in their wake. Yet my mode of treatment was empirical. The great book of na- ture was open to me; I was anxiously inquiring for some happy generalisation that might enable me to condense the facts and observations which I had made into a system. You can now in a faint degree appreciate the delight with which I read the Periodic Theory of Dr. Dickson. I instantly discovered, that every fact which I had observed during a practice of near twenty-five years, as at once arranged under the beautiful, natural periodic system of Dr. Dickson—the periodicity of disease, had dr. turner's notes. 223 often forced itself on me; but until I read this work, I had no idea of the extent to which it might be applied. Of all the nosological arrangements that I have yet seen, this is the most compre- hensive, because the most simple, the most natural. I embraced the principles at once ; they were in complete conformity with my previous notions and practice; it was an easy matter. The severe, and I am sorry to admit, just censure measured out by Dr. Dickson against the professors and reviewers, and many members of the faculty, at first caused me to falter; but on carefully reading his remarks and exposures, there appeared so much truth in them, I could not but reluctantly admit, that the exposure would only be injurious to those members who were making a merchandise of our holy profession, and that his exposure would ultimately benefit the high-minded and honourable portion of the profession. Time has only served to convmce me of the truth of this opinion. Since I first became acquainted with your work, I have in every case used the chrono-thermal treatment, on the strictly chrono-thermal principle. My success has been altogether unprecedented. I now speak with confidence of my ability to remove disease and pain (more especially that of a chronic character) in a manner that may appear to some egotistical, and to smack of quackery. I speak thus, be- cause experience has given me confidence in the mode of treatment. I have not used the lancet in a single instance in my private practice during the last year. This is thought very strange by many of my cotemporaries, as I at one time used the sanguinary treatment to an extent far beyond many of them. As be- fore remarked, for many years I had ceased to use it to a great extent, neither have I used cupping-glasses or leeches during that period. I have not used one-fifth part of the quantity of calomel and other purgatives that I heretofore used; notwith- standing which, my success has been far greater than heretofore, in all forms or manifestations of morbid action. I am physician to a large almshouse in this county. I have strictly carried out the principles there, with the most decided advantage to the patients, many of whom are brought hi with broken-down constitutions, and diseases of long standing. I have used the lancet but twice in the institution, and that against my own opinion; the cases terminated fatally. I do not think the result was due to bleeding, how- ever. The mortality in the institution the year preceding, under the treatment of my predecessor, was over fourteen per cent. During the year just passed, it has been a little over six per cent,; this appears to be a great difference. The records of the house prove its truth. The gentleman who preceded me is an excellent physician. I think the whole difference is fairly due to the mode of treatment. I have said more than I intended when I sat down, and fear I have imposed a burthensome task on you; but I hope you will excuse me. I can scarcely describe the interest I feel on the subject. My principal object in addressing you is to inquire of you, whether there are any other works published on the subject; if so, where can I get them ? Would you be so kind as to let me know, and their cost, that I may send for them ? Although the prejudices of education were strong in my case, having been bred in the school of the disciples of Dr. Rush, the powerful reasoning of Dr. Dickson is more than sufficient to overcome them. With respect, I remain, &c. Dr. William Turner. New York June 1, 1848. My Dear Doctor Turner,—You last winter gave me a copy of your pamphlet, " Triumphs of Young Physic," for which I thank you most heartily. It was the 224 DR. TURNER'S NOTES. means of saving my life. A few weeks after you gave it me, viz., on the 30th March, I burst a large blood vessel, and was in imminent danger. Myself and family were in the greatest alarm. A friend who had bled similarly fifteen days, (the physicians being unable to check it,) was sent for to console us, and was pres- ent when you complied with our call upon you. The case being stated lo you, you said you would beat the fifteen days. You kept your word. I was a well man in twenty-four hours, nor have I bled a drop since. But my chief object in addressing you this note, is to offer you, as a slight token of my gratitude, a few lithographed copies of your portrait I have had engraved for the new edition I see you announce of Dr. Dickson's most valuable " Chrono- Thermal System of Medicine." Believe me to be, With the sincerest respect and regard, Your truly obliged friend, And obd't serv't, H. P. Robinson, 27 Barclay st., New York. Petersburg, Va., March, 1848. Dr. Turner, Dear Sir,—In consequence of the decided stand you have taken in favor of Medical Reform, the Medical Faculty of this Institution have considered you worthy, and have conferred upon you the Honorary Degree of Doctor of Eclectic Medicine • and, sir, I sincerely hope that you will accept it, with our kind wishes for your suc- cess in your glorious undertaking. I have the honor to be, Sir, Your obedient servant, Charles Kenwortht, M. D., Dean of the Medical Faculty of the Scientific and Eclectic Medical College. THE END. 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