Caufe of the putrefaction of the fluids in fever, and not the putrefaction of the fluids the caufe of the depreffion of ftrength." P. 89.

He defcribes the fhades of putrefaction with accuracy, and remarks, that, from 1750 to 1765, putrid fymptoms were common. Since that time, they have been more rare.

Delirium, as a fymptom of fever, engages much of his attention; and his difcrimination of febrile deliriun, as diftinct from mania, is clear and fatisfactory. Of this fymptom he thinks there are two kinds; one a derangement of the mental powers, without any affection of the brain, from the cause of fever itself; the other attended with, and perhaps occafioned by, fullness of the veffels. This diftinction is highly probable; but we would with to imprefs very strongly, on the mind of the young practitioner, that local fullness of the veffels is more common, in fevers, than has been usually fuppofed; and perhaps even the other kind may equally yield to topical evacuations.

Crifis, in Dr. Fordyce's opinion, feldom takes place in this climate; but he confiders crifis, too ftrictly, as a termination of fever, following a more severe exacerbation. The idea which we have entertained, and endeavoured to inculcate, is an amendment, a melioration of fymptoms, on fome days rather than on others, fometimes preceded only by a more fevere exacerbation. In general, however, the writer admits critical days, particularly in warın climates, and explains them. according to the fyftem of Dr. Cullen.

The queftion, whether fevers fhould be left to their own course, or cut fhort by medicine, on the fuppofition that medicines of fuch powers exift, is left undecided. The author first treats of the plan to be followed, in the first cafe, and the remainder of the fubject is purfued in the fecond part of the differtation. He rejects the idea of the neceffity of expelling any fancied morbid matter, and believes with juftice, that, if the progrefs of a fever could be checked, it might be done with impunity.

In confidering the proper treatment of a fever, left to its own movements, he treats largely of the proper temperature to be employed, the food, the clothing, and every external circumstance. Thefe inftructions we with not to abridge; for we advite them to be read attentively in his own words. What he obferves with refpect to pure air (oxygene), we will tranfcribe without a comment.

The next thing to be confidered is, whether a different proportion of pure air would be better adapted to the refpiration of a patient in a fever, than that proportion which is found commonly in the atmosphere.

It is but lately that the proportion of pure air to the other

vapours contained in the atmosphere has been found ouf; it having been long known, however, that there were various other vapours mixed with it in the atmosphere.

Whenever any new and feemingly important fact has been difcovered, and especially if it cannot immediately be applied to any advantageous purpofe in mechanical or chemical arts, mankind in general, and very often even practitioners in medicine, conceive it must be applicable to fome medicinal purpose. Juft as an infant, allured by any thing which glitters in its eye, applies it to its mouth, fuppofing it must be likewife exquifite food; fo infants in medicine are dazzled with any furprising difcovery, and immediately employ it for the cure of difeafes, not confidering how extremely difficult an art medicine is; how fallacious experiments made in it often are, as has been obferved long ago by Hippocrates, and by what flow degrees valuable medicines have had their powers investigated; how long it was before the effects of the bark of the cinchona, of mercury, of antimony, were brought to light, as far as they are already known.

The author, therefore, conceives, that in fever it certainly is not at all known, whether the fever will go through its ordinary courfe better or worfe for the patient's breathing an atmosphere having a larger or lefs proportion of pure air. The other vapours which conftitute the remaining three-fourths of the atmosphere, may fome of them be noxious, and others of them may be breathed along with the proper porportion of pure air, without any detriment.' P. 174.

In fever, he allows no folid animal food; and it is added, with great propricty, that, even after a crifis, it should not be given for five or fix days. The appetite always returus fooner than the powers of digeftion. Every circumftance which relates to food and drink is detailed with accuracy and judgement. The whole which relates to the diet and external management in fevers is fo very nearly the fyftem of Dr.. Cullen, that the refemblance cannot be accidental only. Quo femel eft imbuta recens, &c.' has often occurred to us on reading thefe directions, and few can always diftinguish recollected ideas from those which are strictly their own.

On the fubject of purgatives, we confider Dr. Fordyce as too timid. We obferve, indeed, that he is treating of fever, left to its own progreffive movements, and that he speaks only of the evacuation of the alimentary canal. We have found, however, the inteftinal tube in these cafes peculiarly torpid; and it is as neceffary to evacuate the biliary fyftem, as the canal, to avoid increafing the fever by adventitious ftimuli, which can only be done by fuch medicines as our author is inclined to reject.

Of uting opium in fevers, he is very cautious, and feems to prefer giving finall quantities, at diftant intervals. Other fedatives feldom procure fleep, though our author appears to except

Hoffman's anodyne liquor. The effects of this are, however, confcffedly uncertain. Under proper management, we have feldom found opiates difagree.

As means of fupporting ftrength, our author rejects blifters, the various stimulants, and what are called the warm gums. He admits only wine.

The fecond part of this differtation relates to medicines employed for the cure of fevers, or rather fuch as are calculated to leffen the force of the paroxyfm or render the crifis more perfect. This, in our author's opinion, cannot be effected either by general or topical bleeding. The effects of this remedy we had occafion to notice very fully in our account of the remittent of Philadelphia, and then endeavoured to reconcile what appears to have been, in the hands of fome ́ practitioners, a fuccefsful remedy, with the feemingly oppofite nature of the difeafe. Dr. Fordyce rejects this remedy with too little ceremony. He fhould at least have noticed practitioners fo refpectable as Dr. Ruth and Sydenham, if he flighted the fentiments of Dover.

Purging is equally rejected as a mean of stopping the dif eafe; and the ufe of the remedy is limited to the evacuation of the intestinal canal. Our experience has led us to a different conclufion; and, though we allow that purgatives occafion relapfes, we have more than once feen them, if given within forty-eight hours of the attack, check the progrefs of the difeafe. From a very fœtid ftool after the ceffation of fever, feveral women in neighbouring beds of a hospital ward were affected with fickness, &c. At the febrile period, the following, or next fucceeding evening, three of these fhivered. They had immediately a proper dofe of ipecacuanha; and á fmart laxative was ordered for each the next morning. The vomit had nearly the fame operation in each; but the laxative, in one, failed of producing a confiderable effect; and that perfon only experienced a continuance of fever, which went through its course, though mildly.

Antimonial preparations engage much of our author's attention; and this part of his work contains many fubjects of curious refearch. If Dr. Cullen, as Dr. Fordyce afferts, was the firft eminent phyfician that publicly recommended antimonial medicines, his memory thould be treated with high respect, and he should be ranked among public benefactors.

Dr. Cullen conceived, that the effect of preparations of antimony arose from their producing fick nefs. Tartarifed antimony is much more certain of producing ficknefs, than any other preparation that was known to him; it was therefore preferred by him, and of courfe that preparation of antimony which pro duced fickness in the fmalleft dofe he considered as best,

The author is of a 'different opinion to wit, that it is not the

fickness produced by the preparations of antimony, that has the effect of carrying off fever immediately, but fome other operation of the medicine.

• First, because there are many other remedies which produce fickness to as great a degree as any preparation of antimony; yet thefe have no power whatever of making fever terminate fooner than it would if it was left to purfue its own course. The root of the fquill, for instance, often produces fick nefs to a much more fevere degree than any preparation of antimony, yet it has never been alleged, that it has the power of carrying off fever fooner than it would go off, fuppofing that it was allowed to purfue its ordinary progrefs. Moreover, the author has frequently exhibited the root of the fquill as an emetic, and likewife in fuch dofes as to produce naufea without vomiting; alfo in fuch doses as just not to produce naufea, without ever producing any thing fimilar to the appearances which take place in a crifis of fever, or without ever once occafioning a fever to terminate fooner than it would have done if left to purfue its own courfe. In fo far, therefore, the author must conclude, that the fickness occafioned by the exhibition of a preparation of antimony is not the caufe of its carrying off fever.

Secondly, the ftomachs of different men, though they are otherwife in the fame fituation, are affected differently by the fame quantity of any particular medicine: the ftomach of dif ferent perfons, or of the fame perfon at a different time, being able to bear a larger dofe without its producing fickness or vomiting.

Almoft every medicine given in a certain dofe will produce fickness and vomiting; even opium, if given in a certain dose, that is, to the quantity of two or three grains, will fometimes produce fickness and vomiting, and fometimes purging.

When a medicine is given in fuch a dofe as to produce vomiting, it often lofes its peculiar effect. The bark of the cinchona, when given in such a dofe as to produce vomiting, either from the difpofition of the ftomach of the patient not to bear fo large a quantity as the ftomachs of men will generally bear, or from its being exhibited in a larger dofe than common, will often fail in putting a ftop to the progrefs of an intermittent fever. It may be faid indeed, firft, that the peruvian bark, by producing fickness and vomiting, will be thrown out of the fton ach before it has time to be abforbed and carried into the bloodvetiels. But the author has fhewn in his Differtation on a regular tertian, that it does not put a stop to the progress of an intermittent fever by being carried into the intestines and abforbed, but by the impreflion it makes on the ftomach and inteftines. In the fecond place, it may be faid that the bark of the cinchona, by producing vomiting, is prevented from remaining a fufficient time in the ftomach to make its impreffion there; but the author has alfo fhewn in the fame Dillertation, that the bark of the cinchona exhibited half an hour before the beginning of a paroxyfm of a tertian intermittent, often makes fufficient impreflion to prevent the paroxyfm from taking place. It is often more than

half an hour after the exhibition of a dofe of the bark of the cinchona before it occafions vomiting; but when it does occafion vomiting, it often does not prevent the return of the dif. ease.

In like manner, ceruffa acetata given in a small dofe does not produce either vomiting or purging, but on the contrary a diminution of the peristaltic motion of the intestines, and not uncommonly a paralytic affection of them, and likewife of the extremities; yet when it has been by accident taken in a confiderable dose, to the quantity of a dram or two, as the author has seen in several cafes happen, it has produced both vomiting and purging, but no paralytic affection of the inteftines, or any other part of the body, has enfued.

The author therefore conceives, that when any remedy produces vomiting, it very often lofes by this effect its other operations on the fyftem, and that preparations of antimony, in like manner, if they produce vomiting, or even fickness, though no vomiting fhould enfue, lofe their effect in carrying off fever.

The author conceives, that every medicine given in too great a dofe acts as a fimple ftimulant on the part to which it is applied, and lofes its peculiar effects both on that part, and on the fyftem generally. Thus a moderate quantity of wine makes the ftomach digeft the food more readily than it otherwife would have done, but a large quantity of wine prevents digestion from taking place at all. A moderate quantity of fpice gives a feel of warmth over the whole fyftem, a large quantity of the fame fpice produces pain in the ftomach and coldness over the whole fyftem, and frequently ficknefs and vomiting. It would be too great a digreffion to enter fully on the maximum of the dofes of medicine; if the author fhould live to finish thefe Differtations, it is a fubject that he means to pursue.

In the third place, the author has obferved, when tartarifed antimony has been exhibited in fevers, that when the patient's ftomach could not bear a quarter of a grain of it prepared as has been faid, without producing ficknefs, it has happened rarely that it has produced any thing like a crifis, or in any way diminished or carried off the difeafe. On the contrary, when the ftomach would bear more than a quarter of a grain of tartarifed antimony, prepared in the fame way, and by the very fame individual procefs, without producing any naufea, it has very often produced critical fymptoms, or a complete crifis, fo as to carry off the disease. For thefe reafons, the author differs in opinion from Dr. Cullen, and believes it is not the fickness that has the power of producing a crifis, or any appearance of a crifis in a regular continued fever. P. 39.

As this fubject is of the utmost importance, we have given Dr. Fordyce's fentiments at length, and fhall leave it with a short remark. We believe that Dr. Cullen, in his later years, leaned to Dr. Fordyce's opinion, but gave the antimony in a naufeating quantity, with a view of being certain that the