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to his head. Unable to sleep last night;pulse 90, full; tongue furred, but moist.Twelve leeches to the right elbow.

Vini colchici f. 3ss. 8vis horisOpii, gr. j., omni noete.

12. Pain in the right arm considerablybetter; in the left rather worse. Pain inthe legs more confined to the hams; tonguefurred and dry ; bowels open twice daily ;slept better last night; pulse 90, full.

13. Much as yesterday. Twelve leechesto the left elbow.

Vini colchici f. 3ss. 8vis boris.16. Pain in arms worse, in legs better;

five stools daily ; pulse 102, full.Vini colchici f 3ss., 8vis. horis. Omittr,

opium ; 20 leeches to both elbows. ’

17. Painless; bowels open twice; tonguewhite and dry. Has a troublesome cough,and cannot sleep at night. Pulse 84, full.

19. Nearly free from pain; slept welllast night; tongue dry, and slightly furred;bowels open ; pulse 96, soft and compress-ible.

20. Free from pain ; bowels open ; sleepsbetter.

Vini colchici, 3 j., 8vis horis.23. Free from pain, but complains of

wind on stomach, and nausea. Omittr. vi-nnm colcbici.

Acidi hydrocyanici, m ij., ter die.

The man was discharged on the 29th per-fectly well. The hydrocyanic acid instantlyrelieved his stomach.

Colehicum rarely does any good in acuterheumatism, without purging the bowels;then it is certaiuly more beneficial thanother medicines, which produce equal purg-ing. And I hav0 seen a few casea in whichcolchicum has effected a cure, and in a verydecided manner, without producing anyeffect on the bowels.

The illustration of the opposite kind ofrheumatism and its treatment, I must deferto another occasion.

REMARKS ON DR. ELLIOTSON’S CLINICALLECTURE ON FEVER.

By DR. CLUTTERBUCK.

I HAVE read with much interest, in a lateNumber of ’1’xs LANCET, an abstract ofa clinical lecture delivered by Dr. Elliot-son at St. Thomas’s Hospital, on the sub.ject of fever, two cases of which are givenin detail, with appropriate comments f Hisremarks are entitled to respect, both fromthe ample field of experience enjoyed by

the author, and from his known zeal and de.votion to pathological investigations. Al-

titougb differing in some respects from Dr.Elliotson, yet, in point of theory, he ap-proaches so nearly to the opinions I bare formany years advocated, that I cannot but flat-ter myself that were I fortunate enough tomake myself distinctly understood in Teuardto the views I entertain on the subject, therewould be found but little, if any, discrepancybetween us. The conclusion come to on the

subject of the pathology of fever, willneces-sarity have a considerable influence on thetreatment of the disease. I am naturally,therefore, solicitous to establish a point that,to my seeming, has so strong a practicalbearing.

I agree entirely with Dr. Elliotson in

thinking, that the two cases he has de-scribed are clearly marked cases of the dis.ease (the febris of Dr. Cullen’s arrange.ment-the idiopathic fever of other writers);and that, from the same signs which he ad.duces in proof, namely, " anxiety of COU1t-tenance, heaviness of the eyes, heat of skin,quickness of pulse, and an extreme feelingof debility," which he justly considers as theprincipal circumstances upon which the

diagnosis of fever is founded. To the samepurpose, and nearly in the same language,he further remarks, in regard to these cases,that in both there was the peculiar couu-tenance expressive of fever"—" that peculiarcombination of heaviness and distress, whichalone is enough to characterise the dit-ease."

Speaking of the disease generally, Dr.Elliotson observes, " we almost universallyfind more or less of pain in the head andepigastrium." With regard to pain in thehead’ as a symptom of fever, I am inclinedto speak in a less qualified manner than hehas done; for I have no recollection of hav.ing ever witnessed a case of real feveriawhich pain of the head was not a leadingsymptom, provided the patient retained his..consciousness, and were able to express hisfeelings. It is very common, indeed, forthis symptom to disappear after a time,though strongly marked at first; but thiioccurs under circumstances where the dis-turbance of the sensorium is on the in-

crease, and where either delirium or stu-por is approaching. The cessation of painin such cases, serves but to mark mora

strongly the brain as the seat of disease.As to the nature of fever, Dr. Eitiotson

seems not disinclined to admit, that the dis-ease may consist in inflammation; but stillif it be such, that the inflammation is gene-ral, and not confined to one particular organ,as I conceive to be the case, In some in-stances, he says, one part, as the head; inothers, another, as some one of the abdomi-nal organs, is more affected than the rest.

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And leadds, fever may take place, witha without symptoms of phrenitis, or of in -flammation of the stomach, intestines, or, during life, or any appearanceof one Mother of these inflammations, afterdeath." Presuming that Dr. Elliotson here the term phreaiitis in its ordinary ac-ceptation, that is, as characterised chieflybe active or furious delirium, his observa-tion is, no doubt, well founded : the deli-

observed in fever is not often, though,: sometimes is, of this description. But

I’li Iuestion is, not whether the brain inis disturbed in regard to its mcnta)

i..au,n, but whether it is suffering, andthat constantly, in any or all of those func-tions to which it is destined, and which be-long to it, as it were, exclusively ; namely,sensation, voluntary movement, and intel-lect, flus, I contend, is always the case.,and such is the conclusion, as it appears tcm, to which Dr. Elliotson himself ought KLive come, according to his own statement ’ct the essential phenomena of the disease.ii. as he justly states, anxiety of counle-nance, heaviness of the eyes, heat of skin,quickness of pulse, and an extreme feelingof debility, be the principal circumstancesupuu which the diagnosis of fever is formed,u a peculiar combination of heaviness anddistress be alone sufficient to characterise thedisease, I do not see how, upon physiologi.st grounds, we can avoid considering thehralil as the organ, from the disturbed stateof which such symptoms proceed-to saynothing of the pain in the head, which,even according to Dr. Elliotson’s statement,is rarely wanting, and then only under cir-

- cumstances that may be readily explained.- With respect to the heat of skin, and fre-

quency of pulse, which Dr. Elliotson ranksalong with the diagnostic symptoms, theyserve rather to show the nature of the dis-ease, as consisting in inflammation,’than theactual seat of it. Such symptoms are common to inflammation in general, whatever itsna ture, and wherever seated.

The difficulty that many at present ex-

icritce, in determining the primary andessential seat of proper or idiopathic fever,appears to me to have arisen from their notdistinguishing pufRciemly between the dis-

simple form, and the various com-- to which it is liable. Pure, un-’ fever, wtuch alone deserves the

of simple, is of less frequent occur-rence than the complicated state of it, that is,where it is combined secondarily with some. This frequent eomptina- as probably owing to the variety of mor- influences to which the body is c.m. my exposed, at the same time that it is

upon by the cause of fever itself. Fever sets out in a simple form, but during.: course, especially if this be a protracted

one, inflaimmation arises in some organ, par-ticularly those situated in the abdominalcavity ; and thus the simple fever becomes acomplicated one. If, now, the disease provefatal, the secondary inflammation betrays it-self upon dissection, and is looked upon asan essential part of the disease, thoughmerely secondary and accidental.The examinations post- mortem that have

been lately made in fever, have shown that,in a large proportion of cases that have ter.minated fatally, inflammation and even ulcer-ation, in the lining membrane of the intes-tines, have been found. This, however, isfar from warranting the conclusion that hasbeen drawn from it. The occurrence, thoughfrequent, is far from universal, as I have hadmany opportunities of proving. And further,the number of fatal cases of fever in thiscountry, and others of nearly a similar lati-tude, m which the observation has beenchiefly made, is very small in comparisonwith the number that recover. Such an ap-pearance, therefore, were it even general inthe fatal cases, would be far short of provingthat the same is the case in all. Diarrhoea,and other symptoms denoting abdominalmischief, seldom make their appearance tilllate in the disease, and ought no more to beconsidered as an essential part of it, than theoccurrence of the same symptoms towards.the end of pulmonary consumption, could be90 considered in respect of this disease. In

both cases, it appears to arise from a gene-’ ral disposition to inflammation, produced by, the continued state of febrile action that is, going on in the system. In the case of fever,

there is, I think, much reason to believe,that the occurrence of inflammation in the- mucous membrane of the alimentary caiial,,s has been often the consequence of the intem-y perate use of cathartic drugs, that so much.prevails in the treatment of fever in the

e present day. Where the disease has been,,. subdued, as it often may be, by the. prompt.s and judicious employment of blood-letting,

with little use either of purgatives or any:- other means, 1 know from abundant experi-d ence, that such disorder in the intestinalcanal will rarely be met with

In fine, I repeat, that all proper or idio-pathic fevers, so called, (not of the specifickind, such as the vuriolous, &c.), are either

simple or complicated. By simple fever, Iunderstand those in which all the symptomsthat are essential to it, and therefore con-stant, refer themselves wholly and exclu-sively to the brain, as their primary and-essential seat; and which consist in pain ofthe part, and a disturbed state of its func-tions. This disturbance is observable first,in respect to all the external senses, vision,hearing, the touch, ta.ste, and smell, which,are perverted in different degrees, both ab-solutely and relatively to each other ; and,

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in extreme cases, are altogether annihilated;secondly, iu the prostration of muscular

strength, and sometimes in irregular andinvoluntary movements; and, thirdly, inweakness or disorder of mind, according tc

the violence and danger of the disease. In

complicated fevers, which probably consti-tute a majority, the same signs of disorderedbrain are to he observed, mixed up with,and sometimes much obscured bv, those

arising from inflammation of the different

organs secondarily and casually affected,Thus we have some fevers attended withcatarrhal or pulmonic inflammation ; others,with italamtnat:on in the abdominal viscera,or thin covering, the peritoneum; and someeven with rheumatic inflammation of themuscles and joints. In ali the cases, how-ever, the brain affections may be perceived,and is often ptedominant, so as to give a

character to the whole disease quite differentto the simple inflammation of those parts.Thus, if inflammation should appear in thelungs during the course offever, the ordinarypulmonic symptoms of cough, pain in thechest, and difficult respiration, are found incombination with a brown tongue, pain inthe head, great prostration of strength, rest-lessness, and a tendency to delirium o: stu-

por, thus making the pneumonia typhodes ofauthors; and so of other parts, the inflam-mation of which, when accompanied withsimultaneous inflammation in the brain, as-

sumes what is called the typhoid shape.Season aud climate nppear to have the

chief iiifluence in determining the peculiarform of the combination in cases of cornpli-cated fever. In the spring season, and incold and variable climates, fever is most com-monly found in combination with pulmonaryor rheumatic affections. In the autumn, andin hot climates, the abdominal organs chieflysuffer.

Upon the subject of anatomical investi-gations, as serving to illustrate the nature offever, I agree entirely with Dr. Elliotson(than whom few are more competent to

form an opinion on this point): " Those,"he says,

" who look only to morbid anatomyfor all insight into the nature of diseases,will continually mistake oifles for importantthings ; effects for causes ; and iucidentnifor indispensable circumstances." Thoughfever possesses ail the characters that areessential to, and therefore indicative of,inflammation of the cerebral subaance gene-railv, yet, like all other inflammations, itconsists at 6r:,t in violent and disorderedaction merely, leading on, however, in manyinstances (but neither necessarily nor con-stantiy), to obvious change of structure.It muy continue for weeks without mate-rially affecting the organization of the br.:.nas may be concluded from the almost suddencessation of the disease in many cases, by

what is termed a crisis; wbere the brain,

from being in a state of extreme disorder, -almost immediately resumes tts healthyfunctions, though with powers much dimi-nished. This could scarcely happen if theorganization of the part had suffered muei

change.In regard to the general management of

’ fever, it is satisfactory to me to find myopinions so neariy coinciding with those of Dr. EDiotaun. The treatment, when con.

ducted upon the principle I have endea.voured to establish, is exceedingly simple,and, for the most part, easily understood;and I may venture to add more facourable asto its result, than when treated in anempiri-cal way merely. Like many other inflam-

matious, fever, in the mild form in which itusually appears in this country at present,may be often safeiy left to pursue its course,with the use only of simple and palliativemeans. But if it be desired to bring it to a

speedy and favourable termination by art,this can only be done by the employment ofactive means, such as we are accustomed toemploy in the cure of innammation in gene.ral ; and there are none other. But whetherthe atte mpt is best made hy blood-lettmg,emetics, purgatives, or sudorifics, either

singly or combined; what are the circum.stances which may render one or the otherof these entitled to a prefereuce; togetherwith the objections that belong to eachre.spectively— these are questions which I haveno intention of discussing at present.i New Bridge Street, iVov. 16, 1829.

ON BLOOD-LETTING IN SUDDEN SEIZURES,

APOPLEXY.

By Dr. T. WOODEORDE, Taunton.

HAVING witnessed, in several instances,ill effects from that almost general and iiidis-criminate practice of abstl acting large quan.tities of blood in cases of sudden fits or

seizures, it deserves inquiry, how far soundpnnctples, and how far superficial observa-tion, have conduced to establisli the pro-

I priety of it : for, unfortunately, the evii doesnot end with medical men : the public,although most frequently averse to the ope-ration ill all other diseases, do not now liesi-tate to practise it themselves, in the ab:enceof a professor of the art.

Of the various forms oF sudden seizures,apoplexy deserves to be first considered,both because of its important nature andbecause Jt is that one in which the necessityof rapi(1 and copious venesection is thoughtto be best established. If we were to juu;efrom the practice of every day, we shoutdhe led to conclude, that the cure consistedin the quantity of blood taken away, aud that