ding to this mode of reasoning, medicine is a perfect chaos. In what does disease consist? "In some unknown deviation from the natural and healthy mode of acting."- How is this "unknown deviation" to be removed? "By remedies of either the stimulating or debilitating classes." In short, we know nothing about the matter; and therefore one remedy may be just as good as another.

"The advantages to the medical practitioner," however, "of a just theory of diseases, will scarcely be denied. Experience, undoubtedly, is a sure and safe guide, as far as it goes; but it is too often lame and defective. It is impossible to foresee and provide adequately for the infinite diversity of changes that take place in living bodies, without the aid of analogy and induction: the practice of physic without these must ever be incompetent to meet the continually-varying circumstances of disease." P. ix.

Impressed with these principles, we shall endeavour to apply them in what we have further to offer on this subject.

"Inflammation occurs as readily, generally speaking, in weak as in strong habits: there appears even reason to believe that the former are in some respects more disposed to it than the robust and vigorous. It seems to be a general law of the animal economy, that, in proportion as the powers of the body are diminished, the excitability with regard to impressions, and consequently the disposition to be thrown into irregular action, are increased. Hence weakness, though never of itself a disease, may predispose to it. But the diseases which arise under such circumstances are characterised by less activity, and go on more slowly to disorganisation; and they commonly also require a less active mode of cure.

"When inflammation arises in debilitated habits, it is often not only not curable by general blood-letting and other evacuations, if employed to any considerable extent, but may be even rendered thereby more difficult of removal; and that, probably, for the reason above stated; namely, that weakening the system increases the disposition to irregular action, or predisposes to disease. The rule, however, is by no means constant, that blood-letting is improper as a remedy for inflammation in debilitated habits. On many of these occasions, it is found to be scarcely less effectual than in a state of vigour. To determine in different cases when it may be proper, or otherwise, is a very difficult task, and requires much judgment and. experience on the part of the practitioner. From my own observation, I am inclined to believe, that, when properly adjusted to the actual strength of the system- -a point of the first magnitude, but which has been too much overlooked there are few cases of inflammation that are not capable of being relieved by it, and that it may form a valuable auxiliary to other means, even to those of a tonic and stimulant nature." P. 235.

"This," Dr. Clutterbuck is aware, "is in opposition to received opinions, and will be supposed to involve an incon

sistency" an inconsistency, in our opinion, not to be easily obviated, unless indeed it could be shown that bloodletting is adapted to remove that "unknown deviation from the natural and healthy mode of acting" of which our author speaks. He is "inclined to believe" it, however, from his "own observation;" and on the same ground to believe that "there are few cases of inflammation not capable of being relieved by" blood-letting-i. e. "when properly adjusted to the actual strength of the system." But we are aware of the value of medical facts and observations-we also know something of the nature of medical evidence — and our author knows that "experience is too often lame and defective."

Dr. Clutterbuck's reasoning, however, chiefly hinges on theory, and here we shall follow him.

From the passage which we have just adverted to, we learn that the benefits of blood-letting are only to be expected when it is "properly adjusted to the actual strength of the system." The question of blood-letting then does not involve the "topical inflammation of the brain or its membranes," abstractedly considered; nor the "unknown deviation from the natural and healthy mode of acting,' which Dr. Clutterbuck considers as the true morbid state. It only regards the actual strength or weakness of the system, which, according to our author, is "never of itself a disease," but only predisposes to it.

Now, "inflammation occurs as readily, generally speaking, in weak as in strong habits; there appears even reason to believe that the former are in some respects more disposed to it than the robust and vigorous." Nay, "it seems to be a general law of the animal economy, that, in proportion as the powers of the body are diminished, the excitability with regard to impressions, and consequently the disposition to be thrown into irregular action, are increased." Bleed your patient, then, under the state of predisposition, and increase his susceptibility "to be thrown into irregular action". the true morbid state. But are not to bleed him under the "weakness. " of you predisposition, but after he is "thrown into irregular action," into the real state of disease. "When inflammation arises in debilitated habits," however, "it is often not only not curable by general blood-letting and other evacuations, if employed to an considerable extent, but may be even rendered thereby more difficult of removal, and that probably for the reason above stated; namely, that

weakening the system increases the disposition to irregular action, or predisposes to disease." Again, "I believe that blood is often drawn in too large quantity from the sick, without sufficient attention being paid to their state of weakness at the time. I have observed a manifest reduction of the strength, and a feeling of weakness continuing for several days, induced by the loss of not more than from two to three ounces.” Now the question is-if weakness disposes to "irregular action," or the actual state of disease, will weakening the system still further enable it to throw off these "irregular actions?" This we cannot believe.

Dr. Clutterbuck indeed speaks of blood-letting "in debilitated habits," under fever, with caution; and even admits, that in such habits "it may be rendered thereby more difficult of removal." But what is the difference between the strong and the weak man in fever? If the strongest man be under fever, he is no longer strong. He has suffered the action of certain debilitating powers, and he has all the symptoms of debility. His body is deranged or debilitated, and displays "irregular action," or some unknown deviation from the natural and healthy mode of acting." But we call it derangement, or debility, because we understand as much by these terms, as by "irregular action," or "some unknown deviation," &c.

Reasoning in this manner, we think of the cure, or of promoting a favourable termination of the disease. We avoid all irritating, deranging, or debilitating powers, because they might operate in a somewhat similar manner to those which caused the disease, and we employ those of seemingly opposite tendencies. We excite the system to throw off its "irregular" or morbid action, and we avail ourselves of any thing like true experience. In all our measures we proceed with caution and circumspection; because we know that, on many occasions, the system has a power of repairing its injuries" that fever has a strong disposition to terminate spontaneously "—and that "it is a disease the essence of which is not understood.”

This is our theory with regard to fever; and the general practice we deduce from it. From experience we have little assistance.

"Every age, and almost every practitioner indeed, possessed of sufficient courage to think and act for himself, has had his favourite remedies, which have been relied upon as if they were exclusively adapted to the purpose." P. ix,

The whole Materia Medica has been ransacked; yet who can say that there is any thing like a certain remedy for fever?

Blood-letting has had a long and an extensive trial. "There is to be observed, in the practice of all ages, a strong propensity to employ blood-letting in the cure of fevers." In the present day, however, that "propensity" is much diminished. This, Dr. Clutterbuck thinks, is chiefly owing to the influence of hypothesis. "That it has gone so much into disuse in modern times," says he, "is perhaps more to be ascribed to the influence of hypothesis and speculation than to any direct experience of its ill effects." If it be as advantageous, however, in the cure of fever as Dr. Clutterbuck would have us believe, we can only say, that in setting it so much aside the moderns have acted injudiciously. Yet still there must have been some reason why they went a-hunting after new inventions.

The next remedy which our author proposes for fever is vomiting.

"No fact in medicine is better ascertained" (says he) “than the power of EMETICS in the cure of fevers of every description. Like blood-letting, their efficacy depends much on the earliness of their administration. When given at the very commencement of the symptoms, and before the disease is so fully formed as to have acquired the force of habit, they often put a sudden and entire stop to its progress; and where they fail of producing this effect, they seem to check the violence of the disease, and mitigate its future symptoms." P. 294.

If "no fact in medicine” be “better ascertained than the power of EMETICs in the cure of fevers of every description," medical facts stand on a very flimsy basis. We have had occasion to see them much employed, and have often employed them ourselves, even "at the very commencement of the symptoms" of what is called typhus fever; and we have never seen an instance where they "put a sudden and entire stop to its progress; nor did they "seem to check the violence of the disease, and mitigate its future symptoms." On the contrary, in many cases they evidently increased that violence; and in two instances the energies of the patients sunk immediately after their operation, never to rise again.

The salutary effects which Dr. Clutterbuck ascribes to emetics in fever, he thus explains:

"This effect of emetics is probably in a great measure derived

from their determining powerfully to the surface of the body, and relieving proportionally the internal organs from the force of the circulation."

P. 295.

But while they "determine powerfully to the surface of the body," do they not determine as powerfully to the head? Let our author answer this.

"From theory, the use of emetics in fever might be deemed improper, and even dangerous, from their known tendency to determine the blood with greater violence towards the head; and, in fact, they have been often objected to on this account. No doubt, some caution is necessary in their administration; and experience seems to have ascertained, that they are rendered not only more safe, but more effectual likewise, by previous loss of blood. But experience has also shown, that they may be safely employed, in a great majority of cases, without such a precaution. Where the action of the heart and arteries is already violent, full vomiting certainly cannot be employed without some degree of hazard; and it has sometimes proved fatal in such cases, by occasioning a rupture of vessels in the brain or other vital organ." P. 295.

Thus, in order to render emetics safe, or to diminish their injurious consequences, we must premise blood-letting; i. e. "where the action of the heart and arteries is already violent." We are afraid, however, that our author mistakes accelerated for violent action. And is this all that can be said in favour of emetics?

"In order to account for the efficacy of emetics in the cure of fever, it is only necessary to advert to the intimate relation that subsists between the brain and stomach, and the influence exerted by each over the other, reciprocally. Let the brain be injured by a shock, or by compression, and the injury is immediately pointed out by nausea and vomiting, almost as clearly as by the distur bance of its own peculiar functions. On the other hand, a state of nausea, any how induced, depresses at once the energy of the • brain, and with it that of the whole vascular system. This is evident in the paleness, coldness, and general feeling of debility, that announce the approach of vomiting, and which sufficiently explain its beneficial influence on inflammation in general, but especially when this disease arises in the brain itself." P. 298.

Now this is just the very objection that we have to nausea," that it "depresses at once the energy of the brain, and with it that of the whole vascular system;" for the energy of the brain is already deeply depressed. It is this which constitutes the very essence of fever. Raise the febrile patient from the horizontal to the erect posture, and the same "paleness, coldness, and general feeling of debi