ARTHRITIC, Or GoUTY, in which common inflammation advances with unusual rapidity, and proves very irritative, giving way more to certain peculiar anodynes than abstraction of blood, and in which diseases of debility prove very obstinate, or often terminate fatally. (See SEDATIVES, p. 41.)

MELANCHOLIC, when the patient is disposed to melancholy or mania, and in which many diseases prove intractable.

Some practitioners assert that such distinctions are productive of no practical utility, because the nature of the malady, and not the constitution of the patient, must determine the treatment of every disease. This opinion is peculiar to a class of practitioners too numerous in this country, who are blind followers of their teachers, whose minds are, in fact, too narrow to divest themselves of prejudice, and too shallow to collect facts; and if by chance any occurrence should particularly excite their attention, too weak for observation or reflection that is likely to prove useful to their patients.

Some lecturers treat the doctrines of temperaments, from certain supposed morbid conditions of the fluids, with great contempt, because they imagine the idea of vitiated fluids is without the smallest foundation. The late Dr. Fordyce condemned the doctrine as erroneous; but he admitted that appearances often favoured them, and allowed that, in certain persons born, bred up, and living in all the circumstances of others of the same community, certain temperaments do exist; and this opinion, I think, no practitioner of experience will deny. With respect to the idea that diseases are often dependant on, or aggravated by, a morbid condition of the fluids of the body (on which the humeral pathology is founded), I am satisfied much useful practical knowledge may be collected from this system, as well as from others, for all afford some useful information; and, instead of abandoning these systems entirely, the man who is anxious to exercise his art for the benefit of his fellow-creatures afflicted with disease, will endeavour to separate the substance from the froth, the practical facts from the flights of fancy. Mr. Abernethy is of opinion the fluids of the body are often vitiated by absorption of imperfectly-digested food. He says, part of the food (which has not been perfectly digested) is imbibed from the bowels, and renders the blood impure, and (in his opinion) there being no outlet for such impurities but through the kidneys, they are a cause of foul urine, and for the presence of many substances in that fluid. Whoever considers the processes of nutrition of the body by deposition and the conveyance of unhealthy or old parts of the body, by the absorbents, to the mass of blood, must be convinced that the blood will become impure, when the organs for separating such impurities from the mass of

blood do not perform their offices. I might, therefore, with great propriety, have noticed the temperament of the body termed cacochymic, signifying, according to the humeral pathology, a vitiated state of the fluids, especially of the mass of blood. Old as this doctrine is, it really appears to me to be the basis of the chylopoietic or blue pill system of Mr. Abernethy.

Objections may be made to some of the temperaments of the body I have noticed, particularly the gouty, the rheumatic, the scrofulous, &c., because they are dependant on morbid conditions; but this is not the case: for I speak only of such constitutions as are disposed to the diseases, and by which disposition many maladies, and even inflammation attendant on accidents, are aggravated. Many may object to them, because even three or four sometimes occur in the same person, as the plethoric, the erysipelatous, scrofulous, and the gouty; but this fact, in my opinion, forcibly points out the necessity of keeping all of them in view in the treatment of any malady, either local or general. Whatever objections theorists may start against the temperaments I have noticed, I have no doubt practitioners, whose experience has enabled them to collect practical information, will be satisfied of the importance of a proper knowledge of them in the practice of medicine; and the physicians who do not attend to the temperament or temperaments of his patients, is only fit to talk Greek or Latin to amuse lunatics or maniacs by a variety of sounds. He is, in fact, a mere stage doctor, who attends more to the effect of a false shew of learning, than the effect of remedies. To practitioners aware of the importance of attending to the temperaments of their patients, the absurdity of laying down rules for prescribing scientifically, and of recommending a particular treatment for any disease, as by lecturers and authors of works on the "Practice of Physic," without any regard to the stage of the complaint, or the temperament or peculiarity that may prevail, must appear obvious; and certain I am, that from inattention to these circumstances many valuable remedies have fallen into disrepute. These temperaments I have particularly described in a work I have published under the title of "A Practical Treatise on the Means of regulating the Stomach and Bowels by means of Medicine, Diet, Exercise, in habitual and other varieties of Constipation, &c. &c., and for correcting the scrofulous, gouty, rheumatic, erysipelatous, leucophlegmatic, nervous, and melancholic temperaments, and securing the system against the inroads of the grand climacteric disease, or breaking up of the constitution." It was my intention on commencing this article to have condensed the chapters on the different temperaments, so as to have introduced them into this work; but I found my limits would not admit of

it, without leaving out what I consider to be useful matter; but as the sympathies and peculiarities (idiosyncrasies *) of the body are chiefly, if not entirely, dependant on the nervous temperament, I shall give the substance of the chapter on it.

Singularities or peculiarities of the constitution, which so frequently occur in practice, technically termed idiosyncrasy, appear to be dependant on the nervous system. So general and common is peculiarity of constitution, that almost every individual has, in some degree, a state of health peculiar to himself, independent of the morbid temperaments; as the sanguineous, the leucophlegmatic, the erysipelatous, the nervous, &c. &c. On some persons, a mild application to the skin will produce considerable inflammation, and this effect is sometimes occasioned by a simple ointment of bees-wax; and it is not uncommon for a mild article of diet, as veal, &c. to disorder the bowels. I lately met with a nervous patient, who was in the habit of taking two grains of opium (an article which is commonly administered to check diarrhoea, and which almost uniformly constipates the bowels) to act as an aperient; and he always found it operate as effectually and much more pleasantly than any of the class of opening medicines.

It is, therefore, incumbent on patients to acquaint their medical attendants with the peculiarities of their constitutions, and the duty of physicians not only to attend to such statements, but to obtain a thorough knowledge of them. The fashionable physicians, who generally estimate the success of their practice by the number of their fees, will not spare time to listen to the narratives of their patients. Their duty (to themselves) is confined to a short ceremony of making an imposing exhibition of a watch and its ornamental appendages (a chain and seals), looking at the tongue, and writing a prescription, to entitle them to the fee; and in receiving it, their object is attained. A certain system-monger, celebrated for eccentricity, thinks it waste of time to attend to any such “irrelevant nonsense;" for, let the complaint be chronic or acute, primary or symptomatic, and the peculiarities of the constitution ever so singular, they must give way to the blue pill and an aperient draught; and, although the peculiarities are not diseases, but dependant on original organization, even they must give way to his blue pill system. Peculiarity of constitution has been noticed as an objection to domestic medicine; but, so far from this being the case, we really think it operates in its favour; for, surely, the invalid, who is acquainted with his peculiarities,

When the stomach, or any other part of the body, or the whole system, is affected by an article, either medicinal or dietetic, which it does not in one person of five hundred, it is attributed to idiosyncrasy.

must be as competent, if not more so, to the treatment of his own complaint, as the physician who does not take the trouble to become acquainted with them. All diseases are more or less modified by peculiarities, and, in some constitutions, a disease often requires an opposite treatment to that which is proper in another person; and the power of ascertaining the cause of such modifications is not to be acquired at any school, or even by extensive practice, but by knowledge obtained from the patients themselves. It was the practice of the late Dr. Campbell of Hereford, and the late Dr. Reynolds of London, always to keep in view the nervous system in the treatment of all maladies; and the most experienced practitioners are aware, that, in the treatment of diseases, there is more to combat in the constitution from nervous excitement or peculiarity than in the disease itself.

THE SYMPATHIES existing between the different parts of the living body, not depending on proximity, have engaged the attention of ancient and modern physiologists; and to the physician and metaphysician these phenomena afford an extensive field for research and reflection. Sympathies, contiguous and remote, are like the peculiarities of constitution, greatly dependant on the nervous system, and are no doubt much influenced by singularity and habits. Although the brain is the seat of sensation, the sympathy between it and the stomach is so immediate or direct, and that between the stomach and the other viscera so considerable, that the stomach may be considered the centre of sympathy. Mr. Abernethy, who attributes all local diseases to a disordered state of the liver, stomach, and duodenum, admits, what indeed no surgeon of experience and observation will deny, that the stomach is often sympathetically affected. "When," says he, 66 I find that irritation of the nervous system, however it may originate, deranges the chylopoietic organs, and affects the stomach, bowels, and liver, apparently at the same time, I think it fair to infer, that these organs are equally operated on by the same cause. Disorder of the brain," he observes," may affect the chylopoietic organs, and it is well known that this influence is reciprocal. The stomach is said to be chiefly concerned in producing these effects, but the cause of the sympathetic affection is probably more general. A fit of passion has produced jaundice, and the irritation of teething in children frequently suspends the secretion of bile, so that the stools are not in the least degree tinged with that fluid. If the brain can thus affect the liver, it is reasonable to infer, that the liver may reciprocally affect the head. It is very difficult to form an opinion relative to this subject; for, in the instances which have been mentioned, the affection of the liver may take place, only because it forms a part of the digestive organs, and not from a DIRECT Sympathy existing between it and the brain,

Still, however," says Mr. A., "I do not think it unreasonable to conclude, that irritation of the other chylopoietic organs may, as well as that of the stomach, disorder the source of sensation." Such is the sympathy existing between the brain and stomach, that a disgusting object will often excite vomiting, and even some operations of the mind itself seem to act directly on that organ The seat of grief appears to be the stomach; and the distressing feelings of the hypochondriac being generally referred to the region of this viscus, we have often been disposed to attribute the latter to some disordered or diseased state of the ganglions in its neighbourhood, the use of which is probably to keep up a nervous energy between the brain and the abdominal viscera, i. e. they are probably auxiliaries to the brain for the purpose of equalising the nervous power throughout the contents of the abdomen. "Our bodies," says Mr. Abernethy, " are so constructed, that one part seldom suffers alone; and sometimes the most inconsiderable organ, when injured, excites the most violent affections." Some of the natural sympathies are very remarkable, and not to be accounted for by at least direct nervous connection. The sympathy existing between the uterus and the stomach, and between the uterus and the glands of the breast which secrete milk (mammary), is evident from the nausea which is attendant on pregnancy, and the swelling of the breasts, and even secretion of milk during the last stage of pregnancy, and also by after-pains being brought on two or three days after delivery, by drawing the breasts. The sympathy which exists between the brain and stomach is so great, that it is often extremely difficult to ascertain which is sympathetically disturbed. The sympathy between the stomach and remote parts, in which no natural sympathy apparently exists, is often remarkably increased by disease. Hence, in cases of painful or irritative ulcerations in the extremities, a stimulus applied to the stomach will almost instantaneously aggravate the local disease, without disturbing the nervous system, or accelerating the circulation; and an anodyne taken into the stomach will as speedily allay pain in a remote part. I have known the stomach to be greatly disordered, immediately on the application of a caustic to an ulcer in the rectum : and it is common for even a robust man to experience a distressing sensation at his stomach, and to faint on introducing a sound or bougie into the bladder. When a part is affected with an irritative disease, the sympathy between it and the whole body is proportionably increased with that of the stomach. In cases of irritation in any part of the intestinal canal, the application of cold water, even to the feet or hands, will produce acute pain in the bowels, and even purging. The same degree of sympathy exists between the skin of the extremities with diseased lungs, heart, bladder,