But this should in no way interfere with the power of the poor to participate in such a system. Every hospital and dispensary should institute a distinct department for the conduct of such examinations, and for giving the necessary advice. Every patient discharged from its wards should be submitted to this department before returning to the duties of life.

I have again and again referred in these Lectures to the numberless anomalous symptoms, the pains, discomforts, nervous disturbances, etc., etc., which affect persons in abnormal physiological states, and which increase in their severity, obviousness, and number, as the states of health become more and more degraded, and the occurrence of some acute disease becomes more imminent. I have pointed out to you that these are the states of health which fill our consulting-rooms and the out-patient departments of hospitals and dispensaries.

In further confirmation of my statements on this point I may remind you of some apposite observations by Sir Henry Holland on the subject of symptomatic complaints. In his "Medical Notes and Reflections" he says, speaking of gouty blood, - "Irregular actions of the heart, hypochondriacal depression, as well as the more common symptoms of dyspepsia and disordered secretions, frequently antecede by months the first appearance of gout in the extremities, and occasionally give serious alarm even to those who look with medical eyes upon these ambiguous cases." (P. 246, 3rd edition.)

"Modern observation has led us to recognise some of these relations (of gout with local or constitutional disorders) under the names of gouty headache, gouty ophthalmia, and gouty bronchitis. My own experience would lead me to add many cases of asthma to the number. I have so often seen this disorder prevalent in gouty families, affecting those who do not undergo the disease in the joints, and ceasing wholly or in part when the gout appears externally, that I cannot doubt the existence of this relation.

The greater tendency to apoplexy in this habit is noticed by many of the older writers, and confirmed by general experience.

Reference has already been made to hypochondriasis and hysteria; and it is probable that other disorders of the same class, still less generally viewed under this connection, will hereafter be submitted to it.

The relation of gout to the functions and disorders of the liver is another point of much interest in pathology, clearly attested both in the active symptoms of the disease and by those which are common under other forms of the gouty temperament. This, moreover, is one of the points associating it with that group of maladies bearing the vague name of dyspepsia.

The connection of gout with cutaneous affections is an additional topic, yet almost unexamined; though I cannot doubt, from my own observation, that certain of these disorders occur as effects of the habit in question. (Op. cit., pp. 253-54.)

That enormous quantities of medicine are dispensed in the out-patient departments of hospitals and dispensaries for the temporary relief of this class of functional derangements and local diseases - for complaints which might be prevented by the patients themselves if they were properly informed of the causes and premonitory symptoms of their maladies - is a fact which must be perfectly familiar to all my hearers. Such a system of examination and advice as I propose, if properly carried out, must strike at the root of these evils, and would at the same time reduce the miserable overcrowding of the hospital waiting-rooms, and the enormous expenses incurred for drugs. These are considerations which, however important as elements of social and political economy, are elevated far above the rank of financial questions by the fact I have endeavoured to demonstrate in these Lectures, that by these same means, and at the same time, we shall so largely promote the economy of life.

I hope, Gentlemen, that you will draw the attention of the Treasurers and Governors of any Hospitals, to which you may belong, to this subject. It is necessary to the credit and honour of our profession, that improvements in these medical establishments should not usual amount of drugs for several weeks, gets relief, and goes back to his old habits. A few months more, and he appears again the subject of a skin disease; goes again through the consumption of drugs, and gets well and goes back to work. By-and-bye he comes again with diarrhoea, and goes through the same process; at another time with gravel, and gets relief again. At length, a few years perhaps having elapsed and after some months of depressed health, with palpitations of the heart, gloomy thoughts, irritable temper, and general malaise, he happens to be out on a damp raw day, gets a chill, and applies again at the hospital, with a fresh attack of rheumatic fever. This time he suffers from endocarditis, and after some weeks returns again to his home, "discharged cured," but with disease of the valves of his heart. He has been thoroughly well treated, and is very free from rheumatic poison, and hence goes on for a considerable time without much inconvenience; but having no clear ideas of the nature of the damage he has received, or of the precautions necessary to prevent its increase or the production of secondary diseases dependent upon this damage for their cause, he gradually becomes the subject of congested lungs and liver; of attacks of bronchitis to which he was not formerly inclined; his breathing becomes short, his old dyspeptic troubles, cutaneous affections and gravel, recur again and again, and his capability of following his former occupations gets less and less.

If he does not have another attack of rheumatic fever, he comes back to the hospital some future day with chronic bronchitis, or with apoplectic symptoms, or with congested liver, or still later with albuminuria and dropsy. At length he dies, and his death is registered under the head of apoplexy, heart-disease, or dropsy. (See "Tables showing the Interdependence of Diseases,")

All medical men of experience will admit that this sketch is no exaggeration; that I have, in fact, omitted numerous details of minor diseases and discomforts that are sure to have existed in the case itself. I have said nothing of the effects upon this man's children of his continued ill-health, or of the poverty and want of food brought upon his wife and family by the same cause, and acting as fresh causes of disease in them. But I have said enough to make it quite clear, that, in the course of a life prematurely ended, he must have consumed a vast amount of money in the form of drugs, and a vast amount of nervous energy, if not of brains, in the form of medical advice.

It is to the first causes, to the "wells and springs" of such a series of calamities as this, that I have directed your attention as fellow medical practitioners and students, and to which I now beg that you will direct the attention of the Treasurers and Governors of Hospitals and Dispensaries, of your private patients, and of the public at large.