In bringing to this common stock my humble mite, that the offering may not be wholly worthless, I have confined myself as much as possible to the detail of the facts that have been observed, and the statement of the results that have been obtained from experience. By giving a connected view of the phenomena I have hoped that I might possibly assist the actual practitioner to form a more adequate conception of the disease and guide him to that particular remedy which experience shews to be best adapted to each of the more important affections he is likely to encounter. Out of the means furnished for the accomplishment of these objects by the receptacle of fever for this great metropolis I have endeavoured to select such specimens of the disease as will place before him a vivid and faithful picture of the most interesting aspects it assumes, and such a detail of treatment as will shew what particular remedies afford the best chance of success in each type and stage, and in the most common and therefore the most important modifications they present. If I have at all succeeded in my aim he will find himself placed in a good measure in the same situation with myself; his attention will be directed to the same phenomena in the order in which they occur in the series, and hence he will have the like means of judging of the relations which these phenomena bear to each other, as well as of the accuracy of the analysis that has been at

tempted of the more complicated, and the soundness of the inductions that have been made from a comparison of the whole.

The London Fever Hospital is capable of receiving sixty-two patients; in most seasons of the year its wards are full: often there are numerous applications for admission which cannot be received for want of room; there pass through the wards from six to seven hundred patients annually. Two physicians are attached to the institution under whose care the patients are placed alternately in the order in which they are admitted: there is one assistant physician whose duty it is to perform the office of the ordinary physicians when either of these may be incapable of attending, and there is besides a medical officer resident in the house. A history of each case, containing an account of the age, occupation and residence of the patient, together with as full a statement of the symptoms of the disease and of the order of their succession as can be obtained is entered in the journal by the resident medical officer. Each of the ordinary physicians attends daily and enters in his journal a daily report of each of his own cases. The resident medical officer goes round the wards twice a day, namely, early in the morning and late in the evening, to observe if any change requiring attention may have taken place in any patient; and if any such change be observed by the nurses during the interval between these visits they are reported

to him by the head nurse without delay; all such events with the modification of treatment they may have required are entered in the journals. Every case that terminates fatally is examined after death, and an account of the morbid appearances is entered in a book kept for the purpose. In this manner, in the progress of years a mass of facts accumulates relating to the statistics, the types, the symptoms, the causes, the diagnosis, the pathology and the treatment of the disease, whether successful or unsuccessful, which both on account of the fullness and accuracy of the record and of the extent of the. period it embraces, cannot but be of great value.

I am encouraged in the attempt to make this record, as far as it has yet gone, useful to the public by observing the feeling that prevails among those physicians who have studied fever with the greatest diligence, and who have contributed most to our knowledge of it, that it is a disease which is still little understood and the treatment of which remains extremely vague and uncertain. Perhaps there is no disease so little understood as the ordinary fever of this country and none by the mismanagement of which so much life is lost. Dr. Clutterbuck appears to me therefore to describe the situation of the physician to such an establishment as the Fever Hospital, not more candidly than truly when he says "It becomes a duty incumbent on those particularly who have been placed in situations favour

able for observing the disease, to give the result of their experience to the public, should it tend, in any degree, either to prevention or cure. The enquiry is by no means exhausted, considered either in a theoretical or practical point of view. There is still a want of uniformity of opinion among physicians regarding the nature of the present epidemic, as well as of fever in general: while, I am sorry to add, in practice we are not much better agreed;" and when he further adds ;-"To ascertain these modifications" (that is the modifications which require a modification of treatment) "is the great desideratum, which nothing but the most cautious observation, aided by much time, and the joint efforts of numerous individuals, can fully supply."*

The slightest glance at the history of the doctrines which have been taught relative to the nature and the seat of fever from remote antiquity, and more especially a consideration of the variety and even the contrariety of the received opinions respecting both, in the present day, but too clearly shew that if the ancients were in error, there cannot be many points with regard to which the moderns are right, since there is scarcely one in which they are agreed. Further observation and investigation are therefore not yet superseded. There is as yet no uniformity of opinion among physicians even whether the pri

* Observations on the Treatment of Epidemic Fever, &c. By Henry Clutterbuck, M.D., p. 3—9.

mary seat of the disease be in the fluid or the solid parts of which the body is composed. Scarcely is the most ancient doctrine respecting it of which we have any record, that it consists in a morbid derangement of the fluids, and that the excitement which attends it is the result of an effort of Nature to expel the poison received into or generated within the system, obliterated from the imaginations or banished from the reasonings of physicians. When indeed we see a patient in the latter stage of some of the forms of fever with his dark or leaden skin, pouring forth its peculiar and fetid exhalation; with his foul tongue, his offensive breath, his vitiated and almost putrid secretions and excretions, we can understand why this doctrine should have taken a firm hold of the human mind and should have been able to maintain its ground through many centuries. Yet when the phenomena came to be observed with the accuracy with which we know that they were observed and recorded, and examined with the acuteness with which we have abundant evidence that some of the most powerful minds reasoned upon them, we may justly wonder that the order of the events, together with their great variety and opposite nature did not sooner suggest doubts of the accuracy of the theory and give to the inquiries of these celebrated men a new direction, But so far was this from being the case that when Hippocrates, considering the increased heat as the essence of fever, founded his