easy and oppressed; the bowels inactive; all the secretions tardy; the pulse hard and habitually contracted: this general uneasiness has also an influence over the cast of ideas; the imagination becomes gloomy, and the character suspicious. The very numerous varieties of this temperament were called, by the ancients, the melancholic or atrabilious. A diversity of circumstances may contribute to produce it; such as, hereditary diseases; long continued sorrows; incessant study; the abuse of pleasure, &c. Many physicians, among them Cullen, and Clerc in his natural history of man in a state of disease, consider the melancholic temperament less as a natural and primitive constitution, than as a morbid affection, either hereditary or acquired. the world; abounding in courage, audacity, and activity, signalized by great virtues, or by great crimes, the terror or admiration of the universe: it is also characterized by an early developement of the moral faculties. Since an exSince an excessive action of the liver, with an obvious superabundance of the biliary secretion, must frequently exist with this constitution of the body, in which the vascular system possesses the greatest energy, to the prejudice of the cellular and lymphatic systems, it has been emphatically denomnated, by the ancients, the bilous temperament; it has also been designated by them as he hard and dry temperature. The diseases to which indiviuals of this temperament are 1ost subject, are derangeents of the hepatic organs, ined with changes in the na- If the proportion of liquids ro of the biliary secretion; be too considerable for that of ence the medicines employed the solids, it gives to the whole remedy these affections are body an increased bulk, from nerally active evacuants, the repletion of the cellular rticularly drastic purgatives, texture; hence, the fleshy ntle emetics, &c. parts are soft; the countenance When to this bilious tem- dull; the pulse weak and slow; rament is superadded a mor- the skin fair and pale; the 1 obstruction of some organ hair of some light tint, as flaxthe abdomen, or any de- en or sandy; the figure plump gement in the functions of and without expression; all nervous system; the vital the vital functions are more ctions are carried on in a or less languid; the memory: ak and irregular manner; not tenacious, and the attenskin is more deeply tinged; tion wavering. This is the countenance becomes un- temperament to which the an cients gave the name of acters. Convulsive diseases" phlegmatic, and the moderns are most common to persons that of lymphatic, because it of this constitution. Antireally depends on the excess spasmodics succeed best in the and activity of this system. treatment of the diseases of The individuals of this tem- this system, which always parperament have generally an takes more or less of the iminsurmountable desire of indo- pression of the temperament: lence, and a great dislike both while stimuli are more adto the exercise of body and vantageous in those affections mind. to which the phlegmatic or To these four temperaments lymphatic temperaments are of the ancients, the moderns subject. Trouchin, of Genchave added a fifth, designated va, acquired very extensive rcas the nervous temperament, at- putation, and a large fortune, tended with the existence and by his skill in treating disorascendancy of great nervous ders of the nervous temperasusceptibility. This proper- ment. He made his idle fe-ty, which causes us to be more male patients exercise themor less sensible to impressions selves habitually till they were received by our organs, is fatigued, and restricted them weak in the phlegmatic, almost to simple and plain food.nonexisting in the melancholic, Trotter, of Newcastle, has acute in the bilious, and mowritten largely on the nervous derate in the sanguine. temperament, to which I beg leave to refer you. This temperament is seldom natural or primitive, but most Though candor requires I frequently acquired, and is de- should acknowledge my oblipendent on a sedentary and gations to the eloquent and too voluptuous life, reiterated flowery Richerand, for the pleasures, exaltation of ideas use I have made of his beaukept up by reading works of imagination, &c. It is also distinguished by a slender habit; smallness of the muscles, often soft and wasted; by the vivacity of sensations; by the promptitude and variability of determinations and of the judgment. Hysterical women, whose sensibility is very great, frequently present this state of the body, with all its char tiful definitions of the temperaments; yet I think his mode of illustrating these definitions is faulty; therefore, instead of drawing these illustrations from antique statues, and cel ebrated individuals who have rendered themselves conspicuous in the history of mankind, I have thought they would be more strongly impressed on the mind by exam Should Providence in its anger, and as a punishment for supine and culpable negligence, visit us with a dangerous and malignant epidemic, but which has been hitherto averted; thanks to the well ventilated ples drawn from original tribes, and large masses of mankind. Thus, for example, I would depict the sanguineous as strongly marked in our Teutonic or Germanic ancestors, as described by the strong pen of the sarcastic Tacitus. current of air and water pourWhile, on the contrary, the ed over the rocky bosom of bilious is as impressively mark- the majestic James river, that, ed in the Celtic descendants, to us, magnus fons salutis, of the Southern part of Eu- Should, however, our continurope, as in Italy, Spain, Portu- ed neglect of the shallow pudgal, and the South of France. Perhaps I may be indulged in conceiving a fancied resemblance of the melancholic in 1 the aboriginal Indians of our own country. The inhabitants of Holland remarkably elucidate the effect of climate over the temperament, showing strikingly the influence of cold and moisture in producing the phlegmatic or lymphatic temperament. Happily for us, the nervous temperament does not so frequently occur in large masses as to degenerate into national traits; it is chiefly to be sought for among the 1 victims in the higher ranks of an overstrained and vicious civilization. dles of water, the constant receptacles of every species of filth, overcome the natural salubrity of our city, and we should, in turn, become the victims of a wide spread and dangerous disease: it is to be hoped that we shall not, either influenced by fashion, intrigue, or clamor, adopt indiscriminately any general plan of cure, but rather attentively consider the temperament and idiosyncrasy of those committed to our care, adapting our means of cure to the existing circumstances of our patients, and not indiscriminately pour out torrents of their blood, break down their stamina by drastic evacuants, or keep them in a constant state of stupefaction with wine, brandy, bark and opium, Uninfluenced by fashion or caprice, the conscientious physician will attentively consider how the means of cure may be most conveniently and best adapted to the habit and idiosyncrasy GIVING MEDICINES. Many persons are more disposed to prescribe for the sick medicines whose effects they cannot estimate, and for diseases they do not understand, than to pursue the proper course for preventing sickness. The former is much easier than the latter, for those who do not regard consequences, and is more grateful to their fancied skill and sagacity. To all such we recommend a careful perusal of the following circumstances and conditions which should be fully considered and comprehended by all who undertake the treatment of dis eases. THE DOSES OF MEDICINAL SUBSTANCES are specific with respect to each, and can therefore be only learnt from experience; the young and eager practitioner, however, is too of ten betrayed into the error of supposing that the powers of a remedy always increase in an equal ratio with its dose, whereas THE DOSE ALONE VERY OFTEN DETERMINES ITS OWN SPECIFIC ACTION. "Medicines," says Linnæus, "differ from poisons, not in their nature but their dose." So that food, remedies, and poisons, may be said to branch into each other by indefinable degradations. Five grains of Camphor act as a mild sedative, and slight diaphoretic, but twenty grains induce nausea, and act as a stimulant; so again, Opium, in too large doses, instead of promoting, prevents sleep, and rather stimulates the bowels, than acts as a narcotic. Two ounces of any neutral salt are apt to be emetic, one ounce even of Alum to be cathartic, and two drachms to be refrigerant; in like manner, the preparations of Antimony either vomit, purge, or sweat, according to the quantity exhibited. Would it not appear that powerful doses rather produce a local than general effect? Experience seems to prove in this subject, that the effect of an internal application is similar to that of an external impression; if violent, it affects the part only as pinching does that of the skin, whereas titillation, which may be said to differ only from the former in degree, acts on the whole system, and occasions itching and laughter, and if long continued, weakness, sickness, vomiting, and convulsions.; in like manner, Digitalis, if given in large doses, acts immediately on the stomach or bowels, becoming emetic and cathartic, but in smaller proportions it produces a GENERAL effect, increasing all the excretions, especially that of urine. I am well satisfied that the regulation of the dose of a medicine is even more important than it is usually supposed to be. Substances perfectly inert and useless in one dose, may prove in another active and valuable. Hence may be explained the great efficacy of many mineral waters, whilst the ingrédients which impart activity to them are found comparatively inert, when they become the elements of an artificial combination ; and hence proba bly the failure of many alterative medicines, when no other rational cause can be assigned for it: We need not seek far for an example of the very different and opposite effects which the same substance can produce in different doses; the operation of common salt is familiar to us all; Sir John Pringle has shown that in quantities such as we usually take with our food, its action is highly septic, softening and resolving all ment to which it is applied, whereas in larger quantities it actually preserves such substances from putrefaction, and therefore, when so taken, instead of promoting, destroys digestion. It is moreover probable that medicinal, like nutritive substances, are more readily absorbed into the circulating system when presented in small quantities, than when applied in more considerable proportions. It is on this principle that a large quantity of food, taken seldom, does not fatten so much as smaller quantities at shorter interval, as is exemplified in the universal good condition of cooks and their attendants. It is not pressing the principle of analogy too far to suppose that the action of alteratives, which require to be absorbed, may be more effectually answered by similar management, that is, by exhibiting small doses at short intervals. activity is proportionably increased, as is well known to every person who is familiar with the operation of the Cheltenham waters. Emetics also frequently become more powerful by repetition; but this is probably the effect of the mind; for after the frequent use of such a remedy, the mere sight of it, or even conversation relative to it, will excite nausea. In apportioning the dose of a very active medicine, it is of the greatest moment to determine the relative degrees of power between the system and the remedy, and to know to what extent the latter is likely to be carried, consonantly with the powers of life to resist it; thus, after a patient has been exhausted by protracted and severe suffering and watching, a dose different to one at the commencement of the disease is requisite. The importance of this precept is impressed on my mind, from having witnessed, in the course of my practice, several instances of the mischief which has arisen from a want of attention to it; that disease materially influences the condition of the body, and its susceptibility to remedial impressions has been already demonstrated. Emetics act very readily in febrile affections, while in those of the Neuroses they produce their effects with difficulty. Before we quit the subject of The operation of medicines is in- Dose, it may be necessary to obfluenced by certain general circum- serve, that there are many remedies stances, which should be also kept in that do not act with greater violence mind when we apportion their dose; in a large dose than in one compara for example, Age-Sex-Tempera- tively small; Ipecacuanha, for instance, ment Strength of the Patient is more certain in its operation, but Habit-Diet-Profession-Climate not more violent, when given in a Duration of the Disease-State of large quantity; the same may be the Stomach-Idiosyncrasy-and the said of Aloes, and several other meVariable Activity of the Medicinal dicines. Substance. Women generally require smaller doses than men. Habit, or the protracted use of a medicine, generally diminishes its power, though certain cathartics appear to offer an exception, for when long continued, their THE VARIABLE ACTIVITY OF A MEDICINE should also be appreciated, and perhaps the practitioner would act cautiously if he were to reduce the dose, should it be a very considerable one, whenever a fresh parcel of the medicine is commenced, |