I have preferred to give these two instances of what I conceive to be decided malpractice, to any of the numerous cases which have come under my own observation, as the first-named gentleman was well known to many of the medical profession, while the death-scene of the noble poet will arrest the attention of all who take an interest in his genius. In the generality of cases of disease, Gentlemen, it matters little what may have been the primary Cause. The disease or effect, under every circumstance, not only involves change of temperature, but produces more or less interruption to the two vital processes, Digestion and Respiration. In other words, it impedes SANGUIFICATION, or the necessary reproduction of that living fluid, which throughout all the changes of life is constantly maintaining expenditure. This being in the nature of things one of the first effects of disorder, let us beware how we employ a remedy, which, if it succeed not in restoring healthy temperature, must inevitably hasten the fatal catastrophe—or, in default of that, produce those low chronic fevers, which, under the names of dyspepsia, hypochondria, hysteria, mania, &c., the best devised means too often fail to alleviate, far less to cure. With the free admission, then, that the lancet is capable of giving 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,-remember there is then no income-all is expenditure. And I care not whether you take inflammation of any considerable internal organ,—the Brain, Liver, or Heart, for example, or of any external part, such as the knee or anklejoint with the lancet, you can seldom ever do more than give a delusive relief, at the expense of the powers of the constitution. The man of routine, who has not heard my previous lectures, giving up Fever, perhaps, and a few 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 Apoplexy? 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; in other words, the number of deaths that took place, either in consequence, or in spite of it. Was not that a reason for change of practice? Having in my Military Hospital no 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 result was beyond my best expectations. The first patient was laid out all his length, and cold water poured on his head, from a height. After a few ablutions, he staggered to his feet, stared wildly round him, 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 afterwards lost an apoplectic patient. But, Gentlemen, since I embarked in private practice, I have improved upon my Army plan. With the aperient given after the cold dash, I have generally combined quinine or arsenic-and I have also, upon some occasions, at once prescribed hydrocyanic acid without any aperient at all. This practice I have found highly successful. That Quinine may prevent the apoplectic fit, I have proved to you, by the case given by Dr. Graves. The value of Arsenic in Apoplexy has also been acknowledged, by members of the profession; but whether they have been acquainted with the true principle of its mode of action, in such cases, is another thing. Dr. A. T. Thom 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 containing power! Upon what principle would you, Gentlemen, prescribe arsenic in threatened Apoplexy? Surely upon the same principle that you would prescribe it during the remission in ague-to prolong the period of immunity -to avert the paroxysm. Long after the 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, bleeding 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 debilitates 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 hypothesis, I appeal to indubitable and demonstrative fact.* Let the older members of the profession seriously reflect upon the ultimate injury which may accrue to their own interests, by opposing their school follies and school prejudices to palpable and demonstrative truth. So long as colleges and schools could mystify disease and its nature, any treatment that * M. Copeman, in 1845, gives the statistics of the bleeding and non-bleeding practice in Apoplexy. In 1836, when I first repudiated the lancet in 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, Number not bled, 129 Cured, 51 Died, 78 showing that in the cases where bleeding was practised nearly two out of three died; whereas in the cases treated without blood-letting, more than two out of three recovered! What is the worth of general assertiors in the face of such evidence? 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 rheumatism? Do not these remedies, in numerous instances, lessen the temperature, pain, and morbid volume of these inflammations, more surely and safely than the application of leech or lancet? If, for such 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 injudicious, what remedial means, let me ask, have not proved, not only dangerous, but deadly? Has not mercury done so? Are purgatives guiltless? How many have fallen victims to the lancet? With prussic acid, properly diluted and combined, I have saved the infant at the breast from the threatened suffocation of croup; and I have known it in the briefest space of time relieve so-called inflammation of the lungs, where the previous pain and difficulty of breathing were hourly expected to terminate in death. True, like every other remedy, it may fail; but have we no other means, or combination of means for such cases? With emetics and quinine, I have seldom been at a loss; and with mercury and turpentine, I have cured pneumonia. But will the inflamed heart yield to anything but blood-letting? Fearlessly I answer yes! and with much more certainty. With emetics, prussic acid, mercury, colchicum, silver, &c., I have conquered cases that were theoretically called inflammations of the heart, and which the abstraction of half the blood in the body could not have cured. So also has Dr. Fosbroke, physician to the Ross Dispensary, a gentleman who had the felicity to be associated with Dr. Jenner in his 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 disease. My principal substitutes have been the various remedies which, from time to time, I have had occasion to mention; but in a future lecture I shall again enter more fully into their manner of action. That none of them are without danger in the hands of the unskilful, I admit; nay, that some of them, mercury and purgatives, for example, have, from their abuse, sent many more to the grave than they ever saved from it, is allowed by every candid and sensible practitioner. But that was not the 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, "put bodies of which they knew little, into bodies of which they knew less!" Gentlemen, I have not always had this horror of blood-letting. In many instances have I formerly used the lancet, where a cure, in my present state of knowledge, could have been effected without: but this was in my noviciate, influenced by others, and without sufficient or correct data to think for myself. In the Army Hospitals, I had an opportunity of studying disease, both at home and abroad. There I saw the fine tall soldier, on his first admission, bled to relief of a symptom, or to fainting. And what is fainting? 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, 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 constitution 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 resclution to think for myself-ay, and to act, and my conviction, gained from much and extensive experience, is, that ALL diseases may not only be successfully treated without loss of blood; but that blood-letting, however put in practice, even where it gives a temporary 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 physician; 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, convulsions, 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 stated to you in my last lecture, that the tendency to hæmorrhagic 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. In all the higher animals, man included, the substances composing the food are converted into blood in precisely the same manner. Crushing and comminuting 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 attempting 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 attention, I will 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 excrementitious, 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 upwards along the front of the spinal column, drops its contents-namely, the nutritious portion of the Chyle, into the left subclavian VEIN, a large bloodvessel 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 proceeding 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 |