difeafes, or the endeavouring to generalize, or to ftrike out new and extenfive lights from, fingle and infulated facts; provided that the inquiry be conducted with caution, and founded on obfervation and experience. Indeed the refult of his own ingenious inveftigation of the nature of the putrid acrimony, which terminated in the deriving it from the avolation of the fixed air from bodies, together with his thecretical deduction from thence of a probably fuccefsful method of correcting it, and his practical application of the doctrine to the cure of the putrid or fea fcurvy, furnith us with an appofite proof and example of the extenfive advantages which may be derived from medical theory; though it has been fo much abused by the vifionary and the unfkilful.

The third and fourth books are employed in the arrangement of diseases, in the manner above fpecified. In the latter particularly the Author explains the nature of the feveral difeafes, and in diftinct chapters gives the theory and defcription of each of the orders into which he had divided them: beginning with fevers, defcribing their general caufes, treating of their genera, crifis, &c. He obferves the fame method with regard to inflammations, fluxes, and the other orders above enumerated. In the fifth book he treats of the Semeiology; explaining the nature of the figns by which we are enabled to form a judgment either of the prefent ftate of a difeafe, or of the way in which it will terminate; difcuffing particularly the figns derived from the pulie, blood, urine, refpiration, eruptions, &c. The fixth contains a fummary view of the general means to preferve health; and in the feventh and laft of this first part of the work, is contained the general scheme of curing diseases; in which he defcribes the effects of the ufual means employed for that purpose, under the different heads of bleeding, purgatives, emetics, diaphoretics, regimen, &c.

In the fecond or practical part of the work the Author gives the hiftories of the feveral fpccics of difeafes, and lays down the proper methods of treating each. According to the intire plan it is divided into twelve bocks; nine of which only are here given, which relate to the nine orders of difeafes above ipecified. He next intends to proceed to local difeafes, then to the fexual, and laftly to thofe peculiar to infants within the period of dentition. With regard to this divifion of the work we fhall only obferve that, excepting that in fome parts of it the Author may be thought to be lomewhat too concife, it is executed with judgment; and that the history and treatment of difeafes are delivered in a fenfible, familiar, and perfpicuous manner; fo as to induce us to wish that he may speedily complete his plan, and put the public at length in poffeffion of a complete, rational, and well-digefted fyftem of phyfic.

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ART. IX. Commentaries on the Principles and Practice of Phyfic: Illuftrated by pathological Tables, and practical Cafes, &c. To which is prefixed, An Efay in the Education and Duties of medical Men. By James Makittrick, M. D. &c. 8vo. 5 s. 6 d. Boards. Becket. 1772.

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N this elaborate performance, the Author has endeavoured to explain the fundamental principles of the theory of medicine, and to place the practice of that art on a rational and folid foundation. In the profecution of this defign, a new and fcientific arrangement of difeafes is attempted, on a plan dif. ferent from that which forms the fubject of the preceding ar ticle, and which is chiefly founded on the fimilarity of the organs or functions of the human body that are affected by them; or rather on their fimilarity of nature, prognoftic, and indications of cure, independent of any confideration of the different organs interested in them. On a review of M. Sauvage's arrangement, the Author found that, in his fcheme, natural order had been in many instances very much violated; that his method of claffification was often founded on very remote fimilarity; and that difeafes were accordingly brought together under the fame clafs, order, and genus, that in their nature and method of cure are totally difcordant.' On a confideration of the fubject, the Author was led to an inveftigation of the caufes of difeafes (which indeed conftitute their mature and eflence') as furnishing the most proper foundation for a regular and fcientific clafcation. Accordingly under each cause he has placed all thofe difeafes that depend chiefly upon it. This fcheme of arrangement however, as he candidly and juftly observes, must in many instances be deficient in exactnefs, and is attended with great difficulties; not only becaufe difeafes generally depend upon feveral proximate caufes, but as they are likewife frequently changing in the course of the difeafe. Thus fever, he obferves, begins with rigor, the proximate caufes of which are diminished determination and progreffive motion in the hot fit, increased progreffive mosion and determination are the caules; and in the end, great irritability of the nervous fyftem, and languor of circulation, may be the predominant caufes.'-t will indeed, as the Author elsewhere obferves, require all the young reader's attention to trace the connection, amidst such a variety of caufes and effects

In his Preface the Author informs us, that he should probably have faved himself the labour of preparing this work for the prefs. if he had been apprized of Dr. Macbride's intention of publishing on a plan of this kind. He obferves, however, that there is a very confiderable diverfity in the execution, and that, as far as he can judge from a fuperficial view of the Doctor's book, he has been more explicit on the fundamental principles of prognoftic and practice.

mutually

mutually operating upon each other. A diligent ftudy of the whole plan will however, he flatters himself, amply repay him for his industry.

Of the arrangement of a work, every part of which is fo very intimately, and indeed almoft infeparably, connected with, and dependent on, the other parts of it, it is impoffible for us to give a regular or methodical account. We shall therefore extract the fubftance of two or three detached paffages, as fpecimens of the Author's manner of treating fome particular fubjects; or as containing his fentiments with respect to them: premifing only that this performance is written in the Aphoriftical manner; the propofitions being followed and illuftrated by remarks, accompanied with continual references to other propofitions, or to certain pathological tables, in which the causes, figns, &c. of diffeafes are enumerated and claffed.

Some of the moft ufeful parts of this work are hofe, in which the Author has drawn up, for the ufe of his young reader, fome short fictitious cafes, to which fome real histories are occafionally added; with a view to illuftrate his doctrines, and to point out and explain the proper indications of cure in particular difeafes. The following will be fufficient fpecimens of this ufeful mode of inftruction, by exemplification. They principally relate to fevers, are given under his order of difeafes arifing from Determination fuddenly diminished,' and are preceded by this propofition:

*

If the determination is but recently diminished, and the degree is flight, it may often be fo fpeedily removed, as to fhorten the difeafe, and prevent danger.'-To illuftrate this propofition, he fubjoins to it, among feveral others, the following cafes and remarks.

A has caught a flight cold, which is fucceeded by a catarrhal cough, pains of the limbs, and a mild degree of fever: if he makes ufe of warm diluting drinks, puts his feet and legs

* The Author very frequently in this work makes ufe of the term ♦ Determination,' and its different modifications; confidering and referring to them as morbid principles, or as the proximate causes of an immenfe variety of difeafes. Determination Juddenly diminished he defines to be fuch a fudden diminution of the diameters of cavities or orifices exdued with a contractile power, that neither the quantity, nor motion of their contents, are fufficient to render them so pervious as health requires. Further to explain it, he afterwards adds that every cavity, whofe fides admit of diftenfion and contraction, is fufceptible of this morbid change: fometimes it begins in the fuperficial veffels, as in rigor; fometimes in the inteftinal canal, as in fpafmodic colics, or nervous anxiety; fometimes in the heart, when acted upon by acrimony or fympathy; and fometimes in the voluntary mufcles, as in fpafms, or convulfions.'

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in warm water, lies in bed for 24 hours, and abstains from all ftimulating foods and drinks, a gentle fweat for fome hours will probably relieve him.

• Remarks on cafe A. In this and the fubfequent cafes, the determination having been lately diminifhed, there was reafon to hope, that it may be foon and eafily restored, and much danger thereby prevented. In cafes fimilar to that of A, many fevers have been removed, before they were completely formed, by gently opening the perfpiratory veflels of the fkin, and imme diately restoring that determination, the diminution of which produced the difeafe.

E is feized with a confiderable rigor, bilious vomiting and diarrhoea, accompanied with anxiety, head ach, and depreffion of fpirits; pulle low, quick, and weak, though he has confiderable heat and thirt: ordered a few draughts of warm water to wash out his ftomach, a fixed faline draught, and a clyfter of thin gruel; and direct that he keep his bed, and drink plentifully of warm acefcent drinks.

Remarks on cafe E. From the fymptoms of E's fever, it is not easy to determine precifely, whether it will be a bilious remittent, a putrid fever, or a common ague: it will therefore be prudent to obviate the most urgent fymptoms, and wait the iffue of a few hours.

F having attended perfons ill of a contagious fever, is feized with rigor, head-ach, naufea, vomiting, depreffion of fpirits, and a fenfe of giddinefs and weakness on attempting to raife his head from the pillow; his pulfe is weak and low: I order him a diaphoretic draught, with wine whey, after emptying his ftomach by a mild emetic.

Remarks on caje F. F's cafe we may prefume to be that of a contagious malignant fever; and the indication here is to difcharge the miafmata as foon as poffible; not only from the ftomach, but by the pores of the fkin; and thereby prevent its tainting the mass, or fixing on fome of the principal organs.'

In giving thefe fpecimens of his method of treatment in the preceding cafes, the Author's intention is to fhew the young reader, that he does not approve of interpofing by powerful means in the beginning of difeafes, unless the occafion is urgent; as by officioufly interfering with the operations of the conftitution, we may do irreparable mischief. cafions however, he obferves, when the fafety of the patient There are ocdepends on making ufe of effectual means, even in the beginning of the disease; and in diftinguishing thefe occafions accurately, a rational practitioner manifefts his fuperiority over igmorant quacks.' This reflection introduces the following propofition, followed by fhort fuppofed cafes, refembling the preceding; of which we fhall likewife give a fpecimen or two. • When

• When a difeafe produced by diminished determination is very violent at the first attack, or if it has continued for fome time, an attempt to restore the determination by the means recommended above will generally fail, and may often exasperate the difeafe.

• AA is feized with a rigor, fucceeded by a fever, he goes to bed, and drinks warm wine-whey to promote a fweat. This method, after a trial of 24 hours, does not fucceed, but his fever increases. If I vifit him at this time, I diffuade him from farther attempts to open the skin, but advise a gentle eccoprotic; and recommend dilution, quiet, and the laline mixture, and fuch remedies as may diminish the heat and progreffive motion; keeping the belly open occafionally.

•Remarks on cafe AA. The cafe of the patient AA is fimilar to that of A, only the fever is now formed; the means used being ineffectual, and perhaps injurious; therefore I deem it improper to attempt reftoring the determination by the fkin; for the increase of fever evidently fhews, that diminished determination which began in the fuperficial veffels of the skin, is now extended to the other excretions. His fever was fo moderate as not to demand bleeding; but the eccoprotics and neutral falts will gradually open the inteftinal and renal excretions; and the fever being reduced by low diet and dilution, I fhall wait for a fediment in the urine, which will fhew that the fpafms are refolving, and that by a judicit us attempt to open the fkin by mild diaphoretics, I may now produce a critical fweat; though an attempt to effect this before, especially by heating remedies, might have deftroyed the patient, at least protracted the fever.

BB, after a rigor, has a violent fever, ftrong full pulle, great heat, dry skin, and sparing high coloured urine. I order this patient to be bled plentifully, gently purged, and in the progrefs of the fever to be kept open occafionally; and that he thali ufe nitrous and other fedatives to keep the fever moderate.

Remarks on cafe BB. BB is bled immediately, and here it would have been very injudicious to delay a moment. By this and the other means I attempt to reduce it to a mild and fimple fever when this is done, I may, with fafety and fuccefs, attempt to open the skin, and promote a critical fwe.t.'

As a fpecimen of the Author's manner of thinking on a very important fubject, relating to and connected with the preceding extracts, we shall next give the fubftance of some of his obfervations refpecting the treatment of fevers. After a difcuffion of the flow and gradual method of treating this fpecies of dif orders, which extends no farther than to the paving the way for a crifis, by gently promoting an increase of those excretions. that are most fuitable to the genius of the fever; he proceeds to obferve that it may be fometimes neceffary to take, as it were,

the