ing to the common calculation, and when it first enters any country it is not much less destructive than the plague; for the small pox has raged with fo great violence in Siberia, that whole provinces. have been almoft totally deprived of inhabitants *.

2. The plague, though often joined with a putrid fever, is yet by no means a putrid difeafe; as the learned Orræus obferves, that the carbuncles are free from all stink, and putrefcence, and that no mark of a tendency to putrefaction manifefts itfelf in this diforder when fimple; yet the plague, in the fame manner as the small pox and the other exanthematous diforders, does not always appear under the fame form, but exhibits various fymptoms, according to the various morbid ftates with which it is combined.

3. The plague frequently unites itfelf with other acute diseases unfufpected by the phyfician, from which conjunction it's malignity ought on many occafions to be derived ‡.

4. The plague never proves deftructive to mankind, without fome previous violent epidemic conftitution, which feems to fubfide at the arrival of the plague; but the contagion of the plague is then really joined with the previous epidemical conftitution, hence the. plague undergoes various changes, and prefents itfelf under various forms, according to the different previous epidemic. For instance, the plague of London, which, according to the teftimony of Sydenham §, fucceeded to a violent inflammatory epidemic, repeatedly required bleeding; whereas venefections, though fometimes ufeful in the plethoric, were nevertheless in general evidently injurious in the plague of Mofcovy ||, which, according to the account of Dr. de Mertens, followed after a putrid, and nervous catarrhal fever ¶.

5. Many patients in the plague of Marseilles were so slightly affected, that the eruption of the buboes took place without the leaft fymptoms of a fever, and the patients walked about the streets **; which fhows, that death is not brought on by the peftilential contagion itself, but by the epidemic complicated with it.

6. The change of feafons, and of the ftate of the atmosphere, has also the greatest influence on the plague ††. Dr. Ruffel obferves, that the plague is diminifhed in the winter, increases in the spring, and is at it's height in the fummer ‡‡. This is more strongly confirmed by the learned Orræus, who fpeaks in the following terms: "The plague ravaged principally in the fpring, and the autumn, and was always more violent, if the weather continued rainy and warm; on the contrary as foon as the weather became more dry

Samoilowitz Mémoire fur l'Inoculation de la Pefle, p. 14 and 15, Strafburg, 1782. Orræus, 1. 1. experientiæ 12, p. 66.

+L. 1. confect, 1, p. 162.

§ Opera omnia, fect. ii, cap. ii, p. 104.

Orræus, 1. 1. experientia 26, p. 124.

Obfervat. Med. de Febribus putridis, ac Pefte, párt i. **Chicoincau Traité fur la Pefte, fpec. v, p. 41.

++ Mertens, 1. 1, part ii, cap. 1, p. 89, and cap. ii, p. 109.

++

Natural History of Aleppo.

and fettled, with a north, or north-eaft wind, even in the middle of the fummer, if it were not entirely extinguished, at least it grew much milder. But the winter approaching, the contagion was gradually diminished, and at length totally destroyed by the continually increasing cold."

7. The plague obferves the fame rules in it's courfe as the other exanthematous diseases: for in it's commencement it may be eliminated out of the body by the infenfible perfpiration; whereas the disorder having proceeded farther, the fuppuration of the buboes and the carbuncles, as the only falutary crifis, ought to be promoted with the utmost care *.

8. When the plague appears only sporadically, as often happens, it is found, like the fmall pox, to be much lefs pernicious; as then the contagion may often be vanquished in the beginning of the difeafe, and expelled out of the body by gentle diaphoretics t

9. The plague, when communicated by inoculation, though even the peftilential fever be epidemic, exhibits much flighter fymptoms: hence Dr. Samoilowitz has concluded, and, according to my humble opinion, with the greatest justice, that the plague, like the fmall pox, may be mitigated by inoculation, if the body be properly prepared before-hand ‡.

10. Dr. Orræus has proved by a great number of observations, that the anomalous and most violent fymptons of the plague, called either malignant or acute, are very often owing to a morbid matter, contained in the primæ viæ §.

11. In fine, I must add to all this, that patients labouring under the plague are befides afflicted with despair of the event, and the moft anxious dread of death, to which the want of help does not a little contribute, they being forfaken by every body as foon as the disease appears for it will no doubt be evident to every one, who confiders the great influence the violent paffions of the mind have even in a mild diftemper, that these have likewise a confiderable fhare in the fatal effects of the plague.' P. 171.

The caufes which produce danger from exanthematous complaints are pointed out with fome judicious directions calculated to prevent it. We fully agree with Dr. Ontyd in the greater part of his obfervations on this fubject.

As an appendix to febrile diseases, the author treats of rheumatifin and gout, and diftinguishes thefe two diforders with precifion, following nearly the steps of Dr. Cullen. The hiftory is accurate, and the method of treatment (if we except the application of leeches to gouty fwellings, which, with every

Orræus, 1. 1, experientiæ xix, p. 100. + Orræus, 1. 1, experientia ix, p. 64.

Mémoire fur l'Inoculation, &c. p. 1 to 24: and Lettre fur les Expériences des Frictions glaciales pour la Guérison de la Pefte, p. 51.

• § 1. 1, confect : xxiv et xxv, p. 215 et feq.

CRIT. REV. VOL. XXVII. O&. 1799.

M

other external remedy, we confider as precarious) is that of the ableft practitioners. As a cure for gout, flores fulphuris with rob fambuci are recommended; and the only new remedy is the hydrargyrus muriatus with bark and opium.

The third part relates to death enfuing from the fuppreffion of the action of any vital organ, which diforders the chain of the vital powers, by deftroying the action of fome of the intermediate links. The means by which the fatal event is thus occafioned, are inflammatory difeafes, fluxes, cachexies, difeafes of the nervous fyflem, and of the fecretory organs. These indeed fometimes kill the patient by the deftruction of the vital principle, but chiefly, in our author's opinion, by the deftruction of fome link in the chain of organisation.

The danger of inflammation is properly deduced; first, from the reigning epidemic; fecondly, from the cause of the inflammation; thirdly, from its de ree; fourthly, the importance and ftructure of the organs inflamed; fifthly, the age, fex, and conflitution of the patient; fixthly, the previous ftate of health. Thefe different circumftances are well illuftrated.

In the clafs of fluxes are catarrh, dyfentery, cholera, bloody difcharges from the ftomach or intestines, hemoptoe and other hæmorrhages. Of diarrhoea the account is fhort, and of not great importance. What relates to dyfentery, which our author calls the catarrh of the inteflincs, is full, clear, and judicious. The difcafe, in his opinion, is confined to the small inteftines; and the different opinions of other authors are suppofed to arife from their having obferved different epidemics. Chronic dyfentery is, we believe, exclufively a disease of the colon and rectum. In the treatment, an attention to the prevailing epidemic is highly neceffary. We will felect the abftract of our author's plan of cure.

Moft phyficians, though they allow, that opiates do a great deal of good in dyfentery, are yet of opinion, that, previous to their use, the prime via are to be well cleanfed by the exhibition of neutral falts. diffolved in a large quantity of water for feveral days. Such a manner of proceeding may in most cafes be unattended with danger in private practice, especially if the practitioner have been called in when the difeafe first makes its appearance; but it would by no means be fafe in the dyfenteries happening in the navy and army; which are moftly of fuch fevere kinds, that they would terminate fatally before the prima via were properly evacuated by the neutral falts. Upon the whole I am very much inclined to doubt the propriety of fuch a treatment. For my own part, without lofing time by repeated evacuation of the prima vie by the folution of neutral falts, I immediately give an emetic of ipecacuanha, if the ftomach seem to be at all affected; after which I give my patients the mercurius dulcis from gr. v ad gr. xii, in order to evacuate properly the

bowels at once; and then I proceed to the antidote of dyfentery, opium. The calomel not only cleanses the prime viæ, but it seems to have fomewhat of an antidyfenteric power; for it may be exhibited even to the most delicate conftitutions with perfect safety, and frequently under it's ufe the gripings and pain abate. If, therefore, during the ufe of opium, fordes in the prime via fhould appear, recourfe is occafionally to be had to mercury.' P. 256.

Opium is given in very large dofes; but rhubarb, in the beginning, is deemed dangerous. Aftringents are fuppofed, by our author, to be dangerous; and, in his opinion, the idea of contagion from dyfentery is a product of fancy.' His arguments for this laft opinion are striking and plautible; but they do not fo far carry conviction, as to lead us to defpife precautions. His method of preferving from the difeafe, when epidemic, is proper, and will, we believe, be generally effectual. The remarks on the other difeafes of this clafs, particularly the bloody discharges from the inteftines, deferve notice. Riding on horseback, in hæmoptoe, is, he thinks, a precarious remedy, as it often brings back the bleeding.

The cachexies which prove fatal are hectic fever, phthifis, caries of the bones, lues, leprofy, tabes, jaundice, dropfy, fcrofula, rickets, fcurvy, aneurifm, and mortification. The most copious difquifition is on phthifis. Our author dwells too much on the tonic fyftem, in phthifis from peripneumony, and appears to be prejudiced againit the ufe of milk in this complaint. In carious affections of the bones he highly commends aia-fortida, and thinks it almoft a specific in fuch complaints, if attention be paid at the fame time to the cause. Lime-water is, in his opinion, useful; and perforations, as well as the cautery, are injurious. The fection on lues is judicious, though it contains little novelty. Our author has no confidence in the antifyphilitic powers of mineral acids, or oxygenated falts, and thinks that lues and gonorrhoea are produced by the fame fomes.

Jaundice is not occafioned, in Dr. Ontyd's opinion, by ftones obftructing the paffage of bile; but he thinks that they ftop the orifices of the excretory veffels, forcing back into the liver the bile, which the abforbents carry to the fanguiferous fyftem; but this doctrine is oppofed by facts. In fome cafes the whole fanguiferous fyftem inay, he fuppofes, be changed into an organ preparing bile. This, though an idle fancy, is illuftrated by fpecious reafoning.

In dropfy, our author deems Bacher's tonic pills ufelefs, and fuppofes, with proper precautions, the digitalis not to be injurious. We commend highly the fection on dropiv, as well as that which relates to fcrofula. The latter is confidered as confisting in a debility, combined with too much irritability

of the lymphatic fyftem. In rickets, a fimilar disease, the debility of the lymphatic veffels feems to be greater, and their irritability lefs, in proportion to the age, than in fcrofula. The following remarks are new, and, we believe, juft.

In fine, though it is very difficult to explain how it happens, that fome rickety perfons poffefs a great deal of wit, and others, on the contrary, are found to be very ftupid, I am of opinion, that this phenomenon depends upon the different action of the rachitis on the head, and upon the confequent form the bones of the skull affume. In reality, the shape of the fkull is of the greatest moment for the evolution of the faculties of the mind; fo that, ceteris paribus, the fenfibility or stupidity of the mind, for the most part, may be judged of by it. At least the learned Dr. Veirac, who has had an opportunity of treating many rickety children, always obferved, that children who acquired from the difeafe a large capacious forehead, with prominent eyebrows, and whofe eyes therefore seemed to fink in, were endowed with a fine genius: whereas other children, in whom the rickets occafioned a flat and somewhat crooked forehead, eyes more or lefs protuberant, a rifing crown of the head, and the hinder part of the head prominent, became ftupid.' r. 457.

Scurvy is alfo attributed to weaknefs, joined with increased lymphatic irritability. This idea is fupported by plaufible arguments, though we fufpect that they will not be found fatisfactory. This reafoning may be obviated by confidering the difeafe, as originating in debility, but as confifting in a depravation of the fluids; an opinion which, though combated with zeal by our author, is not, perhaps, affailed with fuccefs.— Aneurism and mortification afford no fubject of remark.

The nervous difeafes are apoplexy, pally, tetanus, and epilepfy the diseases of the fecretory organs are polyfarcia, diabetes, and cancerous ulcer. The whole of what is faid on nervous diseases is judicious and proper; the diftinctions are clear, and the directions inftructive.

Polyfarcia is fuppofed not to be occafioned by fuperabundant nutritious matter, but by the unufual action of the fecretory organs, which feparate oil. Perfons afflicted with it are advited to breathe oxygen gas, and to try fuch remedies as operate on the lymphatic veffels, viz. digitalis, mercury, and fquills, tonics being combined for the counteraction of their fedative power. We may add a vegetable diet and cider; for fuch as chiefly use these, though robuft and active, are feldom corpulent.

The difquifition on diabetes is long, laborious, and in fome refpects fatisfactory. Dr. Ontyd clearly fhows that it is not a difeafe of the fyftem, and advances fome ftrong arguments to prove that, contrary to Dr. Rollo's doctrine, it is not a dif order of the ftomach. Perhaps he has not fully established the