H

the fame exposure to cold or moisture, as it would have done if no fuch difeafe had taken place.

If a perfon has been fubject to indigeftion, flatulency, or difpofition to acidity in the ftomach and inteftines, after the tertian has gone through its natural progrefs, thefe appearances in the inteftinal canal no longer take place. Sometimes, habitual inflam mation, or cutaneous eruptions, leave the patient during the courfe of a regular tertian, and do not afterwards return, although this more rarely happens than in other habitual difeafes. So epilepfy, hysteric affection, and all other difcafes which have become habitual, are in many inftances removed. In many of these cafes, however, no alteraion is made by a tertian, and it likewife happens, that fuch difcafes are alleviated, although not entirely carried off.'

A little farther on, we meet with an observation that is far from holding out a bright profpect to the phyfician. The author tells us, (P. 18.) that he has never feen nor can himself conceive any caufe why a fimple paroxyfm of fever fhould go through its three ftages, and terminate in health, much lefs why a regular tertian fhould begin, grow gradually more perfect, continue for fome time in vigour, then gradually decay and go off; nor after fo many conjectures which have been thrown away on this fubject, does he expect that the caufe of this will be known in his time.'

In confidering the treatment of this difeafe, the doctor goes at fome length into the nature of food, and the proper modes of adminiftering it. On each of thefe he offers many ufeful hints, With refpect to the periods of taking food, however, he may, perhaps, by fome, be thought a little fingular, if not vifionary.

We fhall prefent the reader with his plan of proceeding.

P. 43. To give an example in a regular tertian, whofe paroxyims take place at ten in the morning, and where the intermif fions have become regular and perfect. On the day on which the patient is perfectly free from the difeafe; breakfast in the morning may be, where the patient is accustomed to it, tea with milk and fugar, and bread with butter, not rendered empyreumatic with heat. The dinner, foup, fifh, and meat, with fruits, all of fuch kinds as have been enumerated; but this variety only where the patient has been accustomed to it. The fupper may conft of potatoes or rice, and milk, fago, or other things of the fame kind, with a moderate quantity of wine.

If the patient fhould fleep during the night before the paroxyfm, nothing but a bafon of barley-water fhould be given at fix or eight in the morning. If instead of ten the paroxyfm should not come on till twelve, or later, tea with bread and butter, or fuch other food may be given at eight in the morning. If the paroxyfm fhould take place at ten, it will probably go off by eight in the evening; and the patient when he feels eafy fhould eat fago, barley boiled down with a moderate quantity of wine, and bread with milk, &c.

When intermiffions again become irregular, towards the end of the difeafe no folid animal food whatever fhould be employed,

but

but only fuch as are proper at the beginning of the disease, in more liberal quantity.

To conclude, for the firft fortnight food of eafy digestion fhould be ufed; afterwards more nourishing food, according to the perfection of the intermiffions; again food of calier digestion when they grow imperfect towards the end.'

This matter is ftill more clearly explained in the fubfequent paffage.

P. 50. The only food proper, where the difeafe puts on the appearance of continued fever at the beginning, excepting that exacerbations do not take place in the evening, are folutions of farinaceous matter: where there are crifes at the beginning, although very imperfect, farinaceous matter in fubitance coagulated and boiled down again until foft, fhould form the nourishment: if the crisis at firit thould be nearly perfect, the food during the first, or even fecond week, fhould be farinaceous matter, and fruits; but in the fecond or third week, if the crifis fhould become perfect, or nearly fo, milk not coagulated, and animal broth may be at first added, and fometimes folid animal food of eafy digeftion. When the crisis becomes perfect on the day on which the paroxyfm does not take place, according to the state of the patient, food fhould be exhibited nearly in the fame manner as in health. No folid food of any kind, and of fluids only folutions of farinaceous matter, fhould be allowed for eight hours before the coming on of the paroxyfm. After the paroxyfm is over, farinaceous matter in a folid form, broths or milk may be made use of on the day of the paroxyfm; and finally, the stomach should be kept free from noxious matter by emetics.'

The remarks and cautions refpecting the ufe of purgatives are certainly founded on juft obfervation.

The obfervations on tone, and the means of restoring it when loft, as well as thofe on exercife, and the manner of employing it, are philofophical and juft. We have long thought with the author, that many of the remedies administered with the view of reftoring ftrength were of little real advantage.

The directions for the exhibition of cinchona, and fome other remedies in the fever, may generally be confulted with advantage. by practitioners. In this part, we have noticed a few conclufions which are curious. The author fays, (P. 128.) that the bark of the cinchona, and probably all the medicines that act in a fimilar manner, have no power of taking off a fever when prefent, but only a power of preventing the return; or if they have any action on a fever when prefent, they tend to prolong it, and prevent a perfect crifis from taking place.'

Another is, (P. 133,) that if the cinchona be exhibited in fuch a manner as not to prevent the return of the paroxyfms in the course of a few intermiffions, that its effect is generally loft, and that it never can be exhibited afterwards in any dofe, or in any manner fo as to produce its effect in the manner it would have done if employed in a proper dofe and mode from the first. Frequently its power of preventing the return of the paroxyfm is totally loft, and therefore it is of the utmost importance to use it

at

at the beginning in fuch preparations and quantities as to be effe&tual.'

And at page 153, we are told, that there feems to be a great error in the view of remedies employed in fever; practitioners frequently making no diftinction between thofe ufed to cure the difeafe itself, and those employed to remove accidents that have arifen in it, although fuch diftinctions are extremely neceffary to be made. If, for example, in the courfe of a tertian, a pleurify fhould happen to arife, taking away a quantity of blood would be a powerful remedy for the pleurify, but although the pleurify were removed, the intermittent tertian would go through its courfe juft as if no blood had been taken away, excepting that the patient would be rendered weaker.'

How often the doctor has feen pleurify take place in the courfe of a tertian fever, we are not here informed; we are difpofed to believe, that it has not been very frequently.

This, like most of the author's tracts, contains much ingenious reafoning, and fome novelty of remark.

ART. XI. Medical Reports, on the Effects of Water, cold and warm, as a Remedy in Fever, and Febrile Difeafes; whether applied to the Surface of the Body, or used as a Drink: with Obfervations on the Nature of Fever, and on the Effects of Opium, Alcohol, and Inanition. By James Currie, M. D. F. R. S. &c. 8vo. 314 pages. Price 6s. boards. Liverpool, M'Creery; London, Cadell and Davies. 1797. THE records of medicine contain various notices of the fuccefsful application of water to the furface of the body, in fever and febrile difeafes; and of late, the practice has been frequently followed in hofpitals and private houfes. But it has neither been appreciated, nor reduced to rule. Our author refers the origin of his trials to a narrative by Dr. Wright, in the London Medical Journal for 1786. This gentleman, having been infected by febrile contagion, caufed buckets of fea-water to be thrown over him. He found inftant relief; and by continuance of the process for three days, the fever was ftopped. Equally good effects were produced on the fame occafion by the fame method in another cafe.

Dr. Currie has imitated and improved this practice. His experience in low fever is ample; his cafes fair; and we believe, that he will have earned the praise of afcertaining the full value of what had been ftudied with little care; and of reducing what was before altogether vague, to a certain rule. Here is the statement of that

rule.

P. 15. The exacerbation ufually occurs in the afternoon, or evening, the remiffion towards morning. Thefe exacerbations are marked by increased flufhing, thift, and reftleffness. If the heat of the patient be, at fuch times, taken by the thermometer, it will be found to have rifen one or two degrees in the central parts of the body, above the average heat of the fever, and still more on the extremities.-The fafeft and most advantageous time for ufing the afperfion or affufion of cold water, is when the exacerbation is at its height, or immediately after its declination is begun;

and

and this has led me almoft always to direct it to be employed from fix to nine o'clock in the evening; but it may be fafely used at any time of the day, when there is no fenfe of chilliness prefent, when the beat of the furface is fteadily above what is natural, and when there is no general or profufe perfpiration.-These particulars are of the utmost importance.

1. If the afperfion of cold water on the furface of the body be afed during the cold ftage of the paroxyfm of fever, the refpiration is nearly fufpended; the pulfe becomes fluttering, feeble, and of an incalculable frequency; the furface and extremities become doubly cold and fhrivelled, and the patient feems to ftruggle with the pangs of inftant diffolution. I have no doubt, from what I have obferved, that in fuch circumftances, the repeated affufion of a few buckets of cold water would extinguish life. This remedy fhould therefore never be used when any confiderable fenfe of chillinefs is prefent, even though the thermometer, applied to the trunk of the body, fhould indicate a degree of heat greater than usual.

2. Neither ought it to be used when the heat measured by the thermometer is less than, or even only equal to the natural heat, though the patient fhould feel no degree of chillinefs. This is fometimes the cafe towards the laft ftages of fever, when the powers of life are too weak to fuftain, or react under, fo powerful a ftimulus.

3. It is alfo neceffary to abstain from the ufe of this remedy when the body is under profufe perspiration, and this caution is more important in proportion to the continuance of this perfpiration. T the commencement of perfpiration, efpecially if it has been brought on by violent exercife, the affufion of cold water on the naked body, or even immersion in the cold bath, may be hazarded with little rifque, and fometimes may be reforted to with great benefit. After the perfpiration has continued fome time and flowed freely, efpecially if the body has remained at reft, either the affufion or immerfion are attended with danger, even though the heat of the body at the moment of ufing them be greater than natural.-Perfpiration is always a cooling procefs in itself, but in bed it is often prolonged by artificial means, and the body is prevented from cooling under it to the natural degree, by the load of heated clothes. When the heat has been thus artificially kept up, a practitioner, judging by the information of his thermometer only, may be led into error. In this fituation, however, I have observed that the heat finks rapidly on the exposure of the furface of the body even to the external air, and that the application of cold water, either by affufion or immersion, is accompanied by a lofs of heat and a deficiency of re-action, which are altogether inconfiftent with fafety.-Each of thefe points will be illuftrated more fully in the fequel.

• Under these reftrictions the cold affufion may be used at any period of a fever; but its effects will be more falutary in proportion as it is ufed more early.'

The internal use of cold water is governed by the fame laws, and fo is it's ufe in febrile diforders, as the fmall-pox, concerning which fome facts occur in the prefent publication.

To the confiderations on fever fucceeds an inquiry concerning the disease that arifes from drinking cold liquids after fevere exercise.

We

We are of opinion, that the author has fuccefsfully treated this im portant fubject;-no fmall merit, when we advert to the perplexity in which it has been always involved. The fimple refult is, that the application of cold to the furface or ftomach is lefs dangerous, as the body is more heated; when the body is lofing, or has jult loft it's heat, it is more or lefs dangerous. Dr. C. thinks, that cold may be more freely applied in continued fevers than in intermittents, and in thefe than upon exercife, because, in the former cafes, the body more firmly retains its heat.' All is we invite the reader to fee well explained in the original work.

Here Dr. C. choofes to interpofe reflections on the cold bath in convulfion-and in infanity. He then proceeds to review the doctrines of various authors respecting fever. He briefly recites the principles of each theorist, and then gives theory to the dogs. Difmiffing therefore, as far as is poffible, all theories from the mind, let us briefly confider the procefs of nature in fever,' p. 145. How great, after this refolution, was our furprize, to find a doctrine delivered which, to our perception, has the very effigies, the very affect, the very phyfiognomy of the mechanical doctrine of Cullen! let the reader judge.

P. 150. Debility of a peculiar kind, is then the first operation of the poifon producing fever--the neceflary confequence, or as fome contend, the concomitant effect, is a fpafm, or contraction of the arteries; but more efpecially of the extreme veffels, and the capillaries of the furface--hence follows an accumulation of blood on the heart and lungs-the re-action of thofe organs-the generation of morbid heat and of morbid affociation.' This ftrikes us the more, as the latest author before the prefent, on fever, after equally dif claiming theory, with equal feeming inconfiftency, produces the fame, or a fimilar doctrine. We perceive, indeed, that Dr. C. thinks the experienced will object little to this view of fever. But must not all, that refufe affent to Dr. C., abfolutely reject it? The explanation of the effect of cold water, deduced from these premifes, will eafily be anticipated.

P. 161. The fudden, general, and powerful ftimulus given to the fyftem, diffolves the fpafm on the extreme veffels of the furface, and of the various cavities of the body: the fudden and general evaporation carries off a large portion of the morbid heat accumulated under the fkin; and the healthy action of the capillaries and exhalents being reftored, the remaining fuperfluous heat paffes off by fenfible and infenfible perfpiration. The ftimulus of morbid heat and of morbid fricture being removed, the inordinate action of the heart and arteries fubfides, and the haraffed, and toil-worn patient finks into that peaceful fleep which nature has provided as the folace of our pains and forrows, and the restorer of our strength.'

Without doubt, the effect of cold will eafily adapt itself to every poffible hypothefis of fever, that fhall be founded on the actions of the living folid. Whatever kind of action fhall be fixed upon, nơ ingenuity will be found requifite to difcover, that fudden cold deftroys, or to a certain degree disturbs, that action. The double effe& in the above quotation feems not well imagined. The increase of heat is accompanied, if we rightly conceive the theory, with a relaxation of fpafm. Indeed, it appears from Dr. C.'s own thermo

metrical