no such appearance has been witnessed at any period of the malady. The earliest febrile symptoms, it was maintained, were connected with the nervous system-these were languor, lassitude, mental depression, malaise, sense of cold and pallidity of the surface; the heart then sympathised more palpably, and with disorder in the circulation came on deranged function in every organ, and diseased secretion in every tissue. The unfairness of making the fever of Dublin, and more especially such a fever, the fever of the world, was strongly insisted on, and arguments were drawn from the acknowledged character of the Irish constitution, from the experience of many Irish writers, and from personal acquaintance with the disease among the resident as well as the emigrant Irish, to prove that they are in general little more remarkable, if not a little less, than their neighbours for adynamic fever. And, lastly, it was shewn that the fever of London is essentially inflammatory, that its treatment requires the lancet more than wine, and that the Irish are just that class of patients who stand most in need of full and free depletion. The work of Dr. Smith confirms these views in every point, and establishes them on the basis of a pathology which it is impossible to shake. The fever of London, we repeat, is anything but a disease of weakness. Is increased arterial action a proof of weakness, or is acute pain, or is improvement under depletion, or is the aggravation of every symptom under stimulating treatment? Are increased vascularity, change of structure, deposition of lymph, formation of pus and membranes, the ordinary and legitimate results of debility? Whoever witnessed wide and spreading ulceration from adynamia? Whoever saw the membranes of the brain thickened, adherent, and charged with blood from want of action? What have we after death from ordinary inflammation of the brain and membranes, but what we find in fever? Have we any thing beyond turgid vessels, effused lymph and serum, and altered structure? If we have, it should be pointed out. Have we any thing in Pleurisy, or Pneumonia, or Bronchitis, beyond disorganized or inflamed lungs, inflamed and thickened membranes, increased secretion, adhesion and effusion of lymph and pus? If we have, let them be pointed out. Have we any thing more indicative of action, and of strong action, in Enteritis, or Peritonitis, or any other itis that may be fixed upon, than intestines loaded with engorged vessels and matted into one adhering mass, cavities filled with phlogistic depositions, structure softened into lacerable pulp, ulcerations wide as they are deep? If we have, it were for the sake of truth to make it known. Yet these are the morbid appearances after death from VOL. XII.-Westminster Review.

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adynamic fever, from fever whose essence is weakness, whose seat is relaxed and effete blood, in which we are cautioned from leeching, prohibited from bleeding, advised to try transfusion, and which we are strongly recommended to make merry with wine!

Now let Dr. Smith be heard. He, we think, has given an unanswerable summary of the pathology of fever, drawn from a multitude of dissections, which, if contrasted with any which can be brought against them, are as unequalled in their superiority as number; and, as it would form the best proof of what has been advanced, we feel sorry that its length renders its introduction impossible, while it were only to give half the required proof did we mutilate the passage. The following masterly extract may form a sufficient substitute :

The account of the pathology of fever is the history of inflammation, and the description of the individual changes that take place in the organs that constitute the febrile circle, is an enumeration of various products of inflammation which are formed within them. There is scarcely a fatal case of fever which does not afford, in one or other of the organs of that circle, some inflammatory product; there is no considerable number of fatal cases which does not furnish a specimen of every inflammatory product. And what are the severest cases of fever, and why are they the severest? With the single exception immediately to be stated, the severest cases are those in which, together with a severe primary affection of the nervous system, this inflammatory action is in the greatest degree of intensity, and is seated in the greatest number of organs; and they are the most severe, not only on account of the severity of the primary affection of the nervous system, but also because it is in them that the inflammation is the most intense, and because that inflammation attacks the system at one and the same time in the greatest number of points. From among the preceding cases, fix upon any one in which the powers of life were, from the commencement, the most completely overwhelmed, and in which they were the most rapidly exhausted, and when the last struggle for existence is over, examine the changes that have taken place in the internal organs-what is it that is found? traces of inflammation, legible, deep, extensive; while, in almost every case, these traces are thus legible, deep, and extensive, in proportion to the apparent intensity of the fever, and to the rapidity with which it extinguished life. In this point of view, how important, how instructive, how invaluable, is the lesson which the mixed cases of fever afford! With few and rare exceptions (and in all diseases some exceptions occasionally occur to what appear to be the best established and the most invariable laws) these are the cases in which the symptoms are the most urgent, and in which they run their course with the greatest rapidity; these are the cases in which the debility is the most striking; in which it comes on the most early, and pro ·

ceeds to the greatest degree of prostration; these are the cases which are the most purely typhoid, the most truly adynamic; these are the cases which, in general, commence with the most sudden and alarming deprivation of physical and mental power; in which all pain and uneasiness are soonest lost in stupor, in which the stupor most rapidly increases to insensibility; in which delirium comes, perhaps, as early as the third or fourth night, accompanied with its attendant, muscular tremor, and too often with its most formidable ally, erysipelas; in which, at this early period, the respiration is short and hurried, the skin dusky, the colour of the cheek purple, the tongue brown and dry, the lips and teeth sordid, the abdomen tender, and the stools loose ; in which, in a day or two more, the abdomen is swollen, tense, and tympanitic, the stools passed in bed, the patient prostrate on his back. completely senseless and powerless, while the pulse is 120 or 130, and so feeble that it can scarcely be distinguished. But what is this debility in what does this adynamic state consist? It consists of a peculiar affection of the nervous system, followed rapidly by intense inflammation of the brain or of its membranes, or of both: by intense inflammation of the mucous membrane of the bronchi, and by intense inflammation or extensive ulceration of the mucous membrane of the intestines. And why is the patient weak or adynamic? Because he is not only assailed by an affection of the nervous system, which deprives the organs of the stimulus necessary to enable them to perform their functions with due vigour, but, at the same moment, inflammation is set up in three of the great systems, the healthy action of which is most essential, not only to strength but to life: thus the citadel is attacked at one time at three of its capital points. It is not asserted that inflammation alone constitutes the state of fever, nor that the danger of the patient is always in exact proportion to the degree of the inflammation. How it differs from inflammation, and what is superadded to the inflammatory state, will be shewn immediately; but it is a most important fact, that the degree of the debility is most intimately connected with the intensity and the extent of the inflammatory action. Now and then, as has been already stated, the intensity of the nervous affection is so great, and so rapidly destructive of life, that there is no time for an inflammatory process to be set up, much less for an inflammatory product to be formed. The patient is struck dead as if by lightning, or by Prussic acid, or by apoplexy. In this country, he does not actually die as instantaneously as he might be destroyed by the electric fluid or by poison, although there are countries, seasons, and particular spots, in which the concentration of the febrile poison appears to be sufficiently great to extinguish life instantaneously; and even in this country, life is sometimes destroyed by a stroke of fever as rapidly as it is by a stroke of apoplexy, when the latter does not prove fatal in the first few hours.

Now the peculiarity in these cases is, that the internal organs, after death, exhibit no signs of inflammation, unless vascularity be inflammation. The organs which, in ordinary cases, are inflamed, are in these cases turgid with blood. Are the terms debility or adynamic

appropriate expressions to designate even this condition of the organs? Just as appropriate as they would be to express the condition of a person who is struck dead by lightning, whose muscles are incapable of contraction, and whose blood will not coagulate. Those who apply these terms even to such forms, and, à fortiori, to any other forms of fever, must be ignorant either of the nature of the disease, or of the constitution of the human mind. If they know the disease, they know that the patient appears to be weak because the primary operation of the disease is upon the nervous system—an operation which, as has just been stated, while it disturbs that due and equal distribution of nervous influence which is necessary to the healthful action of the organs, and, therefore, to the general strength of the system, is not incompatible with, but promotive of an excitement of the vascular system, which terminates in inflammation. Debility is the last, the ultimate result of the disturbance of the functions of a certain series of organs, but the part of this very disturbance of function, and a most important part, a part which exerts the greatest influence over the progress of the disease and the life or death of the patient, consists not in the weakened, but in the augmented strength and the increased activity of the vascular system. To designate the ultimate result upon the system by a term which gives an entirely false view of the individual processes in the economy, by which that ultimate result is produced, must, we repeat, arise either from an ignorance of the true nature of those processes, or from not reflecting on the influence which words exert over the manner in which the human mind conceives of things. For the sake of the progress of the science of medicine, for the sake of rendering the language of medicine the correct expression of the knowledge which the science has actually attained, and, above all, for the sake of accomplishing the great object of medicine, the preservation of human life, it is high time that these terms with which physicians have so long allowed their minds to be abused, should be banished from medical nomenclature, or, at any rate, from that part of its nomenclature which appertains to fever.'-pp. 323-528.

The seat of fever appears to be in the nervous system, in place of in the blood, the cause of fever seems to be a specific poison, and the effect is a modified inflammation. It is the peculiarity of the poison, operating upon the peculiar structure which it first invades, that gives a peculiar tinge and type to all the succeeding symptoms, and that renders the morbid action something else than pure inflammation. The cause is peculiar, the structure it attacks is peculiar, and the inflammation which it produces is peculiar. But the cause is an exciting cause, the structure it invades is excited, and the morbid product is a product of excitement. This excitement may be more, or it may be less, just as the cause is more or less intense, or as the structure on which it operates is more or less suscep

tible of excitement. The structure may be weak and the poison may be strong, and then the effect will be sudden and severe; or the poison may be weak and the structure may be strong, and then the effect will be gradual and moderate. The effect may thus be produced in a thousand different degrees, and the action of the heart and arteries may thus be called forth in endless varieties of power. But this effect is always inflammatory, and this action is always irregular. The poison may kill in a few hours, or require a few weeks; the heart may be instantaneously disabled, or excited into the most unmanageable force; nervous symptoms may preponderate at one period, inflammatory symptoms at another. It is this confusing intermixture of nervous symptoms, arising from the nature of the organ attacked, and of pseudo-inflammatory symptoms, depending on the nature of the action modified by the cause, which makes fever appear to many so perplexing and contradictory. All these points have been ably handled by Dr. Smith; and for simplicity of arrangement, perspicuity of view, power of argument, and practical deduction, his Treatise on Fever stands, we believe, without competition at the head of all that has been written upon this abstruse disease. The relation between cause and effect, between symptoms and the states they indicate, was never before so clearly pointed out; the theory of fever is laid down with unprecedented plausibility; and the variety of cases and dissections which are given may furnish him, who questions the conclusions which are drawn, with ample materials to construct inferences of his own. But the treatment proposed by Dr. Smith, and the important question of contagion, must be discussed on another occasion.

ART. XI.-1. Essai Historique sur les Libertés de l'Eglise Gallicane, et des autres églises catholiques, par M. Grégoire, ançien evêque de Blois, &c. Svo. pp. 457. Paris.

2. Histoire critique de l'Assemblée générale du Clergé de France en 1682, et de la Déclaration des quatre articles qui y furent adoptés; suivie du Discours de M. l'Abbé Fleury, avec des Notes par M. Tabaraud. 8vo. pp. 406, Paris. 1828.

PUBLIC attention has been much directed of late to the ecclesiastical feuds in France, in which, as usual, each party misrepresents its adversary.

From a very remote period in the history of France, great disputes on the proper limits of the temporal and spiritual powers