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He purged twice, had some rest in the night, and was cooler on the morning of the 29th. His pulse beat 100 in a minute, The bark was then prescribed, and the fever vanished. On the ad of September he complained of difficulty of breathing, and a pain in his right shoulder. His appetite was good, and he had no thirst; but his thighs, legs, and belly, were confiderably swelled. The following medicine was prescribed : R Syrupi de Rhamno, uncias quatuor. Tartari emetici, grana
fex. Aq. cinnamomi Spirituos, uncias duas. M. Capiat cochlearium fecunda quaque bora, donec bis terve foluta fuerit
alvus. He took the whole in six hours, and had only one small stool. The antimonial medicine was repeated in different forms, but without effect. His complaints increased; he was costive, and made little water.
• On the 13th one drachın of bark, ten grains of rhubarb, and five grains of snake-root were given every fix hours ; after taking three doses, he purged plentifully; the bark and snakeroot were continued without the rhubarb; the swelling was soon discussed, be breathed easily, made water freely, and was restored to perfect health.'
Here follows the author's observation upon it :- " It is pretended, that the bark occasions obstructions in the abdominal viscera, and dropfies; but it is certain that such complaints arise from remitting fevers, when that medicine hath not been taken; and from the tenth case, in this collection, we learn, how ill-founded this prejudice against the bark must be, since it proves an effectual remedy in such disorders, even when they have eluded the force of very powerful laxative and deobstruent medicines.'
Allowing this conclusion to be just, Dr. Millar is not the first who has made it : for, were it necessary, we could produce a number of instances to the fame purpose, from authors of unquestionable judgment and veracity. But, indeed the doctor appears sometimes to be more guided by imagination than careful inquiry, and takes many things for granted, which require to be supported by proof. For there is no reason to conclude that the dropsical swellings, mentioned in the Case last quoted, proceeded from any obstructions in the bowels.
The eruptions mentioned in the XIth Care, would have plainly indicated the bark, even to any other physician not pretending to innovations. But whatever good effects the bark might have on the fever, it appears in the course of the disease to have excited a cough and pain in the side, and to have had a pernicious influence on the expectoration, till these bad symptoms were removed by the usual remedies,
The XIIth Case proved fatal.
In the XIIIth Case, the fever, if it was a fever, seems to have ceased before the bark was administered.
The XIV th Case contains rather the good effe&ts of cold water, in which the patient indulged himself, than the efficacy of the bark; and Dr. Millar falls inadvertently into the same opinion, in his observation on this case.
CAS E XV. , • In the beginning of September, 1769, a young gentleman in York Buildings was seized with coldness and suddering, accompanied with nausea and vomiting, great thirst, ardent heat, and profufe sweating. Having studied phyfic, he undertook his own cure, and on the first invasion of the fever swallowed large doses of Peruvian bark, but his stomach being fqueamish, could not bear it in substance. Being informed of these circumstances, I advised him to the decoction and tincture. He took eight ounces of the former, and four of the latter in twenty-four hours, and being now able to digest the powder, he again used it in that form, and cold water was recommended for ordinary drink. The fever abated, though he was still giddy, and was seized with nausea and vomiting when he endeavoured to get out of bed; but being obliged to undertake a journey to Portsinouth, in order to embark for the East Indies; and relying on the quantity of bark which he had taken, he set out in the stage coach at eleven at night. He made out his journey in one day, without any other inconvenience than a slight return of the nausea and vomiting; and by the continued use of the bark he was soon restored to perfect health.'
We know not in what medical school this Tyro has been educated, or could have imbibed the principles of fo rafh a practice. This, however, is another case which Dr. Millar, without any foundation, alledges to have been a remitting fever. For speaking of it, he says, ' Another, (No XV.) in a remitting fever, of no very mild kind, undertook a journey of seventy miles, and recovered sooner than he probably would have done if he had been confined to bed, kept warm, and carefully nursed.' We submit to the judgment of the reader, whether the fever could be any other than the mildest kind, in which a person is said to have undertaken a journey of seventy miles, with impunity.
In the XVIth Cafe the fever was of the malignant kind, and the practice nothing new.
In the XVIIth Case the fever was likewise of the putrid kind; and the bark was not given till the urine had deposited a sedi. ment.
CAS E XVIII. ' In March, 1769, I was desired to visit a gentlewoman in Burr-street, who had for several months laboured under a remitting fever, accompanied with a head-ach and ophtbalmia. The complaints, though tedious, were at length reinoved by the use of guaiac and Peruvian bark ; but as the disease had been obftinate and of long continuance, a return of it was apprehended in the autumn, and therefore a course of sea-bathing was recommended; but the advice was not complied with, In the end of July the complaints returned with greater violence; the head-ach was severe, the eye much inflamed, its coats considerably thickened, the pain intolerable, and the very feldom had any sleep. Leeches were applied to the temples without effect, but the complaints were again alleviated by taking the bark. She went to the country where her health was much improved ; and being now persuaded that fea bathing was absolutely necessary, the set about it with alacrity, and her recovery was soon perfectly compleated.' On this Case we are favoured with the following observations:
The eighteenth demonstrates the good effects of the bark in cases which have been reckoned inflammatory, and in which the antiphlogistic method of cure had been judged the only resource.'
The good effects of the bark in chronic ophthalmias, such as is related in the above Case, have already been sufficiently alcertained: but it would seem to be the foible of this author to arrogate to himself all the merit of former discoveries.
The XIXth Case is entirely fuperfluous, as only advancing what nobody ever questioned.
We have now candidly examined the merits of this author's practice, upon a principle the fairest and most equitable, the evidence of his own Cases; and we may affirm, that never a more unsatisfactory collection was published, than those we have been reviewing ; which so far from Mewing the success of any new method of cure, as is alledged, are only pretended deviations from the established practice. These cases are nineteen in number, of which there occur only four of his exhibition of the bark, in his fo-much-boasted and extensive practice in the country, during the space of fix years ! It may likewise not be
improper to observe, that in all the cases adduced by this author, there is not a single instance mentioned of any other phy. fician being once joined with him in consultation, who could vouch to the success of his practice. Neither are we favoured with the concurring testimony of any one person, to whom Dr. Millar had communicated his method of cure, in order to afcertain its efficacy by more frequent experiments. This is the more remarkable, as the contrary has always been the custom among physicians who were anxious either to investigate the truth, or confirm their own veracity: and that many such opportunities should not occur in the space of six or eight years, is extremely surprising.
The half of this volume is a narrative of obsolete opinions, such as is annually delivered by medical profeffors, in their preliminary lectures; and differing only from those academi. cal prelections in a deficiency of learning and candor.
Speaking of Galen, he says, he founded his theory of fevers on the jargon of the corpuscular philosophy. The falfhood of this remark must be so obvious to all the learned of the faculty, that instead of exposing it with the severity which it deserves, we shall only observe, as an apology for the author, that indeed it is not surprising, if the idea of the corpuscular philosophy should predominate in the mind of a person who was compiling a work from the scraps of other writers. It was the principle of the corpuscular philosophy, that all the particles of matter were hoinogeneous and of a similar kind, and differed only in size, configuration, and apposition to each other : this philosophy, therefore, would have been entirely incompatible with Galen's doctrine, which was founded on the idea of a distinct separation, and not a confusion of the different particles of matter, that is, on the Aristotelian, not the corpuscular, philosophy ; the four elements of the former na: turally suggesting the doctrine of the temperaments. The same indiscriminate zeal which Dr. Millar discovers for abolishing distinctions in fevers, seems to have led him to confound two systems of philosophy, which are the most opposite and irreconcileable that ever were invented.
The petulancy with which this author has treated the character of the celebrated Boerhaave is equally unjust and absurd. That great professor and physician entered upon the practice of physic in the twenty-sixth year of his age ; a period which may be thought sufficiently early for assuming the office of a profession, which requires not only a mature judg. ment, but an extensive acquaintance with the writings of both antient and modern physicians.
. This This author, however, who seems to measure the proficiency of Boerhaave by a very uncommon standard, remarks, that 'as he was now too far advanced in life to collect a sufficient number of facts from his own experience, he availed himself of the observations which others had recorded.' We with that the work which we are now reviewing, did not abound with the most convincing evidence of the pernicious effect of beginning the practice of phyfick without such a proficiency in medical learning as can only be acquired by time and ftudy ; and of not availing, at an early period, of the observations which others had recorded, as well as of ever availing of such observations of others as are found to be inconîstent with approved experience.-Our author, however, in the passage already quoted, gives us to understand, that we must admit, in his early practice, a penetration and sagacity which it would be unreasonable, according to him, to expect in the maturer years of the great Boerhaave.
The section on the cure of the dysentery is so extremely imperfect and confused, that it is evident the author must have had very little practice in that disease. He has not once mentioned the necessity of bleeding in any case whatever ; his directions for the use of purgative medicines are almost unintelligible; and he has not clearly determined whether these or any other remedies should precede the use of the bark, or in what stage, or particular circumstances of the disease, recourse ought to be had to that medicine. We thall give the whole of this section as follows :
S E C T. V. • Of the cure in the early stage of the dysentery. • It was already observed, that a gentle diarrhea often proves salutary; and as the symptoms of it nearly resemble those of the dysentery, it is therefore prudent at firit to prescribe only thin diluting mucilaginous liquids, which are equally adapted to temper the acrimony of the humours in a cholera inorbus, or diarrhea, and to lubricate the intestines in the beginning of a dysentery. But if the disease continues more than three days, and the symptoms become more violent, it is then absolutely necessary diligently to apply such remedies as may check its progress. For this purpose it is proper to discharge such humours as are already lodged in the stomach or intertines; a vomit is therefore first to be given, and ipecacuan is a remedy fitly adapted to this intention, as it not only effecVOL. XXIX. June, 1770.