new pustules which were in due time produced in that animal, he took matter and inserted it into the arm of a child. The vaccine or cow-pox pustule was the result! and these experiments he has several times repeated with the same success, in the presence of many medical men; so that the cause of small-pox in man (whatever its real nature be) becomes so altered in its vaccine or cow. modification, as to constitute a most valuable preventive against the severer form. What is the nature of the specific agent which produces and reproduces, through such an infinity of individuals, an effect so generally specific? Can it be, as Linnæus 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, become itself magnetic. These are the most probable relations in which the subject may be viewed; if, indeed, it have not some analogy to the continuation and reproduction of all animal life.

There are a few questions connected with this subject, which I confess myself unable to answer. Perhaps the ingenuity of some of you may solve them for me.

1. Why is small-pox, when directly inoculated, more generally mild than when taken casually by infection?

2. Why, after vaccination, have we, in the majority of cases, only one pustule instead of many, as in the case of the small-pox?

3. Why is the cow-pox not infectious, like small-pox, seeing that it is a mere modification of identical agency? The cow-pox, so far as we know, can only be communicated by direct inoculation.

4. Has the protection which the cow-pox and the small-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 chickenpox 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 diseases has the most perfect analogy to the ague; seeing that all have remissions and exacerbations of fever more or less perfect in kind, and that all are more or less amenable to the chrono-thermal remedies; not one of which remedies, however, possessing such specific influence over them, as to be exclusively relied upon in the treatment of any case. Is not this the best of all proofs that there is no "specific" in physic? If 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. Calvert, 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 November, upwards of an hour, to wash and purify his clothes, according to an

order to that effect. On coming out of the water, he was seized with violent shivering and headache, succeeded by heat of skin, and afterwards by sweating, which alleviated the distressing symptoms. On the 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 dressing himself to go to the lazaret, he dropped down and expired."

From a

Disputes still exist as to whether plague be contagious or not. 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 whichsoever side truth lies, there can be no difficulty as to the proper treatment.The indications in plague as in simple intermittent fever, or the small-pox, are to regulate the temperature in the cold and hot stages, by the means already pointed out, and to prolong the remission by quinine, opium, arsenic, &c., according to particular constitutions. Treated in this manner, the disease could not by any possibility be more fatal than we are told it is under the present routine of 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 exacerbation than for the shiverings and alterations of temperature characteristic 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 Johnson'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. Madden. 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

from the Report of the Select Committee on the Western Coast of Africa, appeared in the Times newspaper, wherein, among other things, is the following: "The bleeding system has fortunately gone out of fashion, and the frightful mortality that attended its practice, is now no longer known on board our ships."-Dr. James Johnson, are you satisfied?]

But the eastern practitioner will tell me possibly, that

DYSENTERY

cannot be safely treated in any other fashion. Is he sure he knows 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. Cumming, late of the East India Company's medical service, informs us, that while ascending the Nile, in 1836, he was attacked with dysentery. After suffering for a week, with "intervals of remission," he fairly gave himself up, and so did his 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 fomentation 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 convalescence leads me to contrast my late attack with a precisely similar one which I had at Cawnpore in the autumn of 1829. On that occasion, I was largely bled at the arm, had fifty leeches applied to the abdomen, and during the first four days of the disease, in addition to extensive mercurial frictions, I swallowed 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 nature was my sole physician, (he forgot the sponging part!) and I am now almost as well as before the attack commenced. BRITISH MEDICAL PRACTICE, IN MY HUMBLE OPINION, DEALS TOO MUCH IN HEROICS."

66

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 introduced 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 expectation 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

disease may be seen by the palpable diminution of the swelling on particular days; to say nothing of the hopes both of the patient and physician on such days being excited by general improvement throughout. How should the disease be treated? Not, according to modern practice, by diuretics and sudorifics solely; but by a combination and alternation of these remedies with the medicines of acknowledged efficacy in that most perfect type of all diseases, the ague. Of cases successfully treated by me in this manner, I I could give you hundreds-but to what purpose? The recital, after all, would amount to little more than a mere repetition of the paroxysmal symptoms of ague, minus the sweating stage ;—that stage being typified, nevertheless, by the cellular watery effusion, or by the morbid increase of the natural secretion, which lubricates the varicus 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 Paymaster-Sergeant of the Royals had Dropsy, which, notwithstanding the usual treatment by diuretics, purgatives, &c., was daily getting worse, when Dr. Stephenson, of the 13th Dragoons, suggested the application of poultices of lichen vulgaris to the loins. From that day the amendment was rapid, and the patient 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 universal 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 increased flow of pale urine, so often remarked in ague, is an occasional symptom of the Epidemic Cholera. In more than one instance of cholera, which came under my observation while serving in the east, that secretion passed involuntarily from the patient a short time before death. Suppression of urine, so common in the late epidemic, was a frequent symptom of the Walcherin ague. When there is no hot fit or reaction, death is usually preceded by a sleepy stupor in both. You have ague, too, with hot skin and bounding pulse, a state analogous to the milder forms of cholera, in which you remark the same phenomena. When not fatal, cholera, like ague, has a hot and sweating stage. Moreover, when ague terminates life by a single paroxysm, you find the same appearances after death in the bodies of both. Lastly, frenzy, disease of the lungs, liver, and spleen, with dysentery and dropsy-to say nothing of epilepsy and apoplexy-have been the occasional sequelæ of each. Cholera, then, is an extreme of the cold stage of ague. What are the remedies most beneficial in Cholera ? Attention to Temperature comprehends everything that has either failed or succeeded. Were I myself to become the subject of it, I should feel inclined to trust more to a bottle of brandy than to anything contained in the Materia Medica. While serving in the East Indies, I saw many hundred cases of the disorder, but I never could convince myself of the superiority of any one kind of active medical treatment over another. In my work upon the Diseases of India, I

have proved that death, in the great majority of instances of Cholera, takes place from a palsy of the 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, vomiting, and difficult breathing always-cramps and flatulence frequently; and the animal seldom survives the third day. On dissection, you find the vessels of the head, lungs, and intestines, filled with black blood. That is exactly what you find on opening the bodies of persons who have died of cholera. Shortly after my return from India, Dr. Wilson Philip read a paper at the Westminster Medical Society, in which he took the very same view of cholera; but wherein he forgot to say that his views of the disease had 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-HYSTERIA, 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 delight to stand or walk upon the shore-side, and to see a ship tossed with tempest upon the sea, or to be in a fortified town, and to see two battles join upon a plain; but it is a pleasure incomparable, for the mind of man to be settled, landed, and fortified, in the certainty of truth; and from thence to descry and behold the errors, perturbations, labours, and wanderings up and down of other men." But, Gentlemen, however exciting this kind of pleasure be to him, who should be content with merely making a discovery to himself the making of it public has its drawbacks; for 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 daylight 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 expect from these?-What, but to be whispered away by the breath of calumny, 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 measures ever brought over such implacable enemies to the ranks of their destroyer; or that robbers, rioting in the spoils of their victim, will listen to the voice of the charmer, charm he never so wisely? Surely people must be out of their senses, who imagine that any exposition of Truth will be acceptable to men whose emoluments are chiefly derived from a course of studied