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In the conclusions at which Dr. Caldwell arrives, in regard to the doctrine of unity of disease, and in regard to the importance of a sys'ematic arrangement of diseases, we fully accord with him; but we would not be understood as assenting to all the opinions expressed in his preliminary discourse. In the preference which he gives to Cullen's system of nosology over any other extant, he will, no doubt, be supported by the majority of voices; but, for ourselves, we cannot be so decided in preferring Cullen to Sauvages, not to bring into view the systems of any later writers. We shall fully agree, however, with Dr. Caldwell, in lamenting the imperfection of all the systems of nosology, and we think it would not be difficult to point out certain radioal defects in them all. That they all have important defects, Dr. Caldwell is perfectly aware: in Cullen's system he states, that its faults are numerous, and several of them conspicuous;" and he closes his discourse with a brief consideration of some of the most important of them." On the criticisms which he makes, a few remarks must be offered on our parts.

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First, he objects to Cullen's definition of fever, on account of its concluding clause, sine morbo locali primario.* It was Dr. Cullen's object, by these words, to point out a distinction, long recognised by good observers, between the disease he was defining, called fever, or idiopathic fever, and those diseases included by Cullen in the same class under his order Phlegmasiæ. In the phlegmasia, when pure, there is first a local affection, viz. an inflammation, and then the system is affected by sympathy. The affection of the system in these cases has not one uniform character; sometimes it is marked by an affection of the sanguiferous system most especially, sometimes by an affection of the chylopoietic system, sometimes by an affection of the brain, and nervous system, &c. Similar varieties appear in the idiopathic fever (if the term may be employed), but without our being able to trace them to any peculiar causes. Now Dr. Caldwell contends, that, in the cases where we fail to discover any local disease, such a one must, nevertheless, exist; and he endeavours to prove it by showing, 1st, That it is possible for an adequate local cause to exist without exciting any sensation, and, therefore, if in an internal part, without being recognised. 2d. That "all febrile affections which we are capable of clearly tracing to their commencement, most certainly originate in a topical affection." 3d. That

The definition is, Prægressis languore, lassitudine, et aliis debilitatis signis, pyrexia, sine morbo lecali primario.

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the remote causes of fever cannot "gain access to the whole system at once; they must, therefore, attack locally, and afterwards extend their ravages on sympathetic principles."

It is probable our author would not believe that much was gained, should the two first arguments be admitted in alltheir force, unless the third was also admitted to be valid and to bear upon his point. It will suffice, then, to examine this third. Nor is it to be granted, at first, that all foreign causes, acting on the system, operate on parts and not on the whole. The parts primarily exposed to their action are the organs of sense, the skin, and the mucous membrane of the various passages having external outlets.* According to the doctrine in question, there must be some local affec tion on some of these parts in every case of fever, and the fever arises from sympathy of the whole system with this part.

We think that Dr. Caldwell will agree, that we have represented him fairly in the foregoing statement. But, if the ar gument be pursued, it seems to prove too much. For is any one disposed to deny that the affection of the system in pleurisy in peritonitis, &c. arises in these cases respectively from inflammation of the pleura, of the peritoneum, &c. But these are not the parts, on which the remote causes could have originally acted according to Dr. C.'s opinion; they are not the primary diseases; and, in accordance with the principles which he repeatedly advances, they must arise from sympathy, in consequence of disease in the skin, mucous membrane, &c. Turning, however, to those pages in the book before us, in which these opinions should have been expressed, we do not find them. The inference is, that the editor had not arrived at such conclusions.

The truth is, that the parts first acted upon, or first touched by external causes of disease, must be those before enumerated. But, causes applied to these parts produce disease in other and distant parts, without occasioning any evident disease in the parts first acted upon or touched; or if any thing, which can be called disease, be produced in these parts primarily, this disease is transient, and the continuance of the secondary affection is not dependent upon it. Thus, a temporary interruption of the cutaneous excretion may casion an inflammation in the pleura. Four days afterwards, you may restore the excretion in any degree you please, the inflammation will continue in the pleura. So a temporary

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* It is not necessary, for the purposes of the present discussion, to remark, that, in cases of solution of continuity, different surfaces are exposed to the action of external causes. Nor need we embarrass the question, by bringing into view the influence of the passions as causes of disease.

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interruption of the catamenia, or of the lochia, will occasion inflammation in the peritonenm, or in some other part; but the restoration of the uterine discharge will not remove the disease. The disease is produced uno ictu; and, being produced, it goes through its stages without reference to its cause. At least, after the disease is once fairly established, this is the case.

Now we conceive, that on the same principles may be explained the occurrence of what has been called idiopathic fever; and, that when it is said, that this occurs without a primary local disease, it is not meant to deny, that some unusual impression has been made on some point in the body. Such an unusual impression may, philosophically considered, constitute a disease; but nothing is considered a disease in the common view of the subject, of which we have not some palpable evidence. In this case, it is meant to deny, that there exists any local disease, on which the affection of the system depends for its maintenance or continuance. It is meant to

deny, that the affection of the system stands on the same ground, as that which follows common inflammation, and which may be removed by removing the inflammation. It is true, that idiopathic fever is sometimes removed at an early period, by applications made to the stomach, and sometimes. by applications made to the skin. But this does not prove, that the disease depends, in these cases, on the local affections of the stomach or skin.

Believing as we do, that idiopathic fever, (febris of Cullen,) is an affection of the whole system sui generis, altogether distinct in its nature from the sympathetic affections produced by inflammation, we could not pass unnoticed the attempt from so respectable a quarter, to confound these different affections. But, to expose the whole ground of argument on these topics would lead us too far.

There is another subject, which is taken up in the preli minary discourse, and to which the editor frequently refers in his notes, in which we do not perfectly accord with him. This is the subject of contagion. In condemning the loose and indistinct views, which have too often been entertained by others, he, perhaps, goes to the opposite extreme, and limits too much the evidence to be admitted in proof of contagion. The small-pox may be communicated through the atmosphere by effluvia, and, likewise, by bringing the fluid or dried virus, produced on one subject, into contact with the naked fibre of another. In examining this virus, it is not found to have any sensible or chemical properties, by which it can be distinguished from matter produced in the human 'subject under some other circumstances. The property of reproducing, in a fresh subject, the same disease by which it

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has been formed in another, is learnt only by experience. There are several other circumstances learned by observation and experience, in regard to this disease. 1. When a person has once undergone the disease, he is incapable of undergoing it again. There are, however, some rare exceptions to this; and certain local effects may be repeatedly produced by the virus on the same subject. 2. This disease may be produced by an exceedingly small quantity of the virus, as perfectly as by a large quantity. 3. This disease may be made to occur at all seasons and in all climates. Under this head, however, it is to be remembered, that, in places, where it always exists, it is in certain years and seasons vastly more prevaJent, than in other years and seasons. Alas, it is very different in its degree of severity at different periods. 4. It oc curs at a certain fixed period, that is, about fourteen days after exposure, when produced by effluvia. After inoculation, it also affects the system at a certain period; but this is shorter than when it is communicated by effluvia. Neither of these periods is of precisely the same length in all cases, varying from two to four days, without any obvious cause. In consequence of the intervention of other diseases, they may be protracted much longer. 5. We do not know the origin of this disease; but we have reason to believe, that it has not, for several ages, been produced in any other way than by contagion.

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3 We know then, that small-pox is contagious; and we know, that the laws, just enumerated, exist in respect to this disease. But we do not know, that these laws are necessarily connected with its power of re-producing itself by contagion. We are not, therefore, to deny the property of contagion to any other disease, because the same laws are not found to exist in respect to such disease. If it was certain, -that in regard to the mode of communication, or in regard to all or any of the laws enumerated, all other contagious diseases must resemble small-pox, the difficulty of deciding whether a disease is contagious would be very much dimi'nished." 100

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It certainly is possible, that a disease originating on this day, for the first time, may be contagious. It certainly is possible, that diseases frequently originating de novo, and in various places, may be contagious. It certainly is possible, that a disease may be contagious only among persons, who have been predisposed to it by some atmospheric influence. It is true, that a good deal of circumstantial evidence is necessary to satisfy us of the contagious character of diseases of the descriptions now given. But the possibility of their having such a character cannot be denied. On the other ...NO.222.11

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hand, in proportion as a disease is subject to the laws enumerated as applying to small-pox, we are more ready to admit evidence in favour of its being contagious

What, then, shall be admitted as conclusive evidence of the contagious power of a disease?. We know not that one kind of evidence alone is to be admitted. Inoculation makes the evidence demonstrative; but we must not refuse to be satisfied by any evidence short of this.. If an unusual disease should prevail among us, and it should be made clear, that the first person affected with the same disease had recently arrived from some other district, in which that disease had been prevalent before his departure, there would arise á strong suspicion, that this disease was contagious. Should it appear only among those, who had been, in some way, exposed to the sick, this suspicion would become more strong. Should now a considerable portion of the healthy inhabitants be removed to a neighbouring place, and should all intercourse between them and the other inhabitants be prevented, and should those who had thus removed escape from the disease, while it continued to prevail among the others, the evidence would be nearly irresistible. It is true, that even here it would be possible for us to be misled. The evidence would not be so strong as that arising from inoculation. Yet it would be such as rightfully to influence our conduct. We should in such a case take the same precautions as if we were perfectly sure of the contagious power of the disease.*

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To this subject, the evidence of contagion, there are repeated references in the notes to the work before us, as well

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*Note of the English Editor. There appears to us some falacy, if not danger, in the positions contained in the above paragraph, be-cause the converse of the proposition, as well as the proposition itself, is liable to objection. 1st, Should the disease appear only - among those who have had intercourse with diseased subjects, it will be necessary to inquire, whether they have not had intercourse with those who arrived from the place in which he disease originated; and, if so, the apparel may convey the morbific, effluvia; and, if none in this second district were infected, but those who had approached the strangers, then we should not call the disease contagious, but by some other description, as long as we consider the small-pox contagious. It has been urged, that there may be various kinds and degrees of contagion. As to the first, we have only to answer, that two kinds of any thing should either have two names, or at least some term to distinguish them. As to the degrees, we well know that they in the small-pox at different times. If, therefore, the mode vary of communicating a disease is similar in other respects, the degree is of less importance, because the mode of prevention must be similar,

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