vomiting produces an increase of bile, pancreatic juice, &c. These evacuations (the author thinks) should rather be attributed to the fecond than the first stage of the fever, as it never happens that a fimple fever, or a paroxyfm of an intermittent, is fatal, if vomiting takes place.' P. 66, 67, apparent contraction of all the veffels of the body. P. 68, increased frequency of the pulfe, which fometimes does not happen till the fever has continued half an hour. P. 72, pulfe smaller and obftructed; a quality which he thinks he understands, but cannot explain. P. 80, pain of the head, most commonly over the eyes, and feeming to the patient external. P. 82, pain all over the bones. Delirium. P. 84, anxiety about the præcordia. P.86 -93, lofs of appetite, averfion from food, naufea, vomiting, thirst arifing probably from a particular affection of the stomach. P. 93, we find a fummary of the fymptoms of fever in the following words:

Fever in its appearances as have been enumerated, shows in its attack; depreffion of the powers of the mind; of the fenfibility of the organs of fenfation; of the exertion, and difpofition to be ftimulated in the body; contraction in the vessels throughout the system, which being either confined to, or greater in the fmaller veffels, occafions a larger quantity of blood to be accumulated in the larger vesfels near the heart; together with fome peculiar affection of the ftomach. These external appearances in this disease, seem so very independent upon one another, excepting the quantity of blood accumulated in the larger veffels in confequence of the greater contraction of the small ones, that they can only be confidered as fome alteration of the fyftem which has not hitherto been investigated. therefore, every thing that has been faid relating to the effence of this difcafe has only been conjecture following wild conjecture, to which the author does not mean to add.'

This definition, which is carelessly repeated at p. 102, is fucceeded by fome reflections on the different fenfes of the word fpafm. In allufion, probably, to a well-known hypothe fis, the author drops this reflection:

Converting the Latin word contraction into the Greek word fpafm, will not make the depreffion of the powers of the mind; of the fenfation; of the exertion of powers of the body; or of the dimi nution of the fufceptibility of being affected by external applications in the body, fo as to excite motion, or produce reft dependent upon the contraction; nor will it make the peculiar affection of the ftomach dependent on it.'

P. 103, the Doctor ftops to inquire whether he fhall proceed immediately to defcribe the fubfequent stages of the disease, which (though they depend on the attack,) are no part of its effence; or, whether he shall investigate the causes which produce it? He determines on the fecond mode of proceeding, and premises fome queftionable and fome trite reflections on

cause

cause and effect, p. 106. An apology for the latter is expressed in the following ftrong terms: He (for the third perfon is used throughout the treatife,) is writing for practitioners of medicine, not one in a thousand of whom ever thought of paying the leaft attention to the operations of the human mind!'

In his investigation of caufes, Dr. F. here paffes by what are called the proximate, and attends only to the remote: the first of which is infection. Some obfervations on this head will be thought curious:

• If a number of sheep be confined in a small space without fufficient circulation of air, an infectious matter is generated, which produces fever in them. Fevers also arifing in these animals occafion the formation of infectious matter. Of this the author had an opportunity of being well acquainted during the American war, when live sheep were attempted to be tranfported from England to America, and it was necessary to confine a number of them together in one ship. Although they were felected from flocks in perfect health, where they throve at fea perfectly when taken in fmall numbers to serve for fresh provifions for the officers, yet in many of the fhips where numbers were confined, an infectious fever arofe, even before they quitted the harbour. Whether it be that sheep are more fubject to produce infectious matter when many of them are confined together, or that it more frequently happens that many of them are oftener confined together in a small space, without fufficient ventilation, than quadrupeds of other fpecies; infectious matter is much more commonly generated in them than in any other quadrupeds that are known.

Live hogs were alfo attempted to be exported in the fame manner, and infection was produced among them, although not fo frequently. It would appear that the infection which produces fever either arifing from fever itself, or from numbers confined in a fmall fpace, in one fpecies of animal, is not capable of producing fever in another fpecies; for it happened, that when one fide of a fhip contained sheep, the other hogs, if a fever broke out among the sheep, the hogs were not affected; and that when fever broke out among the hogs, the fheep in many cafes were not at all infected, neither were the crews at all affected, being as healthy as the crews of other fhips making the fame voyage, loaded with different commodities.'

In reading the remarks on variolous matter, (p. 118-121,) we were furprized that Dr. F. fhould never have conceived the idea of diluting this matter with water. The fame reflection fuggefted itself to us on the perufal of his paper on the smallpox. (See Tranf. of a Med. Society.) We imagine that it would more easily and certainly contribute to the introduction of a small quantity of variolous matter than any other method; and confequently, if our author be right in the opinion proposed in that paper, it would be a moft beneficial improvement in inoculation. For this fuggeftion we have the farther fupport of experience in fome hundreds of cafes; and we could enumerate feveral

feveral places in which inoculation in the ordinary mode has of late, without any culpable negligence, proved uncommonly fatal.

In treating, p. 129-139, of fudden expofure to cold as a caufe of fever, it is ftated that, if a perfon remains in perfect health 24 hours after fuch expofure, no difeafe has been the confequence.

P. 139-149, of moisture. Whether moisture excites fever by producing cold, the author does not venture to decide: but that moisture, and, more especially, the moisture of a marshy country, is a caufe of fever, he entertains no doubt.

P. 149, of food. Food of difficult digeftion occafions relapses, but fcarcely ever original fever. P.151, certain paffions probably excite fever. P. 153, other causes yet unknown produce fever.-P. 157-9, there is no ground from experience to believe that any particular ftate of the fluids is followed by fever more than any other ftate. P. 160-70, neither bile, nor other fecreted fluids, nor heat, are caufes of fever. P.170-80, abstract of the doctrines delivered by the author in the paper mentioned above. P. 181, profecution of the description of fever.

The first attack of the disease may be fatal, in the firft, or any fubfequent paroxyfm.

When the first attack of fever has been fatal it has been claffed among fudden deaths, and all of these have been called very erroneously apoplexy or fyncopy. When fubfequent paroxyfms of the difease have been fatal, the expectation of the disease at a certain time has fhown it to be fever. The appearances, however, are the fame, both when the patient dies in the first or fubfequent paroxyfms, viz. fymptoms of depreffion of ftrength, contraction of the fmall veffels, and affection of the ftomach.

• When the attack is fatal it fometimes kills in five minutes, fometimes it requires half an hour, feldom longer than that time. While the patient is yet fenfible, violent head-ach with great fenfe of chilJinefs takes place, the extremities become very cold, and perfectly infenfible; there is great proftration of ftrength, fo that the patient is incapable of fupporting himself in an erect pofture; he becomes pale, his kin of a dirty brown, and he is foon infenfible to external objects; the eyes are half open, the cornea fomewhat contracted. If the patient goes off very foon, the pulfe is diminished, and at laft loft, without any frequency taking place, but if it be longer before he dies, the pulfe becomes exceffively fmall and frequent, all the appearances of life gradually fubfide, and the patient is carried off. Of this, the author has feen inftances, fometimes at the first attack, oftener in the returns of the disease, although but very few; he believes them to be much more frequent in warm climates, where the moisture of the country occafions intermittents, than in colder regions.

Since, when the attack of fever cuts off the patient in eight or ten minutes, the pulfe does not become frequent, it would feem that this frequency was not a fymptom neceffary to conftitute fever; for

if

if a difeafe fhould kill without a fymptom, that fymptom undoubtedly cannot be effential to the disease.'

P. 187, there are powers in the body which repel the fever when once produced; p. 184, horror and rigor are operations of these powers; after horror and rigor no patient is carried off by the acceffion of that paroxyfm; from his own feelings Dr. F. believes horror and rigor to arife from affection of the ftomach. P. 188, frequency of pulfe fhould properly be enumerated among the appearances of the hot fit. P. 189, increase of heat accompanies increafed frequency of pulfe, but is independent of it, because it bears no proportion to it. P. 191-3, an hypothetical explanation of these two symptoms, and of greater ftrength of pulfe, as proper to the fecond stage, is thus ftated: The fmall veffels throughout the fyftem being contracted, propel a larger quantity of blood upon the heart, which ftimulates the heart to make stronger exertions, and fo throw the blood with greater force into these contracted small veffels, force them open, and thus carry off the disease.'

After having obferved that no affignable alteration of the fluids takes place during the hot fit, Dr. F. employs several pages in examining the opinion juft quoted, which is nearly that of Cullen he declares partially in its favour, mechanical as it is, but adds that the increased action of the heart is far from being the only means of the natural cure of the firft ftage: ficknets (p. 200, 201,) is not a caufe that carries off the disease; yet (201-5) medicines, which can act on the ftomach only, thew that fome affection of this organ co-operates with the increafed action of the heart in carrying off the contraction of the fmall veffels but there may be other powers with which we are totally unacquainted. P. 206-8, the palenefs, contraction of the veels, and dirty colour of the fkin, difappear unequally; one arm, for inftance, fhall be red and larger, while the other is pale and contracted. Univerfal redness at length prevails in all cafes of fimple fever. P. 209-16, temperature of the body thermometrical ftate of its heat-increase of thirst-increase of reftleffnefs-inquiry concerning the causes of this reftJefinefs,-reftleffnefs occafioned not only by accumulation of blood near the heart, but by diftention of the fmall veffels throughout the body, and by an affection of the ftomach, as when difagreeable fubftances are lodged in this vifcus without producing naufea or vomiting. P. 216-18, delirium, with internal diftending pain of the head, ftrong pulfation of the temporal arteries, rednefs of the eyes, and Aufhing. P. 21820, duration of the paroxyfm and its parts. P. 220-38, crifis or termination of a fimple fever-fweating more or less profufe -nature of the exuding liquid probably not different from

healthy

healthy fweat. Urine, in cooling, depofits flaky chrystals of a dirty red colour; and this fo conftantly that, where they are wanting, the author would hardly hefitate to fay that the paroxyfm is not of fimple fever, but that it would recur, though all the other symptoms denoted a perfect crifis ;-mouth becomes moist; the cruft of the tongue falls off in a furprizing manner within an hour or two; and the process resembles the feparation of a dead from a living part of the body-fecretion of a larger quantity of faliva-fecretion of the alimentary canal increased-others return to their natural state-obstruction of the pulle goes off, but with very various circumstances-the frequency, fulness, and ftrength of the pulfe alfo go off: but the patient is left exhaufted-a fever, which compleats its course in 8, 10, or 12 hours, is fure to return if the least preternatural appearance remain after the crisis.—In a future differtation, the author proposes to point out the manner in which fimple fever is repeated fo as to produce all the varieties of the disease.

Notwithstanding that Dr. F. has kindly ferved up a little metaphyfical pap for readers of weak digeftion, he has neglected to lend them much other affiftance which they will equally want. His book has no divifions, no fummary of contents, no index. In feveral places, he will be found refuming a fubject which had been treated; and we have already noticed negligent repetitions. These circumstances must prove embarraffing. Whether he compofed his differtation piecemeal, and fent it to the prefs before it was finished, forgetting fometimes what he had already written, we know not: but it is certain that it wants much trimming, pruning, and pleaching. Moreover, if the next edition fhould contain fo many and fuch confiderable errors of the prefs, it might not be amifs to add a lift of corrigenda.

In difcriminating fever, there is not nearly fo much difficulty as in curing it, or in forming a probable judgment of the event. The pretenfions of different and even oppofite methods of treatment are not yet fettled to the public conviction. Of two apparently equal cafes treated alike, one fhall terminate in recovery, and one in death; nor fhall the phyfician be in the leaft able to account for the difference.

It is at all times ufeful to afcertain phænomena precifely; and to ftudy difeafes affiduoufly is the only way in which we can reasonably expect to extricate an art from fuch deplorable uncertainty. Strict obfervation, too, will oblige phyficians to relinquish the unprofitable trade of imagining caufes for imaginary effects-a trade which has perhaps been carried on by them longer than by any other clafs of philofophers. We

make