and some of the more important terminations of what is usually called a perfect ague-fit. I must now tell you that all agues are not equally 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 commencement, be a veritable ague; recurring and re-recurring, in the first instance, at perfectly periodic intervals of a day or more; yet slide by degrees into a fever of the remittent form. And this Remittent Fever again, whether it be the original or secondary disease, from its periods of access 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 Typhus 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? What can a SICK man be but the alteration of a HEALTHY man; his temperature 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 organic affection, every possible local change you can name or imagine, may, with more or less quickness, be developed; giving occasion, of course, to the attending practitioner to baptize the disease anew: and this he may either do, according to the locality of such organic change, or according to the locatity 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 surface of things; how few can see beyond present signs and present symptoms, you will not be astonished that the new doctor, who shall place his finger on the organ 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 practitioner 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 of ten, such new doctor will succeed in securing the esteem of the persons who employ him. Now this is a hard case for the honest and more able practitioner; but so the world wags.

Until the publication of my work, the Fallacy of Physic as taught in the Schools, it was the almost universal belief of medical professors that ague

could only be caused by emanations from the fens; the complaint being very common in fenny countries; indeed I am not sure that this belief is not even now one of the numerous absurdities still taught in our schools and universities. But, Gentlemen, there is no agent in nature which may not cause ague, from a blow to a passion. Lord Byron's mother, according to Mr. Moore, died 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 mistake 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 revolution, without a change of temperature of some kind. Butler, in his Hudibras, tells us,

"LOVE's but an ague fit reversed,

The hot fit takes the patient first."

Seriously, you will do well to ponder on the relations which the effects of the various 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, "produced 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 physicians under the abstract word "FEVER?" The agents which cure fever from a blow, are the same agents which cure fever from a passion, a poison, or a viewless and unknown cause. When a man is hot, and his skin dry all over, no matter what the cause be, you may bring his condition to the state of health by throwing cold water over him. You may do the same by an emetic. Oh! an emetic has a wonderful power in 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 in 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 fever, you may cool him certainly; but unless you cool him to death, you cannot thereby keep the fit from returning. When it does return, you may bleed him again, it is true; but how often may you do this safely? So far as my experience of medical matters goes, few people in these times are permitted to die of disease. The orthodox fashion is to die of the doctor! Gentlemen, we daily hear of the terms "Constant" and "Continued" fever; but there never was, nor can there be, a fever without a remission or period of comparative immunity from suffering, more or less marked. Most writers of name, from Cullen down

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 various chrono-thermal medicines, you may in most cases succeed. But instead of trying to prevent recurrence, practitioners now-a-days only temporise during the fit; and this is the most profitable practice; for a long sickness makes many fees! The honest physician will do his best to keep the fit from returning. Now if blood-letting were certain to do that, how could we possibly hear of people being bled more than once for fever? Do we not hear of repeated applications of the lancet, and of the patient dying notwithstanding? When I come to speak of Inflammation, you shall 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 Indian widow to perish on the funeral pile of her husband-the influence of authority and custom simply! In physic, Gentlemen, as in other things, men are "bred to think as well as speak by rote; they furnish their minds as they furnish their houses, or clothe their bodies, with the fancies of other men, and according to the age and country. They pick up their ideas and notions in common_conversation or in their schools. The first are always 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 believe one-half the rubbish propounded by medical teachers, I cannot now understand; 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 perceive 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 restored to its usual healthy motive condition, periodical repetitions of the diseased motions should yet recur, is a thing not more inexplicable than that the various habits of Health should,-in certain instances with our consciousness, 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 uncomplicated Ague-fit stand out boldly in relief; and as in every other form of disease, however named, or by whatever caused, these symptoms or shades of 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 confined sense. Call the symptoms ague, fever, or what you please, CONSTITUTIONAL DISTURBANCE is the prelude to every disease-the precursor of

every kind of local mischief not immediately produced by chemical or mechanical agency. In numerous cases, if not in all-more especially after repeated 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 destruction or decay. Of the first, you have an example in the spasm or palsy of a muscle, or the suspension or too great flow of a secretion. Of the second, I can give you no better instances than that disorganising disease of the kneejoint, termed "white-swelling," and that too common termination of chest disease in this country-Phthisis, as it is termed by medical men—Consumption or Decline by the vulgar.

The

The propriety of adopting any remedial measure has, in every case, more or less relation to Time and Temperature. But the beneficial influence of the Peruvian BARK, and its preparation Quinine, would appear, more than any other agent, to depend upon the period in which we administer it. 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 doctors 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 RA, 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 neighbourhood. 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 success of that plaster? The general good effect of Quinine in keeping off the ague-fit, when it proceeds from viewless causes, is sufficiently well known to every member of the profession; but it is not so generally understood that the same agent may be equally serviceable in cases produced by local injury. Of this, however, I will give you a proof. A gentleman, shortly after having had a bougie passed, was seized with ague of the most perfect kind; two days after, at the same hour, he had a return, and every alternate day it recurred, till he had experienced about twelve 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.

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

simplicity. What is the meaning of the term Spasm? It means an irregular or unnatural contraction of some muscle of the body; and in the case of the voluntary muscles, you cannot by any effort of the will control or counteract it. By rubbing and warming the part, you may sometimes succeed, and there are a great many medicines by which, when taken 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 lining 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 apparatus of the windpipe, or its divisions, spasm is familiar to you all in the word Asthma; and it is also termed Dyspnea, from the difficult breathing which it certainly occasions. When this spasmodic action affects the muscles about the jaws and throat, and the patient at the same time has convulsions of the face and limbs, there is usually loss of consciousness, with a sudden loss of power in all his members, which causes him to fall. This is the Epilepsy, or "falling sickness." The subject of the disease termed Jaundice, in ninety-nine cases out of a hundred, owes the yellow 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 Passion; in the colon or great intestine, Colic; in the urethra, Spasmodic Stricture. 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 perfectly periodic type in individual cases, and by all being more or less amenable 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 previously 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. In 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 passions, I shall show you that the same passion which has caused an ague or an epilepsy, may cure either. In truth, I scarcely know a disease which the passions, Rage and Fear, have not cured and caused, according to their attractive or repulsive mode of action in particular cases.

I have said that ASTHMA is an intermittent disease. "The fits of convulsive asthma," according to Darwin, "return at periods, and so far resemble the 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