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vanced in 1807, that inflammation of the brain is exclusively the primary cause of fever. This doctrine was distinctly advanced, in a less exclusive manner, as early as the year 1785, by Dr. PEW; (61) and was, indeed, pointed out as a frequent cause of it, by Dr. GILCHRIST, of Dumfries, at a much earlier period. (62) We seem to have let some of our best practical writers fall into oblivion in a very extraordinary manner: the treatment of fever adopted at the present period, is not apparently better than that employed by Dr. Gilchrist.

Dr. Clutterbuck says, "Practical illustrations are issuing almost daily from the press, yet it does not appear that we are advancing a single step towards either a consistent theory, or useful practice, in fever." Page 244. This (when we consider the numerous treatises on the subject, by men of the first-rate talents, which have recently appeared, and all the information which anatomy has furnished,) appears at a first view to be a very extraordinary assertion; but, when we recollect the sentiments expressed in the introductory part of the same work, which shew the spirit that gave rise to these remarks, the mystery is dispelled. When speaking of the difference of opinion existing between himself and Dr. BATEMAN, Dr. Clutterbuck says, "There is, however, such an approximation, that I am willing to flatter myself, a further candid consideration of the subject will have the effect of obliterating the slight shades of difference that subsist between us. Whenever this is accomplished, I shall consider I have achieved a triumph.'

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We include the Treatise on Puerperal Fever by Dr. Armstrong, amongst the important additions to the medical literature of the present period, although a second edition, in consequence of its comprising numerous observations and reflections still further illustrative of the nature of that affection, and of the propriety of the mode of treatment so forcibly inculcated by the author on the first publication of the results of his experience in that disease. This work will engage our particular attention on a future occasion; yet, the interesting nature of the subject induces us now to remark, that it is not excelled in point of apparent accuracy of clinical observation and judicious induction.

The work of Dr. Rogan is principally devoted to observations respecting the origin of the fever at present epidemic in Ireland, the extreme poverty and unparalleled miseries of a great proportion of the people of that country, and to proposals of measures for mitigating some of those evils, and the diseases which thence result: the reflections of Dr. Rogan, on this subject, are as judicious as they are benevolent. This part (61) Medical Sketches. 8vo. London, 1785. (62) An Essay on Nervaus Fevers; in the Edinburgh Medical Essays and Observations, for the year 1736.

of the work is chiefly of local interest only; but, as far as this extends, it should be attentively perused. The remarks of the author relative to the pathology and treatment of the malady, are conformable to the doctrines to which we expressly give our approbation.

The work of Dr. Welsh is chiefly interesting, and more expressly valuable, as a therapeutical dissertation: we shall therefore defer taking a particular view of it until we arrive at the section of this sketch devoted to observations on that part of the application of medical science.

The little tract of Dr. Mills is particularly valuable as an addition to such knowledge as anatomy will furnish respecting the cause of typhous fever. The researches of Dr. Mills have shewn that the brain is an organ very frequently affected with inflammation in that disease, either primarily or secondarily. "In the majority of the patients," says Dr. Mills, "whose cases I have briefly stated, the brain was the organ primarily and principally engaged; but the disorder had sometimes its seat elsewhere,-in the liver, the lungs, or the alimentary canal."

It is with much pleasure that we witness so accurate an observer advocate the doctrine of the essential and primary existence of local inflammation in typhous fever; though we consider he is too restrictive, in not admitting that inflammation of parts will ensue, as a consequence of that previously existing in others, during the course of the disease. He appears to neglect too much the influence of the nerves on the arteries distinctly from affection of the heart, with the consequences of this influence; and the effects of what is usually termed sympathy. Such are the ideas we form from his remarks; but, as they are very concise, we shall wholly transcribe them:

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"I shall now close what I had to offer, by a few observations on the phrase determination of blood,' so often employed by physicians, who attribute the pain, heat, weight, and uneasiness, felt in different organs during fever, to such determination; and, while they allow the application of leeches and blisters for the relief of the affected parts, they regard this as a secondary object, (the affection itself being but secondary, the conse quence of febrile actions in the vessels of the system at large,) where fever is seated, or in what it consists, are points on which they declare themselves incompetent to decide.

"May we now ask, can there be a determination of blood to any organ, as a consequence of the febrile actions of the general system?

"The heart and the blood-vessels transmit the blood; each organ is supplied with a regular determinate quantity, propor tioned to its wants, the importance of its functions, and the

quantity of the circulating mass. Where general plethora exists, there is an increased fullness of the vessels of every part and organ; and the reverse takes place, where there is a deficiency of blood.

"But, where lies the power of transmitting to different organs, at different periods, a preternatural quantity of blood?

The heart and blood-vessels are the great movers and conduits of the circulating mass.

"Does the power lie here? This is not admitted by any physiologist, nor is it consistent with reason or the laws of the animal economy. How, then, are we to account for the pain, the throbbing, the sense of weight or fullness, felt in fever, in different organs

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"In the same manner and on the same principle as in catarrh, enteritis, phrenitis: in these diseases, local inflammation exists, and the general febrile actions are the consequence of such local inflammation. So it is with fever; and this I have endeavoured to shew, from an examination of its causes and phenomena, from the effects of venesection, and from the ap pearances exhibited on dissection.

Thus, fever is essentially the same, depending on local inflammation: it has, indeed, its varieties and modifications. These depend, in a great measure, on the exciting causes; but still more on the patient's temperament of mind and body, and on the diseases with which he was previously affected."

We regret that Dr. Mills has been so concise in his remarks on this subject. It is not evident from them, whether he absolutely denies that local inflammation ever occurs as a consequence of fever, and its local and immediate cause conjoined; or, whether be only considers that it is never a consequence of the general re-action of the system solely. If he means the former, we differ from him in opinion: if the latter, we agree. Our reasons have already been detailed.

Mr. Proudfoot's observations relate to a disease that was epidemic amongst the British troops at Carthagena, in 1812, and which was considered to be yellow-fever. The following brief paragraph will give an idea of his opinions respecting its cause and character.

Yellow-fever has been variously described by different authors, as they considered the disease, contagious or noncontagious, continued or remittent. The term itself, as has been often remarked, is very objectionable, and apt to lead the inattentive into serious error: perhaps it would have been better, had that disease been placed in the order phlegmasia, and described as an inflammation sui generis, excited chiefly by cold applied to the surface of the body; the parts having pre viously acquired a certain susceptibility to disease, from the

state of the mind over the constitution, and from exposure to marsh miasmata under a high atmospheric temperature."

The above observations, though applied to yellow-fever generally, relate also to the disease which was the subject of the present observations; from which we shall transcribe another paragraph, and with that conclude.

"The appearances upon dissection were uniform, and satisfactory, in as far as they agreed with what might have been expected from the symptoms; being chiefly an inflamed state of the stomach and intestines. Upon opening the abdomen and reflecting the omentum, in many cases, nothing of a morbid appearance presented itself; in others, fasciculi of red vessels could be seen running on different parts of the intestines; and when the disease commenced with great violence, and speedily proved fatal, the whole of the peritoneum was much inflamed. Upon making an incision into the stomach, the villous coat appeared crowded with innumerable minute red vessels, forming specks on different parts, of a beautiful scarlet colour; but the appearances varied according to the violence of the inflammation, which in general was greatest at the cardiac orifice. In many cases, the latter part, at first, appeared quite black and mortified; but, upon investigation, this appearance was proved to depend upon an effusion of blood between the nervous and villous coats of the stomach. I have seen the villous coat entirely destroyed in different places, leaving little excavations, and a plexus of innumerable enlarged and denuded blood-vessels; several of these being ruptured."

The treatise of Mr. Dickenson on yellow-fever is too interest ing and important to be briefly considered. This valuable work will engage our attention on a future occasion, when it can be applied to in a more appropriate manner.

As the work of Dr. Hale on the spotted-fever of the United States has already been reviewed in this Journal, we need now only record it amongst the valuable additions to the medical literature of the present period.

. The practical manual of the treatment of fever and inflammation, of Professor Hufeland, is worthy of the author of the Macrobiotics; and it constitutes a valuable addition to his general system of the practice of medicine. The opinions of the author are in general conformable to those now prevalent in Europe; and his practical application of them is judicious, but incapable of being described in an abstract. This physician, we may observe, is one of those who have most contributed to effect the destruction of pure Brunonism, which was at one period so universally prevalent in Germany, and which is yet sufficiently so to counterbalance, probably, all the

benefit the practice of the medical art in that country can effect.

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Dr. Milius, for his observations on nervous inflammatory affections, and remarks on the treatment of nervous fever, merits a civic crown from his compatriots; for, although his doctrines are not novel, being conformable to those on which we have long conferred our approbation, yet the boldly advancing of such in Holland, where Brunonism (53) in its worst forms, conjoined with an unintelligible humoral pathology, has been so popular and so prevalent, claims no small degree of praise.

The doctrine of the connexion of inflammation with nervous fever, Dr. Milius observes, is either not understood in Holland or publicly opposed; and it is to explain that doctrine, and to overcome that opposition, not from a notion that he can add any thing of much value to the excellent works already extant on the subject, that he is induced to take up his pen.

. His remarks, it appears, particularly apply to the opinions advanced by Dr. KIRKHOFF, a physician to the garrison hospital at Antwerp, in a work which he published last year; wherein he states, that nervous, putrid, malignant, and yellowfever, are of one and the same nature; should be termed idio pathic asthenico-nervous fever; and treated by the most powerful stimulants. Antiphlogistic measures, especially blood-letting, Dr. Kirkhoff says, are in no cases useful, and almost always destructive.

Dr. Milius, in his work, adds the results of his own experience to the statements of other physicians, to confirm the truth of the doctrine that nervous fever is dependant on local inflam mation. He also describes the appropriate mode of treatment, in a lucid and accurate manner.

Dr. Lassis has written with a view to show, that what is ordinarily called typhus is not contagious. We shall, in the first instance, transcribe a paragraph, to show, if possible, the nature of the malady to which he applies the term typhus.

"J'ai seulement en vue ces maladies connues autrefois sous le nom de peste, ou de maladies pestilentielles, et que l'on désigne assez souvent aujourd'hui sous celui de typhus, lesquelles ordinairement, sont epidémiques, accompagnées de stupeur, et se développent dans les hôpitaux, les lazarets, les prisons, les camps, les vaisseaux, les villes assiéges, sur les bords des canaux en Egypte, sur ceux des criques en Amérique; en un mot,

(53) It must not be supposed, because we reprobate Brunonism, that we are insensible to the merits of the doctrines of BROWN. They are far different in reality from what they have been interpreted to be: there is much of them, in, deed, in the present system of organism. It is the false and fanatic manner in which they have been applied in practice, against which we exclaim without

reserve!

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