Case 2.-A young gentleman, aged 11 years, had enlarged knee, with great pain and heat, which came on in paroxysms. Leeches, blisters, and purgatives had all been ineffectually tried by his "hospital surgeon," who then proposed amputation; the boy's mother hesitated, and I was called in. I prescribed minute doses of calomel and quinine. From that time the knee gradually got better, but stiff joint was the result; anchylosis or adhesion having taken place before I was consulted.

Case 3.-Another young gentleman, aged seven years, son of Lord Cwas 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 notwithstanding 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 complain of pain of knee, stooping occasionally to place his hand upon it when he walked. There was some alteration in the appearance of the hip of the same side, when I was requested to see him. I adopted a similar treatment as in the above case, and the child rapidly recovered his health, with the complete use of his limb. He had been previously seen by a surgeon, who, though the knee was the painful part, rightly pronounced the case to be one of Hip-disease. To the knee, as you know, instead of the hip, the little patient constantly refers his complaint, a circumstance which occasionally deceives the attending practitioner, as to the nature and locality of this destructive 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," Whiteswelling,' ," "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 continued forms, is, that the periods of the latter are less perfect, and the stages of their curriculum less marked than in the former. No physician will doubt that a purely periodic disease, whatever be its nosological name, partakes of the nature, and is more or less amenable to the treatment successfully followed in ague. Why, then, deny that the same disease, when less obviously periodic, partakes of that variety of ague misnamed "Continued" Fever, since all disorders like it have remissions and exacerbations, more or less perfect in character, throughout their whole course? What are such diseases but varieties of the more purely intermittent type? And what the remedies found to be most beneficial in their treatment, but the remedies of the most acknowledged efficacy in simple ague?

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Remission and paroxysm are equally the law of what are termed local diseases, as of the more general symptoms which are supposed to be the exclusive province of the 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. Radley, of Newton

Abbot, Devon, a gentleman well known for his improved method of treating fractures. Mr. Radley writes thus:-"Many thanks to you for the Unity of Disease,' which contains in it more of the true philosophy of medicine than any book I have ever yet seen. There are some passages that threw me into an 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 midnight, when it lasts one hour and a half or two hours, and again in the middle of the day.' The patient is now doing well under Bark.”

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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 between 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 variations 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,

When medical men hear that I am in the habit of treating all kinds of disease without blood-letting, they generally open their eyes with a stare, and ask me what I do in INFLAMMATION. İnflammation! who ever saw any

part of the body on fire, or in FLAMES? for the word, if it means anything at all, must have something like that signification. To be sure, we have all heard of" spontaneous combustion," but I 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 expression, which, torture it how you please, can only mean a quicker motion and a higher temperature in the moving atoms of a given structure, than are compatible with the healthy organisation of that structure. When you find a considerable degree of heat and swelling, with pain and redness in any part, that part, in medical language, is "inflamed." Now, what are these phenomena but the signs of approaching structural decomposition? During the slighter corporeal changes, the coincident variation of temperature is not always very sensibly perceptible; but whenever there is the least tendency to decomposition, this thermal change is sure to be one of the most prominent features. The phenomena termed inflammation, then, very closely resemble the chemical 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 matter being a new fluid product, differs entirely in its appearance and consistence 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 instances, the matter, after working its way to the surface, escapes by an ulcerated 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 reparative powers of nature. But there is yet another mode in which a cure may be effected, namely, by Absorption; that is to say, the matter of the abscess may be again taken up into the system, and by the inscrutable chemistry of life, become once more 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 temperature characteristic of their natural revolutions. This termination is called Resolution. When the inflammatory action is more than usually rapid, the result may be the 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

I must own I never found myself one whit the wiser, after reading ary of them. Their writers, in almost every instance, use language which they do not themselves seem to have understood, otherwise they would have confined themselves to one sense, instead of including under the same term states the most opposite. Were I to tell you that the word "Inflammation" is used by many writers when a part is more than usually cold, you would think I was laughing at you; yet there is nothing more true, and I will give you an instance. A carpenter had his thumb severely bitten by a rattlesnake; and the effects of the venom are thus described by 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 66 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 previous constitutional disturbance. I do not speak of immediate local inflammation 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 injurious influence, he shivers, fevers, and complains of pain, throbbing, and heat in the head, chest, or abdomen,-phenomena gradually developed according to the patient's predisposition to organic change in this or that locality. Phrenitis, Pneumonia, Peritonitis, (technical terms for 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 inflammation of the brain," he tells you, "you have spasmodic symptoms, slow and progressive paralysis, the course of the disorder being intermittent." Conolly, in his Cyclopædia of Medicine, says, "Diurnal remissions are distinguished in EVERY attack of inflammation." Now, if you prefer the evidence of another man's eyes to your own, this statement ought to be more than convincing, for it comes from the enemy's camp. 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.

Dr.

Whether the particular condition called Inflammation be termed erysipeloid, gouty, rheumatic, scrofulous, it is still remittent; and if you question the patient, he will in almost every case admit that it was preceded or accompanied by cold or hot fits, or both. May not inflammation, then, yield to Bark-to Quinine? The late Dr. Wallace, of Dublin, maintained the affirmative, dwelling more particularly on its good effects in that disorganising 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 of the Eye, as well as the fever, disappear." This was the case which first led him to suspect the fallacy of the blood-letting system in inflammation of

the Eye. Now I shall tell you what first led me to entertain similar doubts of its efficacy. A medical officer of one of her majesty's regiments serving in India, couched a woman for cataract. The next day, the eye having become inflamed, according to received practice he bled the patient; but scarcely had he bound up her arm, when she fell as if she had been shot, and lay to all appearance dead. With the greatest difficulty, he succeeded in recovering her from this state; but it was not till four long hours had passed, that he felt he could safely leave her with ordinary 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 application of stimulants to the nose, mouth, &c., she relapsed into a death-like swoon. More than once he was even obliged to inflate her lungs to keep her from dying. But, in this case, Gentlemen, the blood-letting did NOT cure the 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 preventing 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 inflammation after it has come on; and their beneficial influence will be more generally certain in the latter case, if you first premise an emetic, and wait till its action has ceased before you administer them.

"The Peruvian bark," says Heberden, "has been more objected to than any of these medicines (bitters) in cases of considerable inflammation, or where a free expectoration is of importance; for it is supposed to have, beyond any other stomach-medicine, such a strong bracing quality, as to tighten the fibres (!) still more, which were already too much upon the stretch in inflammation; and its astringency has been judged to be the likely means of checking or putting a stop to expectoration." All this appeared much more plausible when taught in the SCHOOLS OF PHYSIC, than probable, when I attended to fact and experience. The unquestionable safety and acknowledged ́use of the bark, in the worst stage of inflammation, when it is tending to a MORTIFICATION, affords a sufficient answer to the first of these objections; and I have several times seen it given plentifully in the confluent small-pox, without lessening in any degree the expectoration."

Some time ago, I was called to see a young gentleman, who had a swelling under the 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 previous 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 shiverings -which, according to the doctrine of the schools, it ought to have done-the very reverse took place.

I shall now give you one of many instances of indubitable and 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