He purged twice, had fome reft in the night, and was cooler on the morning of the 29th. His pulfe 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 fwelled. The following medicine was prescribed:

R Syrupi de Rhamno, uncias quatuor. Tartari emetici, grana fex. Aq. cinnamomi fpirituofi, uncias duas. M. Capiat cochlearium fecunda quaque bora, donec bis terve foluta fuerit alvus.

He took the whole in fix 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 drachm of bark, ten grains of rhubarb, and five grains of snake-root were given every fix hours; after taking three dofes, he purged plentifully; the bark and snakeroot were continued without the rhubarb; the swelling was foon difcuffed, be breathed easily, made water freely, and was reftored to perfect health.'

Here follows the author's obfervation upon it::- It is pretended, that the bark occafions obftructions in the abdominal viscera, and dropfies; but it is certain that such complaints arife from remitting fevers, when that medicine hath not been taken; and from the tenth cafe, in this collection, we learn, how ill-founded this prejudice against the bark must be, fince it proves an effectual remedy in such disorders, even when they have eluded the force of very powerful laxative and deobftruent medicines.'

Allowing this conclufion to be juft, Dr. Millar is not the first who has made it: for, were it neceffary, we could produce a number of inftances to the fame purpose, from authors of unquestionable judgment and veracity. But, indeed the doctor appears fometimes to be more guided by imagination than careful inquiry, and takes many things for granted, which require to be fupported by proof. For there is no reafon to conclude that the dropfical fwellings, mentioned in the Cafe last quoted, proceeded from any obftructions in the bowels.

The eruptions mentioned in the XIth Cafe, 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 fide, and to

have

have had a pernicious influence on the expectoration, till these bad fymptoms were removed by the ufual remedies.

The XIIth Cafe proved fatal.

In the XIIIth Cafe, the fever, if it was a fever, feems to have ceafed before the bark was administered.

The XIVth Cafe contains rather the good effects of cold water, in which the patient indulged himself, than the efficacy of the bark; and Dr. Millar falls inadvertently into the fame opinion, in his obfervation on this cafe.

CASE XV.

In the beginning of September, 1769, a young gentleman in York Buildings was feized with coldness and fhuddering, accompanied with nausea and vomiting, great thirst, ardent heat, and profufe sweating. Having ftudied phyfic, he undertook his own cure, and on the first invasion of the fever fwallowed large doses of Peruvian bark, but his stomach being fqueamish, could not bear it in fubftance. Being informed of thefe circumftances, 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 digeft the powder, he again used it in that form, and cold water was recommended for ordinary drink. The fever abated, though he was ftill giddy, and was feized with nausea and vomiting when he endeavoured to get out of bed; but being obliged to undertake a journey to Portsmouth, in order to embark for the East Indies; and relying on the quantity of bark which he had taken, he fet out in the ftage coach at eleven at night. He made out his journey in one day, without any other inconvenience than a flight return of the naufea 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 cafe which Dr. Millar, without any foundation, alledges to have been a remitting fever. For fpeaking of it, he fays, Another, (N° XV.) in a remitting fever, of no very mild kind, undertook a journey of seventy miles, and recovered fooner than he probably would have done if he had been confined to bed, kept warm, and carefully nurfed.' We fubmit to the judgment of the reader, whether the fever could be any other than the mildeft kind, in which a perfon is faid to have undertaken a journey of feventy miles, with impunity.

In the XVIth Cafe the fever was of the malignant kind, and the practice nothing new.

In the XVIIth Cafe the fever was likewife of the putrid kind; and the bark was not given till the urine had depofited a sedi

ment.

CASE XVIII.

In March, 1769, I was defired to vifit a gentlewoman in Burr-ftreet, who had for several months laboured under a remitting fever, accompanied with a head-ach and ophthalmia. The complaints, though tedious, were at length removed 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 fea-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 fevere, the eye much inflamed, its coats confiderably thickened, the pain intolerable, and fhe very feldom had any fleep. 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 perfuaded that fea bathing was abfolutely neceffary, fhe fet about it with alacrity, and her recovery was foon perfectly compleated.'

On this Cafe we are favoured with the following obfervations:

The eighteenth demonftrates the good effects of the bark in cafes which have been reckoned inflammatory, and in which the antiphlogistic method of cure had been judged the only refource.'

The good effects of the bark in chronic ophthalmias, fuch as is related in the above Cafe, have already been fufficiently afcertained: but it would seem to be the foible of this author to arrogate to himself all the merit of former difcoveries.

The XIXth Cafe is entirely fuperfluous, as only advancing what nobody ever queftioned.

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 Cafes; and we may affirm, that never a more unfatisfactory collection was published, than those we have been reviewing; which fo far from fhewing the fuccefs of any new method of cure, as is alledged, are only pretended deviations from the established practice. These cafes are nineteen in number, of which there occur only four of his exhibition of the bark, in his fo-much-boafted and extenfive practice in the country, during the space of fix years! It may likewife not be

im

improper to observe, that in all the cafes adduced by this au thor, there is not a fingle inftance mentioned of any other phy. fician being once joined with him in confultation, who could vouch to the fuccefs of his practice. Neither are we favoured with the concurring teftimony of any one perfon, 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 phyficians who were anxious either to investigate the truth, or confirm their own veracity: and that many fuch opportunities fhould not occur in the space of fix or eight years, is extremely furprising.

The half of this volume is a narrative of obsolete opinions, fuch as is annually delivered by medical profeffors, in their preliminary lectures; and differing only from thofe academical prelections in a deficiency of learning and candor.

Speaking of Galen, he fays, he founded his theory of fevers on the jargon of the corpufcular philofophy.' The falfhood of this remark must be so obvious to all the learned of the faculty, that inftead of expofing it with the severity which it deferves, we shall only observe, as an apology for the author, that indeed it is not furprifing, if the idea of the corpufcular philofophy should predominate in the mind of a person who was compiling a work from the fcraps of other writers. It was the principle of the corpufcular philosophy, that all the particles of matter were homogeneous and of a fimilar kind, and differed only in fize, configuration, and appofition to each other this philofophy, therefore, would have been entirely incompatible with Galen's doctrine, which was founded on the idea of a distinct feparation, and not a confusion of the different particles of matter, that is, on the Ariftotelian, not the corpufcular, philofophy; the four elements of the former naturally fuggesting the doctrine of the temperaments. The fame indifcriminate zeal which Dr. Millar difcovers for abolishing diftinctions in fevers, feems to have led him to confound two fyftems of philofophy, which are the moft oppofite and irreconcileable that ever were invented.

The petulancy with which this author has treated the character of the celebrated Boerhaave is equally unjust and abfurd. That great profeffor and phyfician entered upon the practice of phyfic in the twenty-fixth year of his age; a period which may be thought fufficiently early for affuming the office of a profeffion, which requires not only a mature judgment, but an extenfive acquaintance with the writings of both antient and modern physicians.

This

This author, however, who feems to measure the proficiency of Boerhaave by a very uncommon ftandard, remarks, that ' as he was now too far advanced in life to collect a fufficient number of facts from his own experience, he availed himself of the obfervations 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 fuch a proficiency in medical learn ing as can only be acquired by time and ftudy; and of not availing, at an early period, of the obfervations which others had recorded, as well as of ever availing of fuch obfervations of others as are found to be inconfiftent with approved experience. Our author, however, in the paffage already quoted, gives us to understand, that we must admit, in his early practice, a penetration and fagacity 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 difeafe. He has not once mentioned the neceffity of bleeding in any cafe whatever; his directions for the use of purgative medicines are almost unintelligible; and he has not clearly determined whether these or any other remedies fhould precede the use of the bark, or in what ftage, or particular circumftances of the difeafe, recourse ought to be had to that medicine. We shall give the whole of this fection as follows:

Of the cure in the early stage of the dyfentery.

It was already obferved, that a gentle diarrhoea often proves falutary; and as the fymptoms of it nearly refemble thofe of the dyfentery, it is therefore prudent at first to prescribe only thin diluting mucilaginous liquids, which are equally adapted to temper the acrimony of the humours in a cholera morbus, or diarrhea, and to lubricate the intestines in the beginning of a dyfentery. But if the disease continues more than three days, and the symptoms become more violent, it is then abfolutely neceffary diligently to apply fuch remedies as may check its progrefs. For this purpose it is proper to discharge fuch humours as are already lodged in the ftomach or inteftines; 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. tually

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