in common bilious fever, and also, those that belong to asthenic delirium tremens. Early in the disease, the former are the most conspicuous, but as victory must eventually be declared in favor of nervous irritation, the latter will generally obtain, in the course of four or five days, a decided ascendency. The length of time during which this struggle shall last, will depend almost entirely upon the remaining strength of the constitution. The energy of the constitution, and the predisposition to delirium tremens, exist in an inverse ratio.

The length of this pathological disquisition must be pardoned, on account of the magnitude and importance of the subject. Principles are absolutely necessary, to render the treatment of disease rational and scientific. The want of such, as are fairly deducible from a comprehensive view of the facts, has been sensibly felt by the author, in the treatment of the disease under consideration. It must be confessed, that we have been furnished with numerous very important practical precepts; but the most of them, either by an improper application, or injurious extension, have proved extremely deleterious. We may have utterly failed, but it was the desire of the author to prevent this in future, and to fill the wide hiatus, evidently existing, in regard to the pathology of delirium tremens.

[TO BE CONTINUED.]

REVIEW.

Art. I.—1. A Practice of Physic, comprising most of the Diseases not treated of in "Diseases of Females," and "Diseases of Children." By WILLIAM P. DEWEES, M. D., Adjunct Professor of Midwifery in the University of Pennsylvania, &c. In 2 vols. 8vo. Philadelphia: Carey & Lea, 1830.

2. A Treatise on the Practice of Medicine. By JOHN EBERLE, M. D., Professor of Materia Medica and Obstetrics, in Jefferson Medical College, &c. Philadelphia: John Grigg. In 2 vols. 8vo.

(Continued from page 176.)

Causes of Fever.-In the rage now existing among fashionable writers on medicine, to narrow the limits of speculation and inquiry to observations within the dissecting room, the etiology of diseases is much, if not entirely, overlooked. Nay, the existence of all causes which cannot be traced in their operations upon the gastric membranes, has been denied. Among these, malaria has been included, and the very possibility of epidemic influence, independently of sensible causes, acting in conformity to the direction of hypothesis, has been ridiculed. Stubborn facts, and the accumulated observations of successive generations, cannot so easily be put aside, or controverted. There is surely no subject more interesting to the philosophical inquirer, more important to the public health, or more conducive, not only to an enlightened pathology, but also to a judicious and successful practice, than investigations into the nature, extent, and mode of operation of the varying and numerous class of agents which develope diseases. Much research, extended observation, and a curious eye into the operations of nature, are requisite, and it must be allowed that these have not yet been repaid by all the rewards of discovery and knowledge,

so anxiously desired to unfold this department of science. But diligence will have its ultimate reward, and the physician should pride himself in ever remaining a student.

Dr. Eberle divides the "sources of morbific causes" into four classes.

1st. Recrementitious substances, which, in health, are separated and thrown out of the system, but being detained in the circulation, or re-absorbed, become a source of irritation to the sanguiferous system, and, therefore, of irritative fever. These causes are admitted to be always secondary, being the consequences of previous injurious impressions. All those cases of fever induced immediately or remotely by the influence of cold, as by check of perspiration, &c., owe their origin to the agency of this source.

2d. Irritating substances, generated within the body, but wholly independent of any organic actions. They are usually generated in the primæ viæ, as worms, acid and mucous secretions, &c. Our author does not ascribe so great an importance to this class of agents as former writers were wont to do.

3d. Morbific agents, generated out of the body, consisting either of deleterious substances floating in the air, or of the sensible properties of the atmosphere, or, finally, of mechanical causes, viz., miasmata, noxious gases, heat, cold, electricity, humidity, and mechanical injuries.

4th. Contagious, or morbific agents, generated within the body.

In tracing the peculiar effects of each of these agents, Dr. Eberle relates what is most familiarly ascertained in the present stage of medical science. Under the head of miasmata, he pays a just and merited tribute to the labors of Professor JOSEPH M. SMITH, of this city, evinced in his lucid work on the etiology of epidemics. But how comes it that he passes over in silence the subject of meteoration, which has been so fully treated of by the same enlightened author? Its importance entitled it to some notice in a systematic work. Its agency was recognised by the father of medicine, and believed to be so powerful as to deserve the name of To θείον. All accurate observers who succeeded him, have acknowledged its existence, and none after more mature study and reflection, than the immortal Sydenham. It would be difficult to explain the progress of some of the most devastating diseases, such as influenza, and at the very present time, of the Indian and Russian cholera morbus, on any other principle.

Critical days. We are happy to find Dr. Eberle directing the attention of students in this country to the doctrine, so

nearly, yet so unjustly, exploded, of the crisis of fevers. His observations on this subject deserve serious reflection; we, therefore, extract them at large.

Fever

"It may, I think, be assumed as a safe principle, that doctrines or sentiments, concerning facts which are objects of mere observation and experience, cannot be wholly erroneous or illusory, after having obtained the entire confidence, through a series of more that twenty centuries, of a vast number of as accurate and devoted observers of nature as have ever adorned our profession. Without professing a belief in the correctness of the doctrine of crisis, as it was taught by the ancients, and by many of the moderns, we may yet admit, on good grounds, it is conceived, that there exists a natural tendency in the operations of the animal economy, whether in a state of health or disease, to certain periodical fluctuations, which, under particular circumstances, manifest themselves in a way sufficiently conspicuous to exhibit an obvious revolution in the increase and declension of the morbid actions of the animal system. It was early observed that there are certain regular periods in the course of many febrile affections, at which prominent changes are wont to occur, preceded generally by a manifest aggravation of the symptoms, and followed or attended by certain evacuations. These evacuations, from their being almost always followed by an obvious abatement in the symptoms, were called critical, and were thought to consist of noxious or febrific matters, which were thus thrust out of the system by the sanative powers of nature. was supposed to be nothing else than an effort of nature to prepare and cast out of the system the morbific materials which disturbed the regular actions of the animal economy, and that the amendment which ensued was the immediate consequence of such eliminations of morbific matter. At the present day it is, however, more correctly maintained, that these critical discharges are the effects, and not the causes of the melioration which occur about the periods at which they take place; and that they are to be viewed rather as the first manifestations of a favourable change in the condition of the system, than as the immediate causes of such a change. That this is the correct view in relation to the nature of such discharges, there can, indeed, exist no doubt; but this view of the subject does not deprive it of its importance, and directs our attention rather to the periodical exacerbations and inherent tendencies in these maladies to terminate their course at one period in preference to another, than merely to the evacuations which are apt to supervene at such times. In no forms of fever, perhaps, are these tendencies to terminate at a certain fixed period more frequently manifested than in intermittents. There appears in these fevers a septenary revolution, which I have often seen verified in the most unequivocal manner. If an ague of the quotidian type be suffered to run on until it terminates spontaneously, the termination will almost universally occur, if it occurs at all, either after the seventh, fourteenth, or twenty-first paroxysms; and I have repeatedly found

that febrifuge remedies exhibited immediately after these septenary periods will arrest it with more certainty, and with much less liability to relapse, than when employed during any of the intervening intermissions. From the same inherent tendency, the relapses which are so common in this disease, will, in a vast majority of instances, occur about the septenary periods from the time of the last paroxysm, and most commonly about the eighth or fourteenth, and sometimes for several periods about the twentieth day."

"In order to understand the nature of crisis, every fever must be considered as having a tendency to some one of the principal types mentioned above. A simple tertian intermittent may be regarded as the elementary type of fever. In fevers of this type, an exacerbation or paroxysm and a crisis will occur on every odd day; and if we consider a continued fever as made up of tertian paroxysms prolonged and running into each other, or as possessing a natural, though countervailed tendency to the elementary or tertian type, there will, in like manner, occur more or less consider. able tertian exacerbations, with their accompanying discharges. From what has already been said concerning the manifest septen. ary movements of intermittents, the tendency of continued fevers to terminate on the fourteenth or twenty-first days, which can scarcely be denied, would seem to be in conformity to an orginal law of the animal economy under a state of febrile excitement.

The evacuations which usually accompany the crisis of fever are, 1. hæmorrhages; 2. a flow of sweat ; 3. an increase or changed character of urine; and 4. diarrhoea. Critical hæmorrhages are generally attended with an increased action of the heart and arte. ries, and often with a manifest determination to, and congestion in the part from which the discharge occurs. They must be regarded as mere manifestations of a previous change in the system, and hence this kind of critical evacuation cannot be substituted by an artificial abstraction of the blood; since, although blood may be abstracted, the peculiar condition of the action of the solids, which constitutes the actual crisis, or change to a favorable tendency, cannot be thus produced. Crisis, by hæmorrhage, is generally confined to inflammatory fever; or, more correctly speaking, to fevers attended with an increased activity and action of the heart and arteries. Critical hæmorrhages most commonly proceed from the nose, and according to the observations of many of the older writers, are frequently preceded by the dicrotus pulse, in which two distinct wave-like beats occur during each dyastole of the ar. tery. Immediately before the eruption of the blood, the carotids beat strongly; the face becomes flushed; sparks appear before the eyes; the eyes are red and suffused with tears; and, in some in. stances, frequent sneezing, and a thin watery discharge from the nostrils, occurs just before the hæmorrhage appears.

Critical sanguineous discharges have also been known to occur from the uterus, the rectum, and sometimes, though very rarely, from the stomach, and even from the external parts.