of heat. Danger of fudden application of it. Application of thefe principles to difeafes-neceffity of regulating the heat of the body, according to the natural standard in the cure of fome difeafes. Il effects of too great a degree of heat or cold during the night, High living and violent exercife hurtful in warm countries-in cold ones a more liberal diet, an indulgence in ftrong liquors, and hard exercife, may not only be used with impunity, but appear even neceffary.

In the fourth fection, Dr. Gardiner treats of fevers in general.

General caufes of fevers reduced to five, ift, Excess of cold; 2d, Excefs of heat; 3d, Marfh-miafma; 4th, Human contagion; 5th, Specific contagion. Proximate caufe of fevers not known from our ignorance of the laws of the animal oeonomy. Division of fevers into fimple and complicated.-Nature and danger of marsh-miafma.-Marthy and fenny places not the fole fources of it.Human conta gion the most active caufe of fevers.In camps, arifes chiefly from the privies-attains its higheft violence in hoft pitals and jails-neglect of cleanliness gives rife to it in poor families. Diseases arifing from marsh-miasma, and human contagion nearly the fame-Sir John Pringle's Medical Annotations, a manufcript bequeathed to the Royal College of Phyficians at Edinburgh, quoted in fupport of this opinion.

Modes in which the matter of infection may enter the body-by the pores of the fkin-no fufficient evidence ;by refpiration-more plaufible--ftrong objections to it ;-by inoculation;-by being mixed with the faliva and swallowed,-this laft the most probable way of infection being conveyed into the body. Progrefs of infection by inoculation; and the reafons for its being milder ingeniously fuggefted, Effect of cold in diminishing the variolous fever-chewing tobacco and taking care not to fwallow the faliva, a preparative against infectious putrid cafes.-Upon this principle it is, that an emetic and a purge given at the beginning of putrid difeafes, often prevents the progrefs of them. Danger of large bleedings in the beginning of putrid complaints. -If the caufe of the disease act on the fyftem for three or four days, the emetic and laxative may mitigate the fymptoms, but will not remove the fever, which in this cafe will run its ordinary courfe. Further and more pofitive proofs of the infection of malignant fevers being chiefly taken in by the faliva, and affecting the primæ viæ firft. Obstructed perfpiration not

Section 5 Of a Catarrh.

the

the caufe of a catarrh :-Arifes from fympathy between the nerves of the fkin, and thofe of the internal membrane of the bronchi. Anodyne powers of warm bathing in leffening the præternatural irritability of the nervous fyftem. Salutary and pernicious effects of cold on the body. Caufes of difeafes act fome time on the fyftem before the fymptoms appear-inftance, the fymptomatic fever, after wounds and chirurgical operations, feldom 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 fome time, the glands of the ftomach partake of the disease from the fympathy of the lungs with the ftomach.-Hence the utility of emetics in coughs of fome ftanding. Effects of cold do not always fall on the mucous glands, and occafion a catarrh, but frequently fall on parts fubject to fome other difeafes. In this way they bring on fits of the gout, gravel, ftone, &c. The remains of a catarrh, leaving fmall obftructions in the fubftance of the lungs, may produce tubercles, and terminate in a phthiis pulmonalis. A perfon afflicted with a fevere catarrh, ending in a troublesome cough of long duration, becomes more liable to returns on catching cold.-Hence larger fecretions of phlegm from the lungs-increasing as age advances, bringing on hectical coughs, humoral afthmas, and the peripeumonia notha, which laft is ufually brought on by a catarrh. A fimple catarrh, properly managed, ends in fix or eight days.-Curative indications, to remove all tendency to 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 perfpiration-mild vegetable diet-diluting acid drinks -breathing the fteam of warm water-warm bathing-keeping the body open-bleeding ufeful, but with circumfpection-blifters 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 tumbler of water. The fecond and third indications answered also by the fame means, to which the Doctor adds, as having the greatest dependence on it, for leffening the general irrritabi lity of the fyftem, and moderating the mucous fecretions, fmall doses of opium, the fixth or eighth of a grain at a time, fo as to adminifter one grain, or one and a half in twenty four hours, made in form of lozenges, and fuffered to diffolve gradually in the mouth.

Section 6th, Of the Catarrhal Fever.

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

the

the immediate cause of fevers from increafing general irrita! bility. Cold and moift weather the remote caufe of the catarrhal fever-commences with the cold weather at the end of autumn, continues through winter, and becomes more frequent in fpring, efpecially when the weather is ex pofed to fudden changes. Acceffion of fever most difficult to explain. Morbid ftimulus of ftomach and bowels attended with increafed irritability of the fyftem: Symptoms ac counted for. Cold stage arifes from a diminution of the force of the heart, owing to the action of the febrile ftimulus on the prime viæ; as the febrile ftimulus abates, the heart and blood veffels gradually become stronger, there is a proportional increafe of it; hence the tranfition from the cold to the hot ftage. No exact regularity in critical days. Period of a fever may be fhortened or protracted by good or bad practice. Cold stage not effential to the difeafe. Exacerbation of the fever at night; and remiffion in the morning, fuppofed to arife from increafed irritability of the fyftem, 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 feized with fevere continued pain in any part of his body, a feverish paroxyfm is brought on, and the catarrh then puts on the form of a catarrhal fever of uncertain duration. When without a cough, fore throat, or other catarrhal fymptoms, then it is a continued fevergreat ufe of diluting liquors-cool fresh air, cold drink; light bed-clothes to moderate the heat-ufe of bleedingbliftering, next to bleeding, the best way to remove topical inflammation-ufe of antimonials, not to be continued too long-Peruvian bark, cordials, ftimulating remedies-antifpafmodics, and wine to be given in a more advanced ftage. The materies morbi collected during the courfe of the fever, by the daily increase of the putrefcency and acrimony of our fluids.

Section 7th, Of the Cholera.

Heat the remote caufe. An autumnal difeafe chiefly.Effects of heat in producing a cholera most obfervable in warm climates. Bile too acrimonious in this disease to admit of being evacuated by ftimulating remedies--mild; emollient drinks given in large quantities are the only means we fhould ufe for this purpose. Symptoms fometimes fo fevere as to require opium in the first instance; which otherwife thould not be given till the ftomach and bowels are cleared-ufe of bitters among which the columbo toot is thought moft fuccefsful; 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 fymptoms than any other febrile difeafe, to which mankind is fubject. In fenny, fwampy grounds often fatal in forty-eight hours-moft prevalent in moift and hot feafons and climates. In encampments, affumes the form of quotidians, quartans, diarrhoeas, and diffenterics-though fo various, yet the fame difeafe; the fymptoms coming on alternately, one ftopping when the other makes its appearance.-Value of Sir John Pringle's Annotations, much increafed by Dr. Huck's (Saunders) Correfpondence. Similarity between this and the yellow fever of the Weft-Indies. Appears in the fame form in all parts of the world; hence probably arifes from the fame caufe.-Moft fimple ftate of bilious fever, is that in which the bile is only accumulated from excefs of heat. When this caufe is combined with human contagion, the fever ufually continues, when with marfh-miafma, inclined to remit and intermit. The fimple bilious fever more inflammatory, than when combined with the other caufes. Inflammatory ftate of fever does not continue above three or four days; the remiffions 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 fpecies.-In the former, bleeding fometimes indifpenfably neceffary; in the latter, often fatal.-Emetics and laxatives in the beginning.. -Violent evacuations, if the difcafe ftill goes on, hurtful.

A vomit not to be exhibited after the fourth or fifth day.-Saline draughts good vehicles for other medicines; but of little use themfelves, unlefs they could be taken in larger quantities than the ftomach can ufually bear.-Primæ viæ to be carefully cleared in the courfe of the fever, from accumulation of faces, bile, or tough phlegm, by gentle laxatives often repeated-ufe of antimonials after primæ viæ are cleared, to keep up a gentle diaphorefis, and difpofe 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 eight or ten of the calx antimonii nitrata, of the Edinburgh pharmacopeia.-Bark, the proper remedy for carrying off the remains of the difeafe, and fecuring against relapfe.Quantity taken in 24

A

hours

hours, of more confequence than the mode of giving it.→ Remarks on the ufe of antifceptics.

Section IX. Of Intermittents.

Intermittents caufed from marsh-miafma-Defcription of the difeafe-Various times of intermiffion-Of 24 hours; quotidians-Of 48, tertians. This protracted to a day more, conftitutes a quartan; to two days, a quintan; to three days, a fextan.-When thefe periods are varied fo as not to come under fuch denominations, then the terms of double tertitians and quartans are introduced.-These distinctions come rather too far, and not fo neceffary to be attended to, as the periodical returns of the paroxyfms, after the ftate of the fever has ceased for a time.-Marsh-miafmata act as other conagions do, chiefly by being fwallowed with the faliva, &c. cold fit, often accompanied with vomiting of bile, the accumulation of which appears the proximate cause of it.Abforption of phlegm and bile, much facilitated by free use of diluting liquors; hence the feverity of the cold fit gradually abates, and the hot fit commences.-This great abforption occafions a plethora, which is fometimes the cause of delirium in the hot fit. An emetic, given two or three hours before the cold fit, often prevents its return. From this account of the causes, the periodical returns are easily accounted for.-Although an intermiffion takes place, yet the fecretions in the primæ viæ being ftill morbid, will collect again, and in a certain time renew the paroxyfm.—The indications of cure in intermittents, are, 1. to evacuate the ftomach and bowels of their contents.-2. To remove the præternatural irritability of the system.-3. To rectify the morbid fecretions.-4. To prevent relapfe, by ftrengthen ing the system.

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

From this account of the principal observations both with refpect 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, clofe argument, and accurate descriptions; and may therefore juftly be confidered as a valuable addition to the fcience of medicine.

ART. VI.