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· 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; 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.' ».
These are the workings of Nature. The actions of the system gradually rise-the sweat and other excrctions 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 isque. 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 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
P. 437. .: We are next” (says Dr. Clutterbuck) « to consider one of the
most powerful, but at the same time, perhaps, the least understood,
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 ? Bút 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 inathe 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 educuant 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 enetics 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 saine advantage as
calomel." P. 404, 5.
In the midst of this discussion and uncertainty concerning the action of mercury, our author is not forgetful of his favourite hypothesis.
“ Mercury certainly exerts peculiar effects on the brain; and it is probably through the influence of the brain, thus irritated, that the general febrile state is produced which is so coinmonly observed under the free use of mercury, and not by the immediate application of the medicine to the heart and general vascular system. Dr. Adams, remarking on its use in the cure of syphilis, says, the · fever it produces may be truly called specific, from its uniformity " and total difference from all others."
" Moderately used, mercury often relieves headach depending on local increased vascular action; and it is considered as specifc in the cure of that variety of inflammation of the brain or its membranes, which is improperly called hydrocephalus. It has often, also, removed gutta sereni, epilepsy, and other sensorial affections. Employed so as to excite salivation, it has frequently contributed to the cure of obstinate intermittents, by rendering them obedient to the Peruvian bark, which they had before resisted ; and it supersedes various other diseases that are kept up by an acquired habit.” P. 406.
Let it be observed, however, that “when mercury is carried to excess, it produces head-ach, general debility, incapacity for mental exertion, and finally mania;” and that, “as happens with regard to most others, we have yet much to learn of the circumstances which should in all cases govern its administration."
Having discussed the various remedies which he recommends in the treatment of fever, our author proceeds to consider its natural cure or spontaneous termination.
“After all that has been said” (says he) “respecting the cure of fever by the different methods pointed out above, it is not to be overlooked, that feier has a strong disposition to terminate spontaneously after going through certain stages; and hence that the effects of remedies are liable, on many occasions, to be falsely estimated. This tendency is so remarkable, that many physicians have chosen 10 rely on it for a cure, and have dissuaded from all artificial means of bringing the disease to a crisis, preferring to leave the business altogether lo nature. Othery, again, deny the power of medicines to cut short the progress of fever, and think that physicians deceive themselves, by ascribing effects to causes that bave in reality little or no iufluence on their productions." P. 408. We quote this
passage as a proper comment on our author's reasoning in the treatment of fever. He has endeayoured to establish his doctrine on both theoretical and practical grounds. The evidence of experience has been
industriously gathered in. But let it be remembered, " that the effects of remedies are liable on many occasions to be falsely estimated;" and that, as an able writer observes, - the evidence that is requisite to prove or disprove any proposition in the science of medicine is of a peculiar kind. It differs entirely from that species of proof which satisfies a court of law. Both direct and circumstantial evidence, which would leave no doubt in the breasts of judges and juries, have often not the slightest tendency to render a medical fact even probable. The declarations, and even the oaths, of the most conscientious, disinterested, and able men, are all insufficient."
Our author's object has been to establish the two following propositions:~" l'irst, that fever is not originally a disease of the whole system, as is cominonly thought, but a topicul affection of the brain. Secondly, that this affection consists in inflammation; the general disorder observed in the system, or what is called the febrile state, being 'merely symptomatic of this, the same as in other inflammations." The former of these propositions, generally speaking, we do not deny; but the second we cannot admit. The evidence of dissection falls short in establishing the point..
Inflammation, however, is insisted on; and most of the remedies that are commonly employed in inflammation are proposed. But what is inflammation? Can we deduce its proper method of eure from a knowledge of its nature?. Or does experience prove that the common method of cure is properly adapted to its removal? Here, as in other cases, “the effects of remedies are liable to be falsely estimated.” Some patients die, and some recover. But in the latter case can we say that the recovery was owing to the remedies? or in the former, that they had no concern in the death? or that the patient would not have been more safe if he had been left to “the powers of resistance of the constitution --the vis conservatrix nature, which, as Dr. Clutterbuck observes, “is often not only an overmatch for the disease, but for the doctor also ?” Such the nature of medical evidence-such the glorious uncertainty of inedicine! Verily, nostra ars conjecturalis est.
Suppose, then, that "fever is inflammation,” according to our author, still the nature of fever is not explained. And the doubts and difficulties under which we labour, in the treatment of inflammation, must still hang over us in the treatment of fever.
Of all this Dr. Clutterbuck is fully aware.
“ In regard to the cure of fever” (says he), “in relation to the present doctrine, I have endeavoured to speak with due caution. 1 have recommended no remedies with confidence, upon merely theoretical grounds, but have contented myself with hinting only at their probable utility; well knowing how fallacious every thing of this kind is, and how ready we are to discover virtues where we wish to find them.
“ I have no hesitation, however" (continues he), " in expressing my firm belief, that the effects of the remedies whose powers in the cure of fever are well ascertained will be better understood, and the application of them be rendered more precise and beneficial upon the present doctrine, and by keeping always in our view the state of vascular action in the brain, than upon any other hypothesis that has yet been given respecting the seat and nature of fever. P. 435.
Without further comment, let us recommend the work itself to the perusal of our readers; and, whatever they may think of its leading doctrine, we can assure them that they will find much ingenuity and much medical erudition ;- in short, that it is the production of a mind of no common ability.
Transactions of the Horticultural Society of London. Vol. I.
Part I. 4to. pp. 78. 7s.6d. Hatchard; White. WE have often had occasion to exult in the number, spirit, and talents of the learned and philosophical societies instituted and supported throughout the United Kingdom by the voluntary contributions of their members. The appearance of Part 1. of the first volume of the Transactions of the Horticultural Society, which was instituted only in the spring of 1805, is an additional cause for congratulation on the rapid and general diffusion of natural philosophy: There are, indeed, many reasons for considering the extension of this branch of human science as a positive good to society. Its effects on the passions and even appetites are not the least important of these reasons. The profound naturalist will rarely or never become a bacchanal or a gormand, still less an irregular, litigious, dishonest, or quarrelsome person. It is true, we regret to say it, a distinguished botanist may be cited as a proof that an acquaintance with the vegetable kingdom does not necessarily imply an adherence to the law of rational nature with regard to chastity. Yet it will readily be admitted, that an extensive and extending knowledge of the economy of nature is most likely in the present age to form an