Such is the view that would be taken by the great majority of practitioners of this kind of case, and their treatment, without doubt, would be correspondingly inert. And this is the true origin, in many cases, of typhus symptoms; of adynamic fever. The disease is allowed to take its own course; and the product of every fever, at a certain stage of its process, is adynamia: the physician does not perform his office; the disease advances; the restlessness increases; there is no sleep; delirium comes on; muscular tremor begins to be perceptible; the pulse rises; the sensibility diminishes; and stupor, if it be not already present, is close at hand. And now the disease, it is sufficiently obvious, is severe; now, it is admitted, it calls for a powerful remedy; and, now for the first time, the lancet is thought of. But the bleeding relieves no symptom; it increases some; the progress of the inflammation is not checked; the adynamic symptoms are more fully developed; the patient is more prostrate, and the fever, in all respects, of a worse character: the inference is, that bleeding is a most inefficient and dangerous remedy in fever; and this inference is deduced from experience; those who draw the conclusion, judge from what they see; they disclaim reason; they pretend only to understand and to respect the lessons of experience.

'I appeal to the attentive observer, whether this be not a faithful history of the progress and termination of hundreds of fever cases; whether such a history may not be recorded as of daily occurrence; whether what has been stated be not commonly the view, the practice, the result, and the lesson.

'I will not appeal to the different history that belongs to cases that are differently treated. But I do earnestly appeal to the pathology that has been stated; that, at least, is experience, and it teaches a lesson, which it is worse than foolish to despise or to forget. Every symptom just enumerated, has been detailed over and over again in the cases that have been laid before the reader: inspection after death must have made the conditions of the organs, as indicated by those symptoms, familiar to his mind. Of what avail can bleeding be, when the patient is brought into the condition which first excites alarm, in the case here supposed? The blood is no longer in its vessels; it is beneath the membranes, or in the ventricles, or at the base of the brain; the inflamed capillaries have done their work upon the cerebral substance and upon its membranes; and have left proof enough of their activity, in the thickening of the one, and the softening or the induration of the other. What can blood-letting do in this state of the organs? What can shaving the head, and applying cold do? What can blisters do? What can purgatives do? And above all, what can wine do? Nothing can be done; at least, nothing effectually or certainly. pp. 388, 390.

And, surely, it is a sad and unenviable spectacle which the physician, who has trifled away the period for activity, is doomed to witness when his patient arrives at the last stage of fever, with danger undiminished, and symptoms unrelieved. YOL. XII.-Westminster Review.

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Prostrate and powerless, with every nerve unstrung, with every member paralyzed, with every function woefully deranged; without strength to resist death, and too weak to encourage treatment, the unfortunate sufferer lies insensible to his fate, and the practitioner, infatuated by the plausibilities of a system which he can neither defend nor understand, ascribes all to inveterate debility, and heaps upon this scapegoat the conse quences of his own doctrines.

If, then, in nine cases of out ten, in the present fever of this country, the first stage is unmarked by any such debility as should sanction the use of stimulants, if the debility, which is dreaded in the last stages, may in nine cases out of ten be prevented by early and proper treatment, and if the debility, which will infallibly occur in the last stages, if such early and proper treatment be not adapted, is in nine cases out of ten beyond the efficacy of stimulants, does it not follow that little can, little ought to be expected from a system of treatment, which has stimulation for its favourite if not exclusive objects from first to last? But further still; if in nine cases out of ten the present fever of this country betray such symptoms of excitation at the commencement as denote activity, if this activity be what we have to fear in nine cases out of ten, and if the debility, the only formidable debility, which exists in nine cases out of ten, be a relic or result of this activity when neglected or unsubdued, does it not follow that stimulants must be greatly and generally injurious, if employed at the commencement, and that they must naturally promote that state of apathy and nervelessness which it is so desirable to prevent, because so difficult to remove?

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In thus speaking of unmixed stimulation Dr. Stoker's custom of applying a few leeches to the temples "when the head is particularly engaged" is not forgotten; nor that of the application of leeches to the arms with the same view he " reports most favourably." If this can mitigate the offence of stimulation it were cruel to deprive him of the use of it. But, when we find these directions shielded within the following cavete, that, "although topical bleeding is a remedy of paramount importance in those tendencies to unequal distribution of blood in the system, which sometimes occur when typhoid and inflammatory fevers are combined, as well as indeed also for those local inflaminations which so frequently succeed the partial turgidity of blood-vessels which then takes place; yet I feel it my duty on an occasion like the present, to state, that for several years past, but particularly since our epidemies have assumed so pestilential a character, local abstraction of blood has not appeared to me so

frequently applicable for the relief of the symptoms as it had previously been," and when we find the doctor forcing upon us his views and treatment as suitable to London, it cannot be thought strange should we entertain a very indifferent notion of this leeching plan. In many instances topical depletion is very highly beneficial and ought not to be dispensed with; but in many more instances its employment will only interfere with the adoption of an equally safe and far more effectual remedy.

But, while endeavouring to expose the practice of stimulation in fever, it must not be concluded that stimuli are never necessary, and that depletion is always useful. To each of these views we are equally opposed. Čases will occasionally occur in which bleeding to any amount or by any mode, would be certainly destructive; and cases do frequently occur, the mildness of which renders it unnecessary. Where the symptoms are moderate, the excitement trifling, and no pain is particularly complained of-where spare diet, gentle aperients and cooling diluents are all the remedies which are necessary-where, in short, to do nothing is the best treatment-then it were only to make a wanton waste of vital fluid either to leech, or bleed. The duration of the attack can be seldom shortened by it, and the convalescence of the patient it will merely protract. Again, where the constitution has been worn down by age, or wasted by disease where the mind has been unnerved by sorrow, or exhausted by fatigue-where the exciting cause has been peculiarly active, and the powers of life have been suddenly overwhelmed, depression and debility may reign from the first moment of complaint to the last hour of existence; and, in all such cases, even active purging, not to mention bleeding, would be ruinous. Indefinite and indiscriminate depletion is most destructive treatment. Stimulants and tonics must occasionally be tried, and the quantity employed must be measured by no other criterion than their effects.

But instead of bleeding, the proper remedy may possibly be the very reverse: it may be requisite to afford a stimulus. The change of structure produced by the inflammatory process may not have proceeded to such an extent as to be absolutely incompatible with life; but the powers of life may be so exhausted by the inflammatory excitement that, unless aid be brought to them, they will be overpowered, and sink afford them appropriate aid, and they will rally, and, although slowly, ultimately repair the lesion which the organs have sustained.

This is precisely the condition, and perhaps it is the only condition, under which stimuli are really beneficial in Fever. Whenever such remedies are indicated, the vascular action is weak, and there appears to be a want of due supply of arterial blood to the brain.

Of all stimuli, wine or brandy is the best. If it be doubtful whether a stimulus can be borne, or will prove beneficial, a few ounces of wine may be administered. It will soon be manifest whether it be the appropriate remedy. If the restlessness, the heat, the delirium increase under its use, it will be obvious that it cannot be borne; if, after some hours, no perceptible impression be made upon any symptom, it is seldom of the least service, given to any extent, or persevered in for any length of time. If it be capable of doing any good, some improvement in the symptoms is commonly perceptible in a few hours after it is first administered. Sometimes that improvement is sudden and most striking; more commonly it is slight, slow, but still easy to be seen. If the pulse become firmer, and especially slower, the tremor slighter, the delirium milder, the sleep sounder, the skin cooler, and, above all, if the sensibility increase, and the strength improve, it is then the anchor of hope. It will save the patient if it be not pushed too far, and if it be withdrawn as soon as excitement is reproduced, should that happen, which it often does.

No certain indication for the administration of wine can be drawn from one or two symptoms alone: neither from the state of the pulse, nor of the skin, nor of the tongue; neither from the tremor, nor from the delirium. There is an aspect about the patient, an expression not in his countenance only, but in his attitude, in the manner in which he lies and moves, being, in fact, the general result, as well as the outward expression of the collective internal diseased states, that tell to the experienced eye when it is probable that a stimulus will be useful. Depression, loss of energy in the vascular system, as well as in the nervous and the sensorial, indicated by a feeble, quick, and easily compressed pulse, no less than by general prostration, afford the most certain indications that the exhibition of wine will be advantageous and if the skin be at the same time cool and perspiring, the tongue tremulous, moist, or not very dry, and the delirium consist of low muttering incoherence, these symptoms will afford so many additional reasons to hope that it will prove useful. On the contrary, if the skin be hot, the eye fierce or wild, the delirium loud, noisy, requiring restraint, and the general motions violent, it is as absurd to give wine, as to pour oil upon a half-extinguished fire, with the view of putting out the yet burning embers.

When wine is indicated, but does not produce a decided effect, brandy may be substituted. I have seen no benefit arise from giving either in large quantity. When the condition is really present in which alone it can be useful, a moderate quantity will accomplish the only purpose it can serve. In every other condition, wine may be administered to any extent, (and I have given half a pint every hour) until the stomach return it, by vomiting, without the slightest impression being made upon the disease, or any, or scarcely any, upon the system. The malady is in possession of the seat of sensibility; it has destroyed the organ; it has abolished the function: what advantage can result from the application of stimuli?-The spirit that could feel

their impression, and answer to it, is gone: organs destroyed by overstimulation, cannot be regenerated by the application of additional stimuli: the apparatus is broken; the wheels are clogged the obstruction lies in that part of the mechanism in which the main power that works the machinery is generated; that obstruction cannot be removed; the movements of the machine must cease. Even when the case is not thus utterly hopeless, wretched is the physician whose only dependence for the safety of his patient is in wine.'-pp. 389, 391.

All this is intelligible, all this is rational. But when we are told by one that bark can cure continued Fever, the continued Fever of London, nearly, if not quite, as certainly as it can cure ague, and by another that venesection is not called for in nine cases out of ten of Typhus Fever, and by a third that transfusion of blood into the systems of those labouring under Fever is a promising resource, what are we to think or say when we look at Doctor Smith's 100 dissections, and see nothing strewed over the bodies of the dead but vestiges of inflammation and proofs of activity!

I may state from my experience, that small quantities of wine, diluted with water, according to circumstances may be often given advantageously, even at the commencement of malignant Fevers of a decidedly typhoid character. In most cases, therefore, of that kind, especially such as I can ascertain to have been produced by contagion, I have prescribed from the commencement, from two to four ounces of wine, diluted with water; this to be given in divided portions, in the course of twenty-four hours; commencing from the time the patient was placed under my care; but the quantity and the time to be regulated by its effects; e. g. if found to excite distress, the interval between each dose to be increased, and the succeeding dose to be diminished; and mutatis mutandis, to administer it more frequently, and in larger doses, according to the urgency of circumstances. thus administered, need not interfere with such evacuations, as are deemed necessary in typhoid Fevers. The due evacuation of the bowels should be attended to at the same time; and in mixed cases of Fever, where the urgency of symptoms of inflammation, local or general, demands local or general blood-letting, I often find the cordial support of wine to promote the beneficial effects of such evacuation, and to counteract the consequences that would otherwise succeed.

Wine

It is of the first importance, however, in determining on the early employment of wine in Fevers, to ascertain whether they are or not decidedly of a typhoid character; and this is so difficult, during the first three or four days from the attack, that I have rarely ventured even on the small quantity just mentioned, excepting in cases attended with positive signs of debility, or such as I know to be the consequence of exposure to contagion. In such cases, indeed, I have found it highly beneficial, in relieving headache, tendency to delirium,