—No. 3.] LONDON, SATURDAY, JULY 23, 1825.

FROM

LECTURESON THE

PRINCIPLES AND PRACTICE

OF PHYSIC,

BY DR. ARMSTRONG.

Theatre of Anatomy, Webb Street.

The following is an Abstract of Dr.Arinstrong’s Lectures on Chronic

Affections of the Brain and NervousSystem.

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Dr. ARMSTRONG commenced by ob-serving, that all the remote occasionsof chronic affections might be ringedunder three heads: inherent occasions,external occasions, and certain errorsofiugesta; and he premised, that thepathological conditions of chronic af-fections, like those of acute or sub-7acate ones, were few and simple,however complicated, at first sight,might be the-various symptoms bywhich the existence of those condi-tions were indicated. So intimate,

e said, were the relations betweenacute and chronic affections, thatthe practitioner who the most dis-

tinctlv understood the nature andtreatment of the first class would bethe tiiost likely to have most correctnotions of the second class ; and there-fore, in the preceding lectures, he hadendeavoared to give simple elemen-tary views of acute affections, whichhe should now endeavonr to extend,as far as the subject legitimately ad-mitted, to the solution of chronic affec-tions, some of which, however, hewas ready to allow cou!d not be ex-plained by a reference to the doctrineof congestion, simple excitement, orinflammation, though one or the otherof these conditions was indisputably

connected with a large majority ofchronic affections, as the sequel wouldshow. He said he would observe thesame order in illustrating chronic af-fections which he had done in illus-

trating acute ones, and should there-fore begin with chronic affections ofthe brain and nervous system, treat-ing them under certain subdivisions,in order to explain their particularas well as general bearings.

Chronic inflammation of the Brain, orits Membranes, with softening of thesubstance of the Brain.

Chronic inflammation of the brain,or its membranes, is much more com-mon after than before forty years ofage, though Dr. ARMSTRONG has seenseveral cases occurring in young per-sons. The causes which most fre-

quently excite it are mental anxietyor over excitement, the free use ofstrong wines or liquors, repeated

night-watching, great bodily exertion,

I irreguiarity of meals, and licentious

passions ; but sometimes it is the con-sequence of an acute inflammation,and occasionally it arises insidiouslyfrom blows on the head, especiallywhen the diets or drinks had been dis-regarded for some time after snch aninjury. Some persons are more pronehereditarily to it than otlters, but a! disposition to it is often laid, in ad- vanced life, by an earthy deposit onthe arteries within the head, a condi-tion of vessels at least with which itis often connected. Chronic iiiflam-mation of the brain, or the membranesof the brain, is announced bv Dain in

I the head, which the patient generallyrefers to some particular spet. This

pain is mostly continned, but in someI cases it is only occasional in the co :n-mencement. It generally occupies alarger space, when the membranes ofthe brain are chronically inflamed,than when the substance of the brainis inflamed. After this pain has re-

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mained for some time the patient he-comes liable to pains about the neck,scapula, arms, or legs, so that the pa-tient often supposes himself to herheumatic ; bnt these pains differ fromthose of rheumatism, in as much as

,they are not attended by anyswelling.Dr. ARMSTRONG thinks this is a veryimportant point to remember, for hehas frequently known chronic inflam-mation of the brain, or membranes,overlooked by practitioners, under thesupposition, that the pains and affec-tion were altogether rheumatic, anerror which has led to fatal results.When these pains have continued forsome time the patient usually com-plains of creeping sensations, and thenof numbness in the parts affected,which, after that peiiod, gradually,for the most part, but sometimes sud-denly, lose their power under theform of palsy ; but long before thelatter disorder occurs, the mind be-comes depressed or irritable, and some,of the external senses, especially the

sight, are apt to be disturbed in theirfunctions. Giddiness is a very com-mon symptom in the progress of the

complaint, under which the stomachis generally disordered, the bowels

.torpid, and the btadder either irritableor torpid. This affection terminatesin palsy, in apoplexy, in low fever, orin some forms of madness, all whichDr. ARMSTRONG has witnessed.

,

On examining the brain after death,the membranes are mostly found moreor less inflatned, and a portion of the.brain is broken down, softened so asto resemble custard pudding or pulp.Dr. ARMSTRONG considers that this

softening is generally the gradual con.sequence of a primary local illflamma-tion, but he has occasionally found ita secondary one from an effusion of-blood, or from an organic tumour.He thinks it is of the utmost conse-quence to be well acquainted with thesymptoms which attend the first stageof inflammation of the brain, thatwhich sometimes exists many days,weeks, or even months before the

softening occurs as the ultimate effect.The pain in a particular part of thehead, the pains resembling rheuma- tism in other parts of the body, de-pression or in itability of mind, gid-diness, some visual weakness or dis-tutbance, and creeping sensations or

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numbness, he considers the mot diag-nostic signs of that stage, and thinks,that when palsy has actually taken

place, or when the functions of thmind have become decidedly disturb-ed, that the softening process bas

generally taken place, though le hasseen a few cahes which did well 6VUafter palsy had happened in the

tongue, hand, or leg, but he con·idensuch instances rather an exception to

a general fact.In the -first stage of the disease,

Dr. ARMSTRONG has great faiih in

bloodletting, mild aperients, a sparediet, rest of body, with quietude ofmind, as far as the abstraction of alldepressing and exciting occasions canbe withdrawn; and, in proof of thecomplete efficacy of these measures.he adduced some cases,but remarked.that nothing could be done in the ad-var.ced stage, when the disorganiza.tion had actually taken place, but topalliate the symptoms by removintall opposing circumstances, such as

errors in the regimenal and mental

management of the sick. Dr. ARM-STRONG passed some high encomiumsupon ROSTAN, whose able work onthis sllbject he strongly recommendedto his pnpils, as containing an excel-lent account of a disease which wasvery common in this country, and butlittle understood by thegeneratittct ofmedical men, especially those who badbeen educated under the nosologicalsystem still in vogue in our schoolsaud colleges.

Inflammation of the internal Ear, af-fecting the Membranes of the Brainand the Brain itself.

Dr. ARMSTRONG mentioned, that ioflammation of the internal car some-

times spreads to the membranes of thebrain, and even the brain itself, occa-sioning inflammation in both those

parts. This affection, he said, mostfrequently arose from an inflammationof the fauces, extending itselt aloncthe enstacian tube into the internalear, which was most liable to happenin bad cases nf scarlet fever, measles,or small pox, or common chronic alce-rated sorethroat, but the inflamma-tion occasionally commenced in the

lining of the external ear, and 6nalls.from that quarter, invaded the inter-nal one, and ultimately leached the

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brain. In such cases, the

skin andmucous membrane ot the intestinalcanal are.oat of order, and, by conse-quence, the inflammtion pats on anili-conditioned character; the petrousportion of the temporal bone becomescarious, the dura mater is at lengthaffected, and finally the brain. If suchcases he misunderstood, or misma-naged, this is often the fatal resillt ;but wilen they are clearly understoodand well managed, they are often

. arrested ln their progress, the pa-tient’s safferings shortened, and his

, liie save-d. As this inflammation is

generally maintained by a disorderedconditioii ot the skin and, internalmucous tissue, the main object is -to

restore that to a healthy condition, bya simple diet, by the use of the tepidbath, by a fresh atmosphere, by earlyhour, as to sleep, and a train of tem-perate and regular habits, aided bysmall do:es of alkalies and an occa-sional mitd aperient, where the bowelsare not regular. Sometimes evacua-tions by the lancet or leeches are ne-uessar.y, when the inflammation runshigh, but this step is seldom requisttewho) the regiiiieiial and mental ma-nagement is judicious.

Apoplexy.Apoplexy is occasionally the sequei

of softening ot the brain, but it is farmore frequently the product ot sim-ple turgescence Qf that organ, oftenfavoured by that tender condition ot’the vessel, inside the head, which iso commonly found in those who dieapo,)lecric. and which is the result ofan earthy deposit between the co,itsof the arteries. A teamed and ex-celleta person had written a work onapoplexy, ill which he had given theopinions of almost all. anthors on thesubject, and like them, he had comedirectly to the symptoms of the at-tack itselk, as if it were not only sud-den but unpreceded by any warnings.But the tmtli was, that, generally,the attack was distinctly announcedtor .eeeral days, and so4-netime,weP:.s, and this was a fact most im-portant to be known, as the attackitself mighft commonly hI:, warded offby acting on a right knowledge of thepreacoanitury indications. The indica-tions usuallv are,—fuiness, weight,tightness, heaviness, pain within the

head, or giddiness, weakness of sight,or some other defect, noise in theears, coldness or numbness in some ofthe extremities, depression of spirits,a fearfulness or coufusion of mind,palpitation of the heart, nervousness,and oppression about the preeordia.Dr. ARMSTRONG considers the im-

mediate attack to occur under twocircumstances, either under depr4s-sion or excitement. When the attackarisen from depression, the skin is coldand the pulse small and feeble; hutwhen the attack arises from excite-ment, the skin is hot and the pulseexpanded and strong. An interme-diate variety also exists, in which thetemperature is nearly natural andin which the pulse is flagging and qp-pressed, as if by a load. Dr. ARn-STRONG thinks these distinctions im-por tant in a practical point of view_‘When the skin is universalty cold,when the pulse is thready and the re-spiration weak, he thinks that the aseofthe hot air bath to the surface, aud,ofsome diffusible stimnlus to the sto-mach, should precede the employmentof the lancet; but in the two othercases, when the skin is hot and thepulse expanded, or nhen the tempe-rature of the skin is nearly naturaland the pulse flagging, bloodlettingshould at onre be boldly adopted, tothe reiief, if possible, of all the urgentsymptoms. Dr. ARMSTRONG noticed,that most very sudden deaths depend-ed, not on apoplexy, imt on diseasesof the heart, for th,it in apoplexy pa-tients generally survived the attackseveral hours, or sometimes even days,except in those ca,,es wiiere tie rup-ture took place extensively in thecerebelium, and then, he believed, thatIl1e death was amost always verysudden. Bnt Dr. ARMSTRONG dweltat some length on the ueces,ity ofpreventing the attack in those caseswhere fulness of the brain announcedits approach ; for this purpose he re-commended bloodletting, purgatives,and a strictly abstemious diet, and hespoke particularly of the efficacy ofthe last, and of’ the great utility of the,abstraction of all diffusible stimuli.

Palsy.He considered palsy under three

divisions,—first, as arising from anaffection of the bram; secondly, as.

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arising from an affection of the spinalcord ; and thirdly, as arising from anaffection of some particular nerve.

When palsy arose from an affection’of the brain, that affection might bevarious ; sometimes it was softeningfrom chronic inflammation, and thenthe palsy was preceded by pains,creeping, and numbness in the part,in short, the palsy then came on gra-dually; whereas, when it arose from

Simple turgescence of the brain, itwas preceded by signs similar to thosewhich preceded apoplexy, and theattack at last came not gradually butsuddenly. The affection of the brainin either case was generally oppositeto that side of the body which wasaffected, and when one side was af-fected, it was denominated hemiple-gia. Dr. ARMSTRONG noticed one mo-dification of palsy, which he had seenarise in cases of great exhaustion from

the. patient falling into syncope, onthe recovery from which the tongne,or one side, was left paralytic. Headduced some cases of this kind, andcautioned students against allowingpatients to get up again into the erectposition, whenever they had then com-plained of dimness of sight, giddiness,sickness, or faintness. He had seen,he said, similar cases occnr from pa-tients having been retained too iong’in the erect position after conionslosses of blood. This form of palsywas generally connected with an effu-sion within the head, and apparentlyarose from the collapse of the heart,the venous blood, meanwhile, beingimpeded in its return from the brain.Dr. ARMSTRONG noticed, that para-’plegia, or an affection of one half ofthe body transversely, sometimes de-pended upon an affection of the brain,but according to his observation, itwas more frequently the effect of

softening of some portion of the spinalcord, and that again was the effect ofchronic inflammation of that part.Chronic inflammation of the spinalcord, or its membranes, might existin the cervical, dorsal, or lumbar por-tion. It was denoted by pain in the

part affected, by wandering pains andthen numbness, or tingling down the’upper or lower extremities, or throughthe muscles of the trunk, followed byloss of power in the upper or in thelower extremities, according to the

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seat of the chronic inflammation. Healso pointed out an affection of thespina) colnmn itseif, which POTT hadwell described, and which, arisingcommonly as a secondary affection ofsome disorder of the primæ viæ, gene-rallv attacked the bodies of the ver-tebra?, so that in process of time acurve outward was the consequence.with weakness and at length loss ot

power in the upper or lower extre.mities, according as the affection hap,pened to be seated in tke upper orlower portion of the spinal column,The partial palsy which arose froman affection of a particular nerve wasalso various as to its origin, for some,times the cause was a tumour in thecourse of a nerve, or some similarpressure, and sometimes it was simpleinflammation of a nerve ; and he gavesome instances of paresis, or partialpalsy, to illustrate the influence ofeach of these causes. With respect to tothe treatment of palsy, it first con,sisted in the prevention; secondly, inthe removal ; and thirdiy, in the pal.liation. When palsy was preceded bychronic inflammation of the blain, orits membranes, the removal of thatinflammation, before softening occur-red, woiild prevent the attack, audwhen it was preceded by simple tnr-gescence of the brain a similar planwould be alike successful. When theattack had once decidedly taken

place, the recovery was always doubt-ful, where the head was concerned;but he had seen several cases in whichpatients had recovered the use of theaffected limb by perseverance in anabstemious diet, occasional bloodlet-ting, local or general, and mild ape.rient medicines. When inflammationof the spinal cord preceded the sei-

zure, the prevention depended uponthe ordinary measures; and when theattack had occurred from that cause,s ti! the treatment shonld be of a soh-dued anti-phlogistic kind. But whenthe palsy depended upon a disease ofthe bones of the spinal column itself.then rest in the recumbent postnre, afresh atmosphere, a regulated diet,and an occasional gentle alterativeand aperient, with perfect cleanliness,were the most efficacious measnres.

The value of these was indisputable,whereas the nse of caustic issiles wasdoubtful, some having much, and

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others no faith in them at all. In truth,this affection being generally a secon-dary one of some irritation on themucons surface of the primae viae, thecure depended more upon the removalof that, and upon taking off the weightof the trunk through rest than uponany other means ; in corroberation ofwhich some examples were broughtforward. The partial palsy was to berelieved by the removal of its cause,only it was to be remembered, thatpartial palsy did not always dependupon a mere local affection of a nerve,but was oftener the effect of someserious affection of the brain, of whichit was a monitor not to be neglected fora moment in many cases. The historyof every instance, therefore, should bemiuntely investigated, by a referenceto the physiology of the parts con-cerned, so that the cause may, if pos-sible, be correctly ascertained, and acorrespondent treatment pursued. Nofolly was greater than that of sup-po.;ing the same name always impliedthe same conditions, for the symp-toms on which that name was foundedmight be similar, yet the condition onwhich that symptom depended mighthave a different seat and character.Dr. ARMSTRONG noticed, that pa-

ralytic affections from the brain werefar more common among those hotook wine and ardent spirits than

among those who drank nothing butwater; yet he admitted that manyother remote occasions, and especiallymental excitement, was connectedwith the origin of such complaints,which were therefore more commonin large towns than in the country, ,where the mind was less agitated inthe main.

Epilepsy.Dr. ARMSTRONG distinguished two

modifications of epilepsy, one whicharose in children, and which was con-nected with irritation of the mucousmembrane of the intestines ; and ano-ther which arose in adults, and whichwas connected originally with an af-fection of the brain. That which tookp!ace in children could generally becured by a strict regulation of diet,by mild aperients, with small doses ofalkalies, and by an alterative now andthen, when there was a deficiency ofbile, But that which occurred in

adults was far more difficult to ma-

nage, though sometimes it admittedof a cure, but more often only of pat-liation. Whatever exhausted or ex-

cited epileptic adults, did harm, andtherefore copious evacuations on theone hand, and stimulants on the other,were alike to be avoided. That dietwas best which supported the strengthwithout prodacing any excitement, orwithout disturbing the stomach. Dr.ARMSTRONG had seen various medi--cines tried, but upon the whole he -had seen none very decidedly bene-ficial, except the arsenical solution,which in some instances had arrested,and in others mitigated the disorderwhere the diet had been rightly man- -

naged, and when the mind had beenkept tranquil, the last of which wasan essential point towards insuringsuccess.

Dr. ARMSTRONG related the case ofa female subject of epilepsy, in whomthe fit occurred very repeatedly,while she was harrassed by an ill-

tempered person, but who got entire-

ly rid of the disease when she wasplaced in a comfortable situation. Hehad also seen some cases which oc-curred from hard drinking, and some’from the indulgence of licentious pas-sions, which had in like manner been-removed by the removal of the excit-ing cause. In regard to the morbid

anatomy of epilepsy, it had been ex-

tremely unsatisfactory to Dr. ARM-STRONG, the appearances having beenso different in different cases, thatwith the exception of congestion oreffusion, lie had not been enabled tocome to any satisfactory conclusion asto the pathological condition fromwhich epilepsy arose.

Tetanus.

Tetanns was either idiopathic, orsymptomatic. It was idiopathic whenit appeared independently of any lo-cal injury, as from cold ; it was symp-tomatic when it followed a local in-jury, such as a punctured or a lace-rated wound about the hands or feet.But it was clear, that, whether idio-pathic or symptomatic, some concur-ring state of the system must exist tofavour the rise of tetanus, since coldapplied, or since a local injury sus-tained under ordinary circumstances,did not give rise to this affection.

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Dr. ARMSTRONG observed, that tnany‘

years ago the negro infants died oflocked jaw, at Jamaica, on the plan-tation where an acquaintance of hispractised, in such numbers, that aninqniry was institnted as to the causeof death. It was fonnd, that owingto some snperstition, the breast had

not been given at the natural period,that the mecomium for the same

cause had not been purged off, andthat, moreover, the food was crude,and the air of the apartments dose.On correcting these improprieties, the

tetanus disappeared, which clearlyshowed, that some constitutional dis-

turbance had been generated by thatof the primæ viæ, which, concurring

with the irritation at the navel, hadbrought on the attack. Dr. ARM-

STRONG also showed how importantit Mas, in a preventive light, to avoidall the sources of intestinal and other

irritation, after any suspicious injury,’ and stated the remarkable fact, that’ by such a procedure, and the applica-tion of the rectified oil of turpentine,under the form of an unguent, an ex-perienced friend of his had warded offmany attacks of tetanns, which, to

say the least, had been very commonin his practice at Grenada, before he

adopted these precautionary measures.When tetanus merelv attacks the mus-cles about the neck and jaw, itis oftenrecoverable, bnt when the other mus-cles are also affected, it is a most for-midable affection. The morbid ana-

tomy was various, bnt the brain is

mostly somewhere diseotottreo, with

congestion of the lungs and mucous in-ternal membranes, probably in part

the tffect of the convulsive pressureof the muscles on the external veins,as happens in hunted animals.—He thought that those patients hadthe best chance of recovery; whowere mildly treated, and nursed, as itWere, through the disease, In illes-tration of this, he detailed the resultof the experience of two of his friendswho had practised extensively in tro-pical climates, both of whom hadbeen more than commonly succcessful7-’by doing less than had been usuallydone in such cases. Their plan was,moderate and repeated doses of

opium, occasionally laxative enema,light nutriment, and stimulating fric-., tion in the course of the spine, toge-

ther with every attention to the stateof the mind, allaying apprehensions

and inspiring confrdence in the reme-dies employed. Dr. ARMSTRONG K’

lated one case which had recovered,under, his own care, from a milder

’mode of treatment than that nspallyadopted rn this country; bnt, asin thepresent state of knowledge, a largemajority of cases was mortal, he urgedthe necessity of endeavouring to pre.vent the occurrence of the attack, byStudiously avoiding all causes of irri-tation after an accident.

Chorea.

Dr. ARMSTRONG considered choreato originate in irritation of the mu-cous membrane of the stomach, orsmall intestines, together with a dis-ordered condition ot’skin, aud a con.seqsuent torpid or irregular state of

the liver and colon. In the progressof the complaint, the spinal cord andbrain become distended, so as to af-feet the motion, and at last the intel-lect. He spoke highly of the laxativeplan recommended by Dr. HAMILTONsenior, and said that he had never

known it fail, except in two easel,where the aperienis were mild, oc-

casionally conjoined with an altera

tive, where the diet was at the sametime properly regulated, and thefunctions of the skin restored bv a te-pid shower bath, and the inflnenceot’afresh atmosphere. He related a

curious case, in which not onlv pur-gatives, but the arsenical solution,the soinbate of zinc and varions othermeasures failed, but in which musichad the effect of procuring sleepdaily, and at last of removing thedisorder aitogether. He cantionedthe pupils against the free nse of theiaaneet, and adduced a case in which ithad nearly proved fatal; but he as-serted, that he had seen moderate

leeching iisefut in some cases wherethe intestinal lining was distinctly ina very irritable condition. He thonghtit of great consequence in this andmany other nervons affections, not todirect the attention of the patientsmind to the complaint, for it was

thereby apt to be greatly increase,as any one might easily perceive,when- they made many inquiries in

succession as to the motions. The

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cxre of this complaint could seldomhe accompli-hed under any plan inless tban about eix weeks or two

months, and if the diet was neglected,it would generally continue much

longer.Hysteria.

The foundation of hysteria was laidin an excess of sensibility, sometimesassociated with local irritation, espe-cially abont the mucous membrane ofthe intestinal canal, or the mucouslining of the uterus, the latter beingan affection much more common thanmedical authors have supposed. Inthe prevention and cnre of hysteria,Dr. ARMSTRONG thought it was ot theutmost consequence to bear the twoforementioned circumstances in view,for by lessening the general sensibi-lity, and removing the local irrita-tion, this affection. when not asso-

ciated with any other, might be rea-dily removed. The most common

exciting cause of hysteria is some

strong mental rrrotion, and the affec-tion is often protracted day after day,week after week, by the sympathy ofattendant friends, which is the veryfood of hysteria. Dr. ARMSTRONGrelated several cases which he re-

moved, merely by attending to themental, management. He detailedone in particular, where the patienthad been ill for upwards of two

months, the hysteria in that time hav-ing assumed various forms, and hav-ing at last pnt on a violent convulsivecharacter, which so alar med the fi iends.and even the medical attendants, thatshe v as watched day and night bythree or four attendants. Dr. ARM-HRONG removed these attendants,placed an old nurse by the bed side,and told her not to take the least no-tice of the patient whatever mighthappen. Slortly after, a strong convulsive fit occurred, so that the pa-tient tnmbied out of bed upon the car-pet. The old nurse let her lie, andwhen she had recovered from it, re-buked her for being so foolish as to

give way to such fantastic fits. Thepatient had lio return of the affection,and tlie father was se much sur prised, ’,that he said, if any mystery had beenused, the case might have beendeemed miraculous. He mentionedseveral similar case-, and remarked,

that they must be familiar to all ob-servant practitioners, and showedhow easy it might be to deceive thepublic by epetating through the me-dium of mind, if men were disposedto play such a part as the impiousimpostor Prince Hohenioe, whosemonkish pretensions had made sucha noise amongst the ignorant. With

respect to any medical treatment. Dr.ARMSTRONG thought it should consistentirely in the removal of any localirritation which might exist, which,however, should be done by the mild-est measures, as hysterical women el-dombore copious evacuations withoutan increase of that sensibility uponwhich the afi’ection mainly depended.Exercise in the open air, a simplediet, early hours as to sleep, a doeattention to the bowels, and a rightregulation of the mind, he consideredas among the best means cf prevent-ing a return of the affection, togetherwith an avoidance of that open anddeclared sympathy on the part eifiiends, by which it is so freqnenilysupported. At the same time when amedical man recommends this plan,he should clearly explain his motivesto the attendants, otherwise his con-duct might seem harsh, however hu-mane it was in realitv.

Hypochondriasis.

Hypochondriasis, mentally consi-dered, Dr. ARMSTRONG regarded ta

be distinguished by an exclusive andselfish attention to the personal feel-ings, so earnest and undivided, as tobe very apparent on the first inter-view with the hypochondriac. To thisstate of the feelings scme personswere strongly disposed by originalstructure, but it was trequentiy ac-qniied. Sometimes it was associatedwith that general distmbance ot’ thenervous system which is so apt to beinduced, in sensitive frames, by theworry of the world; sometimes it wasconnected with local irritation, espe-cially of the mucous membrane of thestomach, accompanied by an oer-

loaded colon ; and sometimes it wasproduced by men taking an error cous-view of their own case, supp osing itto be really serious, n circumstancevery common amongst medical men,when their strength happens to be

72

broken up, and when, at the sametime, occasions arise to make theraind anxious. In some instances,hypochondriasis is connected with or-ganic affections, bnt this mostly hap-pens in old persons, and seldom oc-

curs at an earlv age, the looks of thehypochondriac often belying the woe-ful tale which he so repeatedly relates.The cnre of hypochondriasis is to beaccomplished bv rightly managing themind of the patient, and by removing,bv mild means, any bodily irritationwhich exists. Dr. ARMSTRONG warnedhis pupils not to indulge such patientsin wishes to take a great deal of me.dicine, but to appeal to their commonsense, so that they may, at the com-mencement, withdraw the mind fromthe contemplation of themselves, andfix it upon some external object withinterest sufficiently intense, as a diver-sion from the distemper. Few per-sons who take regular exercise in the:open air, who moderate their wishes,and who endeavour to live for othersrather than themselves, become thedecided subjects of hypochondriasis.When illusions occur in hypochon-

driasis, DR. ARMSTRONG thinks it nolonger deserves the name, being thena modification of mania, which hewould consider in his next course ofLectures, under a medical, moral, and

metaphysical point of view.

Nervousness.

Dr. ARMSTRONG thought that therewas such a condition as general ner-vousness, without its being refei-i ibleto the existence of any particularlocal affection of the nervous system.He instanced the state induced inome persons by copious losses ofblood, or by want of sleep, in which apulsation was perceptible in almostevery artery of the body, accompaniedby great excess of sensibility. Thiscondition was best removed by pas-sive exercise in the open air, by atepid .shower bath, by a light nutri-tious diet, and by a very moderateallowance of wine, or some otherdiffusible stimulmus, ind the occasionalexhibition of an anodyne and laxative.But Dr. ARMSTRONG noticed, that asnervous seneations were frequentlymixed up with serious affections ofthe brain, heart, stomach, liver, orintestines, so a medical man should

be most assiduons in his examinations,lest he overlook them, and put thepatient upon a treatment the reverse

of that which ought to be adopted.He advised his pupils to be most

guarded in the use of language, sincein medicine mere sonnd was oftensubstituted for science, with whichmany of the profession and of the

public were alike deceived. He thoughtthat much good might be done by wellinformed and honest practirioners en-deavouring to train the public to aright manner of pnttin qnestionsas to the real nature of disorders, andthe conditions of structure on whichthey depend; for as modern patho.loay was very simple, so it was rea-

dily to be comprehended, and beingin some degree familiar to the pub.lie, that mystery of words would soonbe banished, by which many medicalmen make their way, almost ignorantof every thing substantially useful inthe principles and practice of physic.Dr. Johnson long ago observed, thatthe history of some successful physi-cians would be very amusing as anexhibition of the arts and chances bywhich they rose; and certainly ifsuch a biography were fdithfnllywritten, it would prove that some ofthe most shallow men in the profes.sion had gained the confidence ofthe highest clases, and kept it too, bythe cant of technicality, the artofconcealing ignorance, and of pleasingat the same time ; so little have thepublic hitherto been enabled to estimate the comparative merits of themedical men in whom they confidedtheir health and their lives.

LECTURESDELIVERED BY

MR. CRAMPTON

IN THE THEATRE OF THE MEW MEATH

HOSPITAL, DUBLIN.

LECTURE 3.

On the Venereal Disease.

GENTLEMEN,BEFORE I proceed to enter upon

the topics chichi I intend to discussin this lecture, I may observe, thatnext week, when I meet vou at thL

Royal Infir mary, I shall be able to show