leeches, as advised by Dr. Fowler, and trusted chiefly in diaphoretics, diluents, laxatives, and rest. Ultimately Dr. Wells and Willan came nearly to the same conclusion, as respects the treatment of the disease in London and large towns, namely, that blood-letting is either unnecessary or injurious by enfeebling the patient, and favoring internal translations of the malady.

More recently, Mr. Bedingfield and Dr. Craigie have advocated early and large blood-letting. But the former wrote when venesection was a common remedy and was certainly less prejudicial, as respected the prevailing epidemic constitutions, (from 1810 to 1825), than it has been subsequently. Dr. Craigie, practising in Edinburgh, has declared in favor of blood-letting, aided by diaphoretics and cathartics, and contended that, "in order to be beneficial, it ought to be performed early in the disease, and carried to a considerable extent." He considers that the best time is within the first two or three days; or, at all events, within the first week. "It should be carried," he adds, to "twenty, twenty-five, or thirty ounces at once, and, within twenty-four hours, to as much more." And he attributes the want of success of Fowler and others to the smallness of the quantity taken. Mr. Bouilland has advocated a somewhat similar practice to the foregoing; but, instead of abstracting at once the quantity advised by Dr. Craigie, he has adopted the abandoned method of Sydenham, and has advised a smaller quantity on more frequent occasions to be drawn.'

Here is a labyrinth of contradictions! Every possible opinion, it seems, that the human mind can entertain relative to the utility of blood-letting in rheumatism, is, or has been, held by some eminent physician of large experience. Some of these eminent physicians (Boerhaave, Tissot, Pringle, D. Monro, Stoll, Thilenius, Bang, Craigie, and Bedingfield) advocated the necessity of abstracting, once or twice at the outset, a considerable quantity of blood; others (De Baillou, Riverius, and Bouillaud) prescribed small but frequent bleedings; others (Heberden) advised bleeding only

to robust persons; others (Stoerck, Van Swieten) thought the same fit for none but the growing and plethoric, when the pulse is strong and full; others (Sydenham, Latham, Fowler) considered bleeding not requisite; and again, others (Fordyce, Wells, Willan) believed that bleeding causes the rheumatism to quit the joints, but attack the heart and other internal organs. What, then, are we to make of this diversity of opinion? Is it impossible to come to any decision as to whether bleeding is useful, or injurious? Twelve eminent physicians assert that bleeding is required in all cases of rheumatism; three assert that only the young, robust, and plethoric require to be bled; three others assert that neither old nor young require bleeding. And again other three maintain, that 'bleeding is either unnecessary or injurious, by enfeebling the patient and favoring internal translations of the malady.'

'M. Tomès,-Monsieur, nous avons raisonné sur la maladie de votre fille, et mon avis, à moi, est que cela procède d'une grande chaleur de sang: ainsi je conclus à la saigner le plus tôt que vous pourrez. M. Desfonandies. Et moi, je dis que sa maladie est une pourriture d'humeurs causée par une trop grande réplétion: ainsi je conclus à lui donner de l'émétique, M. Tomès. Je soutiens que l'émétique la tuera M. Desfonandies. Et moi que la saignée la fera mourir. M. Tomès. Si vous

ne faites saigner tout-à-l'heure votre fille, c'est une personne morte. M. Desfonandies. Si vous la faites saigner, elle ne sera pas en vie un quart d'heure'! To escape from this slough of conflicting opinions we naturally turn to Dr. Copland's own views upon the subject, hoping to find some explanation of the mutually repugnant and dogmatic assertions which he has raked together; some statement which might make manifest to us the reason why twenty-one equally learned, skilful, and orthodox physicians, each possessed of vast experience, cannot agree among themselves upon the point whether bleeding be beneficial or pernicious to a rheumatic patient. How greatly we were disappointed the reader may imagine, when we found that Dr. Copland showed him only a twenty

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second learned, skilful, orthodox physician of vast experience, and gave merely a dogmatic assent to one of the four propositions, which divide the twentyone 'grandes doctores doctrinæ de la rhubarbe et du Séné'! One would have imagined that twenty-one discordant opinions were enough; and that it was time to leave off delivering oracles, and recur to facts and reason. would have thought that what is wanted is statistics, to prove, by the irresistible might of figures, whether of rheumatic patients who are bled there recover more than of rheumatic patients who are not bled; but Dr. Copland is satisfied to go on like his predecessors and prefers assertion to proof. Dr. Copland says I believe'-who cares to know what Dr. Copland believes? He has told us what Boerhaave, and Sydenham, and other great men, twenty-one in number, believed, and we have profited very little by the information. Are we, then, likely to profit more from an acquaintance with Dr. Copland's belief? However, Dr. Copland says: 'I believe that the treatment of any form of rheumatism by blood-letting, as a general principle of practice, however early in the disease, to be productive of injury in some cases-of rheumatic inflammations of the internal and external membranes of the heart, of the peritonæum, pleura, synovial membranes, &c., of delirium, prolonged convalescence, and of the degeneration of the more acute into the chronic states. I will not deny that the robust, or those in the prime of life, who live well and enjoy a wholesome air, will bear full or even copious depletion at an early period of the disease, generally without detriment, and possibly with advantage; but I am convinced that in large cities or towns, in persons employed in warm, ill-ventilated factories, or those living in crowded rooms, low apartments, cellars, etc., in the very

MUCILAGE OF SNAILS IN CONSUMPTION.

M. DE LAMARE has just presented a paper to the Academy of Sciences of Paris, wherein he states that he has obtained the cure of confirmed consumption, even where the lungs were ulcerated, by the internal administration of the mucilage of snails. The author thinks that this old remedy has fallen into

young, and in the old especially; whereever there is any indication of deficiency or poorness of blood; and, à fortiori, in the ill-clothed and ill-fed, vascular depletion in any form is often most injurious and always unnecessary-rarely required even for the apparently robust; unless it be conjoined with the method of cure which I shall commend in the sequel.' And this is all that Dr. Copland has to bring forward on the subject of bleeding! which amounts, in fact, to just this, that twenty-one physicians entertain among them four different opinions, and that Dr. Copland is convinced that one of the four propositions is true, and the other three false. Not a single argument is brought forward; there is no tabular statement, nor analysis of cases; the whole resolves itself into a bare enunciation of Dr. Copland's opinion, which we would gladly have been spared, for the twenty-one opinions which he has collected are in themselves sufficiently discordant to sicken us of opinions, unsupported by a reference to recorded cases. It is an easy thing, we know, to give an opinion, and it is not difficult to collect the opinions of others, and so to make up the biggest book of the day,' but we venture to predict that 'the biggest book of the day,' so made up, will fall into speedy oblivion, and become the tranquil prey of the moth or worm. What we want in the nineteenth century is proof and not opinion, even though the opinion be enounced by a Cullen or a Copland. We want to have it shown to us that bleeding is good, or that bleeding is bad: we utterly despise the string of authorities arranged on this side and on that side of the question; and, unaccompanied by proof, we have no higher reverence for the opinion of Dr. Copland than he has for the opinion of Paracelsus.

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disrepute, owing to the faulty manner in which it used to be administered, and the small doses employed. He therefore instituted numerous experiments described in his paper, and concludes that broth made with the mucilage are powerless; but that the substance should be highly concentrated and given in large doses presenting but a small bulk.

SCENE. A Physician's consulting room. PHYSICIAN.-Favor me with the particulars of your case, Mr. Brown.

MR. B.-Well, sir, my chief ailment is constipation of the bowels.

PHY.-Have you suffered long from this complaint?

MR. B.-You will perhaps be surprised when I tell you, that I have not had a natural motion for twenty years. Indeed, from the great length of time which it has endured, I believe that my disease is past the skill of medicine.

PHY.-Why, then, do you come to

me?

MR. B. For this reason: my bowels, as I stated just now, have not acted naturally for twenty years, but I have always been compelled to have recourse to aperient medicine. The mischief of this is, that my internals have got to be so familiar with physic, that physic has lost its effect upon me; at least, none but very powerful drugs produce the slightest result. At the commencement of my malady, the bowels responded very well to a few rhubarb pills. But in time these lost their efficacy, and I had to look out for a different remedy. This also answered very well at first, but soon, like the rhubarb pills, it ceased to act. I then took something else, with the same result; and I do believe that there is not an aperient drug in the pharmacopoeia with which my stomach, under the direction of my family attendant, has not been glutted. But in addition to these (a drowning man catches at a straw), there is not a quack pill advertised in the newspapers, that I don't know the taste of. But it has always been the same story. Every medicine acts like a charm when I first begin it, but after a short period it becomes just as operative as so much pounded post.

PHY. And what, then, have you determined to do under these circumstances ?

MR. B.-To consult you. I have heard of some surprising cures which

Dr. Jobson in conversation with his Patient. you have effected; I allude, in particular, to the case of my friend Tippets, who assures me that he was as bad as I am (though I cannot believe that) before he saw you, but that you have completely restored him. This extraordinary cure leads me to believe that you are acquainted with some medicine of a particularly effective character that may suit me, and at length put me in possession of a medicine whose utility will not be destroyed by continual use. That is the thing I want; for, of course, after twenty years of suffering I cannot, like my friend Tippets, expect a cure. Now that I have explained my object in visiting you, will you oblige me with the wonder-working prescription?

PHY.-Indeed, it would give me pleasure to assist you; but I have no such prescription.

MR. B.-How is that? I cannot be misinformed. I am confident that my friend mentioned your name as his benefactor?

PHY.-Very true: but I treated and cured Mr. Tippets without the aid of physic.

MR. B.-Is it possible! I understood his was a very bad case-indeed, as severe as my own.

PHY.-You are correct. It was so: but it was cured without physic notwithstanding; and your's may be cured in the same manner.

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MR. B.-Ah! by diet, I suppose: but assure you, you are mistaken, Doctor. I have tried diet, and it failed.

PHY.-Indeed!

MR. B.-Yes it is now some years since my regular doctor, a very intelligent man, persuaded me to live more quietly. In point of fact, he always had been adverse to my mode of life, which was perhaps in those days a little too free; not that I ever indulged to any excess. I was never drunk in my life, and never ate largely, as some people do. No: beyond a glass of wine, or, perhaps, two glasses at dinner, and a tumbler of

brandy and water with my cigar in the evening, I drank nothing that any one could object to; and, as for eating, I lived in a very plain and homely way. But of late years, as I said, I have restricted myself more closely. I drink no wine, beer, nor spirits. I have left off smoking, and, in point of fact, consider myself a perfect Cornaro. But my bowels are are not in the least degree improved by the sacrifice I made.

PHY.-You continued to take medicine when you changed your diet?

Mr. B.-I was compelled. I waited two days to see if my new diet had any effect; but finding none, and beginning to feel uncomfortable, and knowing how necessary it is that the bowels should act daily, I was afraid to allow matters to go on so, and, therefore, took my pills. And I have often since tried the same experiment, and omitted to take the medicine one or two days, hoping that after the lapse of time the diet might have caused an improvement in the bowels; but I was always disappointed, and driven to fall back upon physic.

PHY.-What is your occupation?
Mr. B.-I am a linendraper.

PHY.-Do you stick close to business? Mr. B.-Why, yes: and in point of fact I have reason to believe that I have stuck too close. I am in the shop from morning to night, or rather till we close, which is now, in consequence of the earlyclosing movement, about eight: but then I am not free, for I have to make up the accounts, which takes me perhaps another hour; so that you see I am constantly immersed in business.

PHY.-Well, sir, I have now heard sufficient: I clearly perceive the origin and nature of your complaint; and will give you a few short, plain, and easy directions; which, if obeyed, will infallibly lead to a cure. The causes of your ailment are the following:-In the first place, by your own confession, you have disobeyed one of the most important-I had almost said the chiefof the laws of health. In confining yourself so closely to business, you have neglected exercise in the open air. No man, woman, nor child, neglecting this prime condition of our nature, can

remain in good health. You have neglected this condition, and suffer for the neglect. The way in which exercise obviates constipation is this,-When the body is put into activity, the pulse is increased in speed; the circulation of blood all over the body is facilitated; the blood is directed particularly to the excreting organs, as the skin, kidneys, and bowels; and, consequently, the secretions from these organs are augmented; but when the due secretion into the bowels is brought about, regular evacuations result.

Mr. B.-But I do not follow that statement satisfactorily. I thought that an evacuation was merely the undigested residue of the food. What have the secretions of the bowels to do in the matter?

PHY. I have not at present time fully to explain to you the doctrine of fœcification: but I may say thus much, Only a small part of an ordinary evacuation is undigested aliment; part is coloring matter of bile; but by far the greater proportion is matter secreted into the bowels themselves out of the blood. This being so, it is manifest that exercise, promoting as it does, all the secretions of the body, and the intestinal secretions among the rest, is a most important safeguard against constipation. The first

piece of advice, therefore, that I have to give to you is this: TAKE EXERCISE. The next point in your case regards the use of physic. You are probably not aware that all medicines have a double action upon the economy. These are termed primary and secondary: and the secondary is in its nature exactly the reverse of the primary. For example, if the first action of a medicine be to excite, its secondary effect will be to depress; if the primary effect of a drug be to increase any secretion in quantity, the secondary effect of that drug will be to diminish the same in quantity. Take the skin in illustration. When a jockey goes into training, he systematically sweats himself by wearing very thick clothing, and taking severe exercise; but after he has persevered in this plan for some time, he sweats with greater and greater difficulty, until at last he is able to undergo the tremendous

exertion of the race, without losing a drop of perspiration. It is the same with the bowels; if we force their secretion by drugs, the natural secretion is diminished: and we may go on artificially exciting the secretion, until at last the secretion becomes so difficult as never to occur independently of medicine, This, sir, is just your position. You have, as it were, so sweated your bowels with drugs, that the natural bowel-perspiration is destroyed.

MR. B.-It is then, as I feared; the natural function of the bowels is irreparably ruined.

PHY.-Not so. Nature is a more bountiful mother than the faults and follies of her children deserve. No, you have yet a chance if you will avail yourself of it; but you will perceive that an essential condition of cure is total abstinence from purgative drugs.

Mr. B.-I see that, according to your principles, every dose of purgative medicine that I swallow augments my disorder, and diminishes the probability of cure. But I do not understand how I am to dispense with these drugs, for my bowels must be opened in some way or another; and I know of nothing but physic that will serve.

PHY.-But I can tell you something that will serve.

Mr. B.-Pray let me know of it.

PHY.-Faith in Nature. Think more worthily of Nature, I pray you, and less highly of Art. Resume the exercise which you took as a child, and discontinue the filthy potions with which you have poisoned your inside.

Mr. B. Well, but I have repeatedly tried that plan. On one occasion I went without my pills for three days; but my bowels were obstinate.

PHY. And do you think three days a sufficient length of time to allow nature to cure a disease of twenty years' standing ?

Mr. B.-Certainly not: and therefore I presume that I must resign the hope of nature curing me.

PHY.-Why so?

Mr. B.-Because if I wait many days for nature to cure my constipation, I fear that the constipation may turn to inflammation, which might speedily

take me out of nature's hands altogether.

PHY. It is a mistake to suppose that any danger of the kind exists. I have never seen, heard, nor read, of a case of constipation turning into inflammation of the bowels; nor is there any intelligible reason why such a thing should happen. Constipation is one of two things: it is either an unduly prolonged retention of a motion in the bowels, or a deficiency of secretion into the bowels from the blood. In the latter case there is no more cause for inflammation of the bowels, than there is for inflammation of the skin under a suppression of perspiration. And in

the case of a retained motion, we should not expect inflammation, for the fæces do not act upon the mucous membrane of the alimentary canal as a mechanical irritant. The alimentary canal is the receptacle provided by nature for the fæces; and, consequently, it is so constructed as not to be injured by substances with which it is of necessity in constant contact. If the fæces acted upon the bowels as a mechanical irritant, and produced inflammation, which of the seventy-two millions of British bowels would be uninflamed?

Mr. B. It is certainly true that the natural fæces are devoid of irritant qualities; but when they have been some days retained, do they not become acrid, and so inflame the bowels?

PHY.-By no means. The only change undergone is a gradual absorption of the watery portion, and consequent semi-solidification of the motion; but this semi-solidified motion remains perfectly innocent as regards the bowels.

MR. B.-Well, sir, of course you know best, and I cannot pretend to reason with you on the subject. But I have always understood that it is matter of experience, that when the bowels have been some time obstinately confined, inflammation is very apt to supervene.

PHY.-Such is certainly the case; but the inference deduced from this fact is incorrect. When from some cause a mechanical obstruction of the bowels occurs, constipation-obstinate, insuperable constipation, ensues, and, after this has lasted some time, inflammation comes