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time benefited by reduction of strength, after a period may be kept up by the very means which at first were salutary, and require contrary measures for their final removal. Circumspection, based upon the belief that any contingency is possible in medicine, and sagacity resulting from a knowledge of all the contingencies which have occurred or are physiologically probable, are the main elements of professional judgment which a medical practitioner has to cultivate. In the present instance, the variety of causes, upon which the classes of symptoms under consideration may depend, is curiously extensive. As a third case, they may proceed, as will be by-and-by illustrated, from an overloaded and deranged stomach alone; or as a fourth case, they may be products of hysteria*; or as a fifth, their source may be purely mechanical†.

* I attended a woman, in whom a complete obliteration of the cavity of the womb had taken place from inflammation; so that there was suppression of the periodical relief. But she was regularly seized with attacks of pain in the head, coldness, numbness, and weakness of one side of the body, which would last three or four days. At the worst, she had an epileptic seizure in addition.

+ Dr. Sweatman attended a lady who had been compelled to remain in the horizontal posture for ten years. If she sat up, in a short time she fell into, or began to fall into deliquium, and fainted. But she looked in perfect health, and had borne several children during this period. The opinions of several eminent London physicians had been taken, who, finding nothing wrong in the circulation, had all recommended tonics. Dr. Sweatman begged to see the patient's legs, which

There are, of course, infinite other disorders besides those which manifest themselves by headsymptoms, in which lowering diet and reduction would be prejudicial. It is to be laid down as a truth of universal application in medicine and surgery, that disturbance of the health of the entire body, or of a part, general or specific, takes its most important character in a practical point of view from the strength or weakness of the system attacked, and is most efficiently controlled by remedies calculated on these elements. And it probably may be assumed that the greater number of complaints, especially when beginning in persons of good stamina, have febrile and inflammatory features, or a sthenic cast; whence it follows, that at the commencement of most disorders, a spare diet, and other means of reducing the strength, are to be employed. Nevertheless, a large proportion of ailments of every description are found in connexion with a lowered habit and exhausted bodily forces; in which the contrary practice is required. It is not the disease, but the constitution of the patient, (and his age, which more than any other cause, modifies the constitution,) that has most to be considered in the plan of treatment. It does

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he found covered with immense varicose veins. when she stood up, all the blood in her body gravitated; and hence she became faint. The legs being bandaged, she was cured at once.

not follow because a vital organ is the seat of organic disease, that the patient is necessarily to be lowered. When the structure of the heart, or of the lungs, or the brain, is materially deranged, it is still often necessary to use means to strengthen, and recruit, and stimulate. Nor is it a remark undeserving attention, that the most scientific elements of medical education, the study of morbid anatomy and discernment of inward changes, have a positive tendency, when too exclusively pursued, to lead into error, from the principle now adverted Taken in connexion with a keen observation of the resources of the constitution, such knowledge cannot, indeed, be too fine and minute for practical usefulness; alone, it may directly mislead. Hence it is, that while the science has progressed, there has been no proportionate advance of the art of medicine, half the best secrets of which are, to be guided by common sense, and to avoid doing harm.

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There are no cases, to the successful issue of which the management of diet more essentially conduces, than those in which capital surgical operations are performed. Here again the general rule is, innutritious food, lowering, and depletion. A patient somewhat reduced in strength is in a more favourable state to undergo a grievous mechanical injury, than one in the utmost force and vigour. Accordingly, after a great operation, the first danger to be thought of is that of fever and inflammation. The French surgeons deservedly

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stand high in the estimation of Europe. Not to mention the great names which they have produced, their Dessaults and Dupuytrens, who have contributed to enlarge the science of surgery, they are bold and skilful operators, not indeed in any degree superior, in these respects, to well-educated English surgeons, but fully their equals. their general management of their patients before and after operation is inferior to that of English surgeons, being based upon too narrow principles; they look to the one point which I have mentioned only, and dread nothing but inflammation. Hence it happens that, as I am assured by a gentleman of great authority (who, being neither French nor English, is likely to be unbiassed), that the mortality which attends the practice of surgery at Paris much exceeds that in London. French surgeons have no idea of treatment beyond that of starving or lowering their patients, and hence many are lost. In strumous children, who suffer amputation of a joint, in all the young and delicate, in middle-aged persons worn by long disease, in persons advanced in life, who are compelled to undergo a surgical operation, the chance of ultimate recovery may depend entirely upon the strength of the patient being recruited and fostered by a more generous diet before the operation, and supported by the same means afterwards. I remember hearing narrated the case of a gentleman who had an ambiguous local affection, which at last

was thought to be cancerous. He was between fifty and sixty years of age. Every means were tried to disperse the tumour before an operation was recommended; and the last resorted to were strict confinement to the horizontal posture, and a course of mercury. These having failed, the operation, not a very serious one, was now resorted to in his debilitated habit. In a few days erysipelas and nervous irritation supervened, and the patient died, who probably would not have died had his strength been previously recruited by liberal diet, exercise, and the like. I have been a party to more than one consultation, where operations for similar disease, under parallel circumstances, have been discussed, and as the narration of this case was useful to myself in warning me from falling into the same fatal error, I mention it here, to be of like service to others. However, it more frequently occurs after than before an operation, that a surgeon has the opportunity of judiciously substituting a nourishing diet, and invigorating means, for the low diet, and reduction, which is the prescriptive treatment in all such cases.

In the observations which I have thus far made, I have considered the regulation of diet in reference rather to the whole system, or to other organs than the stomach; and have supposed no fault in the digestive powers. Let us now look to the cases in which management of the stomach is

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