LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC,

No.7.]

LONDON, SATURDAY,

pressants, common irritants, common stimulants, or common interrnptants; and I have proved, I trust, by a reference to symptoms, to dissections, and to the effects of remedies, that

LECTURES ON THE

PRINCIPLES AND PRACTICE OF

this fever is legitimately divisible into three great leading varieties,

PHYSIC,

namely, simple,

BY DR. ARMSTRONG.

y/tMth’e 0/’ Anatomy, Those of seen

ster

our

Webb Street.

readers who have

the articles in the

surprised

"

LYestntin

z

the" PLAGUE and LAWS," will not be a little to find that the following

Review,"

SANATARY

on

admirable Lecture, which embraces the facts and opinions contained in those articles was delivered by Dr. ARM-

four years since, and they will be still more surprised at the want of candour evinced by the writer of the essays in question in not acknowledging the source from which he derived his information, when we further state, that he was then, and has subsequently been, in the habit of at. tending Dr. ARMSTRONG’S discourses. STRONG

LECTURE 26. 0)! the origin

MAY 21, 1825.

of Typhus Fe’l’er, in which

its Contagious or Non-coratagiotcs ture is considered.

na-

IN my last Lecture, that on Erysipelas, I tinisiipd the consideration of the varieties of Common Fever, that fever which, under all its modifications, arises from the operation of common causes, namely, common de-

common

congestive,

common

and common inflammatory fever. One or two slight deviations have been made from that arrange. ment, as far as the remote occasions are concerned ; and hence, in speaking of inflarnmation of the air pas. sages, I showed that it sometimes arose from a common cause, such as cold, and sometimes from a peculiar cause, such as an epidemic constitution of atmosphere. In like manner, it was explained how the purulent form of opiithalmia sometimes proceeded from the intensity of a common cause, and sometimes from the of a peculiar virus ; and lastly, it was particularly illustrated, that erysipelas, under itsphlegmonoid,

application

erythrematic, or specific varieties, depended upon common or peculiar causes, and

that, in the two last men. tioned varieties, the affection of the skin was only a small part of the disorder, the pia mater and arachnoid,

and more especially the mucous membrane of the bronchia and of the intestines being always affected, and. occasionally even the tunics of some internal arteries and veins. Having proceeded so far, I have now to enter upon the investigation of those agents in nature which have not the properties of common causes, but which are marked by special ones; yetbelievethat I shall here also be able to show, by facts and fair deductions, that these peculiar causes, namely, the poison called malaria, human contaions, and certain epidemic conditions of atmosphere, likewise produce three forms of fever—the congestive, simple, and inflammatory-in reference to.

194

their internal

pathology, blended,

In this lecture I shall confine my-

peculiar effects self to the consideration chiefly of one proceeding from the peculiarity of the infection, namely, that which is vaguely remote cause or occasion ; such ef. called Malaria, or Marsh Mitism, and fects being the most conspicuous in which originates from certain condithe external pathology, such as the tions of the earth and air. It is an rash of measles, the eruption of small exhalation which, evading our senses, pox, or the efflorescence of scarlet is only, in the present state of our .fever. This doctrine, I repeat, shall knowledge, distinguishable by its ef. be confirmed by an appeal to symp- fects. What are these effects ? These toms, dissections, and the effects of are, first, the production of an intermittent form of fever; secondly, ofa remedies. With respect to the peculiar causes remittent form of fever ; and thirdly, which produce fever, there are some of a continued form of fever; each which may be termed infections and having, as will be shown in my next others contagions, for remember tiiat tectnre, a peculiar combination of I make a distinction between infec- symptoms by which they differ from tion and contagion ; infection is a common fever, although their internal local taint, or contamination of air, pathology is similar to fevers proceedwhich arises from a combination of ing from common canses, that is to agents or circumstances external to say, it is congestive, it is simple, or the human body ; whereas, as far as it is inflammatory fever, under the human inquiry has yet legitimately general operation of this peculiar extended, contagion originates, not agent : the intermittent, remittent, without, but within the body, an ap- and continued forms of fever, each parently subtile secretion from the having certain peculiar combinationsof however, with

some

as the regular effects of ma. of the laria, or marsh efliovia. The intermitarcana of nature. Besides, there ap- tent form of fever is simple, the remitpears to be another difference between tent inflammatory, and the continued contagion and infection, namely, that still more highly inflammatory, as will contagion is unquestionably cotiimu- be clearly demonstrated in my next. nicable from person to person, this Though the intermittent, remittent, eommunicability being the true test of and continued forms of fever, from a contagion ; whereas, though it has malaria, pass and repass into each been presumed, that febrile disorder i, other, yet it is to the continued form commencing from an infection, as bye- that the designation of typhus has fore defined, propagates itself by con- been attached, under the supposition tagion, by the new formation or asi- that it proceeds from human contamilation of some subtile and special gions, and that it is not related to the power or poison—though this, I say, intermittent and remittent forms. lias been presumed, yet it has not, to my mind at least, been indisputably Typhus Fever. proved to be the case; and to me it Now it happens that we have no appears a problem still requiring a satisfactory solution. That fever aris- correct definition of typhus, nay, not ing from infection propagates itself by the semblance of a definition, for it is contagion is the prevailing dogma of an insnit to common sense to admit time-established schools and colleges, CULLEN’s definition to be such, which, but there it amounts only to a preju- including none of the essentials of dice ; an opinion taken up and main- typhus fever, is so loosely worded as tained without due examination ; an to be applicable to the last stage of opinion which, like most others de- any fever where the brain has been scended from such authorities, re- much affected in the first. Indeed quires to he tried and tested by onr most of Cullen’s definitions, as they own individual and dispassionate in- are called, are merely nominal, not -v4estigalions, for the time has at length real definitions, since they are abcome when the human mind maintains stract words, by which a number of the sacredness of independent in- symptoms arestrung together, without any reference to the pathological conquiry.

blood itself, the mode of the primary symptoms

generation

of which is

yet

one

195

ditions upon which those symptoms and that change is,

as

I before at-

depend. This is particularly the case tempted to prove, either a state ot in regard to what Cullen denominat- disorder or disease. Ctillen, like many ed febres, concerning the true nature of the older authors, did not, it must

of which he seemed to know little or li be confessed, discover the existence and yet this is the author I of that disorder, and therefore the who is held as a guide in most of our term idiopathic fever was an admiraschools and systematic works ! Yon ble shelter of expression, one nicely are aware that Cnllen has certain fitted to conceal an ignorance respectartificial distinctions, which he calls ingthose alterations which take place classes, orders, genera, and species. within the body. If we pass on to CULLEN’S contiA definition of a class, nosologically, is the most general description which nued fever, he describes it after this can be given of affections which have fashion : " Fever, without intermissymptoms in common; and a defini- sion, not arising from marsh miasma, tion of an order is the next most gene- but continuing with remissions and ral description, while that of the exacerbations, although not very regenera and species becomes more and markable, two paroxysms in each more particular. Now Cullen’s defi- day." Here is an assumption that a nition ofpyrexia is this, After shiver- continued fever never arises from ing succeed, a quick pulse, increased malaria, or marsh miasm ; but the heat, with interrnption and disorder truth is, as will by and bye appear, of several functions ; diminution of that this cause, operating in almost strength, particularly that of the all parts of the inhabited world, does joints." That this definition is very very frequently indeed produce congeneral must be admitted, indeed no- tinned fever, that usually termed tything can be more indefinite ; besides, phus. If we pass on to his snbdiviit is really inaccurate as to matter ofsions of continued fever, we find his fact. Ctillen here assumes, that shiver- synocha, his synochus, and his typhus. ing is always an essential part of fe- As to his definition of synocha, what ver ; but I showed, on a former occa- is it pray? He says, the heat is much sion, that fever sometimes arises from increased, the pulse freqnent, strong, the direct application of a stimulant, and hard, the urine red, the ftinewithout any cold fit or shivering at tions of the sensorium little disturbed. all; neither does the hot stage inva- Now only recollect that synocha is riably follow the cold one, as this de- arranged under the order febres, finition implies, for the cold stage where, according to Cullen, there is sometimes remains and constitutes no primary local disease." But did genuine congestive fever. But to go any m.)n ever see a fever, attended to his order febrcs, which he defines with such symptoms, which was not thus ..... Pyrexia, preceded by languor, preceded by some primary tocat dislassitude, and other signs of debility, order ? Most confidently, I answer, without any primary local disease."— never. Synochus, we are informed, This definition, you will perceive, is by the same authority, is a fever comonly a repetition of the former, with pounded of synocha and typhus; a the addition of a particular clause, synocha in the beginning, and a tynamety, the words, " no primary lo- phns towards the end. Indeed ! Is a cal disease," by which he distinguishes disorder really one thing at the comit from the class. Pyrexia is made, mencement, and another at the close? by Cullen, a part of the definition ofDo small pox, measles, scarlet fever, febes, and the definition of pyrexia pass into each other ? Is there any describes the functions as being much known affection which so changes its distarbed, yet we are told, even in character, nay, its constitution ? This febres, that there is no primary local’. is surely a nosological subtility, not disease. He assumes this, but it issanctioned by what is yet known in a metaphorical and medical absurdity,, the changes of explored nature. But for no disorder of the functions cani let ns- hear what CuM.EN says about possibly take place without havingtyphus. It is, agreeably to his creed, been preceded by some change in theacontagious fever, in which the heat organs connected with such functions,, is but little increased; the pulse

nothing;

"

196

weak, small, and in general quick; tion. The Romans were so well aware urine little changed ; the animal func- of this, that they had no less than tions much disturbed ; prostration of three temples in different parts of strength. But did any man ever wit- Itzily, to inspire the people with conness such a concourse of symptoms fidence, dedicated to the goddess Feunpreceded by primary local disor- bris. In modern Turkey, the doctrine der ?The answer is, assuredly never. of predestination prevails among the Moreover, this enumeration of symp- natives, and travellers assert that they toms is no more applicable to typhus are less liable to plague than stranfever than to any other fever, where gers who do not believe in that docthe powers of life are giving way, trine to the same unqualified extent. and where the brain is oppressed. In Charms were worn in ancient times, truth, it contains no correct allusions i and incantations performed for the to genuine typhus fever, the cliarac- purpose of communicating cottfidence; ters of which I shall endeavonr to nay, even in the present times, people describe, when I shall haepremised, often put camphor bags about their in this Lecture, some remarks on the necks, which give the wearers conremote occasions, and its contagious rage, and courage is the best prevenor non-contagions nature. tive of typhus. The weather also powerfully predisposes to the inflaence of infection, especially damp Remote Causes of Typhus. still weather, and therefore the allThe remote exciting cause of typhus tumn generally favours its operation. is peculiar, but there are certain cir- Cold is by some a cause of cumstances which favour the opera- typhus, but it is merely a concurrent tion of this cause, and they may be one, by weakening the body. Women, called the predisposing causes, all of upon the whole, are more liable than which operate in one mode, namely, men, but the strongest individual may by producing debility. It is in this be attacked, if exposed to a concenway, if an army be in full retreat, trated malaria, or marsh miasm. Forthe minds of the men being harassed, merly I believed, that human contaand their bodies enervated, and if gion was the primary and sole excitthey pass over, and especially if they ing cause of typhus fever; but having rest in, a district where the malaria been led into a new path prevails, typhus is almost sure to of inquiry, and having discovered, ta break out amongst them. It is on the myself, at least, satisfactorily, thatI same principle that famine becomes was mistaken in this respect, the only the predisposing cause of typhus, for reparation which I can make is thus then people experience Ytant publicly to acknowledge my error, and with mental distress. The history ot however humiliating such an acknowthis fever in Ireland has often been fedgment might be to human pride, connected with scarcity, of which yet I have the reward of possessing many proofs might be given. The what I hold to be the truth at last. epidemic which occurred in and about It is now nearly six years ago since London, in the year 1818, shows the I attended an individual who had an influence of the same cause ; many of’ intermittent fever or ague, distinctly the poor were then almost starving, marked by the cold, hot, and sweatand the summer having been anusnally ing stages, followed by a perfect inhot, they were very much predis- termission, and recurring at certain posed to the attacks of typhus. Fast- intervals. But in a few days this fever ing predisposes powerfully in some; lost the intermittent type, it became thus, if a man go out without his as distinctly remittent for a few days, breakfast and fatigue himself by a and then this remittent cleanged its long walk or business, he is very lia- character and became continued, and ble to be attacked by this disorder, if at last assumed the most malignant exposed to the exciting occasion. It symptoms of typhus. This case made is for the same teason, namely that so deep an impression on my mind, of depressing the mental and physical that I could not help asking, whether powers, that fear operates so deci- intermittent fever, remittent fever, the continued fever, called tydedly in predisposing to this affec-

supposed

accidentally

physical

and

197 not be modifications of shall

now adduce those which I have disorder? At all delivered from this place for some events, I determined to investigate years past, and which, I believe, when the subject most minutely, and com- taken together, you will deem permenced it, independently of the for- fectly conclusive as to the primary source from which typhus proceeds: mer prejudice of my college educa1. Typhus often arises simnltaneoustion, as if, indeed, I had known nothing previously on thesitt’ject. The ly, in single cases, in places remote result of my inquiries is, that I be- from each other. This circumstance lieve malaria to be the primary source frequently occurs both in and about of what is commonly denominated London, and I ask, how is it to be extyphus fever, that this fever has an in- plained on the doctrine of contagion, termittent, remittent, and a continued no direct or indirect intercourse havform, and that each of these forms so ing existed, by persons or things in pass and repass into each other as to these situations? show that they all are realiy modifi2. It often attacks many persons at cations of one affection, as far as the sriite time, and in the same place. their remote exciting cause is con- An instance of this occurred sometime cerned. Having imagined, on colle- ago, in which several children were giate authority, for a term of fifteen attacked in one day, in a school where years, that typhus originated from no fever had previously prevailed. hnman contagion, and having disco- How is that to be explained on the vered this opinion to be erroneous, doctrine of contagion? the very relation of such a circum3. Where many persons are attacked stance onght to teach you how cautious in the same place or district, if you yon should he in forming your opinions trace the history of the cases minutely on matters of importance; that you backwards, you will generally find should not, in fact, take them up upon that some appeared under an interthe mere assertions of others, bnt de- mittent, some under a remittent, and duce them from a consideration of others under a continued form, a fact facts, viewed neither through a me- for which the doctrine of contagion dium of prejudice, nor of partiality, cannot account. with respect to particular persons. 4. These forms, namely the interWhen I communicated this change of mittent, remittent, and continued, my opinion to some of my acquaint- pass and repass into each other in ance, I have been much amused to many cases, the intermittent becomobserve how it has been received. ing remittent, and the remittent beOne shrubs up his sloolders, hems, coming continued ; while, on the other and says that it is very strange; ano- hand, the continued sometimes bether cocks his eye into a corner, puts comes remittent, and the remittent his hand into his pocket and smiles, sometimes intermittent; and does the sarcastically smiles ; a third shakes doctrine of contagion at all explain his head, and swears that typhus not this conversion ? It certainiy does only arises from, but propagates itself not, whereas the doctrine of malaria. by contagion ; while a fourth strokes does, since it produces an intermithis chin, seems at a dead stand, and tent, a remittent, and continued fever. says that it is a subject which certain- convertible into each other, a peculy requires fur ther investigation. Now liarity which is not observable, so far if at the end of this Lecture you as I know, from any other remote ocshould stloke yonr chins, and make casion whatever. a similar declaration, I shall be per5. Typhus prevail most remarkably fectly content, for all that I wish is, in particular places. The common not that you should adopt my opinion, opinion is, that it prevails only in but that you should investigate for crowded situations, but this is a great yourselves, with all that sincerity, mistake, as can be easily proved by with all that punity of mind which its an advertence to facts, which are exgreat importance to society demands. hibited within the metropolis, and But to come to the facts; What are without its boundaries in the most he facts which justify the opinion open di-.tricts of the country. A house hat typhus arises from malaria? I had been shut np for some time, when

phns, might one

and the

same

198

be vitiated,

as it is sometimes, those are wrong who speak of an inwhich persons wili wish to eat char-. dividual power of association. Thus ’ coal and clay, then we say that such we are able to rectify by phrenology has a a being bad taste. There is a the abuses of’ philosophy, and whatpower of configuration; is it submit- ever has been said by philosophers of ted to laws ? Can a person having this the mind, can only be explained bya power say, I shall find ugly things reference to the individual powers beautiful ? We want to know whe- themselves, and then we have seen ther the activity of the internal pow- how diversified are the modes of acers is going on right or wrong, and it tion, which have been mistaken for is this sort of decision of the internal primitive powers. We have taken powers acting perfectly that we call quite a new step to-day, particularly regards the modes of action of the judgment. In the arts this power is sometimes -called judgment, and different powers. sometimes taste. The greatest actiNow I wish to touch on another vity of a power does not always indi- point, after having examined the powWe com- ers themselves, their natural lancate the best judgment. pare here the operations of the mind gnage, and their modes of activity, with those of the body, and we find and this is certainly a very important that it is not every one who has the part of the subject, to study the modes best appetite that has the best diges- of the activity of the powers; I come tion ; not every one who has a fine ear to the mutual influence of the poivers; that has a perfect action in the ear; no power acts alone, all the poners nor has every one who has a good act in a combined way, and in this taste a delicate taste. Some who are combined operation there are various fond of music are not capable ofsubjects to be considered. First, How judging correctly of its merits ; some the powers ought to act. It seems to who are fond of colours are not capa- me, that the powers are given, accordble of judging of them ; hence wemay ing to certain riiles, as theyougtitto to have as many judgn:ents as there are act; therefore letns first look at men powers. There is ro fundamental as they ought to be, and then as they power of judgment, but it is the at. are ; but v-e always wish to see mantribute of the powers I have already kind act as they ought to do. The mutual influence of the powers opens spoken of! What we call a philosophical judg- wide field of study, all immense ment in the reflective powers, what fund of phrenological inquiry is open is that ? Thejudgment of each power here, to examine the mutual inflnence is confined to itself, as colour, me- of the powers, and this is necessary if lody, configuration, &c. ; but as we you wish to speak of actions. You have spoken of certain reflective most, I repeat, first discover the difpowers which act differently from ference between the fundamental powothers, we perceive these powers ers, next their different degrees ot acsometimes to be active, and when tivity, and, lastly, their mutual in. they are active, then the result is that fluence. The mutual influence of the which is called a philosophical judg- powers produces a greater decree of ment : but it is not of itself a funda- activity in the powers individually, mental power, it is merely the perfect and therefore produces an infinite state of action of the individual now- number of modifications of actions. ers. One may have a perfect action A power being combined with two, in comparison, but not in causality. three, or four other powers, ivill proIs there a power of association? duce quite a peculiar action, very dif. from what it would do, snppos. Association takes place we know, but is there a power of association ? It is ing it to act alone. The result of the supposed, in general, that one power combined opeiatioii of the powers excites another. I may see a colour, will be considered in a future Lecture. and it may remind me of a person I Iwish now only to call your attention saw with clothes of that colour, of a to one point, that of the powers which thing of that colour. Is there a power act according to determinate rules; of association? There is a combina- some take the lead and others remain and the question for conkidetion of the individual powers, but

by

as

a

feren

behind,

199

damental’ powers. I come to-day to a new sort of consideration. Many who at first opposed phrenology have, from an examination of its doctrines, become converts to it and the greatest number of those who at present show an opposition to it, are not correctly informed of its nature or of its objects. I would say to those who suppose phrenology to have a dangerous tendency, Phrenology, is it true or is it false ? If it be not founded in truth, no danger can attend it, because it cannot stand long ; and you know, that in natural philosophy question about arrangement. Reflect a little oa this, whether a many truths were, when first promulman comes into the world with cergated, considered dangerous, and were taiu his powers ? the attempted ta be suppressed ; the disquestion is very difficult. I wish to coveries of Copernicus were for a long know whether we can change the laws time so treated. Whatever is founded of nutrition, or of circulation, or ofin nature, remains ; hence we begin respiration? I am always inclined to by observing in phrenology the fundefend the rights of the Creator, and damental powers, and if the brain be the laws of Nature. Can you change necessary for the manifestations of the the laws of digestion? mind now, that will remain eternally There are laws to be submitted to, true. I would say to all those who cry but they are not sufficiently attended against phrenology and maintain that to; and I wish to know whether there it is dangerous, Yes, I admit it, I is any arrangement here, whether know no modern doctrine so dangerthere is any internal law given to re- ons as phrenology; but to whom is it dangerous ? Do vou think that anv gulate the fundamental powers. The next time, I shall consider all truth whatever is dangerous to mantbe objections which have been enter- kind at large? Impossible! for that ed against phrenology, as leading to would be to accuse the Creator, who materialism, fatalism, andthe de- is the author of truth. But to whom struction of all moral and physical is it dangerous ? It is dangerous to

ration is, which ought to take the lead, and which ought not ? Frequent" ly I am told by a person, You do of because to not like speak my organs, " they are bad;" but I say, No, I do not, I cannot speak of good organs or bad organs ;" the organs in themselves cannot be good or bad, since these are only relative terms. Is water bad or fire bad or good ? You can only answer this question by making application of either one thing or the j other, and then the application may be good or bad. Now comes the great

good, or is

regulations,-;n

liberty.

speculative philosophers, for’ they must either prove that phrenology is unfounded in nature, or they must give up their self esteem and mere

LECTURE XV.

false systems, and acknowledge that they are ignorant of the human mind. By degrees you will perceive, that It must modffy the opinions hitherto the study of phrenology is very ex- prevalent in society, and this will tensive ; so extensive indeed, that it prove dangerous to mere theorists, embraces the whole range of human who, of the powers of the knowledge. You have seen, that after human mind, yet exclaim against the having studied certain manifestations dangers of phrenology. But phrenoof the mind, and after having observ logy has been considered dangerous ed the correspondence between their in another point of view, namely, in development, that some applica- a moral. It has been urged as an obtion of the knowledge thus derived jection to phrenology, that it leads to hasbeen made to the arts- You have muterialisna, to fatuasm, and so on. seen how opposed phrenology is to It is very easy to cry, but do those the speculative philosophy of the who cry understand the thing they schools, and how deceptive their opi- cry against; this is only done by those nions are, which have regarded the who have taken a superficial view of modifications of the mental powers as the phrenological system. Hitherto it has been customary to powers themselves ; whereas they are but the modes of action of the fun- consider the whole brain as necessary LADIES

AND

GENTLEMEN,

ignorant

200

of regular cloacte to drain and receive does typhus fever, thus originating, the filth of the city. In the reign of ever become contagious? Does it ever Augustus curators were appointed to acquire the property of communicat. cleanse the streets and keep the cIoa- ing itself from one person to another, cae in good condition. The ancient like small-pox, measles, or scarlet Romans, tempted by their fine cli- fever?This, I repeat, is another quesmate, lived much in the open air. tion, and one that requires an unpreBesides, as the government conciliat- judiced examination. ed the people as long as any traces Many men believe that typhus is of liberty remained, the public build- contagious, because they have been ings were magnificent, and much fre- told so at school or col!ege; precisely quented by them ; and unless great on the same principle that children care had been taken as to cleanliness take the assertions of their fathers and of the earth’s surface in particular, mothers as truths upon all subjects. typhus must have been very prevalent A friend of mine was sitting in his there. What a contrast between an- drawing-room, and two of his children cient and modern Rome! What a were playing about him, and they contrast between ancient and modern soon got into an argument, when one London !The one has been enslaved, of them attempted to settle the matand the other free for ages. Rome is ter, by saying that papa said it was now not only infected by the malaria so, and that, therefore, it must be so; of the earth, but that worse malaria of the other little fellow said, but I know, the mind, which makes her the very that if papa said so, he was mistaken, slave of those barbarians whom in for I saw it myself. His father looked her better days she despised; while up and exclaimed, what, you little London nurses within her bosom the dog, did you say that 1 was mistaken? pure spit it of independence, which, Yes, replied he boldly, if you said so, leading from one improvement to an- papa, you weM mistaken. Well, reother, has already made her the envy of joined the father, yon are a fine fel. there is a sliillinl, for vou. and be the world, and which will still be productive of many blessings to present sure always to maintain the truth. and succeeding times. One distin- Now as our fathers and forefathers guished political writer has suggested, of physic have often been mistaken, that in every government there ought we should not take their assertions as to be a minister of health. Be this as necessary truths, and since they lived it may, I am sure that London admits in a less enlightened age than the preof considerable improvement, in re- sent, we should put them to the test ference to the prevention of malaria, of the most minute investigation. and consequently to the prevention of The question, whether typhus fever is contagious or is not contagious, can typhus fever. It is a singular circumstance, that not be decided by any reference to when I first settled in London, the black-lettered books, but by a refecurrent opinion among the profession rence to facts, and facts alone, conwas, that typhus fever originated templated with the most perfect imsolely in human contagion, and it is partiality. You know, that I once remarkable that it should have been believed typhus fever to be conta. reserved for me to discover that mis- gious, but 1 feel it my duty now to take in this metropolis. But the dis- declare, that I have lived to doubt the covery, from what I before mention. correctness of that opinion, and shall ed, was quite accidental, and I take not decide till I have made the most But no credit to myself for having made it, extended and complete inquiry. though, when I reflect upon it, it gives I can say, from a review of a great me great pleasure, because whatever many cases, that if ever typhus prove prejudice may exist in the profession, contagious, the circumstance of its the discovery will make its way, the being so must be rare, and that the truth will triumph, and prove useful to public alarm upon the subject is not mankind. Malaria, then,I hold to be the sanctioned by what occurs in London, primary source of typhus fever. That for I must repeat again and again the I consider as a settled question. But incontrovertible fact, that this affecthis question involves another, namely, tion exists in certain patches or parts

I

I low.

201

of the

metropolis,

parish,

and

almost in every affection which schools and

yet it

spreads

never

must be recollected also, that most of the poor remain in their houses till the very last stage of typhus, and consequently, if this disorder were so contagious as is generally believed, it would spread in all directions. If small pox, measles, and scarlet fever, thus exi,ted in almost every district, and if they were thus allowed to advance to the last

throughout society. It

stage without removal into

some hosdoubt hut each of these affections would be diffused, Now as it were, all over London. why is not this the case in regard to typhus fever? Why, if it be so con- I tagious, is it limited to particular i places, beyond which it does not pass? Why, I repeat, does it observe this law, so different from that by which small pox, measles, and scarlet fever Let the advocates for are regulated ? ttnqaatified contagion answer these

pital,

there

can

be

no

questions. Again, I have known a great many instances in vehich patients labouring under typhus were removed into a fresh atmosphere, and yet in no case did the disorder

propagate

itself to

any other individual. Now how does this happen, if typims be contagions? Had the cases been those of small pox, measles, or scarlet fever, they would have been communicated to many pei-sois, provided those persons had not been before the subjects of such affections. Why does this difference exist between typhus fever, small pox, measles, and scarlet fever? Does it not show that they are, generally speaking at least, essentially different as to the capability of their beingcommunicated ? Besides, I have knownn wives kiss their husbands again and again, when the tongue and teeth of the latter were crusted with the sordess of typhns fever,-I have kuown fathers and mothers do the same thing to their childensimilarly situated,—I have known mothers suckle their children while they were subjects of typhus,—I have kncwn persons in health sleep in the same bed, with those sick of typhus,—and yet, in none of these cases, has the disorder been commnicated. Now I ask yon, once more, how such things could, by possibility, happen if typhus were that contagion! /

’

colleges,

and which those secondary and shallow intellects, who borrow their notions wholly from such authorities, would have ns implicitly to believe ? Perhaps we may be enabled to throw some light upon this obscure subject upon the difference between iufertion and contagion, by referring to some facts observable in certain cases of erysipelas, and of fever following puncture in the dissection of bodies undergoing the putrefactive process. I have repeatedly observed, that if the wards of an hospital he crowded with bad cases, when the air is so stagnant without as to prevent the removal of the foul air within from the fresh air without; I have repeatedly observed, I say, that erysipelas arises under such a combination of circumstances, and alone under such a combination, in the place already specified. In one person the remote occasion shall appear to be the puncture of a leech; in another, cold applied to the cheek; in a third, it shall arise from food offending the stomach, and in a fourth, it shall arise spontaneously, without there being such apparently concurring cause. In the progress of such cases. a continued fever arises. which so exactly resembles the continued typhus from malaria, that putting out of consideration the external erysipelas, it would be difficult, perhaps impossible, to distinguish it from con ti ntied typhus ofmarsh miasm. Though I have carefully watched the iise and progress of this form of erysipelas, which you know I call the erythrematic, by may of distinction, yet I have never known one instance of it in which it appeared to propagate itself from person to person. It occurs within a local taint or contamination of air, and persons removed from that air do not communicate the affection. On reflection, it appeared to me highly probabic, that this local taint or contamination-ofair was the product of the odour of the stools, urine, breath, and perspiration. Assuming this to be the case, when I was physician to the Fever Hospital, induced the committee to establish convalescent wards; and as they enabled me, while I was there, to keep the receiving wards much less crowded, this expedient, together

with free

ventilation, nearly proved

a

202

preventive

of the

erysipelas,

for I but that I have not

yet met with

any

only had two slight cases afterwards well authenticated and considered during the whole of the time which I facts which would justify me in draivremained in that office. With respect ing such a conclusion. Common can. to the low fever which sometimes fol- donr, however, requires me to state, lows puncture in dissecting, it also that I have met with some cases, a puts on so exactly the character of few, indeed, out of a vast many, continued typhus from malaria, that, which at first sight gave a strong colosing sight of the original puncture, loui-ing to the doctrine of contagion, the beamed absorbents np the arm, but which, duty considered, are ex. and the tender glands in the axilla, in plicable on that of malaria. Thus, twelve cases which I have witnessed, for instance, the sister of a young I could not have distinctly drawn the lady who died of typhus, requested to line of demarcation. Yet in none of see the body the day after death, and, thesp. examples has the disorder pro- while standing over it, she became pagated itself, though I have noticed faint and sick, and had an attack of their progress very narrowly, and typhus. But the lady, whom I saw though most of them occurred among in a dying state, and who soon after. my pupils in confined situations. wards expired, lived in a house where Moreover, GASPARD has shown, by I had traced the existence of mala. experiment, that putrid animal or ria for some years; her sister, the se. vegetable matter, introduced into the cond affected, had also lived in that blood, occasions a fever of the typhoid house, and is it not, therefore, pro. or typhous character. bable, that the sight of the body, by Itwould appear, then, that a fever debilitating her frame, was onty the having a peculiar intermittent, remit- predisposing cause, and that this se-

tent, and continued character, arises cond individual, like the first, had

from malaria, and malaria alone, as been exposed to malaria, the predis. far as my observation goes; but it posing cause ? One of the porters of the Fever would also appear, that a fever of a typhoid a continued form, with Hospital was attacked by typhus, and or typhous character, arises, 2dly, an excellent physician told me, that ]From a local taint or contamination this surely was a convincing proof of ofair from the odour of the stools, the contagious nature of the disorder. urine, breath, and perspiration ; and, But I replied, that this porter had 3dly, from the introduction of putrid been almost daily in districts where prevailed, and it turned out, matter, as in the case of puncture from dissection, or of the experiments in investigating the case, that it had

malaria

made by GASPARD on the lower ani- the character of a quotidian agae a ever happen that week before it put on the continued Mali. Now does itunder this form of form, thus showing, that it had arisen labouring the air personsso contaminate a like from malaria. Nurses about the hos-

fever miasm,

or

by putrid product, as to affect pital are occasionally attacked, and approached them in a like especially those who wasli the clothes Or does it ever happen, of the siek. B

those who iiiaiiner ? that the clothes of persons who approach such patients are so imbued with such a miasm, or putrid product, as to give it off again, and occasion thus a similar fever in individuals previously healthy? These are qllestions which can only be answered by an observation at once the most minute and extensive ; and though I have been so long and so laboriously attending to the subject, I must pause, must leave my mind open to the reception of future facts, and decide accordingly. In the mean time would say, that the thing is possible,

, .

!I,

In allusion to the influence of smells, I may mention, that I have seen individuals who, being debilitated by disagreeable odours of a common nature,

were seized, some by intermittent,some by remittent, and others by continued typhus ; and in such cases we can only

suppose, that the disagreeable odour of a common kind had been the predisposing canse, since the symptoms which arose were those of a peculiar character, such, in a word, as arise from malaria or marsh miasm. Confinement within the walls of a hospital is a powerfully predis-

203 to some, and the hos- ria, and has led them to trnst t8 fever stands in one of the malaria hospitals as means of prevention. Bnt districts, to the influence of which its if my observations be correct, fever inmates must be occasionally exposed hospitals are of’iittle or no utility in a. in passing to and from the hospital. I preventive point of view, especially might assume, with as much show of those which receive patients in the last truth, that this theatre is a focus of stage. Indeed typhus obeys moral contagion, and might apparently prove and physical laws to which the overit, by saying that many of my pupils, nors of such establishments do not at far more than the proportion of the all advert, and how can we expect inmates of the Fever Hospital, are them to be useful in a preventive attacked by typhus ; but the fact is, point of view ? So certain am I in the that many of my pupils are broken truth of the doctrine of malaria, and up by hard study; and lodging in one a local taint or contamination of air, of the malaria districts, the Boroagh, that I believe, with the aid of the Lethey become predisposed, and being gislatnre, I could go far to annihilate exposed to its influence, they are at- typhus fever in the British metropolis, tacked. But though their friends wait where many substantial improvements upon them affectionately, as nurses, I might be made in reference to this have never known any of them re- subject. ceive the disorder from the sick. The doctrine of contagion is so inUpon the whole, then, though I would flnential, so pernicious in its unquanot take upon myself to deny, in the lified application, that it ought to be present stage of the inquiry, the pos- sifted to the very bottom. By alarming sibility of typhus being contagious, the healthy, it powerfully predisposes yet I have become more and more them to the operation of malaria and sceptical on the subject, the more mi- other subtile agencies ; it renders the nutely I have inquired into facts. attendants often so selfish, that they Many men, it is true, make confident sacrifice the sick by sending them to declaration-, and say that typhus has hospitals at so late a stage that the spread from such and snch a family fatigue of the removal destroys all as from a focus; but wherever I have reasonable hope of recovery ; it alarms had an opportunity of investigating and debilitates the sick themselves, the matter on the spot referred to, it and in that way often destroys them has happened, either that the evi- through its mental irritation and deIt has endangered the dences of malaria were distinct, or pression. that the drains were in such an iiii- welfare of whole cities, as of Alicant, perfect state as to produce a local where military lines were drawn taint or contamination of air. round, so that the inhabitants could What formerly deceived me, and not leave their homes, but were comwhat still deceives many persons is pelled to breathe the local taint or this, that one, two, or more indivi- contamination of the atmosphere there. duals may be attacked in the same Nav- it mav endanger the verv liberty to house. But if one case arise from of nothing of icommalaria, why not another and an- merce, as recently happened in Spain, other ? And where this is the case, where the doctrine of contagion was generally speaking, we have grounds made an infamous pretence of gatherfor inferring that malaria was the pri- ing together that French army which mary source, because, on minute exa- advanced, more fatally than any conmination of the testimony, it will be tagion, and crushed the rising liberfonnd, that some cases in the com- ties of Spain, and restored all the* mencement assumed an intermittent horrors of an unrestricted despotism. or a remittent character. Yon would do well to ponder upon all The doctrine of contagion has been these things. You would do well to productive of one great practical evilI pause before you admit the doctrine in London and elsewhere. It hasof contagion, since it involves such withdrawn the attention of the pro- momentous conseqnences, private as fession, of the public, and even of thewell as public. Above all, let me adgovernment, from the considerationI vise you, as you value your own apof its primary source, namely, mala-- probation, the health and lives of the

posing cause

pital

a country,

say

204 of your tive to the organization of the brain, I repeat, let to see whether it corresponded with me advise you to examine into the the actions observed, and we observe question through facts, uninfluenced that a very intriguing fellow, who by any prejudice towards others, or plays a double character, will often by any partiality to myself personally. succeed well in the woi ld. There are In my next, I shall consider the some individuals without great merit symptoms, morbid anatomy, and treat- who know how to find their way ment of typhus, and shall, at the same through life, they know how to play time, endeavour to show the identity off to the greatest advantage ; whilst of that affection and what are com- others never succeed, they fail in monly called yellow fever and the every thing they nndertake. GALL was attentive to the organization of plague. such cliai-acteis, and he fouud that (Loud applause followed this long they were broad above the ear, above and excellent lecture.) the organ of destractiveness. This

public, and the advancement

profession,—above all,

a cast) was an individual of the characterI have desciibed ; if you look at the configuration of his head you will find that it is broad here, at the middle, and on the side of the head above destructiveness. This in. dividual (showing a cast) belon"ed to a good family, a very respectable family, he spent agreat deal of money, and then to get more he deceived all his friends ; he borrowed large snms of money of one and then of another, but no one person thought he had borrowed of a second ; he obtained a sum so large, and having spent it all, he could in the end, pay nobody, and thus he was discovered. Dr.GALL found very cunning individuals always very broad here, and he called it the organ of cunning. If you examine cunning individuals you will find that they are broad here, laterally. Indi. viduals in different countries nhoare cunning you will find broad here. However, shall there be an organ of cunning? I will give you my opinion. In order to be cunning, we must possess a certain quantity of intellect, and the feelings I have hitherto spoken of are without intellect and blind, and I have stated that they are blind because they produce a determinate impulse without the exercise of judgment. To be cunning is also natural, but persons do not like to be considered cunning although nature appears to have given a propensity. What then is the fundamental power of this organ ? Ifyou reflect ou the actions of men and animals, you will find that there is a peculiar instinct to hide and conceal ; an instinct which is very necessary and important to animals. Many escape from their

(showing

LECTURES ON

PHRENOLOGY, BY

DR.

SPURZHEIM.

LECTURE 6. LADIES AND GENTLEMEN, I have spoken hitherto of the animal propensities, and theretcmain three to be considered. Secretiveness.

Among the different characters found in society, there is one distinguished by the name of cunning. It is not always that persons excel by judgment, persons may be very cunning and have but little judgment. It is difficult for such persons to give direct answers to questions, they will turn the point, if they can, by evasion, and in speaking with them you must insist upon the argument to induce them to pay attention and to answer you; they prefer to tell lies. (A laugh.) Some individuals are exceedingly fond

of intriguing, and they are fond ofshifting; they turn with the wind. If ever you have to defend an opinion they are ready to join you, and do as you do, and if you alter your opinion they alter their’s. Hence, observing this versatile disposition in some individuals, it was very natural to be atten-