of the disease than its proximate cause; for when we find the intestines inflamed or gangrenous, we naturally inquire what was the cause of this. We find nothing peculiar in Mr. Marshall's TREATMENT, except his not giving mercury till it be probable that effusion of coagulable lymph has begun to produce a thickening of the intestines, whereas, by giving it sooner, he might probably have prevented this circumstance.

In three CASES of TETANUS from wounds, the author tried copious bleeding and large doses of opium in one, and enemata of tobacco in the others, withort any good effect. In the post-mortem inspections, there were no particular morbid appearances perceived, except a darker colour in the voluntary muscles: nothing to support the notion that tetanus is inflammatory.

The account given of EPIDEMIC CHOLERA coincides very much with that which is too well known in the profession to require us to be particular. He is decidedly of opinion that it is not infectious nor contagious. It was often fatal in two or three hours from the first attack,-a circumstance which would lead to the suspicion of some deleterious substance taken into the circulation, His TREATMENT was strong stimulants, to rouse the vital energies and recal heat to the system.

DR. PARK ON THE PATHOLOGY OF FEVER. *

DR. PARK is a clever, ingenious, and philosophic writer, and he would require to be all this in so hopeless a subject as the theory of fever, which has from the earliest records of the profession engaged the attention of most of its distinguished ornaments; but very unsuccessfully, as it would appear, for practitioners seem now to be as far from agreeing about the pathology of fever as they were centuries ago. New theories, indeed, we have in abundance, but none of them Newtonian-none of them eminent enough to drive their competitors from the field, and enforce the general consent. Of late it has been fashionable to refer fever to some local proximate cause. One very ingenious attempt of this kind has been made by Dr. Clutterbuck to refer

* The Pathology of Fever: being the subject of the Gulstonian Lecture, lately delivered at the Royal College of Physicians. By J. R. Park, M. D. Fellow of the Royal College of Physicians. Pp. 161. 8vo. London, 1822.

it to a morbid change in the vascular system of the brain. An other, which Broussais claims,-but with what justice we shall not now inquire,-refers fever to inflammation of the internal coats of the intestinal canal, or, as Broussais calls the affection, gastro-enterite.

Dr. Park's views we shall now briefly sketch, and leave our readers to bring them to the test of their own observation and experience. He has made his inductions more from observation than experiment, which has of late been, perhaps, too exclusively pursued in physiological and pathological researches. Observation, indeed, is much superior to experiment, in so far as it does not produce artificial circumstances, but merely records, when. accurately conducted, the operations and phenomena of nature. We do not, however, mean by this to depreciate experiment, it is often highly useful; but we think it wrong to trust to it exclusively, to the neglect of the endlessly varied experiments which Nature is continually carrying on under our eye. Dr. Park, however, while he avoids one extreme, is prudent enough not to run into the opposite, and in his Supplement examines the bearing which the able and ingenious experiments of Le Gallois, Dr. Wilson Philip, and Mr. Brodie has upon his pathology.

One of the leading principles of Dr. Park is, that there subsists a connexion of every function with, and an immediate dependance upon, the actual state of the circulation; and as every part has a different feeling and a different function, the same change of circulation will cause different effects in the various organs. That state of the vessels, for example, which occasions a sense of cold on the surface is attended by nausea of the stomach; that which causes external heat produces internal thirst; and that which produces great lassitude of the muscles produces confusion of ideas in the brain. Another of his general prin-. ciples is, that the laws of motion appear to be nearly similar in all moving organs, all having certain limits affixed to their powers, and all, in consequence of this limitation, being subject to periodical change of action. Another is, that whatever increases the ordinary exertion of the vessels, or augments their contraction, increases equally their subsequent relaxation when the exciting cause is withdrawn. Thus, cold applied to the Schneiderian membrane contracts the vessels, and produces watery discharge, which is followed by a sense of the vessels relaxing and producing a sense of fullness and heat.

This is precisely the way in which Dr. Park describes the cold and the hot stage of fever. The COLD STAGE may be regarded simply as a state of over contraction in the capillary system;' and the succeeding HOT STAGE, as the rebound of the same.

vessels into a state of relaxation and distension. The SWEATING. STAGE, again, is more properly a solution of the paroxysm, when the immediate cause ceases to operate. This CAUSE, Dr. Park. thinks, is in all cases a spasmodic constriction of the pores or mouths of the exhalent vessels, which are precisely similar to sphincter muscles. The action of these orifices, like that of ' sphincters, appears to be vicarious with that of their vessels, relaxing, when the vessel contracts, and, on the other hand, contracting when the vessels relax,-just as the sphincter of the bladder relaxes when it contracts to expel the urine, and contracts when the bladder, after micturition, relaxes In the hot. stage these orifices accordingly seem to be contracted while their vessels are distended, hence the transmission of perspiration; and in the cold state they seem to be relaxed while their vessels are contracted; and hence the cold sweat which usually breaks out, as it does also from collapse on the loss of blood, and on shrinking from fear.—This proof is all analogical and incapable of strict demonstration.

These states and changes are not, in fever, confined to any particular organ or part of the system, but are universal,—a position which our author shews some ingenuity in illustrating.. For example, the state of the brain may be learned from that of the eyes, which derive their blood directly from it, and accordingly the eyes are found to be of a leaden dulness in the cold stage, whereas, in the hot stage, they become red and fiery. . Previous to describing symptomatic fever, Dr. Park gives an account of INFLAMMATION, which, according to him, is an ineffectual struggle of the vessels to throw off a load which oppresses them, for the pain subsides when the struggle ceases, though at the same time the distention or swelling may increase. The efforts are unavailing in the inflamed and weakened vessels,. which remain distended; while in the healthy vessels, whose tone is unimpaired, contraction takes place, the blood is ex-' pelled, and the circulation diminished.

In slight local inflammation, these effects are local, but when' the inflammation is extensive, they reach to all parts, and a general contraction of the healthy vessels of the whole system" ensues, constituting the cold stage of SYMPTOMATIC FEVER. Dr. Cullen ascribed rigour in this case to atony or loss of tone, whereas it seems to arise rather from excess of tone. The hot stage, of course, follows from the law, that action is followed by relaxation. Fevers of this kind are most severe at the commencement, and assume the continued type from the permanence of the cause, the inflamed vessels keeping up the severity' of the fever, till their power is exhausted; and when this occurs, Ccc

VOL. IV. NO. XV.

the inflammation becomes chronic, and the fever subsides. The evening exascerbation and acceleration of the pulse results from the law, that mobility of the organs increases for a time with exertion; the heart, for example, increases in mobility as the diurnal period of its activity draws to a close.

In INTERMITTENTS there is no evidence of inflammation, and he reverts for the cause to the laws of irritation, which, when it is internal to the organs, excites increased action, and when it is external, diminishes or suspends it. In whatever way, then, the cause is received into the system, before its specific effects manifest themselves, absorption must have taken place; and the impression will then act internally to the vessels, and excite a general contraction of the capillary vessels, and thus a rigor or cold fit will be produced. In ague, the severity of the fit is greater, because the cause acts directly, and not sympathetically. The internal irritation is illustrated by the action of emetics and purgatives, which, for the most part, owing their influence to the irritation they occasion, excite increased contraction of the stomach and intestines; and sudorifics, which by first irritating the internal parts, stimulate the exhalent vessels to contract, and their sphincters relaxing in consequence, perspiration ensues. When the vessels become much emptied, or when the irritating cause is partially removed, an intermission of the fit supervenes.

With regard to continued FEVER, the only cause which he conceives adequate to account for the phenomena of TYPHUS is one that is primarily and essentially debilitating, owing its influence, not to the power of irritating, and thus exciting inordinate action, but to its property of becoming a part of the body by assimilation. That typhus proceeds from debility, he infers from its following unwholesome diet, depressing passions, confined air, want of cleanliness, the abuse of intoxicating liquors, or any habitual excess which impairs the tone and vigour of the body. Genuine typhus, uncomplicated with local affection, may be comparatively rare; and when there is no inflammation, there is little or no cold fit, and never a strong rigor preceding the attack. This arises from the cause not being calculated to excite a rigor, and from the vessels not being in a state to effect one. The chilliness which sometimes precedes typhus, accompanied by languor and debility, is widely different from the strong rigors of ague, and denotes rather diminished impulse in the blood than increased resistance in the vessels. The cause of ague and of typhus differ in this, that the former irritates, because it will not assimilate with the body, while the latter, being derived from the body, is homogenous, easily assimilates with the

body, and does not irritate. Dr. Park proceeds to confirm his views by examining the effects of REMEDIES in the three genera of fevers arising from the three causes of sympathy, irritation, and debility.

In symptomatic fever, then, the INDICATION is to reduce the force of the circulation, by bleeding and other modes of depletion. Bleeding is, indeed, almost a certain specific. In typhus, though more uncertain, it may still prove beneficial at the commencement to relieve the vessels of their load. The frequent complication of this fever with local inflammation renders this still more proper. In the more advanced stage of typhus, this practice would be fatal. Then the debility must be restored by tonics and cordials. The effect of the affusion of cold water, he thinks, strongly proves his doctrine. It often effects an immediate cure, by constrictiug the capillaries, and consequently relaxing their sphincters, and promoting transpiration. Bleeding acts in a similar manner, as Dr. Currie observed-(Med. Rep.) The remedies for intermittents are all found to be externally counter-irritant, thereby preventing the contraction of the vessels from taking place. It is thus that bitters and tonics act upon the vessels of the stomach, and their dose ought, in consequence, always to be large. The effect of the tourniquet, however, when applied in ague to the arm and thigh of one side, Dr. Park thinks the most strongly illustrative of his views, as it stops the fit, by arresting the blood, and preventing undue contraction.

Encyclopaedia Medica.

REFLECTIONS ON THE TREATMENT OF FRACTURES OF THE LOWER EXTREmity, and a Description of a New ApPARATUS; WITH CASES. BY J. AMESBURY, Member of the Royal College of Surgeons in London, &c. &c.

DISEASES have at all times claimed attention in proportion as they intefere with the comforts of social life. The nature of many of these is known, and the principles of treatment well understood. There are others, however, concerning the treatment of which there yet remains much disparity of opinion, and this disparity alone is sufficient to shew that there is, in these diseases, room for much improvement. This is the case in the