"It is not my intention" (says he), " in mentioning this prac tice, to recommend its indiscriminate adoption, more than that of blood-letting, or any other of the means pointed out above. It is sufficient for my purpose to have shown that fevers have frequently been thus treated with success." P. 335.

Aware, however, that this fact might seem to militate against his doctrine, he attempts the following modifying clause:

"This fact may, at first view, seem adverse to the doctrine of fever being founded in inflammation; since it might be difficult to conceive, that an active topical affection should admit of relief from such treatment. We have, however, the analogy of many other in flammations in its support. In certain stages of pulmonic inflammation, when the violence of arterial action has been reduced by previous evacuations; and in habits of body that appear unfavourable for loss of blood; both the volatile alkali and the seneka (a highly acrid root) have been employed with equal freedom and success; as have likewise a variety of other stimulating substances. The use of the most active remedies of this class in membranous inflammation, as in acute rheumatism, is too well known to need dwelling on.” P. 336.

Still he thinks "it hardly necessary to observe, that it is in the latter stages of fever that stimulants are chiefly indicated."

The cinchona is the next remedy which Dr. Clutterbuck treats of in the treatment of fever.

There is no medicine, perhaps, concerning which so many opposite opinions have been entertained as the bark. "Even in our own times," as our author observes, "practitioners have been found to differ very much in their estimate of the Peruvian bark as a remedy for fever." His sentiments on the subject are in unison with his doctrine.

"In inflammation of an active kind, occurring in vigorous habits, and in the early stage of it, experience seems sufficiently to have proved that bark is an improper remedy. But when the disease arises in debilitated constitutions, or has gone on for some time without altering the structure of the part; and when evacuations. have been made proportioned to the activity of the disease and the vigour of the system, bark is found to be really an useful applica

tion.

"In erysipelatous inflammation, occurring in large towns and in persons of no great strength, the Peruvian bark is found to be more successful than an evacuant plan of cure. And it is probable that some fevers partake of the nature of erysipelas, since they often mutually give rise to one another, by what is called metastasis. If bark can be used with impunity, and even with advantage, in such a state of the system as occurs in acute rheumatism, as we learn

from the writings of Morton, Fothergill, and Haygarth, and as experience has very satisfactorily confirmed, there seems little reason to be apprehensive of it in idiopathic fever, with ordinary precautions." P. 345.

We come now to the effects of sensorial stimuli in fever. These stimuli have been termed narcotics, hypnotics, or anodynes. Dr. Clutterbuck, however, objects to these appellations.

"These substances" (he says), "considered as a class, are by no means properly designated by the terms narcotic or anodyne; since some of them neither induce sleep or stupor, nor have any direct tendency to relieve pain. This is the case especially with one of the most powerful of them, the lauro-cerasus. The only circumstance in which they seem to accord, is in their effect on the functions of the brain, which they all primarily disturb, in greater or less degree; affecting the rest of the system in a secondary way only. This, in my opinion, forms a proper basis for denominating them; and I have ventured accordingly to class them under the common name of sensorial stimuli, or medicines that operate specifically on the brain or common sensory.” P. 348.

The sensorial stimuli which our author speaks of in the treatment of fever are opium, wine and alcohol, camphor, lauro-cerasus, digitalis, nicotiana, and mental emotions. Let us see what he says with regard to opium.

"Opium is unquestionably a stimulant with regard to the brain, and increases its vascular action. This being granted, we can pretty well understand the circumstances in which it is likely to be beneficial, or the reverse, in fever.

"The first stage of the disease is commonly a state of active inflammation. The vessels are at this time acting with considerable violence: hence the throbbing of the arteries, the distensile pain and increased heat of the head, the want of sleep, the flushing of the face, and the suffusion of the eyes. In this stage of fever, as in other inflammations, experience has shown opium to be uniformly hurtful: But after the first violence of action has subsided, and the disease has been protracted to a certain period, the same experience proves that stimulating remedies can be employed with safety and advantage; and in this stage it is that opium is found useful, both in fever and other inflammations.

"It is not improbable, however, that in certain cases of fever, particularly in previously debilitated habits, the inflammation is from the beginning of so inactive a kind, as to admit of the early use of stimulating remedies; which will account for the success that many practitioners have experienced in the low state of fever, from a tonic and stimulant plan of cure." p. 355.

That opium "is unquestionably a stimulant with regard to the brain, and increases its vascular action," is ad

mitted; but that "the first stage of the disease is commonly a state of active inflammation," or a state of "violence of action," is quite another question. It is said, however, that "the vessels are at this time acting with considerable violence; hence the throbbing of the arteries, the distensile pain, and increased heat of the head; the want of sleep, the flushing of the face, and the suffusion of the eyes." But is not the picture here a little too highly coloured? Let us compare it with the description which Dr. Fordyce has given of the first stage of fever, which Dr. Clutterbuck has "borrowed on account of its conciseness," and because "it coincides with the history of the disease as handed down to us by the best writers of all ages, and is confirmed by daily observation."

thus:

It runs

"(a) Languor, weariness, weakness; insensibility of the extre 'mities, blindness and insensibility in the organs of sensation, cold and trembling, pain in the back.

(b) Horripilatio; the skin pale, dry, and of a dusky colour; a dry, foul tongue, and thirst; transparent urine; costiveness, and suppression of other secretions; paleness and dryness of ulcers; a 'small obstructed pulse, sometimes intermitting; pain in the limbs, 'joints, and forehead; delirium.

(c) Anxiety; oppression and swelling about the præcordia; frequency of the pulse; quick and laborious respiration, sometimes with a cough; rigour, and horror; thirst, flatulency, loss of appe'tite, nausea, and vomiting." " P. 38.

Now, in all this, where is "the throbbing of the arteries, the distensile pain and increased heat of the head, the want of sleep, the flushing of the face, the suffusion of the eyes, and the violence of action?" On the contrary, there is nothing but impaired function and enfeebled action. And how can it be otherwise? There is no cause of violent action. Some of the causes of fever, indeed, may excite violent action in the first instance-during the period of their operation. But how can this violent action continue after they have ceased to operate? "According to a general law of the system," their operation "soon ends in fatigue, and collapse"-in impaired and deranged action.

Where, then, is the objection to opium, even in the first stage of fever? For what happens in the second stage?

"Rigour and horror: heat rising from the præcordia, and 'diffused over the body irregularly, unequally, and with flushing; a strong, full, obstructed pulse, or a very frequent small one; pain in the head and joints; stupor and delirium; universal soreness; redness arising in different parts irregularly; the urine high coNo. 129. Vol. 32. Mar. 1809.

loured, but transparent; sweating in the head and breast, or over "the whole body; partial secretions.

"At last the pulse becomes free; all the secretory organs are relaxed: hence the skin grows soft and moist, and returns to its 'natural colour; the tongue likewise is soft and moist, the belly is open, and the urine in greater quantity; if transparent when discharged, after a little time it becomes turbid and opaque; the se'cretions are often greatly increased; there arises a copious and 'universal sweat, or a purging, or great flow of urine.

"The frequency of the pulse, and all the other symptoms of the first and second stage gradually subsiding, the patient recovers 'his health; or there arises an inflammation or hæmorrhage ' in some part of the body, the symptom of the first stage suddenly disappearing, or being greatly diminished." " P. 40.

These are the workings of Nature. The actions of the system gradually rise-the sweat and other excretions begin to flow-and, as Cullen expresses it, "as this sweat continues to flow, the heat of the body abates; the sweat, after continuing some time, gradually ceases; the body returns to its usual temperature; and most of the functions are restored to their ordinary state." Why not therefore imitate or assist these operations by art? Why not give opium to excite the system to throw off its morbid actions? It may indeed be said that Nature does her own work best. Still this argues nothing against the point at issue. Nature takes no account of violent action or inflammation when she rouses the actions of the system to throw off a febrile paroxysm. In short we may conclude, not only from the probable effects of the exciting causes of fever, but also from the phenomena of the first stage, as well as from what happens in the second, that there is neither action nor inflammation to forbid the use of opium or any other appropriate stimulus. Nay, if there be any thing in the following observations of our author, we may even conclude that the early exhibition of a powerful stimulus may at once terminate the disease.

"If fever is to be cured speedily, and not suffered to run its course, it can only be done by means which produce a powerful impression on the general system. And it seems, in some measure, indifferent of what nature the impression is, provided it be sufficiently powerful. Some strong counter-movement must be made, such as tends to alter all the circumstances of the habit; and it may take place, either through the mind or through the body. It is, however, indispensable to success, that the attempt be made very early in the disease: at a later period, it may at once fail, and prove nurious." P. 437.

•We are next" (says Dr. Clutterbuck) "to consider one of the

most powerful, but at the same time, perhaps, the least understood, of the agents employed in the cure of fever. Although it be true, in a physical sense, that cold is merely a negative term, implying only a privation or diminution of heat, it cannot be received in this light as applied to the living body, but must be considered as a positive agent, having, like other agents, a power of changing. materially the condition and actions of the system. Its effects are by no means a lower degree of those which that produces, but of a totally different kind." P. 374.

If cold, however, "is merely a negative term implying only a privation or diminution of heat"-if in fact it has no positive existence, how can it be said to produce effects? But Dr. Clutterbuck views it in the light of a positive agent as applied to the living body, and considers its effects first in the healthful state, both as regards the part to which it is immediately applied, and the general system; then its effects as a remedy for inflammation; and lastly, its influence on the course of fever.

The last remedy which Dr. Clutterbuck notices for the cure of fever is MERCURY" a medicine," he says, "whose Herculean powers have made it to be resorted to in many desperate cases of disease, as a forlorn hope, and without any particular indication."

After having cited the authority of several writers in support of its utility in fever and inflammation, but especially in the fevers of tropical climates, he proceeds to speak of its mode of operating.

"Thus there appears to be very satisfactory evidence of the utility of mercury in fevers of various descriptions, as well as in other inflammations. Its mode of acting, however, is not so clearly ascertained. It seems to be not altogether agreed, whether mercury is to be looked upon as an evacuant merely in fever, or as operating specifically, by its well known faculty of superseding various diseased actions in the system. In many of the instances of its employment above recited, we find it not only producing copious evacuations by stool or vomit, but purposely combined with emetics and cathartics of the most active kind. This, however, is no argument against its specific operation; for calomel frequently induces salivation, at the time that its purgative effects are most conspicuous; as I know by repeated observation.

It is, however, I think most probable upon the whole, that mercury, when freely and repeatedly administered, operates wtih advantage in the cure of fever, both as an evacuant, and by its specific powers. We see that, on some occasions, it exerted little or no evacuant effect; and the sublimate, which is not remarkable for its purgative properties, was found to be attended with the same advantage as calomel." P. 404, 5.