his fubject, or on his plan propofed in these quotations; to which, by the way, he has not adhered.

The obfervations are contained in seven sections, the titles of which are, Blood-letting, Emetics and Purgatives, Sudorifics, Blifters, Stimulants, Sedatives, Tonics, or Strengthners. We fhall not stop to fhew on what irregular and improper principles, if there is any principle obferved, the individuals of thefe claffes are affociated.

We shail prefent our readers with an analyfis of the first section, on Blood-letting. After a definition of blood-letting, an incompleat, inaccurate and unneceffary enumeration of the effects of blood-letting, we have much unneceffary verbofity and theory, with refpect to the effects of blood-letting in inducing plethora; which is given as an inftance of the bad effects of unneceffary ufe. We have not lefs than ten or twelve pages to prove that V. S. induces plethora, and renders a repetition of the evacuation neceflary, a fact proper to be noticed in making a compleat enumeration, but fo well known both by phyficians and patients, that it might have been quite fufficiently difcuffed in a single page.

The author treats next of V. S. in the Synochus of Dr. Cullen, after much needlefs remark on the hiftory of the difeafe, and ftating the bad confequences of the neglect and too liberal use of V. S. he relates the circumftances which are to guide the phyfician in this part of practice. This disease is not, as the author fuppofes, to be confidered as one which "affords a very ftriking but a lamentable inftance of the abufe of medicine." For the disease is treated of by fo many popular writers, and those in the English language efpecially; and the effects of bleeding fo evident, that the abufes which he reprefents in fo ftrong a manner are imaginary. But were his obfervations on this part neceffary, we fear the practitioner will not be well directed by the confiderations here ftated. He will be at a lofs to conceive what concurrence of thefe circumftances fhall determine his conduct; and if he wants information in this matter, we must also suppose him ignorant of the degree of dependence he is to place on each. Therefore, had the abuses exifted, as the author imagines, no remedy is here difcovered. It is well known that the circumftances which are most effentially neceffary, to determine our conduct of bleeding in this disease, are the state of the heart and arteries, and symptoms indicating topical inflammation, and the general ftrength of the fyftem accompanying thefe. The prefence or abfence of hardness, efpecially if joined with frequency and ftrength, therefore, fhould have been pointed out, as one of the very principal circumtances to guide us, with, at the fame time, attention to the ftrength

X 4

ftrength of the fyftem in general. The fame fhould have been faid with regard to topical inflammation, when it occurs joined with frength or weakness of the whole fyftem. The other confiderations which he enumerates, thould have been stated as of lefs moment, but nevertheless to be attended to. Thus by merely ftating the author's own remarks differently, a clear guide would have been given, and much writing fpared. The author omitting what we conceive to be the principal abuse in this cafe of fever, proceeds to another fubject.

The abules of which, the Author complains, are fo amply guarded againft, by the writers from whence thefe obfervations are drawn, that a very few remarks would have fufficed; but the abuse of administration of this remedy is the one leaft attended by thefe writers, and of which we have the moft frequent examples in practice. The object of bleeding, in one cafe here, is to produce temporary weakness, not any lafting or permanent weaknefs, if poffible. For as the fever is a disease that naturally exhaufts the ftrength of the system, by which means numbers are deftroyed; and as this diminution of strength, is not only in proportion to the fymptoms, but to the duration of the difeafe; when bleeding is indicated, many writers of the first rank, and practitioners not attentive to thefe circumftances, often remove the prefent symptoms, but weaken the fyftem fo permanently, that the patient dies in the progrefs of the fever, merely from want of ftrength to ftruggle with the difeafe; whereas, by a different mode of adminiftration, the symptoms which pointed out the neceflity of the evacuation are removed, as effectually, and without inducing the dangerous confequences above related.

Sometimes the fever will difappear, and the patient be deftroyed by the debility produced by the imprudent adminiftration of bleeding. In this cafe the friends of the patient, and often the phyfician himfelf, is totally ignorant that thefe fatal confequences arife from the above caufes, and that they might have been avoided by attending to the mode of producing the evacua tion. It is fact that cannot be doubted, that a certain quantity of blood, evacuated by a large orifice, fuddenly will weaken to as great a degree, as perhaps twice the quantity drawn from a fmall orifice flowly, and in a much longer time. But the debility in the first cafe is of much shorter duration, and in the latter, though not in a greater degree than the former, is only in a much longer time, and with more difficulty removed.

Another part of the adminiftration equally neceffary to be mentioned, becaufe little attended to, and of very great importance, is likewife omitted by this writer. This is the time of the diteafe in which the operation fhould be performed. The fever is

a difeafe

a disease confifting, almost always, of repeated paroxyfms, each of which likewife generally is attended with remiffions and exacerbations, and often of three parts called fits or ftages. Now the effects of blood-letting, are very different as performed in the different periods of each paroxyfm, fo that at one time of it it may be highly ferviceable, at another extremely hurtful. Omitting the inftances of abufe in intermittent, remittent, inflammatory and nervous malignant fevers, with their endless complications and varieties, for what reafon we know not; he proceeds to his obfervations on this fubject in local inflammations, viz. of the eyes, throat, pleura and lungs.-His remarks, as we have before said, are fenfible and judicious, but in this part liable to the cenfures of the fame kind, as the former part. He then tells us he cannot stop to treat of the abuse of this remedy in external inflammations, whether cryfipelation or phlegmonic, or in the other inflammations of the thorax and abdo.men. We cannot help remarking how injudicious the Author is here, in the choice of the difeafes on which he treats of the abufe of blood-letting. Thefe diseases on which he is filent, are not like the former, treated of fully and clearly by the best and moft common English authors, but are by no means generally understood by practitioners, and the practice established by writers that are commonly in their hands. The Author would therefore have performed an acceptable fervice, by collecting the obfervations on these diseases that are scattered in the writings on phyfic, and which are not commonly read, and from thence pointing out the conduct with refpect to the cure; inftead of leaving the practitioner at prefent in a state of ignorance, and therefore frequently committing abufes in the treatment. On another account fome of thefe difeafes fhould have been objects of remark. The various methods to which he alludes of treating eruptive inflammations are but little known. He should

therefore have ftated to the public, what experience has yet taught with regard to this matter, and thus the world might be in a capacity of afcertaining the most fuccesful method of treatment. On the acute rheumatifm too he is filent, though there are many abufes committed for which practitioners, have not the remedies fo fully and clearly pointed out as in the diseases he has treated; befides that there are fome abufes discovered by practitioners, and established as fuch, though they have not been as yet published, with which we muft fuppofe our Author acquainted.

But there is a very common inflammation, one very fatal in its confequences when neglected or improperly treated, on which there is very little written; it is generally neglected or miftaken, yet when attended to and treated properly is eafily

cured

cured. This disease, we fay, the Author has not fo much as enumerated, though we maintain there is not a more common and lamentable example of the abuse of medicine, to be found in the fyftem of phyfic.---It is the inflammation of the cellular membrane, lying under the pfoas mufcle; this difeafe from neglect or mistake, is almoft always allowed to proceed to fuppuration which is very often fatal, but there is no disease, perhaps, were it is diftinguished and treated properly, more certainly cureable; and that principally by blood-letting.

The next difeafe of which the writer treats is the Gout, on the hiftory of which, we have about eight pages of very good obfervations, and equally foreign to the author's profeffed defign--After this, follows the Meatles, omitting the other eruptive difeates, though certainly affording equal inftances of abufe.---To this fucceeds one difeafe only from the claís of hæmorrhages, viz. uterine floodings.It is juft neceflary to remark here, as affording a good enough example of one of our cenfures, that the Author does not diftinguifh in many cafes the difference of caufes of the difeafes, though requiring an effentially different method of treatment.---Of the Profluvia of Dr. Cullen he speaks of one difeafe, viz. Catarrh---He then comes to what he most unphilofophically calls Nervous Disorders; thefe are Epilepfy, Hysteric Affection, Melancholy and Madness, which clofe his firft fection. Among the moft valuable of this Author's Obfervations are the following.

*

"With refpect to epileptic and hysterical diforders, it is obferv able, that among a variety of predifpofing caufes, two are principally to be guarded againft; I mean plethora and debility. Both often occafion a morbid mobility of habit, which tends greatly to induce thofe complaints. When the plethoric flate prevails, blood-letting is a promifing means of reliett, but when debility is the caufe of the difeafe, that evacuation always encreafes its violence. It is often difficult to draw the exact line of diftinction between these two oppofite caufes, which frequently approach each other fo nearly as to require the acuteft difcernment to afcertain with accuracy their separate action. An undiftinguishing practice in fúch cafes must evidently bear upon the face of it the plaineft marks of abfurdity. Yet fuch undiftinguishing practice is fometimes apparent even to the molt fuperficial obferver. Errors too in cafes fo obvious as hardly to leave room for the poffibility of a mistake in relation to the caufes of plethora or debility, have frequently been committed by drawing blood too freely or in too fmall a quantity.

Hyilerical complaints, even in the fulleft habits, may be treated with more moderate bleeding. But the epilepty, dependent on plethora, requires large evacuations, and admits of little relief from weak irrefolute practice.

Vid. Van. Swiet. Comm, in Aphor. p. 1075.

+ River. Prax. Med. cap. vii. p. 23. Poftea fi plenitudinis notæ appareant, aut æger fit fanguineo temperamento præditus, phlebotomia erit celebranda.

" One

"One diftinction I would further add. There are obvious reafons for believing that a part of the fyftem may be too copioufly supplied with blood, while the other parts are evidently under a ftate of inanition. Or in other words, the natural balance of the circulation may, in confequence of the occurrence of topical determinations of blood to particular parts, not be equitably maintained. Such a determination to the brain is on very jult grounds fuppofed by Dr. Cullen to be no unfrequent caufe of epileptic fits; though, at the fame time, the general system be neither strong nor plethoric. Thefe cafes unfortunately are very liable to be mistaken. But if the caufe be accurately afcertained, and a judicious method of treatment fpeedily adopted, the patient will fometimes find himfelf unexpectedly freed from the alarming attacks of fo terrible a complaint. In fuch cafes of topical congeftion in the head, with a feeble pulfe and great weakness, general bleeding cannot be ufed with impunity; but topical bleeding, prudently employed, is very conducive to the cure of the diforder. The management of fuch a cafe is fo extremely nice and difficult, that it need not raife our furprise to find the caufe of it frequently overlooked and neglected, till the epilepfy by habit is become irremoveably fixt."

Befides the abufes of medicines in adminiftration, of which we have related examples, there are other fources of abuse referable to the fame head, but these as well as almost all the others, this Auther has not attended to.---Such as the decayed or adulterated ftate of the drugs; their improper preparations; the inaccuracies of the apothecary; the mistakes and neglect of nurfes, &c. &c.

We should have expected that an author acquainted with the present state of philofophy, would not have formed conclufions and entertained hypotheses and theories on fuch erroneous principles as we find in this work, of which the reader will find evident inftances in perufing it for the purpofe we have pointed out. We shall not therefore trouble the reader with more quotations; but content ourselves with a fingle example. Speaking of the effects of volatile alkali, p. 227, among others we are told, inftead of being feptic or inducing putrefcency and diffolving the blood, it is proved to be antifeptic." Why is it antifeptic? Because we are told Sir John Pringle has found a few grains of it will retard or prevent putrefaction in a 3i or zii

Some years ago I had under my care a cafe of palfy, where there was the ftrongest evidence of topical congeflion in the head, and great emptinefs of the general fyftem. A lady, twenty-five years of age, who had led a very fedentary life, and whofe conftitution was extreamly weak, was feized with a pally on the right fide of her neck, in confequence of which her head continually inclined to the left fide. Her pulfe was very weak and irregular. Her appetite but indifferent. She was fubject to violent head-achs, and an uncommon pulfation in the arteries of the head, which frequently disturbed her reft. When the pulfation of the arteries in the head was the ftrongeft, her paralytic affection was the most troublefome. By the ufe of the bark, topical bleeding, bliftering, a moderate diet, and regular continued exercife, the was restored, in the space of three months, to a perfect ftate of health.

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