These observations on sleep have however led me a little from the direct road; but I thought they could not be better introduced than here. I shall now return to the subject of our more immediate inquiry.

By induction we have discovered two of the principal laws by which living bodies are governed: the first is, that when the ordinary powers which support life have been suspended, or their action has been lessened for a time, the excitability, or vital principle, accumulates, or becomes more fit to receive their actions; and secondly, when these powers have acted violently, or for a considerable time, the excitability is exhausted, or becomes less fit to receive their actions. There are therefore three states in which living bodies exist. First, a state of accumulated excitability. Secondly, a state of exhausted excitability. Thirdly, when the excitability is in such a state as to produce the strongest and most healthy actions, when acted upon by the external powers.

From what has been said, it must be evident that life depends continually on the action of external powers on the excitability, and that by their continued action, if they be properly regulated, the excitability will be gradually, and insensibly exhausted, and life will be resigned into the hands of him who gave it, without a struggle, and without a groan.

We see then that nature operates in supporting the living part of the creation, by laws as simple and beautiful as those by which the animated world is governed. In the latter we see the order and harmony which is observed by the planets, and their satellites, in their revolution round the great source of heat and light;

"————— all combin'd And ruled unerring, by that Single Power, Which draws the stone projected, to the ground.

In the animated part of the creation, we observe those beautiful phenomena which are exhibited by an almost infinite variety of individuals; all depending upon, and produced by one simple law; the acting of external powers upon their excitability.

I cannot express my admiration of the wisdom of the Creator better than in the words of Thomson.

"O unprofuse magnificence divine! O wisdom truly perfect! thus to call From a few causes such a scheme of life; Effects so various, beautiful, and great."

Life then, or those functions which we call living, are the effects of certain exciting powers acting on the excitability, or property distinguishing living from dead matter. When these effects, viz. the functions, flow easily, pleasantly, and completely, from the action of these powers, they indicate that state which we call health.

We may therefore, as we before hinted, distinguish three states of the irritable fibre, or three different degrees of excitability, of which the living body is susceptible.

1. The state of health which is peculiar to each individual, and which has been called by Haller, and other physiologists, the tone of the fibre. This is produced by a middle degree of stimulus acting upon a middle degree of excitability: and the effect produced by this action, we call excitement.

2. The state of accumulation, produced by the absence or diminished action of the accustomed stimuli.

3. The state of exhaustion, produced by the too powerful action of stimuli; and this may be produced either by the too powerful, or long continued action of the common stimulants which support life, such as food, air, heat, and exercise; or it may be caused by an application of stimulants, which act more powerfully on the excitability, and which exhaust it more quickly, such as wine, spirits, and opium, musk, camphor, and various other articles used in medicines.

The state of health, or tone, if we use that term, consists therefore in a certain quantity or energy of excitability necessary to its preservation. To maintain this state, the action of the stimuli should be strong enough to carry off from the body the surplus of this irritable principle. To obtain this end, a certain equilibrium is necessary between the excitability and the stimuli applied, or the sum of all the stimuli acting upon it must be always nearly equal, and sufficient to prevent an excess of excitability, but not so strong as to carry off more than this excess. It is in this equilibrium between the acting stimuli and the excitability, that the health, or tone of the living body consists.

When the sum of the stimuli, acting on the body, is so small, as not to carry off the excess of excitability, it accumulates, and diseases of irritability are produced. Of this nature are those diseases to which the poor are often subject, and which will be particularly considered hereafter.

When the sum of the stimuli acting on the body, is too great, it is deprived not only of the excess of excitability, but also of some portion of the irritable principle necessary for the tone of the body: or, to speak more distinctly, the body loses more excitability than it receives, and of course must, in a short time, be in a state of exhaustion. This gives rise to diseases which afflict drinkers, or those who indulge in any kind of intemperance, or persons born in climates where the temperature is moderate, but who emigrate to those which are much warmer.

Thus we have endeavoured, after the example of Dr. Brown, to ascertain the cause of the healthy state, before the causes of diseases were investigated; and though this is contrary to the general practice, yet it must be evident to every one, that unless we are acquainted with the causes of good health, it will be impossible for us to form any estimate of those variations from that state, called diseases: hence it is that a number of diseases, which have been brought on merely by the undue action of the exciting powers, such as gout, rheumatism, and the numerous trains of nervous complaints, which were by no means understood, may be easily and satisfactorily explained, and as easily cured, by restoring the proper action of these powers, and bringing the excitability to its proper state. As this theory, therefore, is so important, not only in respect to the preservation of health, which nearly concerns every individual, but to the cure of diseases, which is the province of the physician, I have endeavoured to explain it as fully and minutely as possible; to make it still plainer we may perhaps make use of the following illustration.

Suppose a fire to be made in a grate or furnace, filled with a kind of fuel not very combustible, and which could only be kept burning by means of a machine, containing several tubes placed before it, and constantly pouring streams of air into it. Suppose also a pipe to be fixed in the back of the chimney, through which a constant supply of fresh fuel is gradually let down into the grate, to repair the waste occasioned by the combustion kept up by the air machine.

The grate will represent the human body; the fuel in it the life or excitability, and the tube behind, supplying fresh fuel, will denote the power of all living systems, constantly to regenerate or produce excitability; the air machine, consisting of several tubes, may denote the various stimuli applied to the excitability of the body; the flame produced in consequence of that application, represents life; the product of the exciting powers acting upon the excitability.

Here we see, that flame, like life, is drawn forth from fuel by the constant application of streams of air, poured into it from the different tubes of the machine. When the quantity of air poured in through these different tubes is sufficient to consume the fuel as it is supplied, a constant and regular flame will be produced: but if we suppose that some of them are stopped, or that they do not supply a sufficient quantity of air, then the fuel will accumulate, and the flame will be languid and smothered, but liable to break out with violence, when the usual quantity of air is supplied.

On the contrary, if we suppose a greater quantity of air to rush through the tubes, then the fuel will be consumed or exhausted faster than it is supplied; and in order therefore to reduce the combustion to the proper degree, the quantity of air supplied must be diminished, and the quantity of fuel increased.

If we suppose one of the tubes, instead of common air, to supply oxygen gas, it will represent the action of wine, spirits, ether, opium, and other powerful stimulants upon the body: a bright and vivid flame will be produced, which however will only be of short duration, for the fuel will be consumed faster than it is supplied, and a state of exhaustion will take place.

We may carry this illustration still further, and suppose that the air tubes exhaust the fuel every day faster than it can be supplied, then it will be necessary at night to stop up some of the tubes, so that the expense of fuel may be less than its supply, in order to make up for the deficiency. When this is made up, the tubes may in the morning be opened, and the combustion carried on during the day as usual. This will illustrate the nature of sleep. In speaking of this subject, it was observed, that the more violently the exciting powers have acted, the sooner is sleep brought on; because the excitability is sooner exhausted. In the same way the more the air rushes through the tubes, the sooner will the fuel be consumed, and want replenishing. When the exciting powers have acted feebly, a person feels no inclination to sleep, because the excitability is not exhausted to the proper degree, and therefore does not want accumulating. But any diffusible stimulus, as spirits, or opium, will soon exhaust it to the proper degree.

In the same way, if the air have not passed rapidly through the tubes, the fuel will not be exhausted: but it may be brought to a proper degree of exhaustion by the application of oxygen gas.

When the air which nourishes the flame is so regulated, that it consumes the fuel as it is supplied, but no faster, a clear and steady flame will be kept up, which will go on as long as the fuel lasts, or the grate resists the action of the fire: but at last when the fuel, which we do not suppose inexhaustible, is burnt out, the fire must cease.

In the same manner, if the different exciting powers which support life were properly regulated, all the functions of the body would be properly performed, and we should pass our life in a state of health, seldom known to any but savages, and brute animals not under the dominion of man, who regulate these powers merely by the necessities of nature.

When air is applied in too great quantity, and especially if some of the tubes convey oxygen gas, then a violent combustion and flame is excited, which will, in all probability, consume or burn out the furnace or grate, or if it do not, it will burn out the fuel, and thus exhaust itself.

In like manner, if the stimulants which support life be made to act too powerfully, and particularly if any powerful stimulus, not natural to the body, such as wine or spirits, be taken in too great quantity, a violent inflammatory action will be the consequence, which may destroy the human machine: but if it do not, it will exhaust the excitability, and thus bring on great debility.

This analogy might be pursued further, but my intention was solely to illustrate some of the outlines of our theory, by a comparison which may facilitate the conception of the manner in which external powers act on living bodies. The different powers which support life, and without whose action we are unable to exist, such as heat, food, air, &c. have been very improperly called nonnaturals, a term which is much more applicable to those substances which we are daily in the habit of receiving into the system, which excite it to undue actions, and which nature never intended we should receive; such as spirituous and fermented liquors, and high seasoned foods. In the preceding illustration, I have spoken of a tube, as constantly pouring in fresh fuel, because it was not easy otherwise to convey a familiar idea of the power which all living systems possess of renewing their excitability, when exhausted. The excitability is an unknown somewhat, subject to peculiar laws, some of which we have examined, but whose different states we are obliged to describe, though, perhaps, inaccurately, by terms borrowed from the qualities of material substances.

Though Dr. Brown very properly declined entering into the consideration of the nature of excitability, or the manner in which it is produced, the discoveries which have been made in chemistry since his time, have thrown great light on the subject, and it is now rendered highly probable that the excitability or vital principle, is communicated to the body by the circulation, and is intimately connected with the process of oxidation.

Many circumstances would tend to show, that a strict connexion exists between the reception of oxygen into the body, and the vital principle.

When an animal has been killed by depriving it of oxygen gas, the heart and other muscles, and indeed the whole system, will be found completely to have lost its excitability. This is not the case when an animal is killed in a different manner. When an animal is shot, or killed in the common manner, by bleeding to death, if the heart be taken out, it will contract for some hours, on the application of stimulants. But this is not the case with an animal that has been drowned, or killed by immersion in carbonic acid, azotic, or hydrogenous gases; in these last instances, the heart either does not contract at all, or very feebly, on the application of the strongest stimulants.

We have already seen that oxygen unites with the blood in the lungs, during respiration: by the circulation of the blood it is distributed to every part of the system, and we shall find, that in proportion to its abundance is the excitability of the body. In proof of this, I shall relate some facts and experiments.

Dr. Girtanner injected a quantity of very pure oxygen gas into the jugular vein of a dog: the animal raised terrible outcries, breathed very quickly, and with great difficulty: by little and little his limbs became hard and stiff, he fell asleep, and died in the course of a few minutes afterwards. It ought here to be observed, that any of the gases, or almost any fluid, however mild, when thus suddenly introduced into the circulating system, generally, and speedily, occasions death.

On opening the chest, the heart was found more irritable than ordinary, and its external contractions and dilatations continued for more than an hour: the right auricle of the heart, which usually contains black venous blood, contained, as well as the right ventricle, a quantity of blood of a bright vermilion colour; and all the muscles of the body were found to be more than usually irritable. This experiment not only proves that the vermilion colour of the blood proceeds from oxygen, but likewise seems to show, that oxygen is the cause of excitability.

A quantity of azotic gas, which had been exposed for some time to the contact of lime water, in order to separate any carbonic acid gas it might contain, was injected into the jugular vein of a dog. The animal died in twenty seconds. Upon opening the chest, the heart was found filled with black and coagulated blood: this organ, and most of the muscles had nearly lost the whole of their irritability, for they contracted but very weakly, on the application of the strongest stimulants.

A quantity of carbonic acid gas was injected into the jugular vein of a dog: the animal became sleepy, and died in about a quarter of an hour: the heart was found filled with black and coagulated blood, and had lost the whole of its irritability; neither it, nor any of the muscles producing any contractions, upon the application of stimulants.

Humboldt likewise mentions a curious fact, which tends strongly to confirm this idea. When the excitability of the limb of a frog had been so far exhausted, by the application of zinc and silver, that it would produce no more contractions, on moistening it with oxygenated muriatic acid, the contractions were renewed.

After the excitability of the sensitive plant (mimosa pudica) had been so far exhausted, by irritation, that it ceased to contract, when further irritated, I restored this excitability, and brought it to a very high degree of irritability, by moistening the earth in which it grew with oxygenated muriatic acid. Seeds likewise vegetate more quickly when moistened with this acid, than when they are not.

In short, we shall find, first, that every thing which increases the quantity of oxygen in organized bodies, increases at the same time their excitability.

Secondly, That whatever diminishes the quantity of oxygen, diminishes the excitability.

The excitability of animals, made to breathe oxygen gas, or to take the oxygenated muriate of potash, or acid fruits, is very much increased.

On the contrary, when persons have inspired carbonic acid, or azotic gas, or have taken into the system substances which have a strong affinity for oxygen, and therefore tend to abstract it, such as hydrogen, and spirits, the excitability becomes very much diminished.

When we sleep, in consequence of the excitability being exhausted, the breathing becomes free, and a great quantity of oxygen is received by the lungs, and combined with the blood, while very little of it becomes exhausted by the actions of the body, for none, excepting those which are called involuntary motions, are carried on during sound sleep: so that in a few hours the body recovers the excitability which it had lost: it is again sensible of the impressions of external objects, and with the return of light we wake.

These facts afford satisfactory proofs that the excitability of the body is proportioned to the oxygen which it receives: but in what manner it produces this state of susceptibility, and how it is exhausted by stimulants, we have yet to learn.

The following theory may perhaps throw some light upon the subject. I propose it, however, merely as an hypothesis, for we have no direct proofs of it, but it seems to account for many phenomena.

It is now well known, that while the limb of an animal possesses excitability, the smallest quantity of electricity sent along the principal nerve leading to it, produces contractions similar to those produced by the will. This is instanced in the common galvanic experiment with the limb of a frog, which I had formerly occasion to show.

From the effects produced, when a stream of electricity is sent through water, I think it not improbable that hydrogen and electricity may be identical. When a piece of zinc and silver are connected together, and the zinc is put in a situation to decompose water, and oxidate, a current of hydrogen gas will separate from the silver wire, provided this be immersed under water; but when it is not, a current of electricity passes, which is sensible to the electrometer.

Now there appears no greater improbability in the supposition that hydrogen, in a certain state, may be capable of passing through metals, and animal substances, in the form of electricity, and that when it comes in contact with water, which is not so good a conductor, it may combine with caloric, and form hydrogen gas, in which state it becomes incapable of passing through the conductors of electricity: I say there appears no greater improbability in this, than that caloric should sometimes be in such a state, that it will pass through metals, and animal substances, which conduct it, and at other times, as when combined with oxygen or hydrogen, it should form gases, and be then incapable of passing through these conductors of heat. Galvanic effects may be produced by the oxidation of fresh muscular fibre without the aid of metals, and contractions have been thus produced in the limb of an animal; and we have already noticed, that when this contraction ceases, it may be restored, by moistening the limb with oxygenated muriatic acid.

The excitability of the body may, most probably, be conveyed by respiration, and the circulation of the blood, which tend continually to oxidate the different parts: and hydrogen or electricity may be secreted by the brain, and sent along the nerves, which are such good conductors of it, and by uniting with the oxygen of the muscle, may cause it to contract; but as the oxygen will, by this union, be diminished, if the contractions be often repeated, the excitability will thus be expended faster than it can be supplied by the circulation, and will become exhausted. But will facts bear us out in this explanation? To see this, we must examine the chemical nature of the substances which produce the greatest action, and the greatest exhaustion of the vital principle: namely, those which produce intoxication.

Fermented liquors differ from water, in containing carbon and more hydrogen: these produce intoxication: but pure spirits, which contain still more hydrogen, produce a still higher degree of intoxication, and consequent exhaustion of the excitability. Ether, which appears to be little more than condensed hydrogen, probably kept in a liquid state by union with a small quantity of carbon, and which easily expands by caloric into a gas, which very much resembles hydrogen gas, produces a still greater degree of intoxication: so that we see the action produced by different substances, as well as the exhaustion of excitability which follows, is proportioned to the quantity of hydrogen they contain.

There is another circumstance which seems to strengthen this idea. The intoxicating powers of spirits are diminished by the addition of vegetable acids, or substances which contain oxygen, which will counteract the effects of the hydrogen. Thus it is known that the same quantity of spirit, made into punch, will not produce either the same ebriety, or the same subsequent exhaustion, as when simply mixed with water.

Recollect however that I propose this only as a hypothesis: its truth may be confirmed by future observations and experiments, or it may be refuted by them: but it is certainly capable of explaining many of the phenomena, which is one of the conditions required by Newton's first rule of philosophizing.

Heat, and light, and other stimuli, may perhaps exhaust the excitability, by facilitating the combination of oxygen in the fibres with the hydrogen and carbon in the blood.

There are several substances which cause a diminution or exhaustion of the excitability, without producing any previous increased excitement. These substances have by physicians been called sedatives: and though the existence of such bodies is denied by Dr. Brown, yet we are constrained to admit them; nor do their effects seem incapable of being explained on the principle laid down, especially if we call in the aid of chemistry.

Any substance which is capable of combining rapidly with oxygen, and diminishing its quantity, will be a sedative. But the action of some of the animal and vegetable poisons is difficult to explain in the present state of our knowledge; such very minute portions of these produce great exhaustion of the excitability, and even death, that we can scarcely explain their action on the supposition that they combine with the oxygen. They may perhaps act as ferments, and occasion throughout the whole system a new and rapid combination of oxygen with the hydrogenous, carbonic, and perhaps azotic parts of the blood and fluids, and even of the solids, which will speedily destroy the excitability, and even the organization.

Many of the vegetable narcotics, though they will destroy life when given in considerable doses, yet when exhibited in less quantities become very powerful remedies, particularly in cases where the excitability is accumulated, in consequence of which violent spasms and inordinate actions take place, which are very quickly calmed by opium, camphor, musk, asafoetida, ether, &c. medicines that occasion a speedy exhaustion of the excitability. In diseases of exhaustion, however, these remedies are improper. The indication here is to accumulate the irritability, by the introduction of oxygen, and by the diminution of the action of the stimulants which support life. In this idea too I dissent from Dr. Brown, who taught that diseases of exhaustion are to be cured by stimulants, a little less powerful than those which produced the disease. This subject will however be more fully discussed hereafter.

This doctrine of animal life, which I have been attempting to illustrate, and render familiar, exhibits a new view of the manner in which it is constantly supported. It discovers to us the true means of promoting health and longevity, by proportioning the number and force of stimuli to the age, climate, situation, habits, and temperament, of the human body. It leads us to a knowledge of the causes of diseases: these we shall find consist either in an excessive or preternatural excitement in the whole or part of the human body, accompanied generally with irregular motions, and induced by natural or artificial stimuli, or in a diminished excitement or debility in the whole, or in part. It likewise teaches us that the natural and only efficacious cure of these diseases depends on the abstraction of stimuli, from the whole, or from a part of the body, when the excitement is in excess: and in the increase of their number and force when the contrary takes place.

The light which the discoveries of Galvani, and others who have followed his steps, begin to throw on physiology, promises, when aided by the principles of chemistry, and the knowledge of the laws of life, to produce all the advantages that would result from a perfect knowledge of the animal functions.

From what has been said, it does not seem improbable that muscular contraction may depend upon the combination of oxygen with hydrogen and azote, in consequence of a sort of explosion or discharge produced by nervous electricity. According to this hypothesis, animal motion, at least that of animals analogous to man, would be produced by a beautiful pneumatic structure. This hypothesis, though not perhaps at this moment capable of strict demonstration, seems extremely probable, it being countenanced by every observation and experiment yet made on the subject. It accounts likewise for the perpetual necessity of inhaling oxygen, and enables us to trace the changes which this substance undergoes, from the moment it is received into the system, till the moment it is expelled. By the lungs it is imparted to the blood; by the blood to the muscular fibres; in these, during their contraction, it combines with the hydrogen, and perhaps carbon and azote, to form water and various salts, which are taken up by the absorbents, and afterwards exhaled or excreted. We know the necessity of oxygen to muscular motion, and likewise that this motion languishes when there is a deficiency of the principle, as in sea scurvy. Thus a boundless region of discovery seems to be opening to our view: the science of philosophy, which began with remote objects, now promises to unfold to us the more difficult and more interesting knowledge of ourselves. Should this kind of knowledge ever become a part of general education, then the causes of many diseases being known, and the manner in which the external powers, with which we are surrounded, act upon us, a great improvement not only in health, but in morality must be the consequence.

With respect to its influence on the science of medicine, we may observe that, from the time of Hippocrates till almost the present day, medicine has not deserved the name of a science but, as he called it, of a conjectural art. At present however, by the application of the laws of life, and of the new chemistry, there is beginning to appear in physiology and pathology, something like the simplicity and certainty of truth. In proportion as the laws of animal nature come to be ascertained, the study of them will excite more general attention, and will ultimately prove the most popular, as well as the most curious and interesting branch of philosophy.

This must be productive of beneficial consequences to society, since these truths, once impressed upon the mind by conviction, will operate as moral motives, by which the sum of disease and human misery cannot fail to be greatly diminished.

LECTURE XI. OF THE NATURE AND CAUSES OF DISEASES.

In the two last lectures I have attempted to investigate the laws of life. I now proceed to the most important part of our course, and for which all the preceding lectures were intended to prepare us; I mean the application of the laws of life to explain the nature and causes of diseases, and the methods of curing them, which must always be imperfect, and conjectural, unless the nature of the diseases themselves be well understood.

We have already seen that life is constantly supported by the action of the external powers which surround us, and that if the action of these powers be properly regulated, and at the same time no other powers be suffered to act on the body, we shall enjoy perfect health, but if, on the contrary, the exciting powers which support life, act either too feebly or too powerfully, then the functions will not be performed with precision and vigour, but irregularly; the mind and body will become deranged, and death will often take place many years before the natural period at which that event might be expected.

As health is the greatest blessing which man can enjoy, it is natural to think, that in the early ages of society, when men began to lose sight of the dictates of nature, and feel the torture of disease, they would regard with gratitude those who had contributed towards their relief, and that they would place their physicians among their heroes and their gods. In the early ages, however, diseases would be very few, for it would not be till civilisation had made considerable progress, that such unnatural modes of life as conduce to their production, would take place.

As the first professors of physic knew nothing of the animal economy, and little of the theory of diseases, it is evident that whatever they did, must have been in consequence of mere random trials. Indeed it is impossible that this or any other art could originate in any other manner. Accordingly history informs us that the ancient nations used to expose their sick in temples, and by the sides of highways, that they might receive the advice of every one that passed.

It would take up too much time to pursue the history of medicine from this rude origin, through all its changes and revolutions, till the present time: let it therefore suffice to say, that after various theories had been invented and overturned, and after one age had destroyed the labours of another, though different branches of the healing art, and particularly anatomy, had been enriched with valuable discoveries, still a rational theory was wanting; there was nothing to guide the practitioner in his way, and we may truly say that till the laws of life, which I have been endeavouring to illustrate, were investigated by Dr. Brown, medicine could boast of no theory which had a title to be called philosophical.

The theories of Stahl, Boerhaave, and Cullen, have passed away, and are almost forgotten, but this, which is founded on nature, and on fact, will, like the Newtonian philosophy, last for ever. It has already influenced the practice of medicine, and is taught in almost all the schools of Europe and America. In this country it seems to have had less attention paid to it than it deserved, because its influence was counteracted by the arrogance and profligacy of its author, as if the grossness of a man's manner affected the conclusiveness of his arguments; but this influence did not extend beyond Britain, while the light of his theory illuminated the opposite hemisphere. And when the manner in which he was persecuted is recollected, the liberal mind will allow something to the deep consciousness of neglected merit.

A circumstance much in favour of this doctrine is, that those who understand its principles thoroughly, are guided by it in their practice with a certainty and success before unknown. I say those who understand its principles, for these were not perfectly understood even by the author himself. He first saw with his mind's eye the grand outline of the system, from which, for want of proper reflection, he often drew wrong deductions, and which he often applied improperly. But whatever errors Brown may have committed in the application of his system, and however short his doctrines may fall of a perfect system of medicine, we may venture to predict that the grand outlines will remain unshaken.

From what has been already shown, it must be evident that if the just degree of excitement could be kept up, mankind would enjoy continual health. But it is difficult, if not impossible, to regulate the action of the exciting powers in this equable manner, and if their action is increased, the first effect they produce on the functions is to increase them, and the next is, to render them disturbed or uneasy; or, in other words, to bring on diseases of increased action, or what have been called inflammatory or phlogistic, both of which terms are improper, as they convey false ideas, and are connected with erroneous theories: Dr. Brown has given the name of sthenic to these diseases, from their consisting in increased strength or action, and this is certainly a more appropriate term. On the contrary, when the action of the exciting powers is diminished more than is natural, the functions become languid and disturbed, and by a still further decrease of the action of these powers, they become irregular and inordinate. This state of the body, which is opposite to the former, Dr. Brown has denominated asthenic.

But the stimulant powers may act so powerfully, and exhaust the excitability to such a degree, that they may overstep the bounds of sthenic or inflammatory disease and bring on debility. Debility may therefore arise either from the stimuli acting too weakly, or from a deficient excitability, while the stimulus is not deficient. Debility produced in the former manner is called direct debility, and in the latter indirect debility.

To explain this more clearly, let us take a common instance. If a person by any means be deprived of the proper quantity of food, he will feel himself enfeebled, and the functions will gradually grow more and more languid, and at last become irregular, and be performed with pain. This state is called direct debility. Here is excitability enough, and even too much, for it has accumulated by the subtraction of a stimulus; but here is a deficiency of excitement from defect of stimulus.

If now we suppose that a person, in good health, begins to take a greater quantity of food than usual, and adds a quantity of wine, all the functions will at first be increased in vigour, but at last they will be irregularly performed, and inflammation, with other symptoms of too great excitement, will be the consequence. This state is called sthenic diathesis or disease. But if the stimulant power be pushed still further, the excitability will become gradually exhausted, till at last there will be too little to produce the healthy actions, even though there may be plenty of stimulus. This state of asthenic diathesis is called indirect debility, because it is not produced by directly subtracting the powers which support life, but indirectly, by over stimulating. An instance of this latter state is afforded by that debility which is the consequence of intoxication.

There is a state however between perfect health and disease, which is called predisposition; and in which, though the functions are undisturbed, the slightest cause will bring on disease. Strictly speaking, there is perhaps only one point, or one degree of excitement, at which the health is perfect: the first alterations from this point, on either side, are scarcely perceptible, but if the morbid causes be continued, the functions will become gradually more and more disturbed, till at last they become so uneasy or painful that they are termed disease.

In order to render what has been said still more plain, it may be proper to make use of an illustration by means of numbers: we must recollect however that it is merely for the sake of illustration, for we have not data to enable us to reduce either the excitability, or excitement, or stimulus, to numerical calculation; if we could do this, the science of medicine would be perfect, and we could cure diseases as easily as we could perform any chemical or philosophical experiment. A very principal object however is to understand the nature of predisposition, and the kind of diathesis, whether sthenic or asthenic, to which it inclines: this not only throws light on the nature of the disease, but affords us the only means of preventing it. When a slight uneasiness or predisposition is felt, it is almost impossible to say from our feelings whether it leads to a sthenic or an asthenic state: here we must be guided chiefly by the exciting powers. If we find that these have acted too powerfully; that is, if we have lived freely, been exposed to heat, and perhaps indulged in some of the unnatural stimuli, such as wine and spirits; and particularly if we previously to the present time perceived the functions to go on with more vigour, our spirits and strength greater, before we experienced the slight disturbance of which we complain, we are verging towards sthenic or inflammatory disease, and therefore to prevent the disease we ought immediately to diminish the action of the exciting powers; the quantity of food ought to be diminished, wine and other liquors abstained from, heat carefully avoided; and even the quantity of blood in the circulating system diminished, if the habit is full and the pulse strong.

On the contrary, if the exciting powers have acted more feebly than is natural; that is, if we have lived on a less nourishing diet, or have taken it in less quantity; if we have been long exposed to cold, without alternating with heat, and other debilitating causes; and if at the same time we find the vigour of the functions diminished, though they are not yet become much disturbed, we are verging towards asthenic disease. To prevent which, we must take a more nutritious diet, and join a portion of wine, and perhaps take some tonic medicines. This however ought to be done gradually, for fear of exhausting the excitability, which in these cases is morbidly accumulated.

It must be evident that the great difficulty here is to determine the nature of the predisposition; for if we make a mistake, instead of preventing, we shall accelerate the disease. For instance, the first slight disturbance of the functions which rises from a sthenic state, often resembles those verging towards a state of debility or asthenia. I have seen various instances arising from plethora, or a sthenic state, where the patient complained of depression of spirits, and inability to move; and, in short, from his own account was labouring under asthenic diathesis: but by inquiring carefully into the action of the exciting causes, examining minutely the state of the pulse and of the functions, I have been convinced that the depression of spirits which he felt, and other symptoms of weakness, depended on fullness, and they have been quickly removed by lowering the diet, administering a laxative, or taking a little blood: whereas if, apprehending from the symptoms that he had laboured under debility, I had ordered him a more generous diet and tonic remedies, an inflammatory disease would have been the consequence, which might have terminated in death.

I have seen various instances where patients have complained of this unusual depression, and inability to move: they have shown me prescriptions in which the stimulant or tonic plan was recommended, but instead of any alleviation the symptoms had become worse from their use. This hint was generally sufficient, for if the disease of predisposition had been asthenic, cordials and tonics ought to have relieved it: if, on inquiry, I found the exciting powers had acted too powerfully, I then, without hesitation, had recourse to the debilitating plan, and with the greatest certainty of success. Before I viewed diseases and their causes in this way, I must confess that I often felt great hesitation in practice; and judging merely from symptoms, which are frequently very fallacious, the operation of a remedy often disappointed me, and I could not pretend to predict the event with the certainty that I now can. This observation is of the greatest consequence in the cure both of predisposition and of disease. Though excitement regulates all the phenomena of life, yet the symptoms of diseases which either its excess or deficiency produces, do not of themselves lead to any proper judgment respecting it. On the contrary their fallacious appearance has proved the source of infinite error.

As excitement both depends on exciting powers and excitability, it is evident that when a middle degree of stimulus acts upon a middle degree of excitability, the most perfect effect will be produced. This point, could we ascertain it, might be called the point of health. For the sake of illustration, we may suppose that the greatest excitability of which the living body is capable is 80 degrees: this may be supposed to be the excitability possessed by the body at the commencement of its life, because no part has then been wasted or exhausted by the action of stimuli. Now, if we suppose a scale of excitability to be formed, and divided into 80 equal parts or degrees, the excitability will be wasted or exhausted in proportion to the application of stimuli, from the beginning to the end of the scale. One degree of exciting power applied takes off one degree of excitability, and every subsequent degree impairs the excitability in proportion to its degree of force. Thus a degree of stimulus or exciting power equal to 10 will reduce the excitability to 70, 20 to 60, 30 to 50, 40 to 40, 50 to 30, 60 to 20, 70 to 10, 80 to 0; and, on the contrary, the subtraction of stimulant power will allow the excitability to accumulate.

[DIAGRAM]

The range of good health is ranked from 30 to 50 degrees in the scale; for perfect health, which consists in the middle point only, or at 40 degrees, rarely occurs; in consequence of the variation of the stimuli to which man is continually exposed, such as meat and drink, heat, exercise, and the emotions of the mind, the excitement commonly fluctuates between 30 and 50 degrees, and yet no particular disturbance of the functions takes place. But when at these points, 30 or 50, predisposition commences, the slightest debilitating cause in the former case, and the slightest stimulating cause in the latter, brings on disease, in which the functions begin to be disturbed in various ways, and this disturbance is always in proportion to the hurting powers which have produced the disease, and the delicacy or importance of the part affected.

The effect produced on the excitability by any stimulus, must evidently be in a ratio compounded of the degree of excitability and the force of the stimulus. The same stimulus will produce greater contractions upon a fibre that is more irritable than upon one which possesses less irritability; and the irritability or excitability of the fibre being given, or remaining the same, the contraction will be in proportion to the strength of the stimulus. Hence it is evident, that the effect or excitement must be in a ratio compounded of the exciting powers and excitability.

Sthenic diathesis and disease is caused by the operation of different exciting powers, which produce too great a degree of excitement in the system: this at first increases all the functions, and, when increased, produces a disturbance and inordinate action of them, which is communicated to the whole body. In diseases of this kind there is often an appearance of debility, but this is extremely fallacious, and arises from the disturbed state of the different functions. Hence it is evidently of the utmost consequence to ascertain carefully whether this debility is real, or the effect of asthenic disease: or whether it is owing to the disturbance of the functions by over stimulating, and in this case fallacious; for should a sthenic disease be treated by stimulants and cordials, the effect would be an aggravation of all the symptoms, and a much higher degree of disease.

Asthenic diathesis and disease is brought on by the excitement of the system being diminished: and this may proceed either from a diminution of common stimulant powers, while the excitability is sufficiently abundant, or it may proceed from an exhausted excitability, while the stimulus is sufficiently abundant. The former is called direct, and the latter indirect debility. The exciting causes therefore of asthenic disease, first impair the functions, then occasion a disturbed or inordinate action of them, giving many of them a false appearance; some of them, for instance, appear to be increased, for in hysteria and epilepsy, which are both diseases of debility, the action of the muscles seems to be preternaturally increased; but this depends chiefly on the accumulated excitability, which gives such a degree of irritability to the system, that the smallest irritation, whether external, such as heat, exercise, &c. or internal, as emotions of the mind, excite a strong spasmodic action, which brings on the symptoms of epilepsy and hysteria. This inordinate action however soon exhausts the morbid excitability, and thus suspends itself, a sleep often follows, from which the patient wakes with only a general sense of languor and debility: but as the same cause still remains, the excitability of the body again becomes morbidly accumulated, and thus the slightest stimulus produces a recurrence of the fit, and the tendency to return will increase with its recurrence, so that at last the slightest imaginable cause will produce it, on account of the power of habit and association.

Gout likewise appears like a sthenic disease, and in inflammation takes place, which resembles pleurisy or peripneumony; but this symptom is fallacious, for it depends on debility, and is only to be cured by means, which in pleurisy and peripneumony, would produce death.

Hence it must be evident that those phenomena of diseases, which we call symptoms, are generally fallacious; but this may be owing to our imperfect knowledge of the animal economy, so that we are not able to explain or understand the manner in which they are produced: we ought however carefully to guard against being misled by them in practice. The great difficulty is to distinguish the nature of the disease, whether it is sthenic or asthenic, or whether it depends on too great excitement, or on debility; for this being once clearly ascertained, we proceed with certainty in our mode of treatment, instead of the random practice, which must be the consequence of not taking a proper view of the laws of life, and the causes of diseases.

The nature of the disease may be generally ascertained, by attending to the habits of the patient, and the manner in which he has lived, as well as to the state of the pulse; but in cases where these circumstances do not render it clear, it may be ascertained, beyond a doubt, by a trifling degree of stimulus, as, for instance, by any cordial, as a little wine or spirits. If the disease be of an inflammatory or sthenic kind, the symptoms will be aggravated, and the cordial will not produce its usual pleasant effects on the system; but on the contrary, if the nature of the disease be asthenic, then the usual pleasant effects of the cordial will be perceived, and the pain and other symptoms will be alleviated. This trial, which is soon made, and without danger, will determine our plan of cure, and we can then proceed with the most perfect certainty. Thus you will see that this view we have taken leads to a very different and much more rational plan of practice than is generally followed, in which the most judicious physicians confess that they have no clue to guide them; and complain that the science of medicine consists merely in a number of insulated facts, not connected by any theory: that they merely prescribe a remedy because they have seen it of use in an apparently similar state, but that they have no certainty of its producing a similar effect in the cases in which they prescribe it. This all depends on trusting to the fallacious appearance of symptoms, and not having taken a proper view of the laws of life, or the manner in which the exciting powers act on living bodies.

After these observations on the diagnosis, or the method of distinguishing the nature of diseases, I shall proceed to consider more particularly the nature of sthenic diseases, and the methods of curing them, which will occupy the remainder of our time this evening.

The powers or causes, which by their action produce inflammatory or sthenic diseases, are, first, heat, which is a very frequent cause, particularly when it succeeds cold; for the cold accumulates the excitability, and then renders the whole body, or a part, more liable to be affected by the heat afterwards applied. In this way is produced rheumatism, catarrh, or, as it is commonly called, a cold, and peripneumony. These complaints have been often attributed to cold, but I believe that there never was a well attested instance where cold alone, without being either followed by heat or some other stimulus, produced a real sthenic, or inflammatory disease. This is not merely a distinction, it is a circumstance of the utmost importance, because it influences the mode of practice to be pursued. Heat is one of the exciting or stimulant powers which support life, and one of the most powerful of these stimulants; but cold is only a diminution of it: how then can this produce a sthenic state, or a state of too high excitement? The blood is one of the exciting powers, which, by its continual circulation supports life; but surely if we abstracted a quantity of this fluid from the body, no person will be bold enough to say, that we by that means should produce an inflammatory disease. Cold renders the body more liable to be affected by heat, or any other stimulus applied, but does not of itself produce any stimulant or inflammatory effects.

To see more clearly the manner in which cold acts, let us inquire how it produces or contributes towards the production of catarrh. When we go into the cold air, at every respiration we take a quantity of it into the lungs, which brushes over the surface of the mucous membrane that lines the nostrils and trachea, and thus, robbing them of their heat, allows the excitability to accumulate. But we feel no fever, no sense of tightness or stuffing, nor any other symptom of catarrh, so long as we continue in the cold. If however we afterwards go into a warm room, and particularly near a fire, we receive by the act of respiration the warm air into those very parts which have been previously exposed to cold, and whose excitability is consequently accumulated. The first effect we perceive is a glow of the parts, which is by no means unpleasant, this however increases; and, in the course of half an hour or an hour, a sense of dryness and huskiness comes on, with a sensation of stuffing in the nostrils, and a tendency to a short dry cough: often likewise, if the exposure to cold has been considerable, and the heat afterwards applied great and sudden, we experience a shivering, and other symptoms of fever. These symptoms are all increased by taking into the stomach any liquid that is either of warm temperature or stimulating quality, or particularly both; we spend a restless night, and awake with all the symptoms of a catarrh, or cold, as it is improperly called. For it is evidently an inflammatory fever, and can be speedily cured by the debilitating plan, and particularly by keeping in a moderately cool place, where the temperature is equable, and not subject to alternations of heat and cold.

But how easily might this complaint have been avoided, were the person subject to it acquainted with its real nature, and the manner in which it is brought on. When we come out of a very cold atmosphere, we should not at first go into a room that has a fire in it; or, if this cannot be well avoided, we should keep for a considerable time at as great a distance from the fire as possible, that the accumulated excitability may be gradually exhausted by the moderate and gentle action of heat; and then we may bear the heat of the fire without any danger; but above all, we should refrain from taking warm or strong liquors while we are hot. In confirmation of this opinion, numerous instances might be brought, where catarrh was cured merely by exposure to cold.

When a part of the body only has been exposed to the action of cold, and the rest kept heated; if, for instance, a person in a warm room has been sitting so that a current of air, coming through a broken window, has fallen upon any part of the body, that part will soon be affected with an inflammation, or what is called a rheumatic affection. In this case, the excitability of the part exposed to the action of the cold, becomes accumulated, and the warm blood, rushing through it, from every other part of the body, excites an inflammation.

Thus catarrh and rheumatism are inflammatory complaints, or depend on too great a degree of excitement, and are to be cured by lowering the excitement, or diminishing the action of the exciting powers; by bleeding, purging, low diet, and particularly keeping in a moderately cool place; and these complaints will be as speedily and certainly cured by these methods, properly and judiciously persevered in, as a slight cut or wound will be healed by what surgeons call the first intention.

There are complaints which resemble these, but whose nature, however, is very different, and which require a very different mode of treatment. After a part has been long affected with rheumatic inflammation the excitability of the muscular fibres becomes so far exhausted, that a state of indirect debility takes place, and an inflammation, accompanied with pain and redness, which is very different from that I formerly described, as it depends upon a debilitated or relaxed state of the parts, instead of too great a degree of excitement. This instance shows strongly the fallacy of symptoms; but it may be readily distinguished from the inflammatory rheumatism, by attention to the effects of the exciting causes. The inflammatory rheumatism is aggravated by heat, hence it is more violent in bed than at any other time. The latter complaint, however, is greatly relieved by heat: the warm bath alleviates all the symptoms; so does a warm bed. It is evident that these diseases, though attended by the same symptoms, are as opposite, and require as different modes of treatment as an inflammation of the brain, and a dropsy. The inflammatory state has been called the acute rheumatism, and the other, the chronic rheumatism; I would, however, prefer the terms sthenic and asthenic rheumatism.

In the same manner, there is a catarrh, which is liable to afflict persons who have often been subject to an inflammatory cold, particularly persons advanced in years; and this depends on a state of indirect debility of the parts, the excitability of which has been exhausted by frequent and violent inflammatory affections. This complaint, which I would call asthenic catarrh, requires directly opposite treatment from the inflammatory or sthenic catarrh. The latter is aggravated by heat, but relieved by a cool temperature. Warm air is peculiarly grateful to those who are afflicted with the former, and if they go into a cool temperature, they are immediately seized with cough, and expectoration; for the disease being a disease of debility, the withdrawing the stimulus of heat, must increase it. The excitability of the parts is so far exhausted, that it requires a stimulus even more than natural to keep them in tone: hence persons labouring under asthenic catarrh, and some species of asthma, which are only varieties of this disease, find themselves best when exposed to a warm temperature, but on the heat being diminished, and consequently the parts relaxed, the cough and difficulty of breathing immediately come on.

Having examined the effect of heat, in producing inflammatory or sthenic disease, I now proceed to the consideration of the other powers. Of the articles of diet, the only food in danger of being too stimulant, is perhaps flesh or land animal food, used in too great quantity, particularly when seasoned, a preparation which adds much to its stimulant power. Spirituous and vinous liquors, let them be ever so weak or much diluted, stimulate more quickly, and more readily than seasoned food, and their stimulus is in proportion to the quantity of alcohol which they contain. These substances, when conjoined with rich food, must bring on a predisposition to sthenic disease, in almost any constitution, particularly in the young and healthy, and, in many instances, those diseases actually take place; or should this not be the case, should the person avoid, or escape the effects of inflammatory diseases, the excitability will be exhausted, and diseases of indirect debility, such as gout, apoplexy, indigestion, palsy, &c. will take place.

These stimulants are never necessary to a good constitution, and their effects will always, sooner or later, be experienced: for though a person with a good constitution may continue for years to indulge in the pleasures of the bottle, or the luxuries of the table, depend upon it that a continuance of them will sap the vigour of the strongest constitution that ever existed.

As nothing contributes more to the health of the body than moderate and frequently repeated exercise, which rouses the muscles to contraction, and promotes the circulation of the blood in the veins towards the heart: it thus produces excitement; but an excess of it will produce sthenic diathesis; and, if carried to great excess, it will produce a state of indirect debility, or exhausted excitability.

When any, or all of these exciting powers act too strongly on the body, the first effect they produce is a preternatural acuteness of all the senses; the motions, both voluntary and involuntary, are performed with vigour, and there is an acuteness of genius and intellectual power. In short, every part of the body seems in a state of complete vigour and strength; that this is the case with the heart and arteries, appears from the strong and firm pulse; in the stomach it is shown by the appetite; and, in the extreme parts, by the ruddy colour and complexion. In short, every appearance marks vigour of the body, and abundance of blood. Could the body be kept in this state, nothing could be more to be desired; this, however, is impossible; the excitement, though still within the bounds of health, has overstepped the point of good health, and is verging fast to predisposition to sthenic disease; so that, to secure a permanent state of health, it is always better to keep the excitement rather under the middle point, or 40 degrees, than above it. During the predisposition to sthenic disease, which is produced by the longer continued, or increased action of these powers, no symptoms of disease appear; but shortly after, disturbed sleep, depressed spirits, languor, a sense of fulness, heaviness, particularly after eating, show that this sthenic state cannot be further increased with impunity. The least increase of sthenic diathesis now brings on a disturbance of the functions, or actual disease; the commencement of which is generally a shivering, and a sense of cold; thirst and heat succeed; and then generally a pain in some part, either external or internal: costiveness generally attends this state, the urine is clear, and secreted in small quantity; memory and imagination become diminished, and there is generally less appetite for food.

In peripneumony, inflammatory sore throat, and acute rheumatism, there is an inflamed condition of the lungs, of the parts about the throat, or of the muscles of the extremities: this shows that the excitement here is greater than in other parts of the body; but it is still increased or too great in every part, only those parts which give the peculiar character to the disease are more affected than other parts of the body, by being more exposed to the exciting causes: thus, if a person be in perfect health, or a little below, he will not be easily affected by any of the exciting causes of sthenic disease, unless their application be very violent; he will go into a warm room out of the cold air, and feel no other effect than a pleasant glow: but if, by high living, or other means, he is brought near the point of predisposition to sthenic disease, then the slightest additional stimulus will bring it on, and if the throat has been exposed to the application of cold, and the person comes afterwards into a heated room, an inflammation of the parts about the throat, or an inflammatory sore throat, accompanied by a sthenic diathesis of the whole system, will be the consequence. This cannot be cured by merely diminishing the excitement of the part, while the excitement of the whole system remains: if we apply leeches to the throat in this state, to diminish the quantity of blood, we only debilitate the vessels, while fresh quantities of blood are poured into them from the too full vessels of the body; even if we could thus remove the sthenic diathesis of the part, we should go but a little way towards removing the inflammatory disease, which universally pervades the system.

The mode to be pursued therefore is, to take a quantity of blood from the body, by opening a vein; to keep the body cool, by remaining in a room where the temperature is at temperate, or a little below; by abstaining from animal food, and from spirituous or fermented liquors; and by the exhibition of purgatives, or at least of laxatives. Then leeches or blisters applied to the part affected will produce a good effect; and even stimulant applications to the inflamed part may be advantageous; for a topical inflammation, as we shall afterwards have occasion to see, depends on a debilitated state of the minute vessels of the part, while at the same time the action of the whole system is increased.

Besides the energy of the exciting hurtful powers, which I have mentioned, there is in the parts which undergo the inflammation, a greater sensibility, or an accumulated excitability; by which it happens that some are more affected than the rest. To this we may add, that whatsoever part may have been injured by inflammation, that part in every future sthenic attack is in more danger of being inflamed than the rest. Hence inflammatory sore throat, rheumatism, and some other complaints of the kind, when once they have supervened, are very apt to recur.

Among the sthenic or inflammatory diseases may be enumerated rheumatism, catarrh, cynanche, or sore throat, scarlet fever, inflammations of the brain, stomach, lungs, &c. &c.

Many of the contagious diseases, particularly small pox and measles, produce a sthenic state, and are to be cured, or their action moderated, by the debilitating plan which has been pointed out; and particularly by a moderate, constant, and equable diminution of temperature. Hence the violence of these diseases is greater when they attack a person already predisposed to sthenic diathesis, but much more mild when the excitement is rather under par.

LECTURE XII. ON INFLAMMATION AND ASTHENIC DISEASES.

The last lecture was taken up chiefly with an account of sthenic diseases, or those depending on too great a degree of excitement, and which have been generally, but improperly, called inflammatory or phlogistic. In that lecture I attempted to show, that when the natural exciting powers, which support life, act with too much power, or particularly if we employ any stimulants not natural to the body, the functions both of body and mind become increased in vigour; but if the exciting causes are continued and increased, the functions become disturbed, and their action becomes painful and distressing. This state, which is called sthenic diathesis, is often accompanied by a redness, swelling, pain, and increased heat of some particular part: these symptoms constitute what is usually termed an inflammation of the part.

The method of cure in sthenic diseases was shown to be, by reducing or moderating the action of the exciting powers; by keeping the body cool; abstaining from high seasoned, and, in general, from animal food; by the use of purgatives, and in many cases by diminishing the quantity of blood in the body. I mentioned likewise, that it would be but of little use to attempt to subdue the excitement of the inflamed part, unless the excitement of the whole system was previously diminished; but that after a general bloodletting, stimulant remedies applied to the inflamed part, might be employed with success. This is strictly agreeable to experience, but at first sight seems so very contrary to the principles that have been advanced, that I shall endeavour to explain the phenomena of inflammation, which do not seem to be in general well understood.

All kinds of inflammation agree, in being attended with redness, increased temperature, pain, and swelling; but they vary according to the situation and texture of the part affected. All parts of the body, excepting the cuticle, nails, hardest part of the teeth, and hair, are subject to inflammation.

Among the causes of these complaints, may be enumerated too full a diet, particularly too free a use of fermented liquors, and whatever increases the impetus of the blood towards the part, as mechanical and chemical irritation, and sudden changes of temperature, particularly from cold to heat.

To explain the nature of inflammation, it may be observed, that such is the wise constitution of the animal body, that whatever injures it, excites motions calculated to correct or expel the offending cause. Thus if an irritating substance is received into the stomach, it excites vomiting; if into the lungs, a violent fit of coughing is excited, and if into the nostrils, sneezing is the consequence. In such cases we can readily trace the motions excited, and the manner in which they act; but cannot trace the manner in which the offending cause excites these motions.

Now if it can be shown that inflammation, like vomiting and coughing, is an effort of the system to remove an offending cause, and if we can trace every step of this operation, with the exception of the changes induced on the nervous system, we shall understand the nature of inflammation as completely as that of any function of the body.

The circumstance the most difficult to explain, is the increased redness of the part affected, which can only depend on an increased quantity of blood in the vessels. This has been supposed to depend upon an increased action of the vessels of the part; but that this is not the case, must be evident from what was said when we were speaking of the circulation of the blood. It was shown, that the circulation could not be carried on by the mere force of elasticity alone; this force, were it perfect, would produce no effect; but as there is no body with which we are acquainted that is perfectly elastic; so the coats of the arteries are very far from being so, hence their effect as elastic tubes will be to diminish the force of the heart, instead of adding to it; for a certain quantity of this force will be spent in distending the vessels, which, were they perfectly elastic, would be restored to them, but as this is not the case, this force is by no means restored. Indeed a variety of considerations, observations, and experiments, tend to prove, that the vessels are endowed with a power very different from elasticity, which differs only in degree from that of the heart; in short, they are possessed of muscular power.

After each contraction of the muscular coat, the elastic will act as its antagonist, and enlarge the diameter, till the vessel arrive at a mean degree of dilatation, but after this there is no further power of distention inherent in the vessel. The action of the elastic coat ceases; and no one will assert that a muscular fibre has power to distend itself.

The only power by which the vessel can be further distended, is the vis a tergo: after the vessel arrives at its mean degree of dilatation, both the elastic and muscular coats act as antagonists to the vis a tergo, or force which propels the blood into, and thus tends further to dilate the vessel. If then the vis a tergo become greater than in health, the powers of resistance inherent in the vessels remaining the same; or if the latter be weakened, the vis a tergo, or propelling force, remaining the same, the vessel must suffer a morbid degree of dilatation. These appear to be the only circumstances under which a vessel can suffer such dilatation.

But if, while the powers of the vessels remain the same, the vis a tergo, or propelling force, be diminished, or the propelling force remaining the same, the power of the vessels become increased; then an opposite condition or state of the vessels, viz. a preternatural diminution of their area, will take place.

In the one case the distending force bears too great a proportion to the resisting force; and preternatural distention is the consequence. In the other the resisting force bears too great a proportion to the distending force, and preternatural contraction is the consequence.

It is not necessary that the vessels should be in a state of greater debility than in health, in order that an inflammation or distention may take place: it is only necessary that the proportion which their action bears to the propelling force be less than in health. If the propelling force remain the same, the vessels must be in a state of debility before an inflammation can take place; but if the propelling force be increased by a fullness of the vessels and sthenic diathesis, inflammation may take place, although the vessels of the part act as powerfully as in health, or more so. But after inflammation has taken place, as the vessels are preternaturally distended, they must also be debilitated.

The degree of inflammation is not however proportioned to the debility of the minute vessels of an inflamed part, but to the diminished proportion of their power to the propelling force.

When, therefore, inflammation arises from an increased action of the arterial system, or an increased propelling force, while the force of the capillaries or minute vessels remains the same, it constitutes what is called an active inflammation, and is to be cured by general bleedings, and then by gentle applications of tonics to the part, to increase its action; but when it arises from a debility of the minute vessels, without any increase of the propelling force, it forms what is known by the name of passive inflammation; in which general bleeding is not required, but the application of stimulants and tonics to the inflamed part to enable the vessels to recover their lost tone, and restore the balance between their action and the vis a tergo. From what has been said, it must be evident, that if inflammation depend on the diminished proportion of the power of the capillaries to the propelling force, it will be more apt to supervene under the three following circumstances.

1. In a state of plethora, because then all the vessels are over distended, and consequently any cause tending further to distend them, whether it be a cause which debilitates them, or increases the propelling force, will be more felt than in health.

2. In a state of general debility, because the vital powers in any part are more readily destroyed than in health.

3. In a state of general excitement, because then the propelling force is every where strong, and consequently apt to occasion distention of the vessels, wherever any degree of debility occurs. These are the states of the system which are found to predispose to inflammation. In the first and last, the inflammation is generally of that kind, which is termed active: the propelling force is considerable, and the larger arteries are readily excited to increased action. In the second state the inflammation is of the passive kind.

This is not merely a useless physiological disquisition; it is of the greatest use in directing our practice; and teaches us that, in passive inflammation, which has all the symptoms of active, and therefore shows in a striking point of view the fallacy of symptoms, we shall not succeed by applying leeches, and other debilitating means, to the inflamed part; on the contrary, we shall aggravate the complaint; and the cure must be effected by stimulants applied to the part.

As an instance of this kind of inflammation, I may mention that kind of ophthalmia or inflammation of the eyes, which is of long standing, and which not only resists the powers of leeches and blisters, but is increased by them. I have frequently been consulted by patients, who had for months been under the debilitating plan, without any benefit; and who have been relieved almost instantly by the application of electricity and a stimulating lotion, which restored the tone of the debilitated vessels of the sclerotic coat, and enabled them to expel their overcharged contents; and the balance between their action and the propelling force being restored, the inflammation disappeared.

Indeed the effects of electricity in these kinds of inflammations are wonderful: it seems to act almost by a charm, so quickly does the inflammation subside; but when we understand the nature of this kind of inflammation, it is nothing but what we might expect from its action.

I have been thus minute on the subject of inflammation, because the theory of it, which I have attempted to defend, differs considerably from the commonly received opinions. I shall now proceed to consider the nature of asthenic diseases.

From what has been already said, it must be evident that the causes of diseases which we have assigned, are very different from those delivered by physicians who preceded Dr. Brown. Some physicians imagined that diseases were caused by a change in the qualities of the fluids, which became sometimes acid, and sometimes alkaline; or on a change of figure of the particles of the blood: some imagined diseases to be owing to a rational principle, which they called the vis medicatrix naturae, which governed the actions of the body, and excited fever or commotion in the system to remove any hurtful cause, or expel any morbid matter, which might have insinuated itself into the body. Others supposed many diseases to arise from a constriction of the extreme vessels by cold; or from a spasm of them, which was a contrivance of the vis medicatrix, to rouse the action of the heart and arteries to remove the debility induced.

We have seen, however, that health and diseases are the same state, and depending upon the same cause; viz. excitement, but differing in degree; and that the powers producing both are the same, sometimes acting with a proper degree of force: at other times either with too much, or too little.

We shall now examine how the diminished actions of the different exciting powers produce asthenic disease; and we shall take them in the same order as when we were speaking of sthenic diseases. It must be recollected however that an asthenic state, or a state of debility, may be produced in two ways. First, by directly diminishing the action of the exciting powers. Secondly, by exhausting the excitability, by a strong or long continued stimulant action. The former state is called direct debility, and the latter indirect debility. This is not merely a distinction without a difference, the body is in very different states, under these two different forms of disease. In the former case, the excitability is abundant, and highly susceptible of the action of stimulants. In the latter, it is exhausted, and the body has very little susceptibility.

Cold, or a diminution of heat, carried beyond a certain degree, is unfriendly to all animals. Dr. Beddoes has shown very clearly in his Hygeia, that it is the cause of a great many diseases which take place at boarding schools, and that it there gives origin to a great number of diseases that afterwards arise, and, indeed, not unfrequently ruins the constitution. It produces relaxation of the vessels, asthenic or passive inflammation, and even gangrene. He has shown that in most schools children are afflicted with chilblains from this cause; this is a case of passive inflammation, but is only a symptom of the general debility induced, which shows itself afterwards by the production of other symptoms. Hence it is necessary for the preservation of health, that the temperature of school rooms should always be kept equable, and regulated by means of a thermometer. It should not exceed 50 degrees, nor should it be allowed to fall much below it. If precautions of this kind are thought to be necessary, and practised with uncommon attention, in places where vegetables are reared, surely they ought not to be neglected in those seminaries where the human species are to be brought to maturity, and a good constitution established.

But though I have no doubt whatever, that this equable temperature would prevent a number of diseases, which originate in too low a temperature, yet I am far from wishing to have it thought that I would not induce a hardy state of the constitution, which would enable it to bear the vicissitudes to which it must be exposed in its journey through life, by every means in my power. Hardiness is the most enviable of all the attributes of animal nature, and can neither be acquired, nor recovered when it is lost, but upon certain terms, to which many people submit with reluctance, because they must give up many indulgences and gratifications with which it is utterly inconsistent.

One of the causes that chiefly contributes to reduce persons living in affluence below the standard of hardiness, is the dependence they place on a considerable degree of external warmth, for preserving a comfortable state of sensation. From what has been said again and again in some of the latest of these lectures, it must be evident that continued warmth renders the living system less capable of being excited to strong, healthy, and pleasant action: heat in excess, whether it may be excess of duration or intensity, constantly debilitates, by exhausting the excitability of the system, and thus producing a state of indirect debility. Every muscle steeped in a heated medium, whether of air or water, loses much of its contractibility. A heart kept in heated air, or put in hot water, will not contract on the application of a stimulus; even the limb of a frog, when heated in this manner, ceases to move on the application of the galvanic exciters. Every nerve grows languid, and when it does become excited, it acquires a disposition to throw the moving fibres, with which it is connected, into starts, twitchings, and other irregular convulsive motions. Though therefore nothing can more contribute to the health of the body than a moderate and well regulated temperature, about 48 or 50 degrees, sometimes for a short interval a little lower, when exercise is taken at the same time, yet when we consider the life led by persons of fashion, we should hope that it proceeded from ignorance of these consequences; so diametrically opposite is it to the dictates of nature and reason.

Instead of rising from table after dinner, and availing themselves of the cooling and refreshing qualities of the air, even in the finest seasons, when every thing which pure and simple nature can offer, invites them abroad, they do every thing they can, as Dr. Beddoes observes, to add to the overstimulating operation of a full and hearty dinner. After taking strong wine with their food, they sit in rooms rendered progressively warmer, all the afternoon, by the presence of company, by the increase of fires, and for more than half the year, by the early closing of the shutters, and letting down of the window curtains. After a short interval, tea and coffee succeed; liquors stimulating both by their inherent qualities, and by virtue of the temperature at which they are often drank. And that nothing may be wanting to their pernicious effect, they are frequently taken in the very stew and squeeze of a fashionable mob. The season of sleep succeeds, and to crown the adventures of the evening, the bed room is fastened close, and made stifling by a fire: and though the robust may not quickly feel the effects of this mode of life, with the feeble it is quite otherwise. These, as they usually manage, rarely pass a few hours of sleep without feverishness and uneasy dreams; both of which contribute to their finding themselves by far more spent and spiritless in the morning, than after their evening fit of forced excitement, instead of having their spirits and strength recruited by the "chief nourisher in life's feast," Perhaps they drink tea before rising, and indulge in a morning nap; this weakens much more than the greatest muscular exertion they would be capable of supporting for an equal time. For the sleep at this time is almost invariably disturbed, and attended by a heat of the skin. The reason of this must be evident to every one who has attended these lectures.

The effect of sleep is to accumulate the excitability, or render it more sensible to the effects of any stimulants applied. This takes place in every constitution, and much more in the more delicate: hence the heat of the bed, and of the tea, acts so powerfully on the surface, as, in general, to produce great perspiration, or, at any rate, great languor and debility.

Let me ask, can any one, who lives in this manner, expect to enjoy good health? With as great probability might we expect, that when we plunged a thermometer into hot water, the mercury would not rise, or when we applied a lighted match to gunpowder, it would not explode. The laws of nature are constant and uniform, and the same, or similar causes, both in the animate and inanimate world, are always productive of the same, or similar effects.

The cure of these complaints is at least obvious, if not easy. It consists in deserting crowded and heated rooms, at least for part of the time they have been usually occupied; in abstaining from strong wines; in keeping the bed rooms moderately cool; and retiring to rest at a proper hour.

With respect to the effects of nutriment, in producing asthenic diseases, we may observe, that all watery vegetable food, too sparing a use of animal food, as also meat which is too salt, and deprived of its nutritious juices by keeping, when more nutritious matter is at the same time withheld, constantly weaken, and thereby tend to produce asthenic diseases. Hence would appear to arise that remarkable imbecility of body and mind which distinguishes the Gentoos. Hence arise the diseases with which the poor are every where afflicted; hence scrofula, epilepsy, and the whole band of asthenic diseases.

But intemperance in eating and drinking, or taking nutritious and highly stimulant substances too freely, will, infallibly, bring on asthenic disease, or a state of indirect debility, by exhausting the excitability; and it must be observed, that this species of debility is much worse to cure than the direct kind; for in the latter we have abundance of excitability, and a variety of stimuli, by which we can exhaust it to the proper degree, and thus bring about the healthy state; whereas, in indirect debility, the vital principle or excitability is deficient; and we have not the means of reproducing it, at pleasure, absolutely under our command. Besides, the subtraction of stimulants, which is one of the most certain means we have of accumulating excitability, if carried to a great extent, in diseases of indirect debility, would produce death, before the system had power to reproduce the lost or exhausted excitability. Hence the cure, in these two kinds of debility, must be very different: in cases of direct debility, as in epilepsy, we must begin with gentle stimulants, and increase them with the greatest caution, till the healthy state is established: we must, however, guard most carefully against over doing it; for, if we should once overstep the bounds of excitement, and convert the direct into indirect debility, we shall have a disease to combat, in which we have both a want of excitement and of exciting power.