FROM LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC,

—No. 3.]

LONDON, SATURDAY,

FROM

LECTURES ON THE

PRINCIPLES AND OF

PRACTICE

PHYSIC,

BY DR. ARMSTRONG.

Theatre

of Anatomy, Webb

Street.

JULY 23, 1825.

connected with a large majority of chronic affections,as the sequel would show. He said he would observe the same order in illustrating chronic affections which he had done in illustrating acute ones, and should therefore begin with chronic affections of the brain and nervous system, treating them under certain subdivisions, in order to explain their particular as well as general bearings. Chronic inflammation of the Brain, or its Membranes, with softening of the substance of the Brain.

following is an Abstract of Dr. Arinstrong’s Lectures on Chronic Chronic inflammation of the brain, Affections of the Brain and Nervous or its membranes, is much more comSystem. mon after than before forty years of Dr. ARMSTRONG commenced by ob- age, though Dr. ARMSTRONG has seen serving, that all the remote occasions several cases occurring in young perof chronic affections might be ringed sons. The causes which most freunder three heads: inherent occasions, quently excite it are mental anxiety external occasions, and certain errors or over excitement, the free use of wines or liquors, repeated ofiugesta; and he premised, that the chronic afconditions of great bodily exertion, night-watching, pathological of meals, and licentious fections, like those of acute or sub7acate ones, were few and simple, passions ; but sometimes it is the conhowever complicated, at first sight, sequence of an acute inflammation, might be the-various symptoms by and occasionally it arises insidiously which the existence of those condi- from blows on the head, especially tions were indicated. So intimate, when the diets or drinks had been dissaid, were the relations between regarded for some time after snch an The

-

strong

I irreguiarity

ethe and acute

chronic affections, that injury. Some persons are more prone practitioner who the most dis- hereditarily to it than otlters, but a tinctlv understood the nature and ! disposition to it is often laid, in adtreatment of the first class would be vanced life, by an earthy deposit on the tiiost likely to have most correct the arteries within the head, a condi-

notions of the second class ; and there- tion of vessels at least with which it fore, in the preceding lectures, he had is often connected. Chronic iiiflamendeavoared to give simple elemen- mation of the brain, or the membranes tary views of acute affections, which of the brain, is announced bv Dain in he should now endeavonr to extend, I the head, which the patient This as far as the subject legitimately ad- refers to some particular spet. is mostly continned, but in some mitted, to the solution of chronic affections, some of which, however, he I cases it is only occasional in the co :nIt generally occupies a was ready to allow cou!d not be ex- mencement. space, when the membranes of plained by a reference to the doctrine of congestion, simple excitement, or the brain are chronically inflamed, when the substance of the brain inflammation, though one or the other of these conditions was indisputably inflamed. After this pain has re-

generally

pain

larger

than

is

66

time the patient he-numbness, he considers the mot diagpains about the neck, nostic signs of that stage, and thinks, scapula, arms, or legs, so that the pa- that when palsy has actually taken tient often supposes himself to he place, or when the functions of th rheumatic ; bnt these pains differ from mind have become decidedly disturb-

mained for comes

some

liable to

those of rheumatism, in as much as ed, that the softening process bas ,they are not attended by anyswelling. generally taken place, though le has Dr. ARMSTRONG thinks this is a very seen a few cahes which did well 6VU important point to remember, for he after palsy had happened in the has frequently known chronic inflam- tongue, hand, or leg, but he con·iden mation of the brain, or membranes, such instances rather an exceptionto overlooked by practitioners, under the a general fact. supposition, that the pains and affec- In the -first stage of the disease, tion were altogether rheumatic, an Dr. ARMSTRONG has great faiih in error which has led to fatal results. bloodletting, mild aperients, a spare When these pains have continued for diet, rest of body, with quietude of time the patient usually com- mind, as far as the abstraction of all plains of creeping sensations, and then depressing and exciting occasions can of numbness in the parts affected, be withdrawn; and, in proof of the which, after that peiiod, gradually, complete efficacy of these measures. some

for the most part, but sometimes sud- he adduced some cases,but remarked. denly, lose their power under the that nothing could be done in the adform of palsy ; but long before the var.ced stage, when the disorganiza. latter disorder occurs, the mind be- tion had actually taken place, but to comes depressed or irritable, and some palliate the symptoms by removint ,of the external senses, especially the all opposing circumstances, such as sight, are apt to be disturbed in their errors in the regimenal and mental functions. Giddiness is a very com- management of the sick. Dr. ARMmon symptom in the progress of the STRONG passed some high encomiums complaint, under which the stomach upon ROSTAN, whose able work on is generally disordered, the bowels this sllbject he strongly recommended .torpid, and the btadder either irritable to his pnpils, as containing an excelor torpid. This affection terminates lent account of a disease which was in palsy, in apoplexy, in low fever, or very common in this country, and but in some forms of madness, all which little understood by thegeneratittctof Dr. ARMSTRONG has witnessed. medical men, especially those who bad On examining the brain after death, been educated under the nosological the membranes are mostly found more system still in vogue in our schools or less inflatned, and a portion of the aud colleges. .brain is broken down, softened so as to resemble custard pudding or pulp. Inflammation of the internal Ear, affecting the Membranes of the Brain Dr. ARMSTRONG considers that this ,

softening is generally the gradual con. sequence of a primary local illflamma-

and the Brain

itself.

Dr. ARMSTRONG mentioned, that io tion, but he has occasionally found it flammation of the internal car somea secondary one from an effusion oftimes spreads to the membranes of the -blood, or from an organic tumour. brain, and even the brain itself, occaHe thinks it is of the utmost conse- sioning inflammation in both those quence to be well acquainted with the parts. This affection, he said, most symptoms which attend the first stage frequently arose from an inflammation of inflammation of the brain, that of the fauces, extending itselt alonc which sometimes exists many days, the enstacian tube into the internal weeks, or even months before the ear, which was most liable to happen softening occurs as the ultimate effect.in bad cases nf scarlet The pain in a particular part of the or small pox, or common chronic alcehead, the pains resembling rheuma- rated sorethroat, but the inflammatism in other parts of the body, de- tion occasionally commenced in the pression or in itability of mind, gid-lining of the external ear, and 6nalls. diness, some visual weakness or dis-from that quarter, invaded the intertutbance, and creeping sensations ornal one, and ultimately leached the

fever, measles,

2

67 In such cases, the head, or giddiness, weakness of sight, some other defect, noise in the membrane ot the canal are.oat of order, and, by consecoldness or numbness in some of quence, the inflammtionpats on an the extremities, depression of spirits, ili-conditioned character; the petrous a fearfulness or coufusion of mind, portion of the temporal bone becomes palpitation of the heart, nervousness, carious, the dura mater is at length and oppression about the preeordia. affected, and finally the brain. If such Dr. ARMSTRONG considers the imcases he misunderstood, or misma- mediate attack to occur under two naged, this is often the fatal resillt ; circumstances, either under depr4sbut wilen they are clearly understood sion or excitement. When the attack and well managed, they are often arisen from depression, the skin is cold arrestedln their progress, the pa- and the pulse small and feeble; hut tient’s safferings shortened, and his when the attack arises from excite, liie save-d. As this inflammation is ment, the skin is hot and the pulse generally maintained by a disordered expanded and strong. An intermeconditioii ot the skin and, internal diate variety also exists, in which the mucous tissue, the main object is -to temperature is nearly natural and restore that to a healthy condition, by in which the pulse is flagging and qpa simple diet, by the use of the tepid pressed, as if by a load. Dr. ARnbath, by a freshatmosphere, by early STRONG thinks these distinctions imhour, as to sleep, and a train of tem- por tant in a practical point of view_‘ perate and regular habits, aided by When the skin is universalty cold, small do:es of alkalies and an occa- when the pulse is thready and the resional mitd aperient, where the bowels spiration weak, he thinks that the aseof are not regular. Sometimes evacua- the hot air bath to the surface, aud,of tions by the lancet or leeches are ne- some diffusible stimnlus to the stouessar.y, when the inflammation runs mach, should precede the employment high, but this step is seldomrequistte of the lancet; but in the two other who) the regiiiieiial and mental ma- cases, when the skin is hot and the nagement is judicious. pulse expanded, or nhen the temperature of the skin is nearly natural Apoplexy. and the pulse flagging, bloodletting Apoplexy is occasionally the sequei should at onre be adopted, to of softening ot the brain, but it is far the reiief, if possible, of all the urgent Dr. ARMSTRONG noticed, more frequently the product ot sim- symptoms. ple turgescence Qf that organ, often that most very sudden deaths dependfavoured by that tender condition ot’ ed, not on apoplexy, imt on diseases the vessel, inside the head, which i of the heart, for th,it in apoplexy paso commonly found in those who die tients generally survived the attack apo,)lecric. and which is the result of several hours, or sometimes even days, an earthy deposit between the co,its except in those ca,,es wiiere tie rupofthearteries. A teamed and ex- ture took place extensively in the celleta person had written a work on cerebelium, and then, he believed, that apoplexy, ill which he had given the Il1e death was amost always very opinions of almost all. anthors on the sudden. Bnt Dr. ARMSTRONG dwelt subject, and like them, he had come at some length on the ueces,ity of directly to the symptoms of the at- preventing the attack in those cases tack itselk, as if it were not only sud- where fulness of the brain announced den but unpreceded by any warnings. its approach ; for this purpose he reBut the tmtli was, that, generally, commended bloodletting, purgatives, the attack was distinctly announced and a strictly abstemious diet, and he tor .eeeral days, and so4-netime, spoke particularly of the efficacy of weP:.s, and this was a fact most im- the last, and of’ the great utility of the portant to be known, as the attack ,abstraction of all diffusible stimuli. itself mighft commonly hI:, warded off

brain.

mucous

.

intestinal skin andorears,

boldly

Palsy. palsy under three tions usuallv are,—fuiness, weight, divisions,—first, as arising from an tightness, heaviness, pain within the affection ofthe bram;secondly, as by acting on a right knowledge of the preacoanitury indications. The indica-

He considered

.

3

68

affection of the spinal seat of the chronic inflammation. He as arising from an also pointed out an affection of the affection of some particular nerve. spina) colnmn itseif, which POTT had When palsy arose from an affection well described, and which, arising ’of the brain, that affection might be commonly as a secondary affection of various ; sometimes it was softening some disorder of the primæ viæ, genefrom chronic inflammation, and then rallv attacked the bodies of the verthe palsy was preceded by pains, tebra?, so that in process of time a creeping, and numbness in the part, curve outward was the consequence. in short, the palsy then came on gra- with weakness and at length loss ot dually; whereas, when it arose from power in the upper or lower extre. Simple turgescence of the brain, it mities, according as the affection hap, was preceded by signs similar to those pened to be seated in tke upper or which preceded apoplexy, and the lower portion of the spinal column, attack at last came not gradually but The partial palsy which arose from suddenly. The affection of the brain an affection of a particular nerve was in either case was generally opposite also various as to its origin, for some, to that side of the body which was times the cause was a tumour in the affected, and when one side was af- course of a nerve, or some similar fected, it was denominated hemiple- pressure, and sometimes it was simple gia. Dr. ARMSTRONG noticed one mo- inflammation of a nerve ; and he dification of palsy, which he had seen some instances of paresis, or partial arise in cases of great exhaustion from palsy, to illustrate the influence of the.patient falling into syncope, on each of these causes. With respect toto the recovery from which the tongne, the treatment of palsy, it first con, or one side, was left paralytic. He sisted in the prevention; secondly, in adduced some cases of this kind, and the removal ; and thirdiy, in the pal. cautioned students against allowing liation. When palsy was preceded by patients to get up again into the erect chronic inflammation of the blain, or position, whenever they had then com- its membranes, the removal of that plained of dimness of sight, giddiness, inflammation, before softening occursickness, or faintness. He had seen, red, woiild prevent the attack, aud he said, similar cases occnr from pa- when it was preceded by simple tnrtients having been retained too iong gescence of the brain a similar plan ’in the erect position after conions would be alike successful. When the losses of blood. This form of palsy attack had once decidedly taken was generally connected with an effu- place, the recovery was always doubtsion within the head, and apparently ful, where the head was concerned; arose from the collapse of the heart, but he had seen several cases in which the venous blood, meanwhile, being patients had recovered the use of the impeded in its return from the brain. affected limb by perseverance in an Dr. ARMSTRONG noticed, that para- abstemious diet, occasional bloodlet’plegia, or an affection of one half of ting, local or general, and mild ape. the body transversely, sometimes de- rient medicines. When inflammation pended upon an affection of the brain, of the spinal cord preceded the seibut according to his observation, it zure, the prevention depended upon was more frequently the effect of the ordinary measures; and when the softening of some portion of the spinal attack had occurred from that cause, cord, and that again was the effect of s ti!the treatment shonld be of a sohchronic inflammation of that part. dued anti-phlogistic kind. But when Chronic inflammation of the spinal the palsy depended upon a disease of cord, or its membranes, might exist the bones of the spinal column itself. in the cervical, dorsal, or lumbar por- then rest in the recumbent postnre,a tion. It was denoted by pain in the fresh atmosphere, a regulated diet, part affected, by wandering pains and and an occasional gentle alterative then numbness, or tingling down the and aperient, with perfect cleanliness, ’upper or lower extremities, or through were the most efficacious measnres. the muscles of the trunk, followed by The value of these was indisputable, loss of power in the upper or in the whereas the nse of caustic issiles was lower extremities, according to the doubtful, some having much, and from arisingand

cord ;

an

thirdly,

gave

A

69 others no faith in them at all. In truth, this affection being generally a secondary one of some irritation on the mucons surface of the primae viae, the cure depended more upon the removal of that, and upon taking off the weight of the trunk through rest than upon any other means ; in corroberation of which some examples were brought forward. The partial palsy was to be relieved by the removal of its cause, only it was to be remembered, that palsy did not always depend upon a mere local affection of a nerve, but was oftener the effect of some serious affection of the brain, of which it was a monitor not to be neglected for The history a moment in many cases. of every instance, therefore, should be miuntely investigated, by a reference to the physiology of the parts concerned, so that the cause may, if possible, be correctly ascertained, and a correspondent treatment pursued. No folly was greater than that of sup-

partial

adults was far more difficult to manage, though sometimes it admitted of a cure, but more often only of patliation. Whatever exhausted or excited epileptic adults, did harm, and therefore copious evacuations on the one hand, and stimulants on the other, were alike to be avoided. That diet was best which supported the strength without prodacing any excitement, or without 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 disorder where the diet had been rightly mannaged, and when the mind had been kept tranquil, the last of which was an essential point towards insuring -

success.

Dr. ARMSTRONG related the case of female subject of epilepsy, in whom the fit occurred very repeatedly, po.;ing the same name always implied while she was harrassed by an illthe same conditions, for the symp- tempered person, but who got entirerid of the disease when she was toms on which that name was founded might be similar, yet the condition on placed in a comfortable situation. He a

ly

which that symptom depended might had also seen some cases which occurred from hard drinking, and some have a different seat and character. Dr. ARMSTRONG noticed, that pa- ’from the indulgence of licentious passions, which had in like manner beenralytic affections from the brain far more common among those ho removed by the removal of the excittook wine and ardent spirits than ing cause. In regard to the morbid among those who drank nothing but anatomy of epilepsy, it had been exwater; yet he admitted that many tremely unsatisfactory to Dr. ARMother remote occasions, and especially STRONG, the appearances having been mental excitement, was connected so different in different cases, that with the origin of such complaints, with the exception of congestion or which were therefore more common effusion, lie had not been enabled to in large towns than in the country, , come to any satisfactory conclusion as where the mind was less agitated in to the pathological condition from

were

which

the main.

Epilepsy. distinguished

Dr. ARMSTRONG

modifications of

epilepsy,

one

epilepsy

arose.

Tetanus. two

which

arose in children, and which was connected with irritation of the mucous membrane of the intestines ; and another which arose in adults, and which was connected originally with an affection of the brain. That which took p!ace in children could generally be cured by a strict regulation of diet, by mild aperients, with small doses of alkalies, and by an alterative now and then, when there was a deficiency of bile, But that which occurred in

either idiopathic, or symptomatic. It was idiopathic when it appeared independently of any local injury, as from cold ; it was symp-

Tetanns

was

tomatic when it followed a local insuch as a punctured or a lacerated wound about the hands or feet. But it was clear, that, whether idio-

jury,

pathic or symptomatic, ring state of the system

some concur-

exist to favour the rise of tetanus, since cold applied, or since a local injury sustained under ordinary circumstances, did not give rise to this affection. must

70

Dr. ARMSTRONG observed, that tnany ther with every attention to the state years ago the negro infants died of of the mind, allaying apprehensions locked jaw, at Jamaica, on the planconfrdence in the remetation where an acquaintance of his employed. Dr. ARMSTRONG K’ practised, in such numbers, that an lated one case which had recovered, his own care, from a milder inqniry was institnted as to the cause of death. It was fonnd, that owing ’mode of treatment than that nspally to some snperstition, the breast had adopted rn this country; bnt, asin the not been given at the natural period, present state of knowledge, a large of cases was mortal, he urged that the mecomium for the same cause had not been purged off, and the necessity of endeavouring to pre. the occurrence of the attack, by that, moreover, the food was crude, and the air of the apartments dose. Studiously avoiding all causes of irriOn correcting these improprieties, the after an accident. tetanus disappeared, which clearly showed, that some constitutional disChorea. turbance had been generated by that of the primæ viæ, which, concurring Dr. ARMSTRONG considered chorea with the irritation at the navel, had to originate in irritation of the mubrought on the attack. Dr. ARM- cous membrane of the stomach,or STRONG also showed how important small intestines, together with a disit Mas, in a preventive light, to avoid ordered condition ot’skin, aud a con. all the sources of intestinal and other seqsuent torpid or irregular state of liver and colon. In the progress irritation, after any suspicious injury, ’ and stated the remarkable fact, that of the complaint, the spinal cord and ’ by such a procedure, and the applica- brain become distended, so as to aftion of the rectified oil of turpentine, feet the motion, and at last the intelunder the form of an unguent, an exHe spoke highly of the laxative perienced friend of his had warded off plan recommended by Dr. HAMILTON many attacks of tetanns, which, to senior, and said that he had never it fail, except in two easel, say the least, had been very common in his practice at Grenada, before he where the aperienis were mild, oc‘

and

dies inspiring

under,

majority

vent

tation

the

lect.

known

casionally conjoined with an altera adopted these precautionary tetanus merelv attacks the mus- tive, where the diet was at the same cles about the neck and jaw, itis often time properly regulated, and the measures.

When

bnt when the other musrecoverable, cles are also affected, it is a most for-

functions of the skin restored bv a teshower bath, and the inflnenceot’

pid

The morbid ana- afresh atmosphere. He related a bnt the brain is curious case, in which not onlv purmostly somewhere diseotottreo, with gatives, but the arsenical solution, congestion of the lungsand mucous in- the soinbate of zinc and varions other ternal membranes, probably in part measures failed, but in which music the tffect of the convulsive pressure had the effect of procuring sleep of the muscles on the externalveins, daily, and at last of removing the hunted animals.— disorder aitogether. He cantioned as happens in He thought that those patients had the pupils against the free nse of the the best chance of recovery; who iaaneet, and adduced a case in which it were mildly treated, and nursed, as it had nearly proved fatal; but he asWere, through the disease, In illes- serted, that he had seen moderate tration of this, he detailed the result leeching iisefut in some cases where of the experience of two of his friends the intestinal lining was distinctly in who had practised extensively in tro- a very irritable condition. He pical climates, both of whom had it of great consequence in this and been more than commonly succcessful many other nervons affections, not to 7-’by doing less than had been usually direct the attention of the patients donein such cases. Their plan was, mind to the complaint, for it was moderate and repeated doses of thereby apt to be greatly increase, opium, occasionally laxative enema, as any one might easily perceive, light nutriment, and stimulating fric- when- they made many inquiriesin ., tion in the course of the spine, toge- succession as to the motions. The

midable

tomy

affection. various,

was

thonght

71 cxre of this complaint could seldom he accompli-hed under any plan in less tban about eix weeks or two months, and if the diet was neglected, it would generally continue much

Hysteria.

The foundation of hysteria was in an excess of sensibility, sometimes associated with local irritation, especially abont the mucous membrane of the intestinal canal, or the mucous lining of the uterus, the latter being an affection much more common than medical authors have supposed. In the prevention and cnre of hysteria, Dr. ARMSTRONG thought it was ot the utmost consequence to bear the two forementioned circumstances in view, for by lessening the general sensibility, and removing the local irritation, this affection. when not associated with any other, might be readily removed. The most common exciting cause of hysteria is some strong mental rrrotion, and the affection is often protracted day after day, week after week, by the sympathy of attendant friends, which is the very food of hysteria. Dr. ARMSTRONG related several cases which he removed, merely by attending to the He detailed mental, management. one in particular, where the patient had been ill for upwards of two months, the hysteria in that time having assumed various forms, and having at last pnt on a violent convulsive character, which so alar med the fi iends. and even the medical attendants, that she v as watched day and night by three or four attendants. Dr. ARMremoved these attendants, old nurse by the bed side, and told her not to take the least notice of the patient whatever might HRONG

an

happen. Slortly after, vulsive fit

a

strong

con

that the patient tnmbied out of bed upon the carpet. The old nurse let her lie, and when she had recovered from it, rebuked her for being so foolish as to give way to such fantastic fits. The patient had lio return of the affection, and tlie father was se much sur prised, ’, that he said, if any mysteryhad been used, the case might have been deemed miraculous. He mentioned several similar case-, and remarked,

occurred,

so

they

must be familiar to all ob-

practitioners, and showed how easy it might be to deceive the public by epetating through the me-

mind, if men were disposed play such a part as the impious impostor Prince Hohenioe, whose monkish pretensions had made such laid a noise amongst the ignorant. With

longer.

placed

that

servant

dium of to

to any medical treatment. Dr. ARMSTRONG thought it should consist entirely in the removal of any local irritation which might exist, which, however, should be done by the mildest measures, as hysterical women eldombore copious evacuations without an increase of that sensibility upon which the afi’ection mainly depended. Exercise in the open air, a simple diet, early hours as to sleep, a doe attention to the bowels, and a right regulation of the mind, he considered as among the best means cf preventing a return of the affection, together with an avoidance of that open and declared sympathy on the part ei fiiends, by which it is so freqnenily supported. At the same time whena medical man recommends this plan, he should clearly explain his motives to the attendants, otherwise his conduct might seem harsh, however humane it was in realitv.

respect

Hypochondriasis. Hypochondriasis, mentally consi-

dered, Dr. ARMSTRONG regarded be

ta

exclusive and selfish attention to the personal feel-

distinguished by

ings,

so

earnest and

an

undivided,

as

to

be very apparent on the first interview with the hypochondriac.To this state of the feelings scme persons were

strongly disposed by original

structure, but it was trequentiy acqniied. Sometimes it was associated with that general distmbance ot’ the so apt to be sensitive frames, by the worry of the world; sometimes it was connected with local irritation, especially of the mucous membrane of the

nervous

induced,

system which is in

stomach, accompanied by

an

oer-

loaded colon ; and sometimes it was

produced by

men

taking

an error cous-

view of their own case, supp osing it to be really serious, n circumstance very common amongst medical men, when their strength happens to be

72

broken up, and when, at the same be most assiduons in his examinations, time, occasions arise to make the lest he overlook them, and put the raind anxious. In some instances, patient upon a treatment the reverse hypochondriasis is connected with or- of that which ought to be adopted. ganic affections, bnt this mostly hap- He advised his pupils to be most pens in old persons, and seldom oc- guarded in the use of language, since curs at an earlv age, the looks of the in medicine mere sonnd was often hypochondriac often belying the woe- substituted for science, with which ful tale which he so repeatedly relates. many of the profession and of the The cnre of hypochondriasis is to be public were alike deceived. He thought accomplished bv rightly managing the that much good might be done by well mind of the patient, and by removing, informed and honest practirioners enbv mild means, any bodily irritation deavouring to train the public toa which exists. Dr. ARMSTRONG warned right manner of pnttin qnestions his pupils not to indulge such patients as to the real nature of disorders, and in wishes to take a great deal of me. the conditions of structure on which dicine, but to appeal to their common they depend; for as modern patho. sense, so that they may, at the com- loay was very simple, so it was reamencement, withdraw the mind from dily to be comprehended, and being the contemplation of themselves, and in some degree familiar to the pub. fix it upon some external object with lie, that mystery of words would soon interest sufficiently intense, as a diver- be banished, by which many medical sion from the distemper. Few per- men make their way, almost ignorant of every thing substantially useful in sons who take regular exercise in the :open air, who moderate their wishes, the principles and practice of physic. and who endeavour to live for others Dr. Johnson long ago observed, that rather than themselves, become the the history of some successful physidecided subjects of hypochondriasis. cians would be very amusing as an When illusions occur in hypochon- exhibition of the arts and chances by driasis, DR. ARMSTRONG thinks it no which they rose; and certainly if longer deserves the name, being then such a biography were fdithfnlly a modification of mania, which he written, it would prove that some of would consider in his next course of the most shallow men in the profes. Lectures, under a medical, moral, and sion had gained the confidence of the highest clases, and kept it too, by metaphysical point of view. the cant of technicality, the artof Nervousness. concealing ignorance, and of pleasing Dr. ARMSTRONG thought that there at the same time ; so little have the was such a condition as general nerpublic hitherto been enabled to esti vousness, without its being refei-i ible mate the comparative merits of the to the existence of any particular medical men in whom they confided local affection of the nervous system. their health and their lives. He instanced the state induced in ome persons by copious losses of LECTURES blood, or by want of sleep, in which a pulsation was perceptible in almost DELIVERED BY every artery of the body, accompanied MR. CRAMPTON by great excess of sensibility. This condition was best removed by pas- IN THE THEATRE OF THE MEW MEATH sive exercise in the open air, by a HOSPITAL, DUBLIN. tepid .shower bath, by a light nutritious diet, and by a very moderate LECTURE 3. allowance of wine, or some other On the Venereal Disease. diffusible stimulmus, ind the occasional exhibition of an anodyne and laxative. GENTLEMEN, But Dr. ARMSTRONG noticed, that as BEFORE I proceed to enter upon nervous seneations were frequently the topics chichiI intend to discuss mixed up with serious affections of in this lecture, I may observe, that the brain, heart, stomach, liver, or next week, whenI meet vou at thL intestines, so a medical man should Royal Infir mary, I shall be able to show