Chapter vi. undertakes to examine the theory of pleasure, and places its most essential condition in variety. The author is of opinion that no emotion, when long continued, stimulates or interests the soul in the same degree as when it was fresh, and that it will finally wear itself out. Hence a necessary appetite, which may be termed curiosity, for new objects of attention. Those which stimulate too powerfully give pain at first, then pleasure, and at length annoy by feebleness of impression. Pain, in the author's judgment, is relative (p. 248.) as well as pleasure; its intensity is measured by comparison, and not by positive sensation. Pain and pleasure, he says, (p. 251.) are but different degrees of affection of mind, and less or more of the same thing. Any situation however miserable, or any pain however great, if we could at first but manage to bear it, would by custom become light. This doctrine is defended by many ingenious and by some strong arguments, and constitutes the most original portion of the volume. It is applied in detail to the more conspicuous phænomena of human nature, in the chapters on Happiness, Sensibility, and Bravery.In a third section, the author contends that oblivion is necessary to re-create novelty, and that originality is but the idol of ignorance: he also converses on Hope and on Sublimity. He draws the following important and consolatory conse quence from his theory, which thus coincides with the inference of Azais in his Compensation of Human Destinies: (see Rev. Vol. lxi. N. S. p. 525. Appendix.)

Every thing, after possession, becomes little. It is the mind which possesses it. As the change, therefore, from a lower to a higher situation, can produce only temporary sensations and transient affections, neither eminence nor obscurity, riches nor poverty, can render one person permanently more or less happy than another. Happiness does not depend on the proportion and relation which one thing bears to another, but on the proportion of the mind and the relation of the disposition to external objects. It is not the difference of things, but the difference of minds and dispositions which distinguishes the happiness of one person from that of another.'

An appendix, on the origin or rather on the nature of evil, concludes the volume. If it can once be proved that pain and pleasure are relative states of the mind, and that we are liable to call the same sensation painful when compared with a very pleasing one, and pleasing when compared with a very painful one; there must, at all times, in all places, and in all ranks of animated being, exist the same tendency to rise above and to fall below the average degree of impression, which to each being appears its point, or level, of indifference. Now, if animated nature reckons nothing as happiness but what rises.

above this average level, and nothing as misery but what sinks below it; and if this average level be itself a fluctuating stage, which rises with the flood of prosperity and sinks with the ebb of adversity; it will follow that all animated beings are equally happy, or equally miserable, from the archangel to the earth-worm, and that their happiness, or misery, can admit of no permanent increase or diminution. To this conclusion the author's arguments obviously tend: but we do not think that all the propositions are satisfactorily established. We consider, however, the second part of his work, in which they chiefly occur, as the most interesting and original portion of it; and we should recommend, in any future edition, a contraction and revisal of the first and greater half, and a dilatation and completion of the second less considerable disquisition.

ART. IV. A Treatise on Fever, with Observations on the Practice adopted for its Cure, in the Fever-Hospital and House of Recovery, in Dublin. Illustrated by Cases. By William Stoker, M.D., one of the Physicians of that Institution, &c. Svo. 75. Boards. Longman and Co. 1815.

WE apprehend that this treatise is to be regarded, at least

in some measure, as a reply, or a counterpoise, to the work of Dr. Mills, which we reviewed in our lxxiiid Volume; and in which the efficacy of general bleeding in fever was advanced as the result of very extensive practical observation in the Dublin Fever-hospital. Dr. Stoker is one of the regular physicians to that establishment, in which Dr. Mills has only been employed on some occasions of peculiar urgency; and the publication of this latter gentleman seeming to express or imply a censure on the practice of the ordinary medical attendants, they wrote a letter of vindication, which was answered. by Dr. Mills: this controversy was carried on in several of the late numbers of the Edinburgh Medical Journal. the present volume, Dr. Stoker details at some length the nature of the establishment, and his mode of treating the disease; which, we suppose, is to be regarded as nearly similar to the plan adopted by his colleagues. In the body of the treatise, he refers to Dr. Mills only by implication, but he re-prints in an appendix a part of the letter which had been published in the Edinburgh Journal.

In

In the preface, Dr. S. gives an interesting account of the plan and situation of the Dublin Fever-hospital, which appears to be the most complete establishment of the kind in the British empire. The whole description is too long to be quoted, but

we select one important point for the information of our readers, respecting the relative advantages of large and small wards. We are told that it was at first a question whether large or small wards were to be preferred: the larger wards were recommended, by their more complete ventilation, by the smaller surface of walls, for contagion to attach itself to, and by the less expence; the smaller, by their affording the means of separating the patients, and by the inconvenience: being avoided of the patients disturbing each other, as well as of the shock which the appearance of death must at times occasion; the smaller wards would also admit of more fre quent cleansing and fumigation." The Committee decided in favour of the subdivision into small wards: but we learn that: they have since had occasion to alter their opinion on this subject, and that a direct experiment was tried for the purpose of ascertaining the comparative benefit of wards of different sizes. The following is stated to be the result:

As it is now but fourteen months since the experiment was instituted, it is perhaps premature to form a decided opinion; but I believe my colleagues think favourably of the large wards, and certainly, from an experience of them for four months, during the two last of which I attended the cases given in the following work, I am disposed to prefer them; ventilation is more complete, and though disturbance from delirious or maniacal patients, or the shock given by the appearance of those in the worst states of fever, is more frequent, yet, on the other hand, I am satisfied that the confidence inspired by a greater number of those recovering, in view at the same time, nearly at least counterbalances that objection, an objection which might be altogether obviated by having one or two additional wards adjacent to each of the large ones, whither such patients as were in a hopeless condition, or became violently delirious, might be removed, or carried in the first instance.'

Our opinion on this subject entirely coincides with that of Dr. Stoker,

It is

The object of the author seems rather to relate the mode of practice which he employs in the hospital, than to enter into any minute detail of the nature and symptoms of fever. assumed that the disease of which he treats is the contagious typhus, which exists in a greater or less degree among the crouded population of large cities, and which either originates from or is much aggravated by impure air, especially by human effluvia. His field of observation appears to have been very extensive, since he informs us that the medical treatment detailed in this work is given as an epitome of his experience for nearly ten years in a hospital in which 15,164 patients had been received during that period. The only remedies which have

15

have proved applicable to all cases of the disease are cleanliness, ventilation, cool regimen, and plentiful dilution, to which he afterward adds partial fomentation and friction:-but, although we learn from this statement that there is no direct specific, nor any general febrifuge, yet many remedies possess great power. in removing particular symptoms, and in counteracting certain conditions of 'the system that are connected with the disease. A list is given of those which are found to be the most generally useful, arranged according to their respective importance; viz. purgatives, topical bleeding, antimonial powders, yeast, wine, emetics, cold or tepid ablution, blisters. We observe that some remedies are here entirely omitted, which a few years ago would have occupied a high rank in the estimation of every practitioner, and at the present time are still very extensively employed. Of these the most important are bark and opium; and we may also refer to general bleeding as a practice which has had its strenuous advocates. Some of our readers may be disappointed at finding cold ablution placed so low in the list: but we are informed that it was seldom applicable in the Dublinhospital, in consequence of the patients being generally affected with or predisposed to some pulmonary complaint. Bark, we are told, is rarely prescribed, except when the disease manifests a tendency to an intermittent or remittent form.-On the subject of general bleeding, it is admitted that the combination of pulmonic affections with fever renders it frequently indispensable, but that it is not conceived to be necessary in pure typhus; and, on the contrary, it is stated as the result of Dr. Stoker's experience, that any apparent present relief which may be obtained from it is more than counterbalanced by the subsequent debility. With respect to the nature of the blood, we are told that, although the portion first taken might be buffed, this appearance rarely continued in successive bleedings: but on the contrary, soon after being drawn, the crassamentum is dissolved or broken into fragments, tinging the serum with its colour, which sometimes is of a very dark brown, and sometimes of a greenish hue.'

Dr. S. then proceeds to consider in succession the respective merits of the remedies which compose the list above mentioned. With regard to purgatives, he states little more than an expression of his complete coincidence in the views of Dr. Hamilton, as detailed in his well-known work on that subject. Topical bleeding stands in the second place, and is of course considered as a remedy of great importance. In almost every degree of febrile excitement, the head is more or less affected with a kind of tendency to the accumulation of blood in this part, which it is extremely desirable to remove. This may

occasionally

occasionally be done, it is said, by the application of cold to thei head, and of fomentations to the feet: but it is generally necessary to draw blood from the part by scarification, or by leeches, or by opening the temporal artery. To the last mode Dr. S. gives a decided preference, both as being the most efficacious and as being an operation very easily accomplished. by those who are in the habit of performing it. The quantity of blood taken is seldom more than six ounces, and frequently. relief will be given by a much smaller portion. Some cases of the good effects of this remedy are related in detail.anner Antimonial powders are a very favourite medicine with the author:

In the commencement of mixed cases of fever, in which evacuants have been employed as far as the warning symptoms of debility admit of, without removal of the inflammatory action of the vessels, and in the advanced stages of slow fevers attended by parched skin and quick pulse, there is no remedy perhaps of superior efficacy. The discharge which they excite will not alone account for their modus operandi; for equal discharges caused by other means are not succeeded by proportionate relief, and sometimes the pulse is reduced both in frequency and hardness, feverish anxiety diminished, and sleep induced during their administration, though no such adequate evacuation be observable.'- To an attentive observer, these powders will often appear to promote the efforts of nature towards health; therefore their efficacy will be more remarkable, when exhibited on any of the critical days; and if the time of the day for administering an increased dose is to be chosen, the usual hour of rest should be preferred, as their effect in relieving anxiety and promoting rest, will be then assisted by the well-known influence of habit on the animal economy.'

We acknowlege that Dr. Stoker's sentiments do not quite agree with our own on this point; and we are disposed to conjecture that the benefit, which he derived from antimony, may depend on the tendency to pulmonary affections that is said to be a frequent occurrence in the Dublin-hospital. We find nothing very particular in the remarks which are made on the remaining remedies. Like most other practitioners who are guided by the result of their own experience in opposition to preconceived hypothesis, the author appears to have gradually adopted more of the depleting and less of the stimulating prac tice; to have given up bark and wine, and to have substituted yeast, if an anti-putrescent were required, or purgatives and topical bleeding.

The particular details of Dr. Stoker's practice are stated in seventy-four cases of idiopathic and twenty-one of symptomatic fever, which are transcribed at full length, and contain a daily report of the symptoms and treatment. They occupy more than half of the volume; and, although it might be wished that

some