courage, and stood so little in awe of popular prejudice, as to admit it in the advanced state of most fevers when the inflammatory diathesis which did prevail is either entirely gone or considerably abated, or whenever we can have any tolerable security that the system is without inflammatory topical determinations to the lungs or to the brain. Upon the whole, there is no sort of doubt, that the use of cold water may be one of the most powerful remedies in fevers, and we have, both by design and accident, innumerable instances of its efficacy." On the subject of exposure to cold air, of which Dr Currie states that Dr Cullen was doubtful of the extent to which it might be admitted in fevers, Dr Cullen observes, in his First Lines, that "when the power of the system generating heat is increased, as is commonly the case in fevers, it is necessary not only to avoid all means of increasing it further, but it seems proper also to supply air of a cooler temperature, or at least to apply it more entirely and freely, than in a state of health. Some late experiments in the smallpox and in continued fevers, shew that the free admission of cool air to the body is a powerful remedy in moderating the power of reaction; but what is the mode of its operation, to what circumstances of fever it is peculiarly adapted, or what limitations it requires, I shall not venture to determine, till more particularly instructed by farther experience.' In his First Lines, Dr Cullen adverted to the fact that not only cool air, but cold water also, may in fevers be applied to the surface of the body, as a refrigerant and perhaps as a tonic remedy. "The ancients," he observes, "frequently applied it with advantage to particular parts as a tonic; but it is a discovery of modern times, that in the case of putrid fevers, attended with much debility, the body may be washed all over with cold water." In his lectures, Dr Cullen was accustomed to enter into an historical detail of the employment of cold washing or cold bathing in cases of fever, referring particularly to the treatise of Dr De Hahn of Breslaw, the original of which, however, he does not appear to have seen. From that detail he conceived it plainly to appear, that from both the ancients and the moderns we have enough of facts to entitle us to consider cold applied to the surface of the body as a remedy of some importance, and that it may be employed wherever the employment of cold water as a drink is admissible. It is unnecessary to say how strong a confirmation this statement subsequently received in the Reports of Dr Currie, to whom, as he has himself very candidly stated, a trial of the practice was first suggested by the perusal of a little memoir on the subject by the late Dr William Wright of Jamaica, and latterly of Edinburgh.* Those who have been led to believe that Dr Cullen was a mere theoretical physician, unacquainted with diseases as they present themselves in nature, and speculating upon them in his closet from the information supplied by the writings of others, and that his own writings exhibit rather the workings of his imagination than the results of his personal experience, would do well to peruse the series of cases of fever * That judicious practitioner and excellent naturalist having satisfied himself of the beneficial effects of the external use of cold water in the smallpox, during the epidemic prevalence of that disease in Jamaica in 1768, was led to make trial of it upon himself on the occasion of his being seized with contagious fever when on his passage from Jamaica to England in 1777. which he was accustomed to sketch in his lectures (Works, vol. i. p. 652, et seqq.), in order, as he says, to illustrate his doctrine with respect to the treatment of these diseases, and to give the particular application of it. No person, it is conceived, who has himself had experience in the treatment of fevers, can rise from the perusal of these few pages with a doubt upon his mind as to their having been written by a man who, to a most logical mind, united singular powers for the accurate observation of the phenomena of diseases, and of the changes induced in them by different modes of treatment, and who, by the diligent and long continued exercise of these powers, had rendered himself a consummate medical practitioner. It is much to be regretted that Dr Cullen should not have embodied his views of fever in a separate and general treatise on that subject. His lectures contained ample materials for such a work; and no one could have arranged them in so perspicuous and accurate a manner as he would himself have done. Some years before the appearance of the first volume of the First Lines (viz. in 1772), Dr Lettsom, who had been a pupil of Dr Cullen's a short time before, published anonymously a small treatise entitled Reflections on the General Treatment and Cure of Fevers. The opinions expressed in this treatise respecting the diseases of the Fluids, respecting Marsh Miasma and Human Contagion, respecting the tendency of these morbific agents to induce debility of the system by suddenly weakening the nervous power and energy of the brain, together with several other opinions both theoretical and practical, shew how largely Dr Lettsom, in compiling this treatise, had drawn upon the lectures of Dr Cullen. That in freely availing himself of these he made no reference to the source from which he derived them, is calculated to create a very unfavourable opinion of Dr Lettsom's candour.* It is satisfactory, therefore, to be able to state his apology in his own words. Dr LETTSOM to Dr CULLEN. HONOURED PROFESSOR, LONDON, GREAT EASTCHEAP, "I know thou art not a stranger to a publication I lately made, entitled Reflections on Fevers, the first and only edition of which is now nearly sold. I write this, therefore, to request the favour of Dr Cullen to permit me to dedicate to him the next edition. It is true, the former was inscribed to Lord Dartmouth, but as I am now about publishing a work to be more immediately under that nobleman's sanction, I can with propriety omit his name in the treatise on fevers. "I am conscious how much information I have received from Dr Cullen, but I thought it would be unjustifiable to ascribe to him doctrines which were neither generally admitted nor generally known. "It appeared to me, therefore, more prudent to risk my character, rather than to attribute those things to another, which I had no authority to publish as such. But now This treatise is noticed in the first volume of the Medical and Philosophical Commentaries, by a Society in Edinburgh, published in the beginning of 1773, in the following terms :-" No name is printed on the title-page of this treatise; nor could the author with justice assume to himself the merits which may be due to those new opinions it contains. We are here presented with a concise, but tolerably distinct view of the doctrine of fevers as, for several years past, been delivered by one of the s of medicine in this University." the circumstances widely differ, as both the Monthly and Critical Reviews, as well as the Public, have expressed such approbation of the first outlines, as induces me to presume to ask Dr Cullen's sanction of the improved edition, which I am now preparing for the press. “Though this little work hath had a hasty sale, I should not have attempted a second edition so early, were it not from a desire to acknowledge openly the obligations I owe to Dr Cullen, and likewise to gratify Dr Macquer, and Dr Dubourg of Paris, who are translating my piece into French, and wait for the second edition to conclude the same, as the former has just informed me. I beg Dr Cullen would indulge me in this favour, to be informed of which, as soon as convenient, will greatly oblige his sincere admirer, "JOHN COAKLEY LETTSOM." Dr Cullen's reply to this communication is peculiarly interesting as a statement of his wishes regarding the publication of his opinions by his students. Dr CULLEN to Dr LETTSOM. MUCH ESTEEMED FRIEND, EDINBURGH, 3d September 1773. I am sorry that both absence from town and much business have prevented me from answering your polite letter so soon as I wished. "I must own to you that I thought myself entitled to some acknowledgments in your former publication, but I willingly accept of your excuse. I am not very vain of my own opinions, and am indeed not willing that my pupils should point them out very particularly, as I am not confident enough in giving them to the public, especially in the imperfect state in which I am sometimes obliged to deliver them, or in the imperfect manner in which they are sometimes taken by my pupils. However, I must also say that I am always proud of having given any light or instruction |