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A Second Differtation on Fever, containing the Hiftory and Method of Treatment of a regular Tertian Intermittent. 8vo. 35. 6d.

A Third Differtation on Fever.-Part I. containing the Hiftory and Method of Treatment of a regular continued Fever, Suppofing it is left to purfue its ordinary Courfe.-Part II. containing an Inquiry into the Effects of the Remedies, which have been employed with a View to carry off a regular continued Fever, without leaving it to pursue its ordinary Courfe. By George Fordyce, M. D. F. R. S. &c. 8vo. 75. 6d. fewed. Johnfon. 1799.

FEVER has, for ages, perplexed phyficians, not only with respect to its nature and treatment, but alfo with regard to the fymptoms and arrangement. To point out the confufion and errors of early practitioners would be a tedious and ufelefs tafk it is fufficient to refer to one of the latest and most accurate obfervers of fevers in this metropolis, Dr. Grant, in whofe work the ufeful and practical remarks are buried and loft under a confufed arrangement of appellations and fymptoms. To feparate the effential from the accidental fymptoms of fever is the firft ftep to our formation of a clear idea of the nature, perhaps the caufe, of the disease; and a mind must not only be clear and exact in obfervation, but judicious and comprehenfive in its views, to difcriminate, among a multiplicity of cafes, thofe fymptoms which conftitute an individual difeafe, from fuch as are accidentally combined with it. This gave value and importance to our author's ideas of fimple fever; but perhaps the next step is still more ufeful. Stahl published a differtation, in which he reprefented the tertian as the prototype of every fever; and very flight obfervation will prove, that fevers, except when they are greatly protracted, follow the tertian type. The amend ment, on alternate days, is an obvious appearance; and the exacerbations, between ten in the morning and ten at night, are equally demonftrative of the tertian nature. As we cannot add any thing more decifive of the value of our author's remarks, we fhall proceed to the fubftance of the second effay.

Dr. Fordyce admits that a tertian fometimes carries off habitual rheumatifin, dyspepfia, cutaneous eruptions, and convulfive complaints. It however fometimes fails, though it has been known to alleviate complaints which it does not cure. The treatment, therefore, is confidered in two views,

For an account of the First Differtation fee Crit. Rev. New Arr. Vol. XXIL p/267.

viz. where it is intended not to check the progrefs of the difeafe, and where it is the object of the practitioner to correct nature and perform her task by artificial means. The The general dietetic management occurs under the former of these heads; and the rules are clear and judicious. Ancient and modern obfervations are connected and explained with great precifion, from the nature and fymptoms of the complaint. We will quote the doctor's recapitulation of his opinions on this fubject.

To recapitulate what we have faid with refpect to the proper food, and rendering the ftomach fit for its digestion, 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 fubftance coagulated and boiled down again until foft, should form the nourishment: if the crisis at first should be nearly perfect, the food during the firft, 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 easy 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, should 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 ufe of on the day of the paroxím; and finally, the ftomach fhould be kept free from noxious matter by emetics.' P. 50.

Purgatives, in this part of the cure, fhould be given only. to expel the noxious contents of the intestines, as emetics to clear the ftomach, independently of any other plan. Those which will only excite the moving fibres of the inteftines, equally diftant from falts, which feem to act by increafing the quantity of the excreted fluids, and from coloquintida, for inftance, which excites fome motion in the whole fyftem, are to be preferred. Such are, in Dr. Fordyce's opinion, rhubarb and fulphur, either together, or feparate.

A difquifition is introduced to explain the action of tonics, particularly of bitters; but we do not find, that our views are much enlarged, or that the fubject is greatly elucidated by the inquiry.

To check an intermittent, by artificial means, is undoubtedly an object of great importance; but, from the variety of medicines recommended for this purpose, it is clear, in Dr. For

dvce's opinion, that no certain plan has ever been fuggefted. Paroxyfms of a tertian return, he thinks, from the crifis. not having been perfect, and from habit; but he first speaks of medicines apparently pointed out by what happens in the difeafe, and fecondly of thofe accidentally difcovered. Emetics are of the former kind; and every emetic, in his opinion, acts on the fyftem, in confequence of its impreffion on the ftomach. This action coincides with the falutary motions of the fyftem, in making the pulse fofter, &c.; and of courfe it renders the crifis more complete. The more active laxatives which excite general action are, in the fame way, of ufe in preventing acceffion of fever.

Bitters, particularly the bark, act lefs obvioufly againft the febrile ftate, but produce the fame effect. Dr. Fordyce gives a clear and judicious view of the management of this remedy; but little of the difcuffion is new. It acts, he thinks, on the ftomach; and he fuppofes that its influence continues at least forty-two hours. But perhaps the fact on which this conclufion refts is not decifive. The following plan of exhibiting the bark in one of the most troublesome fituations, when the disease recurs after having been once removed, deferves particular notice.

Several means have been employed to prevent this re-production of the disease. The first and most efficacious, is to continue. the ufe of the cinchona, by employing it in the fame dose as at firft, at the time that would have been the time of the intermiffion after the paroxyfm that was prevented by it, employing it as frequently as during the time of the first intermiffion. It should be difcontinued at the time when the fubfequent paroxyfm should have recurred; and the fame practice should be repeated during the time of the next intermiffion. That is, if the tertian had commenced at twelve at noon on Sunday, and had. completed its ftages by midnight, a drachm of the cinchona fhould be exhibited at one on Monday morning, and continued every two hours till eleven on Tuesday morning; it is then to be omitted till one o'clock on Wednesday morning, when it is to be given in like manner till eleven o'clock on Thursday morning; it is then to be omitted till one o'clock on Friday morning; it is then to be exhibited till eleven on Saturday, and afterwards difcontinued altogether for a time."

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Many practitioners deny the neceffity of this long ufe of fuch a quantity of cinchona, having frequently cured their patients in a forter time, and with much lefs dofes; but they have alfo very frequently failed. This failure is ufually attributed to the badnefs of the cinchona, to the particular conftitution of the patient, relapfes produced by new caufes, and a thoufand other things, but the author is convinced from his frequent trials of it in all ways.

that in order to enfure fuccefs it must be exhibited as above di-: rected.

This even is not fufficient to enfure fuccefs perfectly, but an ounce should be exhibited during the day time at the end of fix days for two days; and again in the fame manner after an interval of fix days more.' p. 141.

The management of fudorifics, with a view of preventing the recurrence, is equally clear and fatisfactory.

The third differtation is on continued fever,' which dif fers from intermittents, as the new paroxyfm takes place, not only before a crifis has occurred, but before it even commences. It rarely appears, that, in continued fever, the paroxyfm comes on without fome previous indifpofition; and we think, with our author, that our enumeration of the days fhould not take place from the moment of attack, but from the former day, especially if the attack is not in the evening. Continued fevers, as we have faid, attack during the febrile period; and it is true, that, at whatever hour the attack commences, the exacerbations foon fall into the routine of the evening fever. We have ufually feen the attack of continued fever from four to eight in the latter part of the day; and from eight to twelve in the former part, only during the prevalence of an intermitting tendency: we fay tendency, becaufe we have lately found intermittents very rare.

In the diftinction of continued fever, the writer withes to confine the appellation to fevers gradually increating till they reach their acme, aud either terminating critically, or flowly leffening, independently of any local affection. When, for inftance, fever commences generally and local affection fupervenes, it is no longer, in his opinion, fever. But if, on the receffion of the local difcafe, fever continues, he confiders the whole as fever, interrupted in its progrefs by the topical complaint, but otherwife unconnected with it. The outline of the diftinction is undoubtedly correct; but he feems, in fome points, to contract the limits of fever too rigorously, There is certainly, for inftance, an irregular fever to which the name of hectic has been applied, that does not strictly come within this definition, but which, both in a pathological and practical point of view, must be ftyled fever.

The want of fleep, in fevers, leads Dr. Fordyce into a long physiological difquifition, refpecting the ftate of fleep, and its influence on the functions. The conclufion is, that the powers both of body and mind are at reft, or at leaft the more active and fatiguing exertion of mind, judgement. This view is judicious and clear, though, in a few points, we would conteft the author's ftatement. The most important point relates to the judgement. We think it, like the other faculties, only weakened, The mind does not indeed revolt at incon

gruities of a lighter kind, which mature and active judge inent would perceive to be wrong; but ideas of cruelty, oppreffion and difhonefty, in fituations which require a comparison of circumftances, and a decifion of the mind, readily excite refentment. Those who compofe in their fleep are ufually delighted with their own efforts, which, if recollected, appear trifling; but the mind will, even during fleep, sometimes difcriminate between the merits and faults of thefe compofitions. We would not, therefore, except judgement from the general conclufion, that the powers of the mind are weakened only during the sleeping state; nor can we fully agree with the author that the mind is lefs active in the evening. After found fleep, great exertion is often neceffary to roufe the mental powers to their full action. In the evening, the mind will fometimes be jaded by the exertions of the day; but, in the morning, it is more frequently torpid.

On the fubject of pulfe, our author juftly remarks, that the feelings are often indiftinct. As fome then cannot distinguish notes of mufic, fo fome, he fuppofes, cannot diftinguish accurately the nature of pulfations. As a rule, by which they may try their own powers, he lays down the appearance of a buffy coagulum on the top of blood, drawn with proper precautions, as conftantly accompanying a hard pulfe.

The paroxyfms of a fever are of different durations. Dr. Fordyce mentions an ephemera lafting thirty-fix, and ancther forty hours, from the attack to the termination of the crifis. In no inftance do we think that paroxyfm lasts more than twenty-four hours to the commencement of the crifis.

Dr. Fordyce informs us, that he doubted, whether he fhould defcribe fever, in which there is great depreffion of ftrength, as irregular, or regular fever. He decided on the latter, and confiders putrefaction, in fevers, as the effect of depreffion, rather than the caufe. He recapitulates the arguments in the following words:

Since, therefore, the folids and fluids of a living man are placed in fituations the most proper for putrefaction ;

Since there is nothing applied to the living body to prevent putrefaction, which is not alfo applied to the dead body when it putrefies very faft;

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Since no fresh matter is added to the living body during the time in which the dead body, placed in the fame circumstances, would putrefy.

Since the depreffion of ftrength takes place always in a fever before there be any appearances of putrefaction;

And lastly, fince when the blood is rendered putrid by putrefcent matter being thrown into it, depreflion of strength always takes place before there be any appearance of putrefa c

tion:

• It may be concluded, that the depreffion of strength is the

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