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of heat. Danger of sudden application of it. Application of these principles to diseases-necessity of regulating the heat of the body, according to the natural standard in the cure of some diseases. Il effects of too great a degree of heat or cold during the night. High living and violent exercise hurtful in wasm countries-in cold ones a more liberal diet, an indulgence in strong liquors, and hard exer: cise, may not only be used with impunity, but appear even necessary

In the fourth section, Dr. Gardiner treats of fevers in geo neral.

General causes of fevers reduced to five, ift, Excess of cold; 2d, Excess of heat; 3d, Marsh-miasma ; 4th, Humana contagion; 5th, Specific contagion. Proximate caufe of fevers not known from our ignorance of the laws of the animal oeonomy. Division of feveçs into simple and complicated.-Nature and danger of marsh-miasma.-Marthy and fenny places not the fole fources of it.-Human conta: gion the most active cause of fevers. In camps, arises chiefly from the privies--attains its highest violence in hos? pitals and jails-negle&t of cleanliness gives rise to it in poor families. Diseases arising from marsh-miasma, and human contagion nearly the same-Sir John Pringle's Medical Annotations, a manuscript bequeathed to the Royal College of Physicians at Edinburgh, quoted in support of this opinion.

Modes in which the matter of infection may enter the body:-by the pores of the skin-no sufficient evidence ;by respiration-more plausible--strong objections to it;-by inoculation ;--by being mixed with the faliva and swallowed, -this last the most probable way of infection being con: veyed into the body. Progress of infe&tion by inoculation ; and the reasons for its being milder ingeniously suggested, Effect.of cold in diminishing the variolous fever-chewing tobacco and taking care not to swallow the saliva, a prepa: rative against infectioạs putrid cases. Upon this principle it is, that an emetic and a purge given at the beginning of putrid diseases, often prevents the progress of them. Danger of large bleedings in the beginning of putrid complaints. -If the cause of the disease act on the system for three or four days, the emetic and laxative away mitigate ihe symptoms, but will not remove the fever, which in this case will run its, ordinary course. Further and more pofitive proofs of the infection of malignant fevers being chiefly taken in by the saliva, and affecting the primæ viæ first. Section 5 Of a Catarrh. Obstructed perspiration not

the

the cause of a catarrh :-Arises from sympathy between the nerves of the skin, and those of the internal membrane of the bronchi. Anodyne powers of warm bathing in leffening the præternatural irritability of the nervous system. Salutary and pernicious effects of cold on the body. Causes

of diseases act some time on the system before the = symptoms appear--instance, the symptomatic fever, af

ter wounds and chirurgical operations, seldom appearing till the third day., Cough in a catarrh, owing to the accumulation of mucus in the bronchi. When the mucous glands have been affected for some time, the glands of the stomach partake of the disease from the sympathy of the lungs with the stomach. Hence the utility of emetics in coughs of some standing. Effects of cold do not always fall on the mucous glands, and occafion a catarrh, but frequently fall on parts subject to fome other diseases. In this way they bring on fits of the gout, gravel, tone, &c. The remains of a catarrh, leaving small obstructions in the fubstance of the lungs, may produce tubercles, and terminate in a phthifis pulmonalis. A person afflicted with a severe catarrh, ending in a troublesome cough of long duration, becomes more liable to returns on catching cold.--Hence larger secretions of phlegm from the lungs-increasing as age advances, bringing on hectical coughs, humoral asthmas, and the peripeumonia notha, which laft is usually brought on by a catarrh. A simple catarrh, properly managed, ends in fix or eight days.-Curative indications, to remove all tendency tu inflamm tion ; to free the fyftem from preternatu: ral irritability; to rectify the morbid fecretion of the mucous glands. First intention answered, by keeping up a free and gentle perspiration--mild vegetable diet---diluting acid drinks -breathing the steam of warm water--warm bathing-keeping the body open-bleeding useful, but with circumfpection-blisters to remove topical inflammation from four to ten grains of nitre, with double the quantity of crystals of tartar, every two, three, or four hours in a tuinbler of water. The second and third indications answered also by the same means, to which the Doctor adds, as having the greatest dependence on it, for lessening the general irrritabia lity of the system, and moderating the mucous secretions, small doses of opium, the fixth or eightli of a grain at a time, so as to adminifter one grain, or one and a half in twenty four hours, made in form of lozenges, and suffered to dissolve gradually in the mouth.

Section 6th, Of the Catarrhal Fever.

Febrile disorder of a middle nature between a common cold, and an inflammatory fever---affections of the stomach

the

the immediate cause of fevers from increasing general irrita! bility. Cold and moist weather the remote cause of the catarrhal fever-commences with the cold weather at the end of autumn, continues through winter, and becomes more frequent in fpring, especially when the weather is exi posed to sudden changes. Accession of fever most difficule to explain. Morbid itimulus of stomach and bowels attend: ed with increased irritability of the system. Symptoms accounted for. Cold stage arises from a diminution of the force of the heart, owing to the action of the febrile ftimu. lus on the primæ viæ, as the febrile stimulus abates; the heart and blood vessels gradually become stronger, there is a proportional increase of it; hence the transition from the cold to the hot stage. No exact regularity in critical days. Period of a fever may be shortened or protracted by good or bad practice. Cold stage not essential to the disease. Exacerbation of the fever at night; and remiffion in the morning, supposed to arise from increased irritability of the syf: tem, occafioned by the continued exertion of our functions; and of the faculties of the mind through the day. If after three or four days continuance of a catarrh; a patient should catch fresh cold, or be seized with severe continued pain in any part of his body, a feverish paroxysm is brought on, and the catarrh then puts on the form of a catarrhal fever of uncertain duration. When without a cough, sore throat, or other catarrhal symptoms, then it is a continued fever great use of diluting liquors-cool freth air, cold drink; light bed-clothes to moderate the heat-use of bleeding blistering, next to bleeding, the best way to remove topical inflammation--use of antimonials, not to be continued too long-Peruvian bark, cordials, ftimulating remedies-antispasmodics, and wine to be given in a more advanced Itage. The materies morbi collected during the course of the fever, by the daily increase of the putrefcency and acrimony of our fluids.

Section 7th, Of the Cholera.

Heat the remote cause. An autumnal disease chiefly. Effects of heat in producing a cholera moft obfervable in warm climates. Bile too acrimonious in this disease to ad; mit of being evacuated by stimulating remedies--mild; emollient drinks given in large quantities are the only means we should use for this purpose. Symptoms sometimes so severe as tó require opium in the first instance; which otherwise should not be given till the stomach and bowels are cleared-use of bitters among which the columbo toot is thought most successful ; from ten to fifteen, and

twenty

twenty grains twice a day. The Doctor's chief dependence is on the bark, riding, and proper

diet. Section 8th, Of the bilious, remitting, and intermitting Fevers.

The bilious autumnal fever, more various in its danger, form, and symptoms than any other febrile disease, to which mankind is subject. In.fenny, swampy grounds often fatal in forty-eight hours :-most prevalent in moist and hot seafons and climates. In encampments, assumes the form of quotidians, quartans, diarrheas, and diffenteries--though so various, yet the same disease; the symptoms coming on alternately, one stopping when the other makes its appearance. -Value of Sir John Pringle’s Annotations, much increased by Dr. Huck's (Saunders) Correspondence. Similarity between this and the yellow fever of the Weft-Indies. Appears in the same form in all parts of the world ; hence probably arises from the same cause.-Most simple ftate of bilious fever, is that in which the bile is only accumulated from excess of heat. When this cause is combined with human contagion, the fever usually continues, when with marsh-miasma, inclined to remit and intermit. The fimple bilious fever more infiammatory, than when combined with the other causes. Inflammatory state of fever does not continue above three or four days; the remissions then become more perceptible than in the catarrhal fever. Excellent practical rules to determine the propriety or impropriety of bleeding in this fever. Cautions to distinguish between the inflammatory and putrid species.- In the former, bleeding sometimes indispensably necessary; in the latter, often fatal.—Emetics and laxatives in the beginning.. - Violent evacuations, if the disease still goes on, hurtful. -A vomit not to be exhibited after the fourth or fifth day.--Saline draughts good vchicles for other medicines ; but of little use themselves, unless they could be taken in larger quantities than the itomach can usually bear.---Primæ vix to be carefully cleared in the course of the fever, from accumulation of fæces, bile, or tough phlegm, by gentle laxatives often repeated--ute of antimonials after primæ viæ are cleared, to keep up a gentle diaphoresis, and dispose the fever to intermit, thus making way for the bark, which is the grand febrifuge--uncertainty of antimonial preparations and of their operations. Five grains of James's powder, found, on repeated trials, equal to cight or ten of the calx antimonii nitrata, of the Edinburgh pharmacopeia.-Bark, the proper remedy for carrying off the remains of the disease, and securing against relapse. -Quantity taken in 24

hours, of more consequence than the mode of giving it.Remarks on the use of antifceptics.

Section IX. Of Intermittents: Intermittents caused from marth-miasma-Description of the disease-Various times of intermiffion-Of 24 hours; quotidians Of 48, tertians. This protracted to a day more, constitutes a quartan ; to two days, a quintan; to three days, a sextan.- When these periods are varied so as not to come under such denominations, then the terms of double tertitians and quartans are introduced. These diftin&tions come rather too far, and not so neceffary to be attended to, as the periodical returns of the paroxysms, after the state of the fever has ceased for a time.-Marih-miasmata act as other conagions do, chiefly by being swallowed with the saliva, &c. cold fit, often accompanied with vomiting of bile, the accumulation of which appears the proximate cause of it.Absorption of phlegm and bile, much facilitated by free use of diluting liquors; hence the severity of the cold fit

gradually abates, and the hot fit commences. This great abforption occasions a plethora, which is sometimes the cause of delirium in the hot fit. An emetic, given two or three hours before the cold fit, often prevents its return. Froni this account of the causes, the periodical returns are easily accounted for.---Although an intermission takes place, yet the secretions in the primæ viæ being still morbid, will collect again, and in a certain time renew the paroxyfm.- The indications of cure in intermittents, are, 1. to evacuate the stomach and bowels of their contents. -2. To remove the præternatural irritability of the system.-3. To re&tify the morbid secretions.-4. To prevent relapfe, by strengthens ing the system.

Practical directions for administering the bark in the cure of intermittents,--seldom excred one drachm for a dose. If bark fails, this is generally owing to want of care in administering it. When the bark fails, the disease fometimes yields to antispasmodics, particularly camphire.

From this account of the principal observations both with respect to theory and practice, contained in this work, the medical reader cannot but form a proper idea of its utility.It is a performance indeed full of fagacity, nice observation, close argument, and accurate descriptions; and may therefore justly be considered as a valuable addition to the science of medicine.

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