-No.1.] LONDON, SATURDAY, JULY 9, 1825.

FROM

LECTURESON THE

PRINCIPLES AND PRACTICE

OF PHYSIC,

BY DR. ARMSTRONG.

Theairee of Anatomy, Webb Street.

THE following is an abstract ofDr. ARMSTRONG’S Lectures, compre-hending his general view of the pa-thology and treatment of febrile dis-orders, and his management of conva-lescence.

All febrile disorders proceed fromcommon or peculiar remote occasions.The common occasions are the ordi-nary agents of nature, which might besubdivided into depressants, stimu-lants, irritants, and interruptants, themeaning of which he formerly defined.The peculiar occasions are distinguish-ed from the common ones by somespecial inherent property, and the

principal of them are malaria, or

marsh miasm, putrid animal or vege-table matter, general distemperature,of the atmosphere, and human con-tagions. All these various occasions,whether common or peculiar, producethree forms of fever, the congestive,the simple, and the inflammatoryforms. The congestive form, under itsperfect character, is distinguished bythe diminution of the animal heat. onthe surface of the body, by the weak-ness or oppression of the pulse, bythe prostration. of muscular power,And by the marked disturbance ofsome internal organ, especially thebrain, the heart, the lungs, and bron-chial lining, the stomach, liver, andintestinal lining. Sometimes one ofthese parts suffers, sometimes two orthree, and sometimes all. On exa-

mining bodies after death, proofs ofvenous congestion, or the effects ofvenous congestion are found in theorgan, the functions of which hadbeen affected during life, bnt oftenthe capillary arteries, especially thoseof the primæ vise, and bronchial lin-ing, are simultaneously gorged. Thecongestive form of fever frequentlyproves rapidly fatal from common re-mote occasions, but still more rapidlyso when it arises from pectiliar ones,a remarkable example of which latelyoccurred in India, for what was thererecently called the cholera morbns,was only an epidemic congestive fe-ver, in which the liver and intestinallining, the lungs and bronchial lining,mainly suffered, though, according toDr. ARMSTRONG, the authors who havewritten upon the subject did not seemto be aware of the bronchial affec-tion, notwithstanding the existence ofits most unequivocal symptoms in the

livor of the surface during life, andthe darkness of the blood after death.The simple form of fever is distin-

guished by the skin being hotter, andthe pulse at the same time quickerthan natural, without any discover-able sign of internal or external in-flammation; the blood circulates withI more than ordinary speed, but is soequally distributed throughout the

bo,ly, that no particular organ sustainsan interruption sufficient tq give riseto inflammation. This form of feveris the most frequent among children,and can only exist in sound constitu-tions, where the internal or externalparts have no latent faultiness. Thoughthis form of fever most frequentlyproceeds from a common remote oc-casion, yet it sometimes is connectedwith a peculiar one. Thus scarlatiiza,measles, and small-pox, under theirmildest characters, are simple fever,,with reference to the internal organs,which are excited, but not inflamed ;simple, general, and local excitementbeing distinguishable from inflamma-

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tion by the signs which he enumeratedin his former Lecture on that subject.The inflammatory form of fever is I

distinguished by the skin being hotter,and the pulse at the’ same time

quicker than natural, while there areeo-existent signs of some internal orexternal inflammation. The reason

why the fever puts on the inflamma-tory form, when it arises from com-mon remote occasions, is generallythat some hereditary, oetal, sexual,or acquired predisposition exists,which becomes converted into inflam-mation, from the excitement of theheart and vascular system, though un-questionably inflammation may ariseprimarily from the direct influence ofan irritant. The reason why fever,when it arises from a peculiar remoteoccasion, puts on the inflammatoryform so frequently, partly dependsupon the special property of thecause, which operates, as before ex-plained, on particular structures, es-pecially the mucous tissue, and partlyupon the state of the patient at thetime of the attack, for if any internalorgan then be predisposed, that organmay become inflamed, on the ordinaryprinciple of excitement. The inflam-matory form of fever, even when itarises from common remote occasions,necessarily has a most extensive range Iof character, for the inflammationbeing seated in different parts of thebody, and in different structures, thefunctions of which are widely discre-pant, the symptoms of this inflamma-tory form of tever are consequentlyvaried extremely, though its nature beessentially the same, and though it bealways compounded of fever and in-flammation. Even the inflammatoryform of fever, when it arises from pe-culiar causes, has also a considerablevariety of expression, not only withrespect to its external, but to its in-ternal pathology ; for the skin is dif-ferently affected in scarlet fever, inmeasles, in small pox, and in typhusfever, while in the three former, thefauces and air passages are most lia-ble to suffer, but sometimes the lin-

ing of the bowels and sometimes thebrain. Again, in typhus, the pia materand arachnoid, the bronchial and in-testinal lining, are always found in-flamed in fatal cases when the feverhad been developed, and sometimes

even the internal tunic of the arteriesand veins, a circumstance which hadbeen too much overlooked by morbidanatomists in the typhoid or typhousmoditication of fever. If, then, the

practitioner had a clear knowledge ofthe symptoms and the pathologicalconditions, whether of venous conges.tion, simple excitement, or actual in-flammation, with which they were in.separably connected, his philosophy ofphysic would be so far different fromthe ancient and conjectural systemthat it would at once lead him to dis.tinct indications of treatment. Still,however, a man might be an excellentpathologist, and yet a bad practi.tioner; for as a correct pathology canonly be attained by minutely notingdown the symptoms during life, andby minutely examining bodies afterdeath, in order to infer the patliologi.cal, or real cause of the symptoms,soprecision in the application of reme.dies can only be acquired by mostsednlously marking the effects of each,under all the varied eireiiiiistancesoccurring at the time of their admi.nistration. Observation and expe-rience, then, in the strictest sense ofthese words, are necessary to form anaccomptished practitioner, who shoulddespise that system of daily rontipe,which leads the mere man of medicalbusiness to go a certain round daily,like a horse in a mill, without the ex-ercise of his intellect.

In the perfect congestive form offever, tire great object in the first in-stance is, to restore the .balance ofthe circulation between the externaland internal parts, and between thevenous and arterial sides of the cir-cutation.

In all those cases where the skin is

universally cold, and the l1eart’s M-tion sunk, the application of dry heal,under-’the form of an air bath, andthe internal use of stimulants art thebest ; but when the animal heat andthe heart’s action have been in somedegree restored, then the abstractionof blood, if any organ should remainoppressed, is generally the best mea-sore, the quantity being regulatedcarefully by the effect upon the pulseof the patient, the local disorder, andthe general power. In some of thesecases, the symptoms are at once re-moved by these measures; but in

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some they entirely fail, where theshack is most excessive; and in othersthey remove the congestive sytnp-toms, which are soon followed bythose of an inflammatory nature, re-quiring to be managed accordingly.In the simple form of fever, the

objects are to lessen the heart’s ac-tion, to diminish the animal heat onthe surface, and to restore the secre-tions to a natiirat stale. Rest, a

bland spare diet, quietude, tepid ab-lution, a fresh atmosphere, a regn-lated temperature, which shall neitherchill- nor heat the surface, and mildaperient medicines, will almost alwayssuffice in this form of fever, blood-letting, local or general, being com-monly not necessary, never, indeed,except in tho<-e cases where inflam-mation is threatened.The inflammatory form of fever,

even when-it arises from remote com-mon occasions, requires various modi-tcations of treatment ; for though theobject be merely to remove the in-flammation, vet that inflammation oc-curs in different structures, and thosestructures are a part of beings diffe-rent in age, in sex, in strength, andin other peculiarities, all of which re-qnite to be taken properly into ac-count. In infancy and old age, co-

pious evacuations of all kinds, butespecially of blood, are worse snstaiu-ed than at any other period of life,creatina extreme irritation and ex-

hanstion in infancy, and often irre-

trievably sinking the powers in oldage. Besides, the skin and mucousmembranes are more apt to suffer fromirritants in infancy than in adult ormiddle age. Women, generally, donot bear evacuations so well as tnen,hut there is an exception to this re-

mark in fever occuring after child-bed, where the serous membranes areinflamed, and also in puerperal convul-sions from congestion of’ the brain, inboth of which prompt, and sometimesshortly repeated and bold bleedings arenecessary to save the lite of the Datient.Persons of a weak and lax fibre suffermore from copious losses of bloodthan-those of a strong firm fibre. Withrespect to structures, serous and fi-brons inflammations, where the feveris fairly expanded, require, generallyspesking, much more active blood-letting than mucous inflammations;

and again, in mucous membranes, es-pecially of the intestinal canal; localbleeding by leeches is generally pfe-ferable; while in both, if seated in theabdomen, att harsh purgatives shouldbe studiously avoided. Acute inflam-mation generally requires more activeevacuations than subacnte inflamma-tion, but to this remark some excep-tions existed; for when an inflamma-tion was excessively acute, for in-

stance, on the bronchial lining, itsometimes so smothered the excite-ment, so oppressed the vital functionsand changed the blood, as to makethe observant practitioner most guard-ed in the use of all evacuants, exceptthose which operated gently on thebowels and skin. Moreover, in activeinflammation, where the heat was

high on the surface, where the pnlsewas hard as whip-cord, where thetongue was moist, and where the

strength was unsubdued, bloodletting-was generally well sustained; whereas.in passive inflammation, where theheat was low on the surface, wherethe pulse was soft and feeble, where’the tongue was glazd and dry, andwhere the strength was prostrate,every thing like copious evacuationwas to be most diligently shunned.These were among some of the factswhich Dr. ARMSTRONG enumerated toshow the necessity of studying thoseparticular circumstances which modifythe application of general principles;for however valuable, he said, gene-ral principles might be as great andleading guides, yet particulars werso important to be considered, thatlife frequently depended upon theirright appreciation.- In advertencsto this point, he showed the dan-ger of’ prescribing in the same man-ner, under all circumstances, forone and the same supposed disorder,because it bears the same name, - and

he instanced the fatality attendant onthe- ordinary treatment of erysipe-lasin some of the metropolitan hospitals,an affection which he contended re-quired very different metlinds oftreatment, according to the charac-ters which it assumed. According 10.Dr. ARMSTRONG ; erysipelas assumes,in the British metropolis, three cha-racters, each of which demands a dif-ferent mode of management. Thefirst modification of erysipelas he calls

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pblegmonoid; the second, erythema-tic ; and the third, specific, by wayof distinction. The phlegmonoid ery-sipelas attacks strong individuals, andlike the rest, abstractedly considered,may be viewed as an inflammatoryaffection of the skin, which sometimesspreads to the celltilai- membrane be.neath. In this phlegmonoid modifi-cation, the inflamed pait is vividlyred ; it swells rapidly, and is attend-ed by a very hot skin, a full and hard,or a contracted and hard pulse, anda moist tongue throughout its progress.It appears upon the face or exttemi-ties, and is sometimes attendod, in itsorigin or course, with some internalinflammation. The crythematic ery-sipelas attacks weak persons, espe-dally when confined in the wards ot’an hospital, or in a close situation.The inflamed part, generally, has amulberry appearance ; it does not

swell so rapidly, but vesicles are aptto appear earlier upon its surface; theheat of the skin is not so high, thepulse is soft and feeble compared withthat in the phtegmonoid, and the

tongue becomes glazed, dry, and

brown, in fact, the attendant feverpnis on the typhoid character. Inthis modification of erysipelas, whenit proves fatal, the pia mater andarachnoid, the bronchial and intesti-na1 lining, and sometimes the internalcoats of the larger arteries and veins,’exhibit distinct traces of inflamma-tion ; so that Dr. ARMSTRONG consi-dered the external an’ection, called

erysipelas, really the smallest part ofit, so manv internal organs being si-mnltaneously affected. The specificerysipelas arises in the course ofgenuine typhus fever, and may have,at the commencement, the phlegmo-noid, and at the close the erythematiccharacter; but one very remarkablecircumstance in regard to it was, thatit might attend a remittent or a con-tinued form of typhus, a fact whichrequired an important alteration inthe treatment.

Dr. ARMSTRONG showed, that whitethe phtegmonoid erysipelas now re-quired as active evacuations as thoseemployed by SYDENHAM, the erythe-matic, on the other hand, requiredthe greatest caution ; but he repro-bated the wine and bark system, sogenerally adopted in Londou. and, in

its stead, recommended mild evacua.tions from the bowels, with a blanddiet and the influence of a pureal-mosphere, without which no means

would be generally efficacious. Asto the use of wine, it should be hereregulated, in certain cases, by thesan:e rules as he had laid down intyphus. B

As to the specific erysipctas, heshowed that it might be readily cnredwhen combined with the remittenttyphus, by the sulphate of quininewhere the remissions were distinctbut that where it occurred with thcontinued form of typhus, bark wadecidedly prejudicial. He had no faitin any local applications in erysipela;and had abandoned them all, excepthe use of a little arrow rool, dustegently over the part, or the applica-tion of a blister to the nape of theneck, which he had repeatedly seenarrest erysipelas of the face.

Dr. ARMSTRONG finally spoke i

the difference between those fevewhich arose from common and penliar causes, pointing ont that in tilatter case they frequently had asoof determinate duration, which pratitioncs-s should duly regard, bnt thlmake the treatment too active in timiddle and advanced stages. -

The Doctor advised his pupilto be diligent throughout their livein noting the effects of remedieand did not hesitate to say, that learnt to apply them with more pf!pision, endeavouriug to make ever

day and year a useful commentaryupon the fact. Among the nice

adaptation of means to ends, he men-tioned the gradual and, at lengtgreat improvements which he had thembeen enabled to effect with respeto his own practice in the enploymeof bloodletting, aperients,calomel,ai an

opium, and more particularly in thof the regimenal and mental managment of the sirk.

Having pnt them in possession ofwhat he confidentJy regarded as &egrave;or.rect principles of pathology and prac.tice, as to all febrile affections, hecould not refrain from once more cau-tiouing them against those vague doc-trines of debility which were still ad.vocated by some self-elected andelated confederates of old chapteredand exclusive establishments, doc-

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trines which were so entirely of thelast century as to be ntterlyunworthyof this enlightened period-doctrineswhich were alike faise in theory andfatal in practice ; whereas the simpleviews which he had taken of the pa-thology of fever could be fully stib-stantiated by a reference to symptomsand morbid anatomy, white the pre-cise application of the few measureswhich he recommended in practiceled to a success utterly unknown tothose dogmatical and empirical ad-vocates of the old system, some ofwhom, as in the time of SYDENHAM,still attempted to give a tone to theprofessional opinion of the BritishMetropolis in particular, though thetime was now come when such at-

tempts would be completely frustrat-ed by the intelligence, simplicity, andardour of the rising generation ofmedical men. He rejoiced that hewas among the number of thosewho had raised their voices against

- prevailing errors, and it was matterof sincere pleasure to him, that hehad been heard and regarded bythose to whom he had so strenuousiyand sincerely appealed in the causeof troth and humanity..

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Dr. ARMSTRONG next adverted to

convalescence, which he said shouldnot be viewed as a state of recovery,but one of great delicacy, in whichthe body was generally weak, and inwhich particular parts were usuallypredisposed, so that general and localimpressions were liable to produceserious effects. Upon the whole, heremarked, that he has seen more

deaths from relapses than from origi-nal attacks, partly owing to practi-tioners being thrown off their guard,and partly owing to the imprudenceof patients at that period. He refer-red the causes of relapses to errors inthe kind or quantity of the diet anddrinks, to a low or a high tempera-ture, to over exertion of body, to dis-turbance of mind, or to neglect otbowels, and showed how relapsesmight be certainly avoided by gradu-ally recruiting the strength and avoid-iug the remote occasions from whichthey arose.

Having concluded our labours fin

Dr. ARMSTRONG’S lectures on acute

disorders, we shall give an abstract

of his lectures on Chronic Affections,in five parts; the first, on chronic af__tectiolls of the brain and nervous sys-tem ; the second, on those of thef’auces, air passages, lungs, and heart ;the third, on those of the stomach, in-testines and liver; the fourth, on thoseof the urinary and uterine organs;and the last on the pathology and,treatment of dropsical aifectious.

LECTURESON

PHRENOLOGY,BY

DR. SPURZHEIM.

LECTURE 11.

LADIES AND GENTLEMEN,We are now arrived at the consider

ration of the forehead, and no one canbe more convinced of the necessity ofthe brain than myself to the manifes-tations of the mind. It is a common

opinion that the intellectual powers de- _

pend on it; but I confess that I feelmore difficulty, by far more difficnltyin showing that, than I have in show-ing that its- existence is necessary forthe manitestation of the powers calledfeelings. I would not advise you tobegin the study of Phrenology withthe intellectual region, for there aredifficnlties above difficuities in theforehead.

Size.

We have already seen that theforeheads are very different in their

general size. Now as to the size ofthe forehead, we must make somereflections. The size alone is not thecause of the greater activity, it is onlyone of the conditions. In speaking ofthe intellectual powers, we have toconsider the inflaence of the constitu-tion, seeing that with foreheads ofeqnal size, one individual will havepowers more active than another,But we come now to the most imme-diate difficulty, which is to ascertaincorrectly the size of the forehead ; nt tonly is it difficult to judge of the diffe-