broad and profound meaning here. If the modern practice be right, then the old practice must have been wrong, deadly wrong; and in so far at least we must be wiser than our fathers, and entitled to the gratitude of mankind for our superior knowledge and skill. As a young man I well remember that every physician was accustomed to carry a lancet in his pocket, ready for use in any emergency, however unexpected. It was an inseparable companion. In every large city of the Union there were certain men who followed bleeding, leeching, and cupping as a specialty. How the matter now stands everybody knows. The lancet is an obsolete instrument, the office of the bleeder has departed, venesection has long been unfashionable, and few of the present generation of medical men would, if called upon, be able to open a vein in a scientific and creditable manner. Bloodletting, as I have already declared, is, emphatically, one of the lost arts.

How this extraordinary change in sentiment and practice was brought about, by what influence, agency, authority, philosophy, logic or mode of reasoning, is a matter worthy of brief inquiry. The causes, so far as they are patent to my mind, are mainly four: first, the influence or tyranny of authority soon passing into more or less extensive fashion; secondly, the indiscriminate employment of the lancet in the days of what has been termed, not inappropriately,the Sangrado practice; thirdly, a more accurate knowledge of the nature and seat of diseases; and, lastly, the use of certain remedies, unknown a third of a century ago, but now of general, if not universal, resort, in the treatment of inflammatory affections.

1. The influence of authority annually slays millions of human beings. Its pernicious effects upon human life, in its individual and collective relations, are seen and felt in every direction; in the construction of our dwellings, in our habits and occupations, in our dress, in our social entertainments, in our amusements, in our food. and drink, and in a thousand other ways. Of its malign influence in our profession examples daily fall under our observation, as the result of pernicious doctrines and practices. Superstition and fanaticism have kept the world in a state of intellectual bondage from the earliest records of society down to the present moment. The spiritism of the present day had its counterpart in the witchcraft of three centuries ago, fortunately without the hangman's halter. Every age has its peculiar absurdities, characteristic of the minds of some of its people. Mesmerism deluded thousands of persons. The metallic tractors of Perkins enjoyed for a time a

world-wide notoriety. Homoeopathy is still at work in deluding people. Clairvoyance has many devout adherents. Berkeley, in the middle of the last century, effected many wonderful cures. with the aid of his tar water. For upwards of one hundred years the lancet enjoyed unlimited sway. Everybody was bled. Surgeons during the last dozen years have had carbolic acid on the brain as a dressing in wounds and other injuries. Broussaism, Cookeism, and the blue pill of Abernethy each had a reign of at least a quarter of a century. For an equally long period the medical mind of Italy was agitated by the tartar-emetic treatment of Rasori and his followers. Thompsonianism, or the lobelia and Cayenne pepper treatment, is not yet entirely extinct on this continent, although its days were numbered long ago. For nearly a third of a century the doctrine of a change of type in disease has tyrannized over the minds of medical men, and exerted a controlling influence upon their practice. Of all these delusions, the latter, often called Toddism, after Dr. Todd, its author, has exercised the most perversive and baneful effects upon civilized society. Ensconsing itself behind a false position, it has literally enslaved the medical world, entrapping alike the wise and the foolish, and sweeping over human life with a force equal to that of the most destructive hurricane. Unlike the doctrine of sthenic and asthenic diseases of Dr. John Brown, of Edinburgh, who, in the latter part of the last century, enjoyed such a wide celebrity as a medical reformer, it assumes that all maladies are of a low type, imperatively demanding the use of stimulants for their successful management. It countenances no half-way measures. The patient must be upheld by stimulants or he must die. Now and then, perhaps, a few leeches may be tolerated, but only in very exceptional cases, where there is not much depression of the vital powers. Who and what Dr. Todd, the author of this system of medicine, was, it would be needless to inquire. Everybody knows that he was one of the ablest writers and clinical teachers which this century has produced; but that he was a profound thinker I doubt, and it is well to bear in mind that the patients at King's College Hospital, London, of which he had charge, were persons in the lower walks of life, broken down by overwork, privation, and various forms of intemperance, and therefore unable to bear depleting remedies. Such patients as Dr. Todd had are to be found in the wards of every eleemosynary institution in Europe and in this country. It was from a study of this class of cases that this

famous man, in an evil hour, deduced the absurd doctrine of a change of type in disease; I say absurd, for if there ever was any thing absurd this doctrine most assuredly deserves that name.

Who that has any knowledge of the human constitution as it is daily met with in our intercourse with our fellow-citizens, in the various pursuits of life, will lend credence to such an idea, I had almost said, to such a slander? I assert, without the fear of successful contradiction, that man's power of endurance in health and disease is not one particle less than it was fifty years ago, when depletory measures, of every form, were the order of the day, when, in fact, it would have been deemed derogatory to a physician's character to let a patient die without the aid of such remedies. The exploits performed during our late terrible war alone are sufficient to settle this question. Never, since man battled with man for national supremacy, were there so many rapid, laborious, and brilliant marches executed in so short a time as there were on both sides of the line. The exploits of the soldiers of Alexander, Hannibal, Cæsar, and Bonaparte fade into comparative insignificance by the side of those of some of our generals. Our laborers, farmers, miners, hewers of wood and carriers of water, mechanics, artisans, and professional men evince no evidence of decline in muscular power or mental endurance. Our sailors are as hardy a race of men as they were in the days of Sir Francis Drake or Captain Cooke.

If we look at the habits and modes of life of the people at the present day it will be found, if I do not greatly err, that they do not differ in any essential manner from those of a third of a century ago. The different classes of men and women, in city and in country, live very much as they did in my boyhood, using the same kind of food and drink, pursuing similar occupations and amusements, and exercising as much control over their appetites and passions generally as their fathers and mothers did. If there are any differences in any of these particulars, they are certainly not well marked, or so radical in their character as to diminish, in any material degree, the power of endurance of our people in health and disease. On the other hand, owing to the more extensive cultivation of our soil, the destruction of our forests, the draining of our marshes, and the greater attention paid to the study of hygiene, our people, especially those in the rural districts, are much more exempt from the diseases caused by the noxious exhalations from the earth's surface, so prevalent in newly settled countries, and so

pernicious in their effects upon the constitution, than they were in the early days of my white- and bald-headed contemporaries.

Do not men during accidents and surgical operations, and women during parturition, often lose enormous quantities of blood, and yet frequently make excellent recoveries? In epistaxis, hemoptysis, and hematemesis, this fluid is often largely poured out, and yet it is seldom that we hear of a person dying from the effects of its loss.

In the face of such facts as these, and a hundred others that might be adduced if time permitted, the doctrine of a change of type in disease must fall to the ground as utterly untenable.

The influence of fashion is not limited to our profession. We all recollect how the crinoline of the French Empress, invented to conceal a condition of which most ladies are so proud, enslaved the female mind, until every woman, married and single, considered it as an indispensable article of dress. A sofa, however spacious, was hardly long enough for a woman thus arrayed to sit upon. How the fashion has changed within the last six or eight years is familiar to everybody. Now the dress is so narrow as to show the outline of the person, and to compel the greatest care in progressing, lest the fair wearer should trip and tear her garments. Even diseases occasionally become fashionable. When Louis XIV. was laboring under anal fistule, this disgusting malady became at once the fashionable ailment of his debauched court. The use of enemata was cultivated as one of the fine arts in France in the time of Molière, who lashed the faculty without mercy for its follies and extravagances.

2. The indiscriminate employment of the lancet in former days did much to bring bloodletting into discredit, not only with the better thinking class of physicians but the public at large. "We cure the sick," says Gui Patin, a Professor in the Royal College of. France, "when over eighty years old by bloodletting, and also infants of not more than two or three months, with as much success and as little inconvenience." Rush, the great champion of this operation on this side of the Atlantic, bled too, indiscriminately, I had almost said, remorselessly, at all periods of life, the young, the middle-aged, and the old, in all kinds of diseases, in the eruptive fevers, in fever and ague, in puerperal fever, in inflammations, in injuries, in hemorrhages, and even in anemia, often taking immense quantities of blood, and repeating the operation six, eight, or even a dozen times in the same patient. In short, he and his followers VOL. XXVI.-28

used to bleed in every possible disorder until, in many cases, no more blood would flow because there was none left. That such practice would at length work out its own destruction is what might reasonably have been expected. It rang its own knell.

3. That we are much better acquainted with the nature and treatment of diseases than our fathers were, is a fact so universally accepted as to require no argument in its support. Our progress in this respect, during the last forty years, has simply been marvellous; and to nothing are we so much indebted for these improvements as to the study of pathological anatomy and histology, and the astounding developments of chemical science.

4. That the treatment of diseases has been greatly simplified within the period above specified is familiar to every member of the profession. Homoeopathy, by the absurdities of its doctrines and primitive practices, long ago demonstrated to the world that most of its cures are effected spontaneously through nature's restorative powers alone, while the patient's mind is medicated with the decillionth part of a drop or a grain of medicine; and in comparatively recent years two eminent medical philosophers, Professor Bigelow, of Boston, and Sir John Forbes, of London, showed us by a series of admirably conducted observations that certain diseases, as smallpox, scarlatina, measles, typhus and typhoid fevers, are self-limited in character, and, therefore, not to be materially, if at all, abridged in their course by any plan or means of medication whatever. A third of a century ago the only so-called depressants, aside from the use of the lancet, were tartar emetic, calomel, and digitalis, the latter of doubtful efficacy in any case, and the first often exhibited without due discrimination. Of aconite and veratrum viride, now so universally employed as antiphlogistic agents, we were totally ignorant. These two medicines, as I shall endeavor to prove by and by, although frequently of immense service in the treatment of inflammatory affections, are incomparably inferior to bloodletting.

Believing that these are the principal, if not the only, reasons which have led to the abandonment of bloodletting as a therapeutic agent, I propose now to speak of the operation itself, and to point out, first, the classes of diseases to which it is more especially applicable; secondly, the period at which it should be performed to yield the greatest amount of good; and, lastly, its mode of action.

Blood may be abstracted in different ways; as, first, by venesec