the community are commonly even more deceived than those already spoken of.

In managing a case in which disease has become so seated that it cannot be broken up, but must be removed gradually, it is evident that the more judicious the means which are applied, from day to day, to the varying states of the case, the shorter will be the sickness. It is in the accurate adjustment of remedial means to the ends to be accomplished, that unskilfulness makes a great failure; and yet it is a failure which is, for the most part, concealed from the public because it can be satisfactorily detected only by a nice comparison of cases, and this comparison cannot be made by the public.

The adjustment of remedies to the varying states of disease has an influence beyond the mere circumstance of the length of the sickness. The judicious Physician saves his patients from unnecessary complication in their diseases, while the quack is apt, not only to neglect to prevent or remove such complications, but to excite and foster them. For example, if there arise in the course of a case of fever, some local inflammation, the judicious Physician notices the symptoms of it as soon as they appear, and immediately applies remedies to remove it, and commonly succeeds in so doing. On the other hand, unskilfulness would be blind to the fact that such inflammation exists, and would therefore make no efforts to destroy it, but would

perhaps unwittingly increase it. The same difference between skilful and unskilful practice could be pointed out in regard to other kinds of complications, congestions, irritations, and functional derangements of different organs.

But let us look beyond the results which occur during the progress of disease, and examine those which appear after recovery has taken place. When one recovers under injudicious practice, his system is not apt to be in a good state, his convalescence is not a clear one, and his recovery is not full and complete. Perhaps his vital energies are impaired, and his constitution has received an unnecessary injury, from which it may never wholly recover. Perhaps some bad chronic ailment is left behind, which, though it may trouble him but slightly for a long time, may yet be the germ of some future disease. Such a state of things is not inconsistent with a tolerable condition of health, even when there may be such disease, as will gradually accumulate, till it bring him to a bed of sickness, perhaps death.

These remote consequences of bad practice are the more certain to occur, if the patient go on after recovery to administer medicines to himself, according to his own whims, or those of others. Many tedious cases of this kind fall, at length, under the care of the Physician, from the hands of quacks, who are thus often spared from witnessing the results of their ignorance and im

posture, as from bearing in the estimation of the public any responsibility in relation to them.

The influence of bad practice upon the health of families, it is evident from the above facts, must be very great; and yet it is seldom appreciated at all, and never as it should be. There is no question of the fact, that there is generally a much larger amount of sickness from year to year, in families that employ unskilful Physicians or empirics, than there is in those who are under the care of skilful practitioners. And though the public cannot discriminate accurately between individual cases in regard to this point, they can see the evidence of this general fact, especially in comparing good practice with gross quackery. This evidence will go on to increase, inasmuch as the evil effects of quackery, continued in a family from year to year, are constantly accummulating, a result which is materially aided by the unnecessary dosing commonly pursued by them in the interval of sickness. And from this accumulation we may infer, that what we now see of the bad consequences of quackery, is but a shadow of what we may see hereafter.

To sum up the points in which the practice of the really skilful Physician differs in its results from that of the injudicious practitioner and the quack :

1. He has a less number of fatal cases in proportion to the whole number that came under treatment.

2. He has a less number of bad cases, because he

avoids converting light cases into grave ones, and succeeds in arresting disease in many cases in its very

commencement.

3. His patients have, commonly, shorter sickness.

4. They are in a better condition after they have recovered; less apt to have bad results left behind; and less liable to disease in future.

5. He has a less number of patients, and a smaller amount of sickness, in the same number of families.

That these points of difference between the results of good, and those of bad practice, may be appreciated with any correctness, two things are necessary.

First, We must possess a sufficient quantity of evidence. A few facts will not avail in deciding such points, they will only lead to erroneous conclusions. Comparison is to be made, it is true, between individual cases, but there must be many of them, in order to secure the avoidance of error.

The second requisite is the capability of observing correctly. There is no subject in the wide range of human knowledge, the investigation of which requires more care and skill than this does.

Now, it is obvious, that the community in general are very deficient of these two requisites for a proper appreciation of the comparative results of practice. Most men have a very narrow range of facts upon which they can found such an appreciation. Their observation of sickness extends little beyond their immediate family circle; for what they see of disease

anywhere else, is not like watching over it; and what they hear, as you have already seen, is not to be relied upon.

There is much which is styled fact, which is not soit is either mis-statement, or the result of hasty and superficial examination. The actual knowledge which any new professional observer obtains of disease, by any observation of his own, to which he gives any fair amount of attention, is very narrow. But the reader will say, if it be so difficult, and almost impossible for me to discriminate between good and bad practice, by my own observation of their results, what shall I do? How shall I judge of the different modes of practice, and of the skill of different Physicians? In answer to this inquiry, if the reader is really convinced that it is almost impossible for him to judge of practice by the results which come within the compass of his own observation, then it is plain that he must give up, for the most part, this source of evidence as a deceptive one, and rely upon other means for arriving at correct conclusions on these points.

Physicians often err in their readiness to appeal to results, to show the public the superiority of their practice to that of the quack. There is no objection to such an appeal, when a sufficient number of wellobserved and authenticated facts can be produced, bearing upon the point in question. But this cannot ordinarily be done, when the community are to pass judgment in the case. The quack likes to join issue