numbered as one of the most elaborate. In the present part, a large space is occupied by verbal criticism and controversial explanations. When the other promised two parts appear, we shall probably present our readers with a summary of the whole.

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We can enter farther into the following (though likewise an unfinished) work, which belongs to the same class.

ART. XV. J. C. REIL, Lehrer zu Halle über die Erkenntniss und Kur der Fieber; i. e. Professor REIL on the Knowlege and Treatment of Fevers. Part I. The general Doctrine of Fever. 8vo. pp. 580. Halle. 1797.

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work of which this is the commencement must doubtless be acceptable to every reflecting physician. Dr. REIL proposes nothing less than to banish hypothesis altogether out of the doctrine of fever, and to found the treatment solely on an experimental knowlege of the disease. This, probably, is the only way by which the truth can be attained, either in the present important department of the healing art, or in any other.

In order to enable our intelligent readers to judge how far Dr. REIL has fulfilled his intention, it would be necessary to give a detailed account of the 28 chapters into which this his first volume is divided: but, as our limits preclude so extensive an analysis, we shall extract so much of the contents as will qualify the medical philosopher to judge how far the whole work is worth his study.

In referring, says the author, the individual phænomena of animal bodies, in a state of sickness or of health, to general laws, we come at last to the composition and form (or organization) of a peculiar matter, which we denominate animal substance. On composition and form, and their modifications, must the different modes of existence of an animal, the variations of his internal state, and therefore also his health and his diseases, ultimately depend. There are certain rules of form and composition which determine the health of individuals: but with the latter in itself we have no acquaintance. We only know it from its effects. The rules are as numerous as individuals. Disease is a deviation from the rule of healthy form and composition, by which the functions of the individual are injured. The former appear in nature and degree anomalous, and may be infinitely various: but we have no knowlege of that irregular chemical composition, by which the disturbance or injury is occasioned. It is only of the form or organization of the body, that anatomy gives us clear historical evidence; though its ultimate causes, as dependent on the activity of a peculiar substance,

substance, are unknown. We have, therefore, only a scientific knowlege of diseases, arising from a lesion of form. Of the -composition or mixtion of the body, and of all that results from it, we are entirely ignorant; and we cannot in course pretend to any scientific acquaintance with the diseases dependent on injured or altered composition. Our knowlege on this head is purely empirical.

Under this latter class of derangements, fever unquestionably ranks. Most probably, also, a fault in the composition of the solids and fluids is the cause of fever. Hence we can only have historical and no scientific knowlege on this subject: with that, for the present, we must content ourselves; and study fever empirically, according to its characteristics, its symptoms, its effects, and its remote causes. We must endeavour to introduce order into the chaos of febrile phænomena; to distin-guish the genera and species of fever, i. e. sets of symptoms constantly occurring together; and we must observe the relation of these genera and species to certain remedies. We must study complications and the counteraction of several fevers in one individual, with the consequent modifications of the powers of medicines, and thus discover the best mode of

treatment.

In fevers, we can perceive nothing but the external cause, (and not this always,) together with the injury of the functions which are its last effect. These we arrange, according as they depart from the healthy phænomena of the body, under the heads of excessive, altered, and defective actions of the economy. From these we infer correspondent lesions of the powers, and impute them, ist, to an increased susceptibility with proportionally increased power; or, 2dly, to an increased susceptibility with a weakened power; or, 3dly and lastly, to a decrease of both susceptibility and power.

This being premised, we define fever to be a preternatural change in the animal power of an organ, unattended by any correspondent sensible change of structure; the power being either unimpaired or weakened, with an increased susceptibility of those nerves and vessels which belong to the feverish organ. By the chemico-animal processes occasioned by this state, all the animal powers may be destroyed.

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Fever, therefore, pre-supposes a lesion of the powers of the feverish organ. This manifests itself by an increased susceptibility, as is seen in a too rapid action in proportion to the effect of natural stimuli: which is as much as to say that, in fever, the disturbed functions must arise from an internal disease resident in the feverish organ; which disease consists in a permanently increased susceptibility. No foreign stimulus,

the

the organ being healthy, can excite fever. The lesion of the animal powers in the feverish organ, together with the operation of natural stimuli, is quite sufficient to account for its injured functions; and the assumption of preternatural stimuli, or materies morbi, coursing about in the body, is therefore not only unnecessary, but for several reasons utterly erroneous.

After having assigned these reasons, which (we apprehend) will appear very satisfactory, the author proceeds in the developement of his theory.

Exalted or increased susceptibility, he informs us, may, in fever, be accompanied by a proportionally strong or by a diminished power; or else susceptibility and power may be both diminished together. In all the organs of the animal body, and particularly in those in which the vital power exerts itself most, we distinguish a two-fold exertion; namely, susceptibility and power. Though both these faculties are consequences of the particular composition and structure of the matter of which the organs consist, experience teaches that they are in some respect independent on each other, and that one may be affected without the other. Children and hysterical persons are very susceptible, but have little strength. Lunatics, on the contrary, with weak susceptibility, have great power.

Each exertion of the vis vita is therefore in a degree independent, and can be modified without the other. The injured composition of animal matter may, as the cause of fever, sometimes most influence the susceptibility, sometimes the power; exalting one without the other, or weakening the other, or both at once. Hence we may assume a three-fold diseased modification of the feverish organs as the cause of fever, viz.

1. An increase of the susceptibility, with a proportionally increased power.

2. Increase of the susceptibility with decreased power.. 3. Diminution or destruction of both faculties at once. These varieties of disordered vis vite we actually find in experience; and they commonly manifest themselves by signs sufficient to enable us to distinguish the one from the other.

At an inferior degree of lesion of the composition of animal substance, the susceptibility only is exalted, without any injury to the power: the latter is strong in proportion, or stronger than in the natural state. The actions of the feverish organs are in their nature unaltered; only that, in proportion to the stimuli exciting them, they follow too hastily.

more.

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At a greater degree of lesion, the animal faculties suffer The susceptibility is increased, but the power is im paired. The actions of the affected organ follow more quickly,

but but are feebler. Hence the actions become at the same time disorderly, and depart in respect to their nature from the rule of health. From a merely heightened susceptibility of the glands of the urethra, we have only a gonorrhæa benigna :but, if the power be disordered by venereal poison, the glands secrete venereal poison instead of bland mucus. If the susceptibility of the liver be only increased, too much-but healthy-bile is secreted:-but, if its powers be disordered, we have an acrimonious, green, thick bile. When the animal composition is deeply injured, we approach towards the highest lesion, which is complete paralysis. In the greatest degree of injury, the animal faculties can no longer be supported: they pass from one degree of paralysis to another, and at last to total annihilation; which state we call death.

On these distinctions are founded three genera of fever. 1. Synocha, or fever with exalted susceptibility and unimpaired power. It manifests itself by too hasty, but proportionally strong, actions in the feverish organ. 2. Typhus. In this the susceptibility is increased, but the power is diminished. The actions follow quickly, but without strength in proportion; and the transition to paralysis is easier. 3. Paralysis: in which the composition of animal substance is so far injured, that the faculties, both susceptibility and power, are reduced, and at last totally destroyed. The actions are here weak, slow, and at length fail altogether; first locally, and then generally.

Fever is not an absolutely general, but often a local disease; and as such it is not confined to any particular species of organ, but affects sometimes one, sometimes another. However, in all fevers, the nerves and blood-vessels which immediately belong to the feverish organ suffer at the same time. The reason is that the fever manifests itself in the feverish organ by an increased activity; and no actions of organs can take place without the co-operation of the nerves and blood-vessels, those important systems which preside over all chemico-animal processes. In many fevers, indeed, the whole sanguineous and nervous systems suffer: but this is not essential, nor universal. Each organ is in some respect independent, has its peculiar form and structure, its peculiar susceptibility, and can therefore by itself be affected by fever. Common language in this matter can decide nothing. In a scientific doctrine of diseases, we must not adhere to vulgar terms, but describe and distribute diseases according to their essence. Similar diseases, occurring in different organs, must not on this account be parted in our arrangements. The most common character of fever is increased activity of the feverish organ, from preternaturally increased susceptibility. Disease from increased susceptibility in the the hepatic system, having for its effect an increased produc. tion of bile; the same in the salivary glands, attended by salivation; or in the stomach, occasioning vomiting; are not essentially different from that disease of the blood-vessels which we commonly call fever. They have only their seat in different organs. They are therefore fevers; and while they exist, the rest of the body, even the vessels and nerves, (those excepted which belong to the diseased organ,) may be in a perfectly healthy state.

Neither has fever been fixed to certain organs. Physicians no where maintain that it is peculiar to this or that part; and supposing that they admitted of fever as applicable to certain organs only, they must exclude all affections of other organs;and what can the excluded organs be? Not the nerves: for, besides nervous affections, we reckon the disorders of the vascular * system particularly as fevers. Neither the vessels:for we call those disorders fevers, on which certainly all the vascular system does not suffer. Whence should arise saliva. tion, diarrhea, excessive secretion of mucus, nervous affec tions, cutaneous eruptions, which are reckoned among the varieties of fever? They are symptoms, it is said, not kinds of fever. Why, then, is a distinct species of fever established on the cutaneous eruption in small-pox? Symptoms are sensible characteristics and effects of fever, and therefore always depend on it. Phænomena which are self-dependent, and are the ground of a determinate set of symptoms (e. g. a peculiar state of a salivary gland occasioning a salivation,) cannot possibly be symptoms, but must be species of disorders. Lastly, local fevers, affecting part of the head, an arm, or an eye, have been observed; -and what are the disguised fevers (larvatae), which every physician acknowleges as fevers, but local complaints? They have their seat in single organs, in this or that nerve, in a branch of the vascular system, in this or that viscus. Yet they proceed as manifest fevers, pass into them, and the manifest pass again into the disguised.

On the modification of fever, according to the organs in which it occurs, depends its classification. A species of fever is a disorder essentially distinct from all others, and occasioning a set of necessary symptoms which occur in no other species. The species of fever depend on the modification of the genera by the peculiar organization of the parts which they affect. Hence, as many species are possible as there are organs capable of modifying genera. Nay, in an organ or system of organs, (according as the organ or system is com.

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* Is there any mistake here? If so, it does not lie with us.

REV plicated,